STPAN 6 Metropolitan Borough of St. Pancras. REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1916. T. SHADICK HIGGINS, M.D., B.Sc., Lond., D.P.H. Cantab, 3 CONTENTS. page. Public Health Committee 6 Introduction 7 Part I.—General Statistics— Population 9 Marriages 9 Births 10 Illegitimacy 10 Notification of Births Act, 1907 10 Deaths 12 Mortality of Soldiers and Sailors 12 Infantile Mortality 12 Infectious Diseases 14 Part II.—Special, Subjects— Maternity and Infant Welfare 17 Borough Health Visitors 17 Voluntary Maternity and Infant Welfare Centres 19 Midwifery 20 Infantile Diarrhœa 21 Ophthalmia Neonatorum 21 Puerperal Fever 22 Tuberculosis 23 Work Done 26 Treatment of Tuberculosis 27 Scarlet Fever 28 Diphtheria 29 Typhoid Fever 30 Anterior Poliomyelitis 32 Epidemic Cerebrospinal Meningitis 32 Measles and German Measles 33 Anthrax 39 4 CONTENTS— continued. page. Other Notifiable Infectious Diseases 39 Whooping Cough 40 Diarrhoea and Enteritis 40 Syphilis 40 Cancer 41 Dwelling Houses 41 Inspection of Dwelling Houses 43 Underground Rooms 43 Houses unfit for Habitation 43 Inhabited House Duty 44 Canal Boats Acts 44 Factories and Workshops : Bakehouses, Restaurant-kitchens, Laundries, Home-Work 45 Inspection of Food and Food Places 49 Sale of Food and Drugs Acts 49 Summonses 50 Registration of Premises wherein the business of a Wholesale Dealer in Margarine is carried on 50 Public Health (Milk and Cream) Regulations, 1912 50 Inspection of Food 51 Dairies, Cowsheds and Milkshops 51 Ice Cream Premises 52 Fried Fish and Fish Curing Premises 52 Premises where Horse-flesh is prepared for Human food 52 Other Food Premises 52 Slaughterhouses 52 Rag Flock Act, 1911 52 General Sanitary Work 52 Total Inspections 53 Intimation Notices 53 Summonses 53 Smoke Prevention 53 5 CONTENTS—continued. page. Regulated Trades 53 Constructional Drain Work 54 Drainage Register 54 Water Service 55 Disinfecting and Cleansing Station 55 Disinfection 55 Cleansing Station 56 Public Mortuary and Coroner's Court 57 Bacteriological Examinations 57 Staff 57 Appendix— Table No. 1.—Vital Statistics of the whole District for 1916 and previous years required by the Local Government Board 60 Table No. 2.—Showing registered Deaths classified for Causes, Age and Sex 61 Table No. 3.—Summary of above 65 Table No. 4.—Meteorology 66 Table No. 5.—Showing Inspections made by the District Inspectors and Factory and Workshop Inspectors (Male) 67 Table No. 6.—Showing Inspections and other work of the Food Inspectors 68 Table No. 7.—Showing Visits, etc., made by Women Inspectors 69 Table No. 8.—Showing Inspections and Re-Inspections made by individual Inspectors 70 Tables Nos. 9, 10, 11 and 12.—Showing details of Intimation Notices served 71 6 St. Pancras Borough Council. PUBLIC HEALTH COMMITTEE, 1916. CHAIRMAN. Councillor James Mansell Swift (Ward 7). DEPUTY-CHAIRMAN. Councillor Abraham Davis (Ward 8). EX-OFFICIO.. The Right Worshipful the Mayor. (Alderman J. H. Mitchell, J.P.) ALDERMEN. Davies, David, J.P., L.C.C. Hickling, George, J.P. Williams, Charles. COUNCILLORS. Ward 6 Bayly, Christopher Hodgson. 5 Blount, George. 3 Bolsom, Sidney. 2 Brown, Henry Joseph, J.P. 1 Carrington, Thomas. 1 Caunt, George Charles. 1 Coggan, Cornish Arthur. 3 Cooke, Joseph John. 2 Cosburn, George Frederick, J.P. 8 Davies, Alfred Thomas. 5 De Pinto, P. 4 Escott, Arthur. 6 Knight, William Stanley Macbean. 4 Lloyd-Taylor, William, J.P. 3 Rolles, Harry. 5 Saunders, James. 8 Stoney, Rev. Ralph Sadleir, M.A. 7 Wood, William Charles. 7 Public Health Department, Town Hall, Pancras Road, N.W. July, 1917. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of St. Pancras. Gentlemen, I have the honour to present to you the Sixty-first Annual Report on the vital statistics and sanitary condition of the Sanitary District of St. Pancras, including particulars of the year's work of the department. This is the fourth annual report which it has been my duty to submit, and on this occasion it has been considerably abridged with a view to economy. It is satisfactory to record that in 1916, in spite of the continuance of war conditions, the state of health in the borough as revealed by the death rates was good. The general mortality was the lowest for some years, and the rate of infantile mortality the lowest ever recorded in the borough. On the other hand, the decline in the birth-rate has continued. The rate for 1916 was by far the lowest on record for the borough, the number of St. Pancras children born during the year being 753 less than the average for the preceding five years. This decline emphasizes the national importance of redoubled efforts to prevent the loss of infant life, which, although there has been great improvement in recent years, is still much greater than it need be. There was no unusual prevalence of infectious disease in 1916. Scarlet fever was singularly slight in incidence, the number of cases reported being the lowest on record in the borough. The outbreak of cerebrospinal fever, which appeared in the previous year, continued to a less extent. The general work of the department was continued under considerable difficulties owing to the enlistment of sanitary inspectors and clerks, and towards the end of the year two ladies were appointed as temporary sanitary inspectors. At the end of the year also the appointment of two more health inspectors was decided upon, and the appointments were made early in 1917. Additional work was thrown upon the visiting staff by the fact that measles and german measles were made notifiable diseases from the beginning of the year. All cases reported were immediately visited, and by means of a voluntary fund visiting nurses were sent to help during the illness in the cases where they were required. The Work done in connection with this 8 disease is fully set out in the report. The increase in work demanded by this extension has gone a good way towards using up the energies of the extra health visitors who were appointed at the end of the year. The maternity and child welfare work of the various voluntary centres in the borough continued to increase during 1916, and was efficiently co-ordinated with the work of the department. In completion of the Council's scheme for the dispensary treatment of tuberculosis, agreements were concluded with the St. Pancras Dispensary and University College Hospital upon the lines indicated in previous reports. In conclusion, I wish to express my hearty thanks to the members of the staff of my department, who have all continued to give of their best in carrying on the work during the present time of stress and difficulty ; to your Public Health Committee for the support they have given me; and to the members of your Council for the personal consideration they have invariably shown me. I am, Gentlemen, Your obedient Servant, Medical Officer of Health. 9 Metropolitan Borough of St. Pancras. REPORT of the MEDICAL OFFICER OF HEALTH For the Year 1916. Part I.—GENERAL STATISTICS. For the purposes of this Report the year 1916 consists of the 52 weeks ended 30th December, 1916. POPULATION. The estimated total population of St. Pancras at the middle of 1916, including soldiers and sailors recruited from the borough, was 218,387. This is the census population of 1911, and is adopted as the estimate, instead of the lower estimate of the Registrar-General, because the returns of the Rating Department as to occupied houses do not indicate a decrease in the total population since the census year. The Registrar-General's estimate is based on the assumption that the ratio between the total and civilian population is the same in the Borough as in England and Wales as a whole. The removal from the borough of many enlisted men of military age has, however, made it inadvisable to use this estimate in calculating the death rates of the civil population, and the Registrar-General's estimate of the civil population (196,813) is adopted for this purpose. Corresponding figures for the wards do not exist. MARRIAGES. The number of marriages celebrated in St. Pancras during 1916 was 2281 (including marriages of soldiers and sailors). This is equal to a rate of 10.4 per 1,000 total population. 10 BIRTHS. The number of births registered in the borough during 1916 was 4,310. 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 220. The net number of births for St. Pancras registered during 1916 was, therefore, 4,530, making an annual birth-rate of 20.7 per 1,000 total population. In Table 1 (page 60), the corresponding rates for the past five years will be found. It will be seen that there has been a marked fall in the birth-rate in the last two years. 530 births occurred in Public Institutions in the borough, equal to 12.3 per cent. of the total births which took place in the borough. Illegitimacy. Of the 4,310 births which were registered in the borough 272, or 6.3 per cent., were returned as illegitimate. Of the 4,530 births to parishioners within and without the borough 318, or 7.0 per cent., were registered as illegitimate. The corresponding figures for 1915, 1914 and 1913 were 5.4, 4.1 and 4.7 per cent. respectively. The Notification of Births Act, 1907. Notifications were received during the year of 4,185 births, including 4,061 live births, or 94.2 per cent. of the number of births registered. 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 523 543 405 486 713 520 658 462 4310 Births (includingstill-births) notified 475 475 561* 416 628 591* 607 432 4185 Still-births notified 17 6 23 14 18 23 11 12 124 * The excess of notified over registered births in Wards 6 and 7 is due to the non-redistribution of births in institutions in the notification figures. 11 In the tables below the notified births are also classified (in Registration SubDistricts and Wards) according to the person notifying the birth, aud 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 116 51 13 36 165 29 231 116 757 Mothers 15 7 2 2 13 1 19 24 83 Others persons 80 40 40 116 84 64 96 79 599 Medical Students 90 261 63 52 193 349 3 21 1032 Mid wives 157 74 111 121 123 42 196 157 981 Doctors 13 40 153 60 45 13 55 24 403 from Workhouse — — — — — 92 — — 92 Homes of Hope — — — 27 — — — — 27 University College Hospital — — 179 — — — — — 179 Not stated 4 2 — 2 5 1 7 11 32 475 475 561 416 628 591 607 432 4185 4 5 7 8 3 6 1 2 Total Attended in their own homes by— Private Doctors 176 122 37 103 271 38 325 150 1222 Private Mid wives 169 18 6 54 109 9 261 244 870 Doctors from New Hospital for Women 19 8 2 22 29 30 15 18 143 Medical Students from— University College Hospital 91 260 2 5 192 359 2 20 931 „ Middlesex Hospital — 30 97 2 1 3 — — 133 „ Royal Free Hospital — — 7 44 2 — — — 53 „ St. Bartholomew's Hospital — — — 6 — — — — 6 Midwives from— University College Hospital 1 5 21 105 — 4 — — 136 „ Maternity Nursing Association, Myddleton Square 1 — — 41 — — — — 42 „ Maternity Nursing Association, Oakley Square Branch 18 32 4 7 24 31 3 — 119 475 475 176 389 628 474 606 432 3655 Attended in Institutions— University College Hospital — — 179 — — — — — 179 New Hospital for Women — — — — — 25 — — 25 Duchess of Marlborough's Maternity Hospital — — 206 — — — — — 206 Homes of Hope, Regent's Square — — — 27 — — — — 27 Lying-inWard of Workhouse — — — — — 92 — — 92 Highgate Infirmary — — — — — — 1 — 1 475 475 561 416 628 591 607 432 4185 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. 12 On page 21 will be found a table showing the number of births to St. Pancras mothers which took place in institutions within and without the borough. DEATHS. It is not possible to include in the figures relating to the mortality amongst St. Pancras residents the deaths of soldiers and sailors. Deaths of members of His Majesty's Forces belonging to St. Pancras are therefore excluded from the mortality statistics for 1916, and the death rates are accordingly calculated upon the estimated civil population. The number of deaths of civilians that were registered during the year as having taken place in the borough was 2,991. Of these, 565 were of persons whose residence was not in St. Pancras (nonparishioners), 476 dying in St. Pancras institutions, and 89 in other places in the borough. There were also reported by the Registrar-General 571 deaths of St. Pancras parishioners who died in institutions in other parts of the County of London, and 48 who died in other parts of England and Wales. This correction gives the net number of civil deaths for St. Pancras registered during the year as 3,045, making an annual death-rate of 15.5 per 1,000 civil population. (The death-rate, calculated upon the estimated total population, would be 13.9 per 1,000). In Table 1 (page 60), the corresponding rates for the past five years will be found. It will be sren that this year's rate compares favourably with that of previous years. 1,507 deaths occurred in Public Institutions in the borough. Taking from these the number which were of non-parishioners (476), and adding the number of deaths of St. Pancras parishioners in Public Institutions outside the borough (697—both from the Registrar-General's figures), the number of St. Pancras deaths which took place in Public Institutions is shown to be 1,628, or 53.5 per cent. of the total deaths. The deaths are fully classified for causes, sex and age periods in table 2, (pp. 61-65). Mortality of Soldiers and Sailors. The number of deaths of Soldiers and Sailors that were registered during the year in the borough was 41. Of these, 33 were resident without the borough, the number belonging to St. Pancras being 8. Of the 8 deaths, 1 was from wounds received in battle, 2 from other accidental causes, 5 from disease. These deaths, as previously stated are not included with the deaths of the civil population occurring during 1916. Infantile Mortality. 385 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 85 per 1,000 births, which is the lowest annual rate on record for the borough. In table 1 (page 60) the corresponding rates for the past five years will be found. 13 The table required by the Local Government Board, showing the causes of deaths amongst these infants, is set out below:— 1916. 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 & under 6 months. 6 months & under 9 months. 9 months & under 12 months. Total Deaths under 1 year. All causes Certified 103 32 14 16 165 74 56 48 42 385 Uncertified — — — — — — — — — — Small-pox — — — — — — — — — — Chicken-pox — — — — — — — — — — Measles — — — — — 1 — 3 10 14 Scarlet Fever — — — — — — — — — — Whooping-Cough — — — — — 2 3 4 6 15 Diphtheria and Croup — — — — — — — — 2 2 Erysipelas — — — — — — — — — — Tuberculous Meningitis — — — — — — 2 2 1 5 Abdominal Tuberculosis — — — — — 1 — — — 1 Other Tuberculous Diseases — — — 1 1 1 1 1 1 5 Meningitis (not Tuberculous) — — 1 — 1 2 4 — — 7 Convulsions 2 3 1 — 6 — — 1 2 9 Laryngitis — — — — — — — — — — Bronchitis — 4 1 3 8 13 13 13 10 57 Pneumonia (all forms) 2 — — — 2 3 3 — 2 10 Diarrhoea — — — — — 1 2 3 — 6 Enteritis 1 1 — 2 4 8 10 8 5 35 Gastritis — — — — — — 2 — — 2 Syphilis 1 1 — 2 4 5 1 4 — 14 Rickets — — — 1 1 1 1 1 — 4 Suffocation (overlying) 3 1 — 1 5 4 — — — 9 Injury at birth 3 — — 1 4 — — — — 4 Atelectasis 7 2 — — 9 — — — — 9 Congenital Malformations 15 5 1 2 23 8 1 1 1 34 Premature birth 53 8 7 — 68 5 1 1 — 75 Atrophy, Debility and Marasmus 9 3 2 2 16 15 8 3 1 43 Other causes 7 4 1 1 13 4 4 3 1 25 Totals 103 32 14 16 165 74 56 48 42 385 Nett Births in the year legitimate 412.h, Nett Deaht in the year of legitimate infants 328 Illegitimate 318 Illegitimate infants 57 14 The work that is being done in regard to the prevention of infant mortality is described elsewhere in this report (pages 17-21). INFECTIOUS DISEASES. The number of cases of the compulsorily notifiable infectious diseases that have been notified during 1916 is shown in the table below, where they are also classified according to ages. The figures have not been corrected for subsequent revision of diagnosis. DISEASES. At all Ages. At Ages—Years. Under 1. I 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 448 11 126 171 74 40 26 — 3. Diphtheria and Membranous Croup 424 14 135 153 65 37 20 — 4. Typhus Fever — — — — — — — — 5. Enteric or Typhoid Fever 38 1 3 6 5 5 18 — 6. Fever, Simple or Continued 1 — — — 1 — — — 7. Relapsing Fever — — — — — — — — 8. Puerperal Fever 18 — — — — 5 13 — 9. Erysipelas 120 4 9 3 6 14 75 9 10. Cholera — — — — — — — — 11. Plague — — — — — — — — 12. Anthrax 1 — — — — — 1 — 13. Glanders — — — — — — — — 14. Hydrophobia — — — — — — — — 15. Cerebrospinal Meningitis 23 3 9 2 1 3 5 — 16. Anterior Poliomyelitis 9 — 6 1 2 — — — 17, Ophthalmia Neonatorum 38 36 — 2 — — — — Total under Public Health (London) Act, 1891, Sec. 55 1120 69 288 338 154 104 158 9 Tuberculosis—Public Health (Tuberculosis) Regulations, 1912. Primary Notifications on Forms "A," "B," " C " & " D " : Pulmonary 735 6 25 44 42 95 488 35 Do. other Forms 138 4 28 38 20 23 19 6 Public Health (Measles and German Measles) Regulations, 1915— Measles 1855 129 995 605 40 46 40 — German Measles 381 16 84 116 46 61 58 — 15 The notifications of, and deaths from, the notifiable infectious diseases, are classified in the following table according to their Wards and 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. 