STPAN 7 Metropolitan Borough of St. Pancras. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1918. T. SHADICK HIGGINS, M.D., B.Sc., Load., D.P.H. Cantab. 9 CONTENTS. page Public Health Committee 6 Introduction 7 Part I.—General Statistics — Population 9 Marriages 9 Births 10 Illegitimacy 10 Notification of Births 10 Deaths 11 Infantile Mortality 13 Infectious Diseases 15 Part II—Adminstration and Special Subjects— Maternity and Child Welfare 18 Maternity and Child Welfare Sub-Committee 18 Infant and Maternity Consultations 19 Midwifery 19 and 24 Hospital Facilities for Children under School Ago 20 Advice Cards 20 Home Visiting 20 Maternity and Infant Welfare Centres 21 Clinic for Sick Mothers and Children under School Age 23 Dental Clinic for Mothers and Children under School Age 23 Supply of Milk to Necessitous Mothers and Children under School Age 24 Work by Voluntary Agencies in Connection with Mothers and Young Children not paid for by the Borough Council (Home Helps, Home Nursing, Day Nurseries, Hospital Accommodation.) 25 Government Grants 26 Infantile Diarrhoea 27 Opthalmia Neonatorum 27 Puerperal Fever 28 Tuberculosis 28 Work Done 32 Treatment of Tuberculosis 32 4 CONTENTS — continued. page. Scarlet Fever 33 Diphtheria 34 After-care of Diphtheria and Scarlet Fever 35 Typhoid Fever 35 Anterior Poliomyelitis 36 Epidemic Cerebrospinal Meningitis 36 Encephalitis Lethargica 37 Measles and German Measles 37 Anthrax 39 Other Notifiable Infectious Diseases 39 Influenza 39 Cinematograph Theatres 44 Whooping Cough 44 Diarrhœa and Enteritis 45 Syphilis 45 Cancer 45 Dwelling Houses 46 Inspection of Dwelling Houses 46 Underground Rooms 46 Houses Unfit for Habitation 46 Inhabited House Duty 47 Canal Boats Acts 47 Factories, Workshops and Workplaces, Bakehouses, Restaurant Kitchens, Laundries 47 Inspection of Food and Food Places 51 Sale of Food and Drugs Acts 51 Summonses 52 Public Health ( Milk and Cream ) Regulations 1912 53 Inspection of Food 53 Dairies, Cowsheds and Milkshops 53 Ice-Cream Premises 53 Fried Fish and Fish Curing Premises 54 Other Food Premises 54 Slaughter-Houses 54 Rag Flock Act, 1911 54 General Sanitary Work 54 Inspections 54 5 CONTENTS—continued. Page. Intimation Notices 55 Summonses 55 Smoke Prevention 56 Regulated Trades 56 Constructional Drain Work 56 Drainage Register 57 Water Service 57 Disinfecting and Cleansing Station 57 Disinfection 57 Cleansing Station 58 Public Mortuaries and Coroner's Court 59 Bacteriolgical Examinations 59 Staff 59 Administration of Food Controller's Orders 60 Appendix : — Table No. 1.—Vital Statistics of the whole District for 1918 and previous years required by the Local Government Board 64 Table No. 2.—Showing Registered Deaths classified for Causes, Age and Sex 65 Table No. 3.—Summary of Above 69 Table No. 4.—Meteorology 70 Table No. 5.—Showing Inspections made by District Inspectors, Temporary Women Inspectors and Workshop Male Inspector 71 Table No. 6.—Showing Inspections and other work of the Food Inspectors 72 Table No. 7.—Showing Visits &c., made by Women Inspectors 74 Table No. 8.—Showing Inspections and Re-Inspections made by Individual Inspectors 75 Tables Nos. 9, 10, 11 and 12.—Showing details of Intimation Notices Served 76 6 St. Pancras Borough Council. PUBLIC HEALTH COMMITTEE, 1918. CHAIRMAN. Councillor Abraham Davis (Ward 7). DEPUTY-CHAIRMAN. Councillor Arthur Escoit (Ward 1). EX-OFFICIO. The Right Worshipful the Miyor. (Alderman C. Williams J.P.) ALDERMEN. Bryan, James Thomas. Davies, David, J.P., L.C.C. Tapping, Dan. COUNCILLORS. Ward 6 Bayly, Christopher Hodgson. 5 Blount, George. 3 Bolsom, Sidney. 2 Brown, Henry Joseph, J.P. 1 Carrington, Thomas. 1 Coggan, Cornish Arthur. 3 Cooke, Joseph John. 2 Cosburn, George Frederick, J.P. 2 Gardner, George. 8 Hensman, William. 4 Lloyd-Taylor, William, J.P. 5 Mayes, Henry Arthur. 8 Newton, William. 3 Rolles, Harry. 5 Saunders, James. 1 Shearing, Arthur George. 7 Swift, James Mansell. 7 Wood, William Charles. 7 Public Health Department, Town Hall, Pancras Road, N.W. 1. July, 1919. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of St. Pancras. Ladies and Gentlemen, I have the honour to present to you the Sixty-third 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 Public Health Department. This is the sixth annual report which it has been ray duty to submit. The abridgement which has been made in the report in recent years with a view to economy has been continued. The year has been marked by a continued fall in the birth-rate, and an unusual increase in the death-rate as a result of the outbreak of influenza in the latter half of the year. The effect of these two factors has been that for the first time within record the deaths for the year have actually exceeded in number the births, the excess of deaths being roughly 600. The factors which increased the deaths and diminished the births may both be considered to be of a temporary character, though this is more uncertain in the case of the births. The fact that there is a cessation of the natural increase in population which has always obtained is an additional reason for pressing forward all measures making for improved public health, whether amongst children or adults. The particulars as to the decreased birth-rate and the mortality from influenza will be found in the body of this report. Apart from the influenza deaths the mortality rates were not exceptionally high, when the long continued war conditions are taken into consideration. It may be said that the influenza epidemic constituted the only exception to the statement that was made in last year's report that the civilian mortality had not seriously increased during the war. The most important step taken during the year in connection with public health administration was the assumption by the Borough Council of a large part of the cost of the Maternity and Child Welfare work done at and in connection with the voluntary centres. This has previously been borne by the voluntary funds, with the help of Government grants. The Council now pay the salaries and fees of the medical officers and trained workers at the centres, as well as the rental of their premises. There was also started during the year a Municipal Dental Clinic in connection with Maternity and Child Welfare. In addition, new responsibility has been assumed by the Council in regard to midwifery, hospital accommodation for young children, and the supply of milk in cases of necessity to mothers and young children. Details of this new work will be found in the report. 8 In regard to housing matters there is the formation of the Special (Housing) Committee towards the end of 1918 to be recorded. Their work, however, belongs to 1919. I have once more to express my appreciation of the manner in which the staff of the department have carried on the work amidst the difficulties caused by war conditions. I would also like to offer my thanks to your Public Health Committee for the support they have given me ; and to your Council for the personal consideration they have always shown me. I am, Ladies and Gentlemen, Your obedient Servant, Medical Officer of Health. Metropolitan Borough of St. Pancras. R E P O R T of the MEDICAL OFFICER OF HEALTH For the Year 1918. Part I —GENERAL STATISTICS. For the purposes of this Report the year 1918 consists of the 52 weeks ended 28th December, 1918. POPULATION. Considerable changes in the population have taken place in this and other districts owing to the War, from the circumstance that large numbers of men of military age have been called to the Colours, and other movements of population occurred in connection with the manufacture of munitions, &c. It has, therefore, not been possible to continue to use the previous methods of calculating the population based on the 1911 Census. The Registrar-General, however, has adopted an estimate of the population based on various sources of information, and this for the middle of 1918 is 175,716 for the civilian population, exclusive of soldiers and sailors whether serving at home or abroad, and 196,883 for the total population, including all noncivilian males from the borough. The former (civilian population) is used in calculating the death rates, because the deaths among the non-civilian males are not recorded in the local returns; while the latter rate (total population), which includes all the elements of the population contributing to the birth and marriage rates, is used in calculating the latter rates. MARRIAGES. The number of marriages celebrated in 1918 was 2202 (including marriages of soldiers and sailors). This is equal to a rate of 11.2 per 1,000 total population. 10 BIRTHS. The net number of births for St. Pancras registered during 1918 was 3,318, making the annual birth-rate of 16.8 per 1,000 total population. The number of births registered as having taken place in the borough was 3,339, and the net figure is obtained by deducting 21, which, according to information received from the Registrar-General, is the excess of births to non-parishioners occurring inside the borough over births to parishioners occurring outside the borough. In Table 1 (page 63), the corresponding rates for the past ten years will be found. It will be seen that there was no stay in the fall of the birth-rate, which bad shown itself during the war, and that the figure for 1918 was lower than ever. The number of births in the year was 39 per cent, less than the average for the three years 1911-13. As a result of this decline and of the increase in the deaths which took place during the year, for the first time in our records the number of deaths for the borough exceeded the number of births. This was also the case in regard to the whole of London and England and Wales, so that during 1918 there was an actual decline in the population. 657 births occurred in Public Institutions in St. Pancras, equal to 19.7 per cent. of the total births which took place in the borough. Illegitimacy. Of the 3,339 births which were registered in the borough during the year, 310 or 9.3 per cent., were returned as illegitimate. Of the 3,318 births to parishioners within and without the borough, 314 or 9.5 per cent. were returned as illegitimate. The corresponding figures for 1917, 1916, 1915, 1914, and 1913 were 7.2, 7.0, 5.4, 4.1 and 4.7 per cent. respectively. Notification of Births. Notifications were received during the year of 3,224 births, including 3,121 live births, or 94 per cent. of the number of births registered. In the table below the notified births are classified (in Registration SubDistricts and Wards) according to the person in attendance upon the mother in her confinement, or where the confinement was in an institution, the institution. 11 Births. W. S. E, N. Total 4 5 7 8 3 6 1 2 Attended in their own homes by- Private Doctors 106 96 15 36 139 19 222 100 733 Private Midwives Doctors from the Elizabeth Garrett 138 16 6 38 85 4 196 217 700 Anderson Hospital 18 4 — 10 29 11 2 10 87 Medical Students from— University College Hospital 69 178 3 13 121 90 2 16 492 „ Middlesex Hospital 1 17 43 1 — 5 — — 67 Royal Free Hospital — — — 37 2 — — 2 41 „ St. Bartholomew's Hospital — — — 3 — — — — 3 Midwives from— University College Hospital — 4 14 83 3 140 — 1 245 ,, Maternity Nursing Association, Myddleton Square — — — 39 — — — — 39 „ Maternity Nursing Association, Oakley Square Branch 17 39 5 4 35 20 5 2 127 Attended in Institutions— University College Hospital — — 177 — — — — — 177 Elizabeth Garrett Anderson Hospital — — — — — 38 — — 38 Duchess of Marlborough's Maternity Hospital — — 362 — — — — — 362 Homes of Hope, Regent's Square — — — — — — — — — Lying-in Ward of Workhouse — — — — — 111 — — 111 Royal Free Hospital 1 — — 2 — — — 2 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. On page 24 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. Deaths of civilians only are included in the following figures. The net number of St. Pancras (civil) deaths registered during the year was 3,914, making an annual death-rate of 22.3 per thousand civil population. (The death-rate, calculated upon the estimated total population, would be 19.9 per thousand). The gross number of civil deaths registered during the year as having taken place in the borough was 3,789. Of these 626 were of persons whose residence was not in St. Pancras (non-parishioners), 537 dying in St. Pancras Institutions, and 89 in other places in the borough. There were also reported by the Registrar-General 698 deaths of St. Pancras parishioners who died in institutions in other parts of the County of London, and 53 who died in other parts of England and Wales. The net figure on which the death-rate is based is corrected for inward and outward transfers. 12 In Table 1 (page 63) the corresponding figures for the past ten years will be found. It will be seen that the rate is considerably higher than it has been for many years. It exceeded by 37 per cent. the average (16.3) of the four previous war years 1914-1917. This unusual increase in the number of deaths associated with the decrease in the number of births has resulted in the excess of deaths over births for the year. The abnormal mortality for 1918 was due to the outbreak of a fatal form of influenza, to which reference is made later in the report (page 39). The leading causes of mortality are set out for the ten years, 1908-1917, in the following table, in which the number of deaths from the respective causes during 1918 may be compared with the corresponding figures for the past ten years. Diseases. 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 Average for 10 years. 1918 Enteric Fever 10 6 4 7 2 6 4 8 5 6 6 5 Small-pox — — — — — — — — — — — — Chicken-pox — — — 1 1 1 — 1 1 — — — Measles 46 102 143 113 94 36 53 63 42 118 81 75 Scarlet Fever 20 16 17 10 5 6 19 22 8 4 13 7 Whooping Cough 67 27 92 48 47 36 49 52 39 27 48 80 Diphtheria and Croup 23 28 21 37 27 19 30 24 23 25 26 3' Influenza 75 61 20 15 14 42 15 35 35 21 33 700 Erysipelas 7 10 7 10 7 10 9 11 3 3 8 11 Tuberculosis—Pulmonary 362 374 297 230 318 325 365 398 310 353 336 40.3 Ditto Other form 99 78 76 83 83 67 67 102 83 91 83 82 Cancer, malignant Disease 288 232 266 274 247 285 251 258 267 281 265 269 Rheumatic Fever 13 12 8 6 5 6 10 11 7 7 8 8 Cerebral Hemorrhage, Embolism, and Apoplexy 164 168 131 147 227 116 141 169 119 116 150 131 Heart Disease 2 74 301 282 283 217 276 319 422 359 393 313 378 Bronchitis, Pneumonia, and Pleurisy 701 732 630 560 525 691 566 664 535 514 612 618 Diarrhnæa and Enteritis 108 101 75 248 45 148 142 114 72 97 1155 56 Nephritis and Bright's Disease 154 138 97 86 110 101 112 132 103 104 114 98 Puerperal Fever 1 — — 4 7 2 7 5 4 5 3 2 Congenital Debility and Malformations, including Premature Birth 146 149 138 130 207 191 164 187 176 144 163 132 Injuries 165 130 148 156 161 148 150 150 112 125 144 119 Id It will be seen that not only was there an unprecedented mortality from Influenza during 1918, but that there was also an increase in the deaths from Pulmonary Tuberculosis, which was in fact almost confined to the fourth quarter of the year, and may be regarded as due to the Influenza epidemic. The excess of deaths from these two causes in 1918 over the average number during the preceding 10 years was 734, and if this number is deducted from the total deaths for the year we havo the figure 3,180 (or 18 per 1000 civilian population), which on reference to the table on page 63 will be seen to be not very different from the mortality of the previous year. The reduced figure probably includes a number of deaths really caused by Influenza, and in this respect reference may be made ti> the figures for heart disease and for Bronchitis, Pneumonia, and Pleurisy in the foregoing table. The excess of deaths from these causes during the outbreak of Influenza is better shown by the table on page 40, to which reference may be made. As bearing upon the total deaths for the year, reference to the table shows that mortality from Whooping Cough was comparatively high and that from Diarrhoea and Enteritis low. The deaths for the year are fully classified for causes, age, and sex in Table 2, pages 64-68. 1,895 deaths occurred in Public Institutions in the Borough. Taking from these the number which were of non-parishioners (537), and adding the number of deaths of St. Pancras parishioners in Public Institutions outside the Borough (718)—both from the Registrar-General's figures—the number of St. Pancras deaths which took place in Public Institutions is shown to be 2,076, or 53 per cent, of the total deaths. Infantile Mortality. 340 deaths of St. Pancras infants under one year of age took place during the year. This is equal to a rate of 102 per thousand births. In Table 1 (page 63) the corresponding rates for the past ten years will be found. From this it will be seen that the infantile mortality did not share in the excessive mortality which took place for other ages during th'c year, largely owing to Influenza. The table required by the Local Government Board showing the causes of deaths amongst these infants, is set out below : — 14 1918. 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 65 11 9 13 98 67 68 51 56 340 Uncertified — — — — — — — — — — Small-pox — — — — — — — — — — Chicken-pox — — — — — — — — — — Measles — — — — — — — 8 8 16 Scarlet Fever — — — — — — — — — — Whooping-Cough — — — — — 4 4 5 14 27 Diphtheria and Croup — — — — — — — — 1 1 Erysipelas — — — — — 1 — — — 1 Influenza — — — — — 3 6 7 2 18 Tuberculous Meninigits — — — — — — 1 1 6 8 Abdominal Tuberculosis — — — — — — 1 — — 1 Other Tuberculous Diseases — — — — — — 2 1 — 3 Meningitis (not Tuberculous) — — — — — — 1 — 2 3 Convulsions — — — — — 1 1 1 — 3 Laryngitis — — — — — — — — — — Bronchitis — — 1 — 1 10 9 10 16 46 Pneumonia (all forms) — — — — — 3 9 1 2 15 Diarrhœa 1 1 — 1 3 1 2 — — 6 Enteritis 1 2 — 3 6 8 8 5 4 31 Gastritis — — — — — 1 — — — 1 Syphilis — — — 1 1 5 5 2 — 13 Rickets — — — — — — — — — — Suffocation (overlying) 5 — — — 5 — 1 — — 6 Injury at birth — — 2 — 2 — — — — 2 Atelectasis 6 — — — 5 1 2 — — 8 Congenital Malformations 6 — — — 10 3 3 1 — 17 Premature birth 36 2 3 2 43 6 1 — — 50 Atrophy, Debility and Marasmus 7 1 3 6 17 16 8 4 1 46 Other causes (including Influenza 4 1 — — 5 7 10 12 2 36 Totals 65 1 9 13 98 67 68 51 56 340 Nett Births in the year legitimate 3004 illegitimate 314 Nett Deaths in the year of legitimate infants 275 illegitimate infants 65 16 The work that is being done in regard to the prevention of infant mortality is described elsewhere in this report (pages 18-27). INFECTIOUS DISEASES. The number of cases of the compulsorily notifiable infectious diseases that have been notified during 1918 is shown in the table below, where they arc also classified according to ages. The figures have not been corrected for subsequent revision of diagnosis. DISEASES. At all Ages. At Ages—Years. Under i. 1 and [ under 5. 5 and under 10. 