STPAN 75 Metropolitan Borough of St. Pancras. REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1913. T. SHADICK HIGGINS, M.D., B.Sc. (Lond.), D.P.H. (Camb.). 3 CONTENTS. PAGE Map of St. Pancras, showing the Registration Sub-Districts 6 Public Health Committee 7 Staff of Public Health Department 8 Introduction 10 Part I.— General Statistics— Population 13 Marriages 13 Births 14 Notification of Births Act, 1909 15 Deaths 16 Infantile Mortality 19 Infectious Diseases 23 Part II.— Special Subjects— Prevention of Infant Mortality 27 Infant Consultations 28 Ophthalmia Neonatorum 30 Puerperal Fever 32 Tuberculosis 32 Work Done 40 Treatment 41 Letter from Local Government Board re Treatment in London 42 After Care 50 Scarlet Fever 52 Return Cases 53 Diphtheria 54 Outbreak at Foundling Hospital 55 Typhoid Fever 56 Anterior Polio-Myelitis 58 Epidemic Cerebro-Spinal Meningitis 60 Other Notifiable Infectious Diseases 61 Measles 61 Whooping Cough 62 Diarrhcea and Enteritis 62 Syphilis 63 Alcoholism 64 4 CONTENTS— continued. page Cancer 64 Vaccination 65 Dwelling Houses 66 Food Storage 66 Water Supply 67 Underground Rooms 67 Inspection of Dwelling Houses 69 Closing Orders 73 Inland Revenue Act, 1903 74 Housing and Town Planning Act, 1909 74 Housing Schemes 74 Canal Boats Acts 74 Factories and Workshops 75 Inspection of Food and Food Places 78 Sale of Food and Drugs Acts 78 Summonses 80 Public Health (Milk and Cream) Regulations, 1912 81 "Facing" of Rice 82 Inspection of Food 82 Dairies, Cowsheds and Milkshops 84 Ice Cream Premises 87 Other Food Premises 87 Slaughterhouses 88 Rag Flock Act, 1911 88 General Sanitary Work 89 Total Inspections 89 Intimation Notices 89 Summonses 89 Smoke Prevention 90 Regulated Trades 90 Other Businesses giving rise to effluvia 91 Constructional Drain Work 91 Drainage Register 92 Water Service 92 Disinfecting and Cleansing Station 92 Disinfection 92 Cleansing Station 93 5 CONTENTS— continued. page Public Mortuary and Coroner's Court 95 Bacteriological Examinations 95 Clerical Work 95 Staff 96 Appendix— Table No. 1.— Vital Statistics of the whole District for 1913 and previous years required by the Local Government Board 98 Table No. 2.— Showing Deaths registered at all Ages and all Causes during the year 99 Table No. 3— Summary of above 103 Table No. 4.— Showing the number of Deaths at all Ages from certain groups of diseases, and the number per 1000 Population and per 1000 Deaths from all Causes 104 Table No. 5.— Showing Birth-rates, Death-rates and Infantile Mortality-rates of England and Wales and of certain large Towns, and of the County of London, and the Metropolitan Cities and Boroughs 105 Table No. 6.— Showing Inmates of, and the number of Births and Deaths occurring in Public Institutions 106 Table No. 7.— Meteorology 107 Table No. 8.— Showing Inspections made by the District Inspectors and Women Inspectors 108 Table No. 9.— Showing Re-Inspections do. do. 110 Table No. 10.— Showing Inspections and other work of the Special Inspectors 112 Table No. 11.— Showing Inspections and Re-Inspections made by individual Inspectors 113 Tables Nos. 12, 13 and 14. — Showing details of Intimation Notices served 114 New Legislation 117 General Acts 117 Local Acts 118 Orders 118 By-Laws 118 Legal Decisions 119 6 7 St. Pancras Borough Council. PUBLIC HEALTH COMMITTEE, 1913. CHAIRMAN. Councillor George Blount (Ward 5). DEPUTY-CHAIRMAN. Councillor Dr. Kenneth Harrison Alloa Kellie (Ward 5). EX-OFFICIO. The Right Worshipful the Mayor. (Councillor Cornish Arthur Coggan, J.P.) ALDERMEN. Hickling, George, J.P. McGregor, Donald. Mitchell, Joseph Henry. Williams, Charles. COUNCILLORS. Ward. 3 Bolsom, Sidney. 2 Brown, Henry Joseph. 1 Carrington, Thomas. 1 Caunt, George Chari.es. 3 Cooke, Joseph John. 8 Davis, Abraham. 3 Edwards, Alfred Harold. 4 Escott, Arthur. 2 Gardner, George. 8 Groom, Henry. 1 Jennens, Henry Harbridge. 4 Johnson, Henry Charles. 6 Knight, William Stanley Macbean. 4 Rogers, Joseph James. 8 Stoney, Rev. Ralph Sadleia, M.A. 7 Swift, Mansell James. 5 Washington, Alfred Charles. 6 Woffendalk, Rev. Zephaniah Banks. 7 Wood, Will' am Charles. 8 STAFF OF PUBLIC HEALTH DEPARTMENT, 1913. MEDICAL OFFICER OF HEALTH. T. Shadick Higgins, M.D., B.Sc., D.P.H. PUBLIC ANALYST. J. Kear Col welt,, F.LC. SANITARY INSPECTORS. District Inspectors. District. Ward. Inspector. N. 1 (Highgate) l G. Rackham. N. 2 (St. John's Park) and N. 3 (Gospel Oak) l W. L. Brown. N. 4 (Grafton) and N. 5 (Maitland Park) 2 B. H. Thompson. E. 1 (Bartholomew), E. 2 (Camden Square), and E. 3 (College) 3 C. H. Johnston.* E. 4 (Oakley Square) 6 W. G. Auger. E. 5 (Ossulston) 6 R. E. James. W. 1 (Castle) and W. 2 (Chalk Farm) 4 H. G. West. W. 3 (Mornington) and W. 4 (Regent's Park) 5 J. I. Lonnon. W. 5 (Euston) 5 G. W. Adkins. S. 1 (Argyle) and S. 2 (Mecklenburgh) 8 E. G. Holmes. S. 3 (Burton) 8 A. H. Walker. S. 4 (Endsleigh) 7 E. J. Dillon.† S. 5 (Whitfield) 7 J. Landen. Inspectors of Food and Food Places. South and West Divisions J. Osborne. E. 3 (College) and E. 4 (Oakley Square) W. G. Auger. North and rest of East Divisions H. R. Child. Women Sanitary Inspectors. For women's workplaces and for consumption Miss M. E. Bibby, B.A. For infant mortality and cleansing of children Miss Celia Smith.‡ Temporary Health Visitor Miss Mary Giles. * Mr. Johnston died 3rd October, 1913 ; Mr. billon was transferred to this district. † Mr. R.c. Akers, was appointed to this district on 17th December, 1913. ‡ Miss Smith is appointed as a Sanitary Inspector and Health Visitor. 9 CLERICAL STAFF. Chief Clerk A. Powel Coke, Barrister-at-Law. First Clerk Harry Riches. Second Clerk Alfred George Capel. Clerk Percy Charles Taylor. Clerk Henry Frank Mullis. Clerk George Netherton Cove. Junior Clerk Percy William Pottier. Bov Clerk Joseph Bernard Molloy. DISINFECTING STAFF. Foreman of Disinfecting Station R. C. Akers. Disinfector Henry Catch. Assistant Disinfector and Driver Joseph Roots. Stoker and General Assistant T. Bartholomew. Matron of Personal Cleansing Station Mrs. Alice Oakey (and Assistant) RESIDENT CARETAKERS, ETC. Mortuaries and Coroner's Court S. N. Davey. Goldington Buildings Walter Brown. Flaxman Terrace John Evans. Prospect Terrace A. H. Reid. Prospect Terrace Baths— Male Attendant A. Smith. Female ,, Mrs. Reid. 10 Public Health Department, Town Hall, Pancras Road, N.W. April, 1914. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of St. Pancras. Gentlemen, I have the honour to present to you the Fifty-eight Annual Report on the vital statistics and sanitary condition of the Metropolitan Borough of St. Pancras. This is the first occasion on which it has been my duty to submit an Annual Report to you. On January 28th, 1913, the Borough sustained a great loss in the death of Dr. J. F. J. Sykes, who had held the position of Medical Officer of Health of St. Pancras since 1885, a period of almost 28 years. I took up my duties in the Borough on June 23rd, and have therefore acted for the last six months of the year only. The subject of tuberculosis has received much attention during the year, particularly in regard to the duty which the Borough has undertaken of making suitable arrangements for the provision of dispensaries for the treatment of this disease, and for subsidising the treatment of those of its population who are not provided for by the National Insurance Act. A great deal of work has been done by the staff in regard to housing. From January 1st the routine inspections of the houses in the Borough prescribed by the Housing, Town Planning, etc., Act, 1909, has been carried out. In the latter part of the year the regulations made under this Act in respect of underground sleeping-rooms have been put in operation, and a number of unhealthy basement rooms closed for sleeping purposes. In addition the provisions of the London County Council (General Powers) Act, 1907, as to the water-supply in tenement houses have been applied to the houses inspected (in compliance with a Council Minute of 23rd July, 1913), and extra water-supply thus secured in many tenement-houses where it was badly needed. Closing Orders have been made during 1913 for the first time under Section 17 of the Housing and Town Planning Act; 71 houses unfit for human habitation have been closed by such orders, which were still in operation at the end of the year. 11 Attention may also be drawn to the work which has been done by the staff during the last quarter of the year in regard to milkshops. This consisted of a careful enquiry into all such shops in the Borough, with the object of determining what action should be taken in regard to that part of the London County Council (General Powers) Act, 1908, which gives your Council discretionary powers as to the registration of milksellers. These powers had not been utilized, and the condit ions of many shops in which milk was sold made it appear desirable that they should be exercised. The results of this work have been presented to your Council as a separate report since the close of the year. A special report was presented to your Public Health Committee in October dealing with the work of the Women Inspectors and Health Visitors, and suggesting the appointment of additional Health Visitors. This report was considered by your Committees and is at present under the consideration of your Council. In conclusion I have to acknowledge my indebtedness to the staff of the Public Health Department, who have without exception given me unstinted assistance, which has considerably lightened the burden which would naturally have fallen upon me in my first year of office; and to thank your Council for the consideration they have shown me during the year. I am, Gentlemen, Your obedient Servant, I. Shadhik Niqquis Medical Officer of Health. Metropolitan Borough of St. Pancras. REPORT OF THE MEDICAL OFFICER OF HEALTH For the Year 1913. Part I.— GENERAL STATISTICS. In this Report the year 1913 is taken to be the 53 weeks ending 3rd January, 1914. The fact that the year consisted of 53 weeks instead of 52 weeks is considered in the calculation of all rates, which are therefore comparable with those of other years. POPULATION. The estimated population* of the Borough at the middle of 1913, upon which the rates in this report are based, is 218,387. The Registrar-General's estimate is 214,330. This is based on the assumption that the decrease in population which took place between the censuses of 1901 and 1911 has since continued at the same rate. The returns of the Rating Department give the number of houses used as dwellings (less "empties") to be 22,542 for 1911, and 22,606 for 1913, a slight increase instead of a decrease. It has therefore been considered advisable to take the 1911 census population for the 1913 estimate, rather than that of the Registrar-General. MARRIAGES. The number of marriages celebrated in St. Pancras during 1913 was 2165, equal to a rate of 9.73 per 1000 population. * The estimate given in the last two quarterly reports for 1913 has been revised. 14 BIRTHS. The number of births registered in the Borough during the year was 5167. From information received from the Registrar-General the excess of births to parishioners occurring outside the Borough over births to non-parishioners occurring inside the Borough was 350. This correction gives the net number of births for St. Pancras registered during the year as 5517, making an annual birth-rate of 24'7 per 1000 population. The following table shows the number of births and the birth-rate for each of the four registration Sub-Districts into which the Borough is divided, and also the corresponding rates in former years. In this table from 1911 onwards the transferred births referred to above are allocated to the Sub-Districts in proportion to their respective populations, but the births which took place in St. Pancras Institutions are not re-distributed, but are allocated to the Districts in which the Institutions are situated. DISTRICTS. Estimated Population. West St. Pancras. South St. Pancras. East St. Pancras. North St. Pancras. Whole Borough. Rates for whole Borough calculated on the 1911 census population (218,887). Number of Births Registered for the year 1913 .. 1380 1034 1652 1451 5517 Birth Rate per 1000 population .. 23.3 22.5 28.2 24.8 24.7 Birth Rate for the Year 1903 237032 26.6 22.9 29.5 27.8 26.7 „ „ 1904 237088 26.9 20.7 29.3 26.8 25.8 „ „ 1905 237149 25.3 20.9 26.2 25.2 24.5 „ „ 1906 237149 23.3 20.6 27.4 25.4 24.2 „ „ 1907 237173 23.9 17.3 25.7 25.2 23.1 „ „ 1908 237247 24.2 18.2 27.6 23.2 23.4 „ „ 1909 237247 22.4 17.9 24.7 23.0 22.1 24.0 „ „ 1910 237247 22.7 18.5 25.5 23.9 22.7 24.1 „„ 1911* 237129 23.3 19.9 25.5 24.7 *23.4 25.4 „ „ 1912 220353 22.1 23.4 27.7 24.0 *24.4 24.6 „ „ 1913 218387 23.3 22.5 28.2 24.8 *24.7 24.7 * For 1911 onwards the number of births and the rates are corrected for inward and outward transfers. It will be seen from this table that the birth-rate has remained fairly constant for the last five years. 15 281 births occurred in Public Institutions in the Borough and are tabulated initable 6 on page 106. These are equal to 5.4 per cent. of the total births which took place in the Borough. Table 5 on page 105 shows the birth-rate for 1913 of England and Wales, the County of London, the several Metropolitan Boroughs, and the 30 large towns with a population exceeding 125,000. It should be noted that the St. Pancras figures are shown in the table on the basis of the RegistrarGeneral's estimate of the population which, as explained before, differs from the estimate made in this report. Illegitimacy. Of the 5,167 births which were registered in the Borough, 184 or 3.56 per cent. were returned as illegitimate. Of the 5,517 births to parishioners within and without the Borough, 259 or 4.69 per cent. were illegitimate. This is the figure which is to be taken as representing the proportion of illegitimate births in the St. Pancras population. The Notification of Births Act, 1909. Notifications were received during the year of 4749 births, or 91.9 per cent. of the total births occurring in the Borough. In the following table the total births notified and registered in the Borough are classified according to the registration sub-districts in which the births took place. Births. W. S. E. N. Whole Borough Total Births (excluding still-births) registered 1286 962 1559 1360 5167 Births (including still-births) notified 1171 896 1444 1238 4749 Still-births 38 35 43 34 145 Of total births registered illegitimate numbered 27 54 83 20 184 16 In the tables below the notified births are also classified (in registration subdistricts) according to the person notifying the birth, and according to the person in attendance upon the mother in her confinement. Notification of Births. w. S. E. N. Whole Borough Notified by—Fathers 460 102 494 620 1676 „ „ Mothers 14 1 22 22 69 „ „ Other persons 273 311 280 120 984 „ „ Medical Students 85 42 152 1 280 „ „ Midwives 204 147 152 354 857 „ „ Doctors 109 100 215 79 503 „ „ from Workhouse — — 87 — 87 „ „ Homes of Hope — 30 — — 30 „ „ University College Hospital — 157 — — 157 „ „ Not stated 26 6 42 42 116 1171 896 1444 1238 4749 Attended by—Doctors (1) 469 276 547 595 1887 „ „ Midwives (2) 281 478 291 628 1678 „ „ Medical Students 421 142 606 15 1184 Total 1171 896 1444 1238 4749 (1) Including cases in Homes of Hope. (2) „,„ Workhouse and University College Hospital. DEATHS. The number of deaths that were registered during the year as having taken place in the Borough was 3409. Of these 728 were of persons whose residence was not in St. Pancras (nonparishioners), 650 dying in St. Pancras Institutions, and 78 in other places in the Borough. There were also reported by the Registrar-General 611 deaths of St. Pancras parishioners who died in institutions in other parts of the County of London, and of 51 who died in other parts of England and Wales. This correction gives the net. number of deaths for St. Pancras registered during the year as 3343, making an annual death-rate of 15.0 per 1000 population. As compared with England and Wales for sex and age distribution, the factor of correction for St. Pancras is 0.9971, which makes the death-rate so corrected 15.0 per 1000 of population per annum. The following table shows the number of deaths and death-rate for each of the four Registration Sub-Districts into which the Borough is divided, and also the corresponding rates in former years. In this table deaths in Public Institutions, whether within or without the Borough, are classified in the respective Sub-Districts of their previous residence:— 17 DISTRICTS. Estimated Population. West St. Pancras. South St. Pancras, East St. Pancras. North St. Pancras. Whole Borough. Number of Deaths Registered for the Year 1913 .. 883 690 904 866 3343 Rates for whole Borough calculated on the 1911 Census population (218387). Death Rate per 1000 population .. 14.9 15.0 15.3 14.8 15.0 Death Rate for the Year 1903 237032 16.0 17.0 17.9 13.8 16.2 „ 1904 237088 17.8 18.1 18.3 15.5 17.4 „ 1905 237149 16.0 16.2 16.6 14.1 15.7 „ 1906 237149 15.8 16.1 16.9 14.5 15.8 „ 1907 237173 15.4 14.9 16.3 13.4 15.0 „ 1908 237247 14.7 14.9 16.5 13.8 15.0 „ 1909 237247 15.6 14.4 16.0 13.3 14.8 16.1 „ 1910 237247 14.3 12.0 15.5 13.1 13.8 15.0 „ 1911 237129 14.8 1.4 15.1 14.0 14.1 15.4 „ 1912 220353 14.5 14.7 15.2 12.9 14.3 14.4 „ 1913 218387 14.9 15.0 15.3 14.8 15.0 15.0 It will be seen from the last column that the death-rate for 1913 was the lowest yet recorded, except those for 1910 and 1912. It may be noted in this connection that the death-rate for the County of London for 1913 (14.2) was greater than those for 1910 (13.7) and 1912 (13.6) only. 1707 deaths occurred in Public Institutions in the Borough. These are tabulated in table 6 on page 106. Taking from these the number which were of non-parishioners (650), and adding the number of deaths of St. Pancras parishioners in Public Institutions •outside the Borough (611—both from the Registrar-General's figures), the number of St. Pancras deaths which took place in Public Institutions is shown to be 1668 or 49.9 per cent. of the total deaths. That one-half of the deaths of St. Pancras parishioners took place in Public Institutions is a striking fact. Table 5 on page 105 shows the death-rates for 1913 of England and Wales, the County of London, the several Metropolitan Boroughs and the 30 large towns with populations exceeding 125,000. It should be noted that the St. Pancras figures are shown in this table on the basis of the RegistrarGeneral's estimate of the population which, as explained before, differs from the estimate made in this report. 18 Causes of Death. The deaths are fully classified for causes and age periods in table 2 Inn. 99-102). The following table shows the deaths from infectious diseases and certain other causes classified according to the Registration Sub- Districts. DISEASES. West St. Pancras. South St. Pancras. East St. Pancras. North St. Pancras. No Address. Totals St. Pancras. Enteric Fever 3 — — 3 — 6 Small-Pox — — — — — — Chicken-Pox 1 — — — — 1 Measles 8 5 6 17 — 36 Scarlet Fever — 1 1 4 — 6 Whooping Cough 8 3 8 17 — 36 Diphtheria and Croup 6 1 6 6 — 19 Influenza 12 12 12 6 — 42 Erysipelas 3 2 2 3 — 10 Tuberculosis, Pulmonary 87 92 69 65 12 325 „ Other Forms 22 16 16 13 — 67 Rheumatic Fever — 1 3 2 — 6 Heart Disease 79 57 82 91 6 315 Bronchitis, Pneumonia & Pleurisy 161 134 197 195 15 703 Diarrhœa and Enteritis 42 29 42 34 1 148 Injuries 42 30 44 29 3 148 Ages at Death. The next table shows the deaths for the year classified according to ages and to Registration Sub-Districts. AGES AND RATES. West St. Pancras. South St. Pancras. East St. Pancras. North St. Pancras. Totals St. Pancras. Under 1 year (infants) 140 106 149 117 512 1 and under 5 56 47 83 85 271 5 and under 10 14 7 20 17 58 10 and under 15 9 9 10 8 36 15 and under 25 25 22 34 30 111 25 and under 65 384 298 353 320 1355 65 and upwards 255 201 255 289 1000 Total Deaths at all Ages 883 690 904 866 3343 19 The table below is constructed to show what percentage of total deaths is furnished by these age groups:— Ages. Percentage of deaths at all Ages. West. South. East. North. Whole Borough. Under 1 year 15.9 15.4 16.5 13.5 15.4 1 and under 5 6.3 6.8 9.1 9.8 8.1 5 „ 15 2.6 2.3 3.3 2.9 2.8 15 „ 25 2.8 3.2 3.8 3.5 3.3 25 „ 65 43.5 43.2 39.1 36.9 40.5 65 and upwards 28.9 29.1 28.2 33.4 29.9 In the following table is shown the death-rate for the whole Borough for each of the age periods per 1000 population living at each period:— (Based on the figures of the 1911 Census.) Ages. Population. Death-rate. Under 1 year 4755 105.6 1 and under 5 16,995 15.6 5 „ 10 19,475 2.9 10 „ 15 18,073 1.9 15 „ 25 40,000 2.7 25 „ 65 108,378 12.2 65 and upwards 10,711 91.7 218,387 15.0 Infantile Mortality. 512 deaths of St. Pancras infants under one year of age took place during the year. This is equal to a rate of infantile mortality of 93 per 1,000 births. 20 The table required by the Local Government Board, showing the causes of deaths amongst these infants is set out below:— 1913. Nett Deaths from stated causes at various Ages under 1 Year of Age. cause of death. Under I week. 1 —2 weeks. 2—3 weeks. 3—4 weeks. Total under 4 weeks. 4 weeks & under 3 months. 3 months & under 6 months. (5 months & under 9 months. 9 months & under 12 months. Total Deaths under 1 year. All causes Certified 120 25 28 17 190 94 102 70 56 512 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox .. ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... 1 ... 1 Measles ... ... ... ... ... ... 3 3 4 10 Scarlet Fever ... ... ... ... ... ... 1 ... ... 1 Whooping-Cough ... ... ... ... ... 1 2 3 6 12 Diphtheria and Croup ... ... ... ... ... ... ... 1 ... 1 Erysipelas ... ... ... 2 2 ... 1 ... ... 3 Tuberculous Meningitis ... ... ... ... ... ... 2 1 2 5 Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... 1 4 2 1 8 Meningitis (not Tuberculous) ... ... ... ... ... ... 1 3 4 8 Convulsions 6 ... 1 ... 7 4 2 2 1 16 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis 2 2 7 3 14 34 22 17 18 105 Pneumonia (all forms) ... ... ... 1 1 1 2 3 2 9 Diarrhœa ... ... 2 1 3 3 4 6 6 22 Enteritis ... 3 2 2 7 16 25 17 8 73 Gastritis ... 1 ... ... 1 ... 1 ... ... 2 Syphilis 3 5 1 ... 9 4 1 ... ... 14 Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying 3 l 1 1 6 6 2 ... ... 14 Injury at birth 4 ... ... ... 4 ... ... ... ... 4 Atelectasis 2 1 .. ... 3 ... ... ... ... 3 Congenital Malformations 11 1 ... .. 12 6 4 1 1 24 Premature birth 66 9 9 5 89 2 1 1 ... 93 Atrophy, Debility and Marasmus 10 ... 3 2 15 12 17 6 3 53 Other causes 13 2 2 ... 17 4 7 3 ... 31 Totals 120 25 28 17 190 94 162 70 56 512 Nett Births in the year {legitimate 5258 illegitimate 259 Nett Deaths in the year of {legitimate infants 468 illegitimate infants 44 21 The next table shows the number of deaths of infants and the rates of infantile mortality for the several Registration Sub-Districts for the past 8 years:— Infantile Mortality. West St. Pancras. South St. Pancras. East St. Pancras. North St. Pancras. Whole Borough. Deaths of Infants under 1 year of age 140 106 149 117 512 Infantile Mortality rate per 1,000 births 101 102 90 80 93 Infantile Mortality rate for year 1905 130 165 139 116 136 „ „ 1906 131 148 130 119 131 „ „ 1907 107 144 130 84 114 „ „ 1908 126 128 115 94 115 „ „ 1909 125 127 99 90 119 „ „ 1910 108 108 128 85 108 „ „ 1911 130 94 113 107 112 „ „ 1912 96 83 95 76 88 „ „ 1913 101 102 90 80 93 It will be seen that the rate for 1913 was, with the exception of that for 1912, less than any formerly recorded. The number of deaths of illegitimate children under one year of age during 1913 was 44. This is equal to a death-rate of 170 per 1,000 illegitimate births. By difference the number of deaths of legitimate children under one year of age was 468, equal to a death-rate of 89 per 1,000 legitimate births. The rate of mortality amongst illegitimate children was therefore nearly twice (191 per cent.) that amongst legitimate children. The illegitimate births and deaths according to the registrars' returns are classified below in registration sub-districts:— West. South. East. North. Whole Borough. Number of Births 80 52 64 63 259 Number of deaths under one year of age 15 19 6 4 44 The infantile mortality occurring during the whole year per 1,000 births is classified in the following table according to the quarter of the year in which the deaths took place, and the corresponding figures are given for each of the past 8 years:— 22 Infantile Mortality. 