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 75 42 19 42 83 56 56 75 .. 448 1 .. .. .. 2 3 1 1 .. 3. Diphtheria and Membranous Croup 54 51 14 49 60 51 80 65 .. 424 2 4 .. 2 4 5 5 1 .. 4. Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 5. Enteric or Typhoid Fever 2 8 9 4 .. 9 6 .. .. 38 .. 3 1 .. .. 1 .. .. .. 6. Fever, Simple and Continued .. .. 1 .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. 7. Relapsing Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 8. Puerperal Fever 4 1 1 1 4 1 3 3 .. 18 .. 2 .. .. 1 .. 1 .. .. 9. Erysipelas 7 16 9 9 28 27 14 9 1 120 1 1 .. .. .. .. 1 .. .. 10. cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 11. Plague .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 12. Anthrax .. .. .. 1 .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. 13. Glanders .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 14. Hydrophobia .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 15. Cerebrospinal Meningitis 2 1 1 7 3 5 2 2 .. 23 .. .. .. 4 2 3 2 1 .. 16. Anterior Poliomyelitis 2 1 .. 1 .. 2 2 1 .. 9 .. .. .. 1 .. .. .. .. .. 17. Ophthalmia Neonatorum 6 4 6 11 7 1 1 2 •• 38 .. .. .. .. .. .. .. .. .. Total under Public Health (London) Act, 1891, Section 55 152 124 60 125 185 152 164 157 1 1120 4 10 1 7 9 12 10 3 .. Tuberculosis primary notifications- Public Health (Tuberculosis) Regulations 1912, Primary notifications on Forms "A " " B " "C " and " D „ Pulmonary 97 96 59 108 111 85 73 59 47 735 41 56 28 58 41 28 42 29 17 „ other forms 15 14 13 15 18 28 16 15 4 138 12 9 4 11 7 13 17 9 1 Public Health (Measles and German Measles) Regulations, 1915— Measles 324 230 53 231 182 92 325 416 2 1855 7 4 2 4 3 6 2 14 .. German Measles 74 44 37 100 30 13 58 25 •• 381 .. .. .. .. .. .. .. .. .. 16 Below is given the number of advices received from the London County 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 1346 345 Measles 1522 712 Whooping Cough 459 345 Chicken-pox 829 483 Mumps 178 162 Other Definite Diseases 222 162 Suspicious Symptoms 68 66 Ringworm 251 233 Impetigo, &c. 269 253 Scabies 108 106 Pediculosis — — 5252 2867 17 PART II.—SPECIAL SUBJECTS. MATERNITY AND INFANT WELFARE. The animal statistics in regard to births and deaths of infants are given on pages 10-11 and 12-13 of this report. Work of the Borough Health Visitors. The time of the two half-time health visitors was very much taken up during 1916 by work consequent upon the notification of measles and german measles which was introduced at the beginning of the year. They were therefore compelled to reduce still further the limited amount of visiting in connection with maternity and other child welfare work which they were doing. In spite of an increase in the visiting which was done from the voluntary centres in the borough, the work done in this direction during the year cannot but be regarded as inadequate in amount. Appointment of two new Health Visitors.—In view of this position, the Council decided at their last meeting in 1916 to carry into effect their resolution of July, 1915, to engage two more women health workers, the appointment of whom had been deferred by a later decision. Advertisements were accordingly issued, and two new full-time health visitors were appointed in January, 1917. This increase brought the Council's permanent staff of women visitors to five; viz.: one full-time sanitary inspector, two visitors who are half-time sanitary inspectors and half-time health visitors, and two full-time health visitors. The additional work amongst mothers and babies which the increase in staff will permit is much curtailed by the time which the visiting of notified cases of measles and german measles absorbs. The female inspectorial staff was further increased during the year by the temporary appointment on 22nd November, 1916, of two women sanitary inspectors to help to relieve the male sanitary inspectors, amongst whom there are six vacancies owing to the war. Notified Births.—The ordinary work of the department in regard to births reported under the Notification of Births Act has been continued, an advice card being sent to all the mothers, and a certain amount of visiting being done by the health visitors. They were able to visit only 308 of the births notified, and there was but little re-visiting done. This work was supplemented to some extent by visiting done by the workers of the voluntary centres. Practically all mothers bringing their children to the consultations were visited from time to time, but in addition some initial 18 visits to notified births, where visits had not been made by the borough staff, were paid from the centres. For this purpose lists of selected notifications comprising 500 cases were sent to certain centres, and these cases were visited to induce the mothers to bring their babies to the consultations. Expectant Mothers.—The work of the previous year in this direction was continued during 1916. By an arrangement with University College Hospital and Middlesex Hospital, which attend a great many St. Pancras women in their confinements, weekly lists of expectant mothers have been obtained, and some of these have been visited by the borough staff. In addition some of the maternity centres have been supplied with names from the lists and have paid visits. The lists obtained from hospitals comprised 1388 names (1052 from University College Hospital and 336 from Middlesex Hospital), and 692 of these were forwarded to the local centres. Cards of advice to expectant mothers, drawn up by the Medical Officer of Health, have been supplied to University College Hospital, Middlesex Hospital and the Maternity Nursing Association, one card being given to every St. Pancras expectant mother when she attends there to arrange for her confinement. The work done by the departmental staff during the year in connection with maternity and infant welfare is indicated by the following figures: — Total births (excluding still-births) notified 4061 Advice cards sent to cases notified (on receipt of notification) 4061 Advice cards sent to cases registered but not notified 345 Cautionary letters sent to cases registered but not notified 345 Expectant mothers reported from hospitals 1388 „ „ „ to local maternity centres 692 Advice cards for expectant mothers supplied to maternity hospitals, etc. 1327 Number of births visited 308 Additional visits 525 Total visits to mothers with infants (by Council's visitors) 833 Number of expectant mothers visited 131 Additional visits 31 Total visits to expectant mothers (by Council's visitors) 162 Extra visits (to Centres, Hospitals, Midwives, etc.) 436 19 Work done br Voluntary Maternity and Infant Welfare Centres. Attendances. Visits by Trained Visitor. Expectant Mothers. Children. Expectant Mothers. Children New cases. Total attendances. New cases. Total attendances. St. Pancras School for Mothers 96 574 297 2608* 1407 North St. Pancras School for Mothers:— Rhyl Street Centre 31 84 298 3796 55 2539 Winscombe Street Centre — — 55 554 6 368 Passmore Edwards Settlement School for Mothers 8 28 587 62 287 Camden Town Mothers' and Infants' Welfare Centre 17 22 89 763 4 119 Argyle Square Mothers' and Infants' Welfare Centre 35 72 172 1585 286 2800 Maternity Nursing Association, ' 73, Oakley Square 133 450 68 594 228 616 University College Hospital 1178 — — Royal Free Hospital 595 519 * Exclusive of 2523 attendances in the day nursery. The Four Boroughs Maternity Scheme have supplied the Medical Officer for weekly pre-natal consultations at the North St. Pancras School for Mothers (Rhyl Street) and the Argyle Square Centre. About the end of 1916 a branch consultation in connection with the Argyle Square Centre was opened at the Wesleyan Schoolroom, Falkland Road, Kentish Town. It was decided also to open a second branch of the North St. Pancras School for Mothers at the Public Baths, Prince of Wales' Road, in rooms lent free by the Borough Council, but this was not begun until the early part of 1917. A satisfactory feature of the year was the development of the Infant Consultation at University College Hospital. This institution, attending more than a thousand St. Pancras births every year, has a magnificent opportunity for a complete scheme of maternity and child welfare on a large scale. Lists of expectant mothers (from University College and Middlesex Hospitals) and of recently notified births have been supplied from time to time to certain of the centres, in order that visits might be paid to the homes 20 from the centrcs. The number of names supplied was as follows:— Centres. Expectant Mothers. Births. St. Pancras School for Mothers 554 – 40, Argyle Square 88 196 Passmore Edwards Settlement 50 105 Winscombe Street — 96 Falkland Road – 87 Greenland Street — 16 Government Grants were made in 1916 to the various maternity and child welfare centres as follows: — From the Local Government Board:— £ s. d. North St. Pancras School for Mothers (and branch) 140 14 9 Passmore Edwards Settlement School for Mothers 34 8 4 Camden Town Centre, Greenland Street 26 9 10 Maternity Nursing Association's Centre, Oakley Square 35 7 2 From the Board of Education:— St. Pancras School for Mothers 502 9 3 Infants' Clinic. —A. special clinic for sick children under school age is held at the St. Pancras Dispensary, 39, Oakley Square. The infants are referred to the clinic from the various infant welfare centres and other sources. During 1916, 390 new cases under five years of age were treated at the dispensary, of which 110 were treated by the dispensary doctor in their own homes. The total number of attendances of these children was 1123, and the total number of home visits 425. A grant of £52 10s. was made by the Local Government Board in 1916. The dispensary also attended 72 women for illness associated with pregnancy or the puerperium. Midwifery Work. "Extern" Midwifery. — The number of St. Pancras mothers attended gratuitously at their confinements in their own homes during 1916, according to the birth notifications, was as follows: — * New Hospital for Women (doctors) 143 University College Hospital (medical students) 931 ,, „ ,, (midwives) 136 Middles) x Hospital (medical students) 133 Royal Free Hospital (medical students 53 St. Bartholomew's Hospital (medical students) 6 •Maternity Nursing Association, Myddleton Square and Oakley Square (midwives) 161 1563 (or over one-third of the total number of births). *In some of these cases the women were charged reduced fees. Grants in aid of extern midwifery work were made by the Local Government Board in 1916 to University College Hospital (£650 13s.) and the Maternity Nursing Association (£238 8s. 3d.). These amounts were in respect of work jn neighbouring boroughs as well as St. Pancras, 21 " Intern " Midwifery.—The number of St. Pancras births which took place in hospitals were as follows : — University College Hospital 133 Middlesex Hospital 112 Queen Charlotte's Lying-in Hospital 211 City of London Lying-in Hospital 94 * Duchess of Marlborough's Maternity Hospital, 21, Endsleigh St. 56 St. Pancras House 74 Other hospitals 43 723 (or one sixth of the total number of births). (* Including paying patients). Infantile Diarrhcea. 41 deaths of infants under one year of age from diarrhoea and enteritis were registered during 1916. The number of such deaths in each quarter of the year was as follows :— First quarter 5 Second „ 9 Third „ 14 Fourth „ 13 The number of deaths of children under 5 years of age from diarrhoea and enteritis was 56. OPHTHALMIA NEONATORUM. 38 cases of ophthalmia neonatorum were notified during 1916, 29 by medical practitioners, 9 by midwives. Of these, three cases developed the disease before being brought into St. Pancras and were notified elsewhere, and one proved not to be suffering from the disease. The corrected number of notified cases was therefore 34, equal to an incidence rate of 7.5 per 1,000 births. Other numerical details will be found on pages 14-15. In regard to severity, 8 of the cases were regarded by the visitor as grave, 14 as moderate, and 12 as slight. The cases are classified in the following table according as the mothers were attended in their confinement by doctors, midwives, or medical students (in their own homes), or were delivered in hospital. Attended at birth by Cases of Ophthalmia Neonatorum. Total number of births notified. No. of cases per 1000 births notified. Doctors 10 1365 7.3 Medical Students 4 1123 3.6 Midwives from Institutions 2 297 6.7 Private Midwives 12 870 13.8 Delivered in Hospitals and Institutions 6 723 8.3 34 Eight of the cases were illegitimate. 22 The results of treatment were as follows : — Complete recovery 27 Sight slightly damaged, but improving 2 Cases lost sight of 4 Died before recovery 1 34 PUERPERAL FEVER. 18 patients were notified as suffering from puerperal fever during the year. Of this number one case proved not to be suffering. In addition one other case was reported after death. The actual number of cases was therefore 18, equal to an incidence rate of 4.0 per 1,000 births. 4 deaths from this disease were registered during the year, giving a case mortality of 22.2 per cent. 11 cases followed the birth of live-born infants, and 7 cases abortions. 10 of the patients were primiparae (i.e., women who had not previously borne children), and 8 multipara;. In 4 cases "instruments" were used at the confinement, and in 2 cases operations were performed after 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. In one case the patient had a bad fall some weeks before confinement. 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 11 1365 8.1 Midwives from Institutions 0 297 0 Private Midwives 6 870 7.0 Medical Students 0 1123 0 In Hospital and Institutions 1 723 1.4 23 TUBERCULOSIS. The total number of notifications of cases of tuberculosis received during 1916 (Forms A, B, C and D), including duplicate notifications, was 1,628 (1,430 pulmonary; 198 non-pulmonary). 768 notifications (641 pulmonary, 127 non-pulmonary) were received during the year on forms A and B. Of these 93 (83 pulmonary, 10 nonpulmonary) had been notified to this authority before ; so that the number of primary notifications received on forms A and B was 675 (558 pulmonary, 117 non-pulmonary). 860 notifications (789 pulmonary, 71 non-pulmonary) were received on forms C and D Of these 198 (177 pulmonary, 21 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, 873 (735 pulmonary, 138 non-pulmonary). In the previous year (1915) the number of primary notifications received was 1083 (933 pulmonary, 150 non-pulmonary). In the table on the next page the notifications received are set out in the form suggested by the Local Government Board. The deaths from tuberculosis during the year numbered 423, of which 340 (218 males, 122 females) were from phthisis, and 83 (46 males, 37 females) from other forms of tuberculosis. The death rates for 1916 from tuberculosis based on the 1911 census population of the borough, and the rates based on the civil population, were therefore:— Of males per 1000 male population. (census). Of females per 1000 female population. (census). Total persons per 1000 population. (census). Total persons per 1000 civil population. Phthisis 2.04 1.09 1.55 1.73 Other forms of tuberculosis .43 .33 .38 .42 All forms of tuberculosis 2.47 1.42 1.93 2.15 24 Public Health (Tuberculosis) Regulations, 1912. Summary of Notifications during the period from l <tf January, 1916, to the 30th December, 1916 (inclusive).] Age Periods. Number of Notifications on Form a. Number of Notifications {on Form B. iNumber 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. 