10 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. i. Variola or Small-pox — — — — — — — 2. Scarlatina or Scarlet Fever 332 5 93 147 57 18 12 — 3. Diphtheria and Membranous Croup .. 399 7 124 13 53 38 24 — 4. Typhus Fever — — — — — — — — 5. Entericor Typhoid Fever 1 — — — 1 4 12 — 6. Fever, Simple or Continued — — — — — — — — 7. Relapsing Fever — — — — — — — — 8. Puerperal Fever 5 — — — — 2 3 — 9. Erysipelas 121 7 8 — 9 16 to 21 10. Cholera — — — — — — — — 11. Plague — — — — — — — — 12. Anthrax 1 — — — — — 1 — 13. Glanders — — — — — — — — 14. Hydrophobia — — — — — — — — 15. Cerebrospinal Meningitis 1 1 5 2 2 1 2 — l6. Anterior Poliomyelitis 1 — 1 — — — — — 17. Ophthalmia Neonatorum 40 40 — — — — — — 18. Chicken-pox* 401 22 144 188 30 12 5 Total under Public Health (London) Act, 1891, Sec. 55 1330 82 375 490 12 91 119 21 Tuberculosis—Public Health (Tuberculosis) Regulations, 1912, Primary Notifications on Forms "A," "B," " C D Pulmonary 1034 2 21 72 80 18 667 34 Do. other Forms 203 5 48 53 29 31 31 6 Public Health (Measles and German Measles) Regulations, 1915— Measles 2144 124 1153 749 37 46 35 — Germen Measles 311 18 100 128 21 18 26 — * Notifiable part year only. 16 In the following table the number of notifications are set forth for the past 10 years : — Diseases. 1908 1909 1910 1911 1912 1913 19 4 1915 1916 1917 1918 Small-pox - - - - - - - - - - - Scarlet Fever 957 774 681 445 598 568 1207 1009 448 246 332 Diphtheria and Membranous Croup 296 315 262 419 550 440 458 446 424 451 399 Typhus Fever - - - - - - - - - - - Enteric or Typhoid Fever 60 50 61 66 29 41 44 36 38 24 17 Fever, simple or continued - - - - - - - - - - - Relapsing Fever - - - - - - - - - - - Puerperal Fever 8 15 14 16 10 11 18 14 18 9 5 Erysipelas 156 160 186 201 190 210 223 202 120 126 121 Cholera - - 1 - - - - - - - - Plague - - - - - - - - - - - Anthrax - - - - - - - - 1 — 1 Cerebro-spinal Meningitis 5 6 10 7 3 5 2 40 23 25 13 Anterior Poliomyelitis - - - 2 3 9 3 8 9 I 1 Ophthalmia Neonatorum - - - 26 18 23 34 31 38 31 40 Chicken-pox (part of year) - - - 198 - - - 247 — — 401 Measles - - - - - - - - 1855 3681 2144 German Measles - - - - - - - - 381 609 311 17 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. w hole Borough. West. Ward South. Ward East.; Ward North. Ward No Address. Whole Boroueh. 4 5 7 8 3 6 2 4 5 7 8 3 6 1 2 1. Variola or Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2. Scarlatina or Scarlet Fever 36 53 15 33 54 30 57 54 332 1 1 1 i 2 1 .. 7 3. Diphtherit and Membranous Group 48 50 24 57 62 31 76 7 399 4 6 3 2 7 4 3 2 .. 31 4. Typhus Fever. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 5. Entericor Typhoid Fever. 1 3 4 3 2 2 2 .. .. 17 .. .. 1 1 1 .. 1 1 5 6.Fever, Simple and Continued .. .. .. . .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 7. Relapsing Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 8. Puerperal Fever .. 1 3 .. .. 1 .. .. .. 5 .. 1 .. .. .. .. 1 .. .. 2 9. Erysipelas 14 10 5 5 25 22 26 16 121 1 2 2 2 2 1 1 .. .. 11 10. Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 11. Plague .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 12. Anthrax .. .. .. 1 .. .. .. .. .. 1 .. .. .. 1 .. .. .. .. .. 1 13. Glanders .. .. .. .. .. . .. .. .. .. .. .. .. .. .. .. .. .. .. 14. Hydrophobia .. .. . .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 15. Cerebrospinal Meningitis* 1 3 2 3 1 .. 1 2 .. 13 1 2 2 .. .. 2 1 .. 9 16. Anterior Poliomyelitis .. .. .. .. .. .. .. 1 .. 1 .. .. .. .. .. .. .. .. .. 17. Ophthalmia Neonatorum 7 4 7 5 3 4 6 4 .. 40 .. .. .. .. .. .. .. .. .. .. 18. Chicken-pox 12 52 9 52 65 114 60 37 .. 401 .. .. .. .. .. .. .. .. .. .. Total under Public Health (London) Act, 1891, Section 55 119 176 69 159 210 208 228 161 .. 1330 15 22 12 14 28 15 20 16 3 146 Tuberculosis—Public Health (Tuberculosis) Regulations 1912, Primary "C'and "D"; Pulmonary 123 151 99 107 156 114 118 92 74 1034 63 64 26 54 50 35 41 27 43 403 „ other forms 27 3° 9 15 26 27 30 27 9 203 16 12 11 5 9 12 8 8 1 82 Public Health (Measles and German Measles) Regulations, 1915— Measles 258 109 75 201 469 188 519 325 .. 2114 10 5 1 6 10 15 18 0 1 75 German Measles 38 37 26 44 29 33 56 48 .. 311 .. .. .. .. .. .. .. .. .. .. * Includes one death from Posterior Basic Meningitis. 18 PART II.—ADMINISTRATION AND SPECIAL SUBJECTS. MATERNITY AND CHILD WELFARE. The statistics for the year in regard to births and deaths of infants will be found on pages 10-11 and 13-14 of this report. In last year's report was recorded the formation, as a sub committee of the Public Health Committee, of the Maternity and Child Welfare Sub-Committee. This has been increased somewhat in size and at the end of 1918 was made up of representatives of the following bodies and institutions. (The figures in brackets are the number of representatives in each case) : — The Borough Council (9): St. Pancras School for Mothers (3): North St. l'ancras School for Mothers (3): Passmore Edwards Settlement School for Mothers (1): Camden Town Mothers' and Infants' Welfare Centre (1): Argyle Square Mothers' and Infants' Welfare Centre (2): South Highgate Mothers' and Infants' Welfare Centre (1): Maternity Nursing Association (1): St. l'ancras Dispensary (1): University College Hospital (2): Royal Free Hospital (l) St. Pancras Day Nursery (1): Whitefield's Day Nursery (1): Kentish Town Day Nursery (1): Somers Town Nursery School (1): 29 members in all. The Maternity and Child Welfare Act, 1918, required the setting up of a Maternity and Child Welfare Committee, of which two-thirds of the members must be Borough Councillors. The work of the sub-committee already in existence had been so satisfactory that it was thought undesirable to alter its constitution to meet this requirement, and consequently the Public Health Committee was appointed as the Maternity and Child Welfare Committee under the Act, with an instruction from the Council that it shall, unless in its opinion the matter be urgent, receive and consider the report of the subcommittee before reporting to the Council upon matters of maternity and child welfare. The most important action of the Council during the year in this connection was their decision to take over a large share of the financial responsibility for work done by the numerous voluntary agencies in the borough for the welfare of mothers and young children. The voluntary work which it was decided to subsidise falls into the following groups:—(1) infant and maternity 19 tions, together with the consequent home visitation : (2) the provision of midwifery both in institutions and in the patients' own homes: and (3) the institutional treatment of sick children under school age. Infant and Maternity Consultations.—In regard to the maternity and child welfare centres, the needs of the Borough were already met to a considerable extent by the thirteen voluntary centres. St. Pancras had taken a leading part in this work, and though the funds had not been supplied from the borough rates, the voluntary organizations had always been closely associated with the work of the Health Department. The Medical Officer of Health had, in fact, suggested the institution of most of the centres, and he and members of the Department were on the Committee (in some cases in the chair) of all the centres except those at the hospitals. The representation of the centres on the Maternity and Child Welfare Sub-Committee had established a still closer link. The work of the centres was cramped for want of money and it was felt that continued reliance upon voluntary funds would prevent its proper development. At the same time it was desired to preserve the co-operation of the voluntary workers at the centres, and to retain, as far as possible, the sources of voluntary funds for further experimental and pioneer work, especially in the more purely sociological direction. It was therefore decided to pay in full the fees of the medical officers at the centres and the salaries of the superintendents and health visitors attached to them. At the end of 1918 this involved the payment of the medical officers (at the rate of One Guinea per consultation) for 16 consultations every week and 7 other consultations every month, in addition to a weekly clinic for sick mothers and children; and 8 full-time and 4 part-time superintendents and health visitors attached to the centres. This is exclusive of the staff of the centre at University College Hospital, which did not accept the Council's financial assistance, though continuing to co-operate in the borough scheme, and the medical officers at the other hospital centres Since the end of the year the number of consultations and visitors paid for by the Council has been increased. The Council also undertook the responsibility for the rent (and rates and taxes) of the premises of the centres where such payments were made. Only two of them (St. Paneras Scho >1 for Mothers and Argyle Square Centre) had full-time premises, two (Grafton Road and South Highgate Centres) worked in part-time premises in the public library and public baths lent by the Council, and the rest in mission-rooms given up to their use on certain days in the week. It was also arranged that two others (North St. Pancras and Camden Town Centres) should have full-time premises for which the Council would pay the rent and also the expense of equipment, but suitable premises for this purpose have not yet been obtained. Midwifery.—In regard to midwifery work, also, there was a great deal already done by voluntary agencies. About one-third of all St. Pancras births were attended gratis or at reduced charges by doctors, medical students and midwives sent to the mothers' own homes by hospitals and the Maternity Nursing Association; and one-sixth took place in various maternity hospitals within and without the borough. It was not thought necessary to take the full expense of this work on the rates, nor, as an immediate step, to provide new intern or extern midwifery facilities, and it was therefore decided to make 20 grants of 5s. per extern case and 10s. per intern case to the institutions already carrying out the work. These grants are not accepted by University College and Middlesex Hospitals. Hospital facilities for children under school age.—During 1918 the Committee of the Mayoress' Nursing Fund for Sick Children started a Home for Sick Poor Children at Avalon, 1, St. Albans Road, N.W. 5. This is a wellappointed house with good grounds, with beds for 20 children under school age, and it is intended for the reception of cases who are ailing and needing better observation or treatment than can be given them in their own homes, and who are not of the kind which are admitted to ordinary hospitals. To this institution the Council decided to make a grant of £500 per annum. University College Hospital, also, had four beds for the observation and treatment of infants referred from the hospital infants consultation, and the Council offered to pay an annual sum for the reservation of four more beds for the use of St. Pancras infants for the same purpose. The Hospital did not, however, see its way to doing this. All the above-mentioned payments for work done by voluntary agencies began on October 23rd, 1918. Work done during 1918. Advice Curds.—Cards of advice have been posted to the mothers of all infants whose births have been notified. 968 cards of advice to expectant mothers have also been distributed through University College Hospital, Middlesex Hospital, and the Maternity Nursing Association to those expectants who have arranged for their confinement through those institutions. Home Visiting.—The department includes two full-time health visitors and two who are health visitors as to half their time and sanitary inspectors as to the other half, as well as one full-time health visitor who devotes her time to the visiting of cases of measles. These ladies made during the year 2,953 visits to 1,239 infants (apart from cases of measles). They also made 389 visits to 177 expectant mothers, from lists of expectants supplied by University College and Middlesex Hospitals. Much more visiting work was done by the paid visitors at the various infant welfare centres. They undertook the visiting of all children in attendance at the centres, and also of large numbers of infants in their districts referred to them by the Medical Officer of Health upon the notification of their birth being received. The method adopted was as follows: Blank case-cards with the name of the infants written in were sent to the centres for such births as the Town Hall visitors were not dealing with, and these were returned to the Medical Officer of Health when they had been filled up after visiting by the paid visitors of the centres, in many cases supplemented by the attendance of the infant at the centres. Copies of these case-cards were made at the Town Hall, which, together with the case-cards of the Town Hall visitors, constituted a complete card index of all the 1918 births. At the end of the year the cards at the centres were again sent in to the Medical Officer of Health and returned after the additional particulars thereon had been transferred to the 21 copies in the card-index. It is hoped to continue to post up the cards as far us possible until the children reach the age of five years, and to establish similar indexes in future years. In all, the 12 trained visitors (4 part-time) at the centres made, during the year, 16,984 visits to 1,557 infants. The total number of visits to young children (apart from measles, etc.) made by all the trained visitors at the Town Hall and the centres was therefore 19,937; though, in adding together the number of children visited (viz.: 1,239 and 1,557) to a total of 2,796, it is not possible to state precisely how many are common to the two groups, having been visited by both set of visitors. (The effect on the figures of this overlapping is, however, lessened, by the circumstances that the number of children visited from the University College Hospital centre, not being supplied, is omitted). The number of notified live births for the year was 3,121. The visitors at the centres also made 1,622 visits to 752 expectant mothers referred to them by the Medical Officer of Health from lists supplied by the institutions referred to above. The same method as to case-cards was used in this work as in the case of births, and the same cards were used by the two sets of visitors. In all, therefore, 2,011 visits were paid to 929 expectant mothers, the latter figure, however, being an over-statement by reason of some of the expectants being visited by both the Town Hall visitors and those at the centres. Maternity and Infant Welfare Centres.—The work done at the 13 centres is set out in the table on the next page, including the home visiting referred to in the foregoing paragraph, as well as the attendances at the consultations. The figures are supplied by the centres. It will be seen that in all, 1,698 new children under one year of age attended during the year, or 51 per cent. of the total births for the year (3,318), and that 16,264 total attendances were male by children under that age. 2,602 attendances were made by children over one year, and there were 157 children over that age who attended during the year for the first time. In this connection it is interesting to record that at the Argyle Square Centre, and also its branch at Falkland Road, special monthly consultations were instituted in the course of the year for children over 18 months old. The mothers of children of that age on the books of the centres are invited, by post-card, to bring up their children by special appointment to these consultations, so that the children are medically examined every three months, or more often if necessary. This system affords the necessary link between the consultations for young infants and the subsequent medical inspection of school children. 754 attendances were made by expectant mothers at the ante-natal consultations held at the centres, 373 expectants attending during the year for the first time. These figures are exclusive of the 1,437 attendances made by expectant mothers at the Obstetric Deparment at University College Hospital, where 970 new cases attended during the year. These attendances were made at 790 infant consultations (739 in St. Paneras) which were held during 1918, and 9 for children over 18 months only; and 317 ante-natal consultations (including 100 each at University College and the Royal Free Hospitals). At certain of the consultations, particularly those at Passmore Edwards Settlement, University College Hospital, and the Royal Free Hospital, residents in neighbouring boroughs are also dealt with. The figures in the table, however, apart from accidental inclusions, refer to St. Pancras residents except where otherwise stated. 22 centre. Attendances. Visits by Trained Visitors. Infant Consultations. Expectant Mothers Consultations. Visitors. Expectant Mothers. Children. Expectant Mothers. Children. New cases. Total attendances. New cases. Total attendances. First visits. Total visits. First visits. Total Visits. Per week. Total. Per week. Total. Whole Time. Part Time. Under 1 year Over 1 year. Total. Under 1 year. Over 1 year. Total. Town Hall Health Visitors — — — — — — — 177 389 1239 2953 — St. Pancras School for Mothers:— Ampthill Square 104 184 269 52 321 3115 778 3893 354 583 241 2215 3 141 1 48* 3 — Chalton Street † 11 27 31 19 50 154 62 216 45 64 57 174 1 16 — — — 1 North St. Pancras School for Mothers:— Rhyl Street 38 95 225 13 238 3627 38 3665 28 193 140 2133 2 96 211 21 3 — Grafton Road — — 83 11 94 811 95 906 — — 119 1013 1 49 — — — — AVinscombe Street 3 — — 28 1 29 402 1 403 — — 63 341 1 36 — — — — South Higligate Mothers' and Infants Welfare Centre 4 3 6 17 1 18 153 62 215 3 18 44 221 1 16 — — — 1 Passmore Edwards Settlement School for Mothers 5 11 47 53 31 84 531 960 1491 37 66 87 477 2 91 — — — 1 Camden Town Mothers' and Infants' Welfare Centre 17 28 116 18 134 1328 448 1776 20 75 82 845 1 44 — — 1 1 Argyle Square Mothers' and Infants' Welfare Centre 31 92 719 9 71 11219 489 1169 62 210 175 1218 16 506 211 20 3 — Branch at Falkland Road 23 53 1849 19 185 16669 309 1696 34 118 284 2083 17 517 211 16 — — Maternity Nursing Association 90 120 143 — 143 1045 — 1045 128 223 218 399 1 52 111 12 1 — University College Hospital 3 970 1437 606 — 6088 2803 — 2803 — — — 6819 1 51 2 100 — 2 —. — 439 — 439 2031 — 2031 — — 4940 — — — — — — Royal Free Hospital 5 45 102 26 6 32 114 52 166 41 72 47 925 1 46 2 100 — 1 South Hampstead Centre, Lisburne Road 10 — — 13 4 17 166 28 194 — — — — 1 51 — — — — Totals 373 754 1698 157 1855 16264 2602 18866 929 2011 2796 19937 — 790 — 317 — — *Ailing mothers are also seen at the consultations. † Last 4 months of 1918 only. (3) To August 98th only. (4) Last 4 months only (transferred from Winscombe Street ) (5) St. Pancras cases only. (6)A\nd also a new monthly consultation for children between 18 months and 2 years (6 consultations, 48 attendances). (7) And also a new monthly consultation for children between 18 months and 2 years (3 consultations, 30 attendances). (8) Including cases living outside St. Pancras (of the 606 new cases—children, 439 were St. Pancras cases). (9) Under and over 18 months of age respectively. (10) Outside St. Pancras. (11) Per month. 