1st Quarter. 2nd Quarter 3rd Quarter. 4th Quarter. Whole Year. Infantile Mortality rate per 1000 births for year 1905 130 96 175 139 135.7 „ „ 1906 128 103 172 121 131.7 „ „ 1907 109 122 102 123 113.8 „ „ 1908 120 91 116 130 115.0 „ „ 1909 1l8 87 106 125 108.8 „ „ 1910 94 103 95 143 107.8 „ „ 1911 100 82 178 126 121.3 (112.1)* „ „ 1912 105 82 87 102 94.3 (88.0)* „ „ 1613 97 72 105 121 99.1 (92.8)* * The figures in backets are corrected for outward and inward transfers. This additional information was supplied by the Registrar-General for the first time for the year 1911. The table below shows the total infantile mortality and that from congenital, intestinal, pulmonary and certain zymotic causes, contrasted for a series of 8 years with certain meteorological records taken at Camden Square, N.W., indicating the severity of the summers as regards heat and dryness and the severity of the winters as regards coldness:— Year. Maximum monthly earth temperature taken at Camden Sq. at 4 ft. 0 in. depth. Rainfall during the third quarter. Inches. Lowest mean weekly temperature recorded during the year. Rate of Infantile Mortality. Deaths under one year of age. Injury at Birth, Atelectasis, Congenital Malformations, Premature Birth, Atrophy, Debility and Maramus. Diarrhœa and Enteritis. Bronchitis and Pneumonia. Measles. Whooping Cough. 1905 60.8 5.65 27.8 135.7 251 159 144 15 29 1906 60.7 2.98 25.9 131.1 199 189 136 24 28 1907 57.8 3.77 26.6 113.8 198 75 150 20 33 1908 59.8 8.15 26.5 115.0 221 94 129 11 31 1909 58.8 7.43 23.4 108.8 211 74 109 28 8 1910 58.2 6.08 28.4 107.8 213 52 106 42 40 1911 62.8 2.94 28.6 121.3 (112.1)* 204 168 105 17 16 1912 58.4 5.64 237 94.3 ( 88.0)* 75 32 70 13 21 1913 58.0 5.43 31.2 99.1 ( 92.8)* 177 †95 114 10 12 * The figures in brackets are corrected figures (see Note above). † The figures prior to 1913 are for "Diarrhœa and Dysentery.'' It will be seen that the rate of infantile mortality has tended to vary in direct proportion to the 4 ft. 0 in. earth temperature, the temperature appearing to exercise a greater influence than the amount of rainfall. The mortality 23 in the last three years in the table is distinctly lower than in the earlier years with corresponding earth temperatures, and it seems reasonable to ascribe this to a betterment in the conditions under which the infant population lives. The table does not show any connection between infant mortality from bronchitis and pneumonia and cold weather, but the data are insufficient to exclude such a connection. Table 5 (page 105) shows the infantile mortality rates for 1913 of England and Wales, the County of London, the several Metropolitan Boroughs, and the 30 large towns with a population exceeding 125,000. INFECTIOUS DISEASES. The number of cases of compulsorily infectious disease that have been notified during 1913 is shown in the following table, where they are also classified according to ages. The figures have not been corrected for subsequent revisions of diagnosis:— DISEASES. At all Ages. At Ages—Years. Under 1. 1 and under 5. 5 and under 10. 10 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. 1. Variola or Small-pox .. .. .. .. .. .. .. .. 2. Scarlatina or Scarlet Fever 568 4 135 223 119 64 23 .. 3. Diphtheria and Membranous Croup 440 9 126 181 64 35 25 .. 4. Typhus Fever .. .. .. .. .. .. .. .. 5. Enteric or Typhoid Fever 41 .. 1 1 1 15 23 .. 6. Fever, Simple or Continued 1 .. .. .. .. .. 1 .. 7. Relapsing Fever .. .. .. .. .. .. .. .. 8. Puerperal Fever 11 .. .. .. .. 3 8 .. 9. Erysipelas 210 12 10 9 6 32 120 21 10. Cholera .. .. .. .. .. .. .. .. 11. Plague .. .. .. .. .. .. .. .. 12. Anthrax .. .. .. .. .. .. .. .. 13. Glanders .. .. .. .. .. .. .. .. 14. Hydrophobia .. .. .. .. .. .. .. .. 15. Cerebro-Spinal Meningitis 5 .. 2 2 .. 1 .. .. l6. Polio-Myelitis 9 1 5 1 2 .. .. .. 17. Ophthalmia Neonatorum 23 22 1 .. .. .. .. .. Total under Public Health (London) Act, 1891, Sec. 55 1308 48 280 417 192 150 200 21 Tuberculosis- Public Health (Tuberculosis) Regulations, 1912, Primary Notifications on Forms "A," "B," "C & D": Pulmonary 928 2 24 54 34 167 616 31 Do. other Forms 230 7 37 70 41 18 50 7 24 In the accompanying tables (inset) are shown the number of notifications of the notifiable infectious diseases received in each week of the year, and also the corresponding weekly numbers of deaths from these and certain other diseases. In the next table the number of notifications are set out for the past ten years. Diseases. 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 Small-pox 28 3 - - - - - - - - - Scarlet Fever 647 840 987 791 851 957 774 681 445 598 568 Diphtheria 489 332 278 271 337 292 312 259 416 550 440 Membranous Croup 6 7 4 4 8 4 3 3 3 — — Typhus Fever - — - — - - - - - - - Enteric Fever 83 135 72 96 54 60 50 61 66 29 41 Fever, Simple and Continued — — 1 — 1 — — — — — 1 Relapsing Fever - - - - - - - - - - - Puerperal Fever 5 9 10 10 4 8 15 14 16 20 10 Erysipelas 222 251 228 231 188 156 160 186 201 190 210 Cholera — - - - - - - 1 — — — Plague - - - - - - - - - - - Chicken-pox (part of year) 16 407 .. .. .. .. .. .. 198 .. .. Cerebro-Spinal Meningitis .. .. .. .. 5 5 6 10 7 3 5 Polio-Myelitis .. .. .. .. .. .. .. .. 2 3 9 Ophthalmia Neonatorum .. .. .. .. .. .. .. .. 26 18 23 Totals 1496 1984 1580 1403 1448 1482 1320 1215 1380 1411 1308 SAINT PANCRAS, LONDON. WEEKLY NUMBER OF INFECTIOUS CASES CERTIFIED TO THE MEDICAL OFFICER OF HEALTH DURING THE YEAR 1913. Quarters First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Totals. Quarters. Months January February. March. April. May. June. July. August. September. October. November. December. Months. Week ending 4 11 18 25 Feb. 1 8 15 22 Mar. 1 8 15 22 29 5 12 19 26 May. 3 10 17 24 31 7 14 21 28 5 12 19 26 Aug. 2 9 16 23 30 6 13 20 27 4 11 18 25 Nov. 1 8 15 22 29 6 13 20 27 Jan. 3 .. Week ending. Number of Week 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 .. Number of Week. Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Small-pox. Scarlet Fever 7 12 9 10 11 15 7 3 14 6 4 5 5 6 2 8 5 9 8 6 8 9 11 11 8 7 11 12 12 11 6 11 17 5 14 12 6 20 22 10 15 18 18 8 12 14 16 7 19 19 17 10 20 568 Scarlet Fever. Diphtheria and Membranous Croup 7 10 8 8 9 10 6 16 6 10 7 11 6 3 5 6 7 1 1 10 10 6 8 7 2 8 8 6 14 6 9 6 9 0 8 9 8 11 14 17 12 10 8 7 13 10 8 9 10 13 9 2 11 440 Diphtheria and Membranous Croup. Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Typhus Fever. Enteric Fever 1 1 2 1 2 • • 1 .. .. 2 .. 1 1 1 1 1 .. .. 1 2 .. 1 .. .. .. .. 3 .. .. .. .. 2 .. 2 1 1 2 .. 1 4 .. 1 1 2 .. .. .. .. .. .. .. .. 2 41 Enteric Fever. Continued Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. 1 Continued Fever. Relapsing Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Relapsing Fever. Puerperal Fever .. 1 .. .. .. .. .. .. .. .. 1 .. .. 1 1 .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. 1 .. .. .. 1 .. .. .. .. .. .. .. .. .. 1 .. .. .. 1 1 .. 1 .. 11 Puerperal Fever. Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cholera. Erysipelas 2 3 3 3 3 5 3 1 3 3 6 3 4 3 5 4 4 .. 3 5 2 2 4 3 7 .. 6 3 6 6 .. 4 1 7 4 5 2 2 4 9 5 11 8 4 5 3 5 4 6 5 3 3 5 210 Erysipelas. Palgue .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Plague. Cerebro-Spinal Meningitis .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. 1 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. . . 1 .. .. .. .. .. .. .. .. .. .. 5 Cerebro-Spinal Meningitis Polio-Myelitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 1 .. .. .. .. 1 .. .. .. 1 .. 1 .. .. .. .. .. .. .. .. .. .. 2 .. .. .. .. 1 1 .. 9 Polio-Myelitis. Ophthalmia Neonatorum .. 1 .. .. .. .. .. .. .. 2 .. .. .. .. 2 .. 1 .. .. .. .. 1 .. 1 .. .. .. 1 .. .. .. .. .. 1 .. 2 1 .. .. .. .. .. .. 1 1 .. .. .. .. 2 3 2 1 23 Ophthalmia Neonatorum. Totals 17 28 22 22 25 30 17 20 23 23 18 21 16 14 16 19 18 11 13 23 20 19 24 23 17 15 28 22 34 23 16 23 28 20 29 29 19 33 41 41 32 40 36 22 33 29 29 20 36 40 33 19 39 1308 Totals. 282 232 345 449 SAINT PANCRAS, LONDON. WEEKLY NUMBER OF CERTIFIED DEATHS FROM THE DANGEROUS INFECTIOUS DISEASES DURING THE YEAR 1913. Quarters First Quarter. Second Quarter. Third Quarter. Fourth Quarter. total Quarters. Months January February. March. April. May. June. July. August. September. October. N ovember. December. Months. Week ending . . 4 11 18 25 Feb. 1 8 15 22 Mar. 1 8 15 22 29 5 12 19 26 May. 3 10 17 24 31 7 14 21 28 5 12 19 26 Aug. 2 9 16 23 30 6 13 20 27 4 11 18 25 Nov. 1 8 15 22 29 6 13 20 27 Jan. 3 .. Week ending. Number of Week 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 .17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 .. .. Number of Week. small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .... .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Small-pox. scarlet fever .. .. .. .. .. .. .. 1 .. .. 1 .. .. 2 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 6 Scarlet Fever. Diphtheria and Membranous Croup 2 1 .. 2 .. .. 1 .. 1 .. .. .. .. .. 1 2 .. .. .. .. 1 .. 2 1 .. .. .. .. 1 .. .. 1 .. 1 .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 19 Diphtheria and Membranous Croup. Typhus fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Typhus Fever. Enteric Fever 1 .. .. .. 1 1 .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. 1 .. .. .. .. .. .. .. .. .. 6 Enteric Fever. Continued Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Continued Fever. Relapsing Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Relapsing Fever. Puerperal Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 Puerperal Fever. Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cholera. Erysipelas .. 1 .. .. .. 2 .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. 2 .. 1 .. .. .. 1 1 .. .. .. .. .. 10 Erysipelas. Plague .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Plague. Cerebro-Spinal .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Cerebro-Spinal Meningitis Ophthalmia Neonatorum .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Ophthalmia Neonatorum. Polio-myelitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Polio-Myelitis. Totals 3 2 .. 2 1 3 1 1 1 2 | 1 .. 2 3 2 .. .. 1 .. 1 .. 2 1 .. .. .. 1 2 .. 1 1 .. 2 .. .. .. .. .. .. 2 .. 7 7 .. 1 1 1 .. .. .. .. 1 45 Totals. Phthisis (Pulmonary) 10 13 ! 9 4 11 7 8 8 7 9 7 8 9 8 6 8 8 7 4 5 4 8 6 3 1 5 3 9 1 7 4 6 6 4 3 8 3 4 4 5 5 8 4 7 2 5 6 6 6 8 6 12 325 Phthisis (Pulmonary) Measles .1 1 .. 2 2 .. .. 6 5 2 .. 3 3 3 2 1 .. 2 .. .. .. 1 .. .. 1 .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. 36 Measles. Whooping Cough 1 .. .. .. 1 2 .. 3 1 1 1 1 .. .. 2 2 1 1 1 3 2 1 1 .. .. .. 1 .. .. 2 .. .. .. 1 .. 1 .. .. .. .. .. .. .. .. .. .. .. 1 2 I 2 36 Whooping Cough Diarrhoea and Enteritis 1 1 1 .. .. 3 1 1 2 2 1 2 3 .. 1 2 .. .. 2 1 2 1 3 1 1 3 5 5 3 3 5 3 1 11 5 2 11 8 6 5 6 6 4 4 4 3 2 1 .. 4 2 1 3 148 Diarrhoea and Enteritis. Influenza .. .. 1 4 .. 1 .. 2 4 1 2 1 5 .. 6 3 1 .. .. .. .. 2 .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. 1 .. .. .. 1 1 .. .. I 1 .. .. 1 .. I 1 42 Influenza. 25 The notifications of and deaths from the notifiable infectious diseases are classified in the following table according to Registration Sub-Districts : — INFECTIOUS DISEASES. Notifications, Deaths. West. South. East. North. No Address. Whole Borough West. South. East. North. No Address. Whole Borough i. Variola or Small-pox - - - - - - - - - - - - 2. Scarlatina or Scarlet Fever '59 100 114 195 — 563 — 1 1 4 6 3. Diphtheria and Membranous Croup 134 94 87 125 — 440 6 1 7 5 — 19 4. Typhus Fever — — — — — — — — — — — — 5. Enteric or Typhoid Fever 15 6 4 16 — 41 3 — — 3 — 6 6. Fever, Simple and Continued — — — 1 — 1 — — — — — — 7. Relapsing Fever - - - - - - - - - - - - 8. Puerperal Fever 4 — 2 5 — 11 1 — — 1 - 2 9. Erysipelas 53 40 52 60 — 210 3 2 2 3 — 10 10. Cholera - - - - - - - - - - - - 11. Plague - - - - - - - - - - - — 12.Anthrax — — — — — — - — — — — — 13. Glanders — — — — — - - - - - — — 14. Hydrophobia — — — — — — — — — — — — 15. Cerebro-Spinal Meningitis 2 1 1 1 — 5 — — 1 — 1 16. Polio-Myelitis •• 4 3 2 — 9 — 1 — — — 1 17, Ophthalmia Neonatorum 4 4 8 7 — 23 - - - - - - Total under Public Health (London) Act, 1891, Section 55 376 249 271 412 — 1308 13 4 12 16 - 45 Tuberculosis—Public Health (Tuberculosis) Regulations 1912, Primary notifications on Forms "A" "B" "C " and " D " 261 228 215 182 42 928 87 92 69 65 12 325 Other forms 59 5° 58 55 8 230 22 16 16 13 — 67 26 In the following table is shown the number of cases of infectious diseases notified luring 1913 in the several Metropolitan Cities and Boroughs, and in the County of London: — Boroughs. Estimated Population in the middle of 1913. Total Cases. Enteric Fever. Typhus. Continued Fever. Small-pox. Scarlet Fever. Diphtheria (including Membranous Croup). Cholera. Erysipelas. Cerebro-Spinal Fever. Puerperal Fever. Anthrax. Glanders. . Ophthalmia Neonatorum. Poliomyelitis. West. Paddington 142,210 960 25 ... ... ... 487 304 ... 112 ... 8 ... ... 22 17 2 4 Kensington 171,284 880 28 ... ... ... 558 145 ... 112 3 13 ... ... 23 1 Hammersmith 123,745 821 13 .. ... ... 537 138 ... 101 ... 19 2 ... 20 2 Fulham 157,117 1,238 34 ... ... ... 767 270 ... 121 5 8 1 ... 3 3 Chelsea 64,598 323 7 ... ... ... 206 61 ... 35 ... ... ... City of Westminster 154,810 701 29 ... ... ... 379 192 ... 75 ... 6 ... ... 16 4 North. ... 78 3 4 ... ... 9 1 St. Marylebone 114,532 662 19 ... ... 1 417 130 ... 33 ... 1 ... ... 11 4 Hampstead 86,346 400 15 ... ... ... 208 128 ... 215 5 11 ... ... 24 9 St. Pancras 214,330 1,309 41 ... 1 ... 565 438 ... 228 8 28 ... ... 40 19 Islington 325,584 2,239 50 ... ... ... 1,315 551 ... 35 1 2 ... ... 1 5 Stoke Newington 50,518 246 9 ... ... ... 109 84 ... 184 8 19 ... ... 31 15 Hackney 223,353 1,419 39 ... 1 ... 821 331 ... 29 . ... ... 3 2 Central. Holborn 46,949 234 7 ... ... ... 60 ... 125 ... 1 ... ... 6 3 Finsbury.. 84,679 5 49 15 ... 1 ... 132 107 ... 8 5 14 ... ... 1 3 City of London ... 17,916 94 6 ... ... .. 274 39 ... 153 ... 9 ... ... 22 8 East. Shoreditch 109.654 757 15 ... 1 47 185 ... 265 4 13 ... ... 19 5 Bethnal Green . 127,824 958 23 ... 354 223 ... 364 1 34 2 ... 24 14 Stepney 275,300 1,810 68 2 l 411 471 ... 173 10 26 1 ... 47 3 Poplar 160,913 1,397 10 ... 1 2 754 315 ... 5 ... ... ... South. Southwark 188,487 1,586 39 1 2 1 880 327 ... 260 130 15 14 ... ... 55 24 3 Bermondsey 124,739 1,171 27 i 1 9 731 243 ... 219 6 25 ... ... 65 8 Lambeth. 297,139 2 170 39 ... 9 1,397 408 ... 123 3 10 ... ... 31 5 Battersea 167,461 1,431 20 ... 2 949 288 ... 206 9 32 ... ... 37 14 Wandsworth 330,395 1,800 52 ... ... 1,007 447 ... 257 6 12 1 ... 30 5 Camberwell 261,805 1,893 23 ... 1 1,155 403 ... 232 1 ... ... 19 Deptford 109,280 1,140 17 ... 625 267 ... 112 5 ... ... 17 Greenwich 96,015 739 8 ... 330 451 ... 84 ... ... 11 5 Lewisham 168,822 1,238 34 ... 670 402 ... 72 3 ... ... 13 1 Woolwich 122,382 1,155 14 ... ... ... 645 ... 8 ... ... Port of London ? 5 2 ... 2 ... ... 1 ... ... Administrative County of London 4,518,191 31,367 (758 4 15 4 17,552 7,654 ... 4148 92 349 4 1 641 145 27 Below is given the number of advices received from the London County Council Schools respecting the exclusion from school of children (patients, contacts, and suspects) on account of infectious conditions :— School Notification of Exclusion (patients, contacts, and suspects). Notifiable Infectious Diseases. 1191 Tuberculosis 8 Measles 1073 Whooping Cough 641 Chicken-pox 526 Mumps 307 Other Definite Diseases 112 Suspicious Symptoms 101 Ringworm 332 Impetigo, &c. 147 Scabies 34 Pediculosis 119 4591 PART II.—SPECIAL SUBJECTS. PREVENTION OF INFANT MORTALITY. In his Annual Report for 191] (p. xliv), the Registrar-General gives a table showing the mortality of infants arranged according to the fathers' occupation. He finds that the infant mortality of a group (the best) made up of the children of artists, merchants, medical practitioners, solicitors, naval and army officers, woodmen, C.E. clergymen, and persons connected with education, was 42 per 1,000 births; whereas in a group (the worst) made up of general, foundry, dock and factory labourers, workers in iron, earthenware, brass, flax and hemp, etc., makers of tubes, lamps, salt and patent fuel, navvies, tin runners, scavengers, curers, costers and hawkers, the rate was 171 per 1,000 births, or four times as great. There could be no more eloquent testimony to the vast wastage in infant life which is occurring in the lower grades of society ; unless, indeed, it is to be assumed that the "stock" in these lower grades is itself so inferior as to account for the mortality independently of environmental conditions. The balance of evidence is against any such assumption. It is a fact to be faced that in St. Pancras (as in other Boroughs) there is a great amount of sickness and death amongst infants due solely to the conditions under which they live. The statistical report on this subject will be found on pages 19 to 23. 28 It should never be forgotten that all work for the betterment of the social and economic conditions of the submerged population, and all the work of the sanitary staff in promoting cleanliness, better housing conditions, pure milk supply, etc., has a direct influence in increasing the health and diminishing the mortality of our child life. In St. Pancras the direct attack upon infantile mortality, although largely carried on by voluntary associations, has in the past been mainly inspired and directed from the Town Hall by the late Medical Officer of Health, Dr. Sykes. The work done in the Department during the year has consisted in the following up of births which have been notified to the Medical Officer of Health under the Notification of Births Act. The statistics relating to these notifications will be found on pages 15 and 16. A printed card of advice on the subject of infant nurture has been sent to the mother of every child whose birth has been notified. Where the returns of registered births have shown births which have not been notified, a warning letter has been sent to the parent pointing out the provisions of the Act in this respect. Only a small proportion of the mothers have received personal visits. There has been available for this purpose only one health visitor (Miss Smith), and part of her time has been devoted to other work. She has therefore been able to visit only about one-tenth of the notified births. The work done is indicated by the following figures : — Total births (excluding still-births) registered 5167 Births (including still-births) notified 4749 Still-births notified 145 Advice cards sent to cases notified (on day of receipt of notification) 4604 Advice cards sent to cases registered but not notified (on receipt of Registrars' returns) 598 Cautionary letters sent to cases registered but not notified 598 Visits—No. of births visited 485 Additional visit 506 Total visits to mothers 991 (Of these, number where case was not traced) 11 Extra visits (to Infant-Consultations, Hospitals, Midwives, etc.) 485 Voluntary Workers. Very good work is being done at the Infant-consultations, which are conducted by voluntary societies. At these places the mothers bring up their babies periodically to be weighed and receive medical advice as to the feeding, etc., of the infants. They are also visited, where necessary, by the staff of the Institution, and classes are held at some of the "Welcomes" in hygiene, cookery, needlework, etc. 29 At two of the centres free or cheap dinners are also available for needy mothers. There are at present four such Infant-consultations held in St. Pancras, of which two, namely, that at the Passmore Edwards Settlement, Tavistock Place, W.C., and the Ilighgate New Town School for Mothers have been founded during 1913. The work that has been done during 1913 amongst St. Pancras mothers by these Institutions is shown in the following table : — No. of Mothers who have attended. No. of Attendances. St. Pancras School for Mothers, 1, Ampthill Square, Hampstead Road, N.W. North St. Pancras School for Mothers, 366 2412 4, Rhyl Street, N.AV School for Mothers, Passmore Edwards Settlement, Tavistock 259 2769 Place, W.C. (opened 29th September, 1913) 57 208 Ilighgate New Town School for Mothers, Winscombe Street, N.W. (opened 11th December, 1913) 14 14 It is difficult to over-estimate the value of the work of Infant-consultations, and it is to be hoped that many more centres will be founded in the Borough. It is not only the very poor who need the advice and example that these Institutions afford, but also those working-class mothers who are more fortunately placed. Indeed it is probably the latter class who are able to benefit most from advice. In a complete scheme all mothers (in suitable cases) should be visited by one of the staff of the Borough Council, and Infant-cousultations should be available within reasonable distance of all mothers who -can be persuaded to attend. It can hardly be expected that this can be completely achieved by voluntary effort, and it is important, if and when, public money is granted for the upkeep of Infant-consultations that it should be so applied as to link them up closely with the work of Medical Officers of Health who receive notifications of all births, and have charge of other measures designed to lessen the illness and mortality amongst infants. Motherless children.—There is often great difficulty in getting efficient care for those infants who are deprived of their mother's attention by death, sickness, or other causes. The St. Pancras Motherless Children's Committee opened in August, 1913, a small house at 59, Clarendon Square, and engaged the services of a " Visiting Mother," with the object of dealing with such cases, and of ascertaining by practical experiment on what lines this difficulty might be met. This Committee has worked in close connection with the officials of the Public Health Department and of the London County Council. 30 OPHTHALMIA NEONATORUM. This disease is an inflammation of the eyes of newly-born infants due to theinfection of the eyes during birth. It has been compulsorily notifiable by medical practitioners in London since March, 1911. Its importance is due to the fact that it is responsible for more cases of blindness than any other single cause. Observers have found that more than one-third of the inmates of blind asylums owe their blindness to an attack of this disease in the first few days of their life. The disease is largely preventible by proper treatment of the eyes immediately after birth, and even when it has developed, early and skilful treatment will generally avoid permanent damage to the eyes. The object of the notification of the disease is to secure that such treatment shall be obtained. 