1 Total Notifications (i.e,, including cases previously notified by other Doctors). Poor Law Institutions. Sanatoria. Poor Law Institutions. Sanatoria. 0 to l to S 5 to 10 io to '5 15 to :o 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 t>5 and upwards. Total. Under 5 5 to 10 10 to 15 Total. Pulmonary—Males 3 12 IS 13 10 25 76 70 56 3i 20 33' 38' — 5 3 8 ■ 1 259 81 142 92 ,, Females .. 3 S i4 16 '4 =5 55 43 22 13 5 215 244 — 2 2 4 5 73 65 25 51 Non-pulmonary—Males — 16 'S 9 7 1 5 4 3 ' 2 b3 "0 — 5 2 7 7 19 » • 1 4 „ Females .. 4 6 io 4 6 3 2 2 1 — 3 4' 4 + — 4 2 6 6 10 7 6 3 Totals 10 39 54 42 37 54 13s 119 82 45 30 O50 739 — 16 9 25 29 361 164 184 151 Age Periods. Number of Primary Notifications on Form c. included in above. Number of Primary Notifications on Form D. included in above. 0 to i to 5 S to 10 10 to ■5 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 '5 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 05 and upwards. Total. Pulmonary—Males — 2 — 3 2 8 27 20 18 18 6 io4 — 2 0 — 1 — 4 3 — — — '3 „ Females .. — 4 2 4 2 S 10 5 6 3 3 44 — — 3 — 3 5 1 2 — 1 16 Non-pulmonary—Males — 4 2 1 4 — — 1 — — — 12 — 1 — — — — — — — — — 1 „ Females — — 2 ' 1 1 — — — — 1 6 — 1 — i — — — — — — — 2 Totals — io 6 9 9 14 37 25 24 21 10 166 — 4 6 • | 1 3 9 4 ! 2 - i 32 25 The deaths from tuberculosis in 1916 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 Persons. Pulmonary Tuberculosis 1 1 4 16 30 51 43 36 16 2 — 200 3 4 6 16 20 29 12 11 4 – — 105 305 Phthisis (not defined as tuberculous) — — — 3 2 3 4 3 3 — — 18 — — 1 2 1 4 3 2 3 1 — 17 35 Total Pulmonary Tuberculosis 1 1 4 19 32 51 47 39 19 2 — 218 3 4 7 18 21 33 15 13 7 1 — 122 340 Acute Phthisis — — — — — 1 — — — — — 1 — — 1 1 — — — — — — — 2 3 Acute Miliary Tuberculosis — — — 1 2 — — — — — — 3 — 1 — — — — — — — — 1 4 Tuberculous Meningitis 2 13 5 2 3 — — — — — — 25 3 10 4 — 1 1 — 1 — — — 20 45 Tabes Mesenterica — — — — — — — — — — — — 1 — — — — — — — — — — 1 1 Other Peritoneal and Intestinal Tubercle — 4 3 — — — — — — — — 8 — 2 4 1 — — — — — — — 7 15 Tuberculosis of Spinal Column — — — 1 — — — — — — — 1 — — — — — 1 — — — 1 — 2 3 Tuberculosis of Joints — — — 1 — — — — — 1 — 2 — — 1 — — — — — — — — 1 3 Lupus — — — — — — — — — — — — — — — — — — — — — — — — — Scrofula — — — — — — — — — — — — — — — — — — — — — — — — — Tuberculosis of other Organs — — — — 1 1 — — — — 1 3 — — — — 1 — — — — — — 1 4 Disseminated Tuberculosis 1 1 — — — — 1 — — — — 3 — 1 — 1 — — — — — — — 2 5 Total Non-Pulmonary Tuberculosis 3 18 8 6 6 2 1 — — 1 1 46 4 14 10 3 2 2 — 1 — 1 — 37 83 Total all forms of Tuberculosis 4 19 12 25 38 56 48 39 19 3 1 264 7 18 17 21 23 35 15 14 7 2 — 159 423 26 In the next table the new cases notified during 191 fi are classified according to the part of the body affected and according to age and sex. Location or Disease. Ages. Total. 0-5 5-15 15 and upwards. Males. Females. Males. Females. Males. Females. Pulmonary Tuberculosis 19 12 42 44 395 223 735 Bones and Joints 6 2 11 11 12 11 53 Meninges 9 4 5 2 3 1 24 Glands 4 2 13 9 7 8 43 Abdominal — 1 2 — — — 3 Genito-Urinarv — — — — — — — General — — — — — — — Other Organs 2 2 3 2 6 — 15 Total Non-pulmonary Tuberculosis 21 11 34 24 28 20 138 Total all forms of Tuberculosis 40 23 76 68 423 243 873 Work Done. As in former years the work in connection with tuberculosis has been done by the female visiting staff under the direction of the Medical Officer of Health. The number of cases visited during the year has been much less than in previous years owing to the demands which the visiting of cases of measles has made upon the time of the female visiting staff. Disinfection of bedding and bedrooms has been carried out on the advice of the tuberculosis visitors, 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. 27 The work done by the visiting staff is shown below :— Number of visits to homes of notified cases— (a) First visits 496 (b) Subsequent visits 129 Number of cases in which disinfection was carried out 96 Attendances of inspector or visitor at the dispensaries 80 Other visits made for various purposes 226 Treatment of Tuberculosis. The agreements between the Borough Council on the one hand, and University College Hospital and the St. Pancras Dispensary respectively on the other, were concluded during tbe year. The scheme for the dispensary treatment of tuberculosis, to which these agreements gave effect, was described in previous annual reports. The work done at the dispensaries during 1916 is shewn in the following table based on figures supplied from the dispensaries:— Tuberculosis Dispensary at University College Hospital. Tuberculosis Dispensary at StPancras Dispensary 39, Oakley Square Branch Tuberculosis Dispeasary of St. Pancras Dispensary at 132, Maiden Road. Insured persons. Uninsured persons. Total. Insured persons. Uninsured persons. Total. Insured persons. Uninsured persons. Total. No. of new cases 115 130 245 216 248 464 21 73 94 Total attendances 366 526 892 642 1700 2342 89 552 641 Home visits by Tuberculosis Officer *4 *1 *5 8 8 16 — — — Home visits by Dispensary Nurse 104 181 285 194 732 926 28 102 130 Written Medical Reports to Public Authorities *36 *18 *54 58 50 108 12 14 26 Do., to Practitioners *77 *9 *86 121 30 151 1 0 1 Specimens of sputum examined 51 33 84 47 31 78 3 0 3 * Last 9 months only. Residential Institutions.—Institutional treatment (sanatorium and hospital) is provided by the London Insurance Committee for insured persons, and by the London County Council for uninsured persons. In addition, many tuberculous poor are dealt with by the Guardians in the Infirmaries, and charitable societies send away a certain number of cases. 28 SCARLET FEVER. 448 St. Pancras (civil) patients were notified during 1916 as suffering from scarlet fever. Of the 448 cases notified, 44 were afterwards found not to be suffering from scarlet fever, 43 by Medical Superintendents of the Metropolitan Asylums Board hospitals, and one by other medical practitioners. This gives the net number of cases of scarlet fever notified during the year as 404, equal to an incidence rate of 1*85 per 1,000 population, and 2-05 per 1,000 civil population. With the exception of 1911, when the figures were about the same, this is a smaller number of cases than in any other year since 1889, when the disease was made notifiable. The number of deaths from scarlet fever certified during the year was 8, equal to a death-rate of 0.03 per 1,000 population, or 0.04 per 1,000 civil population, and a case mortality of 2.0 per cent., of cases notified. Other statistical facts in regard to the disease will be found on pages 14-15. Of the notified cases of scarlet fever, 429 (or 95.8 per cent.) were removed to hospital, as follows:— To Metropolitan Asylums Board Hospitals 426 To other hospitals 3 429 There were no outbreaks of scarlet fever of any importance in any of the schools and institutions in the borough in 1916, and no evidence of any spread of the disease through infected milk supplies. Return Cases.—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 26 return cases of scarlet fever during 1916, occurring in 20 houses. There were 6 instances in which there were two return cases in the same house. In 12 of these outbreaks the return case or cases were in the same family as the infecting (?) case, in 7 in a different family in the same house, and in 1 both. 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:— 3 days 1 8 days 3 14 days 1 4 „ 1 9 „ 2 21 „ 1 5 „ 1 11 „ 3 24 „ 1 6 „ 2 12 „ 1 7 „ 1 13 „ 2 Six of the infecting (?) cases had rhinitis subsequently to their return from hospital (of which one also had otorrhœa) and one boils. (All the infecting (?) cases were not examined, and therefore there may have been others with discharges or other infectious conditions). 29 In addition to the above cases there were 6 cases of scarlet fever occurring more than 4 weeks and less than 8 weeks after the return of a former case to the same house. In two instances cases of scarlet fever occurred shortly after the return home from hospital of a case of diphtheria in the same family. DIPHTHERIA. 424 St. Pancras (civil) patients were notified during 1916 as suffering from diphtheria or membranous croup. Of these 41 were afterwards found not to be suffering from diphtheria, 38 by Medical Superintendents of the Metropolitan Asylums Board hospitals, and 3 by other medical practitioners. This gives the net number of cases of diphtheria notified during the year as 383, equal to an incidence rate of 1.75 per 1,000 population, and 1.94 per 1,000 civil population. The number of deaths from diphtheria certified during the year was 23, equal to a death-rate of 0.11 per 1,000 population, and 0.12 per 1,000 civil population, and a case mortality of 6 0 per cent. of cases notified. Other statistical facts in regard to diphtheria will be found on pages 14-15. Of the notified cases of diphtheria 405 (or 95.5 per cent.) were removed to hospital as follows:— To Metropolitan Asylum Board hospitals 369 To other hospitals 36 405 Institutions.—31 cases of diphtheria were notified during 1916 from the Guardians' Receiving Home (St. Margaret's Home), Leighton Road. These were not all ordinary cases of the disease, a number of them being discovered by bacteriological examination of discharges from the nose and ear, through the vigilance of the Medical Officer of the Home. There were two outbreaks, one, comprising 7 cases, in January, and the other, comprising 22 cases, in June and July. The latter was associated with 4 cases of scarlet fever. The girls and infants were most affected, but, there were also cases amongst the boys, and in one ward-maid. There had been 7 cases in the Home in 1915, and two cases only have since been reported in the first half of 1917. Return Cases. — In one house a case of diphtheria occurred ten days after the return from hospital to the same house and family of a former case of diphtheria. Klebs-Loeffler bacilli were found in the nose of the (?) infecting case. Cases of diphtheria occurred following upon the return from hospital to the same house of a case of scarlet fever in four instances, the intervals between the return of the first case and the onset of the return case being 3, 21, 25, and 33 days respectively. In one of these cases Klebs-Loeffler bacilli were found in the nose of the (?) infecting case, and in one other there was a history of sores about the face and "damp nose" in the (?) infecting case. 30 TYPHOID FEVER. 38 cases were notified as suffering from typhoid fever during 1916. Of these 38 cases, 9 were afterwards reported not to be suffering from the disease by Medical Superintendents of Metropolitan Asylums Board hospitals. Of the remaining 39 cases one was a military case of paratyphoid fever. There was also one case notified as continued fever which proved to be one of typhoid fover. The true cases of typhoid fever belonging to the civil population notified during the year were therefore 29 in number, equal to an incidence rate of 0.15 per 1,000 civil population. Of the 29 notified cases, 5 died, the case mortality being therefore 17.2 percent. There were no "inward transfers" and the total number of St. Pancras deaths was therefore 5, equal to a death rate of 0.03 per 1000 civil population. Other statistical facts in regard to the disease will be found on pages 14-15. The 39 persons notified were treated as follows:— Cases notified. Not Typhoid. Diagnosis not contradicted. In hospitals of the M.A.B. 24 9 15 In other public hospitals 14 0 14 In their own homes 1 0 1 39 9 30 Outbreaks of Typhoid Fever. A local outbreak of typhoid fever occurred in a Somers Town street during October. The first case, W.B., male, 21/2, Drummond Crescent, had diarrhoea for two weeks about the end of September, and received no medical attention. His blood was examined on 4th November and found to give a positive Widal reaction 1 in 80 with B. typhosus upon which alone the diagnosis of typhoid fever was based. The second case, G.A.B., age 9 (brother), became ill about 3rd October, and was admitted to hospital 8 days later. The third case, L.P., female, 13, lived at 46, Drummond Crescent, immediately opposite. She used to play with the B. children, but did not take food in their house. She fell ill about 9thOctober, and was admitted to hospital 14 days later. 31 The fourth case, E.G., age 32, lived at 18, Little Drummond Street, a few doors away. He was uncle to the B. family and lived in close connection with them. He fell ill about the 17th October, and was admitted to hospital 14 days later. The fifth case, J.H., male, 41, lived in separate rooms at 9, Drummond Crescent. He fell ill on 19th October, was admitted to hospital on 4th November, and died of perforation of a typhoid ulcer, confirmed pott mortem, on 16th November. He was the only fatal case. The sixth case, A.G.B., age 17, sister of first case, became ill on 21st October, and was admitted to hospital 7 days later. The seventh case, L.H., female, 9 (daughter of fifth case, J.H.), became slightly ill about 27th October. She was admitted to hospital on 4th November, owing to a positive Widal reaction and in hospital had an intermittent temperature only. All these cases gave positive Widal results with B. typhosus. The cause of this outbreak was not discovered, and no food was incriminated. There was no special prevalence of the disease in other parts of the borough at the time. Four nurses at the North Infirmary developed typhoid fever on the 3rd and 11th (two cases) of November and the 2nd December respectively. They all worked in the same ward, in which a patient with Pott's disease had had fever and diarrhœa during October, whose blood was found on 20th November to agglutinate typhoid bacilli freely. He was regarded as the probable cause of the outbreak and removed to the fever hospital. He had been in the ward for 18 months, and no source for his infection was traced. Another localised outbreak of typhoid fever took place at 9, Maple Street. A woman aged 29 was removed to hospital with typhoid fever on 11th April, and her three children, M. 7, F. 2, and F. 5, on 23rd April, 24th April, and 5th June respectively, in each case after a few days' illness. No cause for the outbreak was traced. Of the other 13 cases one was a nurse who probably caught her infection from military cases. No source was traced for the other 12. Two of them had eaten oysters shortly before the onset of the illness, and several (including these two) quite probably contracted the infection outside of St. Pancras. Each case was in a separate house. 32 ANTERIOR POLIOMYELITIS. 9 cases of Anterior Poliomyelitis were notified during 1916. 7 of these began in the period from August to November (inclusive). The details of the cases are set out in the following table:— Date of Notification. 1910. Age and Sex. Date of Onset. 