23 Clinic for Sick Mothers and Children under school age.—The special weekly clinic (Dr. F. L. Provis) has been continued at the St. Pnncras Dispensary, 39, Oakley Square. The patients are referred to the clinic from the various infant welfare centres, the health-visitors, and other sources. During 1918, 386 new cases under five years of age were treated, the total number of attendances of sick children being 1666; 81 women were also attended for illness associated with pregnancy or the puerperium, who made 230 attendances. The Medical Officer is paid by the Borough Council, and there is a half-time Visiting Nurse, half of whose salary is repaid to the Dispensary by the Mayoress of St. Pancras Nursing Fund for Sick Poor Children. In 1918 the nurse made 718 visits to children under 5. Dental Clinic for Mothers and Children under school age.—The Borough Council hold a dental clinic at the British Dentists' Hospital, 31, Camden Road, N.W. 1, at which are dealt with mothers and children attending at and referred by the infant welfare centres in the borough. The hospital is paid by the Council for the use of the premises, including a fully equipped dental surgery, and the services of the matron, on such afternoons as it is required (once a week in 1918); and the Council's dentist (Mrs. "Winifred Murch, l.d.s.) is paid at the rate of One Guinea per afternoon clinic, as is also the anaesthetic (Dr. J. Maughan) who attends when anaesthetics are required. The clinic was opened on April 15th, 1918, and for the rest of the year was held once a week. Up to the end of 1918 the work done was as follows:— Number of Clinics 34 „ new cases (m thers) 122} 161 ,, „ (children) 39} Total number of attendances 495 Number of attendances for extractions under nitrous oxide (" gas ") 79 ,, ,, „ „ local anaesthessia 47 ,, ,, when fillings were done 88 „ ,, ,, scalings were done 50 „ ,, for impressions, fitting dentures, etc 172 ,, „ ,, examinations, etc. 103 No charge is made for extractions (with or without " gas "), fillings and scalings, but the patients are required to pay towards the expense of dentures. For these the dentist is paid separately at the rate of £2 for a single denture, and £4 for two dentures. The patients obtain assistance from the Metropolitan Sunday Hospital Fund, pay the uselves according to our assessment, and the remainder of the fees are paid from a special voluntary fund (the St. Pancras Dental Fund) which has been raised by the efforts of Councillor A. Escott, Chairman of the Maternity and Child Welfare Sub-Committee. In general the patients themselves pay for the dentures about one half of the dentist's fees. To the end of the rear 26 patients were fitted with dentures. The total cost of these was £80, of which £45 5s. Od. was paid by the patients themselves, £14 10s. Od. (for 20 patients) by the St. Pancras Dental Fund, and £'20 5s. Od. by the Hospital Sunday Fund. The number of dentures fitted has been greater since the end of the year. The proportion of children dealt with has also increased since that time. 24 The success of the dental clinic has been most satisfactory, and the number of sessions will need to bo increased. The success is due to the dentist's skill and kindness, and also to the ability and assiduity which Miss Celia Smith, who has had charge of the administrative arrangements, has given to the work. Supply of milk to necessitous mothers and children under school age.—On March 20th, 1918, the Borough Council decided to make grants of milk to expectant mothers and young children who were suffering from their inability to obtain a sufficient quantity of this food. A sum of £100 per annum, later increased to £200, was set aside for the purpose, the decision as to the granting the milk being left with the Medical Officer of Health. To the end of the year milk was granted in 82 cases at a cost of £50 7s. 9d. The usual amount allowed was one pint per day. Dinners for necessitous expectant and nursing mothers, and young children, have also been supplied from voluntary funds at the St. Pancras School for Mothers, and (in connection with the North St. Pancras School for Mothers) by the Kentish Town Dining Room for Mothers, Lyndhurst Hall, Warden Road, N.W. 5: and also by the St. Pancras Invalid Kitchen, Crowndale Road, N.W. 1. Dried milk has been sold at specially reduced price at all the centres through the Government scheme. Midwifihy Work. "Extern" Midwifery.—The number of St. Pancras mothers attended gratuitously at their confinements in their own homes during 1918, according to the birth notifications, was as follows:— Elizabeth Garrett Anderson Hospital (doctors) 87 University College Hospital (medical students) 492 „ „ „ (midwives) 245 Middlesex Hospital (medical students) 67 Royal Free Hospital „ 41 St. Bartholomew's Hospital (medical students) 3 Maternity Nursing Association, Myddleton Square and Oakley Square (midwives) 166 (or one-third of the total number of births). 1101 *In these eases the women were charged reduced fees. "Intern" Midwifery.—The number of St. Pancras births which took place in hospitals were as follows:— University College Hospital 107 Marlborough .Maternity Hospital (Roval Free) 82 Middlesex Hospital 129 Queen Charlotte's Lying-in-Hospital 139 City of London Maternity Hospital 31 St. Pancras House 90 Other hospitals 31 (or one-fifth the total number of births), 609 *Inclnding paying patients. 25 Payment for Medical Help to Midwives.—On July 25th, 1017, the Council decided to pay medical practitioners upon a tixed scale when they are called in bv midwives to mothers in connection with confinements, or to new-born children, and the family are unable to pay the medical fee. The scale of payment was as follows: One Guinea for a normal confinement, and Two Guineas for a confinement presenting special difficulty, or requiring operative interference, including, in each case, the necessary subsequent at'endances, and for calls not for the confinement itself, but before or after confinement: 5s. for the first visit (10s. 6d. if between 9 p.m. and 9 a.m.) ard 2s. fid. for each subsequent visit. Later a fee of One Guinea to a doctor called in to administer an a aesthetic was added to the scale. During 1918 (including a few 1918 cases paid for early in 1919) payment was made to doctors under this scheme in 50 cases, the total payments being £60 11s. In 40 instances the attention of the doctor was required for the mother, the particular emergencies being as follows:— Difficult or complicated labour 17 Retained placenta 5 Ruptured perineum 5 After stillbirth 4 Pyrexia or septic infection 3 Miscarriage 2 Haemorrhage 2 Illness after confinement 2 In 10 cases the doctor was called in to the infant, the particular emergencies being as follows:— Premature birth 6 Ophthalmia neonatorum 3 Icterus neonatorum 1 The Midwives Act, 1918, placed the duty of making payments of this kind on the Local Supervisory Authority under the Midwives Act (in London, the London County Council) as from the end of 1918: and the effect of this was that the work of the Borough Council in this direction, which was going on s noothly and satisfactorily, was stopped at the end of the year and transferred to the County Council. Work By Voluntary Agencies in Connection with Mothers and Young Children not paid for by the Borough Council. Home Helps.—The need for domestic assistance for women in sickness and childbirth had long been felt, and, towards the end of 1917, a small fund, collected for the purpose by ladies of the south St. Pancras War Pensions Committe , was put at the disposal of Miss Bibby, and a committee was formed, of which the Medical Officer of Health was made Chairman, and Miss Bibby, Hon. Secretary, for the purpose of putting a scheme into operation. Earlier in the War a considerable number of Helps had been employed in this connection by the Home Helps Committee of the Womens' Employment Committee, organised by the Prince of Valea' Fund- 26 During the year, including a few eases during December, 1917, 59 cases were dealt with as follows :— Maternity and illness connected with maternity 22 Consumption 5 Other illnesses 21 Taking children to hospital 4 Not dealt with beyond an initial visit 7 Three home helps were regularly employed, and one other occasionally. In most cases, either no payments or nominal payments only were received, but in certain of the maternity cases, the home help was employed full-time in connection with the confinement and lying-in, and substantial payments were made by the women for the service. In these cases a system of paying in advance by small instalments was adopted. Home Nursury.—A large amount of this, including the nursing of mothers and children, is done by the four local district nursing associations, supported by voluntary subscriptions. The work done in cases of measles, whooping cough, and ophthalmia neonatorum on behalf of the Mayoress of St. Pancras Nursing Fund for Sick Poor Children is referred to on pages 28, 38 and 45. The Maternity Nursing Association, 79, Oakley Square, undertakes "monthly nursing" as well as supplying midwives. Day Nursrries.—There are four day nurseries in St. Pancras, viz.: The St. Pancras (''Edith Rendel"), 26, Cartwright Gardens; The Whitefields, 53, Whitfield Street; The Kentish Town, 27, Gospel Oak Grove ; and the Margaret, 44, Ampthill Square. These have accommodation for 145 children. The St. Pancras School for Mothers have also a day nursery for their own ailing children. Hospital Accommodation.—There is a considerable amount of accommodation for sick children, and women suffering from diseases of pregnancy and parturition, in the various hospitals in St. Pancras and the neighbouring parts of London, in addition to the poor law infirmaries. Governemnts Grants. Government Grants were made during the year ended March 31st, 1919, in r. spect of Maternity and Child Welfare as follows :— From the Local Government Board: — £ s. d. St. Pancras Borough Council 260 11 11 North St. Pancras School for Mothers (and branches) 281 15 3 * Passmore Edwards Sett'ement School for Mothers 57 9 1 Camden Town Centre, Greenland Street 56 8 1 Centres at Argyle Square and Falkland Road 228 3 4 The Four Boroughs Maternitv Centre 126 17 9 Maternity Nursing Association (for Infant Welfare Centre) 75 0 0 * Maternity Nursing Association (for extern Midwifery and Maternity Nursing) 291 0 0 27 £ s. d, University College Hospital (for extern Midwifery and Infant Welfare Centre) 1052 16 11 266 19 9 Royal Free Hospital (for extern Midwifery and Infant W< lfare Cen re) 133 0 0 St. Pancras 1 ispensarv (Infant Clinic) 51 12 2 Mayoress of St. Pancras Nursing Fund (Home Nursing) St. Pancras Home Helps Committee 6 10 0 Front th° Board of Education :— St. Pancras School for Mothers 639 3 7 St. Pancras Day Nursery 235 5 10 Whitefield's Day Nursery 236 0 0 Kentish Town Day Nursery . 493 11 2 *Including expenditure on work amongst residents outside St. Pancras. Infantile DiarrhŒa. 37 deaths of infants under one year of age from diarrhoea and enteritis were registered during 15)18. The number of such deaths in each quarter of the year was as follows:— First Quarter 10 Second ,, 2 Third ,, 15 Fourth „ 10 The number of deaths of children under 5 years of age from diarrhoea and enteritis was 47. OPHTHALMIA NEONATORUM. 40 cases were notified during 1918, 31 by doctors, 8 by midwives, and 1 by both doctor and midwife. In 2 other cases the diagnosis was afterwards altered, the corrected number of cases being therefore 38. 5 of the cases were regarded by the visitor as grave, 15 as moderate, and 18 as slight. 6 of the cases have since died. 11 were illegitimate. The cases are classified below according to the manner in which the mothers were attended at their confinement. Attended at birth by cases of Ophthalmia Neonatorum. Total number of births notified. No. of cases per 1000 births notified. Doctors 2 820 2.4 Medical Students 6 603 9.9 Midwives from Institutions 2 411 4.9 Private Midwives 13 700 18.6 Delivered in Hospitals and Institutions 15 - - 28 A visiting nurse was called in in 22 cases, 4 eases were removed to hospital, and 6 cases were kept in the institutions in which they were born till their recovery or death. The other 6 cases were nursed by their own families. The results of treatment were as follows:— Complete recovery (including 4 who afterwards died) 29 Blind 0 Sight damaged 3 Died before recovery 2 Removed and lost sight of 4 The same facilities, as in the case of measles (see page 38), are available for the home nursing of cases of Ophthalmia Neonatorum, through the Mayoress' Nursing Fund. In 1918 the visiting nurses made 4(36 visits to 20 children in this connection. PUERPERAL FEVER. 5 cases were notified during 1918, equal to an incidence rate of 1.5 per 1,000 births. 2 deaths occurred amongst these, giving a case mortality of 40 per cent. All 5 cases followed the birth of live-born infants 3 of the patients were primiparac (i.iwomen who had not previously borne children), and 2 multiparas. In 3 cases " instruments " were used at the confinement. In no case was there any obvious source of infection in the house. 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 oases per 1000 births. Doctors 2 820 2.4 Private Midwife 1 700 1.4 Tn Hospital 2 — — TUBERCULOSIS. The number of notifications of civilian eases of tuberculosis received during the year are set out in the form suggested by the Local Government Board in the table on the next page. The total number of primary notifications (civilian) received during the year on Forms A, B, C, and D, was 1237 (1034 pulmonary, 203 non-pulmonary), equal to a notification rate of 7.04 (5.88 pulmonary, 1.16 non-pulmonary) per 1000 civilian population. The deaths from tuberculosis during the year numbered 485, of which 4 ,3 (234 males, 169 females) were from phthisis, and 82 (49 males, 33 females) from other forms of tuberculosis, 23 Public Health (Tuberculosis) Regulations, 1912. Summary of Notification* (luring the period from 3W December, 1917, to the 28t/i December, 1918 (mcluxire). Age Periods. Number of Notifications on Form A, Number of Notifications on Form B. i\ umber of Notifications on Form c. Nnmlit'i of Is O-itications on Form D. Primary Notifications. Total Notifications (i.e.,including cases previously notified by other Doctors). Primary Notifications. Total Notifications (i.*,, including cases previou ly notified t y other Doctors). Poor Law Institutions. Sanatoria. Poor Law Institutions. Sanatoria. 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 05 and upwards. Total. Under 5 5 to 10 10 to 15 Total. Pulmonary—Males — 9 18 20 33 39 112 95 75 43 10 460 513 — 15 11 20 50 204 139 85 145 ,, Females 1 4 10 21 18 4' 76 70 3" 10 9 299 338 3 15 14 3 44 102 59 57 63 Non-pulmonmy—Males 2 21 13 3 2 1 6 3 4 1 5 61 67 3 13 8 24 30 12 5 5 7 „ Females 3 16 14 3 13 8 6 4 1 3 1 72 86 1 12 11 24 3o 19 8 12 5 Totals 6 50 64 47 66 89 200 172 110 57 31 892 1004 7 55 44 106 134 337 211 159 220 Ags Periods. Number of Primary Notifications on Form C. included in above. Number of Primary Notifications on Form D. included in above. 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 40 45 to 55 55 to 65 65 and upwards. Total. 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 5 S to 05 65 and unwnrds. Total. Pulmonary— Male « 1 3 — 5 8 3 29 27 22 14 7 119 — 1 — 1 5 1 5 3 3 1 1 21 „ Females - 1 5 5 4 5 20 14 5 3 3 65 — — — 3 1 — 4 2 1 1 - 1 2 Non-pulmonary—Males — 3 1 1 3 1 1 — — 1 — 11 — — — — — — — — — — — — ,, Females - 4 — 3 1 1 — 1 — - 1 11 — — — — — — — — — — — — Totals 1 11 6 14 16 to 50 42 27 18 11 206 — 1 — 4 6 1 9 5 4 2 1 33 30 This is equal to a death-rate of 2.76 (2.29 pulmonary, 0.47 non-pulruonary), per 1000 civilian population. The deaths are classified in the following table:— 0-1 l-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 - 3 7 26 24 41 53 31 13 4 — 205 - 2 9 31 31 41 •23 7 7 1 152 357 Phthisis mot defined as tuberculous; - - 1 2 5 10 4 6 1 - - 29 - - - 6 2 2 2 5 - - - 17 46 Total Pulmonary Tuberculosis - 3 8 28 29 54 57 37 14 1 - 234 - 2 9 37 33 43 25 12 7 1 — 169 403 Acute Phthisis - - - - - - - - - - - - - - - - - - - - - - - - - Acute Miliary Tuberculosis - 1 - - - - - - - - - 1 - 1 - - - - - - - - - 1 2 Tuberculous Meningitis 5 11 7 - - 1 - - - - - 24 3 7 7 1 - - - — — — 18 42 Tabes Mesenterica - - - - - - - - - - - - - - - - - - - - - - - - - Other Peritoneal and Intestinal Tubercle — 1 2 - - 1 - 1 1 - _ 6 1 5 - 1 - - - - - 7 13 Tuberculosis of Spinal Column — 1 2 - 2 1 1 1 8 1 1 — — 1 — 3 11 Tuberculosis of Joints — - - 1 - - — 1 — — - 2 — — — — — — — - — — — — 2 Lupus - - - - - - - - - - - - - - - - - - - - - - - - - Scrofula - - - - - - - - - - - - - - - - - - - - - - - - - Tuberculosis of other Organs _ 1 1 - - — 1 1 - 1 5 - - _ — - 1 1 6 Disseminated Tuberculosis 1 1 - - 1 - - - - — - 3 2 - - - - — - 1 - — — 3 6 Total Non-Pulmonary Tuberculosis 6 16 12 1 3 3 2 3 2 1 - 49 C 11 8 2 — 1 1 - 1 - 53 82 Total all forms of Tuberculosis 6 19 20 29 32 57 59 10 16 5 - 233 6 16 17 39 33 43 26 13 7 2 202 185 In the next table the new cases notified during 1918 are similarly classified. 31 Location of Disease. Ages. Totai,. 0-5 5 - 15 15 and upwards. Males Females. Males. Females. Males. 3; Females. Pulmonary Tuberculosis 14 9 70 82 542 317 1034 Bones and Joints 10 9 11 18 13 8 6!) Meninges 5 7 5 7 1 1 26 Glands 9 — 15 16 2 22 64 Abdominal 3 1 3 9 — 2 11 Genito- Urinary — — — — 1 1 General — 1 — 1 — 1 3 Other Organs 2 5 4 2 10 6 29 Total Non-pulmonary Tuberculosis 29 23 38 40 27 40 203 Total all forms of Tuberculosis 43 32 108 128 569 357 1237 In the following table is shown the number of notifications received and deaths occurring, together with the notification and death-rates from Tuberculosis for the past ten years : — Year. Estimated Populatien. Primary Notification!. Deaths. Notification Rate. Heath Rate Phthisis. Other forms. All forms. Phthitis. Other forms. All forms. Phthisis. Other forms. All forms. Phthisis. Other forms All forms. 1909 23:247 936 936 374 78 452 3'94 i'5s •33 .■9. 1910 23:247 872 872 297 76 373 3.68 1 25 32 1.57 1911 237129 1464 1464 330 83 413 6.17 1.39 .35 1.74 1912 220353 1735 1735 326 75 401 7.87 1.48 .32 ! "82 1913 218387 928 230 I I58 325 67 392 4.17 1.03 5'20 1.49 .30 1.79 1914 2183S7 893 121 1014 365 67 432 4.00 55 464 1.67 .30 1.97 1915 218387 933 150 1083 398 102 500 4.27 69 4.96 1.82 .47 2.29 1916 218387 735 138 873 340 83 423 3.36 63 3.99 1.55 .38 1.93 1917 218387 825 169 994 353 91 444 3.78 .77 4.55 1.62 .42 2.03 1918 2183.7 1034 203 1237 403 82 485 4.74 .93 5.67 1 85 .37 2.22 From the tabic it will be seen that the marked tendency to diminish which the disease had shown for many years does not seem to have continued in the past few years. 