23 cases of this disease have been notified during the year. In addition to these notified cases information has been received from the Medical Officer of Health of the London County Council in respect of four other cases of inflammation of the eyes in the newly-born. The information in these cases was received from registered midwives by the County Council as the Local Supervising Authority under the Midwives Act. They were all true cases of ophthalmia neonatorum, though slight. The total number of cases which have come to the knowledge of theDepartment during 1913 was, therefore, 27, equal to an incidence rate of 4'90 per 1,000 births. Other numerical details will be found on pages 23-26, The cases are classified below according as the mothers were attended at birth by doctors, midwives, or medical students (in their own homes), or were delivered in hospital: — Attended at birth by Cases of Ophthalmia Neonatorum. Total number of births notified. No. of cases per 1000births notified. Doctors 13 1857 i Midwives 7 1434 5 Medical Students 1 1184 0-9 Delivered in Lying-in Hospitals 4 .. ,, Workhouse 2 .. .. 27 .. .. It will be seen from these figures that ophthalmia neonatorum was more prevalent in the practice of doctors and midwives than in that of the extern midwifery "charities" of the hospitals (University College, Royal Free and Middlesex) which send out medical students. This fact was pointed out by Miss Smith in last year's report. At these hospitals it is a definite instruction that a silver nitrate solution be dropped into the eyes of the new-born in everv case. This is not a usual custom amongst doctors and midwives. It should be noted that the midwife cases include those of the midwives sent out by University College Hospital, who also use the silver nitrate method, so that the percentage of ophthalmia cases amongst midwives may thus be lessened. * The custom in the University College Hospital extern practice is to droit a 0*5 per cent. sol. of AtjNC) into the eyes soon after birth. The lioyal Free Hospital practice is to use a 1 per cent, solution in the same way. At the Middlesex Hospital the eyes are swabbed with 1 in 1000 HgCh, anil painted next day with 2 per cent. sol. of Ay NO 3 31 Taking the total notifications of ophthalmia neonatorum since the disease became notifiable (1911, 1912 and 19131, the figures become :— Attended at birth by Cases of Ophthalmia Neonatorum. Total number of births notified. No. of cases per 1000 births notified. Doctors 26 5684 5 Midwives 27 4291 6 Medical Students 2 3455 0.6 Delivered in Hospitals 11 . . .. The striking difference which appears in regard to the incidence of ophthalmia neonatorum in the poor-class practice of the medical students from that in the practice of doctors and midwives, gives support to the view that the instillation of silver nitrate drops into the eyes of the newly-born is a powerful preventative of this disease. (The figures might also be explained, of course, on the assumption that cases amongst the medical students' patients are not notified, but there is no reason for assuming that this is so; indeed the hospital authorities state that they do not get any cases of ophthalmia in their practice, and attribute the fact to the use of the silver nitrate). Each case was visited by the health visitor, Miss Smith, who made enquiries and, where necessary, took steps, often in consultation with the doctor in charge of the case, to ensure that the baby's eyes received adequate attention. The 27 cases were treated as follows:— By private Doctor, nursing being done by members of the family (including the four cases not formally notified) 13 ,, ,, ,, Visiting Nurse 2 At first by private Doctors, and afterwards referred to Hospital 3 (Viz. : - Central London Ophthalmic Hospital, North-West London Hospital, and Royal Westminster Ophthalmic Dispensary : nursing done at home by members of family in 2 cases, and by Visiting Nurse in 1 case). By Central London Ophthalmic Hospital, nursing being done by members of family 2 ,, University College Hospital, nursing being done by Visiting Nurse 1 ,, London Temperance Hospital, nursing being done by Visiting Nurse 1 Admitted to Highgate Infirmary 1 Treated in Lying-in Ward of Workhouse 2 Treated in Queen Charlotte's Lying-in Hospital 2 27 The results of the treatment of the cases were very satisfactory, as will be from the following figures :— Complete recovery 23 Sight damaged, but improving 1 Blindness 0 Cases lost trace of 3 27 32 PUERPERAL FEVER. During 1913 12 cases of puerperal fever were notified, equal to an incidence rate of 2'18 per 1,000 births. Two deaths were registered from this disease during the year, giving a case mortality of 16.8 per cent. Nine of the cases followed the birth of live-born infants and three followed abortions. Three of the patients were primiparas (i.e. women who had not formerly borne children), and nine multipara. Other statistical details respecting the disease will be found on pages 23-26. In the next table the cases are classified according to the manner in which the patients were attended in their confinements : — Confinement attended by No. of cases of Puerperal Fever. Total number of births notified. No. of cases per 1000 births Doctors 6 1857 3 Midwives 4 1434 3 Medical Students 0 1184 0 In Hospital 1 — — In view of the absence of cases in the practice of the medical students, it is interesting to note that in 1912 there was a greater proportion of puerperal fever per 1000 births amongst their cases than in the practice of doctors and midwives. The cases of puerperal fever were treated as follows : — At home 5 In M.A.B. Hospitals 5 Other Hospitals 2 TUBERCULOSIS. Notification.—In the early part of the year the compulsory notification of Tuberculosis was governed by the Public Health (Tuberculosis) Regulations, 1908, the Public Health (Tuberculosis in Hospitals) Regulations, 1911, and the Public Health (Tuberculosis) Regulations, 1911. These provided for the compulsory notification of all cases of pulmonary tuberculosis in * One was notified as continued fever, but was found to be a case of puerperal fever and is thus counted. 11 were actually notified as suffering from puerperal fever. 33 Poor Law Institutions, in the practice of Poor Law Medical Officers, in voluntary hospitals, dispensaries, etc., and in the", ordinary practice of medical practitioners. In fine they provided for a system of compulsory notification by medical practitioners of all cases of pulmonary tuberculosis with certain specified minor exceptions. They also required certain notification of the movements of Poor Law cases by Superintending Officers and Relieving Officers. On February 1st, 1913, the Public Health (Tuberculosis) Regulations, 1912, came into operation and replaced all former Tuberculosis Regulations. Under these Regulations the notification of all cases of all forms of tuberculosis became compulsory, with certain exceptions similar to those provided under the former Regulations. The notification of change of patients' address by Poor Law Superintending and Relieving Officers was also abolished, and provision made for weekly lists of patients admitted to and discharged from Poor Law Institutions and Sanatoria to be sent by the Medical Officers of such Institutions to the Medical Officer of Health of the Sanitary Districts within which the residence or place of destination of the patients are situate. The other principal change made by the new Regulations is that Medical Officers of institutions are now required to notify to the Medical Officer of Health of the district in which the residence of the patient is situate and not of the district in which the institution is situate. The effect of the successive tuberculosis orders is shown in the following table, in which is set out the number of notifications of tuberculosis received year by year : — Notifications (including Duplicates). Pulmonary. Other Forms. 1906 System of voluntary notification instituted 1st January, 1906 207 - 1907 235 — 1908 249 — 1909 Public Health (Tuberculosis) Regulations, 1908, came into operation 1st January, 1909 936 - 1910 907 — 1911 Public Health (Tuberculosis) in Hospitals Regulations, 1911, came into operation 1st May, 1911 1464 - 1912 Public Health (Tuberculosis) Regulations, 1911, came into operation 1st January, 1912 1735 1913 Public Health (Tuberculosis) Regulations, 1912, came into operation 1st February, 1918 1877 273 The notifications which were received daring January, 1913 (under the old Regulations) were as follows :— 34 Primary notifications:— From Private Practitioners 35 „ Poor Law Medical Officers 28 ,, Hospitals, Dispensaries, etc. 40 ,, School Medical Officers 2 - 105 Duplicate notifications 60 Total 165 There were also received during January, 80 notifications of change of address from Superintending Officers. From February 1st notifications were received under the 1912 Regulations, and these are set out in the following table in the form required by the Local Government Board. Public Health (Tuberculosis) Regulations, 1912. Summary of Notifications during the period from .1st February, 1913, to 3rd January, 1914. Age Periods. Number of Notifications on Form A, Primary Notifications. Total Notifications (i.e.,including cases previously notified by other Doctors), 0 to I I to 5 5 to 10 10 to •5 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 5 65 and upwards. Total. Pulmonary—Males .. 11 15 10 26 29 72 ?6 65 26 10 350 456 ,, Females 1 7 15 11 31 29 66 59 39 -4 12 204 382 Non-pulmonary—Males 3 24 35 14 2 4 11 8 5 3 4 113 126 ,, Females 4 9 14 12 6 3 '3 4 1 1 2 69 80 Totals 8 51 79 47 65 65 162 157 110 54 28 826 1044 Age Periods,, Number of Notifications on Form B. Number of Notifications on Form C. Number of Notifications on Form D. Primary Notifications. Total Notifications (i.e,, including cases previously notified by other Doctors). Poor Law Institutions. Sanatoria. Poor Law Institutions. Sanatoria. Under 5 5 to 10 10 to 15 Total. Pulmonary—Males 6 3 9 10 433 52 134 48 ,, Females — 1 1 1 92 46 18 40 Non-pulmonary—Males 1 10 10 21 22 9 9 2 6 ,, Females — 4 J 7 7 3 6 1 2 Totals 1 20 17 38 40 537 113 155 96 35 Of the 901 notifications received on Forms C and D (i.e., of admissions and discharges of cases of tuberculosis to and from Poor Law Institutions and Sanatoria), 189 were in respect of cases which had not been notified previously to this Authority. The total number of primary notifications received during the year (composed of January primary notifications and primary notifications on the new forms A, B, C and D), was, then, 1,158 of which 928 were in respect of pulmonary tuberculosis and 230 of other forms of tuberculosis. These are set out and analysed for age and sex in the following table: — Primary Notifications during 1913. Ages. Pulmonary Tuberculosis. Other Tuberculosis. Total all forms. Males. Females. Total. Males. Females. Total. 0-1 2 2 3 4 7 9 1—5 16 8 24 27 10 37 61 5—10 31 23 54 50 20 70 124 10—15 18 16 34 25 16 41 75 15—25 78 89 167 6 12 18 185 25—35 104 87 191 12 14 26 217 35 -45 116 75 191 8 5 13 204 45- 55 101 49 150 5 1 6 156 55—65 57 27 84 4 1 5 89 65 upwards 17 14 31 4 3 7 38 Totals 538 390 928 144 86 230 1158 The rates for 1913 of (primary) notification of tuberculosis based on the 1911 census population of the Borough (Males 106,728, Females 111,659} were therefore: — 30  Of males per 1000 male population. Of females per 1000 female population. Total persons per 1000 population. Pulmonary tuberculosis 4.94 3.42 4.17 Other forms of tuberculosis. 1.32 .75 1.03 All forms of tuberculosis 6.26 4.17 5.20 The deaths from tuberculosis during the year numbered 392, of which 325 were from phthisis, and 67 from other forms of tuberculosis. These are analysed for age and sex in the following table :— Deaths prom Tuberculosis during the Year 1913. Ages. Phthisis. Other Tuberculosis. Total. Males. Females. Total. Males. Females. Total. 0-1 2 3 5 4 4 8 13 1—2 1 1 2 8 5 13 15 2—5 2 1 3 8 4 15 18 5—10 1 — 1 8 9 17 18 10—15 2 — 2 4 — 4 6 15—25 21 16 37 1 1 2 39 25-35 46 18 64 — 1 1 65 35-45 56 21 77 — — — 77 45—55 50 24 74 1 - 1 75 55—65 26 17 43 2 2 4 47 65—75 10 6 16 1 1 2 18 75—85 — 1 1 — — - 1 85 upwards - - - - - - - Totals at all Ages. 217 108 325 37 30 67 392 37 The death rates for 1913 from tuberculosis based on the 1911 census population of the borough were therefore :— Of males per 1000 male population. Of females per 1000 female population. Total persons per 1000 population. Phthisis 1.99 .95 1.46 Other forms of tuberculosis .34 .26 .30 All forms of tuberculosis 2.33 1.21 1.76 The standardising factors for 1911 for St. Pancras (supplied by the Local Government Board) are as follows : — Males. Females. Persons. Phthisis .9043 .9479 .9206 Other forms of tuberculosis . 1.1021 1.0969 1.0986 All forms of tuberculosis .9537 .9918 .9685 These factors enable standardised death rates to be made for tuberculosis in St. Pancras, which are strictly comparable with standardised rates for other districts, irrespective of differences of the age and sex distribution of the population. The standardised tuberculosis death-rates for St. Pancras for 1913 were as set out below :— Males- Females. Persons. Phthisis 1-79 •90 1-34 Other forms of tuberculosis. . •37 •28 •32 All forms of tuberculosis 2-22 1-20 1-70 38 It will be seen from the foregoing tables that the incidence of and deaths from pulmonary tuberculosis have been greatest in the age periods 15 to 55, but in the case of other forms of tuberculosis in the age periods 0 to 15. This is an expression of the fact that tuberculosis of the lungs is commonest in adults, and tuberculosis of other parts of the body (such as of glands, meninges, joints, and abdominal tuberculosis) commonest in children. The males have suffered all round from tuberculosis to a greater extent than the females. This is found in the aggregate by the Registrar-General to he the case in all urban communities, but hardly at all in purely rural districts. The excessive mortality in man is evidently, then, a product of urbanisation, and, especially as it is not seen in childhood, is probably due to the difference between the industrial life of men and the domestic life of women. The St. Pancras notifications also show an excess of males. The great excess of notifications of non-pulmonary tuberculosis in children under 15 amongst males (105) over that amongst females (50) is probably accidental; there is no excess in the corresponding figures for deaths. The deaths from and primary notifications of tuberculosis are classified in the following table according to the part of the body affected ;— Deaths. Primary Notifications. Pulmonary Tuberculosis 252 J928 Phthisis (not defined as Tuberculosis) 73 Acute Phthisis — 325 - 928 Acute Miliary Tuberculosis 6 - Tuberculous Meningitis 36 15 Tabes Mesenterica 4 — Other Peritoneal and Intestinal Tubercle 10 9 Tuberculosis of Spinal Column 3 24 Tuberculosis of Joints 2 Lupus — 7 Scrofula — — Tuberculosis of Other Organs 5 75 Disseminated Tuberculosis 1 — 67 - 230 Total, all forms of tuberculosis 392 1158 In the following table the deaths from and primary notifications of tuberculosis, together with the corresponding rates are classified in Registration Sub-Districts :— 39 Registration Sub-District. Primary Notifications. Notification Rates. Deaths. Death-rates. Pulmonary. Other Forms. All Forms. Pulmonary. Other F .rim. All Forms. Phthisis. Other Forms. All Forms. Phthisis. Other Forms. All Forms. West 261 59 320 4.39 1.03 5.39 87 22 109 1.46 .37 1.83 South 228 50 278 4.95 1.08 6.03 92 16 108 1.99 .35 2.34 East 215 58 273 3.67 .99 4.66 69 1.6 85 1.18 .27 1.45 North 182 55 237 3.11 .94 4.05 65 1.3 78 1.11 .22 1.33 No Address 42 8 50 — — — 12 — 12 — — — Whole Borough 928 230 1158 4.17 1.03 5.20 325 67 392 1.46 .30 1.76 It is noteworthy that the distribution of deaths from tuberculosis in the four districts differs from that of total deaths (see page 16). In both cases the North district suffered least. But whereas the East had the highest general death-rate, it is a good second to the North as regards lightness of tuberculosis death-rate. The South division had by far the highest death-rate from all forms of tuberculosis. It is possible that these variations in general and tuberculosis death-rates are due to the kind of industrial employment in the four divisions. The weekly distribution of deaths from tuberculosis will be found in the table inset at pages 24-25. In the table below are shown the death-rates from tuberculosis for the past 10 years : — Year. Estimated Population. Tuberculosis Death — Rate. Corresponding rates for "all Forms" based on 1911 census Population. Phthisis. Other Forms. All Forms. 1904 237088 1.86 .57 2.43 1905 237149 1.49 .40 1.89 1906 237149 1.69 .52 2.21 1907 237173 1.59 .43 2 02 1908 237247 1.53 .41 1 94 1909 237247 1.58 .33 1.91 207 1910 237247 1.25 .32 1.57 1.71 1911 237129 1.39 .35 1.74 1.89 1912 220353 1.48 .32 1.82 1.84 1913 218387 1.49 .30 1.79 1.79 40 Reference to the last column shows that the death-rate from all forms of tuberculosis was lower in 1913 than in any former year except 1910. Work Done. As in former years the work in connection with tuberculosis has been done by the female staff under the direction of the Medical Officer of Health. Miss Bibby early in the year found herself unable to cope with the large amount of work which the Regulations entailed, and as a consequence, Miss Mary Giles was engaged as a full-time temporary visitor from 30th December, 1912, to 30th May, 1913, and again from 14th July onwards. The work which has been done has consisted mainly in the visiting of notified cases. At these visits a case paper is filled up for each case, and advice is given as to the means that can be adopted by the patients to assist their recovery, and by the families of the patients to avoid contracting the disease. Where there are contacts whose health is not all that can be desired, or where the patient appears not to be under adequate medical attention the contacts or patients are advised to seek medical advice. In such cases much use has been made of the St. Pancras Tuberculosis Dispensary, Oakley Square, who have willingly examined any persons sent to them by the Department. Care has been taken not to trespass upon the preserves of private practitioners, and no complaints have been received on this score. Practically all cases notified during the year have been visited, and in the latter part of the year a good deal of systematic re-visiting has been done. Disinfection of bedding and bedrooms has been carried out on the advice of the tuberculosis visitors, and on application after the death or removal of patients, and in other cases. Where insanitary conditions have been found they have been reported by the tuberculosis visitors to the District Sanitary Inspectors, and dealt with in due course. Much good work has been done by the tuberculosis visitors in putting necessitous patients and families into touch with various charitable and other agencies. They have also been in frequent attendance at the St. Pancras Tuberculosis Dispensary to see cases who have been treated there. The actual work done by the Lady Inspector and Visitor is shown below : — No. of visits to homes of notified cases— (a) First visits 1703 (b) Subsequent visits 1027 No. of cases in which disinfection was carried out 110 Attendances of inspector or visitor at St. Pancras Dispensary 112 Other visits made for various purposes 181 No. of contacts and suspects examined at the St. Pancras Dispensary at the instance of the inspector or visitor 196† * This figure is greater than the total number of persons visited, because in many instances more than one visit was paid to a patient's home in the course of the original inquiry. A number of patients were visited for the first time in 1913, who had been notified in 1912. f This figure does not include those cases who were given cards to be examined at the St. Pancras Dispensary but did not arrive there; nor the numerous cases who were examined at otherInstitutions or by their private doctors at the instance of the inspector or visitor. 41 Treatment of Tuberculosis. In the report of the Medical Officer of Health for 1912 was included a report by the Chief Clerk (Mr. A. Powel Coke) upon the administrative measures in St. Pancras in relation to tuberculosis. This gives a full account of the scheme for treatment in the Borough up to April, 1913, with special reference to the National Insurance Act. Before the inception of the National Insurance Act, 1911, a number of local sanitary authorities had undertaken, at the expense of the rates, the treatment of tuberculosis, either by the provision and maintenance of Sanatoriums, or by paying for the treatment of patients in private Sanatorium. Some local authorities and voluntary societies had also established out-patient treatment on lines which foreshadowed the tuberculosis dispensaries of the Astor report. "With the advent of the Insurance Act, and its "Sanatorium benefit," attention was concentrated upon this disease, and during 1912 the Report of the Departmental Committee on Tuberculosis laid down certain considerations of general policy in regard to it. They recommended that every district should be provided with (1) a tuberculosis dispensary, with an expert consulting officer, and (2) resident institutions, such as sanatoriums and hospitals. In the case of London they suggested that it should be considered whether the resident institutions should not be provided by the Metropolitan Asylums Board and the dispensaries by the Borough Councils. The report also emphasised the point that any scheme ought to provide for the non-insured as well as the insured; and the Local Government Board later made it clear that in addition to capital grants towards the provision of institutions they were prepared to make annual maintenance grants to local -authorities to the extent of one-half of the expense incurred after the deduction of the maintenance contribution made by the local Insurance Committees. Until towards the end of the year (1913) it appeared to be somewhat doubtful whether the County Council or the Borough Council were to be the providing authority for the treatment of tuberculosis. On the one hand the Borough Council was the authority under the Public Health (Tuberculosis) Regulations, and had been invited by the Local Government Board to provide or arrange for the provision of dispensaries, and on the other hand the County was the unit for insurance purposes. It was later decided that the provision of residential institutions should be arranged for by the County Council, and that of dispensaries by the Borough 'Council, and that the County Council should contribute towards the cost of dispensaries, exercise a certain measure of control over them, and be the coordinating authority for tuberculosis in London. This was made clear by the letters of the Local Government Board addressed to the County Council on the 24th September, 1913, and to the Borough Councils on the 19th December, 1913, and the resolutions of the County Council of the 4th November. 