1916. District. Ward Removal to Hospital. Muscles affected. Result. May, 1917. Notified by. Feb. 9 F. 11 Jan. 24th W.l 4 No. Right arm Paralysis persists. Medical Mission. April 11 M. 4 June, (1915) N.5 2 No. Right leg. Lost sight of. Ditto. Sept. 18 M.3½ Sept. 3rd E.5 6 No. Both legs. Able to walk, though badly. R.M.O. at Great Ormond St. „ 26 F. 15 Aug 28th W.4 5 No. Left arm. Arm better, but hand still affected. Private Doctor. Oct. 11 M.l1/12 Oct. 4th S.3 Q Royal Free Hospital. Legs& trunk. Died after six days' illness. R.M.O. at Royal Free Hospital. „ 16 M. 4 „ E.5 6 Great Ormond Street Hospital. Right leg. Partial recovery, able to walk R.M.O. at Great Ormond St. 27 M.31/12 Oct. 16th W.l 4 No. Both legs. Complete recovery. Ditto. „ 28 M.13/12 Oct. 3rd N.3 1 No. Ditto. Contracture of L. foot. R.M.O. at University College Hospital. Nov. 24 F. 5½ Nov. 5th N.2 1 No. Ditto. Complete recovery. Private Doctor. No source of infection or relation between the cases was discovered. EPIDEMIC CEREBROSPINAL MENINGITIS. The increased incidence of this disease which appeared in the borough (and the rest of the country) in 1915 continued, with a slight reduction, in 1916. 21 civilian cases were duly notified, 4 of which afterwards proved not to be suffering from this disease. In addition 3 other cases were reported after death. The number of true cases reported was therefore 20, giving an incidence rate of 0.10 per 1,000 civilian population. Of these 20 cases, 12 were fatal, making a case mortality of 60 per cent. There were no "inward transfers," and the total number of St. Pancras deaths was therefore 12, equal to a death rate of 0'06 per 1,000 civilian population. 33 In 14 of the 20 cases the diagnosis was confirmed by identification of the meningococcus (in six cases grown in pure culture) in the cerebrospinal fluid (12) or exudation on brain and cord p.m. (2) and in 2 others the recognition of the germ was doubtful. Amongst the 12 fatal cases post-mortem examinations were made in 9 cases and there is no record in one other. The 9 autopsies showed typical cerebrospinal meningitis with exudation in 4 cases, oedema and softening of the brain without exudation in 4 cases, and a doubtful result in one case. Amongst the 8 cases who recovered, one was left quite blind, and one stone deaf. In the other six cases the recovery was practically complete. In only 3 of the 20 cases was any history of hsemorrhagic rash obtained; one of these died and 2 recovered, one being left blind. 5 of the cases (3 fatal) were under one year of age, 7 (6 fatal) between one and 5, 4 (2 fatal) between 5 and 15, and 4 (1 fatal) over 15. There was not much tendency for the cases to group round foci. No source was traced in any case, and there were no secondary cases in the affected houses. The patients were all of the working class. In addition to the above civilian cases, there was one case notified in the person of a soldier, not a St. Pancras resident but billeted in the borough. This case was fatal, had a hæmorrhagic rash and was confirmed bacteriologically during life and on post-mortem examination. These diseases were made compulsorily notifiable from January 1st, 1916, by the Public Health (Measles and German Measles) Regulations, 1915. Fairly reliable statistics as to the incidence of the diseases are therefore now available. All cases are notifiable by parents and guardians, but only the first case occurring in an outbreak in a household or institution is notifiable by medical practitioners, an interval of two months since the last case c instituting a new outbreak. Subject to correction for diagnosis in certain instances, 1,855 civil cases of measles and 381 of german measles were notified in the borough during 1916. This represents an incidence rate of 9 4 per 1000 civil population for measles, and 1.9 for german measles. 42 deaths from measles were registered during the year, equal to a deathrate of 0'2 per 1000 civil population, and a case mortality rate of 2.3 per cent. amongst the notified cases. There were no deaths from german measles. MEASLES AND GERMAN MEASLES. The cases were notified or reported as follows:— Measles. German measles. Notified by medical practitioners 1167 309 ,, ,, parents and guardians 485 46 Discovered otherwise 203 26 1855 381 34 Every notified case of measles, and a considerable number of the cases of german measles, have been visited by one of the women visitors without delay. Careful inquiries have been made in each case and a case paper filled up. Upon receipt of the notification a card of advice is sent to the patient's home, together with a printed addressod post-card form of notification— unstamped — for the notification of secondary cases in the household. Upon a secondary case being notified another copy of the post-card form has been promptly sent to the parent for further secondary cases, if any. It has long been observed that mortality from measles is very largely restricted to the poorer classes, deaths from this cause amongst the well-to-do being uncommon. This is probably due in part to superior stamina from better nurture prior to the attack of measles, and perhaps also to other factors, such as a difference of age between the patients in the two classes. But there seems to be no doubt that it is also largely the result of improper nursing of the patients, which is much commoner amongst the poorer classes than the more well-to-do, and is the result of poverty, ignorance, or carelessness. We have therefore aimed at securing something like adequate nursing for the measles cases, and to this end "The Mayoress' Nursing Fund for Sick Children" was instituted early in the year by the Mayoress, Mrs. J. H. Mitchell, at the suggestion of the Medical Officer of Health. An arrangement was made with the four local district nursing associations to send a visiting nurse to such cases of measles as were referred to them by the Medical Officer of Health, payment being made by the Mayoress' Fund at the rate of one shilling per visit. In certain cases of necessity this assistance was supplemented by the provision from the fund of milk, eggs, coal and clothing. Where the home conditions were so bad that even with such help as this it appeared impossible to secure reasonable accommodation for the case, the patients were removed to the Metropolitan Asylums Board's hospitals. This, it is understood, was only possible owing to the low inciderce of scarlet fever and other eases received by the Board, and in some years it will probably not be possible, with the present arrangements, to get measles cases removed on the request of the Medical Officer of Health. Some cases were also removed to the Infirmary. The provision of hospital accommodation for a proportion of measles cases is essential to an effective scheme. This work of the Nursing Fund began in April, and by the end of the year, during which time 1,650 cases of measles were notified, 205 families were dealt with, and 1,231 visits were paid by the nurses, the average number of visits per family being 6. 1 patient nursed in each of 152 families. 2 patients „ „ „ „ 40 „ 3 „ „ „ „ „ 10 „ 4 „ „ „ 1 family. 5 ,, „ „ ,, „ 2 families. The total number of patients nursed was 276, and 126 families received milk and eggs, and 8 coal. The cost of this work to the end of the year was £81 15s. 11d. As to the effect of this work in reducing mortality, it is encouraging to note that the number of measles deaths in 1916 was less than in any recent 35 year with the exception of 1013. In view of the great variation in measles incidence from year to year, it is obvious that no definite conclusions on this point can be drawn from the records of a single year, The results of the work are set out in a paper in "Maternity and Child Welfare," Vol. 1 (1917), page 7. Importance is to bo attached not only to the nursing work in connection with preventing measles mortality, but also to the call paid by the official visitor to every case, and the sending of a card of advice. Besides their direct influence, such measures help by fostering the opinion that measles is a dangerous disease which needs to be seriously dealt with, and thus tending to prevent its careless handling. Analysis of Cases.—An analysis of the measles (morbilli) cases reported during the first 6 months of 1916 was carefully made, and the following results were obtained:— The total number of cases reported as occurring in private houses during this time, exclusive of cases developed in hospital, military cases, and wrong diagnoses, and inclusive of cases discovered without notification, was 800. Of these, 525 were notified by doctors and 143 by parents, 70 were reported by school teachers, and 62 were otherwise discovered. Tlio following is a classification of the cases according to age and sex. 0-1 1-2 2-3 3-4 4-5 5-6 6-7 7-8 8-15 15 & up. Total. Male 34 53 52 46 52 60 24 13 17 16 367 Female 30 53 62 59 48 74 38 12 19 38 433 Thus 480 cases were under school age (0-5), 257 of school age (5-15) [221 aged 5-8 (infants school age), and 36 aged 8-15 (upper school age)], and 54 over school age (15 and upwards). The following is a division of the cases into primary cases (i.e. first cases in houses), and secondary cases (i.e. subsequent cases in the same houses), classified into these age groups:— Under 5. 5-15 15 & up. Total. Primary cases 274 211 50 535 Secondary cases 215 46 4 265 36 These figures show a much larger proportion of the children of school age to have been "primary cases," i.e. to have caught their infection outside their homes (211 out of 257), than was the case amongst children below school age (274 out of 489). The actual number of measles cases recorded as attending schools were:— primary cases 257, secondary cases 56 (313 in all). By a careful examination of the records it is possible, by studying the dates of onset, etc., of the cases in school outbreaks, to form a rough estimate of the number of cases who did in fact become infected at school. The number of such cases in the series under investigation was 209, so that the great majority of primary cases in school children are to be regarded as having caught the disease at school. But the causing of 209 cases out of 800 by no means represents the amount of infection spread by schools. The secondary cases in the same homes as these 209 cases amounted to 170, so that the number of cases directly traceable to school infection was 379, or nearly half the total reported cases. And this is not a full statement of the effect of schools in spreading measles, for there are undoubtedly a large number of cases in other houses caught from the school cases. Our experience shows that when there are no school outbreaks there is very little measles, and that a measles outbreak in a neighbourhood (speaking of such an urban district as this) is practically always ushered in by a school outbreak. Occasionally outbreaks in day nurseries or similar places where children are aggregated have the same effect. During the six months over which this numerical inquiry extends measles was comparatively quiescent, and there were only 12 marked school outbreaks affecting the borough, one of them numbering 33 cases, and one—16 cases—in a day nursery. In the corresponding months of 1917 there were 37 such school outbreaks, and two in day nurseries. In each case inquiry was made into the source of infection. Where the infection was caught in a school outbreak and in some other instances ihe source was obvious. But in most other primary cases it was impossible to say exactly how the infection was contracted, although there was generally an obvious source, such as other cases of measles in the same street, from which it mail have come. In the following table the source is stated to have been traced only in those cases where it was practically certain:— Source. No. of Cases. School 209 Other Institutions 16 Other cases traced 21 Previous case in same house 265 Total traced 511 Source unknown or doubtful 289 Thus nearly two-thirds of the total number of cases reported were of definitely known origin. 37 In regard to the question of the completeness of notification, 525 cases were notified by medical practitioners and 143 by parents. Thus 132 or 16 per cent. were not notified. 70 of the 132 were reported by school teachers, and 62 discovered otherwise. In order to check the completeness of our records of secondary cases, a visit was later paid to all houses where a primary case but no secondary cases had been reported, and where there were children who had not had measles. In 27 amongst 156 of such houses visited (about one-sixth) it was found that there had been secondary cases not notified. In the 27 houses there were 40 cases discovered in this way (included in the total of 800). Seeing that this was the case, even though the parents had been emphatically told that any secondary cases were to be notified and supplied with cards for the purpose, it is evident that there must have been an appreciable number of cases never brought to our knowledge. This was probably kept within moderate limits, however, by reports of school-teachers and other sources of information. The cases were carefully analysed with a view to determining what proportion of household contacts developed the diseaae. In this connection the records as to secondary cases are to be regarded as fairly but not quite complete. The question of whether the contacts had previously suffered from measles is determined by the statements made by themselves and friends. It is to be remembered that in St. Pancras there are very frequently more than one family per house. The results are epitomized as follows: There were 657 house or family contacts of 8 years old or over said to have had measles already; and of these 3 developed the disease (0'5 per cent.). There were 55 house or family contacts of 8 years old or over said never to have had measles; and of these 4 developed the disease (7 per cent.). There were 185 family contacts under 8 said to have had measles already; and of these 13 developed the disease (7 per cent.). The corresponding figures for house contacts were 294 and 7 (2 per cent.). There were 282 family contacts under 8 said never to have had measles ; and of these 187 developed the disease (66 per cent.). The corresponding figures for house contacts were 306 and 67 (22 per cent.). In connection with the question of the chance of a person who had had measles before developing the disease again it is interesting to note that amongst the primary cases 50 gave a history of having had measles before. This figure is not exhaustive, as this particular point was not inquired into in all primary cases. The date of onset and the date when the rash was first noticed as stated by the friends was recorded by the visitor in all cases. We were therefore enabled to record the interval between primary and secondary cases in the same house. The most definite date is the onset of rash, and in the following table is given the number of days between the appearance of the rash in the primary and secondary cases respectively in 226 cases. Where the interval 38 Was four days or less the cases were regarded as arising from a common source and not as being primary and secondary:— Under 9 days 10 9 13 10 „ 31 11 „ 45 12 „ 37 13 „ 19 14 „ 28 15 „ 16 16 „ 15 Over 16 „ 12 226 It is to be noted that the above table is compiled from the statements of the patients' friends, and not from exact observation. The excessive number of instances where 14 days is given as the interval no doubt results from the tendency to quote a round number of weeks. The following tables compiled from the visitors' reports on measles cases may also be of interest:— No. of cases in families occupying 1 room 40 „ „ „ „ 2 rooms 185 „ „ „ „ 2 rooms 153 „ „ „ „ 4 „ 65 „ „ „ „ 5 and over 77 Not known 15 535 No. of cases in houses occupied by 1 family 129* „ ,, „ „ 2 families 120 „ „ „ „ 3 „ 175 „ „ „ „ over3 „ 93 Not known 18 * Including self-contained flats. 