32 Work Done. The visiting work done during 1918 by the female visiting staff is indicated in the following table: — Number of visits to homes of notified cases— (a) First visits 709 (b) Subsequent visits 699 Number of cases in which disinfection was carried out Attendances of inspector or visitor at the dispensaries 35 Other visits made for various purposes 125 Treatment of Tuberculosis. The work done during 1918 at the approved tuberculosis dispensaries, which are completely subsidised by the Borough Council and through them by the Local Government Board, the London County Council and the London Insurance Committee, is shown in the following table based on returns supplied by the dispensaries:— Tuberculosis Dispensary at University College Hospital. Tuberculosis Dispensary at StPancras Dispensary 39, Oakley Square Bronch Tuberculosis'Dispensary of St. Pancras Dispensary at 18.2, Maiden Road. Insured persons. Uninsured persons. Total. Insured persons, Uninsured persons. Total. Insured persons, j Uninsured persons. Total. No. of new cases 119 91 210 232 274 506 23 116 139 No. found to be suffering from pulmonary tuberculosis 65 21 86 167 84 251 18 42 60 Ditto non-pulmonary do. 2 3 5 4 27 31 1 7 8 Ditto non-tuberculous 9 19 28 11 24 35 1 11 12 No. in whom diagnosis was found to be doubtful 43 48 91 50 139 189 3 56 59 Total attendances 918 794 1712 712 2652 3364 56 1023 1079 No. of above attendances at which physical examinations and records were made 262 252 514 252 529 781 40 345 385 Home visits by Tuberculosis Officer 4 2 6 90 67 157 Inc luded in Oakley Square Ditto by Dispensary Nurse 304 263 567 100 357 457 56 135 191 No. of persons referred to the hospital to which this Dispensary is affiliated 2 0 2 12 14 26 0 8 8 No. of consultations with Medical Practitioners ] 1 2 3 0 3 0 0 0 No. of written reports to:— (a) Public Authorities 107 73 180 514 543 1057 39 196 235 (b) Practitioners 16 13 29 47 2 49 0 4 4 No. l of Specimens of sputum examined 35 13 48 30 22 52 Included in Oaklley Square 35 SCARLET FEVER. 332 (civil) patients were notified in 1918 as suffering frrm scarlet fever. Of these 43 were afterwards found not to be suffering from the disease by Medical Superintendents of the Metropolitan Asylums Board. The corrected number of scarlet fever cases (civil) notified was therefore 289, equal to an incidence rate of 1.64 per 1,000 civil population. The number of deaths from scarlet fever certified during the year was 7, equal to a death-rate of 0.04 per 1,000 civil population, and a case mortality of 2.4 per cent. of cases notified. Other statistical facts will be found on pages 15-17. Of the notified cases of scarlet fever, 318 (or 95.8 per ccnt.) were removed to hospital, as follows:— To Metropolitan Asylums Board Hospitals 318 To other hospitals— 318 Return Cases. —(Definition: A case of scarlet fever occurring within 28 days of the return from hospital to the same house of a previous case of scarlet fever). There were 10 such cases in 1918 occurring in 9 houses. In 7 instances the return case was in the same family as the (?) infecting case, and in two instances (3 cases) in a different family in the same house. Id 7 instances the (?) infecting case had rhinitis or nasal discharge following upon the return from hospital, and in two instances showed no discharges or other sign of infectiousness. The intervals between the return of the (?) infecting ease and the onset of the illness of the return case were respectively 2, 6, 9, 11, 17, 18, 2G, and 28 days. In the instance in which there were two cases of scarlet fever following the return of a previous case, the first return case occurred within 12 days, and the second within 18 days of the return of the first case (in a different family in the same house which showed rhinitis— negative swab—and was readmitted to hospital. In the family where these two return cases of scarlet fever occurred there were also two cases of diphtheria, which began 20 and 22 days respectively after the return of the case of scarlet fever in the other family. There was in addition a case of scarlet fever occurring 7 weeks after the return from hospital to the same family of a previous case, which showed no signs of infectiousness. There were also two houses where cases of scarlet fever occurred after the return from hospital of a case of diphtheria to the same family. The intervals were 8 and 5 days respectively. In one instance the earlier case showed purulent rhinitis (positive swab), and in the other no discharges or other sign of infectiousness. In the latter instance there were two simultaneous return cases of scarlet fever. On page 35 will be found a reference to after-care work amongst scarlet fever and diphtheria cases. 34 DIPHTHERIA. 399 (civil) patients were notified in 1918 as suffering from diphtheria or membranous. croup. Of these 58 were afterwards found not to be suffering from the disease by Medical Superintendents of the Metropolitan Asylums Board Hospitals, and 1 by other medical practitioners. The corrected number of diphtheria cases (civil) notified was therefore 310, equal to an incidence rate of 1.93 per 1,000 civil population. The number of deaths from diphtheria certified during the year was 31, equal to a death-rate of 0.17 per 1,000 civil population and a case mortality of 9.1 per cent. of cases notified. Other statistical facts will be found on pages 15-17. Of the notified cases of diphtheria, 370 (or 92.7 per cent.) were removed to hospital as follows:— To Metropolitan Asylums Board Hospitals 367 Other Hospitals 3 370 Return Cases.—(Definition: A case of diphtheria occurring within 28 days of the return from hospital to the same house of a previous case of diphtheria). There were 4 such cases in 1918, occurring in 4 houses, and in each case in the same family as the (?) infecting case. In every instance the (?) infecting case bad rhinitis showing diphtheria bacilli. The intervals between the return of the (?) infecting case and the onset of the illness in the return case were respectively 7, 13, 15, and 21 days. There was a similar care occurring after an interval of 47 days, and in this also the (?) infecting case had rhinitis showing diphtheria bacilli. There was one instance also, in which a case of diphtheria occurred 3 days after the return from hospital to the same house (and in this instance, the same family) of a previous case of scarlet fever. The former case returned herself sickening for diphtheria and thus infected her sister. Nasal Diphtheria.—There is reason to believe that one of the causes of the spread of diphtheria is the existence of eases of rhinitis, generally characterised by nasal discharge with or without bleeding, excoriation in and about the nostrils, and sometimes "spottiness" of the face. The patients are not generally acutely ill, though frequently "out of sorts," and arc very commonly overlooked, either through not being brought to the notice of the doctor or being disregarded by him. A few of such cases have been notified by doctors, and the women Sanitary Inspectors have brought to the notice of the Medical Officer of Health any suspicious cases which they have discovered in investigating cases of diphtheria. They are sometimes found in association with cases of scarlet fever, and occur as the "infecting case" of return cases of scarlct fever or diphtheria. Where the clinical appearances have been bacteriologicallv confirmed the patients—nearly always children—have been isolated in hospital. 35 The following is a summary of the nasal cases known to have been discovered during 1918, and confirmed bacteriologically :— Discovered by Medical Practitioners and Hospitals 7 Swabs taken by Medical Officer of Health 13 Swabs taken at request of Medical Officer of Health 4 24 After-care of Cases of Diphtheria and Scarlet lever.— In continuation of last year's work, all children who have returned from hospital after diphtheria and scarlet fever have been visited by the women sanitary inspectors within about three months of their discharge. Those needing further treatment have been dealt with through existing facilities. The details of the work done are set out below:— Diphtheria. Cases notified, less revisions of diagnosis and deaths 309 Children visited for after-care 199 Children who appeared to have recovered satisfactorily 141 Children who required treatment 58 Of the 58 cases needing further treatment, 17 were treated at the St. Pancras Dispensary, 14 at hospitals (one afterwards going to a convalescent home), 11 by private doctors, and 11 others were taken away for convalescence. In 51 cases the visitors obtained some information as to the conditions for which treatment was required. They were as follows : Debility 22, cough or "chest trouble " 7, heart 3, rheumatism 4, throat and nose 9, ears 1, eyes 3, teeth 1, paralysis 1. Scarlet Fever. Cases notified, less revisions of diagnosis and deaths 282 Children visited for after-care 201 Children who appeared to have recovered satisfactorily 152 Children who required treatment 49 Of the 49 cases needing further treatment, 13 were treated at the St. Pancras Dispensary, 11 at hospitals, 14 by private doctors, and 10 others were taken away for convalescence. In 44 cases the visitors obtained some information as to the conditions for which treatment was required. They were as follows :—Debility 16, "chest trouble " 6, heart 1, rheumatism 4, throat 6, ears 6, kidney 2, abdominal and digestive 2, rash 1. TYPHOID FEVER. 17 cases (all civilian) were notified during 1917 as suffering from typhoid fever. Of these 6 proved not to be suffering from this disease, the number 36 of actual cases notified baing therefore 11, equal to an incidence rate of 0*06 per 1,000 civil population. Of the 11 cases, 5 died, the case mortality being 45.4 per cent. Other statistical facts will be found on pages 15-17. The 17 persons notified were treated as follows :— Cases notified. Not Typhoid. Diagnosis not contradicted. In hospitals of the M.A.B. 6 4 2 In other hospitals 9 2 7 In their own homes 2 — 2 The cases were all in different homes, except that one ease in January followed previous cases in the same family at the end of 1917. In two cases the patients developed the illness in other parts of the country, arriving in London already ill, and in two other cases the infection was contracted while away on holiday and developed after returning to London. In the latter two cases shellfish (oysters, mussels, and cockles) had been eaten and might have been the source of infection. In the other six cases no source of infection was traced. Of these six one was a hospital nurse (one of the cases developed out of London was also a sick nurse); in two cases the diagnosis was somewhat doubtful and not bacteriologically confirmed; and one case, where there was a history of the illness beginning with abdominal pains and nausea following the eating of some sausages on the same day, gave a positive agglutinin reaction 1 in 200 with B. paratyphosus B, 1 in 50 with B. typhosus, and negative with B. paratyphosus A. ACUTE ANTERIOR POLIOMYELITIS. Only one case of this disease was notified in 1918. The patient was a girl aged 3½ (Ward 1, District N. 2), onset 25th August, notified 10th October. The case was wrongly diagnosed as post-diphtheritic paralysis in the first place. The paralysis affected both legs, especially the right leg from the knee downwards, where it still persists. The patient was treated in a Metropolitan Asylums Board Hospital. EPIDEMIC CEREBROSPINAL MENINGITIS. There was a reduction in the number of cases of this disease notified during 1918 as compared with 1915, 1916, and 1917, when it was unusually prevalent, the numbers, however, still remaining higher than normal. The mortality amongst the notified cases was very great, only one recovering. 13 cases were notified as suffering from the disease, but 4 were found to be wrongly diagnosed, so that the total number of actual cases reported during the year (all civilian) was 9, equal to an incidence rate of 0.05 per 1,000 civil population. The corrected number of cases for 19l7, 1916, and 1915 were 21, 20, and 37 respectively. Of the 9 cases, 8 died, making a case mortality of 88.9 per cent. There was one other death of a case notified during 1917, so that the number of deaths for the year was 9, equal to a death-rate of 0 05 per 1000 (civil) population. sr The number of deaths for 1918,1917, 1916, and 1916 were 9, 16, 12 and 24 respectively, and the case mortality 89, 76, 60, and 55 per cent. respectively (some of the deaths were "inward transfers," not affecting the mortality amongst notified cases). The case that recovered lost one eye in the illness. One case took its onset in January, 2 in February, 2 in March, 2 in May, and 2 in June. The duration of illness in the 8 fatal cases was as follows: —Under 1 day, 1 day, 2 days, 4 days, 8 days, about 3 weeks, 50 days, and 58 days. Five of the cases were in males (4 fatftl), and 4 in females (all fatal). One of the cases was under 1 year of age (fatal), two between 1 and 2 (one fatal) one between 3 and 4, four between 8 and 15, and one l(i (all fatal). In all the cases the meningococsus was identified; in 5 cases (2 culturally) during life, and in the other 4 postmortem (one culturally). In two of the cases the meningitis appeared postmortem to be confined to the spinal cord. No connection between the cases and no source of infection was traced, and in no instance was there more than one case in a house. The first six cases were all in the more southern part of the borough, and the last three cases all in the more northern part, but the cases were geographically well scattered one from the other. All the patients were of the working class. One case was treated in a Metropolitan Asylums Board hospital, 5 in general hospi als and 3 at home. ENCEPHALITIS LETHARGICA. During 1918 cases of an obscure disease, with cerebral symptoms of a lethargic nature and other characteristic signs, were described in various parts of the country. It was at first suggested that they were of a similar nature to the rare cases of food poisoning known under the name of Botulism, but the disease was finally regarded as a definite clinical entity, to which was given the name of epidemic lethargic encephalitis. It was not made notifiable until January 1st, 1919, but during 1918 five St. Pan eras cases, which were probably instances of the disease, and took their onset in February, March, April, and May (2), were reported to the Medical Officer of Health. MEASLES AND GERMAN MEASLES. All cases of these diseases 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 constituting a new outbreak. Subject to correction for diagnosis in certain instances, 2,144 civil cases of measles, and 311 of german measles were notified or otherwise discovered in 1918. This represents an incidence rate of 12.2 per 1,000 civil population for measles and 1.7 for german measles. 75 deaths from measles were registered during the year, equal to a deathrate of 0.43 per 1,000 civil population, and a case mortality rate of 3.5 per cent. amongst notified cases. There were no deaths from german measles. 38 The cases wore notified or reported as follows : — Measles, German measles. Notified by medical practitioners 1508 256 „ parents and guardians 300 29 Discovered otherwise 336 26 2144 311 Further statistical facts in regard to the cases will be found on pages 15-17. Practically every case has been visited without delay by one of the women visitors. In September an additional health visitor was engaged especially for the visiting of cases of measles. In every case, also, a card of advice and a printed postcard form of notification (unstamped) have been delivered to the parent. By reason of facilities placed at the disposal of the Medical Officer of Health by the Mayoress' Nursing Fund for Sick Poor Children it has been possible to send a visiting nurse once or twice a day to all cases where the visitor reported that such help was necessary, and where arrangements were not made for the removal of the patient to hospital. Milk, eggs, and coal were also paid for out of the fund in certain cases. In the course of this work 3(50 cases of measles in 282 families were nursed during the year, 1,086 nursing visits being made. In 196 families the patients were supplied with milk, &c. In the following table are set out the deaths and death-rates from measles for the past 10 years for the whole borough and the four registration subdistricts. Year, Deaths. Rate per 1,000 population. West. south. East. 'North. No address Whole Borough West. South. East. North. Whole Borough 1908 9 13 5 19 .. 46 014 0.23 008 0.31 019 1909 30 9 30 33 .. 102 0.48 016 0.50 I 0.55 0.43 1910 39 21 60 23 .. 143 0.65 0.37 1.00 0.38 0.60 1911 26 28 19 40 .. 113 0.42 0.50 0.32 0'68 0.47 1912 25 11 33 25 .. 94 0.41 0.24 0 58 1 0.43 0.42 1913 8 5 6 17 .. 36 0.13 0.10 0.10 0.29 0.16 1914 10 10 21 12 .. 53 0.17 0.22 0 56 0.19 0.24 1915 20 14 14 15 .. 63 0.34 031 0.24 0.26 0.29 1916 12 6 8 16 .. 49 0.20 0.13 0.14 0.28 0.19 1917 35 17 32 33 1 118 0.60 0.38 0.56 0.57 0.54* 1918 15 7 25 27 1 75 0.25 0.15 0.43 0.47 0.34* * Based on census population. Of the 75 deaths, 16 were in children under one year of age, and 70 in children under five years of age, 39 ANTHRAX. One case of Anthrax (fatal) was notified during 1918. The patient lived in a Rowton House in St. Panoras, and worked at a wharf in the City. The illness began as a pimple on the face, and the patient attended at Guy's Hospital for the first time on April 4th, when the place then had a black centre and a large red indurated zone around, and was considered to be about three days old. Death took place on April 6th, and an inquest was held at the Southwark Coroner's Court. The diagnosis was bacteriologically confirmed, The infection was probably contracted in the course of the man's work, which was; at a Thames-side wharf in the City where Siberian horse hair was being handled. OTHER NOTIFIABLE INFECTIOUS DISEASES. No cases of smallpox, typhus, cholera, plague or human glanders or hydrophobia were reported in St. Pancras during the year. As usual, persons who had been in contact with smallpox and other exotic diseases (mostly on shipboard) were reported and were kept under observation, with negative results in all cases. A number of soldiers were reported as having returned to St. Pancras after suffering from dysentery, enteric, and malaria. No cases of these diseases were caused by their return. INFLUENZA. The year 1918 was characterised by the occurrence of a world-wide wave of influenza, in which St. Pancras was involved with the rest of London. Since the influenzal prevalence of 1890-1900 the disease had been comparatively quiescent, as will be seen from the following table showing the yearly number of St. Pancras deathsfrom the disease asfar back as our records extend: — Year. Influenza Deaths. Year, Influenza Deaths. Year Influenza Deaths. 