42 There is set out below a copy of the Board's circular letter of the 19th December, to the Borough Councils :— Treatment of Tuberculosis in London. Local Government Board, Whitehall, S.W., 19th December, 1913. Sir, I am directed by the Local Government Beard to advert to the letter which they addressed to the London County Council on the 24th of September last, a copy of which was forwarded to the Metropolitan Borough Council, in regard to the arrangements to be made for the institutional treatment of tuberculosis in London. Having regard to the recent decisions of the London County Council, the Board think it desirable to set out in further detail, for the information of the Borough Council, their general views as to the lines upon which the arrangements for providing dispensaries for the treatment of tuberculosis in London should be further developed. As intimated in their letter to the London County Council, the Board, acting on the suggestion made by the Departmental Committee on Tuberculosis in their Interim Report, have invited Metropolitan Borough Councils to provide or arrange for the provision of these institutions, and have at the same time urged the view that all possible use should be made of existing institutions, and that hospitals and other voluntary institutions which are to be recognised as forming part of the tuberculosis scheme for London should undertake to work in close co-operation with the local authority. The provision of an efficient dispensary organisation for London is facilitated by the decisons arrived at by representatives of 12 general hospitals at a meeting in London which was held on the 23rd October last. At this meeting it was resolved :— (1) That it is important in the interests of the public and of medical education that the general hospitals with medical schools should be utilised to the fullest extent in the treatment of tuberculosis in the London area. (2) That any local institution carrying out dispensary treatment shall refer special cases for consultative purposes to appointed hospitals; and that amongst the appointed hospitals for consultative purposes be the 12 general hospitals with medical schools, viz.:— St. Bartholomew's Hospital. London Hospital. Guy's Hospital. St. Thomas's Hospital. University College Hospital. Charing Cross Hospital. St. George's Hospital. Westminster Hospital. King's College Hospital. St. Mary's Hospital. Middlesex Hospital. Royal Free Hospital. (3) That in addition to being recognised as consultative hospitals, such institutions should, where they desire, also act as tuberculosis dispensaries, and in respect of such work should conform to the general conditions regulating dispensary treatment elsewhere. 1. Dispensary Schemes. The Board consider that, in developing schemes for the provision of dispensaries in London, the following general principles should be observed : — (1) One or more dispensaries should be available for each Metropolitan Borough, or combination of Boroughs, to which any person residing in the area for which the dispensary is provided and who is suffering from, or suspected to be suffering from, tuberculosis, may have access for diagnosis and treatment. 43 These dispensaries may actually be provided either at general hospitals or hospitals for consumption, or at voluntary dispensaries, or by the Borough Councils themselves. (2) Where there is a general hospital, or a hospital for consumption, situated in the Borough or sufficiently near to serve as a dispensary for the Borough or some part of the Borough, and the authorities of the hospital are willing to provide a tuberculosis dispensary which will comply with any rules which the Board may find it necessary to make as to dispensaries in London, and to work in co-operation with the Borough Council and the Loudon County Council, the Board are of opinion that arrangements should be made for such a dispensary to serve the whole or part of the Borough. The nature of such arrangements will no doubt vary in different Boroughs, but it will usually be found desirable that an agreement should be entered into with the hospital authorities, indicating the nature and extent of the services which they will provide and specifying the amount of the payment which the Borough Council will make to them. A draft of any such agreement should be submitted to the Board and their approval obtained before the agreement is executed, and a copy of the draft agreement should be sent to the London County Council when the draft is submitted to the Board. (3) Where a voluntary dispensary is already in existance which is found to be efficient and to suffice for the needs of the area served by the dispensary, and the dispensary authorities are prepared to comply with any rules which the Board may find it necessary to make as to dispensaries in London and to work in co-operation with the Borough Council and the London County Council, it appears to the Board that arrangements should be made for including the dispensary in the scheme of the Borough Council. In these cases also an agreement should be entered into with the authorities of the dispensary, indicating the nature and extent of the services which they will provide and specifying the amount of the payment which the Borough Council will make to them. A draft of any such agreement should be submitted to the Board and their approval obtained before the agreement is executed, and a copy of the draft agreement should be sent to the London County Council when the draft is submitted to the Board. (4) In cases in which the needs of a Borough or a combination of Boroughs cannot be adequately met by the utilisation of tuberculosis dispensaries which the hospital authorities either have established or are prepared to establish at hospitals, or of voluntary dispensaries already in existence, the Borough Council or Councils should establish, alone or in combination, a dispensary to serve the areas which would not otherwise be provided for. (5) Every dispensary, other than those established at hospitals, should be affiliated to a general hospital or a hospital for consumption to which specially difficult cases would be referred for diagnosis or treatment. (6) It is desirable that beds should be available to which cases needing observation for the purpose of diagnosis, or for determining the form of treatment best adapted to the patient's needs, may be sent. The Board consider that such beds should not be provided at the dispensary itself, but that the most convenient course will be that beds for this purpose should be provided by the County Council. 2. Preventive Measures. It is essential that arrangement* should be made for the complete co-ordination of the work of the dispensary with the preventive work of the Borough Council and their officers under the Tuberculosis Regulations, 1912. (i) In the case of a dispensary established by a Borough Council, this will be secured by attaching the medical officers of the dispensary to the staff of the Public Health Department of the Council, it being understood that although these officers are independent of control in clinical matters they will act under the administrative supervision of the Medical Officer of Health. 44 (ii) As regards dispensaries established at hospitals, it will be necessary to appoint a medical officer with suitable qualifications to take charge of the work of the dispensary, and arrangements should be made for complete interchange of information between the Medical Officer of Health and the medical officer of the dispensary. Tbe Medical Officer of Health of the Borough and the County Medical Officer of Health should, of course, be free to visit the dispensary and should have access to the dispensary records. The duties of the medical officer of the dispensary should include the examination of "contacts" and "suspects." The examination would usually take place at the dispensary, but the officer should be prepared to visit, for this purpose, the homes of patients in cases where this is necessary. If the authorities of the hospital appoint a health visitor in connection with the dispensary, it is desirable that her reports on visits to the homes of patients should be forwarded to the Medical Officer of Health as well as to the medical officer of the dispensary, and that the health visitor should obtain any information required by the Medical Officer of Health. (iii) The remarks in (ii) above will apply generally to voluntary dispensaries other than those provided at hospitals. It will usually be found that the medical officer and health visitors of the dispensary pay systematic visits to the homes of patients, and that unnecessary duplication of visits can be s voided by arranging that the officers of the dispensary shall be available, so far as practicable, to undertake, under the direction of the Medical Officer of Health, the domiciliary visits and enquiries under the Tuberculosis Regulations. The Borough Council should be willing to furnish the County Council with such information as is required for administrative and statistical purposes. 3. Duties of Medical Officers of Dispensaries. Under the Board's Order of 26th July, 1912, relating to the domiciliary treatment of insured persons suffering from tuberculosis, the medical officer of a dispensary approved by the Board under the National Insurance Act, 1911, becomes the " Consulting Officer, " within the meaning of that Order, for insured persons resident in the area served by the dispensary who are receiving sanatorium benefit in the form of domiciliary treatment; and in arranging for the services of voluntary dispensaries it should be borne in mind that the duties of the medical officer of the dispensary will include that of acting as " Consulting Officer" for the purposes of the Order. Moreover, it has usually been found convenient to arrange that insured persons applying for sanatorium benefit should be referred in the first instance to the appropriate dispensary for examination, and it is desirable that any arrangements which may be made with the London Insurance Committee for the provision of dispensary services for insured persons in the borough should provide that the medical officer of the dispensary will be available to examine such persons and report to the Insurance Committee and to attend their meetings when required. The Medical Officer of a dispensary should also be prepared to furnish such information in his possession as may reasonably be required by any medical practitioner in attendance upon patients who are also attending the dispensary, and by the medical officers of residential institutions. 4. Finance. (i) It appears to the Board that where the scheme of the Borough Council includes any voluntary dispensary, whether attached to a hospital or not, it is desirable that the contributions of the Borough Council towards the expenses of the dispensary should be made in respect of the whole population of the Borough, and that the payment of the Insurance Committee for the dispensary treatment of insured persons should be made to the Borough Council. I am to remind the Borough Council that the Government grant towards the annual cost of schemes is limited to 50 per cent, of the amount chargeable to rates, and that no portion of the grant will be payable direct to voluntary institutions ; this consideration should be borne in mind in fixing the contributions to be paid by the Council towards the expenses of voluntary dispensaries. Similarly, the payments made by the Borough Council to the hospital with which the dispensary is affiliated should be regarded as covering the whole population of the Borough. The general principles to be kept in view are :— 45 (a) That the Borough Council are to be regarded as the providing authority for dispensaries, although the dispensary which will serve the borough may be provided at a hospital or by a voluntary organisation; and (b) That the dispensary is to serve the needs of the whole community including insured persons. The Borough Council will arrange with the Insurance Committee as to the contributions to be paid by the latter in respect of insured persons, and the Board think it would be preferable that these contributions should take the form of lump sum payments, the amount of which would be subject to revision in the light of experience, rather than that fees per case should be paid. Similarly, the contributions made by the Borough Council to the expenses of hospitals and other voluntary dispensaries should be in the form of lump sum payments. (ii) I am to refer to the terms of the resolution passed by the London County Council on the 4th ultimo, which have, as the Board understand, been communicated to the Borough Council, and to point out that the County Council are prepared to contribute up to 50 percent. of the net cost of the dispensary treatment of uninsured persons in the City of London and in each metropolitan borough, after deducting the Government grant, provided that the County Council are satisfied with the local scheme in force in the area and that the arrangements and expenditure are annnually submitted to and approved by the County Council. As the Board have already explained, all the various agencies should be properly co-ordinated through the County Council so as to form parts of a complete scheme of institutional treatment. Each Borough Council should therefore work in close co-operation with the County Council, and it appears to the Board to be very desirable that the Borough Council should avail themselves of the offer of the County Council to contribute towards the cost of dispensary schemes provided by or through the Borough Council. The scheme of the Borough Council should be forwarded to the London Couuty Council when it is submitted to the Board, and in those cases in which the Board have already approved of the general principles of a scheme, but the Borough Council have not yet fully developed the scheme or have made no arrangements for linking up a dispensary with a general hospital or a hospital for consumption, the Board should be informed as soon as possible of the arrangements proposed for completing the scheme and a copy of the complete scheme should be forwarded to the London County Council. Where it is proposed to establish new dispensaries, information as to the premises to be used for this purpose should be supplied to the London County Council when application is made for the approval of the Board. (iii) The expenditure of the Borough Council on their dispensary scheme, after deducting the payment made by the Insurance Committee in respect of treatment of insured person, and any other contributions, will met as follows:— (a) 50 per cent. from the Board. (b) 25 per cent. from the London County Council. (c) 25 per cent. out of the rates of the borough. The Board may observe that the promise of the grant of 50 per cent. of the net cost of schemes is subject to the expenditure being kept within reasonable limits. When preparing the scheme the Borough Council should communicate with the London Insurance Committee with a view to arrangements being made between the two bodies as to the terms on which the services of the scheme will be available for insured persons residing in the Borough. These arrangements will require the approval of the Insurance Commissioners. The Insurance Committee will inform the Insurance Commissioners of the arrangements proposed and the Council should send similar information to the Board: the arrangements should not be finally completed until the Board have expressed their concurrence. 16 5. Approval of Dispensaries. The Board's approval of dispensaries under the provisions of the National Insurance Act, 1911, will usually be given subject to the following conditions:— (a) That the dispensary will be open to inspection at any time by any of the Board's officers or inspectors ; (b) That such records will be kept in connection with the dispensary as the Board, after consultation with the Insurance Commissioners, may from time to time require ; (c) That the Board will be informed of any proposed change in the ownership or management of the dispensary, and of any proposed alteration in or addition to the medical staff of the dispensary; and (d) That any rules which the Board may find it necessary to make in regard to dispensaries in London will be complied with. 6. Residential Institutions. The Board understand that the London County Council are prepared to provide or arrange for the provision of the residential accommodation required for the treatment both of insured and uninsured persons who are suffering from tuberculosis subject to the condition that in the case of issured persons the cost of treatment will be borne by the Insurance Committee. Arrangements should be made for forwarding to the London Insurance Committee all recommendations made by the medical officers of dispensaries for treatment of insured persons in residential institutions. Copies of these recommendations and recommendations in regard to uninsured persons should be forwarded to the London County Council. In conclusion the Board wish to urge on the Borough Council the importance of completing their dispensary arrangements as early as practicable, and of co-operating in every way with the London County Council in formulating and carrying out the scheme for the Borough. Six additional copies of this Circular are enclosed for the use of the Borough Council, and further copies may be obtained, if desired, by application to the Board. I am, Sir, Your obedient Servant, H. C. MONBO, The Town Clerk. Secretary. In their circular letter to the Borough Council of the 11th December, the London County Council laid down certain conditions under which they will be prepared to make grants (to the extent mentioned above) in respect of the dispensary treatment of uninsured persons suffering from tuberculosis. These conditions are in the main on the same lines as those suggested in the letter of the Local Government Board set out above. It is anticipated that the cost of the similar treatment of insured persons will be met from insurance funds. At the end of 1913 the Borough was provided with two well-equipped tuberculosis dispensaries, viz., the St. Pancras Dispensary, Oakley Square, and the newly completed tuberculosis dispensary at University College Hospital. This is in addition to the ordinary out-patient departments of general hospitals, of which the chief are University College Hospital, the Royal Free Hospital, the London Temperance Hospital, and the North-West London Hospital; there are also others just outside the Borough boundary. 47 (1) The St. Pancras Dispensary. A full account of the tuberculosis dispensary here was given in the Chief Clerk's report published in the annual report for last year. This institution has been approved by the Local Government Board under Sec. 16 (1) (a) of the National Insurance Act. It is managed by a special committee consisting of six representatives of the Borough Council, six of the parent dispensary committee, the Medical Officer of Health, the Consulting Physician, the Woman Inspector and three other members, and by reason of an agreement made on 11th April, 1913, the Borough Council have undertaken to take over the tuberculosis dispensary if the dispensary committee fail to maintain it to the satisfaction of the Local Government Board. On 21st June, 1913, the Borough Council were informed by the Local Government Board that the Board would make a capital grant of £278 towards the cost of establishing the tuberculosis dispensary. This amount was later forwarded to the Borough Treasurer and paid over to the dispensary. On 14th October, 1913, the Secretary of the dispensary addressed a letter to the Borough Council asking that a grant be made by the Council to the dispensary in respect of the treatment of non-insured St Pancras cases. This matter was under consideration by the Council at the close of the year. The dispensary on the 29th November, 1913, received a communication from the London Insurance Committee offering a grant of £80 in respect of the treatment of insured persons up to 14th July, 1914. Throughout the year the dispensary has worked in close and cordial touch with the Public Health Department, and has welcomed the presence of the Borough women inspectors at its consultations (which have been held on Monday and Thursday afternoons). Through the courtesy of the Hon. Secretary, Mr. H. Peter Bodkin, I have been supplied with the following particulars as to the attendances at the tuberculosis dispensary, and other work done there during the year. 1913. Attendances of Tuberculous Patients. Tuberculin Injections. Laboratory Examinations. January 118 37 29 February 117 48 28 March 143 49 36 April 102 54 27 May 169 73 21 June 98 59 20 July 125 — 10 August 96 - 17 September 134 — 18 insured Non-Insured. October 119 + 84 = 203 53 28 November 94 + 113 = 207 55 31 December bo + 105 = 170 32 11 Whole Year 1682 276 48 The institution is centrally situated in the Borough, and practically all its patients are St. Pancras residents. 196 "contacts and suspects" have been examined at this dispensary during the year at the request of the Medical Officer of Health. (2) The Tuberculosis Dispensary at University College Hospital, Goicer Street, W.C. This also is a well-equipped tuberculosis dispensary, consisting of waiting-room, dressing-rooms, consulting-room and laboratory, and is worked by a specially appointed tuberculosis officer under the superintendence of the consulting staff. The dispensary is available for teaching purposes, this hospital being attached to a large medical school. The premises were not ready until 1st January, 1914, but for some months before that date the dispensary officer was working at the hospital in the general out-patient department. On 22nd January, 1914, the Local Government Board expressed themselves as satisfied with the general arrangements of this dispensary, but withheld their formal approval under the National Insurance Act until the dispensary should have come to some arrangement with the Councils of the Boroughs in its neighbourhood with a view of its serving a definite area of local government. I am informed by the Dispensing Officer, Dr. M. M. Khan, that during the last six months of 1913 there were 398 attendances at this tuberculosis dispensary, of which about 134 were of insured persons. As mentioned above, however, the dispensary was not in full working order during these months. Not all of the above were St. Pancras patients, as this hospital, being situated near the Borough boundary, serves an area which comprises parts of neighbouring Boroughs. Besides the two existing dispensaries above mentioned, the Borough Council have received communications from the Royal Free Hospital, Gray's Inn Road, indicating the desire of the hospital to establish a tuberculosis dispensary. A letter was addressed to the Board to this effect by the Secretary to the hospital on 8th January, 1913. Up to the end of the year, however, no tuberculosis dispensary had been founded by the hospital. Although two tuberculosis dispensaries were in active work in the Borough at the close of 1913, no Borough scheme for the dispensary treatment of tuberculosis had been formulated. The question of the preparation of a scheme for submission to the Local Government Board was at that time under consideration by the Council. With the St. Pancras Dispensary (and a projected branch in the north of the Borough) for the part of the Borough lying north of Euston Road, and the dispensary at University College Hospital for the part lying south of Euston Road (viz., Wards 7 and 8) there is now ample accommodation for an efficient scheme of dispensary provision in the Borough. Residential Institutions. The duty of making arrangements for the treatment of tuberculosis in residential institutions rests with the County Council, but no scheme for such treatment appears to have been settled, and, in fact, no such treatment is yet being provided out of public funds for the non-insured. 