535 No. of cases under the care of a doctor 571* „ „ not „ „ „ 229 * The doctor did not visit regularly in all these cases. No. of cases nursed in a separate room 118 „ „ not „ „ „ 682 No. of cases nursed in a separate bed 400 „ „ not „ „ „ 400 No. of cases nursed in a living-room 275 „ „ not „ „ „ 525 39 ANTHRAX. A case of Anthrax in the person of H. B. M., aged 51, male, of 7, Sandwich Street, W.C. 1, was reported as having died on 26th June, 1916, and was subsequently notified to the Medical Officer of Health. Inquiries elicited the following facts:— The deceased lived at this address and worked as a waterside labourer. On 20th June he was engaged at Hibernia Wharf, Montague Close, Southwark, opening bags of Persian wool for inspection before sale. On 21st June a boil appealed on the left side of the neck, which was swollen, hot, and painful. He slept at home that night. Next day (22nd) he was admitted to Guy's Hospital, when the part was excised, and he died there on 26th June. The diagnosis of Anthrax was based on bacteriological evidence. There was no evidence of infection from shaving brushes, as was the case in certain instances of the disease in London and elsewhere prior to this. The verdict of the Coroner's court was "Coma : Meningitis : infection by Anthrax bacillus while handling Persian or China wool at work : Misadventure." Disinfection at 7, Sandwich Street, was carried out, and there were no further cases. OTHER NOTIFIABLE INFECTIOUS DISEASES. No cases of Small-pox, Typhus, Glanders or Hydrophobia in man or animals, Cholera, or Plague, were reported in St. Pancras during the year. In 9 instances persons who had been in possible contact with cases of Smallpox (mostly on shipboard) were reported as having arrived in St. Pancras. These comprised 55 persons, and they were kept under observation, with negative results. 17 soldiers were reported by the military authorities as returning to St. Pancras addresses after suffering from Dysentery. These were all visited, and 10 of them stated they were still suffering from abdominal pains (6 with diarrhœa also) and 2 from other symptoms; 2 were in good health; and in the case of 3 no information was obtained. No cases of the disease were caused by the return of these men. 40 soldiers were similarly reported on coming to St. Pancras after typhoid or paratyphoid fever. They were all visited, and there was no evidence of their causing secondary cases. 40 WHOOPING COUGII. In the following table will be found the deaths and death-rate from whooping cough for the past ten years for the whole borougli and for the four registration sub-districts:— Year. Deaths. Rate per 1,000 population. West. South. East. North. No address Whole Borough West. South. East. North. Whole Borough 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 31 5 41 15 .. 92 0.50 0.08 0.68 0.25 0.38 1911 13 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 1915 10 13 15 12 2 52 0.17 0.29 0.26 0.21 0.24 1916 13 .. 17 9 .. 39 0.22 .. 0.36 0.16 0.18 Of the 39 deaths. 15 were of children under one year of age and 38 of children under five years of age. DIARRHŒA AND ENTERITIS. 72 deaths from diarrhoea and enteritis were registered during 1916, equal to a death-rate of 0.3 per 1,000 population. Of these 56 were in children under five years of age and 41 in babies under one. Reference is made on page 21 to infantile diarrhoea. SYPHILIS. In the following table are given the age and sex distribution of deaths certified during 1916 as due to (a) declared syphilis, (b) locomotor ataxy and general paralysis of the insane, which are believed by most experts to be late 41 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—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—S5 85 up. Total Females. Total Persons. Syphilis 7 - - - - - 1 2 1 - - 11 7 1 - 1 - - 1 - 1 - - 11 22 Gummatous disease - - - - - - - - - - - - - - - - - - - - - - - - - Total declared Syphilis 7 - - - - - 1 2 1 - - 11 7 1 - 1 - - 1 - 1 - - 11 22 Locomotor ataxy - - - - - 2 2 3 1 2 - 10 - - - - - 1 - - - - - 1 11 General paralysis of the insane - - - - - 6 10 2 1 - - 19 - - - 1 - 4 - 1 - - 6 25 Aortic aneurysm - - - - - 2 - 4 1 1 - 8 - - - - - - - - - - - - 8 CANCER. 267 deaths were registered during: 1916 as due to cancer, under the various names of cancer, carcinoma, epithelioma, scirrhus, rodent ulcer, sarcoma, &c. This is equal to a death-rate of 1.22 per 1,000 population, and 1.36 per 1,000 civil population. The sex distribution of the deaths and death-rates is shown in the following table:— Sex. No. of Deaths. Death-rates per 1,000 males or females living (based on 1911 Census). Males 125 1.17 Females 142 1.27 Roth Sexes 267 1.22 DWELLING HOUSES. Reference has been made in previous annual reports to the unsatisfactory state of the housing of the working classes in parts of St. Pancras. A special report by the Medical Officer of Health was presented to the Council in November, 1916, dealing with the inadequacy of the provision made for individual families in many tenement-houses, with special reference to the opportunity afforded by the reversion of such properties to ground landlords upon the falling in of leases. The report arose out of certain instances in which new leases had been granted in respect of such tenement houses without any 42 structural alterations being' made with a view to making better provision for the needs of the families living in them. The Council passed the following resolution:— "That upon information that the leases of tenement properties in the borough are about to expire, or that rebuilding schemes are taking place, the Town Clerk be authorised to communicate with the ground landlords, calling their attention to the recommendations of the Medical Officer of Health as regards sanitary provision, and suggesting that they should be incorporated as far as possible in the covenants of the new leases or rebuilding schemes." The following statement upon the matter was drawn up by the Medical Officer of Health, and was subsequently approved by the Council. Town Hall, Pancras Road, N.W. March, 1917. HOUSING ACCOMMODATION IN TENEMENT HOUSES. The housing accommodation in many working class tenement houses in StPancras is very deficient. This arises from the fact that the houses were originally built for the accommodation of one family each, and are now let in such a way that each house is occupied by several families, without the alterations having been made which are necessary to provide proper sanitary provisions for each separate family. Very commonly the houses consist of four floors, each containing two rooms and each floor is let to a separate family. Sometimes, however, the tenant has a single room; or on the other hand, may be able to afford three or four rooms. In the latter case he may occupy the whole of two floors. In parts of the borough some of the tenement-houses have three rooms on each floor. It is quite usual to find such a sub-let house provided with only one w.c.— generally in the yard—and with no scullery accommodation or separate sinks for the various tenants, though frequently there are one or more water-taps for the common use of the tenants on the staircase. It is thus brought about that in many tenement-houses families have to live in one, two, or more rooms, with no proper separate accommodation in the way of w.c., scullery, sink, water supply, yard (or balcony), etc., and frequently separated from the common w.c. or water-tap by several flights of stairs. It cannot be doubted that grave injury results to the public health from these evils. They are not confined to the "slums," but are endured by many respectable working-class people who pay rents which would in many other towns provide them with good separate cottages. While the houses are owned by lessees who have, as is frequently the case, difficulty in making them pay, it is difficult to suggest a method of ameliorating the conditions. But when the leases terminate and the houses revert to the freeholders, it is most important that they should not be leased again for a further term of years with no alterations except the repair of dilapidations. New leases should not be granted unless such alterations are made as will provide sanitary accommodation for all the families who live in the houses. Once they pass out of the freeholder's hands the opportunity has gone. Grave public responsibility, therefore, devolves upon the freeholder when leases upon tenement-house property terminate, and this is especially so in the case of the ground-owners of large estates. In determining the future of such houses it first has to be decided whether they ought to be demolished in order to make room for dwellings offering proper accommodation for families, or whether alterations can be made for the same 43 end. In the event of it being decided to make alterations, the following matters are essential if the tenants are to be given reasonable accommodation:— (1) Each tenement for a family should include proper scullery provision, with water-tap and suitable sink, and if possible a bath. (2) Separate and convenient w.c. accommodation for each family should be aimed at. (3) There should be to each tenement a proper cooking stove, a suitable food cupboard with external ventilation, and facilities for storing coal and house refuse, and for washing clothes. In some St. Pancras houses these requirements might be met without complete rebuilding, by the building of a sanitary annexe at the rear, giving to each floor a balcony, w.c., and scullery (or bathroom-scullery). In the above statement I have not entered into the question of what number of rooms should be considered as the minimum requirement of a family. Clearly there ought to be at least one living room, not used as a bedroom, and a sufficient number of bedrooms to admit of a decent separation of sleepers of opposite sexes. For a married couple with one young child one bedroom may be sufficient, but where there are boys and girls in the family, at least three bedrooms are required, one for the parents, one for the boys, and one for the girls. In arranging for permanent alterations in a tenement-house the needs of sucl) families requiring at least four rooms should be considered. T. SHADICK HIGGINS, Medical Officer of Health. Inspection of Dwelling-houses. The inspections of dwelling-houses made during the year will be seen in table 5 on page 67, where they are divided into those following infectious disease, those made upon complaint, those carried out under the Housing, Town Planning, etc., Act, 1909, inspection of registered tenement houses other than the preceding, and other house-to-house inspections. Underground Rooms. During the year letters were sent in respect of 32 underground rooms (in 30 houses) which did not comply with the requirements of the Housing, Town Planning, etc., Act, 1909, and the Regulations made thereunder. 14 closing orders in respect of underground rooms (in 14 houses) were made. In addition 9 intimation notices were served in regard to underground rooms illegally occupied as dwellings. Houses unfit for Human Habitation. Only one house (36, Ferdinand Place) was represented during 1916 as unfit (16th February), and a closing order was made by the Council in respect of it. Closing orders were determined in respect of 14 houses (11-20, Equity Buildings and 3-6, St. George's Mews), 44 In accordance with the Housing (Inspection of District) Regulations, 1910, the following table is submitted for the year 1916:— The number of dwelling-houses inspected under and for the purposes of Section 17— Totals. First routine inspections 4 Subsequent „ 1038 1042 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 1 ,, underground rooms (32 rooms) 30 31 The number of representations made with a view to the making of closing orders— As regards the whole house 1 ,, underground rooms (14 rooms) 14 15 The number of closing orders made— As regards the whole house 1 ,, underground rooms (14 rooms) 14 15 The number of dwelling-houses, the defects in which were remedied without the making of closing orders 1041 The number of dwelling-houses which, after the making closing orders, were put into a fit state for human habitation 14 Inhabited House Duty. Applications for certificates under Section 11 of the Inland Revenue Act, 1903, were received during 1916 in respect of 6 blocks of dwellings comprising 63 tenements. In 4 cases, comprising 58 tenements, the applications were granted, and in 2 cases, comprising 5 tenements, refused. Canal Boats Acts. During the year Inspector Auger inspected 21 boats, registered to carry 66 adults and 19 children, and actually carrying 36 adults and 28 children. No notices were served for contraventions, but two cautionary letters were sent in regard to 2 boats which were in need of repairs and cleansing. 45 FACTORY AND WORKSHOP ACTS. The following five tables are 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) 799 157 — Workshops (including workshop laundries) 1563 246 — Workplaces (other than Outworkers' premises included in Part 3 of this Report) 414 94 — Total 2776 497 — 2.—Defects Found. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspectors. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts*:— Want of cleanliness 71 69 1 Nil. Want of ventilation 1 1 Overcrowding — — Want of drainage of floors — — Other nuisances 53 53 Sanitary accommodation Insufficient 8 7 Unsuitable or defective 222 211 Not separate for sexes 10 8 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) 132 132 Other offences (Excluding offences relating to outwork which are included in Part 3 of this Report) — — Total 497 481 1 — * Including those specified in sections 2, 3, 7 & 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 46 NATURE OF WORK. Outworkers' Lists, Section 107. Outwork in unwholesome premises, Sec. 108. Outwork in infected premises, Sections 109, 110. 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). 3.—Home Work. 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. — 31 80 — — — — — — — — — — — — (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 — — — — — — — — — — — — — — — Brush making — 2 — — — — — — — — — — — — — Pea picking — — — — — — — — — — — — — — — Feather sorting — — — — — — — — — — — — — — — Carding, etc., of buttons, etc. — — — — — — — — — — — — — — Stuffed toys — — — — — — — — — — — — — — — Basket making — — — — — — — — — — — — — — — Total — 33 80 — — — — — — — — — — — 47 4.—Reoistbred Workshops. Workshops on the Register (See. 131) at the end of the year. Numbers. (1) (2) Bakehouses 146 Restaurant kitchens 304 Laundries 75 Domestic workshops — Other workshops where women are employed 321 Other workshops 880 Total number of workshops on Register 1726 5.—Other Matters. Class (1) Number (2) Mattel's 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 14 Reports (of action taken) sent to H.M. Inspector 14 Other — Underground bakehouses (s. 101):— Certificates granted during the year — In use at the end of the year 88 48 The number of factories, workshops and workplaces added to and removed from the register during 1916 was as follows:— Added to register. Removed from register. Bakehouses— Workshop 0 5 Factory l 0 Laundries— Workshop 3 41 Factory 1 3 Restaurant kitchens 100 18 Other factories 99 60 The number of inspections that were made during 1916 were as follows:— Factory and Workshop Inspector. Woman Sanitary Inspector. Total. Inspections. Re-inspections. Inspections. Re-inspections. Inspections. Re-inspections. Bakehouses 364 271 — — 364 271 Restaurant kitchens 229 77 — — 229 77 Laundries 44 4 — — 44 4 Domestic workshops — — — — — — Other workshops 640 365 l — 641 365 Other workplaces 47 53 8 — 55 53 Other factories 320 351 2 — 322 351 Total 1644 1121 11 — 1655 1121 Bakehouses.—At the end of the year there were 176 bakehouses on the register, including 30 factory bakehouses. 128 of these were underground bakehouses, of which 40 were unoccupied. Restaurant Kitchens.—At the end of 1916, 304 restaurant kitchens were on the register. 49 INSPECTION OF FOOD AND FOOD-PLACES. Sale of Food and Drtjgs Acts. 750 samples have been taken under those Acts, and 684 of these proved to be genuine and 66, or 8'8 per cent., adulterated. The details are given in the following table:— Articles of food of which samples have been taken. Total number samples. Genuine. Adulterated. Arrowroot 3 3 — Baking Powder 21 12 9 Brawn 2 2 — Butter 198 178 20 Camphorated Oil 6 6 — Cocoa 21 20 1 Cod Liver Oil 5 5 — Coffee 31 30 1 Cream 3 3 — Egg Powder 8 7 1 Fish Paste 3 — 3 Flour, Self Raising 10 10 — Jam 4 4 — Lard 23 23 — Milk 366 336 30 Mustard 19 19 — Olive Oil 5 4 1 Oatmeal 1 1 — Pepper 19 19 — Sausages (Garlic) 1 1 — Flowers of Sulphur 1 1 — Total 750 684 66 Of the 750 samples 2 were informal samples of butter which were found to be adulterated. Prosecutions were undertaken in respect of 28 of the 66 samples which were reported as being adulterated. These are set out in the following table:— 50 Summonses—Under the Sale of Food and Drugs Acts. NO. of Sample. Article. Result of Analysis. Date of Hearing of Summons. Result of Proceedings. Penalty. Costs. A. 15 Milk Deficient in milk . 