1857 7 1878 l 1899 70 1858 3 J 879 1 1900 140 1859 3 1880 0 1901 25 1860 2 1881 0 1902 51 1861 4 1882 0 1903 22 1862 1 1883 1 1904 22 1863 1 1884 2 1905 14 1864 5 1885 0 1906 44 1865 1 1886 0 1907 36 1866 3 1887 0 1908 75 1867 3 1888 0 1909 61 1868 1 1889 1 1910 20 1869 1 1890 34 1911 15 1870 4 1891 171 1912 14 1871 3 1892 153 1913 42 1872 4 1893 69 1914 15 1873 1 1894 49 1915 35 1874 0 1895 115 1916 35 1875 0 1896 20 1917 21 1876 0 1897 29 1918 700 1877 0 1898 83 40 The only statistical records of the progress of the disease during the yoar are the weekly returns of death, and in the following table these are set out for influenza (and certain other causes of death which are apt to increase with that disease) for 1918 and part of 1919:— Week No. Week ended Influenza. Diseases of Heart. Bronchitis. Pneumonia. Pulmonary Tuberculosis. Week No. Week ended Influenza. Diseases of Heait. Bronchitis. Pneumonia. Pulmonary Tuberculosis. 1918 1918 1919 1919 1 Jan. 5 13 8 9 5 1 Jan. 4 1 9 4 2 6 2 ,,12 — 14 8 5 12 2 „ 11 3 9 3 — 11 3 v 19 — 12 6 13 10 3 „ 18 2 3 6 1 5 4 ,, 26 — 12 — 8 7 4 ,, 25 1 12 6 7 4 5 Feb. 2 1 10 2 3 6 5 Feb. 1 4 12 10 8 4 6 ,, 9 1 10 7 3 5 6 „ 8 ... 6 7 11 6 7 7 „ 16 — 6 4 4 4 7 „ 15 22 11 24 11 11 8 ,, 28 — 5 4 4 10 8 ,, 22 40 13 31 26 6 9 Mar. 2 — 11 3 4 7 9 Mar 1 52 7 27 18 8 10 ,, 9 — 8 6 11 6 10 „ 8 30 9 11 5 4 11 ,, 16 — 7 6 9 4 11 „ 15 33 13 14 8 3 12 „ 23 — 6 10 6 6 12 22 12 9 12 6 5 13 „ 30 — 5 5 3 9 13 „ 29 7 14 7 2 6 14 April 6 — 5 5 4 9 14 April 5 4 5 6 1 3 15 ,, 13 — 4 5 14 8 15 „ 12 6 9 5 1 5 16 „ 20 — 11 4 8 7 16 ,, 19 4 13 5 1 5 17 ,, 27 1 11 3 4 6 17 „ 26 3 3 3 3 8 18 May 4 — 8 1 5 5 IS May 3 5 7 4 4 5 19 ,, 11 — 5 3 4 5 19 „ 10 2 6 5 2 6 20 „ 18 — 11 1 3 9 20 „ 17 1 6 2 3 6 21 „ 25 — 9 4 2 10 21 „ 24 1 4 2 — 5 22 June 1 — 3 2 2 6 22 „ 31 1 5 2 1 3 23 „ 8 — 5 1 5 10 23 J une 7 — 11 — 2 7 24 „ 15 — 3 2 3 7 24 „ 14 — 4 2 1 4 25 22 — 6 4 4 11 25 „ 21 1 6 2 1 1 26 „ 29 2 7 2 7 5 26 ,, 28 — 6 — — 5 27 July 6 8 8 3 2 13 28 „ 13 21 5 1 11 9 29 „ 20 8 7 2 9 4 30 ,, 27 6 7 2 5 9 31 Aug. 3 1 6 2 2 2 32 „ 10 1 4 2 3 10 33 ,, 17 2 7 — 1 1 34 ,, 24 — 3 — 2 6 35 „ 31 3 4 1 1 2 36 Sept. 7 3 4 1 5 3 37 „ 14 3 5 1 — 5 38 ,, 21 — 7 1 3 9 39 28 2 3 1 5 8 40 Oct. 5 3 7 5 6 3 41 „ 12 10 3 5 10 2 42 „ 19 31 13 6 15 12 43 „ 26 99 12 15 28 12 44 Nov. 2 144 17 12 19 12 45 „ 9 111 10 10 20 13 46 „ 16 71 7 15 15 19 47 „ 23 49 10 10 10 13 48 „ 30 46 9 7 17 12 49 Dec. 7 34 5 13 11 4 50 „ 14 16 7 6 3 10 51 „ 21 9 8 6 6 7 62 ,, 28 10 3 4 5 14 The figures given in the above two tables are shown graphically in the attached charts. Deaths from Influenza are indicated by the thick line Deaths from Diseases of the Heart, Bronchitis, Pneumonia and Pulmonary Tuberculosis are indicated by the thin line 41 It will be seen that there were three distinct waves of the disease. The first began during the :26th week (ended June 29th), reached its maximum in the 28th week, and aft rwards declined. The second wave was very much greater. It had definitely begun during the 41st week (ended October 12th), and reached its height in the 44th week (ended November 2nd), when there were no fewer than 144 deaths from influenza, and then, slowly declined until, in January, 1919, the mortality was small. It began to rise again in the 5th week of 1919 (ended February 1st), and reached a maximum in the 9th week (ended March 1st), practically disappearing by the end of April (18th week), since which date there has been no recrudescence up to October. The third wave was less severe than the second. In regard to whether the disease is likely to increase again seriously in the near future, it should be noticed that in the outbreak of the "nineties," the abnormal mortality from influenza continued for several years, and was almost as great in 1895 and 1900 as in 1891 and 1^92. In the following table the total deaths from influenza, from the week ended October 5tb, 1918, to the week ended May 3rd, 1919 (the second and third waves), are classified according to age and sex. Age period Second Wave (Oct. 5,1918—Jan. 25,1919) Third Wave (Feb. 1—May 3, 1919) Total Deaths M. F. M. F. M. F. 0—1 12 5 6 2 18 7 1—2 6 13 4 1 10 14 2—5 24 18 3 3 27 21 5—10 27 13 2 5 29 18 10—15 13 19 0 1 13 20 15—25 45 65 7 10 52 75 25—35 53 98 18 35 71 133 35—45 40 37 19 14 59 51 45—55 33 24 19 11 52 35 55—65 31 13 22 15 53 28 65—75 23 17 12 11 35 28 75—85 11 0 2 6 13 6 85 and upwards 0 0 0 0 0 0 Total 318 322 114 114 4S2 436 The table shows that the disease was most fatal amongst young adults, the age period 25—35 furnishing the highest number of deaths. The mortality at all ages amongst the sexes was equal, but at the ages 15 — 35 was higher amongst females than males. 42 A record was kopt of certain points in connection with 280 fatal oases, which werj visited in the October and November (second outbreak), whereby the following facts were observed. The duration of the illness (from onset to death), was given as follows, showing the commonest duration in fatal cases to have been about a week:— I day 3 cases 8 davs 31 cases. 2 davs 4 „ 9 „ 9 „ 3 „ 5 „ 10 „ 11 „ 4 „ 9 „ 11 „ 11 „ 5 „ 17 „ 12 „ 9 „ 6 „ 1/5 „ 13 „ 7 „ 7 „ 28 „ 14 „ 13 „ Over 14 days 21 „ In 94 out of 207 instances visited, the fatal case was the first of influenza in the household, and, in only 19 of these 94 primary cases was the probable source of infection known. With regard to the suggestion as to a connection between cinematograph enter!ainments and the disease, it was found that there was a history ot having attended a "cinema" recently in only 15 cases whereas in 148 cases there was no such history. In regard to the patient's previous state of health, it is noteworthy that amongst 216 fatal cases, the patient was said to have been of ordinarily strong constitution in 98 cases, while in 100 instances a statement of bad health prior to the illness was given, in addition to 18 cases where the patient was over 60 years of age. Inquiries were made as to difficulty previously experienced by the deceased in obtaining sufficient suitable food, and such deprivation was stated to have occurred in only 10 out of 181 cases. As to the treatment available for the patient, amongst 208 cases, the patient was removed to hospital in 61 instances, was attended by a visiting nurse in 16, and was nursed by friends only in 131. It should be borne in mind that these were all fatal cases. In 11 cases it was noted that the attention had been obviously insufficient. During the outbreak the following notice of advice was placarded throughout the borough, and distributed as handbills. One of the latter was given to evary school child to take home to his (or her) parents:— Metropolitan Borough of St. Pancras. INFLUENZA. Prevention. Persons suffering from any kind of cough, cold or fever should stay at home for a few days and until all symptoms have abated, and shotdd not go to their workshop, office or school, or elsewhere where they are likely to spread the complaint. 43 Persons in charge of these places should forbid the attendance of' such sufferers, and their exclusion should be insisted on by their fellow-workers. Coughing and sneezing without protecting the mouth spreads the disease to others. The mouth should be covered with a handkerchief, which should be afterwards boiled or, if of paper, burnt. Indiscriminate spitting is a danger to the public health. Sick persons and old people should especially be protected from exposure to influenza. Avoid overcrowding in dwellings, or in badly ventilated places of assembly and amusement. Keep your living and sleeping rooms constantly flushed with fresh air when in use, and wear suflicient warm clothing. Over-fatigue and mental strain, and still more alcoholic excess increase the risk of influenza, and of a fatal result. It is recommended, when influenza is prevalent (not otherwise) that the throat be gargled night and morning with the following lotion, which should also be poured into the palm of the washed hand, snuffed up through the nostrils, and spat out from the mouth. THE LOTION:— Dissolve a salt-spoonful of common salt in half a tumbler of warm water and colour it a light purple by adding a sufficient quantity of solution of permanganate of potash in water. It is also a useful preventative to breathe in through the nose the fumes from Formalin (which can be obtained from any chemist) a few drops on the handkerchief, several times a day, or after exposure to possible infection. Treatment. Many deaths from influenza would be prevented if the patients would go to bed FROM THE VERY FIRST. Do not get up until all fever has gone and symptoms have abattd. Avoid chill or over-exertion during convalescence. 1 hese precautions tend to prevent the pneumonia and other complications which are so fatal. During the catarrhal stage douching of the nose, throat and mouth with the following lotion is also useful. THE LOTION;—Dissolve a salt - spoonful each of common salt, bicarbonate of soda and borax in half a tumbler of warm water. Call in a doctor if the patient is really ill. Town Hall, Pancras Road, N.W. 1. T. SHAD1CK HIGGINS, Medical Officer of Health. Copies of this handbill can be obtained for personal use or for distribution on application at the Public Health Department, Town Hall, Pancras Road, N.W. i, where application should also be made in cases of nursing or domestic difficulty arising from influenza. 44 Cinematograph Theatres, In view of the prevalence of Influenza, the Local Government Board framed the Public Health (Influenza) Regulations, 1918, which came into operation on November 25th. As amended, their principal effect was to prohibit the continuance of any kind of entertainment, though affecting chiefly "cinemas" where the performance is continuous, for a longer period than 4 hours, and to require between the performances an interval of not less than 30 minutes, during which the hall must be thoroughly ventilated. The sanitary authority however, were enabled to relax the conditions generally, or for any particular hall, if advised by their Medical Officer of Health that this could safely be done. The Regulations were rescinded on May 6th, 1919. Relaxation of the Regulations during a part of the epidemic was granted in the case of 5 of the "cinema" halls in use in St. Pancras. These were halls which were well ventilated mechanically, and the relaxation was granted on condition that the premises were kept sufficiently ventilated throughout the performance. WHOOPING COUGH. In the following table will be found the deaths and death-rates from whooping cough for the past ten years for the whole borough 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 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 0.11 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 10 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 1917 6 3 10 8 .. 27 0.10 0.07 0.17 0.14 0.12* 1918 19 11 26 22 2 80 0.32 0.24 0.45 0.38 036* 45 The same facilities, as in the case of Measles (see page 38), are available for the home.nursing of cases of "Whooping Cough, through the Mayoress' Nursing Fund, but, the disease not being notifiable, fewer cases are brought to the notice of the department. In 1918, the visiting nurses paid 99 nursing visits to 21 patients in 16 families, and milk, etc., were supplied patients in 11 families. DIARRHOEA AND ENTERITIS. 56 deaths from diarrhoea and enteritis were registered during 1918, equal to a death-rate of 0.28 per 1,000 population. Of these, 47 were in children under five years of age, and 37 in babies under one. Reference is made on page 27 to infantile diarrhoea. SYPHILIS. In the following table are given the age and sex distribution of deaths certified during 1918 as duo to (a) declared syphilis, (b) locomotor ataxy and general paralysis of the insane, which are believed by most experts to be late manifestations of the disease, and (c) aortic aneurysm, which many authorities now consider to be at any rate frequent.lv caused by it:— 0-1 0-5 1 5-15 15 25 25—35 35—45 45—55 55—65 65—75 75—S5 85 up. Total Males. 0-1 1-5 5-15 15—25 25 -35 35-45 45-55 1 55-65 65—75 75—85 85 up. Total Females. Total Persons. Syphilis 9 1 — 1 — 1 — — — — _ 12 4 — — — — — — 1 — — — 5 17 Locomotor ataxy — — — — — 1 1 1 1 — — 4 — — — — — — — — — — — — 4 General paralysis of the insane — — — 1 1 6 1 1 — 10 — — — — 1 2 — _ 3 13 Aortic aneurysm — — — — — 1 3 2 — — — 6 — — — — — 1 1 — — — — 2 8 CANCER. 269 deaths were registered during 1918 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 1.37 per 1,000 population, and 1.53 per 1,000 civil population. The sex distribution of the deaths and death-rates is shown in the following table:— Sex. No. of Dgatlis. Death-rates per 1,000 males or females living (based on 1911 Census). Males 125 1.17 Females 144 1.29 Both Sexett 269 1.23 46 DWELLING HOUSES. In previous annual reports, reference has been made to the need for improvement in the housing conditions in many parts of the Borough. Following upon the armistice in November, 1918, the housing difficulties were greatly increased by the lack of a sufficient number of dwellings, which began to be felt throughout London. A Special (Housing) Sub-Committee was constituted by the Borough Council on December I8th, 1918, consisting of six members of the Parliamentary and General Purposes Committee, and six of the Public Health Committee. The work of this Committee belongs properly to the period after the end of 1918, and will not be further referred to here. Inspection of Dweli.ing-houses. The inspections of dwelling houses made during the year will be seen in table 5 on page 70, 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 Booms. During the year letters were sent in respect of 3 underground rooms (in 3 houses) which did not comply with the requirements of the Housing, Town Planning, etc., Act, 1909, and the regulations made thereunder. No closing orders in respect of underground rooms were made. In addition 5 intimation notices were served in regard to underground rooms illegally occupied as dwellings. Houses unfit for Human Habitation. One house (15, Ferdinand Street), was represented during 1918 as unfit and a Closing Order was made by the Council in respect thereof on May 29th. In accordance with the Housing (Inspection of District) Regulations, 1910, the following table is submitted for the year 1918:— The number of dwelling-houses inspected under and for the purposes of Section 17— Totals. First routine inspections 573 Subsequent „ 1362 1935 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 (3 rooms) 3 4 The number of representations made with a view to the making of closing orders— As regards the whole house 1 „ underground rooms — — 1 47 Totals. The number of closing orders made— As regards the whole house 1 „ underground rooms — 1 The number of dwelling-houses, the defects in which were remedied without the making of closing orders 1934 The number of dwelling-houses which, after the making of closing orders, were put into a fit state for human habitation 1 Inhabited House Duty. Applications for certificates under Section 11 of the Inland Revenue Act, 1903, were received during 1918 in respect of 8 houses comprising 58 tenements. In 3 cases (38 tenements) the applications were granted, and in 5 cases (20 tenements) refused. Certificates were also given in respect of 3 houses (0 tenements) for which application was made in 1917. Canal Boats Acts. During the year Inspector Auger inspected 6 boats, registered to carry 17 adults and 4 children and actually carrying 13 adults and 6 children. 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 and bakehouses 693 130 — Workshops (including workshop laundries and bakehouses 1085 168 — Workplaces (other than Outworkers' premises included in Part 3 of this Report) 159 16 — Total 1937 314 — 48 2.—Defects Found. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.JVi. Inspectors. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts*:— Want of cleanliness 78 78 Want of ventilation 1 1 Overcrowding — — Want of drainu pre of floors 4 4 Other nuisances 90 88 Sanitary accommodation Insufficient1 7 1 Unsuitable or defective 55 54 , Not separate for sexes 5 5 Nil 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) 69 69 Other offences 1 Excluding offences relating to outwork which are included in Part 3 of this Report) 5 5 Total 314 311 — — * Including those specified in sections 2, 3, 7 & 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health A.cts. 3.—Home Work. The only matter to report under this heading is the receipt of the following lists of outworkers for employers sending twice in the year:—19 in respect of the making, etc., of wearing apparel, comprising the name of 21 out-workers (contractors) and 73 outworkers (workmen), and 1 in respect of brushmaking, containing the name of 1 outworker (contractor). 49 4.—REGISTBKKD WORKSHOP. Workshops on the Register (Sec. 131) at^the end of the year. Nuinbers. (1) (2) Bakehouses 140 Restaurant kitchens 420 Laundries 35 Domestic workshops — Other workshops whore women arc employed 332 Other workshops 767 Total number of workshops on Register 1694 5.—Other Matters. Class Number (l) (2) Matters notified to H.M. Inspectors of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) — Action taken in matters referred by H.M. Inspector as remedi- Notified by H.M. Inspector able under the Public Health Reports (of action taken) 9 Acts, but not under the Factory 1 sent to H.M. Inspector and Workshop Act (s. 5) 9 Other — Underground bakehouses (s. 101):— Certificates granted during the year — In use at the end of the year 75 50 The number of factories, workshops and workplaces added to and removed from the register during 1918 was as follows:— Added to register. Removed from register. Bakehouses— Workshop 0 1 Factory 0 0 Laundries— Workshop 0 0 Factory 0 0 Restaurant kitchens 35 0 Other workshops and workplaces 42 5 Other factories 34 2 The number of inspections that were made during 101S were as follows:— Factory and Workshop Inspector. Woman Sanitary Inspector. Total. Inspections. Re-inspections. Inspections. He-inspections. Inspections. Rc- inspections. Bakehouses 348 279 — — 348 279 Restaurant kitchens 15 5 21 — 36 5 Laundries 4 3 — — 4 3 Domestic workshops — — — — — — Other workshops 443 145 1 — 444 145 Other workplaces 47 71 — 47 71 Other factories 281 268 5 — 286 268 Total 1138 771 27 — 1165 771 Bakehouses.—At the end of the year there were 174 bakehouses oil the register including 34 factory bakehouses. 127 of these were underground bakehouses, of which 52 were unoccupied. Restaurant Kitchens.—At the end of 191S, 120 restaurant kitchens were on the register. 