49 The position then in St. Pancras is that no treatment of the non-insured' tuberculous is being provided by any public authority (except inasmuch as the Local Government Board have made a capital grant to the St. Pancras Dispensary). On the other hand, the London Insurance Committee have been providing "sanatorium benefit" for the insured population of the Borough. This has mainly taken the form of treatment in sanatoriums and hospitals, generally for periods of a few months. Most of the institutions to which the insured have been sent have been private or voluntary (including University College Hospital in St. Pancras, which has been recognised as a suitable residential institution), but patients have also been sent to institutions belonging to the Metropolitan Asylums Board (under Sec. 39 of the National Insurance Act, 1913). In all cases the arrangements have been made directly by the London Insurance Committee with the governing bodies of the respective institutions. According to information received from the London Insurance Committee, 165 St. Pancras insured patients have been admitted to residential institutions for treatment during the year at the expense of the Insurance Committee. All of these, except about four (glands, finger, hip), were suffering from pulmonary or laryngeal tuberculosis. These cases have been carefully followed up by this department, and I have been assisted by Miss Bibby in getting out the following information in regard to them:— The table below indicates what institutions have been utilised for the treatment of St. Pancras insured persons:— Men. Women. Brompton Hospital for Consumption, etc. 8 2 Royal Hospital for Diseases of the Chest, City Road. — 1 City of London Hospital 6 — University College Hospital i 2 St. Thomas's Hospital — 1 Metropolitan Hospital 2 — Northern Hospital, Winchmore Hill (M.A.B.) 6 25 The Downs Sanatorium (M.A.B.) 67 — Mount Yernon Hospital 16 10 Brompton Hospital Sanatorium, Frimley 3 — Royal National Hospital for Consumption, Yentnor 2 1 St. Catherine's Home, Ventnor 1 — Fairlight Sanatorium, Hastings 1 — Making's Farm Sanatorium, Nayland 2 2- East Anglian Sanatorium, Nayland — 1 Hawthorn Dene Home for Phthisis, Bonchurch 2 — Metropolitan Convalescent Home, Cranbrook 2 1 Helling Sanatorium, Holt 1 — Ipswich Borough Sanatorium 2 — Great Baddow Encampment 1 1 Royal iSea Bathing Hospital, Margate 1 — Chilton Hill House Sanatorium, Sudbury — 4 130 51 50 By reason of transference of patients from one institution to another the 130 admissions of men represent 121 persons, and the 51 admissions of women 44 persons. The next table shows the length of stay of patients in these institutions:— Men. "Women. Persons. Less than 1 month 15 3 18 Between 1 and 2 months 19 4 23 „ 2 „ 3 „ 23 11 34 „ 3 „ 4 „ 30 7 37 „ 4 „ 5 „ 12 8 20 ,, 5 „ 6 ,, 5 6 11 „ 6 „ 7 „ 1 1 2 „ 7 „ 8 „ 3 1 4 „ 8 „ 9 „ 1 — 1 Not stated, or not yet discharged 12 3 15 121 44 165 After-care.— The Medical Officer of Health has been advised by the Insurance Committee whenever a St. Pancras insured person has been admitted to an institution for sanatorium benefit and again upon his discharge. This has enabled disinfection and any other necessary measures to be undertaken after the patients' removal, and some supervision to be exercised after their return. The arrangements for after-care have not been satisfactory, half of the patients not being under systematic medical care after their return home. The approved dispensary has not been much utilised for this purpose during the year. Most of the after-care that has been exercised has been done by the patients' panel doctors. Of the 121 men and 44 women who have been through residential institutions during the year, after-care has been provided in the following cases by the agencies named:—- Men. Women. Panel doctor 39 10 Other doctors 2 — St. Pancras Dispensary 13 3 University College Hospital 2 1 Mount Vernon Hospital 1 — Dispensary and panel doctor — 2 57 16 An attempt has been made to judge of the change in the patients' condition brought about by the stay in the sanatoriums or other institutions. The following table is based upon the conditions in April, 1914, of patients admitted during 1913 as judged by the visiting inspector: — Men. Women. Total. Dead 22 6 28 Worse 16 3 19 No change 25 4 29 Improved 27 13 40d) Thought to be cured 3 4(3) 7 Lost sight of, or not yet discharged 28 14 42(2) 121 41 165 (1) Of these 10 are, however, not satisfactory. (2) Of these 6 men were Rowton House residents and 7 women were domestic servants. (3) Two of these said to be "not phthisis." 51 The same cases are classified in the next table according to their capacity for work:— Men. Women. Persons. Dead 22 6 28 Unable to work by reason of physical condition 19 4 23 Cannot get work because of physical condition 9 4 13 Cannot get work because known to be consumptive 4 — 4 At work, but failing in health 9 1 10 At work, and doing well* 22 12 34 Now in Infirmary or Home for Advanced Cases 4 1 5 Returned to Insurance Committee Institutions 4 2 6 Lost sight of, or not yet discharged 28 14 42 121 44 165 * Five of these are included with hesitation. It will be seen from the above two tables that a considerable proportion of the insured patients who have been sent away to institutions have done badly. Of the 123 cases in which the information is complete only 47 are said at the present time to have improved, and only 34 to be at work and doing well. It must be remembered also that us time progresses a worsening will certainly take place in many of the patients, and for conclusive results further inquiries must be made at a later date. This is brought out by the fact that of the 165 cases dealt with 13 have been discharged since the end of 1913, and 48 others during the last three months of 1913. As some patients no doubt have been admitted to institutions who were known to be incapable of cure, the following table is added showing the results classified according as to whether the patient was treated in a London hospital only (Brompton, City Road, City of London, University College, St. Thomas's, or Metropolitan) or in the other institutions mentioned in the list above:— Treated in a London hospital only. Treated in other institutions. Total. Dead 9 19 28 Worse 2 17 19 No change 3 26 29 Improved 5 35 40 Thought to be cured 2 5 7 21 102 123 Lost sight of or not yet discharged 42 165 Although many insured tuberculous persons have been treated during the year as dispensary patients at the St. Pancras Dispensary only a few of these have been "sanctioned" by the Insurance Committee for dispensary treatment. The medical examination of St. Pancras insured persons for "sanatorium" benefit has been carried out during the year by the Expert Medical Adviser of the Insurance Committee, and not by the medical staff of the local approved dispensary. 52 A very large amount of the treatment for tuberculosis which has been received by insured persons has been provided for them by the panel doctors. Indeed, except for treatment in residential institutions, this represents the greater part of the treatment provided by the Insurance Committee. The circular letter of the Local Government Board of 27th July, 1912, in reference to the domiciliary treatment of tuberculosis (set out in the annual report for 1912) in which it is suggested that the medical practitioner should act in consultation with a "Consulting Officer" and inform the Medical Officer of Health of conditions adversely affecting the patient, appears to have become practically a dead letter in St. Pancras. In a few cases the Insurance Committee, on the application of the panel doctor, have sanctioned the provision out of insurance funds of foodstuffs such as eggs and milk as accessories to domiciliary treatment. About a score of such cases have come to the knowledge of this department. Bacteriological Examinations.— 198 specimens of sputum from St. Pancras patients have been examined for medical practitioners by the Lister Institute of Preventive Medicine at the expense of the Borough. 40 of these were reported as containing tubercle bacilli and 158 as negative. SCARLET FEVER. 568 patients were notified during 1913 as suffering from scarlet fever. Of these 32 were afterwards returned as not suffering from this disease (31 by the Medical Superintendents of Metropolitan Asylum Boavd Hospitals, and 1 by a private practitioner). This gives the net number of oases of scarlet fever notified during the year as 536, equal to an incidence rate of 2.41 per 1,000 population. The number of deaths from scarlet fever certified during the year was 6, equal to a death-rate of 0.03 per 1,000 population, and a case-mortality of 1.12 percent. of cases notified. In the following table are set out the number of cases of scarlet fever notified, the number of deaths, and the corresponding rates during the past ten years. Year. Number of Notifications. Notification rate per 1000 Population. Number of Deaths. Death—Rate per 1000 Population. Case-Mortality per Cent. 1903 647 2.70 23 0.10 3.60 1904 810 3.54 27 0.11 3.22 1905 987 4.16 27 0.11 2.74 1906 791 3.34 32 0.13 4.05 1907 851 3.59 26 0.11 3.06 1908 957 4.01 20 0.08 2.09 1909 774 3.26 17 0.07 2.20 1910 681 2.87 17 0.07 2.49 1911 445 1.88 10 0.01 2.24 1912 598 2.71 5 0.02 0.08 1913 568 (536) 2.55 (2.41) 8 0.03 1.06 (1.12) The figures in brackets are corrected for errors of diagnosis. The other figures are not corrected. 53 It will be seen from the table that the number of deaths from this disease is at present very much less than it was five or six years ago, and that this is clue to a decrease in its severity is shown by the case-mortality rate. On pages 23-26 will be found set out for scarlet fever: — (a) The age and sex distribution of the cases. (b) The number of cases notified and deaths certified in each week of the year. (c) The distribution of the cases and deaths in Registration Sub-Districts. (d) The number of cases notified during the year in the several Metropolitan Boroughs and in the County of London. There was an increase in the number of cases notified during the autumn all over London, and St. Pancras shared in this increase, but to a less extent than many other parts of London. Only four Metropolitan Cities and Boroughs (viz., Stoke Newington, Westminster, Hampstead and the City of London) had a smaller notification rate of scarlet fever for 1913 than St. Pancras. All notified cases of scarlet fever have been handed to the district inspectors each morning, and have been visited by them without delay. Enquiries have been made in every case touching possible sources of infection, but in the vast majority of cases it has been found impossible to trace the infection. Where the notifying doctor has not had the case removed to hospital this has been arranged with the Metropolitan Asylums Board. In all cases the bedding and other infected clothing, etc., have been removed for steam disinfection and the room disinfected. Of the notified cases of scarlet fever 535 (or 94 per cent.) have been removed to hospital, as follows:— To Metropolitan Asylums Board hospitals 521 To other hospitals 14 535 Return Cases of Scarlet Fever.— During the last six months of 1913, during which time 362 cases of scarlet fever were notified, 22 return cases occurred, a return case being one occurring in a house within four weeks of the return from Hospital of a former case of scarlet fever to the same house. In 5 instances more than one case followed upon the return of the former Base, there being 14 houses in which one or more return cases ensued upon the home-coming of former cases. There have been no important outbreaks of scarlet fever in St. Pancras institutions during the year, and no infection through milk-supply has been traced. 54 DIPHTHERIA. 440 patients were notified during 1913 as suffering from diphtheria or membranous croup. Of these 49 were afterwards returned as not suffering from this disease (all by the. Medical Superintendents of the Metropolitan Asylums Board hospitals). This gives the net number of cases of diphtheria notified during the year as 391, equal to an incidence rate of 1.76 per 1,000 population. The number of deaths from diphtheria certified during the year was 19, equal to a death rats of 0.08 per 1,000 population, and a case-mortality of 4.86 percent. of cases notified. In the following table are set out the number of cases of diphtheria notified, the number of deaths, and the corresponding rates during the past ten years:— Year. Number of Notifications. Notification Rate per 1000 Population. Number of Deaths. Death Rate per 1000 Population. Case- Mortality per cent. 1903 495 2.10 39 0.16 7.90 1904 338 1.43 40 0.17 11.80 1905 282 1.19 26 0.11 9.22 1906 275 1.16 0.09 8.00 1907 345 1.45 28 0.12 8.12 1908 296 1.25 23 0.09 7.77 1909 315 1.33 28 0.12 8.89 1910 262 1.10 20 0.08 7.63 1911 419 1.77 37 0.15 8.83 1912 550 2.50 26 0.11 4.73 1913 440 (391) 1.98 (1.76) 19 0.08 4.31 (4.86) The figures in brackets are corrected for errors of diagnosis. The other figures are not corrected. It will be seen that there were fewer deaths from diphtheria in 1913 than in any former year. This is due to the decrease in the case-mortality, which has been much reduced during the last two years. On pages 23-26 will be found set out for diphtheria:— (a) The age and sex distribution of the cases. (b) The number of cases notified and deaths certified in each week of the year. (c) The distribution of the cases and deaths in Registration Sub-Districts. (d) The number of cases notified during the year in the several politan Boroughs and in the County of London. The St. Pancras (uncorrected) notification-rate of diphtheria for 1913 was exceeded by Woolwich, Greenwich, Lewisham, Deptford, Paddington, and Poplar. The other Metropolitan Boroughs had lower rates than St. Pancras. 55 The notified cases have been dealt with in the same way, as regards visiting, disinfection, etc., us the scarlet fever cases. Of the notified cases of diphtheria 429 (or 97 per cent.) have been removed to hospital as follows:— To Metropolitan Asylums Board hospitals 401 To other hospitals 28 429 Foundling Hospital.— An outbreak of diphtheria occurred during the year in this institution, which is composed of 132 boys, 125 girls, 110 infants and staff. The date of the onset of the first case was August 28th, 1913, and the cases continued until the end of November, when the outbreak ceased. In all 38 cases were notified. Of these two were subsequently found not to be suffering from diphtheria, so that the total number of diphtheria cases in the epidemic was 36. The outbreak was entirely confined to the girls' side, the boys and infants escaping completely. It began in Ward G4, and this ward suffered most. In all there were 12 cases in Ward G4, 10 in G3, 8 in Gl, and 6 in G2. Nearly all the cases were mild, some being only recognised bacteriologically, and there were no deaths. The control of the epidemic was in the hands of the medical officer of the institution, who saw all children who had any suspicious symptoms. All cases were promptly removed to the Infirmary block, and from there to the Metropolitan Asylums Board's hospitals. All cases of suspicion where diphtheria was not immediately diagnosed were kept under observation in the infirmary block until the diagnosis was cleared up. On 24th September, when 11 cases had been removed to hospital, the Medical Officer of Health consulted with the Medical Officer at the Institution. All the girls in Wards 3 and 4, which had then provided 9 of the 11 cases, and the staff in contact with those wurds, were examined, and swabs were taken from the nose and throat respectively of those who showed any suspicious signs (such as sore nose or recent history of sore throat). Swabs were taken from 8 persons, 4 with positive results (3 cases of rhinitis and one of recent sore throat). These 4 were removed to hospital, and also 2 others who were discovered a few days later to be "carrying" the germ. These 6 "carriers" were included in the total number of cases given above (36). After the removal of the "carriers" no further cases occurred for three weeks, when they began to uppear again. No cases of notifiable infectious disease were reported from the Institution after November, 1913. 56 A larger outbreak of diphtheria occurred at the Foundling Hospital a year before. This began with the first case which was removed on 17th August, 1912, and continued until 7th November, 1912, when the last case was removed. 71 cases were removed to hospital daring this outbreak, 66 boys and 5 girls. The cases were confined to the boys' and infants' sides of the Institution, the girls' side escaping completely. It will be noticed that this epidemic took place in the same time of the year as the 1913 outbreak. There were, in addition, 4 cases of diphtheria removed from the Foundling Hospital between 4th and 23rd January, 1913. These consisted of 3 boys and 1 girl. No explanation has been found for the occurrence of these outbreaks of diphtheria. It is probable from the fact that in the middle of the 1913 outbreak 6 children were readily found harbouring diphtheria bacilli, but not otherwise showing themselves as cases of faucial diphtheria, and also from observations that have been made in other outbreaks of this disease, that the germs were a good deal more widely spread amongst the children than was shown by the incidence of the clinical cases. It will be noticed that both outbreaks occurred at the time of the year when most cases of diphtheria (and of scarlet fever) are reported. The drains of the Institution were examined and made sound at the time of the 1912 epidemic. Bactcriological Examinations.— 266 swabs from St. Pancras patients were examined during the year by the Lister Institute of Preventitive Medicine for the presence of diphtheria bacillus at the expense of the Borough. Of these 97 gave positive results and 169 negative results. TYPHOID FEVER. 41 notifications of typhoid fever were received during 1913. Of these one case was notified twice, and 14 proved to be not suffering from typhoid fever. The number of actual cases of typhoid fever reported during the year was therefore 26, equal to an incidence rate of 0.12 per 1,000 population. The number of deaths certified during 1913 was 6. This represents a death-rate of 0.03 per 1,000 population, and a casemortality (reckoned on the actual cases notified during the year) of 23.0 per cent. In the following table are set out the number of cases of typhoid fever notified, the number of deaths, and the corresponding rates during the past 10 years:— 57 Year. N umber of Notifications. Notification Rate per 1,000 Population, No. of Deaths. Death Rate per 1.000 Population. Case-mortality per cent. 1903 83 0.40 13 0.05 15.60 1904 135 0.57 17 0.07 12.60 1905 72 0.30 8 0.03 11.11 1906 96 0.40 13 0.05 13.54 1907 54 0.22 4 0.02 7.40 1908 60 0.25 10 0.04 16.67 1909 50 0.21 6 0.03 12.00 1910 61 0.26 4 0.02 6.56 1911 66 0.27 7 0.04 10.60 1912 29 0.13 2 0.01 6.89 1913 41 (26) 0.18 (0.42) 6 0.03 14.6 (23.0) The 40 persons notified were treated as follows:— Cases Notified. Not Typhoid. Diagnosis not contradicted. In hospitals of the M.A.B. 28 13 15 In other hospitals 6 — 6 In private nursing home 2 — 2 In their own homes 4 1 3 40 14 26 The figures in brackets are corrected for errors of diagnosis. The other figures are not corrected. Other statistical facts in reference to the notified cases of this disease will be found on pages 23-26. The 1913 (uncorrected) notification rate of typhoid fever for St. Pancras was roughly equal to that of the whole of London. It will be seen that a large majority of the cases were treated by the Metropolitan Asylums Board. In all those 14 cases (except one) where the original diagnosis of typhoid fever was contradicted, the revision of diagnosis was made by the M.A.B.'s Medical Superintendents. Of the 28 cases removed to these hospitals, as many as 13 (nearly half) proved to be "not typhoid." Inquiries were made in all cases as to possible sources of infection, and disinfection of the patients' bedding carried out after their removal or recovery. (a) It was found that 6 of the 26 cases were imported: 1.— Became ill 10 days after landing in England from Sydney. There was another case elsewhere from same ship. 2.—Landed in England from Sydney, already ill. 3.—Arrived in St. Pancras, already ill. Caught the disease in a Yorkshire epidemic. 4.—Arrived in St. Pancras from Ilfracombe, already ill. 5.—Arrived in St. Pancras from Margate, already ill. (Oysters eaten regularly in Margate for a month). 6.—Arrived in St. Pancras from Finsbury, already ill. 58 (b) One case derived his infection from a former case in the same family, and one was a nurse who had been nursing cases of typhoid fever. (c) In 6 cases (in addition to the Margate case mentioned above) there was a history of having eaten shell-fish prior to developing the disease: — Oysters.—2 cases, both in same-family. Onset stated to be 7 days and 13 days respectively, after eating from same lot of oysters. Mussels.— 2 separate cases. One "some days" after eating the mussels, and the other about 15 days (dates doubtful; after eating them. Cockles.— 1 case doubtful. Crab.— 1 case. Onset about a week after eating crab. (d) In the other 12 cases the source of infection was not traced. No evidence of "carrier cases" nor of milk infection was found, and enquiries into the source of other food-stuffs did not unmask any other channel of infection. Bacteriological Examinations.— 31 specimens of blood of St. Pancras patients were examined by the Lister Institute of Preventive Medicine for the Widal re-action of typhoid fever at the expense of the Borough. Of these 17 gave positive results, and 14 negative results. ANTERIOR POLIO-MYELITIS. (INFANTILE PARALYSIS). 9 cases of anterior Polio-Myelitis were notified during the year. In no case did there appear to be any reason to revise the original diagnosis. Only one case was fatal. In the following table is shown the quarterly distribution of the cases since 1st September, 1911, when the disease became compulsorily notifiable in London:— St. Pancras. County of London. Fourth Quarter, 1911 2 41 First „ 1912 — 19 Second ,, ,, — 22 Third 3 09 Fourth ,, ,, — 24 First „ 1913 — 9 Second ,, ,, 9, (both in June) 22 Third 3 00 Fourth ,, ,, 4 (two in Dec.) 55 It will be seen that the disease has had a distinct seasonal variation, and has been most prevalent from June to the end of the year. This distribution resembles that of scarlet fever and diphtheria. Judging from the number of cases diagnosed the incidence of the disease has been almost trifling since it became notifiable. Experience has shown that it can at times become epidemic, and take on a much more serious character from the point of view of public health. An important point about the disease is the fact that a considerable proportion of those who contract it are left with lameness or other permanent paralysis. It is one of the commonest causes of crippling. 59 All cases have been visited and enquiries made. In view of the absence of evidence of the spread of the disease by infected articles, disinfection has not been insisted on in recent cases. In none of the 9 cases notified in 1913 was any definite cause found and no history pointing to infection from previous cases or "carriers" except that two cases (onset of first early in June, and onset of second on 14th August) occurred in the same block of modern flats, though in distinct and separate flats. Particulars about the individual cases are given in the following table: Date of Notification 1913. Name. Age and Sex. Date of Onset. 1913. Sub- division of Boro. Removal to Hospital. 1913. Muscles affected. Result. Remarks. 13 th June D— C— F. 11 Early | in June S.3 (Burton) (Ward 8) Yes. N. W. Hospital (M.A.B.) Throat. Still cannot swallow or speak properly . Notified by Medical Superintendent of N. W. Hospital. 3rd June C— F- F. 1½ 26th May N.3 (Gospel Oak) (Ward 1) Yes. Hampstead General Hospital Legs and back. Partial recovery (slight lameness left). Notified by doctor at the Hampstead General Hospital. 