5.3 per cent. 1916. 29th Feb. £ s. — d. £ 2 s. 2 d. 0 A. 32 Butter Added water, 5.8 per cent. 21st March 3 0 0 0 12 6 C. 34 „ Foreign fat, other than the fat of butter, 40 per cent. 7th April 1 0 0 0 10 6 C. 46 Milk Added water, 11.8 per cent.; also deficient in milk fat, 12.0 per cent. 7th „ Warranty successfully defence pleaded. C. 57 Butter Foreign fat, other than the fat of butter, 82 per cent. 14th „ 0 12 6 A. 78 Milk Deficient in milk fat, 7.3 per cent. 12th May Warranty successfully defence pleaded. A. 96 „ 17 ,, 12th „ 5 0 0 0 10 6 C. 89 Coffee Chicory, 33 per cent. 16th „ 1 0 0 0 10 6 C. 91 Milk Added water, 16.4 per cent. 19th „ 3 0 0 0 10 6 C. 92 Butter Foreign fat, other than the fat of butter, 80 per cent. 19th „ 3 0 0 0 10 6 A. 123 „ „ 82 20th June 4 0 0 — A. 128 Milk Deficient in milk fat, 11.2 per cent. 27th ,, — 0 12 6 C. 145 „ „ 19.3 14th July 0 10 0 0 10 6 A. 147 Butter Foreign fat. other than the fat of butter, 40 per cent. 25th „ 1 0 0 0 10 6 A. 163 Milk Deficient in milk fat 30 per cent. 11th August 1 0 0 0 10 6 C. 181 „ Added water. 17.2 per cent. 25th „ 2 0 0 0 10 6 C. 182 Butter Foreign fat; other than the fat of butter, 82 per cent. 25th „ 5 0 0 0 10 6 C. 184 „ „ 78 25th „ 1 0 0 0 10 6 A. 192 Milk Added water, 5.9 per cent. 1st Sept. 0 10 6 0 10 6 A. 209 „ „ 5.8 „ 12th ,, 0 10 0 0 10 6 A. 203 Cocoa Sugar, 35 per cent.; starch, 15 per cent. 22nd ,, 2 0 0 — C. 212 Milk Added water, 6'8 per cent. 20th October 0 15 0 0 10 6 A. 214 „ „ 6.3 „ 22nd Sept. 10 0 0 — C. 249 Butter Foreign fat, other than the fat of butter, 80 per cent. 17th Nov. 2 0 0 0 10 6 C. 261 „ ,, ,, ,, 50 ,, also added water, 16 per cent. 24th „ 0 10 0 0 10 6 A. 293 „ Foreign fat, other than the fat of butter, 88 per cent. .. 16th Dec. 10 0 0 — A. 337 „ „ „ „ 85 „ 1917. 12th Jan. 15 0 0 — A. 339 Milk Added water, 10.1 per cent. 13th „ 2 0 0 — Registration of Premises Wherein the Business of a Wholesale Dealer in Margarine is Carried on. On 22nd November and 20th December, 1916, the following premises, all belonging to the same Company, were registered for this purpose under the Sale of Food and Drugs Acts : — 214, Kentish Town Road, 22, Chapel Street, Somers Town, and 251, High Street, Camden Town. Puklic Health (Milk and Cream) Regulations, 1912. The following is a report of the work done under the regulations during ihe year ended -51st December, 1916 : — 366 samples of milk ,md 2 of cream not sold as preserved cream were taken, and in no case was a preservative reported to be present. One sample of cream sold as preserved cream was taken, and was found to be in order No other contraventions of the regulations were discovered. 51 Inspection of Food [Public Health (London) Act, 1891, Sec. 47]. The Food-Inspectors 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. The inspections of market streets by district inspectors in the summer were discontinued this year. One seizure of unsound food has been made during 1916, as follows:— Date. Division and Sab Division. Description of Article. Prosecution and Result, 1916. Sept. 24 East—Ossulston 8 J lb. of pieces (mutton and beef) 7Alb. of bacon Fined £5 On 32 occasions during the year unsound food has been surrendered by the owners to the food inspectors and destroyed as trade refuse. Dairies, Cowsheds, and Milkshops. Cowsheds.—There were at the end of 1916 five licensed cowsheds in the borough, as in the previous year. These are registered for 110 cows. They have been kept under inspection by the food inspectors, 64 inspections having been made during the year. Milkshops and Dainet.—18 applications for registration under the Dairies, Cowsheds, and Milkshops Orders were considered during 1916, and of these the Council decided to register in 15 cases, and to refuse to register on account of unsuitability in 3 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 1915 247 Deduct No. of purveyors removed from register during 1916 20 Add No. of purveyors added to register by resolution of Council during 1916 15 No. of purveyors of milk at retail milkshops on register at end of 1916 242 At the end of 1916 there were on the register in addition to these 242 retail milkshops and 5 cowsheds (of which 4 are attached to retail milkshops included in the 212), 2 persons in respect of premises where only a wholesale milk trade is done, and 6 itinerant vendors without milkshops. Legal Proceedings.—No prosecutions were undertaken under the Dairies, Cowsheds, and Milkshops Order of 1885 and 1886 in respect of the sale of milk by unregistered persons. 52 Ice-Cream Premises. 45 visits were paid to these premises by tlie food inspectors during 1916. N legal proceedings were taken in respect of tlie manufacture or sale of ice cream. Fried Fish and Fish Curing Premises. At the end of 1916 there were 56 fried fish vendors' premises in the borough, at 3 of which fish curing was also carried on. There were 14 fish curers' premises, including these three. 206 visits were made by the food inspectors to these premises during the year. 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. Premises where Horse-flesh is prepared for Human Food. Towards the end of 1916 premises were opened in Camden Town for the preparation of horse-flesh for human food. The proprietors are Belgians, and the food is understood to be mainly for Belgians in various parts of the country. No horses are killed on the premises, nor is there any retail trade there. The dressed carcases are brought in from horse slaughterers outside the borough. The principal products are salted horse-flesh (filet d' An vers) and horse tongues, a cooked sausage of the " german sausage " type (ceivelas), and a dried uncooked sausage (saucisson de Boulogne). These fetch good prices and are as well prepared as foods made from beef, etc. Certain alterations to the premises were suggested and carried out. In 1917 other premises were opened in the south of the borough for the same purpose by another Belgian firm. 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, &c., will be found in table 6 on page 68. Bakehouses and restaurant kitchens are referred to under the heading of Workshops (see pages 45-48.) Slaughter-Houses. There were 12 licensed slaughter-houses in the borough at the end of 1916. 226 visits to slaughter-houses were made by the food inspectors during the year. The Rag Flock Ac:r, 1911. No samples were taken under this Act during 1916. 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. 53 Total Inspections. Altogether 37,371 inspections were made during1 1916 by the staff of Inspectors. These consisted of 22,508 inspections and 14,863 re-inspections (generally after the service of intimation notices). Of these inspections 22,250 were made by the District Inspectors 2,765 by the Factories and Workshops Inspector, 6,226 by the Inspectors of Food and Food-places, and 6,130 by the Women Inspectors and Visitors. The inspections actually made by each individual Inspector are shown in table 8 on page 70. The work of the District Inspectors, Factories and Workshops Inspector, Women Inspectors, and Food Inspectors is set out in detail in tables 5 to 8 on pages 67 to 70. Intimation Notices. 1,974 intimation notices (comprising 3,847 items) were served by the Sanitary Inspectors during 1916. These were made up as follows — In respect of Nuisances 2,309 In respect of Breaches of the Tenement House By-laws 425 In respect of Breaches of Statutes in Factories, Workshops and Work-places 497 In respeot of other Breaches of Statutes and By-laws 616 3,847 These intimation notices are classified in tables 9, 10, 11 & 12 on pages 71 and 72. Summonses. The following prosecutions were undertaken in respect of general Sanitary work:— Situation of Property. Offence. Date of Hearing of Summons. Result of Proceedings. 11, Gaisford Street Constructing a new sink waste contrary to by.law May 6th Penalty £2. ,, ,, Failing to deposit with Sanitary Authority plans of addition to the drainage ,, Costs 28. 11, Little Edward Street Defective roof Dec. 12th Costs £,1 3s. 21,,, Defective roof and part of premises dirty ,, Penalty £1. 132, King's Eoad Defective roof ,, Penalty £2. 35, Ferdinand Place Do. ,, Costs £1 3s. 37, ,, Do. „ Costs 2s. Smoke-Prevention. During the year 57 observations of smoke shafts were made and 12 reinspections after the service of notices. There were no prosecutions. Regulated Trades. Offensive Truden.—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. 54 Constructional Drain Work. The construction of, and repairs to, house drains are supervised by the sanitary inspectors. urmg the year the following work has been done under this heading:— First inspections. Consequent rc-inspections. Drainage work done under notice 94 1861 Voluntary drainage work 878 1798 Drains of new buildings 157 763 1129 4422 The tests which have been applied to drains during 1916 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 Grenada. 1 Defects found 29 41 6 — 6 — 82 r No result 382 106 34 — 16 1 539 3. Total 411 147 40 - 22 1 621 By Smoke. 1. Defects localised — 1 — — — 1 2. No result — — — — 5 2 7 3. Total - 1 - - 5 2 8 By Watar. 1 Not found water-tight — — — — 18 3 21 2 Found water-tight — — — — 397 31 428 3. Total - - — — 415 34 149 Total 29 42 6 — 24 3 104 382 106 34 — 418 34 974 411 148 40 — 442 37 1078 Drainage Register.—The following is an analysis of the Drainage Register during 1916:— Plans deposited—Old Buildings under Notice 75 „ „ —Old Buildings, Voluntary 108 ,, „ —New Buildings and Additions 22 205 Applications without Plans 114 Total number of Applications and Plans 319 55 Watek Service. The following notices have been received from the Metropolitan Water Board as to houses from which water has been cut off:— 1.—Demolition 2.—Empty 3 3 —Leakage 3 4.—Non-payment of Rates 10 5.—No statement (Withdrawals) — 6.—By request 1 17 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 Kooms Sprayed and Fumigated. Scarlet Fever 420 404 432 432 Diphtheria 386 381 406 406 Enteric Fever 32 32 32 — Erysipelas 67 67 67 — Puerperal Fever 14 14 14 — Cerebro-Spinal Meningitis 26 26 27 28 Consumption 112 112 90 98 Measles 37 37 36 24 Cancer 29 29 30 12 Vermin aud Scabies 101 101 101 — Other Diseases 55 55 56 43 Totals 1279 1258 1291 1041 Below is shown the number of articles destroyed or disinfected during the year on account of infectious disease and verminousn-ess:— Infectious Disease Destroyed. Disinfected. Verminousness. Destroyed. Disinfected. Beds, mattresses and palliasses 62 1259 12 46 Bolsters and pillows 26 2690 7 74 Sheets, blankets and counterpanes 35 4194 7.1 2819 Hugs, mats, cushions, carpets, covers, and curtains 19 839 6 545 Wearing apparel 51 3206 22 1726 Books — 18 — — Sundries — 1060 22 72 Total 193 13266 140 5282 56 These figures include 2030 blankets, 446 rugs, 14 bolsters, and 1090 articles of wearing apparel which were disinfected on account of verminousness for the militarjr authorities, or for voluntary bodies (such as the Y.M.C.A.) who provide accommodation for soldiers. The following table shows the number of persons cleansed and disinfected after having been in contact with infectious disease:— MALES. FEMALES Children under 10. Scarlet Fever 4 2 — Puerperal Fever — 9 — Measles 3 — — German Measles 1 — — Cleansing Station. The amount of work done here during the year is indicated in the following table. The figures represent the number of attendances. At each attendance the person receives a bath, and his or her clothes are stoved. Men. Women. Children under 15. Total. St. Pancras Cases Vermin 283 11 1808 *2102 Scabies 26 22 1009 *1057 Cases from outside St. Pancras Vermin 51 — 651 702 Scabies 2 5 409 416 Total 334 11 2459 2804 28 27 1418 1473 362 38 3877 4277 *Includes 132 males and 2 females who had no home address. The school children included in the above table have in the main been brought to the cleansing station from the Public Elementary Schools 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 Act, 1908, Sec. 122. 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 1,696. 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 their verminous conditions. For this purpose the bedding and bedfellows in the household have been cleansed in many instances. The visits paid for this purpose have numbered 60, but the female staff is quite inadequate to deal with this problem effectively. 57 23 verminous persons from common lodging houses outside the borough were paid for by the London County Council at the rate of Is. per attendance, and also 23 persons from Finsbury paid for by the Finsbury Borough Coxmcil at the same rate. PUBLIC MORTUARIES AND CORONER'S COURT. Number of bodies deposited in the General Mortuary during 1916 402 „ ,, Infectious ,, „ 10 Total 412 Inquests held during 1916— In the Coroner's Court —General Cases 336 ,, ,, Poor Law ,, 44 Elsewhere in St. Pancras — Total 380 BACTERIOLOGICAL EXAMINATIONS. The following work has been done by the Lister Institute of Preventive 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. diphtherias 202 72 130 ,, sputum for B. tuberculosis 243 64 179 ,, blood for Widal reaction (typhoid) 17 5 12 THE STAFF. At the beginning of 1916 the working staff of the department had lost 5 male sanitary inspectors and 4 clerks by enlistment, and was short of one further sanitary inspector owing to the fact that the vacancy caused by death in 1914 had not been filled. During the year there were no further losses of permanent staff. Mr. W. C. Harvey, temporary clerk, was called up on 21st June, and Mr. J. Molloy, junior clerk (permanent) returned to the Council's service from the Army on 31st August. Temporary clerks were appointed in the persons of Miss M. Gardner and Miss H. Loder on 30th May and 10th July respectively. Temporary sanitary inspectors were appointed in the persons of Miss II. Payne and Miss M. MacKenzie on the 22nd November. The normal staff of 15 male inspectors and one full-time and two half-time female sanitary inspectors were therefore represented at the end of 1916 by 9 male sanitary inspectors and 3 full-time and 2 half-time female sanitary inspectors. APPENDIX. 60 Table No. 1. VITAL STATISTICS OF WHOLE DISTRICT OF ST. PANCRAS DURING 1916 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. A.t all Ages. Number. Rate. Number. Rate. Number. Rate per 1,000 Nett Births. Number. Rate. 1911 23129 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 1915 218387 4458 4754 21.8 3523 16.1 672 692 497 105 3543 16.2* 1916 218387 4310 4530 20.7 2991 13.7 565 619 385 85 3045 13.9† 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, Yol. V.). * Or 17.7 per 1000 civil population. †Or 15.5 per 1000 civil population. 61 Table No. 2. Deaths Registered from all Causes for the Year 1916. 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. 1.