51 INSPECTION OF FOOD AND FOOD-PLACES. Sale of Food and Drugs Acts. 750 samples have been taken under these Acts, and 685 of these proved to be genuine and 65, or 8.7 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. Brawn 5 4 1 Butter 52 51 1 Cocoa 52 52 — Cocoa Butter 1 1 — Corned Beef 7 7 — Dripping 14 13 1 Fish Paste 5 4 1 Flour, Self-Raising 66 65 1 Galantine 1 — 1 Jam 5 5 — Lard 2 2 — Margarine 8 8 — Milk 448 398 50 ,, Condensed 4 3 1 ,, Evaporated 4 4 — „ Manufactured 1 — 1 Mustard 18 17 1 Oatmeal 3 3 — Ox Tongue 1 1 — Pepper 24 24 — Salad Oil 3 3 — Sausages 9 7 2 Tablets, Aspirin 1 1 — „ Formalin 2 — 2 „ Indigestion 4 2 2 Veal Loaf 1 1 — Vinegar 9 9 — Total 750 685 65 The 750 include 3 informal samples of bntter, 1 of milk, and 1 of SelfRaising Flour. Prosecutions were undertaken in respect of 46 of the 65 formal samples which were reported as being adulterated. These are set out in tho following table 52 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. 1918. £ s. d. £ s. d. A. 14 Milk Added water, 6.7 per cent. 22nd Feb. 2 0 0 1 1 0 C. 15 " Deficient in milk fat, 7.3 per cent. 15th March Summons withdrawn A. 42 7.0 22nd ,, Summons dismissed A. 36 Flour (Selfraising) Flour, other than self-raising flour 22nd ,, Warranty proved 0 10 0 0 10 6 C. 54 Milk Added water, 46.2 per cent. 12tli April . 10 0 0 0 10 6 C. 55 " 12.2 12th ,, 2 0 0 0 10 6 A. 85 " 10.7 12th ,, Summons dismissed Warrant y proved C. 62 " Deficient in milk fat, 7.0 per cent 12th „ .. Dit to A. 96 " Added water, 10.2 per cent. 26th ,, 1 0 0 — A. 108 " ,, 5.4 „ 3rd May .. Summons dismissed Warranty proved A. 109 " 6.3 3rd „ Dit to C. 95 " Deficient in milk fat, 8.0 per cent. 10th „ — 2 2 0 C. 122 " Added water, 9.5 per cent. 14th June 1 0 0 0 10 6 G. 139 " 12.3 „ 14th „ 0 10 0 0 10 6 C. 140 " 1.55 14th ,, 0 10 0 0 10 6 C. 138 " Deficient in milk fat, 10.6 per cent. 14th „ Summons dismissed Warrant y provided A. 166 " 10.3 „ 28th „ 0 10 0 0 10 6 A. 169 " 6.6 19th ,, Summons withdrawn C. 148 " Added water, 6.5 per cent. 21st ,, 1 0 0 0 10 6 C. 167 " " 6.1 „ 28th „ Summons dismissed Warrant y proved C. 158 " 5.0 28th Dit to A. 195 Deficient in milk fat. 26.6 per cent. 26th July — 2 2 0 A. 198 7.6 26th ,, 0 15 0 1 1 0 A. 212 Mustard Added starch, 12 per cent. 2nd August 2 0 0 0 10 6 C. 167 Milk Deficient in milk fat, 6 per cent. 19th July Summons dismissed Warrant y proved C. 173 " „ 13.3 19th „ 5 0 0 0 10 6 A. 238 " 8.6 16th „ — 0 12 6 A. 241 " 10.6 23rd — 0 10 6 A. 245 " Added water, 6.2 per cent. 17th ., 2 0 0 0 10 6 A. 251 " 5.8 ,, 23rd 8 0 0 0 10 6 C. 221 " Deficient in milk fat, 23.3 per cent. 23rd ,, 2 0 0 0 10 6 C. 203 26.6 23rd ,, 2 0 0 0 10 6 C. 253 "" Added water, 12.9 per cenl. 25th Oct 1 0 0 0 10 6 A. 276 " 21.7 15th Nov. 1919. 5 0 0 2 2 0 A. 324 9.7 10th Jan. 0 10 0 1 1 0 A. 330 " 11.7 17th Summons dismissed A. 339 Condensed Milk Deficient in milk fat .61 per cent. 17th 1918 15 0 0 0 10 6 C. 308 Milk 21.0 „ 20tli Dec. 6 0 0 2 2 0 0. 326 " Added water, 11.8 per cent. 20th ,, 8 0 0 3 3 0 0. 327 " 17.6 20th 8 0 0 — C. 328 " 18.0 20th 3 0 0 A. 341 tured Milk 18.2 24th 2 10 0 A. 34 Milk 9.1 „ 24th 1919 Summons dismissed Warrant v proved C. 333 " 5.5 ,, 17th Jan. 15 0 0 0 in 6 C. 371 " 15.5 13th Feb. Summons dismissed 2 2 0 C. 373 " „ 15.5 13th „ 0 10 0 2 2 0 53 Public Health (Milk and Cream) Regulations, 1912. The following is a report of the work done under the regulations during the year ended 30th December, 1918:— 448 samples of milk were taken, and in no cases were preservatives reported to be present. No other contraventions of the regulations were discovered. Inspection ob1 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. No seizures of unsound food were made during 1918. On 91 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 1918 four licensed cowsheds in the Porough. Ihese are registered for 96 cows. Milkshops and Dairies.—16 applications for registration under the Dairies, Cowsheds, and Milkshops Orders were considered during 1918. They were all acceded to. 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 1917 223 Deduct No. of purveyors removed from register during 1918 2-') Add No. of purveyors added to register by resolution of Council during 1918 16 No. of purveyors of milk at retail milkshops on register at end of 1918 214 At the end of 1918 there were on the register in addition to these 214 retail milkshops and 4 cowsheds (which are attached to retail milkshops included in the 214), 2 persons in respect of premises where only a wholesale milk trade is done, and 3 itinerant vendors without milkshops. Legal Proceedings.—No prosecutions were undertaken in respect of the sale of milk by unregistered persons. Ice-Cream Premises. 49 visits were paid to these premises by the food inspectors during 1918. No legal proceedings were taken in respect of the manufacture or sale of jce cream. 54 Fried Fish and Fish Curing Premises. At the end of 1918 there were 49 fried fish vendors' premises in the borough, at 2 of Which fish curing was also carried on. There were 14 fish curers' premises, including these two. 107 visits were made by the food inspectors to these premises during the year. A large number of these premises are cot in compliance with the by-laws as regards the structure of their premises and apparatus, but as practically all of thein have been in use for some years they are exempt from the operations of the by-laws in this respect. Other Food Premises. The number of inspections made of butchers' and fishmongers' shops, premises where prepared meats (such as sausages, pies, tripe, cooked meat, &c.) are made, marketing places, &c., will be found in table 6 on page 71. Bakehouses and restaurant kitchens are referred to under the heading of Workshops (see pages 70 and 73.) Slaughter-Houses. There were 10 licensed slaughter-houses in the borough at the end of 1918. 153 visits to slaughter-houses were made by the food inspectors during the year. The Rag Flock Act, 1911 No samples were taken under this Act during 1918. GENERAL SANITARY WORK. In this section reference is made to sanitary work carried out during the year by the staff. Some of this is mentioned in the foregoing parts of the report. Total Inspections. Altogether 53,346 inspections, including 8,465 Food Control inspections, were made during 1918 by the staff of Inspectors. These consisted of 33,595 inspections, including 8,352 Food Control inspections and 19,751 reinspections, including 113 Food Control re-inspections. Of these inspections 27,069 were made by the District Inspectors, 2,937 by the Factories and Workshops Inspector, 7,358 by the Inspectors of Food and Food-places, and 15,982 by the Women Inspectors and Visitors. The inspections actually made by each individual Inspector are shown in table 8 on page 74. The work of the District Inspectors, Factories and Workshops Inspector, Women Inspectors, and Food Inspectors is set out in detail in tables 5 1o 8 on pages 70 to 74. •« The work of the paid workers at the Maternity and Child Welfare Centres is set out on pages 2l and 22. 55 Intimation Notices. 2,307 intimation notices (comprising 4,74-H items) were served by the Sanitary Inspectors during 1918. These were made up as follows — District Inspectors. Factory & VVorksbop Inspector. Temporary Women Inspectors. Total. In respect of Nuisances 2860 40 482 3382 In respect of Breaches of the Tenement House By-laws 241 1 242 In respect of Breaches of Statutes in Factories, Workshops and Workplaces _ 293 _ 293 In respect of other Breaches of Statutes and By-laws 717 8 101 826 3818 341 584 4743 These intimation notices are classified in tables 9, 10, 11 & 12 on pages 70 and 76. Summonses. The following prosecutions were undertaken in respcct of general Sanitary work:— Under the Public Health (Loudon) Act, 1891 (except in respect of Food). Situation of Property. Offence. Date of Hearing of Summons. Result of Proceedings. 17, Clarence Gardens Failing to remedy dampness, repair ceiling, and cleanse and repair staircase 1918. March 1st Summons withdrawn, costs £2 2s. 62, Hampstead Road Drain defective Apr. 15th and May 27th Summons dismissed 34, Drummond Crescent Roof defective Sept. 20th , 83, Euston Street Rooms dirty and roof defective .. " 7, Little Drummond St Rooms dirty, roof and guttering defective " Summons withdrawn, 35, Drummond Crescent Ceiling dirty, washhouse walls dirty and roof defective " costs £2 2s, 1, Hawley Mews Roof and drain defective " Abatement Order, costs £1 Is. 14, Tolmers Square Walls, ceilings, landing and anteroom dirty, roof to back addition and dust-bin defective " Abatement Order, 33, Inkerman Road Roof defective Oct. 4th costs £1 3s. 61, Marsden Street Rainwater pipe defective Summons withdrawn, 43, James Street Walls, ceiling, staircase, and passage dirty, rainwater pipe defective " costs £3 38. 18, Little Randolph Street Walls, room, passage and staircase dirty, ceilings, washhouse and addition roof defective Nov. 15th Fined 5s. Costs £2 is. 2, Win8combe Street Dustbin, Absence of Dec. 13th Fined £5. 56 Smoke-Prevention. During the year 22 observations of smoke shafts were made. There Wore no prosecutions. Regulated Trades. Off'ensive Trades.—There are two licensed premises for such trades in St. Pancras, viz., a tripe-dresser's in Kentish Town Road, and a tallow-nielter's in Tudor Place. 58 visits were paid to these premises, a number of these being spccial night observations of the tallow-melting premises, made in consequencc ot a complaint made to the Council under Sec. 21 of the Public Health (London) Act, 1891. Constructional Drain Work. The construction of, and repairs to, house drains are supervised by the sanitary inspectors. During the year the following work has been done under this heading:— First inspections. Consequent re-inspections. Drainage work done under notice 180 2186 Voluntary drainage work 679 1272 Drains of new buildings 6 244 865 3702 The tests which have been applied to drains during 1918 arc shown in the following table: — After Infectious Disease. Upon Complaint. Upon systematic Inspection Old Buildings. New Buildings at completion of work. Total. At commence ment of work. At completion of work. By Grenade. 1. Defects found — 20 — — 1 — 21 2. No result 3 50 — — 6 1 60 3. Total 3 70 — — 7 1 81 By Smoke. 1. Defects localised — — — — — — — 2. No result — — — — 1 — 1 3. Total — — — — 1 — 1 By Water. 1. Not found water-tight — — — — 12 2 14 2. Found water-tight... — — — 1 108 30 139 3. Total — — — 1 120 32 153 — 20 — — 13 2 35 Total 3 50 — 1 115 31 200 3 0 — 1 128 33 235 57 Dmiiiugc Register.—The following is an analysis of the Drainage Register during 1918:— Plans deposited—Old Buildings under Notice 46 „ „ —Old Buildings, Voluntary 55 ,, ,, — New Buildings and Additions 6 107 Applications without Plans 57 Total number of Applications and Plans 164 Water Service. The following notices have been received from the Metropolitan Water Board as to houses from which water has been cut off:— 1.—Demolition — 2. - Empty 3 3 — Leakage 7 4.— Non-payment of Bates 8 5.—No statement (Withdrawals) — 6.—By request 5 7.—Broken Supply Pipe 1 24 DISINFECTING- AND CLEANSING STATION. Disinfection. The work done during the year by the disinfecting staff is shown in thf following table:— Disease. No. of Cases. No. of Houses. No of Rooms Contents Disinfected or Destroyed. No. of Rooms Sprayed and Fumigated. Scarlet Fever 801 292 291 298 Diphtheria 369 866 363 367 Enteric Fever 16 16 16 5 Erysipelas 83 88 82 10 Puerperal Fever 8 8 7 2 Cerebro spinal Meningitis 18 13 18 16 Consumption 95 94 71 74 Measles 36 87 30 25 Cancer 81 31 29 16 Vermin aud Scabies 80 80 81 2 Other Diseases 127 126 118 44 Totals 1159 1146 1101 854 58 Below is shown the number of articles destroyed or disinfected during the year on account of infections disease and verininousnes-: — Infectious Disease Verminousnesk. Destroyed. Disinfected. Destroyed. Disinfested Beds, mattresses and palliasses 42 1346 4 38 Bolsters and pillows 19 2/30 1 53 Sheets, blankets and counterpanes 11 3776 2 438 Rugs, mats, cushions, carpets, covers, and curtains 11 G47 — 19 Wearing apparel 5 1743 — 93 Books — 2 — — Sundries 7 572 12 23 Total 95 10816 19 664 These figures include 381 blankets, rugs, covers, and 15 beds and mattresses, 21 bolsters, counterpanes and sheets, 19 covers and cushions, and 75 articles of wearing apparel and sundries which were disinfected on account of verminousness for the military authorities, or for voluntary bodies (such as the Salvation Army) 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. Femals, Children under 10. Diphtheria 1 — — Puerperal Fever — 2 — Measles 4 — — Cleansing Station. The amount of work done here during the year is indicated in the following table. The figuras 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 336 3 1095 *1434 Scabies 22 81 2190 22y3 Cases from outside St. Pancras Vermin 19 — 234 253 Scabies 8 9 982 999 Vermin 355 3 1329 1687 Scabies 30 90 3172 3292 Total 385 93 4501 4979 * Includes 123 males and 1 female who had no home address, 59 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, 1901, Sec. 36, and the Children Act, 1908, Sec. 122. A sum of one sbill ng per bath is paid by the County Council to the Borough Council, according to an agreement between the two Authorities, and 4422 baths were paid for on this scale during the year. 14 verminous persons from common lodging houses outside the borough were paid for by the London Co mty Council at the rate of Is. per attendance, PUBLIC MORTUARIES AND CORONER'S COURT. Number of bodies deposited in the General Mortuary during 1918 357 „ „ Infectious ,, ,, 5 Total 362 Inquests held durino 1918— In the Coroner's Court—General Cases 298 „ „ Poor Law ,, 33 Elsewhere in St. Pancras 42 Total 373 BACTERIOLO G1ICAL EX AMI NATIONS. 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. diphtheriae . . 188 61 127 „ sputum for B. tuberculosis 271 54 217 „ blood for Widal reaction (typhoid) 4 2 2 THE STAFF. At the beginning of 1918 the working staff of the department was deplete I by the absence of 4 male sanitary inspectors (Messrs. Lonnon, James, Adkins and Thompson) and 3 clerks (Messrs. Spokes, Mullis and Cove) serving with H. M. Forces, and through one other vacancy amongst the -unitary inspectors caused by death in 1914 not having Veen filled. Mr. Landen, sanitary inspector, was also away owing to illness from February 9th, 1918, onwards. Mr. James, sanitary inspector, returned to civil life and recommenced his duties on June 17th, 1918. 60 At the end of the year the normal staff of 15 male and one full-time and 2 half-time female sanitary inspectors was represented by 10 male and 3 fulltime and 2 half-time female sanitary inspectors. M iss M. Giles, health visitor and sanitary inspector, resigned on April 6th, 1918, ou appointment else a here, and Miss V. Blaxland was appointed in her place on May 30th, 1918. Miss J. Camman was appointed as an additional health-visitor for the visiting of cases of measles on September 11th, 1913. The health visitors in the department at the end of the year were 3 wholetime and 2 half-time. The health visitors attached to the maternity and child welfare centres and paid by the Borough Council are-referred to on page 19. Mr. R. Capel was appointed as temporary boy clork in July, 1918. ADMINISTRATION OF THE FOOD CONTROLLER'S ORDERS. The male Sanitary Inspectors have continued during 1918 to make the necessary inspections aud purchases of samples, under the supervision of the Medical Officer of Health as Enforcement Officer of the St. Tancraa Local Food Control Committee, for the purpose of securing the enforcement of these Orders. This work has been done mainly after ordinary working hours. The details arc set out in the following table:— 61 Inspections Made and Samples Taken under the Orders of the Food Controller, 1918. Samples. Mr. Rackham Mr. Brown. Mr. Dillon. Mr. A leers. j Mr. Walljer. Mr. Landen, Mr. James. Mr. affa. Mr. West. Mr. Auger. Mr. Child. All Inspections. In accordance with order. In contravention of order. Warning letters sent. No. of prosecutions. Result of Proceedings Fines. Costs. Ale _ — _ — — — — — — — 6 6 6 — — — £ s. d. £ s. d. Bacon — 42 38 44 10 — 2 18 1 — 5 185 176 9 6 3 14 2 0 8 8 0 Beans 28 30 76 33 41 4 40 82 — 334 33 2 2 1 1 5 0 0 2 2 0 Beer — — — — — — — — — 6 6 6 __ — — __ Bread — — — — 2 — — — — 104 5? 165 160 5 — 5 15 2 0 9 9 0 Butter 32 31 47 36 27 — 18 13 — — 204 201 3 3 — — Cake and Cake Alixlure — — 2 — — — — — — 1 1 4 3 1 2 10 0 0 7 11 0 Cheese 6 7 4 6 I — — —— — — — 24 22 2 1 1 — — 2 2 0 Cocoa 111 175 147 94 124 — 87 134 — 1 — 873 806 67 57 10 44 12 0 19 8 6 Cocoa Butter — — 1 8 2 — — 1 — 12 12 — — — — — Coffee 70 92 75 99 84 17 45 99 — — 581 485 96 65 31 84 7 6 48 11 0 Cocoanut — 1 — 2 — — — — — 7 2 — — — — — _ Corned and Spiced Beef 1 6 1 3 2 — 1 7 — 21 18 3 1 2 12 0 0 4 4 0 Dripnjfig — 10 — 3 1 — — 14 13 1 1 — — — — Eggs 6 4 — 2 6 — 1 1 2 — 24 20 4 4 30 10 0 4 4 0 Fish — 2 — 3 — — — — — 76 45 126 122 4 3 1 5 5 0 2 2 0 Flour 107 84 170 130 90 8 29 I20 — 48 50 866 836 30 15 15 25 15 0 19 7 6 Gooseberries — — — 1 — — — — — — — 1 1 _ — — — — — Grape Nuts — 1 — 2 — — — — — — — 3 3 — — — — — — Ice Waters — — — — — — — — — — 1 2 1 1 — — — — Jams and Jellies 33 63 69 28 48 3 11 42 — — 3 297 284 13 7 6 24 8 0 11 10 0. Lard 13 10 10 5 5 — 9 4 — — — 56 55 1 1 — — — — Lemons 5 1 1 5 5 — 1 2 — — — 20 20 — — — — — — Lentils 4 18 16 2 2 1 — 2 — — 45 45 — — — — — — Maize Products 3 3 3 — 1 2 2 — — 14 14 — — — — — — Margarine 21 18 32 19 17 4 11 13 — — 135 134 — — — 1 1 0 1 1 0 Meals (Restaurant) — — — — — — — — 10 — 10 6 4 1 2 2 1 0 4 4 0 Meat Milk — — — — — — — — — 62 39 101 80 21 2 19 198 15 0 52 9 0 — — — — — — — 128 179 307 259 48 13 42 132 1 0 75 10 0 Milk (Tinned) 37 74 50 42 49 — 23 23 — — 298 277 21 — 8 2 3 3 6 11 0 6 Oats and Products A(r«i 36 71 61 28 63 4 22 30 — — 1 318 312 6 3 3 23 3 10 0 3 3 0 Offal — — — — — — — — — 4 4 4 — — — — — Onions — — — 1 — — — — 1 — — — — — — Oranges 1 — 4 5 5 — 2 1 l8 18 — — — — — Peas 12 27 58 16 8 2 15 10 — 154 153 1 1 — — — Potatoes — — — 1 — — — — — — 1 — — — — — Poultry — — — — — — — — — 3 3 — — — — — Rabbits — — — — — — — — — 1 1 — 1 — 1 2 2 0 2 2 o Rice and Products 82 99 155 99 90 — 70 93 — — — 688 664 24 16 8 9 12 0 8 18 6 Sausages — — — — — — — 11 8 19 18 I — 1 2 0 0 2 2 0 Syrup 1 — — — — — — — — 1 1 — — — — — Suet — 11 — 8 — — — — 19 17 2 1 1 1 1 0 1 1 0 Sugar 6 12 14 11 13 — 16 16 — 88 88 — — — — — Sweets and Chocolates 1 1 2 1 — — 1 2 — 14 12 2 1 — 2 0 0 2 2 0 Tapioca — — — — — — 1 — — — 1 1 — — — — — Tea 36 43 39 38 26 7 28 68 — 285 284 1 1 — — Tripe — — — — — — — — 1 — 1 1 — — — — Sundries 1 — 6 — — — — — — — — — 7 — — — — — Total samples purchased 670 942 1081 775 724 52 433 790 14 471 401 6361 5986 375 214 168 648 17 0 302 12 0 Total visits made 744 976 655 819 749 86 324 894 986 1207 1025 8465 Other Prosecutions — Failing to keep Records 6 7 1 0 5 5 0 „ ,, Register 1 0 0 1 1 0 ,, display Notice 2 12 0 0 3 3 0 „ furnish Returns 5 50 0 0 J 5 5 0 ,, have on sale 1 1 0 0 1 1 0 Imposing a condition of sale • 5 11 8 0 10 IO 0 Waste of Foodstuffs 2 Summons dismissed Purchasing without authority 1 3 3 0 2 2 O Selling without authority 1 1 1 0 2 2 O Retention of Ration Card 1 0 10 6 0 10 6 Supplying without Coupons 3 5 0 0 3 13 0 Serving unregistered Customers 8 5 9 0 8 3 0 Obtaining Ration Document improperly 1 2 2 0 1 1 0 Obtaining more than Ration 2 1 1 0 1 1 0 Bread under 12 hours old 6 2 16 6 5 5 0 Improper use of Sugar Permit 1 3 3 0 2 2 0 214 758 12 0 354 16 6 APPENDIX. 