17th July G— H— M.A&7 12 4th July S.l (Argyle) (Ward 8) Yes. Children's Hospital, Great Ormond Street. Arms, chest, and diaphragm. Died. P. M. showed inflammation of anterior horns and other parts of spinal cord. loth Aug. E— N— F. 3¼ 6 th Aug. S.4 (Endsleigh) (Ward 7) No. Bight arm. Complete recovery. Notified by the doctor at the National Hospital for the Paralysed land Epileptic, Queen's Square. ~28th Aug. D- Mc- F. 1 11/12 14th Aug S.3 (Burton) (Ward 8) No. Legs. Partial recovery; still improving. Notified by private practitioner and verified later by National Hospital for the Paralysed and Epileptic, Queen's Square. 13th Nov. S- C- M.1¼ Early in Oct. E.2 Camden Square) (Ward 3) No. Legs. Partial recovery. Notified by the doctor at the London Temperance Hospital. 12th Nov. C— S— M. 13 25th Oct. E.l Bartholomew) Ward 8) Yes. Hampstead General Hospital Arms, legs & abdomen (bladder & rectum affected). Complete paralysis of both legs & one arm. Notified by the doctor at the Hampstead General Hospital. 20th Dec. P— M— .M. 2 10/12 Early in Nov. N.4 I (Grafton) Ward 2) No. (O. P., London Temperance Hospital). Right leg. Recovery almost complete. Notified by the doctor at the London Temperance Hospital. Operated upon at the London Temperance Hospital on 12th Dec. 23rd Dec. S— It- M. 3 11th Dec. E.3 £ College) Ward 3) To. (O. P., N. W. London j Hospital). Left leg. Lame, but improving. Notified by doctor at the N.W. London Hospital. 60 EPIDEMIC CEREBROSPINAL MENINGITIS. Five notifications of cases supposed to be suffering from Epidemic Cerebrospinal Meningitis were received during 1913. Of these two were found on post-mortem examination in the North-Western Hospital (M.A.B.) to have suffered from tuberculous meningitis and not meningitis due to the meningococcus. There were therefore only three cases in which the diagnosis was not revised. No connection was traced between these cases, details of which are given being:- W. G. G. Male, aged 16. Notified 20th March, 1913, District North 2, in Ward 1:— Onset 19th March, when he returned from school with headache, earache and glands slightly swollen under ear. Vomiting and delirium later. No record of any rash. Removed to North-western Hospital (M.A.B.) on 20th March, and died 21st March. No bacteriological examination. Post-mortem examination showed inflammation of meninges of brain and cord, with much lymph and an excess of cloudy spinal fluid. E. K. Male, aged 19. Notified 16th April, 1913, District West 4, in Ward 5:— Onset sudden on 12th April. Headache, vomiting, muttering delirium, head retraction, tache cerebrate, Kernig's sign. No rash except herpes labialis on day of onset. Removed to Middlesex Hospital on 16th April. No organism identified from nose. Two lumbar punctures, but no fluid withdrawn. Complete recovery. There was said to be no reason for revising diagnosis. E. B. Female, aged 1. Notified 25th April, 1913, District West 5, in Ward 5:— Onset 15th February, began with diarrhoea and later vomiting. Head retraction and Kernig's sign by 21st February. Muscular rigidity well marked by 3rd March. Slight erythema over face, abdomen and limbs. No record of petechial rash. Removed to University College Hospital. Died on 3rd May from broncho-pneumonia and inanition. Gram-negative diplococcus found, grown in hæmoglobin-agar (Nasgar medium not tried). Result of post-mortem examination:— old thickening of membranes round the cerebellum and inter-peduncular space; no recent exudate. No source of infection was traced in any case, nor any connection between the cases. Since epidemic cerebro-spinal meningitis was made notifiable the number of cases notified year by year in St. Pancras and in London as a whole, have been as follows:— St. Pancras. County of London. 1907 (from 12th March) 5 136 1908 5 85 1909 6 111 1910 10 115 1911 i 101 1912 3 105 1913 5 92 61 OTHER NOTIFIABLE INFECTIOUS DISEASES. There have been no (human) cases of Small-pox, Typhis Fever, Cholera, Plague, Anthrax, Glanders, or Hydrophobia notified in St. Pancras during 1913. Information was received during the year of the arrival of two groups of persons who bad been in contact with cases of small-pox, and one person who had been in contact with a case of plague. These persons were kept under observation and did not sicken. Three outbreaks of glanders in horses were reported during the year in stables in the Borough by the Veterinary Inspector of the London County Council. In each case the stables were visited, but no human cases occurred. MEASLES. In the following table will be found the deaths and death-rate from measles for the past ten years for the whole Borough and for the four registration sub-districts:— Year. Deaths. Rate per 1,000 population. West. South. East. North. Whole Borough. West. South. East. North. Whole Borough. 1903 49 33 78 29 189 0.79 0.59 1.31 0.49 0.80 1904 33 30 31 31 125 0.54 0.54 0.52 0.52 0.53 1905 14 15 23 25 77 0.22 0.26 0.38 0.41 0.32 1906 28 26 30 12 96 0.45 0.46 0.50 0.20 0.40 1907 37 5 33 16 91 0.60 0.08 0.55 0.27 0.40 1908 9 13 5 19 46 0.14 0.23 0.08 0.31 0.19 1909 30 9 30 33 102 0.48 0.16 0.50 0.55 0.43 1910 39 21 60 23 143 0.65 0.37 1.00 0.38 0.60 1911 26 28 19 40 113 0.42 0.50 0.32 0.68 0.47 1912 25 11 33 25 94 0.41 0.24 0.58 0.43 0.42 1913 8 5 6 17 36 0.13 0.10 0.10 0.29 0.16 It will be seen that in 1913 there were fewer deaths from measles than in any of the past ten years. The North registration sub-district (Wards 1 and 2) suffered more than the rest of the Borough. 32 of the 36 deaths were children under live years of age, and there was only one fatal case of measles over 10 years of age. The weekly distribution of deaths will be found in the table inset at page 24, and it will be seen that most of the deaths occurred in the first four months of the year. 62 WHOOPING COUGH. In the following table will be found the deaths and death-rate from whooping cough for the past ten years for the whole Borough and for the four registration sub-districts:— Year. Deaths. Bate per 1,000 population. West. South. East. North. Whole Borough. West. South. North. East. Whole Borough. 1903 23 18 25 20 86 0.37 0.32 0.42 0.34 0.36 1904 20 20 15 24 79 0.32 0.36 0.25 04.0 0.33 1905 15 17 31 17 80 0.24 0.39 0.51 0.28 0.33 1906 18 15 22 13 68 0.29 0.27 0.37 0.21 0.28 1907 17 19 22 18 76 0.27 0.34 0.37 0.30 0.32 1908 22 12 16 17 67 0.35 0.21 0.26 0.28 0.28 1909 2 6 9 10 27 0.03 0.10 0.15 0.16 0.14 1910 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 It will be seen that 1913 was a favourable year in regard to this disease. The North registration sub-district (Wards 1 and 2), as in the case of measles, suffered most. 35 of the 36 deaths were children under five years of age. The weekly distribution of the deaths will be found in the table inset at page 24, and it will be noticed that most of the deaths took place during the first five months of the year. It may be noted that although 1913 was a particularly favourable year as regards measles and whooping cough, yet the number of deaths from each of these diseases exceeded those from scarlet fever, diphtheria and enteric fever put together. DIARRHœA AND ENTERITIS. 148 deaths from diarrhoea and enteritis were registered during 1913, equal to a death-rate of 0.66 per 1,000 population. Of these 127 were in children under five years of age and 95 in babies under one. These figures are higher than would have been expected from the weather conditions during the year. 63 In 1912 the deaths from diarrhoœa and enteritis numbered 45, or less than one-third of the 1913 figures. The weekly distribution of the deaths throughout the year will be found in the table inset at page 24. Reference is made to the infantile diarrhœal mortality on page 22. SYPHILIS. Many more deaths are caused through this disease than appear under its name. There are two reasons for this. Firstly, there is a natural reluctance on the part of medical practitioners to hand a death certificate to the friends of a deceased child or adult with this name upon it; and, secondly, many deaths from disease of various parts of the body are due to antecedent syphilis. For these reasons any statistical representation of the facts of this disease, based on the death returns, must be understated. It must also be remembered that very many still-births (abortions and miscarriages) are due to syphilis, and that much injury to health must be attributed to it apart from actual fatality. It is beyond question that this preventible disease is responsible for a very large amount of illness and death. In the following table are given the age and sex distribution of deaths certified during 1913 as due to (a) declared syphilis, (b) locomotor ataxy and general paralysis of the insane, which are believed by most experts to be late manifestations of the disease, and (c) aortic aneurysm, which many authorities now consider to be at any rate frequently cau-ed by it:— 0-1 1-0 5—] 5 15—25 26—85 8.5—4) 45—55 55—65 65—75 75—35 85 up. Total Males. 0-1 1 -6- 5-15 15—25 25 —35 35— 45 45—55 55—65 65—75 75-85 85 up. Total Females. Total Persons. Syphilis 9 1 1 - _ - 1 - - — - 12 4 - — - - — — _ — - - 4 16 Gummatous disease - - - - - - 2 - - - - 2 - - - - - - - - - - - — 2 Total declared Syphilis 9 1 1 — — - 3 — - — — 14 4 - - - - - - - - - - 4 18 Locomotor ataxy- - - - - - - - 1 - - - 1 - - - - - - - - 1 - - 1 2 General paralysis of the - - - — 2 7 6 3 — - — 18 — — - — — 1 3 — — - — 4 22 Aortic aneurysm - - - - - - 5 1 1 — - 7 - - — - - - — 1 - - - 1 8 The above figures are too small to allow of any conclusions being drawn, but it will be noticed that the deaths of males are in considerable excess over those of females. This extends in this year also to the cases under one year of age (congenital). Preventive measures.— As in most other sanitary areas, nothing is being done at present by this authority with a view of lessening the mortality from this disease, and it is a subject which will undoubtedly demand attention in the future. The subject is at present under the consideration of a Royal Commission. 64 ALCOHOLISM. As in the case of the last disease, the number of deaths due to excessive use of alcohol is in no way represented by the number certified as such. During 1913 nine deaths were returned as due to alcoholism, and two others to alcoholic cirrhosis of the liver. There were 29 deaths from cirrhosis of the liver not returned as alcoholic. CANCER. 285 deaths were registered during 191.3 as due to cancer, under the various names of cancer, carcinoma, epithelioma, scirrhus, malignant disease, rodent ulcer, and sarcoma. This is equal to a death-rate of 1.28 per 1,000 population. The sex distribution of the deaths and death-rate is shown in the following table : — No. of Deaths. Death-rates per 1,000 males or females living (based on 1911 Census) Sex. Cancer, Carcinoma, &c. Rodent Ulcer. Sarcoma. , Total malignant • disease. Sex. Cancer, Carcinoma. tfce. Rodent Ulcer. Sarcoma. Total malignant disease. Males . 118 2 7 127 Males . 1.08 .02 .06 1.16 Females 149 1 8 158 Females 1.31 .01 .07 1.39 Both Sexes. 267 3 15 285 Both Sexes . 1.20 .01 .07 1.28 Owing to the importance of this cause of death it has been thought worth while to make a more exhaustive classification than appears in the table of deaths (page 99). In the accompanying table, therefore, the deaths for 1913 have been classified according to age and sex and the part of the body affected, as stated on the death certificates. The cases are also classified according to the term used on the death certificates to express the cause of death (cancer, carcinoma, &c.) All "cancer" cases have been grouped with carcinoma, but rodent ulcer and sarcoma have each been grouped separately. It will be seen that, females appear to have suffered more severely than males, an I this is more than accounted for by the 63 deaths from cancer of organs peculiar to women, balanced by only one corresponding death amongst men. On the other hand there were 52 deaths in males from cancer about the mouth, throat and gullet compared with 6 in women. There were a greater number (70) of deaths among women from cancer of the abdominal organs (other than sexual) than amongst men (57). * Rodent ulcer is here classified as a variety of cancer or malignant disease. DEATHS FROM CANCER, CARCINOMA, EPITHELIOMA, MALIGNANT DISEASE, SCIRRHOUS, &e., 191-3. Locality. Cancer. Carcinoma. Epithelioma. Malignant disease. Scirrhous. Papilloma. Males. Females. 0 to 5 5 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65' to 75 75 to 85 85 up. Total. 0 to 5 5 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 up. Total. Total all Ages. Mouth M 5 3 - - - - F - - - - - - - - - - - - 5 2 1 — 8 - - - - - - - - - - - 8 Tongue M 2 6 - — — — F 1 2 - - - - - - - - 1 3 3 3 1 — 13 - - - - - - - - -- - - - Lip M — 1 — . — — — F - - - - - - - - - - - - - - 1 - 1 - - - - - - - - - - - 1 Jaw M 1 2 — — — F - - - - - - - - - - - - 3 - - 3 - - - - - - - - - - - 3 Nose M — — — — F 1 - - - - - - - - - - - - - - - - - - - - - - - 1 - - 1 1 Pharynx M 1 1 - - - - F - - - - - - - - - - 1 - - 1 - - 2 - - - - - - - - - - - 2 Throat M — 1 — — — — F - - - - - - - - - - - 1 - - - - 1 - - - - - - - - - - - 1 Larynx M - 4 — — — — F - - - - - - - - - - - - 2 1 1 — 4 - - - - - - - - - - - 4 Thyroid M — 1 — — — — F - - - - - - - - - - - - - 1 - - 1 - - - - - - - - - - - 1 Neck M — 2 — — — — F - - - - - - - - - - - 1 1 - - - 2 - - - - - - - - - - - 2 Oesophagus M 1 11 1 3 — — F - 2 — — — — - - - - - 4 0 6 1 — 16 - - - - - - - 2 - - 2 18 Stomach M 6 12 - 1 - - — F 3 13 - - - - - - - - 2 - 11 4 — — 19 — — — — 1 2 5 7 1 — 16 35 Bowel (unless stated as Rectum) M - 17 — 2 - — F 6 19 1 2 - - - - - - - 1 10 5 1 — 19 — — — — — 9 5 7 8 1 28 47 Rectum M •> 9 — — — — F 7 3 - - - - - - - - — 1 2 4 - — 11 — - — - - - 3 1 - - 4 15 Alimentary Canal M - - — — — - F - 1 - - - - - - - - - - - - - - - - - - - - - 1 - - - 1 1 Liver M - 4 - - - - F 2 10 — 2 — — — — — — — — 3 1 — — 4 — — — — 1 3 7 3 — 11 18 Gall Bladder M 1 - — — — — F - - - - - - - - - - - - - 1 - - 1 - - - - - - - - - - - 1 Pancreas M - - - - - - F — 5 — - - - - - - - - - - - - - - - - - - 1 2 1 - 1 - 5 5 Peritoneum M — 1 — — — — F — 1 — 1 — —- - - - 1 - - - - 1 - - - - - - - - 2 - 1 - 2 3 Omentum M — 1 — — — — F - - - - - - - - - - - 1 - - 1 - - - - - - - - - - - - - 1 "Abdominal" M - - - 1 - - F - - - - - - - 1 - - - - - - 1 - - - - - - - - - - - - - 1 Bronchus M — 1 — — — — F - - - - - - - - 1 - - - - - - - 1 - - - - - - - - - - - 1 Lungs M - 2 - - - F 1 2 - - - - - - - - - 2 - - - - -2 - - - - - 1 1 1 — — - 5 Bladder F — 1 — 1 — 1 F — 3 — 1 — — - — — — 1 1 - 1 — — 3 — - — - - 2 1 1 - - 4 7 Spine M - - - 1 - - F - - - - - - - - - - - - - 1 - - 1 - - - - - - - - - - - 1 Skin of Neck M 1 — F - - - - - - - - - - - - 1 - - - 1 - - - - - - - - - - - 1 Navel M - 1- - - - - F - - — 1 — - - - - - - - - - - - - - - - - - - - - - 1 1 Rodent Carcinoma of shoulder M — 1 — — — — F - - - - - - - - - - - - - 1 - - 1 - - - - - - - - - - - 1 Locality not Stated M - - - - - - - F — 2 - - - - - - - - - - - - - - - - - - - - - - 2 - - 2 2 Female Breast and Generative Orijan Breast s— F 6 17 1 2 - - - - - - - - - - - - - - - 1 2 3 5 12 2 1 26 26 Ovaries F 2 — — — — — - - - - - - - — - - - - — — 2 — — — — 2 2 Uterus F 7 26 - 1 - - - - - - - - - - - - - - - - — 2 6 12 8 6 — 34 34 Vulva F - - 1 - - - - - - - - - - - - - - - - - - 1 - - - - - 1 1 Male Breast and Generative Organs— Breast - - - - - - - - - - - - - - - - - - - - - - - - - - - — Prostate M - 1 - - - - - - - - - 1 - - - 1 - - - - - - - - - - - - 1 Total -1-8 187 11 18 2 1 - - 1 4 10 14 17 33 9 - 118 - - - 1 7 29 39 48 23 2 149 267 llodent Ulcer— Of Face - - - - - - 1 - - - - - - - - - - - - - - - - - - - - 1 2 Locality not stated - - - - - - - - - 1 - - - - - - 1 - - - - - - - - - - - 1 Sarcoma. Maxilla - - - - - - - - - 1 - - - - - - 1 - - - - - - - - - - - 1 Scapula - - - - -—- - - - - - - - - - - 1 1 - - - - - - - - - - - 1 Femur (fibro-sareoma) - - - - - - - 1 - - - - - - - - 1 - - - - - - - - - - - 1 Pelvis - - - - - - - - - - 1 - - - 1 - 1 - - - - - - - - - - - 1 Foot (melanotic sarcoma) - - - - - - - - - - - 1 - - - - 1 - - - - - - -- - - - 1 Tonsil - - - - - - - - - - - - - 1 - - 1 - - - - - - - - - - - 1 Thyroid - - - - - - - - - - - - - - - - - - - - - - - 1 - - - 1 1 Spleen - - - - - - - - - - - - - - - - - - - 1 - - - - - - - - 1 Liver - - - - - - - - - - - - - - - - - 1 - - - - - - - - - - 1 Kidney - - - - - - - - - - - - - - - 1 - - - - - - - - - - - - 1 Bowel - - - - - - - - - - - - - - - - - - - - - - - 1 - - - 1 2 Lung - - - - - - - - - - - 1 - - - - 1 - - - 1 - - 1 - - - - 2 Uterus - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - Total - - - - - - - - 1 1 - 2 - - 1 - 7 1 - - 2 - - 3 1 1 - 8 15 TOTAL MALIGNANT DISEASE - - - - - - 1 - 2 5 10 17 47 35 10 - 125 1 - - 3 7 29 42 50 24 2 158 285 65 VACCINATION. The following table is drawn up from returns kindly supplied by the Clerk to the Guardians in respect of children whose births were registered in the Parish of St. Pancras from 1st January to 31st December, 1912, inclusive:— Number. Percentage of Births registered. North. East. West. South. Whole Borough. North. East. West. South. Whole Borough. Births registered 1323 1508 1243 1005 5079 100.0 100.0 100.0 100.0 100.0 Dead, unvaccinated 68 112 97 75 352 5.2 7-4 7-8 75 6.9 Successfully vaccinated 560 664 630 464 2318 42.3 44.1 50.7 46.2 45.6 Had small pox 0 0 0 0 0 — — — — — Insusceptible of vaccination .. 2 0 0 2 4 01 — — 0-2 01 Received certificates of conscientious objection 421 295 214 130 1060 31.8 19.6 17.2 12.9 20.9 Postponed by medical certificate 56 64 31 20 171 4.2 4.2 2.5 1.9 3.4 Moved to known address in other districts.. 10 26 21 36 93 0.7 1.7 1.7 3.6 1.8 Lost sight of by removal 178 305 240 269 992 13.5 20.2 19.3 26.8 19.5 Unvaccinated and not accounted for in previous columns 28 42 10 9 89 22 2.8 0.8 0.9 1.8 It will be seen that 1,060, or 20.9 per cent. of the children born, were the subjects of certificates of conscientious objection to vaccination, the percentage being as high as 31.8 per cent. in the North division. The children with such certificates, tog-ether with those unvaccinated and not otherwise accounted for (bottom row in table), numbered 1,149 or 22.6 per cent. of the total births. The corresponding figures for the past ten years are as follows: — Year. Births, Successfully vaccinated. Per cent. Conscientious Objections, and Children otherwise escaping Vaccination. Per cent. 1902 6341 3731 58.9 157 2.4 1903 6384 3923 61.5 120 1.9 1904 6157 3891 63.2 138 2.2 1905 5816 3798 65.3 93 1.6 1906 5816 3952 68.0 80 1.4 1907 5508 3351 60.8 226 4.1 1908 5437 3357 61.7 618 11.3 1909 5285 3097 58.6 622 11.8 1910 5394 2787 51.7 953 17.6 1911 5139 2353 45.8 1235 24.4 1912 5079 2318 45.6 1149 22.6 66 It will be seen from this table that since 1906 there has been a very great increase in the number of children who escape vaccination, the figures having risen from under a hundred to over a thousand, and the percentage sixteenfold. The effect of this is seen in the reduction of the percentage of children successfully vaccinated from 68 to under 46 since the same year. This change is, no doubt, a consequence of the Vaccination Act, 1907, which provided for the substitution of a statutory declaration as to conscientious objection for the certificate of the Justices. As a result, the immunity to small pox of the population of the Borough, and particularly of the younger members, must be much less than six years ago. DWELLING HOUSES. The outstanding feature of the housing problem in St. Pancras is that the great majority of the houses are let to more than one family. This is brought out by the 1911 census returns, which show that in that year there were 52,310 "private 'families (or tenements)," comprising 200,735 persons, and living in less than 25,451 dwelling houses. (In arriving at this estimate of the number of dwelling houses, an ordinary dwelling-house which is sub-let is counted as a single house, but every flat in blocks of flats is counted separately). No doubt this is due to these three inter-dependant causes, viz.: (1) That most of the St. Pancras houses were built for families who could then afford tooccupy six or more rooms; (2) That the rental value of the houses has, for various causes, risen greatly since they were built, and (3) That the average population of the Borough is less well-to-do than it was formerly. The effect of the sub-letting (apart from overcrowding) is that a large part of the population of the Borough have to live without private yard, watercloset, dust-bin, or scullery accommodation. Such conditions have a marked tendency to discourage proper domestic cleanliness, and incidentally call for much supervision by sanitary inspectors and health-visitors. Food Storage. Experience shows also that by reason of living in rooms which were evidently intended originally to form only part of a house, many families in the Borough are without adequate food-storage accommodation, in many cases living and sleeping in the same room as that in which all their food is stored. This is very prejudicial from the point of view of public health, and probably has the effect of increasing the incidence of and mortality from intestinal diseases, especially in infants. There is no doubt that every tenement ought to be provided with a suitable food-cupboard, ventilated when possible to the open air, and affording complete protection from dust and flies to the food stored therein. Section 16 of the London County Council (General Powers) Act, 1909, enacts that such accommodation for food-storage shall be provided in tenement houses, but only in the case of houses which were not sub-let before the framing of the Act. This proviso makes the Act practically inoperative in St. Pancras at the present time. 67 Water Supply. Another evil present in many of our tenement houses is the inconvenienceof the water supply. A common arrangement is that in which there are watertaps on the ground floor or basement, but none in any of the two or more floors above the ground floor. As the result of this arraugement the occupiers of a tenement (say) on the 2nd floor have to carry all their water up several flights of stairs to their rooms. The effect of this is that there is good reason for using as little water as possible for cleansing purposes, and for keeping drinking water for prolonged periods in pails, etc., instead of taking it fresh from the mains whenever it is wanted. The effect of Section 78 of the London County Council (General Powers) Act, 1907, is to enable the Sanitary Authority (subject to provisos) to insist on a water-tap being fitted on every floor where rooms are sub-let, and on 23rd July, 1913, the Council passed a resolution that "the Sanitary Inspectors are " to report any cases that come under their observation to which the Act " applies, in order that the necessary notices may be served." Since that date owners of all tenement houses which have been found, on inspection, not (o have water supply within reasonable reach of each family have been called upon to provide additional water-taps and sinks. Up to the end of the year intimation notices were served under this Section in respect of 353 houses. There were no prosecutions during the year consequent upon these notices. Underground Rooms. A very large part of the St. Pancras houses are built with the basement rooms wholly or partly underground. In many tenement houses these rooms are used for sleeping purposes, and very frequently the whole of a tenement consists of such underground rooms. The use of most of these rooms as sleeping places or even as living rooms is very undesirable, and in the opinion of most sanitarians is responsible for much tuberculosis and other conditions of ill-health and mortality. This may be accounted for by three conditions which tend to prevail in many underground rooms: — 1.