-General Diseases 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. Enteric Fever — 1 — 1 — — — 2 — — — 1 — — 1 — 1 — — — — — — — — — — — 2 3 5 2. Typhus „ — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 3. Relapsing Fever — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 4. Malaria — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 5. Small Pox- (a) Vaccinated — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (b) Not Vaccinated — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (c) Doubtful — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 6. Measles 6 8 6 6 7 6 19 20 2 1 — — — — — — — — — — — — — — — — — — 21 21 42 7. Scarlet Fever — — — 1 1 3 1 4 1 1 — — — — — — — — — — — — — — — — — 3 5 8 8. Whooping Cough 8 7 5 7 — 11 13 25 — 1 — — — — — — — — — — — — — — — — — — 13 26 39 9. (a) Diphtheria 1 1 — 3 8 5 9 9 2 1 1 1 — — — — — — — — — — — — — — — — 12 11 23 (b) Croup — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 10. Influenza 1 — — — 1 — 2 — — — — — — — — 1 2 1 3 — 3 3 — 4 3 9 1 3 14 21 35 11. Miliary Fever — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 12. Asiatic Cholera — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 13. Cholera Nostras — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 14. Dysentery — — — — — — — — — — — — — — — 1 — 1 1 — — — — 1 — — — — 1 3 4 15. Plague — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 16. Yellow Fever — — — — — — — — — — — — — — — — — —:— — — — —:— — — — — — — — — — — 17. Leprosy — — — — — — — — — — — — — —:— — — — — — — — — — — — — — — — — — 18. Erysipelas — — — — — — — — — — — — — — — — — — — — — — 2 — — — 1 — 3 3 19. (a) Mumps — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (b) German Measles — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (c) Varicella — — — — — — — — — 1 — — — — — — — — — — — — — — — — — — 1 — 1 (d) Other Epidemic Diseases — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 20. (a) Pyæmia — — — — — — — — — — — — — — — — — — — — — 1 2 — — — — 4 2 6 (b) Septiæmia 1 — — — — 1 1 2 1 — — — — — 1 — 2 1 3 1 2 — 1 1 — — — — 5 10 15 (c) Vaccinia — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 21. Glanders — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 22. Anthrax (Splenic Fever) — — — — — — — — — — — — — — — — — — — 1 — — — — — — — — 1 — 1 23. Rabies — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 24. Tetanus — — — — — — — — — — — — — — — — — — 1 — — — — — — — — — — — 1 25. Mycoses — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 26. Pellagra — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 27. Beri-eri — — — — — — — — — — — — — — — — — — — _l — — — — — — — — — — 28. (a) Pulmonary Tuberculosis 1 3 — 1 1 2 7 1 2 3 4 16 30 20 51 29 51 29 43 12 36 11 16 4 2 — — — 200 105 305 (b) Phthisis (not defined as tuberculous — — — — — — — — — — — 1 3 2 2 1 3 4 4 3 3 2 3 3 — 1 — — 18 17 35 29. (a) Acute Phthisis — — — — — — — — — — — 1 — 1 — — 1 — — — — — — — — — — — 1 2 3 (b) Acute Miliary Tuberculosis — — — — — 1 — 1 — — — — 1 — 2 — — — — — — — — — — — — — 3 1 4 30. Tuberculous Meningitis 2 3 5 3 8 7 15 13 5 1 — 3 2 — 3 1 — 1 — — — 1 — — — — — — 25 20 45 31. (a) Tabes Mesenterica — 1 — — — — — 1 — — — — — — — — — — — — — — — — — — — — — 1 1 (b) Other peritoneal & intestinal tuber els — — — 1 4 1 4 2 2 3 1 1 1 1 — — — — — — — — — — — — — — 8 7 15 32. Tuberculosis of Spinal Column — — — — — — — — — — — 1 — — — — — — 1 — — — — — — — 1 — 1 2 3 33. Tuberculosis of Joints — — — — — — — — — — 1 1 — — — — — — — — — — — — — — — — 2 1 3 34. (a) Lupus — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (b) Scrofula — — — — — — — — — — — — — — — — — — — — — — — — — —•— — — — — — (c) Tuberculosis of other Organs — — — — — — — — — — — — — — 1 1 1 — — — — — — — — — 1 — 3 1 4 35. Disseminated Tuberculosis 1 — — 1 1 — 2 1 — — — — — 1 — — — — 1 — — — — — — — — — 3 2 5 36. Rickets, Softening of Bones — 4 3 1 1 1 3 5 — — — — — — — — — — — — — — — — — — — — 3 5 8 37. Syphilis 7 7 — 1 — — 7 8 — — — — — 1 — — — 1 1 2 — 1 1 — — — 11 11 22 38. Other Venereal Diseases — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 39. Cancer of the Buccal Cavity — — — — — — — — — — — — — — — — 3 — 1 — 4 — 7 — 2 1 — — 17 1 18 40. ,, Stomach, Liver, &c. — — — — — — — — — — — — 2 3 — 8 6 16 10 12 11 11 5 — — 50 34 84 41. ,, Peritoneum, Intestines, and Rectum — — — — — — — — — — — — — — — — 2 — 2 7 7 5 8 8 4 1 — — 28 21 44 42. „ Female Genital Organs — — — — — — — — — — — — — — — 1 — 1 — 8 1 12 — 9 — 3 — — 1 34 25 43; ,, Breast — — — — — — — — — — — — — — — 2 — 4 — 5 — 10 — 6 — 5 — 1 — 33 33 44. ,, Skin — — — — — — — — — — — — — — — 1 1 — — — — — 1 1 1 — — 2 2 4 45. Cancer of other or unspecified Organs — — — — — — — — — — — — — — 1 1 6 1 8 7 4 2 11 5 2 1 — — 32 17 49 46. Other Tumours (situation undefined) — — — — — — — — — — — — — — — — — 1 — 1 — — — — — — — — — 3 3 47. Rheumatic Fever — — — — — — — — — — — 2 1 — — 1 — — — — 1 1 — 1 — — — — 3 5 7 48. (a) Chronic Rheumatism — — — — — 1 — 1 — — — — — — — — — — — — — — — — — 1 — — — 2 2 (b) Osteo-Arthritis — — — — — — — — — — — — — — — — — — — 1 1 — 2 2 2 — — — 5 3 8 (c) Gout — — — — — — — — — — — — — — — — — — — — — — — — — — — — 2 — 2 49. Scurvy — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 62 Deaths Registered from all Causes for the Year, 1916—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 1. General Diseases-Con 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 50. Diabetes — — — — — — — — — — — — — 2 — — 1 — 2 5 3 4 4 2 1 — — 11 13 24 51. Exophthalmic Goitre — — — — — — — — — — — — — — — — — — — — — 1 — — — — — — — 2 2 52. Addison's Disease — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 53. Leucocytha3mia Lymph adenoma — — — — — — — — 1 — — — — — 1 — — — — — — — — — — — 2 — 2 54. Anæmia, Chlorosis — — 1 — — — 1 — — — 1 — — — — — —|— 1 1 — — 4 1 — — — — 4 5 9 55. (a) Diabetes insipidus — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (b) Purpura — — — — — — — — — — — — — 1 — — — — — 1 — — — — — — — — — 2 2 (c) Haemophilia — — — — — — — — — — — — — ——— — — — — — — — — — — — — — — — — — (d) Other General Diseases — — — — 1 — 1 — — — — — — — — — 1 — — — 1 — — — — — — — 3 — 3 56. Alcoholism (acute or chronic) — — — — — — — — — — — — — — — — 1 — 2 1 — — — — — — — — 3 1 4 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 — 3 1 — 2 2 3 5 1 — — 1 — — — 1 _ — — — — — — — — — — — 4 7 11 — — — — 1 — 1 — — — — — — — — — — — — — — — — — — — 1 1 (c) Meningitis, other forms 3 1 1 1 2 — 6 2 — — — — — — — 1 2 — — — — 1 — — 1 — — — 9 4 13 62. Locomotor Ataxy — — — — — — — — — — — — — — — — 2 1 2 3 — 1 — 2 — — — 10 1 11 63. (a) Anterior Poliomyelitis — — 1 — — — 1 — — — — — — — — 1 — — — — — — 2 2 2 l — — 6 6 12 (b) Other Diseases of the Spinal Cord — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 64. Cerebral Haemorrhage, Apoplexy 1 — — — — — 1 — — — — — — — — — 1 1 5 6 17 12 13 14 4 10 — 1 41 44 85 65. Softening of Brain — — — — — — — — — — — — — — — — — — 1 3 2 — 1 1 1 — 1 4 6 10 66. Paralysis without specified cause — — — — — — — — — — — — — — — — 1 — — 1 7 — — — 3 — 2 1 13 2 15 67. General Paralysis of the Insane — — — — — — — — — — — — — — — 1 6 10 4 2 — 1 1 — — — — 19 6 25 68. Other forms of Mental Alienation — — — — — — — — — — — — — — — — — 1 — 1 2 1 — — — — — — 2 3 5 69. Epilepsy — — — — — — — 1 — 1 — 2 — 3 — 1 1 2 2 2 1 — — — 1 — 14 3 17 70. Convulsions (Non-puerperal; 5 years and over) — _ _ — — — — — — — — — — — — — — — — — — — — _ — — _ — 71. Infantile Convulsions (under 5 years) 4 5 1 — — — 5 5 — — — — — — — — — — — — — — — — — — — — 5 5 10 72. Chorea — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 73. Hysteria, Neuralgia, Neuritis — — — — — — — — — — — — — 1 — — — 1 — 1 — 1 — — — — — — — 4 4 74. Other Diseases of the Nervous System — — — — — 1 — 1 — — — 2 — 1 1 — 1 — 2 2 — — —- — — — — — 4 6 10 75. Diseases of the Eyes and Annexa — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 76. (a) Mastoid Disease — — — — — — — — — — 1 — — — — — — 1 — — — 1 — — — — — — 1 2 3 (b) Other Diseases of the Ears — 1 — — 1 — 1 1 — — — — — — — — — — 1 — — — — — — — — — 2 1 3 3. Diseases of the Circulatory System. 77. Pericarditis i 1 1 — — — 2 1 1 — — — — — — — — — — — 1 — — — —- — — — 4 1 5 78. Acute Myocarditis and Endocarditis — — — — — 1 — 1 — — — 2 1 2 — 4 — 1 1 — 1 1 — 1 — 1 — — 3 13 16 79.(a) Valvular Disease. 1 — — — — 1 1 — — 1 1 3 4 4 8 10 15 15 13 15 23 1 1 7 10 2 1 75 72 47 (b) Fatty Degeneration of the Heart — — — — — — — — — — — — 1 — — 1 1 2 — 4 7 7 6 7 — 3 — 2 15 26 41 (c) Other Organic Disease of the Heart — — — — — — — — 1 1 — 2 — 1 1 4 6 6 15 6 l6 19 25 31 10 17 1 9 75 96 171 80. Angina Pectoris — — — — — — — — — — — — — — — — — — — — 1 — 1 — 1 — - — 3 — 3 81. (a) Aneurysm — — — — — — — — — — — — — — — — 2 — — - 4 — 1 — 1 — — 8 — 8 (b) Arterial Sclerosis — — — — — — —- — — — — — — — — — — 1 2 1 6 1 8 8 6 8 1 1 23 20 43 (c) Other Diseases of Arteries — — — — — — — — — — — — — — — — 1 1 1 — — — — — — — — 2 1 3 82. (a) Cerebral Embolism and Thrombosis — — — — — — — — — — — — 1 — — — — 1 — 5 4 2 5 10 2 4 — — 12 22 34 (b) Other Embolism and Thrombosis - - - - - - - - - - - - - - - — - - - 1 — 1 - - - - - - — 2 2 83. Diseases of the Veins Varices, Hæmorrhoids Phlebitis, etc.) - - - - - - - - - - - - - - - - - - - - - - - 1 - - - - - 1 1 84. (a) Status Lymphaticus. — 1 - - - - — 1 - - - - 1 - - - - - - - - - - - - - - - 1 1 2 (6) Other Diseases of the Lymphatic System - - - - - - - - - - - - - - - - - - - - - - - - - - - - - — 85. Hæmorrhage; other Diseases of the Circulatory System - - — - - - - - - - - - - - - - - - - - - - - - - - - - - - — 4. Diseases of the Respiratory System. 86. Diseases of the Nasal Fossae - - - - - - - - - 1 - - - - - - - - - - - - —: - - - - - 1 1 87. Diseases of the Larynx - - 1 - - 1 1 — 1 - - - - - — - - — - - - - - - - - 1 2 3 83. Diseases of the Thyroid Body - - — - - - — — — - - - - - - - - - - 1 — - - 1 — 1 - - 1 3 3 89. & 90. Bronchitis 9 8 2 1 4 — 15 9 1 - - - - - 2 1 5 3 19 9 17 23 52 34 30 50 7 13 148 142 290 91. Broncho-Pneumonia 19 21 9 15 8 6 36 42 1 - - - - - - - 3 2 2 3 4 2 4 5 2 2 - - 52 56 108 92. (a) Lobar Pneumonia 1 3 2 1 - 5 3 9 9 1 - - - 2 2 2 4 2 3 3 1 8 4 1 1 1 - - 20 29 49 (b) Pneumonia (type not stated) 2 4 2 4 2 1 6 9 2 - 1 — 1 1 5 1 7 2 5 3 9 — 11 6 - 5 1 - 48 27 75 93. Pleurisy — — 1 — — 1 1 1 — — — — l — 1 1 1 — 2 1 — — 2 1 — 1 — — 8 5 13 63 Deaths Registered from All Causes for the Year, 1916—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 83 and upwards Totals. 4. Diseases of the Respiratory System— con. 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 94. Pulmonary Congestion. Pulmonary Apoplexy — - - — - — — — — — - — - — 1 — - — 3 — 1 2 2 1 — — - 1 7 4 11 95. Gangrene of the Lung — - - - - - - - - - - - - - - - - - 1 — - - - - - - - - 1 — 1 96. Asthma — - - — - — — — — — — — — 1 - 1 - - 1 - - 2 1 — — - - 4 2 6 97. Pulmonary Emphysema — - - — — - - - - - - - - - - - - - 1 — - - 1 — — - - - 2 — 2 98. (a) Fibroid Disease of the Lung — — - - - - - - - - - - - - - - - — 1 — 1 1 — — — — - - 2 1 3 (b) Other Diseases of the Respiratory System 1 - - - - — 1 - - - - - - - 1 - - - - - - - 1 — — - - — - — 3 5. Diseases of the Digestive System 99. (a) Diseases of the Teeth and Gums — — - — - — — — — — - — — — - - — — — — - — — — — - - — — — — (b) Other Diseases of the Mouth and Annexa 1 - - - - - 1 - - - - - - - - - - — — - - - - 1 1 100. Diseases of Pharynx, Tonsillitis — — — — - — — — — — — — - — — - — — — — :— — — — - - - — — — 101. Diseases of (Esophagus - 1 - — - — — 1 — — — — - — - - - - - - - - - - - - - - - 1 1 102. Perforating Ulcer of Stomach — - - - - - - - - 1 — — - — — — 2 — 2 3 3 - 2 1 — 1 - — 9 6 15 103. (a) Inflammation of Stomach — 2 - — - - — 2 — — — — - — — — — 1 — 1 - 2 — 1 3 2 1 3 10 13 (b) Other Diseases of Stomach — —- — - - — — — — - - - — — - — — — 1 - — - — 1 — - — 1 1 2 104 & 105. (a) Infective Enteritis 5 3 - 1 - 1 5 5 1 — — - - - — — — — — — - - — — - - - - 6 5 11 (b) Diarrhœa (not returned as infective) 4 2 - - - - 5 2 - 1 - - - - - - - - - - - - - 1 - 1 - - 5 5 10 (c) Enteritis (not returned as infective) 3 5 1 3 - - 4 8 1 1 - - - - - - - 1 - 2 - 2 - 1 1 1 - - 6 16 22 (d) Gastro-Enteritis (not returned as infective) 14 5 2 4 — 18 9 - 1 - - - - - - - - - - - - - - - - - 1 18 11 29 (e) Dyspepsia (under 2 years of age - - - - - - - - - - — — - — — — — — - — - - - - — - - - - - - (f ) Colic - — - - - - - — - — — - - — — — - - — - - - - - - - — - - - (g) Ulceration of Intestines - — - - - - - — - — — — - 1 — — — - — — - 1 — — - — - - - 2 2 (h) Duodenal Ulcer - — - - - - - - - — — — - - - — 3 — 1 1 1 - - — - - - - 5 1 6 106. Ankylostomiasis - - - - - - - — - — — — - — — - — - - - - - - - - - - - - - - 107. Other Intestinal Parasites - - - - - - - - - — — — - - — — — - — — - — - — — - - - - — — 108. Appendicitis - - — — - - — - - — 2 1 1 1 — 2 - - — 1 - — — — — - - — 3 5 8 109. (a) Hernia - - - — - - - - - - - - - - - — — — 2 1 2 — 3 1 - - - 3 1 9 (b) Intestinal Obstruction 2 1 - - 1 - 3 1 - — 1 1 — — 1 1 1 — 1 - - 1 2 - - - — 7 7 14 110. Other Diseases of the Intestines 1 - - — - - 1 - - — — — - — — — - - — - - — - — — - - — 1 — 1 111. Acute Yellow Atrophy of Liver - - - - 1 - 1 - - — — — - - — — - - — — - — - — — - - - 1 — 1 112. Hydatid of Liver - - — - - - - - - — — — - — — - - — — - — - — — - - — — — — 113. (a) Cirrhosis of the Liver (not returned a3 alcoholic) - - - - - - - - - - - - - 1 1 1 - 1 5 6 11 2 5 3 - 2 - - 2 16 38 (b) Cirrhosis of the Liver (returned as alcoholic) - - - - - - - - - - - _ - - - - 1 - - - - - - - - - - - 1 - 1 (c) Diseases formerly classed to “Other Diseases of Liver and Gall Bladder” - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 114. Biliary Calculi - - - - - - - - - — — — - - — - — - — — - - - — — - - — - - - 115. Other Diseases of the Liver - - - - - - - — - — - - - — — 1 — - — 1 - 1 2 1 1 - - — 3 4 7 116. Diseases of the Spleen - - - - - - - - - - - - - — — — — — — — - - - - — - - — - - - 117. Peritonitis (cause unstated) - - - - — - - - - - - - - - - - - 1 - - - - - 1 — - - - - 2 2 118. Other Diseases of the Digestive System . - - - - - - - - - - — — - - — — — — — — - - — — - - - — — - - 6. Non-Venereal Diseases of the Genito—Urinary System and Annexa. 119. Acute Nephritis - - - - - - - - 1 - - 1 - 1 _ 1 2 2 3 1 3 1 4 - 1 - - 7 14 21 120. Rright's Disease - 1 - - - 1 1 1 - - - - 4 1 2 2 3 3 7 4 11 8 17 8 7 2 1 - 53 29 82 121. Chyluria - - - - - - - - - - - - - - - - — - - — - - - - - - - - - - - 122. Other Diseases of the Kidney and Annex — - - - - - - - - — - - - - - - 1 1 - - - - 1 1 - - 2 2 4 123. Calculi of the Urinary Passages - - - - - - - - - - - - - — — - - - - - - - - - - 1 - - - 1 1 124. Diseases of the Bladder - - - - - - - - - — - — - — — — — — — — 2 - 2 - 4 - - - 8 - 8 125. Diseases of the Urethra, Urinary Abscess &c. .- - - - - - - - - - - - - - - - - - - - 2 — - - - - - - - - 2 126. Diseases of the Prostate - - - - - - - - - — - - - — - — - - - — - 3 - 1 - - — 4 — 4 127. Non-Venereal Diseases of Male Genital Organs . - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 128. Uterine Hæmorrhage (Non-puerperal) - - - - - - - - - - - - - - - 1 - - - - - - - - - - - - - 1 1 129. Uterine Tumour (Non-cancerous) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 130. Other Diseases of the Uterus - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 131. Ovarian cyst, Tumour (Non-Cancerous) - - - - - - - - - - - - - - - - - 1 - - l - - - - - - - 2 2 132. Other Diseases of the Female Genital Organs - - - - - - - - - - - - - - - - - 1 - - - - - - - - - - - 1 1 133. Non-puerperal Diseases of the Breast (Non-cancerous) - - - - - - - - - - - - - - - - - - — — - - - - - - - - - - - 64 Deaths Registered from all Causes for the Year, 1916— 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. 7. The Puerperal State. 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 134. Accidents of Pregnancy - - - — — — — - — - - — - - — 3 - - - - - - — — - - - - — 3 3 135. Puerperal Hæmorrhage - - - — — — — - — - - — - 1 — - - - - - - - — — - - - - - 1 1 136. Other Accidents of Childbirth - - — — — — — - — - - — - 1 — 1 - - - - - - — — - - - - - 2 2 137. Puerperal Fever - - — — — - - - — - - — - 1 — 1 - 2 - - - - — — - - - - - 4 4 138. Albuminuria and Convulsions - - — — -— — — - — - - — - 1 — 1 - 1 - - - - — — - - - - — 3 3 139. ,, Phlegmasia Alba Do-lens, Embolism and sudden death - - - - - — — - — - - — - - — - - - - - - - — — - - - - — — — 140. „ Insanity - - — — - - - - - - - — - - — - - - - - - - — - - - - - - — — 141. ,, Diseases of the Breast - - - - - - - - - - - — - - — - - - - - - - — - - - - - - - - 8. Diseases of the Shin and of the Cellular Tissue 142. (a) Senile Gangrene - - - - - - — - — - — - - - 1 - - — — - 2 - 1 — 3 2 - 6 2 8 (b) Gangrene (other types) - - - - - - - - - - — — - - — - - - - 1 1 - — — - - - - 1 1 2 143. Carbuncle, Boil - - - 1 - 1 — 2 - - — — - - — - - — - - — - — — 1 - - - 1 2 3 144. Phlegmon, Acute Abscess - - 1 — - — 1 — - - - — _ - — - - - - - - - — — - - - - 1 — 1 145. Diseases of the Integumentary System - - - - - - 1 — - - - — - - — - - — - - - - - — - - — - 2 — 2 9. Diseases of the Bones and of the Organs of Locomotion. 