64 Table No. 1. VITAL STATISTICS OF WHOLE DISTRICT OF ST. PANCRAS DURING 1918 AND PREVIOUS YEARS. Year. Population estimated to middle of each Year Civil Population. Births. Total Deaths Registered in the District. Transferable Deaths Nett Deaths belonging to the District. Uncorrected Number. Nett. of Nonresidents registered in the District. of Residents not registered in the District. Under 1 Year of Age. At all Ages. Number. Rate. Number. Rate. Number. Rate per 1,000 Nett Births. Number. Rate. 1908 237158 — 5546 — 23.4 — — — — 638 115 3555 15.0 1909 237247 — 5238 — 22.1 3688 15.4 738 591 570 108 3521 14.8 1910 237178 — 5385 — 22.7 3415 14.4 710 562 580 107 3267 13.8 1911 237129 — 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 200322 4458 4754 21.8* 3523 17.6† 672 692 497 105 3543 17.7† 1916 214135 196813 4310 4530 21 .2* 2991 15.2† 565 619 385 85 3045 15.5† 1917 208006 186600 3635 3796 18.2* 3099 16.6† 608 718 402 106 3142 16.8† 1918 196883 175716 3339 3318 16.8* 3789 21.5† 626 751 340 102 3914 22.3† Area of district in acres (land and inland water), 2694.4; total population at all ages, 218,387; number of inhabited houses, 22,246; average number of persons per house, 9.82; at Census, 1911 (cf. Census, Vol. V.). *Based on total population. †Based on Civil population. 65 Table No. 2. Deaths Registered from all Causes for the Year 1918. 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 Che limits of the Borough are included. Cause of Death. AGES. 0 to 1 l to 2 2 to 5 Total under 5 5 to 10 10 to 15 15 to 25 25 to 35 35. to 15 1 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 1 - 1 1 - - - - - - - - - - 3 2 5 2. Typhus - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 3. Relapsing Fever - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- 4. Malaria - - - - - - - - - - - - - - 1 - - - - - - - - - - - - - 1 - 1 5. Small Pox— (a) Vaccinated - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - (b) Not Vaccinated - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - (c) Doubtful - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 6. Measles 10 6 23 14 8 9 11 29 - 3 - - - 2 - - - - - - - - - - - - - - 41 34 75 7. Scarlet Fever - - - - - 4 -- 4 - 1 - - 1 - - - - 1 - - - - - - - - - - 1 6 77 8. Whooping Cough 15 12 13 20 10 8 38 40 1 1 - - - - - - - - - - - - - - - - - - 39 41 80 9. (a) Diphtheria - 1 1 2 10 9 11 12 1 3 - 1 - - 1 - - 1 - - - - - - - - - 13 17 80 (b) Croup - - - - - 1 - 1 - - - - - - - 1 - - 1 - - - - - - - - - - 1 1 10. Influenza 12 6 8 12 25 19 45 37 30 16 14 23 47 71 60 l07 41 41 40 28 31 13 27 16 13 - - - 348 352 700 11. Miliary Fever - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 12. Asiatic Cholera - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 13. Cholera Nostras - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 14. Dysentery - - - - - - - - - - - - - - - 2 2 1 1 7 3 2 1 3 - 2 - - 7 17 24 15. Plague - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- 16. Yellow Fever - - - - - - - - - - - - - - - - 1 - - - - - - - - - - - - - - 17. Leprosy - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 18. Erysipelas - 1 - - - - - 1 - - - - - - - - - 2 - - - - 3 2 - - - - 6 5 11 19. (a) Mumps - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - (b) German Measles - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - (c) Varicella - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - (d) Other Epiidepmic Diseases - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - . 20. (a) Pycomia - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - (b) Senticœimia. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - (c) Vaccinia - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 21. Glanders - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 22. Anthrax (Soleaic Fever) - - - - - - - - - - - - - - - - - - - - - - - - - - l - 1 23. Rabies - - - - - - - - - - - - - - - - - - - - - - - - - - - - 24. Tetanus - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 25. Mvcosps - - - - - - - - - - - - - - - - - - - - - - - - - - - - 26. Pellagra - - - - - - - - - - - - - - - - - - - - - - - - - - - - 27. Beri-Beri - - - - - - - - - - - - - - - - - - - - - - - - - - 28. (a) Pulmonary Tuberculosis - - 2 - 1 2 3 2 5 5 2 4 26 31 24 31 44 41 53 23 31 7 13 7 4 1 - - 20 152 357 {b) Phthisis (not defined as tuberculous) - - - - - - - - - - 1 - 2 6 5 2 10 2 4 2 6 5 1 - - - - - 29 17 46 29. (a) Acute Phthisis - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - {b) Acute Miliary Tuberculosis - - - 1 1 - 1 1 - - - - - - - - - - - - - - - - - - - - 1 1 2 30. Tuberculous Meningitis 5 3 1 4 10 3 16 10 6 6 1 1 - 1 - - 1 - - - - - - - - - - - 24 18 42 31. (a) Tabes Mesenterica - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 32. Other peritoneal & intestinal - 1 1 3 - 2 1 6 1 - 1 - - 1 - - 1 - - 1 - 1 - - - - - 6 7 13 32. Tuberculosis of Spinal Column - - - - 1 1 1 1 1 - 1 1 - - 2 - 1 - 1 1 - - 1 - - - - - 8 3 11 33. Tuberculosis of Joints - - - - - - - - - - - - 1 - - - - - - - 11 - - - - - - - 2 - 2 34. (a) Lupus - - - - - - - - - - - - - - - - - - - - - - - - - - - - - (b) Scrofula - - - - - - - - - - - - - - - - - - - - - - - - - - - - - (c) Tuberculosis of other Organs - - - - 1 - 1 - 1 - - - - - - - - - 1 - 1 - - - 1 1 - - 5 1 6 35. Disseminated Tuberculosis 1 2 - - 1 - 2 2 - - - - - - 1 - - - - - - 1 - - - - - - 3 3 6 36. Rickets, Softening of Bones - - - - 1 - 1 - 1 - - - - - - - - - - - - 1 - - - - - - 2 1 3 37. Syphilis 9 4 - - 1 - 10 4 - - - - 1 - - - 1 - - - - 1 - - - - - - 12 5 17 38. Other Venereal Diseases - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 39. Cancer of the Buccal Cavity - - - - - - - - - - - - - - - - 1 - 6 - 8 1 5 - - - - - 20 1 21 40 ,, Stomach, Liver, &c. - - - - 2 5 12 6 15 6 11 20 4 8 - - 44 45 89 41. ,, Peritoneum, Intestines, and Rectum - - - - - - - - - - - - 1 - - 2 2 2 3 3 8 8 7 2 4 - - - 25 17 42 42. „ Female Genital Organs - - - - - - - - - - - - - - - 1 - 5 - 6 -- 10 - 8 - 2 - - - 32 32 43. „ Breast - - - - - - - - - - - - - - - 1 - 1 - 13 1 6 - 3 - 2 - 1 1 27 28 44. „ Skin - - - - - - - - - - - - - - - - - - - - - - - 2 - 2 - - - 4 4 45. Cancer of other or unspecified Organs - - - - - - - - - - - - 1 - - - 2 2 - 4 9 4 11- 6 - 2 - - 35 18 53 46. Other Tumours (situation undefined) - - - - - - - - - - - - - - - - - - 9 2 2 - 1 - 3 - - - 3 2 5 47. Rheumatic Fever - - - - - - - - - 1 - 1 - - - - 1 2 - - 1 - 1 - - 1 - - 3 5 8 48. (a) Chronic Rheumatism - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - (b) Osteo-Arthritis - - - - - - - - - - - - - - - - - - 1 - - 2 1 1 - 1 - - 2 4 6 (c) Gout - - - - - - - - - - - - - - - - - - - - - - - - 1 - - - 1 - 1 49. Scurvy - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 66 Deaths Registered from all Causes for the Year, 1918—continued. Cause of Death. ages. 0 to 1 1 to 2 2 to 5 Total 1 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. :\r. F. M : F M. F. M. F. M. F. M. F. F. M F. PERSONS 50. Diabetes - - - - - - - - - - - - - - - - - - 3 2 - 1 1 1 1 - - 8 6 14 51. Exophthalmic Goitre - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 52. Addison's Disease - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 1 53. Leucocythæmia Lymphadenoma - - - - - - - - - - - - - - - - - - 2 1 - - - - - - - - 2 1 3 54. Anaemia, Chlorosis - - - - - - - - - - 1 - - - - - - - 2 - - - - l - - - - 3 1 4 55. (a) Diabetes insipidus - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - (b) Purpura - - - - - - - - - - - - - - - - - - - 1 - - - - 1 - - 1 1 9 (c) Haemophilia - - - - - - - - - - - - - - - - - - — - - - — - - - - - - - - (d) Other General Diseases - - - - - - - - - - - - - - - - - —: - - - - - - 1 — — 1 1 56. Alcoholism (acute or chronic) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - — — 57. (a) Occupational Lead Poisoning - - - - - - - - - - - - - - - - — - - - - - - - - - - - - - - (b) Non-occupational Lead Poisoning .. - - - - - - - - - - - - - - - 1 - - - - - - - - - - - - - - - 58. Other Chronic Occupational Poisonings - - - - - - - - - - - - - - — — - - - - - - - - - — - —: — — 59. Other Chronic Poisonings — — - - — - - — - - - — - - - - - - - - - - —: - - — — 2. Diseases of the Nervous System and of the Organs of Special Sense. 60. Encephalitis - - - - 1 - 1 - - - - - - - - - 2 - 1 - - - - - - - - - 4 - 4 61. (a) Cerebrospinal Fever - 1 - - - 1 - 2 l 2 2 l - - - — - - - - - - - - - - 4 4 8 (b) Posterior Basal Meningitis - - - 1 - - - 1 - - - - - - - - - - - - - - - - - - - - - 1 1 (c) Meningitis, other forms - - - - - - - - - - - - - - - - - | - - - - 1 - - - - - 4 4 8 62. Locomotor Ataxy - - - - - - - - - - - - - - - - 1 - 1 - 1 - 1 - - - - - 4 - 4 63. (a) Anterior Pollimyelitis 1 : 2 5 3 8 (b) Other Disease of the spinal Cord 1 - - - - - - - - - - - - - - - - - - - - 2 1 3 2 - - - 4 2 6 64. Cerebral Hæmorrhage, Applexy - 1 - - - - - 1 - - 1 - - - - - 2 3 6 9 11 14 15 16 9 11 2 - 46 54 100 65. Softening of Brain - 1 - - - - - - - - - - - - - - - - - 1 1 4 - 2 - - - - 1 7 8 66. Paralysis without specified cause - - - - - - - - - - - - 1 1 1 - 2 9- 5 2 4; 4 5 4 - - 18 13 31 67. General Paralysis of the Insare - - - - - - - - - - - - - 1 1 1 2 6 - 1 - 1 - - - 10 3 13 68. Other form of Mental Alienation - - - - - - - - - - - - - - - 1 1 1 2 - - 1 2 - - - - - 5 3 8 69. Epilepsy - - - - 2 - 2 - - 1 - - - 2 - 1 1 3 - 1 1 1 1 - 2 - - - 7 9 16 70. Convulsions (Non-puerperal; 5 years and - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 71. Infantile Convulsions (under 5 year) 2 1 2 - - 1 - 2 - - - - - - - - - - - - - - - - - - - 4: 2 6 72. Chorea - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 73. Hysteria Neuralgia, Neuritis - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 1 74. Other Diseases of the Nervous system - - 1 - 1 - 2 1 - - 1 - - 1 - - - 1 4 - 1 - 1 1 - - - - 9 4 13 75. Diseases of the Eyes and Annexa - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 76. (a) Mastoid Disease ] - - - - 1 - - - - - - - - - - - - - - - - - - - - - - 1 - 1 (b) Other Diseases of the Ears - 1 - - - 1 - 2 - - - - - - - - - 1 - - - - - 1 - - — - - 4 4 3. Diseases of the Circulatory System. 77. Pericarditis - - - - - - - - - 2 1 - - - - 1 1 - 1 - - - 2 - - - - 3 5 8 78. Acute Myocarditis and Endocarditis - - - - - - - - 1 - - - - 2 1 3 1 - 2 - - - - 1 - - - 5 6 11 79. (a) Valvular Disease - - - - - - "1 - 1 - - 1 1 1 3 9 3 11 10 11 17 9 16 7 10 1 61 69 130 (b) Fatty Degeneration of the Heart - 1 - - - - - - - 1 - - - - 1 2 - 1 2 - 1 1 3 3 2 - - - 9 8 17 (Other) Embolism and Thrombosis 1 - - - - 1 - 1 - 1 2 1 3 1 1 4 - 7 12 2 30 22 46 34 26 23 4 10 127 104 231 80. Angina Pectoris - - - - - - - - - - - - - - - - - - - - 1 - - 3 - - - - 1 3 4 81. (a) Aneurysm - - - - - - - - - - - - - - - 1 1 3 1 2 - - - - - - - - 6 2 8 (b) Arterial sclerosis - - - - - - - - - - - - - - - - - 4 1 4 1 8 4 4 4 1 1 2 2 11 33 (c) Other Disease of Arteries - - - - - - - - - - - - - - - - - - - - - - - - 1 - - - 1 1 82. (a) Cerebral Embolism and Thrombosis - - - - - - - - - - - - - - - - 2 1 1 3 3 4 4 9 4 - - - 17 11 33 (b) Other Diseases - - - - - - - - - - - - -— - - - - - - 1 - - - - - - - - 1 1 83. Diseases of the: Veins (Varices, Haemorrhoids - - - - - - - - - - - - - - - - - - 1 - - - - - - - - - 1 1 84. (a) Status Lymphaticus 1 1 - - - 1 1 - - 1 - - - 1 - - - - 1 - - - - - - - 2 2 4 (b) Other Diseases of the Lymphatic System - - - - - - - 1 - - - - - - - - - - - - - - - - - - - 1 - 1 85. Hemorrhage; other Diseases of the Circulatory System - 1 - - - - 1 - - - - - - - - - - - - - - - - - 1 - - - 2 2 4. Diseases of the Respiratory System. 86. Diseases of the Nasal Fosse - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 87. Diseases of the Larynx - - - 1 1 - - - - - - - - - - - - - 2 - - - 1 - - - - 4 - - 4 8S. Diseases of the Thyroid Body - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 89. & 90. Bronchitis 10 7 3 1 1 - 14 8 2 1 - - 1 1 1 5 4 15 7 20 29 33 33 18 20 - 5 7 113 115 228 91. Broncho-Pneumonia 18 11 19 17 13 18 50 46 6 3 1 1 - 1 2 4 2 6 3 8 3 6 9 5 4 2 - - 80 82 162 92. (a) Lobar Pneumonia 6 - 1 - 1 - 8 - - - 3 2 2 3 5 8 13 10 9 2 3 4 2 1 2 1 - - 46 34 80 (6) Pneumonia (type not stated) 5 4 6 1 3 4 14 9 5 2 - 2 1 7 6 12 10 11 11 5 12 3 9 8 6 1 - - 74 60 134 93. Pleurisy - 1 - - - - 1 - 1 1 - - 2 -- - - - 2 1 1 2 1 2 - - - — - 5 9 14 67 Death Registered Causes for the Year, 1918-continued Cause of Death. Ages 0 to I 1 to 2 2 to 5 Total under 5 5 to 10 10 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 and upwards Totals. M. F M. F. M. F.. M.i F. M. F. M. F. M, F. M. F. M. F. M F. M. F. M.. F. M F. M F. M. F. PERSONS 4. Diseases of the Respiratory system-com 91. Pulmonary Congestion Pulmonary Apoplexy - - - - - 1 - 1 - - - - - - - 1 - - 2 - 2 - 2 - 4 1 1 - 11 3 14 95. Gangrene of the Lung - - - - - - - - - - - - - - 1 - - - - - - - - - - - - - 1 - 1 96. Asthm - - - - - - - - - - - - - - - 1 - - - - 2 2 - - - 1 - - 2 5 7 97- Pulmonary Emphysema - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 98. (a) Fibroid Diseases of he Lung - - - - - - - - - - - - - - - - - - - - 1 1 - - - - - - 1 1 2 (b) Other Diseases or the Respiratoty System - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 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 - - - - - - - — — — — — — — — - - - — — 1 — — - - - - 1 - 1 101. Diseases of (Esophagus - - - - - - - - — - — — — 1 1 - - — 2 2 1 — 1 - 2 - - 5 7 12 102. Perforating Ulcer of Stomach - - - - - - - 1 - - - - - - - 1 - - 1 - 2 — — 1 — 1 — - 3 4 7 108 (a) Inflammation of Stomach 1 - - - - - 1 - - - - - — _ — — — 1 — — 1 1 — — — — — — 2 2 4 (b) Other Diseases of Stomach 2 4 1 :- - - 4 4 — — — — — — — — — — — — — — — - - — - 4 4 8 101 & 105. (a) Infective Enteritis - - - - - - - - - - - - - - - - - - - - - - - - -1 - - - - - - (b) Diarrhoea (not returned as infective) 4 2 — - - 1 4 3 - - - - - - - - - - - - - - - - - - - - 5 3 8 (c) Enteritis (not returned as infective) 7 4 - 1 2 1 9 6 — — — — — — — - - — 4 — 1 1 — - 1 - 15 7 22 (d) Gastro-Enteritis (not returned as infective) 6 8 1 - 1 1 8 9 — - — — — -- — - — - — - - - - 1 — — — - 8 10 18 (e) Dyspepsia (under 2 years of age - - - - - - - - - - - - — — — — — — — — — — — — - — - - — — (f) Colic - - - - - - - - - - - — — — — 1 — — 1 — — — — — - — — — 2 2 (g) Ulceration of Intestines - - - - - - - - — — — — — - 1 2 1 — 2 — — — 1 — - 5 2 7 (h) Duodenal Ulcer - - - - - - - - — — — — — — — — — — — — — — — — — - — — — 106. Ankylostomiasis - - - - - — — — — — — — — — — — — — — — — — - - - - — - 107. Other Intestinal Parasites - - - - 2 1 2 1 — — 1 — — 1 1 - - - 1 2 - - — - 2 - - 5 4 9 108. Appendicitis - - - - - — — — — — — - — - - - — 3 1 2 1 1 2 - - 2 8 10 109. (a) Hernia 2 - - - - — 2 — — — — — — — - 1 2 — 3 2 6 3 3 - - - - 8 16 24 (b) Intestinal Obstruction - - - - - — - — — — — — — — - - — - - - 1 — - - - - 1 2 3 110. Other Diseases of the Intestines - - - - - — - — — — — — — — - - - — — - - - — - - - - - - - 111. Acute Yellow Atrophy of Liver - - - - - - - — — — — — — — — - - - — — - - — — - - - - - - - 112. Hydatid of Liver - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 113. (a) Cirrhosis of the Liver (not returned as alcoholic) - - - - - - - — — — — — — — — — 1 - 1 1 2 1 1 2 - - - - 5 4 9 (b) Cirrhosis of the Liver (returned a alcoholic) - - - - - - - - — - — — — — — — — 2 - — — — 1 — — — - 2 1 3 (c) Diseases formerly classed to other Diseases of Liver and Gall Bladder - - - I - - - — — — — — — — — — - - - - - 1 — — 1 - - - 1 1 2 114. Biliary Calculi - 1 - - - - 1 — - — — — — — - - 1 — 1 — — — — — - 2 1 3 115. Other Diseases of the Liver - - - - - - - - - - - - — — —- — — — — — 1 — — — — — — 1 1 116. Diseases of the Spleen - - - - - - - - - - - - — 1 — — — — — 1 — — — 2 — — 4 4 117. Peritonitis (cause unstated) - - - - - - - - - - - - - - — — — - — — — — - - — — — - — — 118. Other Diseases of the Digestive system - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 6. Non- Venereal Diseases of the Genito-urinary System and Annexa119. Acute Nephritis - - - - - — - — 1 _ — - - - - - - - - 1 1 1 1 1 5 2 - 3 3 3 6 120. Bright's Disease 1 2 2 2 7 1 10 6 21 9 12 9 5 2 - 3 57 35 92 121. Chyluria - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 122. Other Diseases of the Kidney and Annex - - - - - - - - - - - - - - - 1 — - — — — - - 1 — — 1 — 1 1 2 123. Calculi of the Urinary Passages - - - - - - - - - - - - - 1 - - - - - - - - 1 - - - 1 - 1 2 3 124. Diseases of the Bladder - - - - - l - 1 - - - - - - - - - - - - 2 1 4 - 3 - 1 - 10 2 12 125. Diseases of the Urethra, Urinary Abscess &c. - - - - - - - - - - - - - - - - - - - - 1 — - — 1 — - - 2 - 2 126. Diseases of the Prostate - - - - - - - - - - - - - - - - - - - - 1 - 4 - 3 - 2 - 10 - 10 127. Non-Venereal Diseases of Male Genital Organs 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - — - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 28. Uterine Haemorrhage (Non-puerperal) - - - - - - - — - — - - - - - 1 1 - - - - - - - - - - - 2 2 129. Uterine Tumour (Non-cancerous) - - - - - — - - - - - - - - - - - - - - - - - - - - - - - - - 130 Other Diseases of the Uterus - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 131. Ovarian cyst, Tumour Non-Cancerous) 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 132. Other Diseases of the Female Genital organs - - - - - - - — — — — — 1 - 3 2 — - - - - - - - - 6 6 133. Non-puerperal Diseases of the Breast (Non-cancerous) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 68 Deaths Registered from all Causes for the Year, 1918—continued. Cause of Death, AGES. 0 to 1 1 to 2 2 I 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 - 1 - - - - - — - - - - - 1 — 1 — - — - — — — — — - — — — 2 2 135. Puerperal Hemorrhage - - - - - - — — - - - - - - — 1 — 1 — — — — — — — - — — — 2 2 13G. Other Accidents of Childbirth - - - — - - - - - - - I - - - 1 — 2 — — - - — — — - — — — 3 3 137. Puerperal Fever - - - - - - - - - - - - - - - 2 — — — — — — — - — — — 2 2 138. ,, Albuminuria and Convulsions - - - - - - - — - - - - - 1 - 2 - - - - - - - - - - - - - 3 3 139. ,, Phlegmasia Alba Dolans, Embolism and sudden death - - - - - - - - - 1 - - - - - 1 - 1 - - - - - - - - - - - 2 2 140. ,, Insanity - - - - - - - - - - - - - - - - - - - - - - - - - - - - - — — 141. ,, Diseases of the Breisl - - - - - - - - - - - - - - - - - - - - - - - - - - - - — — — 8. Diseases of the Shin and of the Cellular Tissue 142. (a) Senile Gangrene - - - - - - - - - - - - - - - - - - - - - - 2 4 - 1 - 7 5 19 (b) Gangrene (other types) - - - — — - 1 - - - - - - - - - - - - 1 - - - - - - - 1 ] 143. Carbuncle, Boil - - - — — - - - - - - - - - - - - - - - — — — — - 1 — - - 1 1 141. Phlegmon, Acute Abscess — - - — — - - — — —- - - - - - - - — 1 - - - 1 — — - - 2 - 2 145. Diseases of the Integumentary System ... 