—Absence of light, due to the windows abutting on "areas" instead of the open sky. This partial darkness leads to a depressed vitality, aids the growth of the germs of disease (for sunlight is a powerful disinfectant), and discourages proper household cleanliness. 2.—Dampness. Many of our underground rooms are damp owing to the absence of proper damp-courses, though very frequently the dampness is hiden behind the match-boarding with which the walls are lined. Damp habitations are one of the most fertile sources of consumption, and other illnesses. 3.—Exhalations from the earth. Most of the basements of the tenement houses have no impermeable structure (such as concrete) between the wooden floor and the earth, and sometimes no space between the floor and the earth, or no ventilation of such space when it exists. The consequence of this is that ground-air and dampness must readily find their way into the basement rooms, being drawn up by the internal warmth of the house, as well as by other causes. Section 96 of the Public Health (London) Act, 1891, enacts that no underground room shall be occupied separately as a dwelling unless it complies with a list of requirements set out in the section. The great disadvantage of this 68 -section is that it has no effect on any underground room, however bad, if the room is let with another room which is not underground within the meaning of the section. A large number of underground rooms have been closed for sleeping purposes in the past under this section, though, in many cases, the owners have circumvented the Act by letting another room with the unhealthy underground rooms, which have therefore continued to be used as sleeping places. Section 17 (7) of the Housing, Town Planning, etc., Act, 1909, has given further power in this direction, and states that any underground room is unfit for use as a sleeping place unless, (a) it is at least seven feet in height from floor to ceiling, and (b) it complies with regulations that the local authority may make. Regulations were made by the St. Pancras Borough Council under this section, and were approved by the Local Government Board on 2nd April, 1913. These were set out in full in the Annual Report for 1912 (p. 103). The 1909 Act and Regulations are an improvement on the 1891 Act in that no underground room may be used for sleeping purposes unless it conforms to certain standards, and irrespective of whether it is let separately as a dwelling; but it is to be noted that they do not prevent any underground room, however bad, from being used as a living room as long as it is not slept in. There are many underground rooms in the Borough which ought not to be used at all for living purposes. The procedure provided by Section 17 (7) for underground rooms is somewhat cumbrous, and before any pressure can be brought to bear a closing order has to be made. The method which has been adopted in St. Pancras since September, 1913, when tie section was first put in operation is as follows:— The Sanitary Inspector reports to the Medical Officer of Health any underground room which appears to be illegally occupied, full details and measurements being supplied to the latter on a special form. If the room is not in conformity with Section 17 (7), a printed letter is sent to the owner and occupier respectively informing him of the fact, and asking him to see that the use of the room for sleeping purposes is discontinued. If after a delay of two months the room is found to be still used for sleeping purposes the case is reported to the Public Health Committee for the purpose of making a closing order. After the closing order has been made the provisions of the Act are allowed to take their course. During 1913 18 notices were issued for the closing of underground dwellings under the Public Health (London) Act, 1891. There were no prosecutions under this section. Other underground rooms were closed for living purposes on account of general defects, such as dampness. From September to the end of the year letters were sent in respect of 106 underground rooms (in 90 houses) which did not comply Avith Sec. (17) 7 of the Housing, Town Planning, etc., Act, and the Regulations made thereunder. One closing order only was made under Sec. 17 (7) during the year. (Front basement room of 20, Euston Street). 69 Inspection of Dwelling Houses. At the present time inspection of dwelling houses is carried out under the following circumstances:— 1.—Whenever a case of notifiable infectious disease (except Consumption) is reported, the house where the case occurred is subjected to a sanitary inspection and the drains tested. During the year 1057 such inspections were made, followed by 1533 re-inspections. 2.—Whenever a complaint is received as to the condition of any house a sanitary inspection of the house is carried out. The drains of many houses are tested by this procedure. During the year 2857 inspections were made in consequence of complaints, and 7047 consequent re-inspections. 3.—All registered tenement houses, and certain other dwellings which require frequent inspection (known as " inscribed dwellings ") are visited periodically (six monthly, where possible,) and inspected. There were at the end of 1913 2360 houses on the tenement house register (i.e. the register of "houses let in lodgings, or occupied by members of more than one family"). These are sub-let houses which are of such a nature as to make frequent inspection desirable. They are nearly all let unfurnished. Two such houses were added to the register during 1913. The number of " inscribed dwellings" at the end of the year was 207. 1763 routine inspections and 3287 consequent re-inspections of these houses were made during 1913, in addition to those made under the Housing, Town Planning, etc. Act, 1909 (see below). Weekly inspections were also made of the yards of mews and stables. 4615 inspections of these and 237 consequent re-inspections were made in the year. 4.—During 1913 the routine inspection of houses prescribed by Sec. 17 (I) of the Housing, Town Planning, etc. Act, 1909, has been put in operation. This sub-section provides that " it shall be the duty of every local authority to cause to be made from time to time inspection of their district with a view to ascertaining whether any dwelling house therein is in a state so dangerous or injurious to health as to be unfit for human habitation." It also enacts that in this connection regulations made by the Local Government Board must be complied with. These regulations [The Housing (Inspection of District) Regulations, 1910], were summarised in the Annual Keport for 1912 (p.p. 98 and 9!)). In accordance with the regulations a list of streets was prepared by the late Medical Officer of Health, the houses in which, in his opinion, ought to be inspected at once. This consisted of those streets, the majority of the houses in which were already subject to periodical inspection as registered tenement houses or "inscribed dwellings." The number of houses included in these streets was 3821. The inspections under the regulations were begun on 1st January, 1913, and in every instance a case paper has been filled up and filed. A number of streets which are not included in the above-mentioned list have also been inspected. 1545 houses have been inspected during the year under Sec. 17 and 26 of the houses received a second routine inspection later in the year, so that the total inspections carried out under the Section in 1913 was 1571. The re-visits consequent upon these inspections numbered 3668 (see table 9, page 110). The details of this work are shown in the following table- 70 HOUSING, TOWN PLANNING, &c., ACT, 1909. Inspections for the Year, 1913. Division and SubDivision. Street or Place. No. of Houses inspected under Sec. 17 No. of intimations served. No, complied with. No. of Statutory Notices served. No. complied with. No. of Warning Letters. No. complied with. No of Summonses issued. No. complied with before Hearing. No. of Convictions. North Highgate Balmore Street (45) 45 49 17 32 29 3 3 ... ... ... „ „ Lulot Street (45) 42 34 26 3 1 2 1 ... ... ... „ „ Raydon Street (53) 47 34 6 26 19 ... ... ... ... ... „ „ Be tear Street(43) 43 31 13 18 9 1 ... ... ... ... „ St. John's Park Fortess Grove (20) 20 13 7 4 4 ... ... ... ... ... ,, Gospel Oak Gospel Oak Grove (33) 3 2 ... 1 ... 1 1 ... ... ... 11 11 Piercefield Street (23) 22 15 10 3 3 2 2 ... ... ... „ „ Rochford Street (37) 18 18 2 11 6 4 ... ... ... ... „ „ Weedington Road (1) 1 ... ... ... ... ... ... ... ... ... „ Grafton Litcliam Street (50) 50 65 52 28 18 10 5 ... ... ... ,, ,, Tovey Place (2) 2 ... ... ... ... ... ... ... ... ... Maitland Park Newberry Mews (18) 9 9 2 6 2 ... ... ... ... ... „ „ Preston Street (37) 37 52 30 10 7 3 3 ... ... ... East Bartholomew Priory Street (23) 1 1 1 ... ... ... ... ... ... ... „ „ Torriann Cottages (12) 1 1 1 ... ... ... ... ... ... ... „ Camden Square Marquis Road (102) 1 1 1 ... ... ... ... ... ... ... „ College Bay ham Street (123) 2 2 1 1 1 ... ... ... ... ... „ „ Camden Street (113) 1 ... ... ... ... ... ... ... ... ... ,, ,, Queen Street (53) 1 1 1 ... ... ... ... ... ... ... „ Oakley Square Little Clarendon St. (54) 54 27 9 18 6 12 8 ... ... ... „ „ Clarendon Street (76) 71 40 25 24 22 1 1 ... ... ... „ „ Barclay Street (55) 55 16 12 4 2 ... ... ... ... ... „ „ Bridgewater Street (33) 26 8 6 2 ... 2 2 ... ... ... „ „ Johnson Street (57) 41 15 14 1 1 ... ... ... ... ... „ „ Sidney Street (30) 30 17 16 1 1 ... ... ... ... ... ,, Ossulston Drummond Crescent (56) 30 26 4 22 17 5 ... ... ... ... „ „ Equity Buildings (40) 27 ... ... ... ... ... ... ... ... ... „ „ Little Drummond St. (24) 24 17 7 10 9 1 1 ... ... ... „ „ Lancing Street (21) 21 21 21 ... ... ... ... ... ... „ „ Ossulston Street (250) 4 4 4 ... ... ... ... ... ... ... "West Castle Haverstock Street (19) 19 17 15 3 1 2 2 ... ... ... „ „ Little Charles Place (8) 8 8 ... 8 1 7 7 ... ... ... „ „ Hethersett Street (15) 15 15 11 4 3 1 1 ... ... ... „ Chalk Farm Dewsbury Terrace (10) 10 9 1 8 ... 8 ... ... ... ,, „ Stucley Place (12) 1 1 ... 1 1 ... ... ... ... „ „ Whiffen's Yard (3) 3 2 2 ... ... ... ... ... ... ... „ Morning ton Arlington Road (151) 8 8 6 2 1 ... ... ... ... ... „ Regent's Park Red hill Street (62) 23 22 8 14 14 ... ... ... ... ... ,, ,, Clarence Gardens (58) 1 ... ... ... ... ... ... ... ... ... ,, ,, Edward Street (7) 3 3 3 ... ... ... ... ... ... ... „ „ Laxton Place (8) 1 1 ... 1 1 ... ... ... ... ... „ „ Robert Street (72) 1 1 ... 1 1 ... ... ... ... ... „ „ Wybert Street (13) 2 2 ... 2 2 ... ... ... ... ... Euston Cobourg Street (16) 1 1 1 ... ... ... ... ... ... ... „ „ Euston "Road (461 1 1 1 ... ... ... ... ... ... ... ,, „ Euston Street (103) 94 99 69 30 20 8 8 ... ... ... „ „ Drummond Street (101) 30 27 19 8 5 3 3 ... ... ... „ „ Carried forward (2233) 950 731 403 328 208 76 48 2 ... 2 * The streets printed in italics were not included in the original list 71 Inspections for the Year, 1913. - con. Division and SubDivision. Street or Place. No. of Houses inspected under Sec. 17 No. of intimations served. No. complied with. No. of Statutory Notices served. No. complied with. No. of Warning Letters. No. complied with. No. of Summonses issued. No. complied with before Hearing. No. of Convictions. Brought forward (2238) 950 731 403 328 208 76 48 2 ... 2 West Euston Exmouth Street (30) 2 2 2 ... ... ... ... ... ... ... „ „ George Street(76) 2 2 2 ... ... ... ... ... „ „ Melton Mews (25) 16 12 11 1 1 ... ... ... ... ... „ „ Seaton Street (31) 1 1 1 ... ... ... ... ... „ „ Stanhope Street (53) 7 7 6 1 1 ... ... ... ... ... „ „ Stanhope Buildings (19) 7 7 7 ... ... ... ... ... South Argyle Britannia Street (26) 24 17 15 2 2 ... ... ... ... ... „ „ Wicklow Street (32) 23 16 11 5 4 1 ... ... ... ... ,, Meckleburgh Burgess Court (2) 2 ... ... ... ... ... ... ... ... ... „ „ Elm Place (3) 3 ... ... ... ... ... ... ... ... ... „ „ Gough Street (54) 28 16 1'2 4 4 ... ... ... ... ... „ „ Kenton Street (12) 6 6 6 2 2 ... ... ... ... „ „ Sidmouth Street (27) 18 18 2 16 10 5 ... ... ... ... ,, Burton Bidborough Street (32) 17 14 12 2 2 ... ... ... ... „ „ Cromer Street (37) 5 4 2 2 ... 2 2 ... ... ... „ „ Harrisen Street (78) 78 75 42 33 26 4 4 ... ... ... „ „ Hastings Street (25) 13 10 10 ... ... ... ... ... ... ... „ „ Leigh Street (22) 9 6 6 ... ... ... ... ... ... ... „ „ Sandwich Street (34) 30 17 14 2 2 1 1 ... ... ... „ „ Seaford Street (5) 5 10 4 5 5 ... ... ... ... ... „ „ Speedy Place (6) '3 ... ... ... ... ... ... ... ... ... „ „ Sidmouth Mews (16) 8 9 3 6 6 ... ... ... ... ... „ „ Sidmouth Street (16) 13 13 11 2 2 ... ... ... ... ... „ „ Thanet Street (25) 17 8 8 ... ... ... ... ... „ „ Wakefield Mews (18) 10 5 1 4 2 ... ... ... ... ... Endsleigh - (...) ... ... ... ... ... ... ... .... ... ... Whitfield Bennett Street (4) 4 4 3 1 1 ... ... ... ... ... „ „ Charlotte Street (93) 24 12 6 6 6 ... ... ... ... ... „ „ Charlotte Place (6) 6 3 3 ... ... ... ... ... ... ... „ „ Colville Place (25) 24 ... ... ... ... ... ... ... ... ... „ „ Gresse Street (12) 7 4 4 ... ... ... ... ... ... ... „ „ Little Goodge Street (26) 26 11 4 7 3 4 ... ... ... ... „ „ Pitt Street (15) 15 12 2 10 5 5 2 ... ... ... „ „ Stephen Street (27) 19 15 9 6 3 3 1 ... ... ... „ „ Tottenham Street (44) 27 7 5 2 1 1 ... ... ... „ „ Tudor Place (12) 11 3 3 ... ... ... ... ... ... ... „ „ Whitfield Street (92) 82 55 45 10 4 6 4 ... ... ... Totals (3293) 1545 1132 669 461 300 110 62 7 ... 4 Subsequent Inspections. South Burton Seaford Street (5) 5 5 5 Harrison Street (78) 21 8 4 4 3 Totals (83) 26 13 9 4 3 * The streets printed in italics were not included in the original list. 72 The number of houses inspected under Sec. 17 by individual Inspectors is shown in the next table:— Inspector. Number of Houses Inspected. Total. 1st routine inspection. Subsequent routine inspection. Mr. Rackham 177 - 177 ,, Brown 64 — 64 ,, Thompson 98 — 98 ,, Dillon 7 — 7 „ Auger „ James 277 106 — 277 106 ,, West 56 — 56 ,, Lonnon 39 — 39 ,, Adkins 161 — 161 ,, Holmes 104 — 104 „ Walker 211 26 237 ,, Landen 245 - 245 Total 1545 26 1571 As was previously stated most of the above recorded inspections involved subsequent visits for supervising work in progress and other purposes. The notices which were served by the Inspectors in respect of houses inspected under the 1910 Regulations were all served under Acts and bylaws [such as the Public Health (London) Act, 1891, and the tenement house by-laws], independently of any new powers conferred by the Housing and Town Planning Act. The intimation notices which were served numbered 1132. In addition closing orders were made under Sec. 17 in respect of certain houses (see p. 73), and the use for sleeping purposes of a number of basement rooms was forbidden under the same section (see p. 67). Section 15 of the Act was not brought into operation. Reference is made (p. 67) to the provision of water supply on the different floors of tenement houses. As a result mainly of the house to house inspections, intimation notices were served during 1913 for this purpose, under Sec. 78 of the London County Council (General Powers) Act, 1907, in respect of 3.53 houses. The plan of routine inspection under the Housing Act practically replaces the routine inspections carried out under the old system. 73 Closing Orders. During 1913 71 houses were represented by the Medical Officer of Health as unfit for human habitation. Closing Orders were made by the Council under Sec. 17 of the Housing and Town Planning Act, 1909, in respect of all these houses, after they had been inspected by the View Sub-Committee. The list of these houses is given in the following table:- Addresses of Houses. Date of M.O.H. 'S Representation. Date of Closing Orders. Little C' arendon Street, ( Nos. 29 to54 inclusive) 16th July, 1913 17th September, 1913 Equity Buildings, (Nos. 1 to 37 inclusive), (Nos. 2a and 3,\) Warren Street, No. 37. 22nd Oct, 1913 26th November, 1913 Little Clarendon Street, No. 16. Johnson Street, No. 23. 22nd Oct., 1913 26th November, 1913 Aldenham Street, Nos. 94, 98, and 104. (For closing orders in respect of underground rooms see p. 67). None of the above closing orders' were determined, and no demolition orders were made during 1913. An appeal was made to the Local Government Board by the owners in respect of 104, Aldenham Street, but was not heard during the vear.† In accordance with the Housing (Inspection of District) Regulations, 1910. the following table is submitted: — Number of dwelling-houses inspected under and for the purposes of Section 17 1545 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 72 The number of representations made with a view to the making of closing orders 72* The number of closing orders made 72* The number of dwelling-houses, the defects in which were remedied, without the making of closing orders 1474 The number of dwelling-houses which, after the making of closing orders, were put into a fit state for human habitation nil. *Including one house in which the representation and closing order referred to an underground room only. *This appeal has since been heard and has been dismissed. 74 Inhabited House Duty. Inland Revenue Act, 1903. Applications for certificates under Section 11 of the above Act (dealingwith the abatement of Inhabited House Duty in the case of certain tenement dwellings) were received by the Medical Officer of Health during 1913 in respect of 6 blocks of dwellings. The certificates required are to the effect "that the house is so constructed as to afford suitable accommodation for each of the families or persons inhabiting it, and that due provision is made for their sanitary requirements." The certificates were refused in 2 cases (in both of which they had also been refused formerly) and granted in the other 4 cases. These four were all new blocks of flats in Ward 8, consisting of 42, 70, 63 & 59 flats respectively. Housing and Town Planning, Sfc.. Act, 1909. Section 35 of the Act provides that lodging-houses taking in working-class persons at a charge not exceeding sixpence a night shall be exempt from Inhabited House Duty on the production of a certificate from the Medical Officer of Health in similar terms to that mentioned above. Two applications for such certificates were received during the year. Onewas refused and one (in respect of the Registered Common Lodging House at 15 and 16, Litcham Street) granted. Housing Schemes. Goklington Buildings.—The gross income for the year ended 31st March,.. 1914, from rents amounted to £ 1402 19s. 0d., as compared with £1288 16s. 9d. during the previous year. The loss from empties, &c., amounted to £40 19s. 3d. (equal to 2'7 per cent.), as compared with £211 17s. 6d. (equal to 13.8 per cent.) for the previous year. This large decrease must be attributed to the revision of the rents. The arrears at the end of the year amounted to £21 16s. 3d. Ftaxitian Terrace.—These flats continue to let well. During the year the loss from empties amounted to £8 8s. 0d (equal to 0.41 per cent.) out of a gross rental of £2028. The sum of £14 17s. Od. was also received for the use of the perambulator and bicycle sheds. Prospect Terrace. — These flats also continue to let well. The loss from empties amounted to £5 10s. 6d. (equal to 0.32 per cent.) out of a gross rental of £1725 2s. 0d. A sum of £9 17s. 1d. was also received for the use of the sheds and £234 3s. 9d. from the baths, as compared with £205 0s. 3d., for the previous year. Canal Boats Acts. During 1913 Inspector Osborne made 69 inspections. In no case has it been necessary to serve notices. There has not come to the notice of thedepartment any cases of infectious disease or other illness, and the requirements of the Acts have been fairly well observed. 75 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) 43 12 - Workshops (including workshop laundries) Workplaces (Other than Outworkers' 192 100 — premises included in Part 3 of this Report) 220 30 — Total 455 142 - 2.—Defects Found. Particulars. (1) Number of Defects. Number of Prosecutions. (5) Found. (2) Remedied. (3) Referred to H.M. Inspectors. (4) Nuisances under the Public Health Acts*: — Want of cleanliness 85 85 Want of ventilation 2 2 Overcrowding — — Want of drainage of floors 2 2 Other nuisances 4 4 Sanitary accommodation Insufficient 6 6 Unsuitable or def ect ive 8 8 Not separate for sexes 4 4 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) 29 29 Other offences (Excluding offences relating to outwork which are included in Part 3 of this Report) 2 2 Total 142 142 — — *Including those specified in sections 2, 3, 7 & 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 76 13.—Home Work. NATURE OK WORK. 1 Outworkers' Lists, Section 107. Outwork in unwholesome premises, Sec. 108. Outwork in infected premises, Sections 109, 110. Lists received from Employers. Notices served on Occupiers as to keeping or sending lists. Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made (S. 110). Prosecutions (Sections 109,110). Failing to keep or permit inspection of lists. Failing to send lists. Sending Twice in the year. Sending Once in the year. Lists. 2 Outworkers. . Outworkers. Contractors. Workmen. Lists. 5 Conractors. Workmen. 3 4 6 7 8 9 10 11 12 13 14 15 16 Wearing Apparel— (1.) making, etc. 38 52 161 6 — 17 - - - - - - - - - (2) cleaning and washing - - - - - - - - - - - - - - - Household linen 2 — 14 - - - - - - - - - - - - Lace, lace curtains and nets - - - - - - - - - - - - - - - Curtains and furniture hangings - - - - - - - - - - - - - - - Furniture and upholstery — - - - - - - - - - - - - - - Electro-plate - - - - - - - - - - - - - - - File making - - - - - — - - - - - - - - - Brass and brass articles - - - - - - - - - - - - - - - Fur pulling - - - - - - - - - - - - - - - Cables and chains - - - - - - - - - - - - - - - Anchors and grapnels - - - - - - - - - - - - - - - Cart gear - - - - - - - - - - - - - - - Locks, latches and keys - - - - - - - - - - - - - - - Umbrellas, etc. - - - - - - - - - - - - - - Artificial flowers - - - - - - - - - - - - - - - Nets, other than wire nets — - - - - - - - - - - - - - - Tents - - - - - - - - - - - - - - - Sacks - - - - - - - - - - - - - - - Racquet and tennis balls - - - - - - - - - - - - - - - Paper bags and boxes 2 — 12 - - - - - - - - - - - - Brush making - - - 1 - 1 - - - - - - - - - Pea picking - - - - - - - - - - - - - - - Feather sorting - - - - - - - - - - - - - - - Carding, etc., of buttons, etc. - - - - - - - - - - - - - - - Stuffed toys - - - - - - - - - - - - - - - Basket making - - - - - - - - - - - - - - - Total 42 52 187 7 - 18 — — — — — — — — — 77 4.—Registered Workshops. Workshops on the Register (Sec. 131) at the end of the year. (1) Numbers. (2) Bakehouses 132 Restaurant kitchens 333 Laundries 74 Domestic workshops 71 Other workshops where women are employed 424 Other workshops 1314 Total number of workshops on Register 2348 5.—Other Matters. Class (1) Number (2) Matters notified to H.M. Inspectors of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) Action taken in matters referred by H.M. Inspector as remedi- Notified by H.M. Inspector able under the Public Health Reports (of action taken) Acts, but not under the Factory sent to H.M. Inspector and Workshop Act (s. 5) 54 54 Other — Underground bakehouses (s. 101):— Certificates granted during the year — In use at the end of the year 101 The inspection of workshops and work plaees where women are employed, and of domestic workshops and work places where home-workers are employed, is done by the Woman Inspector (Miss Bibby). Miss Bibbv combines a great deal of other work with these duties, and during 1913 devoted but little of her time to workshops. During the year she made 15 inspections of workshops, in respect of which seven defects were found (viz., want of cleanliness, five; want of drainage of floors, one; unsuitable sanitary accommodation, one). Written notices were sent in respect of these defects, which were all remedied. In addition, the District Inspectors included in their work a number of inspections of workshops where women are employed. 