146, Diseases of the Bones - - - - - - - - - - - - - - 1 - - - - - - - - - - 1 - 1 147. Diseases of the Joints - - - - - -_- - - - - - - - - - - - - _ - - - - - - - _ - 1 1 148. Amputations - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 149. Other Diseases of Locomotor System - - - - - - - - - - - - - - - - - - - — - - - - - - — - 10. Malformations. 1 150. Congenital Malformations 17 17 - - - - 17 17 — - - 1 2 - - - - — — - - - - - - - - - 19 18 37 11. Diseases of Early Infancy. 151. (a) Premature Birth 40 35 - - - - 40 35 - - - - - - - - - - - - - - — — — - - 40 35 75 (b) Infantile Debility, Icterus, and Sclerema 28 21 3 — - - 26 21 - - - - - - - - - - - - - - - - - - - - 26 21 47 152. Other Diseases peculiar to early Infancy 9 5 - - - - 9 - - - — - - — - - - - - - - - - - - - 9 5 14 153. Lack of Care 1 2 _ - - - 1 2 — - - - - - - — - - - - - - - - - - 1 2 8 12. Old Age. : 154. (a) Senile Dementia - - - — - - - - - - - - - - - - - - - - - 1 1 2 - 3 1 - 2 6 8 (b) Senile Decay - - - - - - - - - - - - - - - - - - - — - - 15 25 27 42 15 18 59 85 144 13. Affections Produced by External Causes. 155 to 163. Suicides - — — - - - - - - - - — - - - 1 2 2 2 — 2 1 2 1 - - - 8 5 13 164. Poisoning by Food - - - - - - - - - - - - - - — - - - - - - — - — - — — - - — - 165. Other Acute Poisonings - - 1 _ - - 1 - - - - - - - . - - - - - - - - — - - - - 1 — 1 166. Conflagration - - - - - - - - - - - - - - - - - - - - — - - - - - - - - — — 167. Burns (Conflagration excepted) - 1 1 - - 5 1 6 2 1 1 - 1 - - - - 1 - - - - - 1 - - - 5 9 14 168. Absorption of Deleterious Gases (Conflagration excepted) 2 7 - - - 1 2 8 - - - - - - 1 - - - - - 1 - - - - - - - 4 8 12 169. Accidental Drowning - - - - - - - - - - -—- - - - - - - - 1 — 3 - - - - - 4 - 4 170 to 176. Injuries 1 - 1 2 1 4 1 6 — 4 1 3 1 4 1 3 - 6 3 5 6 4 3 4 1 - 3 43 20 63 177. Starvation - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 178. Excessive Cold - - - - - - - - - — - - - — — - - - - - _ — - - - - - - - — — 179.Effects of Heat - - - - - - - - - - - - - - - - - — - - - - - - - - - - - - - 180. Lightning - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 181. Electricity (Lightning excepted) - - - - - -:- - - - - - - - - - - - - - — - - - - - - - - - — — 182 to 184 Homicide - - - - 2 - 2 - - - - - - — - - - — - - - - - - - - — - 2 — 2 185. Fractures (cause not specified) - - - - - 1 - 1 - - - - - — - - - - - - - - - - - — - - - 1 1 186. (a) Other Violence - - - - - - - - - - - - - — - - - - - - 1 — - - - - - - 1 — 1 (b)„ „ through Hostile Aircraft - - - - - - - - - - - - - - - - - - - - - — - 1 - - — - - 1 1 14.. Ill-defined Causes. : 5 187. Dropsy - - - - - - - - - - — - - — - - - - - — - - — - - - — - - — — 188. (a) Syncope (aged 1 year and under 70) - - - - - - - - - - - - - — — - - - - - - - — - - - — - - - — (b) Sudden death (not otherwise defined - - - - - - - - - - - - - — - - - - - - — - - - - - - — — 189. (a) Heart Failure (aged 1 year and under 70) - - - - - - - - - - - - - - - 1 1 - - - 2 - _ - - - - 3 1 4 (b) Atrophy, Debility, Marasmus (aged 1 year and under 70) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - (c) Teething - - - - - - - - - - - - - - - - - - - — - - - - - - - - - - - (d) Pyrexia - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - (e) Other ill-defined Deaths - - - - - - - - - - - - - - - - - - - - - - - - - - - - — (f) Cause not specified - - - - - - - - - - - - - - - - - 1 - - - - - - - - - 1 - 1 65 Table No. 3. Summary of Ages. 0 to 1 1 to 2 2 to 5 Total under 5 yearn. 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 63 48 70 181 27 24 50 75 129 139 153 127 60 6 971 Diseases of the Nervous System and of the Organs of Special Sense 18 5 9 32 2 5 4 8 22 39 56 36 25 6 235 Diseases of the Circulatory System 4 1 1 6 6 5 11 18 39 67 99 138 70 17 476 Diseases of the Respiratory System 68 89 27 134 9 1 5 18 30 58 69 129 93 22 568 Diseases of the Digestive System 49 11 6 66 6 5 4 6 12 28 26 24 14 2 193 Non-Venereal Diseases of the Genito-Urinary System and Annexa 1 - 1 2 1 1 5 6 11 18 28 35 18 1 126 The Puerpsral State — - _ 4 6 3 - 13 Diseases of the Skin and of the Cellular Tissue 1 2 1 4 - - - - - 1 3 1 7 - 16 Diseases of the Bones and of the Organs of Locomotion - - - - - - - - - - - - 2 Malformations 34 34 1 2 - - - - - - - 37 Diseases of Early Infancy 136 3 - 139 - - - 139 Old Age — — - - __ 3 43 72 34 152 Affections produced byExternal Causes 11 3 12 26 9 6 4 8 7 13 19 11 6 3 112 Ill-defined Causes - — — — — — — 1 1 1 2 - - - 5 Totals 385 112 127 621 60 48 89 147 254 364 459 544 365 91 3045 66 Table No. 4. METEOROLOGICAL TABLE FOR SAINT PANCRAS, 1916. (.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., ll.d. January. February. March. April. May. June. July. August. September. October. November. December. Barometer. Mean Pressure at 32° F. at Station Level* (Bar 123 ft. above M.S.L.) 30 063 29-638 29-533 29-776 29-803 29-80 29-917 29-809 29-914 29-749 29-761 29-506 Aii- Temperature. Mean of Maximum A. 50.8 45.7 46.1 59.7 67.7 65.0 72.1 74.4 66.1 60.2 50.1 41.9 Minimum B. 40.7 34.9 35.0 39.8 47.5 47.9 53.0 55.7 49.8 47.3 39.1 32.8 Mean of A. and B 45.8 40.3 40.6 49.8 57.6 56.5 62.6 65.1 58.0 53.8 44.6 37.4 Difference from Average† + 7.4 +0.3 -2.1 +l.6 +3.1 —4.4 —1.5 +1.9 —0.4 +3.2 +0.6 -2.4 Humidity—Morning 88% 86% 86% 71% 68% 69% 74% 72% 81% 83% 90% 94% Earth Temperature at 4 ft. depth 45.1 44.1 41.7 43.8 49.3 53.0 55.5 59.1 57.0 54.2 50.0 '45.3 Bright Sunshine. Total Observed (Daily mean) Hours 1.06 2.24 1.65 6.03 5.03 4.63 4.74 4.71 3.17 2.58 1.63 0.14 Per cent, of total possible 13 23 14 44 33 28 30 33 25 25 19 3 Difference from Average† Hours — — - — — — — — — — — — Rain and other forms of Precipitation. Number of Days 14 21 22 15 13 16 13 16 13 23 12 18 Total Fall Inches 1.3 3.4 4.6 1.3 1.8 2.1 1.6 5.5 1.4 3.2 4.6 2.5 Difference from Average † ,, —0-47 +1.73 +2.99 —0.47 +0.12 -0.08 -0.87 + 3.19 —0.47 +0.63 +2.32 +0.35 * 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, 67 Table No. 5. lnspeetiont and lie-inspections made by District Inspectors and factory and Workshop (MaIf) Inspector during the year 1916. DUTIES AND PREMISES. Inspections. Re-inspections alter intimations. DISTRICT INSPECTORS. Infectious Diseases—Inquiry, removal, disinfection, etc. (1)1421 (4) 168 Subsequent sanitary inspection, etc. (2) 718 826 Complaints (3) 1651 4677 Drainage—Under notice. Plans, supervision, etc. 94 1861 Voluntary 878 1798 New Buildings 157 763 Yards of Mews and Stables 2683 28 House-to-House Inspections — Housing, Town Planning, etc., Act, 1909: 17 (1). First Inspections . 4 848 Subsequent routine Inspections 1038 1105 Inspections of registered tenement houses other than above 267 868 Other house-to house Inspections — S Visits to closed underground rooms 188 66 Smoke Shafts observed .. 57 12 Regulated Trades. Offensive Trades — — Rag and Bone dealers — — Other effluvia businesses — — Inspections of Market Streets — — Other Duties 68 1 Totals 9224 13026 FACTORY & WORKSHOP (MALE) INSPECTOR. Factories (including Factory Laundries) 320 351 Laundries 44 4 Bakehouses (Factories and Workshops) 3e4 271 Restaurant Kitchens 229 77 Other Workshops 640 36s Other Workplaces 47 S3 Other Duties — — Totals !644 1121 (1) Including 80 by temporary woman inspector. (2),, 50 ,, ,, ,, (3) „ 1,, ,, ,, (4) ,, 1 ,, ,, ,, 68 ble no. 6. Inspections and Re-Inspections and other work of the Food Inspectors during 1916. DUTIES AND PREMISES. Visits and Inspections. Re-Inspections after Intimation Notices, Mr. Auger. Mr. Child, Totals. Mr. Auger. Mr. Child. Totals. Milkshops 131 450 58l 1 - 1 Dairies 196 23 219 - - - Cowsheds.. 5 59 64 Other Premises of Milk Purveyors - 7 7 Margarine Factories — - - - - - Butter Factories — __ Ice Cream Premises 23 122 145 Slaughter Houses 9 217 226 Premises where Prepared Meats are made (sausages, pies, tripe, cooked meat, &c.) 16 215 231 - - - Butchers' Shops 10 314 324 Fishmongers' Shops 56 115 171 - tried Fish Shops and Fish Curer's premises 49 157 206 Marketing Places 1708 1376 3084 Other Premises where Food or Drugs are sold 2 2 - Other Visits 45 l61 161 — — — Total 2250 3171 5421 1 — 1 SAMPLES, &c., TAKEN. Formal Sa mples Infor mal Samples No, of Milk samples „ Cream samples 179 137 300 — - - ,, Butter and Margarine samples — 3 3 — - - ,, Other samples (specified below)— 100 96 196 — 2 2 Lard - - - - - - Coffee 4 19 23 — — — Self Raising Flour 16 15 31 — — — Oatmeal 5 5 10 — — — Camphorated Oil - 1 1 — — — Arrowroot 6 - 6 — — — Mustard - 3 3 - - — Brawn 10 9 19 — — — Flowers of Sulphur 2 - 2 - - — Olive Oil - 1 1 - — — Pepper 5 — 5 — — — Jam 11 8 19 — — — Cocoa — 4 4 — — — Cod Iiver Oil 13 8 21 — — — Fish Paste 5 — 5 — — — Garlic Sausages 3 — 3 — — — Baking Powder 1 — 1 — — — Egg Powder 11 4 10 4 21 8 — — - Total 375 373 748 - 2 2 UNSOUND FOOD. No, of surrenders and seizures : surr end! red Sei zed Meat, &c. I 4 5 - 1 1 Fish 6 1 7 - - Other Foods (specified below) Fruit 3 2 5 - - - Eggs - 11 11 - - - Cream (Tins of) - - 1 - - - Greens 1 - 2 - - - Liver and Garlic Sausages , 1 — 1 — — — Total 12 20 32 — 1 1 Inspections of Registered Canal Boats 21 — 21 — — — 69 Table No. 7. Visits, etc., made by Women Inspectors during 1916. DUTIES, First Visits. Re-Visits. Miss Bibby, Miss Smith Miss Giles. * Aliss Payne. Whole Borough. Miss Bibby. Miss Smith. Miss Giles. * Miss Payne. Whole Borough. Births visited — 268 118 — 386 — 224 48 — 272 Other visits re births where admission not obtained — 219 19 — 238 — — 3 — 3 Visits re verminous persons — 37 — 13 50 — 5 — 5 10 Other „ where admission not obtained - - - - - - - - - - Visits re Ophthalmia Neonatorum — 36 1 — 37 — 57 3 — 60 Visits re Puerperal Fever — 18 1 — 19 — 4 1 — 5 Visits re other cases of illness, &c. 729 928 1150 11 2818 — 176 47 — 223 Visits re Tuberculosis notifications 5 — 381 — 386 — — 122 — 122 Other „ „ where admission not obtained 4 23 83 — 110 — — 7 — 7 For other purposes ,, ,, ,, ,, — 50 61 5 116 — — 9 3 12 Visits to Hospitals and other voluntary institutions 244 400 94 — 738 — — — — — Factories 2 — — — 2 - - - - - Domestic Workshops - - - - - - - - - - Home W orkplaces 6 — — — 6 - - - - - Laundries - - - - - - - - - - Restaurant Kitchens - - - - - - - - - - Other Workshops 1 - - - 1 - - - - - Other Workplaces 2 - - - - - - - - - Other Visits, Inspections and Committees. 225 61 220 — 506 — 1 — — 1 Total 1218 2040 2128 29 5415 - 467 240 8 715 * Miss Payne also carried out 133 District Inspections (sse Table 5, on page 67). 70 Tadi.e No. 8. Total Number of Inspections and Re-inspections made by individual Inspectors during the year 1916. Inspector. Inspections. Re-inspections. Total. 1. Mr. Raekham 865 1876 2741 2. ,, Brown 1428 2369 3797 3 „ 'Thompson — — — ,, *Pottier (Temporary Inspector) — — — 4. „ *Dillon — — — ,, Auger (District Inspections) 320 491 811 5. „ *James — — — 6. ,, Akers 2102 866 2968 7. ,, *Lonnon — — — 8. „ *Adkins — — — 9. „ Holmes 1161 2075 3236 10. „ Walker 1251 2889 4140 11. „ Landen 1749 2334 4083 12. „ West (Factories & Workshops) 1861 1246 3107 13. " Auger Food and 2658 1 2659 14. „ Child Foocl Premises 3567 — 3567 15. Miss Bibby 1218 — 1218 16. „ Smith 2040 467 2507 17. „ Giles 2128 240 2368 18. „ Payne 160 9 169 Totals 22508 14863 37371 * Away 011 Active Service during whole of 1916. 71 Table No. 9. Intimations as to Nuisances and Breaches of statutes and By-laws served by the Sanitary Inspectors during 1916. Schedule of Nuisances. Whole Borough. 1 Part of the house in a dirty condition 301 2 ,, damp ,, 101 3 Roof defective 487 4 Guttering-defective 64 5 Water fittings defective 136 6 Water-closet apartment with absence of external ventilation 19 7 , ,, so foul as to be a nuisance or dangerous to health 14 8 Water-closet basin foul 64 9 ,, ,, defective 59 10 ,, ,, choked 110 11 Urinal in a foul condition 2 12 Privy in a foul condition 1 13 Soil pipe defective 25 14 ,, unventilated 9 15 ,, improperly ventilated 3 16 Absence of waste pipe to sink, lavatory or bath 3 17 Waste pipe of sink, lavatory, or bath connected with drain 3 18 ,, ,, ,, ,, defective 32 19 ,, ,, ,, ,, foul 17 20 Inlet of drain improperly trapped 8 21 Drain defective 121 22 ,, stopped 93 23 ,, ventilating pipe defective 32 24 Rain-water pipe in direct communication with drain 15 25 ,, ,, defective 84 26 Unpaved condition of roadway — 27 Undrained ,, ,, — 28 Area or part unpaved 2 29 ,, undrained 1 30 Yard or space unpaved 5 31 ,, ,, undrained 7 32 Defective condition of washhouse paving 33 33 Dust-bin defective 114 34 ,, in an improper position 1 35 Accumulation of stagnant water which is a nuisance dangerous to health 19 36 Accumulation or deposit which is a nuisance dangerous to health 131 37 Animals kept in such a manner as to be a nuisance dangerous to health 14 38 Part of the house so overcrowded as to be dangerous to health 37 39 Space below floor in basement or ground floor insufficiently ventilated 6 40 Issuing of black smoke in such a quantity -is to be a nuisance 3 41 Discharging smoke in such a manner as to cause part of a building to be a nuisance dangerous to health 1 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 132 Total 2309 Table No. 10. Registered Tenement Houses—Breaches of By-Laws. Whole Borough. 1 Overcrowding 2 2 Inadequate water supply — 3 Contaminated water supply - 4 Foul closet, basin or trap 15 5 Want of means of ventilation — 6 Want of annual cleansing 15 7 Want of cleansing of the part or parts of premises used in common 167 8 ,, ,, ,, in sole use 213 9 Want of cleansing of the room or part of tae dwelling 12 10 Animals improperly kept 1 11 Other breaches — Total 425 72 Table No. 11. Factories, Workshops and Work Places—Breaches of Statutes. Whole Borough, 1 Want of cleanliness 71 2 Want of ventilation 1 3 Want of air space, overcrowding 4 Sanitary accommodation, absent or insufficient 8 5 ,, ,, unsuitable or defective 222 6 ,, ,, not separate for sexes 10 7 Want of drainage of floors — 8 Other nuisances 53 9 Illegal occupation of underground bakehouse 10 Breach of speoial sanitary requirements for bakehouses 132 11 failure as regards list of outworkers — 12 Giving out work to be done in premises which are unwholesome — 13 I, . ii ii infected — 14 Allowing wearing apparel to be made in premises infected by scarlet fever or small-pox __ 15 Other contraventions Total 497 Table No. 12. Breaches of other Statutes and Statutory By-laws. Whole Borough. 1a An occupied house without a proper and sufficient supply of water(1907 Act, Sec.78) - 1b ,, ,, ,, ,, (other than above) 13 2 Water supply used for domestic purposes connected with cistern which is used for flushing the water-closet - 3 Water-closet not supplied with a sufficient quantity of water for securing its effective action 132 4 Tank, cistern, or other receptacle for storing of water used or likely to be used by man for drinking purposes—dirty condition of 12 5 Tank, cistern, or other receptacle for storing water used or likely to be used by man for drinking purposes—absence of a proper cover to 13 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 — 8 Offensive matters not deposited in manure receptacle 3 9 Manure not removed at proper intervals 14 10 Manure—absence of proper receptacle for 6 11 Manure receptacle not properly constructed — 12 Sufficient drain to stables or cowshed—absence of a 13 Receptacle for house refuse—absence of a proper 146 14 Receptacle for house refuse—absence of a proper cover for 7 15 Yard or open space unpaved 4 16 ,, paving defective 64 17 Insufficient water-closet accommodation to "lodging house" 25 18 A furnace improperly constructed or negligently used — 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 2 22 Slaughterhouses—breach of By-laws as to 1 23 Steam whistle—use of a, without authority 1 24 Parts of houses infested with vermin requiring stripping, purifying, and cleansing 128 25 Articles in an unwholesome condition requiring to be purified or destroyed — 26 Underground room illegally occupied as a dwelling 9 27 Other breaches 36 Total 616