1 - - - - - - - - - - - - 1 - - - - - - - - - - - - — — 1 1 - 9. Diseases of the Bones and of the Organs of Locomotion. 14 i. Diseases of the Bonos - 1 - - - - - 1 - 1 - - - - - - - - - - - - - - - - - - - 2 2 147- Diseases of the Joints - — 1 — — 1 — — - — - - - - - - - - - - - - - - - - 1 1 148. Amputations - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 149. Other diseases of Locomotor System - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 10. Malformations.' 150. Congenital Malformations 9 8 1 - - 2 10 10 - - - - 1 - - - 1 - - - - - - - - - - - 12 10 22 11. Diseases of Early Infancy. 151. (a) Premature Birth 27 23 - - - - 27 23 - - - - - - - - - - - - - - - - - - - - 27 23 50 (b) Infantile Debility, Icterus, and Sclerema 23 23 - 3 - - 23 26 - - - - - - - - - - - - - - - - - - - - 23 26 49 152. Other Diseases peculiar to early Infancy 4 4 - - - - 4 4 - - - - - - - - - - - - - - - - - - - - 4 4 8 153. Lack of Care 3 - — - — - 3 - - - - - - - - - - - - - - - - - - - - - 3 - 3 12. Old Age. 154. (a) Senile Dementia - - - - - - - - - - - - - - - - - - - - - - 1 1 - - - 1 1 2 3 (h) Senile Decay - - - - - - - - - - - - - - - - - - - - 3 1 14 37 40 57 20 31 77 126 203 13. Affections Produced by External Causes. 155 to 163. Suicides - - - - - - - - - - - - 1 - 1 - 1 - 3 - 3 - 1 - - - - - 10 - 10 164. Poisoning by Food - - - - - - - - 1 - - - - - - - - - - - - - - - - - - - 1 — 1 165. Other Acute Poisonings - - - - - - - - - - — — — - - - - - - - - - - - - - - - — — 166 Conflagration - — - - — - - — - - - — — - - - - - - - - - - - - - - - - - - 167. Burns (Conflagration excepted) - - 1 1 1 3 2 4 1 - - 1 — - - - - - - - - - - - — 2 - 1 3 8 11 168. Absorption of Deleterious Gases (Conflagration excepted) 2 4 I - - 1 5 - - 1 - - - - - - - 1 - - - 1 - - - - - 6 5 11 169. Accidental Drowning - - - - 1 - - - - -— — - - 2 - - - - - 1 1 - - - 1 - - 5 2 7 170 to 176. Injuries - - l - - - - - - - - - 2 - 2 2 4 - 8 9 8 - 5 2 4 5 1 44 ]9 56 177. Starvation - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 178. Excessive Gold - - - - - :— - - - - - - - — - - - - - - - - - - - - - - - - — 179. Effects of Heat 180. Lightning - - - - - - - - - - - - - -: 1 - - - - — — - - - - - - - - - 182 to 184. Homicide - - - - - - - - - - - - - 1 1 - 2 - - - 1 — - - 1 - - - 6 6 185. Fractures (cause not specified) - — - - — :— - - - - - - - - - - - - 2 — — — — 1 - - - 4 - 4 186. (a) Other Violence - - - - - - - - - - - - - - 1 - - - 1 — - — - — - - - - 3 — 3 (b) ,, ,, through Hostile Aircralt - - - — - :— - - - - - — 3 2 - 1 - - 1 - - - - - - - - - - 3 10 (.c) ,, ,, ,, Submarine - - - - - - - - - - - - - - 1 - - - - — - — — - - - - - — 14. Ill-defined Causes. 187. Dropsy .. - - - - - - - - - - - - - - - - - - - - - - - - - 1 - - - 1 1 188. (a) Syncope (aged 1 year and under 70) - - - - - - - - - - - - - - 1 - - - - - - - - - - - - - - - — (6) sudden death (not otherwise define;! - - - - - - - - - - — :- - - - - - - - — - - - - - - - - - - — 189. (a) Heart Failure (aged'1 year and under 70) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - (b) Atrophy, Debility, Marasmus (agar 1 year and under 70) - - 2 - - - 2 - 1 - - - - - - - - - - - - - - - - - - - 3 - 3 (c) Teething - - 1 - - - 1 - - - - - - - - - - - - - - - - - - - - - 1 - 1 (d) Pyrexia - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - (e) Other ill-defined Deaths - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - (f) Cause not specified - - - — — - - - - - - - - - - - - 1 - - - - - - - - - - - 1 1 69 Table No. 3. Summary of Ages. 0 to 1 1 to 2 2 to 5 Total under 5 years 5 to 10 10 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 and upwards Totals. General Diseases. 88 105 128 321 83 52 194 245 218 235 192 157 56 1 1754 Diseases of the Nervous System and of the Organs of Special Sense 10 4 10 24 5 5 6 5 23 33 46 57 34 2 240 Diseases of the Circulatory System 5 — 1 6 3 8 9 22 33 52 95 146 92 17 483 Diseases of the Respiratory System 62 48 42 152 23 9 18 46 60 73 85 107 60 13 646 Diseases of the Digestive System 42 5 9 56 — 1 2 7 10 23 29 17 13 — 158 Non-Venereal Diseases of the Genito-Urinary System and Annexa — — 1 1 1 1 6 7 11 17 37 32 15 7 135 The Puerparal State — — — — — — 2 8 4 — — — — — 14 Diseases of the Skin and of the Cellular Tissue 1 — — 1 — — 1 — — 1 1 7 7 — 18 Diseases of the Bones and of the Organs of Locomotion 1 1 — 2 1 — — — — — — — — — 3 Malformations 17 1 2 20 — — 1 — 1 — — — — — 22 Diseases of Early Infancy 107 3 — 110 — — — — — — — — — — 110 Old Age — — — — — — — — — — 4 53 97 52 206 Affections produced by External Causes 7 6 6 19 10 3 10 9 10 18 14 9 14 3 119 Ill-defined Causes — 3 — 3 1 — — — 1 — — — 1 — 6 Totals 340 176 199 715 127 79 249 349 371 452 503 585 389 95 3914 70 Table No. 4. METEOROLOGICAL TABLE FOR SAINT PANCRAS, 1918. (Extracted from the Monthly Returns of the Meteorological 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 320 F. at Station Level 29.584 30.072 29.929 29.809 29.947 29.988 29.842 29.914 29.677 29.914 29.915 29.746 Air Temperature. Mean of Maximum A. 44.6 49.2 52.9 50.4 69.1 71.7 73.3 74.1 64.8 57.2 49.1 50.5 Minimum B. 34.2 38.4 31.8 38.7 47.8 48.3 54.1 54.2 49.5 43.8 37.1 41.0 Mean of A. and B. 39.4 43.8 44.3 46.1 58.5 59.7 63.7 64.1 57.2 50.5 43.1 45.8 Difference from Average † +0.6 +3.8 +1.4 —2.3 +3.4 —1.3 —0.6 +0.9 —1.4 —0.2 —1.2 +5.3 Humidity—Morning 87% 88% 81% 86% 70% 62% 70% 73% 79% 86% 92% 91% Earth Temperature at 4 ft. depth 41.4 43.2 42.9 44.7 49.3 55.2 57.7 19.2 57.8 54.1 50.0 48.1 Bright Sunshine. Total Observed (Daily mean) Hours 0.94 1.39 3.29 2.51 5.97 6.27 5.27 5.06 4.10 1.54 0.74 0.39 Per cent. of total possible 11 14 28 18 39 38 33 35 33 14 8 5 Difference from Average † Hours —0.12 —0.35 +0.45 —2.12 +0.32 +0.30 —0.41 — 0.03 —0.78 —0.49 —0.19 Rain and other forms of Precipitation. Number of Days 18 15 8 20 11 11 18 12 24 16 16 24 Total Fall Inches 2.9 1.1 1.1 3.2 2.11 1.3 4.7 1.8 5.7 1.2 2.3 2.3 Difference from Average † ,, +1.02 —0.55 —0.75 +1.69 +0.35 —0.71 +2.32 —0.43 +3.90 —1.42 —0.04 —0.08 *The Readings for Pressure (Bar. 103 ft. above M.S.L.) given are those taken at Enfield; the hours of observation are 9 a.m. and 3 p.m., local time, no readings being recorded at Camden Square during 1918. †The averages used are obtained from observations extending over 35 years for Rainfall and Temperature and 25 years for Sunshine. 71 Table NO. 5, Inspections and Re-inspections made by District Inspectors and temporary Women Inspectors and by Factory and Workshop (Male) Inspector during the year 1918. DUTIES AND PREMISES. Male Inspectors. Temporary Women Inspectors. total. Inspections. Re-inspections. Inspections. Re-inspections. Inspections. Re-inspections. DISTRICT INSPECTORS. Infectious Diseases—Inquiry, removal, disinfection, etc. — — 1865 91 1865 91 Subsequent sanitary inspection, etc. — — 1335 697 1335 697 Complaints 1709 5854 — — 1709 5854 Drainage—Undernotice. Plans, supervision, etc. 180 2185 — — 180 2186 Voluntary 679 1272 — — 679 1272 New Buildings 6 244 — — 6 244 Drain Tests 22 8 — — 22 8 Yards of Mews and Stables 2619 36 — — 2619 36 Housing, Town Planning, etc., Act, 1909: 17 (1).— First Inspections 573 1000 — — 573 1000 Subsequent routine Inspections 1362 3507 — — 1362 3507 Inspections ot registered tenement houses other than above 47 160 — — 47 160 Other house-to-house Inspections — — — — — — Visits to closed underground rooms 78 4 — — 78 4 Smoke Shafts observed 22 — — — 22 — Regulated Trades. Offensive Trades — — — — — — Rag and Bone dealers — — — — — — Other effluvia businesses 34 — — — 34 — Inspections of Market Streets 38 — — — 38 — Other Duties 152 68 — — 152 68 Food Control 5228 19 — — 5228 19 Totals 12711 14358 3200 788 15911 15146 FACTORY & WORKSHOP (MALE) INSPECTOR. Factories 281 268 — — 2(???) 268 Laundries—factories 1 — — — 1 — Workshops 3 3 — — 3 3 Bakehouses- Factories 64 73 — — 64 73 Workshops 284 206 — — 28 4 206 Restaurant Kitchens 15 5 — — 15 5 Other Workshops 413 145 — — 443 145 Other Workplaces 47 71 — — 47 71 Other Duties 34 8 — — 34 8 Food Control 892 94 — — 892 94 Totals 2064 873 — — 2064 873 72 Table No. 6. Inspections and Re-Inspections and other work of the Food Inspectors during 1918. DUTIES AND PREMISES. Visits and Inspections. Re-Inspections after Intimation Notices. Mr. Auger. Mr. Child. Totals. Mr. Auger. Mr. Child. Totals. Milkshops 133 369 502 — — — Dairies 183 13 196 — — — Cowsheds 3 5 8 — — — Other Premises of Milk Purveyors — 7 7 — — — Margarine Factories — — — — — — Butter Factories — — — — — — Ice Cream Premises 2 47 49 — — — Slaughter Houses 25 128 153 — — — Premises where Prepared Meats are made (sausages, pies, tripe cooked meat, &c.) 22 148 170 — — — Butchers' Shops 5 181 186 — — — fishmongers' Shops 13 65 78 — — — Fried Fish Shops and Fish Curer's premises — 107 107 — — — Marketing Places 1664 932 2596 — — — Other Premises where Food or Drugs are sold 1 23 24 — — — Other Visits 42 161 203 — — — Total 2093 2186 4279 — — — SAMPLES, &c„ TAKEN. Formal Samples Informal Samples No. of Milk samples 203 244 447 — 1 — ,, Cream samples — — — — — — ,, Butter and Margarine samples 36 21 57 2 1 — ,, Other samples (specified below)— — — — — — — Lard — 2 2 — — — Dripping 3 11 14 — — — Oatmeal — 3 3 — — — Self Raising Flour 38 27 65 1 — — Cocoa Butter 1 — 1 — — — Condensed and Evaporated Milk 2 7 9 — — — Veal Loaf — 1 1 — — — Mustard 13 5 18 — — — Brawn 3 2 5 — — — Galantine 1 — 1 — — — Ox Tongue — 1 1 — — — Corned Beef 3 4 7 — — — Fish Paste — 5 5 — — — Sausages 7 2 9 — — — Pepper 16 8 24 — — — Jam 2 3 5 — — — Cocoa 32 20 52 — — — Vinegar 9 — 9 — — — Formalin and Mint Tablets — 2 2 — — — Indigestion Tablets — 4 4 — — — Aspirin Tablets — 1 1 — — — Salad Oil 3 — 3 — — — Total 372 373 745 3 2 — 73 Table No. 6—con. Inspections and Re-inspections and other work of the Food Inspectors during 1918. DUTIES AND PREMISES. Visits and Inspections. Re-Inspections after Intimation Notices. Mr. Auger. Mr. Child. Totals. Mr. Auger. Mr. Child. Totals. FOOD CONTROL (No. of Samples, Inspections, &c.) 1207 1025 2232 — — — UNSOUND FOOD. No. of surrenders and seizures:— surrendered Sei zed Meat, &c. 7 17 24 — — Fish 8 11 19 — — Shellfish 1 2 3 — Other Foods (specified below):— Fruit — 1 1 — — — Eggs 1 1 2 — — — MilK (tins of) 1 6 7 — — — Vegetables 2 ??? ??? — — — Yeast — 1 1 — — — Flour 1 — 1 — — — Corned Beef — 1 1 — — — Rabbits 3 — 3 — — — Fowl — 1 1 — — — Tongue — 1 1 — — — Offal 1 — 1 — — — Cheese — 2 2 — — — Rice 1 — 1 — — — Butter 1 — 1 — — — Total 27 64 91 — — — Inspections of Registered Canal Boats 6 — ??? — — — 74 Table No. 7. Visits, etc., made by women Inspectors during 1918. First Visits. Subsequent Visits. Call made but admission not obtained. Miss Bibby. Miss Smith. Miss Giles. *Miss Payne. *Miss MacKenzie Mrs. Hunter. Miss Anderson. Miss Blaxland. Miss Cammon. Total. Miss Bibby. Miss Smith. Miss Giles, Miss Payne. *Miss MacKenzie. Mrs. Hunter. Miss Anderson. Miss Blaxland. Miss Gammon. Total. Miss Bibby. Miss Smith. Miss Giles. *Miss Payne. miss : MacKenzie. Mrs. Hunter. Miss Anderson. miss Blaxland. Miss Cammon. Total. Grand Total. Infants — 459 24 — 1 315 421 19 — 1239 — 330 — — — 245 169 8 — 752 — 484 2 — — 163 301 12 962 2953 Expectant Mothers — 148 — — — 21 7 1 — 177 — 88 — — — 6 6 1 — 101 — 107 — — — 3 1 — — 111 389 Ophthalmia Neonatorum — 35 — — — 3 — — — 38 — 73 — — — — — — — 73 — 17 — — — — — — — 17 128 Puerperal Fever — 7 — — — — — — — 7 — 5 — — 1 — — — — 6 — — — — — — — — — — 13 Tuberculosis 44 — ??? — 6 16 2 378 — 709 6 3 27 15 39 1 — 225 — 316 7 — 52 — 3 — — 321 — 383 1408 Measles and German Measles 15 39 56 20 29 735 709 312 1312 3227 2 18 24 16 64 62 36 120 342 1 — — 1 3 16 69 33 30 153 3722 Whooping Cough — 6 3 5 3 52 169 1 — 239 — 1 — 2 5 — 28 6 — 42 — 2 — — — 7 47 1 — 57 338 Scabies — — 66 106 4 1 177 14 1 — — — 15 — — 10 20 2 — — — 32 224 Other Cases of Illness 48 15 56 109 147 54 77 506 _ 12 — 12 1 13 8 14 13 73 — 16 — 4 2 5 25 18 10 80 659 Verminous Persons _ 2 — 16 46 — — — — 64 — — — 5 2 _ — — — 7 — — — 2 30 — — — — 32 103 To Hospitals and other Voluntary Institutions 222 436 8 — 2 229 118 129 11 1155 — — — — — _ 1 — 1 — 2 4 _ 8 1163 Domestic Workshops — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Home Workplaces — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Laundries—Factory — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — ,, —Workshop — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Restaurant Kitchens — — — — — — — — — 21 — — — — — — — — — — — — — — — — — — — — 21 Other Factories 5 — — — — — — — — 5 — — — — — — — — — — — — — — — — — — — — 5 ,, Workshops 1 — — — — — — — — 1 — — — — — — — — — — — — — — — — — — — — 1 ,, Workplaces — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Attendances at Committees, &c. 157 8 — — — 3 — — — 168 — — — — — — — — — — — — — — — — — — — — 168 Other Visits and Inspections 74 38 50 — — 234 71 8 54 529 — 1 — — — 6 8 70 — 85 — 10 — — — 11 35 27 2 85 699 Totals 518 1226 404 122 * 219 1742 1644 903 1454 8262 8 ??? 27 72 65 335 281 360 133 1812 8 637 54 17 * 59 207 480 416 42 1920 11994 *Exclusive of those shown in Table 5. 75 Table No. 8. Total Number of Inspections and Re-inspections made by individual Inspectors and Visitors during the year 1918. Inspector. Inspections. Re-inspections Call made but admission not obtained. "Food Control." Total. Inspections. Re-inspections. 1. Mr. Backhaul 965 1950 — 744 3659 2. „ Brown 1018 2307 — 968 8 4301 3. ,, †Thompson — — — — — — ,, †Pottier (Temp. Inspector) — — — — — — 4. „ Dillon 429 2388 655 3472 5. „ James 684 1402 — 324 — 2410 6. „ Akers 1557 1111 — 819 — 3487 7. ,, †Lonnon — — — — — — 8. ,, †Adkins — — — — — — 9. „ Jaffa (Temp. Inspector) 1526 2171 — 894 — 4591 10. „ Walker 1121 2800 — 738 11 4670 11. „ Landen 150 157 — 86 — 393 12. „ West (Factories and Workshops) 1205 817 — 892 94 3008 13. „ Auger (Food and 2501 15 — 1207 — 3723 14. „ Child Food premises.) 2625 — — 1025 — 3650 15. Miss Bibby 518 8 8 — — 534 16. ,, Smith 1226 531 637 — — 2394 17. „ *Giles 404 27 54 — — 485 18. „ Payne 1810 503 17 — — 2330 19. „ MacKenzie 1761 422 59 — — 2242 20. Mrs. Hunter 1742 335 207 — — 2284 21. Miss Anderson 1644 281 480 — 2405 22. „ Blaxland 903 360 416 — 1679 23. „ Camman 1454 133 42 — — 1629 Totals 25243 17718 1920 8352 113 53346 *Up to 6th April, 1918. †Away on Active Service. 76 Table No. 9. Intimations as to Nuisances and Breaches of Statutes and By-laws served by the Sanitary Inspectors during 1918. Schedule of Nuisances. Whole Borough. 1 Part of the house in a dirty condition 775 2 ,, ,, damp ,, 146 3 Roof defective 605 4 Guttering defective 98 5 Water fittings defective 257 6 Water-closet apartment with absence of external ventilation 12 7 „ ,, so foul as to be a nuisance or dangerous to health 59 8 Water-closet basin foul 93 9 ,, ,, defective 99 10 ,, ,, choked 108 11 Urinal in a foul condition 1 12 Privy in a foul condition 1 13 Soil pipe defective 10 14 ,, unventilated 8 15 ,, improperly ventilated 1 16 Absence of waste pipe to sink, lavatory or bath 7 17 Waste pipe of sink, lavatory, or bath connected with drain 1 18 ,, ,, ,, ,, defective 87 19 „ „ „ „ foul 15 20 Inlet of drain improperly trapped 6 21 Drain defective 43 22 ,, stopped 131 23 ,, ventilating pipe defective 18 24 Rain-water pipe in direct communication with drain 5 25 ,, ,, defective 157 26 Unpaved condition of roadway — 27 Undrained ,, ,, — 28 Area or part unpaved — 29 ,, undrained — 30 Yard or space unpaved 1 31 ,, ,, undrained 2 32 Detective condition of washhouse paving 18 33 Dust-bin defective 168 34 „ in an improper position 1 35 Accumulation of stagnant water which is a nuisance dangerous to health 25 36 Accumulation or deposit which is a nuisance dangerous to health 88 37 Animals kept in such a manner as to be a nuisance dangerous to health 21 38 Part of the house so overcrowded as to be dangerous to health 35 39 Space below floor in basement or ground floor insufficiently ventilated 11 40 Issuing of black smoke in such a quantity as to be a nuisance — 41 Discharging smoke in such a manner as to cause part of a building to be a nuisance dangerous to health — 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 1 43 Other nuisances 268 Total 3382 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 5 5 Want of means of ventilation — 6 Want of annual cleansing — 7 Want of cleansing of the part or parts of premises used in common 89 8 ,, ,, ,, in sole use 136 9 Want of cleansing of the room or part of the dwelling 7 Animals improperly kept — 11 Other breaches 3 Total 242 7 7 Table NO. 11. Factories, Workshops and Work Places—Breaches of Statutes. Whole Borough 1 Want of cleanliness 78 2 Want of ventilation 1 3 Want of air space, overcrowding — 4 Sanitary accommodation, absent or insufficient 7 5 ,, ,, unsuitable or defective .55 6 ,, ,, not separate for sexes 5 7 Want of drainage of floors 4 8 Other nuisances 69 '9 illegal occupation of underground bakehouse — 10 Breach of special sanitary requirements for bakehouses 69 11 Failure as regards list of outworkers — 12 Giving out work to be done in premises which arc unwholesome — 13 ,, ,, ,, infected — 14 Allowing wearing apparel to be made in premises infected by scarlet fever or small-pox — 15 Other contraventions 5 Total 293 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) 19 1B ,, ,, ,, ,, (other than above) — 2 Water supply used for domestic purposes connected with cistern which is used for flushing the water-closet. 2 3 Water-closet not supplied with a sufficient quantity of water for securing its effective action 201 4 Tank, cistern, or other receptacle for storing of water used or likely to be used by man for drinking purposes—dirty condition of 13 5 Tank, cistern, or other receptacle for storing water used or likely to bo used by man for drinking purposes—absence of a proper cover to 10 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 bo likely to pollute the water supply — 8 Offensive matters not deposited in manure receptacle — 9 Manure not removed at proper intervals 2 10 Manure— absence of proper receptacle for 2 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 233 14 Receptacle for house refuse—absence of a proper cover for 2 15 Yard or open space unpaved — 16 ,, paving defective 32 17 ??? water-closet accommodation to "lodging house" 13 18 A furnace improperly constructed or negligently used — 19 ??? 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 — 22 Slaughterhouses—breach of By-laws as to — 23 Steam whistle—use of a, without authority — 21 Parts of houses infested with vermin requiring stripping, purifying, and cleansing 260 25 Articles in an unwholesome condition requiring to be purified or destroyed 6 26 Underground room illegally occupied as a dwelling 5 27 Other breaches 26 Total 826