78 The inspection of all other workshops and factories (including bakehouses and restaurant kitchens) is carried out by the District Inspectors. All the work in the above tables, less Miss Bibby's visits, was done by them. Bakehouses.—At the end of the year there were 132 workshop bakehouses on the register, including 101 underground bakehouses. The list of bakehouses (including 5 factory bakehouses, and 3 bakehouses in hotels) was inserted in last year's annual report (p. 179). In 1913, 249 inspections and 255 re-inspections of bakehouses were made by the District Inspectors. Restaurant Kitchens.—At the end of the year 175 restaurant kitchens were included in the register. 141 inspections and 79 re-inspections of them were made during the year, principally in the Whitfield Division of Ward 7. INSPECTION OF FOOD AND FOOD-PLACES. Sale of Food and Drugs Acts. 750 samples have been taken under these Acts, and 674 of these proved to be genuine and 76 adulterated. The details are given in the following table: — Articles of food of which samples have been taken. Total number samples. Genuine. Adulterated. Milk 396 351 45 Cream 9 2 7 Butter 192 176 16 Lard 19 19 — Pepper 21 21 — Mustard 20 20 — Rice 4 4 — Coffee 26 25 1 Jam 8 7 1 Flower of Sulphur 6 6 — Arrowroot 1 1 — Cheese 3 3 — Camphorated Oil 13 12 1 Glycerine 8 8 — Demerara Sugar 7 3 4 Vinegar 3 2 1 Cod Liver Oil 5 5 — Oatmeal 6 6 — Seidlitz Powders 3 3 — Total 750 674 76 79 In addition, five informal samples have been purchased and submitted for analysis, yiz., four of butter and one of liver. All of these were found to be adulterated. Many informal samples have been taken and not submitted for analysis. The milk samples are further classified in the following table: — Stage of Sale. Place. Reason. Number of Milk samples examined. Result of Analysis. Genuine. Adulterated. Prosecutions. On sale to public In street Periodical—Week-day ,, Early morning „ Sunday 19 17 2 ... ... ... ... ... 88 80 8 4 By request ... ... ... ... ,, hi shop Periodical—Weekday „ Sunday 184 165 19 10 27 20 7 6 Consecutive ... ... ... ... By request ... ... ... ... On delivery At shop Periodical ... ... ... ... Consecutive ... ... .. . ... By request ... ... ... ... ,, At Railway Depot or Station Periodical 60 57 3 1 Consecutive By request 18 12 6 5 Totals 396 351 45 26 The record of the samples taken and the results of analysis are shown in the following table for the past ten years:— Year. Number of samples analysed. Number of samples adulterated. Percentage of adulteration. 1904 750 130 17.3 1905 750 96 12.8 1906 750 145 19.3 1907 750 126 16.8 1908 750 117 15.6 1909 750 95 12.7 1910 750 67 8.9 1911 750 86 11.4 1912 750 76 10.1 1913 750 76 l0.1 Prosecutions were undertaken in respect of 50 of the 76 samples which were reported during the year as being adulterated. These are set out in the following table: — 80 Summonses—Under the Sale of Food and Drugs Acts—Adulteration. No. of Sample. Article. Result of Analysis. Date of Hearing of Summons. Result of Proceedings. Penalty. Costs. £ s. d. £ s. d. 0.20 Milk Deficient in milk fat, 7.6 per cent. 14th March Warranty successfully defence pleaded. A. 1 ,, Added water, 5.8 per cent. 25th „ 2 0 0 0 12 6 O. 35 Butter Foreign fat, other than the fat of butter, 22 per cent. 27 th ,, 5 0 0 0 12 6 C. 31 ,, ,, ,, ,,85 28th ,, 1 0 0 0 12 6 C. 71 ,, ,, ,, ,,86 9th May 3 0 0 0 12 6 C. 85 ,, ,, ,, ,,48 16th „ 3 0 0 1 16 6 C. 86 ,, ,, ,, ,, 85 16th „ 4 0 0 1 16 6 C. 88 ,, ,, ,, ,, 85 16th ,, 4 0 0 1 16 6 O.94 ,, ,, ,, ,, 83 6th June 2 0 0 0 12 6 A. 25 Milk Added water, 10.2 per cent. 20th „ 5 0 0 1 1 O A. 24 Butter Foreign fat, other than the fat of butter, 82 per cent. 20th ,, 5 0 0 1 1 0 0. 135 Milk Added water, 10.8 per cent. 2 th ,, Warranty successfully defence pleaded. O. 143 ,, Deficient in milk fat, 11.0 per cent. 8th July 0 5 0 1 4 6 O. 145 ,, ., 17.6 ., 8th „ 0 5 0 1 4 6 A. 28 ,, 12.0 11th 2 0 0 0 12 6 O. 160 ,, Admixture of crystallised boric acid. 7.1 grains per pint 16th ,, 0 1 0 0 12 6 O. 154 Cream ,, ,, 0.36 per cent. 16th 1 10 0 1 3 0 O. 172 Milk Added water. 5.8 per cent. 18th ,, 1 0 0 0 12 6 O. 171 ,, Deficient in milk fat, 10 per cent. 18th ,, 0 10 0 0 12 6 C. 132 ,, 6.6 ,, 24th ,, 0 10 0 0 12 6 C. 144 ,, 6.3 1st August 5 0 0 0 12 6 A. 43 ,, ,, 17.6 ,, 8th ,, - 0 12 6 A. 46 ,, Added water, 6.4 per cent. 8th ,, - 0 12 6 O. 183 ,, Deficient in milk fat, 8 per cent. 8th ,, - 0 12 6 A. 37 Butter Foreign fat, other than the fat of butter, 81 per cent. 8th & 15th August 5 0 0 0 12 6 C. 130 Milk Added water, 17.4 per cent. 21st ,, 5 0 0 0 12 6 C. 131 ,, 9.7 21st ,, - 1 3 6 C. 151 Cream Admixture of crystallised boric acid, 0.142 per cent. 21st ,, - 0 12 6 C. 153 0.124 22nd ,, 1 0 0 0 12 6 C. 176 Milk Deficient in milk fat, 16.6 per cent. 22nd ,, 0 5 0 0 12 6 C. 184 Butter Foreign fat, other than the fat of butter, 78 per cent. 5th Sept. 2 0 0 0 12 6 C. 181 „ ' „ ,, „ 84 5th ,, 2 0 0 0 12 6 C. 180 ,, ,. ,, ,, 45 ,, 5th ,, 5 0 0 0 12 6 O. 186 Milk Deficient in milk-fat, 8 per cent. 11th ,, - 0 12 6 O. 200 ,, 15.6 „ 12th „ W succ arr ess mty ully defence pleaded. C 189 Butter Foreign fat, other than the fat of butter, 84 per cent. 12th „ 3 0 0 0 12 6 O. 197 ,, „ „ „ 20 „ 12th ,, 2 0 0 0 12 6 C. 202 Milk Deficient in milk fat 7 per cent. 10th October 0 5 0 0 12 6 C. 196 Cream Admixture of crystallised boric acid, 0.124 per cent. 17th „ - 1 16 6 C. 195 ,, 0.16 17th ,, - 1 16 6 C. 217 Coffee Admixture of chicory, 50 per cent 24th 28th October 1914. - 1 13 6 C. 277 Milk Added water, 6.7 per cent. 2nd January 1913. 2 0 0 0 12 6 C. 249 ,, deficient in milk fat, 5 per cent. 28th Nov 0 3 0 0 12 6 C. 268 Butter Foreign fat. other than the fat of butter, 82 per cent. 5th Dec. 30 0 0 1 3 0 O.299 Camphorated Oil Deficient in camphor, 14.2 per cent. 1914. 8th January 1 10 0 0 12 6 C. 279 Raspberry Jam Admixture of apple pulp, 25 per cent. 9th ,, 0 5 0 0 12 6 C. 280 Vinegar Vinegar containing 100 per cent,.of vinegar other than malt vinegar 9 th ,, 0 5 0 0 12 6 O. 309 Milk Added water, 41.7 per cent. 9th ,, 6 0 0 1 13 6 O. 324 „ 5 6th February - 0 12 6 A. 97 „ Deficient in milk fat, 8 per cent. 6 th ,, Warranty successfully defence pleaded. 81 The Public Health (Milk and Cream) Regulations, 1912. The following is the Report of Administration in connection with the above regulations, asked for by the Local Government Board in their circular of 27th October, 1913. PUBLIC HEALTH (MILK AND CREAM) REGULATIONS, 1912. Report for Year ended 81st December, 1913. 1. Milk, and Cream not sold. as Preserved Cream. Number of samples examined for the presence of a preservative. Number in which a preservative was reported to be present. Milk 396 1 Cream 7 5 Nature of preventive and action taken: — Milk. 0.046 boron trioxide, equal to 7.1 grains per cent, of crystallised boric acid. Fined Is. and 12s. 6d. costs. Cream. 0.203 boron trioxide, equal to 0.36 grains per cent. of crystallised boric acid. Fined £l 10s. and £1 3s. costs.* ,, 0.08 boron trioxide, equal to 0.142 grains per cent. of crystallised boric acid. Fined nil, 12s. 6d. costs.* ,, 0.07 boron trioxide, equal to 0.124 grains per cent. of crystalised boric acid. Fined 20s. and 12s. costs. ,, 0.09 boron trioxide equal to 0.16 grains per cent. of crystallised boric acid. Fined nil, 36s. 6d. costs.* ,, 0.07 boron trioxide equal to 0.124 grains per cent. of crystallised boric acid. Fined nil, 36s. 6d. costs.* * Under Sale of Food and Drugs Acts (see p. 80). 2. Cream sold as Preserved Cream. (а) Instances in which samples have been submitted for analysis to ascertain if the statement on the label as to preservatives were correct— 1. Correct statements made 2 2. Statements incorrect - 2 (b) Determinations made of milk fat in cream sold as preserved cream. None. (c) Instances where (apart from analysis) the requirements as to labelling or declaration of preserved cream in Article V (1), and the proviso in Article V (2) of the Regulations have not been observed. None. (d) Particulars of each case in which the Regulations have not been complied with, and action taken. Nil. 3. Thickening substances. There was no evidencs of the addition to cream or preserved cream of any thickening substances. 82 "Facing" of Rice. On 17th December, 1913, the Council had before them a communication from the Kensington Borough Council, dated 21st November, in which they stated that they have had under consideration a report which was submitted to the Local Government Hoard in 1909 by Dr. J. M. Hamill, one of the Board's Inspectors, on the subject of ''facing" and other methods of preparing rice for sale. Dr. Hamill in his report pointed out that the presence in a food like rice of quantities such as 1 to 2 per cent. of unsuitable and possibly irritating mineral matter might in some cases be prejudicial to health, especially as this food is often given in considerable quantities to infants and invalids. He mentioned also that the practice was extending to other cereals, such as pearl barley. Dr. Hamill further stated that "if polishing is regarded as permissible at all, on account of its trade advantages, it should only be tolerated when the amount of mineral matter which is left in the rice by the polishing process is so small as practically to be negligible," and suggested that "an outside limit of not more than 0.5 per cent. of mineral matter would seem amply to meet the requirements of traders who represent this practice as necessary." The Kensington Borough Council expressed the opinion that 0.5 per cent. of mineral matter cannot be said to "be so small as practically to be negligible," if by that expression is meant 0.5 per cent. of extraneous mineral matter, and mentioned that on that point Dr. Hamill's report does not contain at definite statement. They further stated that they had reason to believe that a considerable section of traders favour the entire prohibition of the practice of treating rice and other cereal foods sold in this country with extraneous mineral matter, and they had therefore communicated with the Local Government Board urging that the addition of any mineral matter to rice should be entirely prohibited, and they asked the Council to support their action. In accordance with a resolution passed by the Council at that meeting, on the recommendation of the Public Health Committee, a communication was addressed to the Local Government Board in support of the views submitted to them by the Kensington Borough Council as to the desirability of prohibiting entirely the addition of any mineral matter to rice in this country. Inspection of Food [Public Health (London) Act, 1891, Sec. 47], The Food-Inspectors, J. Osborne, H. R. Child, and W. G. Auger (parttime) have kept under regular inspection food exposed or deposited for sale in slaughterhouses, shops (especially butchers', cooked meat and fishmongers' shops), stalls, and market places. In addition, the district inspectors assist during the summer (from June to September, inclusive) with the inspection of market streets. During these months four district inspectors and one food inspector are on duty for this purpose on every Saturday night, and two district inspectors and one food inspector every Sunday morning. They are selected for this duty by rotation. A list of the principal market streets was included in the Annual Report for 1912 (p. 178). 83 Four seizures of unsound food have been made during 1913. The details of these are given in the next table. Date. Division and Sub-Division. Description of Article. Prosecutions and Result. July 5th North—Gospel Oak 12½lbs. strawberries Nil. ,, 20th West—Regent's Park 1 leg of mutton Nil. Sept. 3rd South— Kndsleigh Pears, peaches & plums Nil. „ 28th West—Euston (9, Seaton Street) 10 lbs. 8 oz. beef Fined £10 and 2s. costs, or 1 month (31st Oct. 1913) ,, ,, ,, ,, 3 lbs. 8 ozbeef ,, ,, ,, ,, 1 lbs. 4 oz. veal ,, ,, ,, ,, 2 lbs. 12 oz. beef i ,, ,, ,, ,, 2 lbs. 8 oz. pieces In addition, the following unsound food has been surrendered by the owners to the food inspectors and destroyed as trade refuse at the dust-destructor:— Date. Division and Sub-Division. Description of Article. Removal requested. Prosecutions and Result. 1913. Jan. 2 North—Gospel Oak 3 stone of skate wings Yes. Nil. ,, 6 West — Chalk Farm 8 stone of beef ,, ,, 6 East—College White sea plaice ,, ,, Feb. 15 North—Grafton 36 boxes of tomatoes ,, ,, Mar. 8 East—College 2 bags of mussels ,, ,, April 24 College 1 case of salted herrings ,, ,, May 8 „ Bartholomew 1 bullock's head, lungs and liver ,, ,, ,, 15 ,, ,, ,, ,, ,, ,, „ 28 „ Ossulston 6 pieces of neck of mutton ,, ,, „ 31 North—Gospel Oak 2 boxes of apples (60 lbs.) ,, ,, June 2 West—Castle 1 box of kippers ,, ,, 4 East — Camden 2 ton 8 cwt. of potatoes ,, ,, July 1 South—Endsleigh 16 fowls ,, ,, „ 16 East—Bartholomew 1 bullock's liver ,, ,, „ 24 West—Regent's Park 5 rabbits ,, ,, Aug. 16 „ Chalk Farm 100 lbs. pears ,, ,, „ 22 East—Ossulston 1 ton 13 cwt. plums ,, ,, „ 23 „ Oakley 10 boxes of kippers ,, ,, 25 ,, Ossulston 1 ton 7 lbs. of yeast ,, ,, Sept. 10 East—College 1 trunk of cat fish ,, ,, „ 30 „ Camden Square 3 pairs sheep's lungs ,, ,, Oct. 1 West—Chalk Farm 1 trunk mixed fish ,, ,, 7 North—Highgate 1 pig's pluck & spleen 1 bullock's liver ,, ,, „ 14 East—Bartholomew ,, ,, „ 16 West—Chalk Farm 10 stories skate ,, ,, ,, 21 East—Ossulston 14 tins condensed milk ,, ,, „ 27 North—Maitland Park 15 boxes of tomatoes ,, ,, Nov. 7 East—Oakley Square 2 trunks cod & whiting ,, ,, Dec. 2 ,, Bartholomew 1 bullock's liver ,, ,, ,, 8 North —Gospel Oak 1 trunk of cod ,, ,, „ 31 South — Argyle 1 trunk of whiting ,, ,, ,, ,, East —Bartholomew 1 bullock's liver ,, ,, 84 Dairies, Cowsheds, and Milk Shops. Cowsheds.—There are 6 licensed cowsheds in the Borough, registered for 134- cows, there having been on alteration in the list of licensed cowsheds made during the year. The list was set out on page 176 of the Annual Report for 1912. These have been regularly inspected by the food inspectors, 84 inspections having been made during the vear. Milk Shops and Dairies.—Sec. 5 of the London County Council (General Powers) Act, 1908, enables the sanitary authority, subject to certain provisos, to remove from the register, or refuse to register, any person carrying on the trade of dairyman or purveyor of milk upon premises which are in their opinion for any reason unsuitable for the sale of milk therein. For several reasons, amongst which was the expectation of a new Milk and Dairies Bill becoming law; this new power was not put into force in St. Pancras until 1913. Before his illness and death Dr. Sykes had collected certain information on the matter, but further action was then interrupted. During the autumn of 1913 a special inquiry was instituted into all shops in the Borough where milk was sold. For this purpose an enquiry schedule was drawn up, and the details tilled in separately for each shop by the three food inspectors who carried out the necessary visiting. It was found that (in November) the total number of registered milk shops actually selling milk by retail in the Borough was 389. The amount of milk sold daily by retail in these shops otherwise than by milk-rounds, proved to be about 1,460 imperial gallons (based upon the estimates of their daily sales made by the shopkeepers themselves). The following table gives the numerical results of the enquiry: — No. of shops where milk is sold by retail by registered persons 389 Total quantity of milk sold per diem 1,460 gallons. Average do. do. per milk sho 3.8 ,, No. of shops in which one gallon or less of milk is sold per diem 93 or 24 per cent. Do. between one or two gallons do. 109 ,, 28 ,, Do. over two gallons do. 187 ,, 48 ,, No. of shops in which the registered milk seller has also a " milk-round " 105 ,, 27 ,, Do. do. not do. 284 ,, 73 „ No. of "dairies" 107 ,, 27 ,, Do. "general shops" 246 ,, 63 ,, Do. grocery and provision shops 22 „ 6 ,, Do. other shops 14 ,, 4 ,, 85 No. of milk shops where paraffin oil is sold 123 or 32 per cent. Do. do. firewood is sold 264 ,, 68 ,, Do. do. pickles are sold (otherwise than in closed jars) 240 ,,62 ,, Do. do. coal blocks, coal or coke are sold 91 „ 23 Do. do. greengrocery is sold 31 ,, 8 ,, Do. do. other dirty goods are sold (hearthstone, &c.) 182 ,, 47 ,, No. of milk shops with floor so lumbered with articles or goods that it cannot be kept properly clean 192 ,, 49 ,, Do. do. with sleeping room in direct communication 25 ,, 6 ,, Do. do. without fixed permanent ventilation 266 ,, 68 ,, Do. do. with floor not structurally sound. . 44 ,, 11 ,, Do. do. without a properly covered milk- vessel 298 ,,76 ,, An outstanding feature of these results is the fact that a very large proportion of shopkeepers who sell milk do so on a very small scale. Nearly a quarter (93) of the whole sell no more than one gallon a day, and more than a half (202) sell no more than two gallons a day. The principal type of shop in which milk is sold in this small way is the general shop, commonly known as the chandler's or huckster's shop). It will be noticed that this kind of shop makes up 63 per cent. of registered milk shops, and the same fact is indicated by the small proportion of the total which have a milk-round attached to the business (27 per cent.). The ordinary general shop is well-known to be one which sells almost everything that is required in a household, and is found principally in the poorer parts of the Borough. They are crowded with a great variety of goods usually sold in grocers' shops, oil shops, chemists', hardware, and even drapers' shops, and many of them sell firewood, coal or coal-blocks, hearthstone, soap, soda, greengrocery (potatoes, onions, &c.), vinegar, pickles (open as well as in closed jars), paraffin oil, and other dirty, dusty, or strong-smelling commodities, which are likely to lead to contamination of the milk. In the foregoing table it is shown how that amongst the St. Pancras milk shops a large proportion sell these various goods (firewood 68 per cent., open pickles 62 per cent., paraffin oil 32 per cent., coal or coal-blocks 23 per cent., &c.). Many of the general shops are kept in a dirty condition, and even when the shopkeeper is a clean and careful person, the crowded condition of the shop, and the fact of the floor being permanently lumbered up with such objects as boxes, barrels, firewood, &c., often effectually prevents proper cleanliness. One half of the milk shops in the Borough have their floors lumbered up in this way. It is now generally recognised that, milk, probably more than any other food, requires special care in its handling. This is due to the circumstance that on the one hand it readily takes up any kind of contamination to which it is exposed, and on the other hand it is an eminently suitable medium for the 86 multiplication of all kinds of microbie and other injurious growths. This is all the more important for the reason that cow's milk is almost the sole food of many of the infants in our population. The use of contaminated milk for this purpose is one of the factors maintaining the high rate of infantile mortality which prevails in the poorer parts of the Borough, where the worst type of milk shop is commonest. Disturbance of the digestive system is, in years of hot summers, the largest cause of death in infants under one year of age, and some of this form of illness must be attributed to the use of contaminated milk. It is very significant in this connection that breast-fed children are far less liable to this malady than are those fed on cow's milk. There is no doubt that, so long as milk is stored and sold as at present in open vessels, the milk shop ought to be so ordered as to minimise the risk of the milk becoming contaminated. At present, i.e., at the end of 1913, many of the milk shops in the Borough are far from such a standard.* Besides the shops which strike one at once as being quite unsuitable for the sale of milk, many of the others require certain improvements. For instance, many need more ventilation. Nearly 70 per cent. of the whole are without any fixed permanent ventilators. Again, a few (25) are in direct communication with sleeping rooms. Another important matter is the vessel in which the milk is stored. Many of the dealers keep their milk on the counter in open pans, or in other vessels which do not protect the milk from flies and particles floating in the air. Only one quarter of all milk shops are furnished with milk-pans provided with proper metal covers. The 107 milk shops which are here classed as "dairies," and a proportion of the other milk shops cAn readily, where necessary, be made suitable for the sale of milk. In the case of the remainder this will depend upon how far the vendor is prepared to go in order to bring his milk shop into line with any standard that may be set up. In over a hundred shops the conditions are very bad, and so long as the class of trade that is carried on in them remains as it is they can hardly be made suitable. Conversation with the shopkeepers makes it clear that the majority of those who sell only small quantities of milk do not do so for the doubtful profit which they make, but in order to attract customers for their other goods, and many would even be pleased to give up the trade if their competitors did the same. The above facts are sot out in a report which was presented by the Medical Officer of Health to the Public Health Committee on 7th January, 1914, and in the early part of 1914 the matter was under the consideration of the Council. In addition to the 389 registered milk shops where milk is sold by retail, four itinerant vendors and one dairy farmer without milk shops, and two wholesale dairymen who do not sell milk by retail, are also on the register. *During 1914, a number of milksellers with unsuitable premises have been removed from the Register. 87 During 1913 the names of 52 purveyors of milk were added to the register.. One application was refused oil the ground that the premises (25, Redhill Street) were unsuitable for the sale of milk therein. Two prosecutions of unregistered persons carrying on the business of a milkseller without being registered were undertaken in 1913, as follows: — Situation. Offence. Date of Hearing of Summons. Result of Proceedings. 21, King Street Unlawfully carrying on the business of a Dairyman without being registered 2nd May Fined £2. Costs £ 11s. 0d. 1, Lamble Street Do. do. 22nd August Fined £1 0s. 0d. and 2s. costs Ice-Cream Premises. A list is kept of premises in the borough where ice-cream is made, and 491 premises are on this list. These are regularly inspected during the ice-cream season. During the year 289 visits were paid by the food inspectors to them. Two prosecutions were undertaken under Sec. 42 of the London County Council (General Powers) Act, 1902, for failure to take proper precaution for the protection of ice-cream from contamination, as follows: — Situation. Offence. Date of hearing of Summons. Result of Proceedings. 24, Mount Pleasant Failing to take proper precaution for the protection of icecreams from contamination 20th June Fined 2s. and 2s. costs. ,, ,, ,, ,, ,, ,, ,, ,, Other Food Premises. The number of inspections made of butchers' and fishmongers' shops, premises where prepared meats (such as sausages, pies, tripe, cooked meat, etc.) are made, marketing places, premises where fish is fried or cured, etc., will be found in table 10 on page 112. Lists of fried fish shops and fish-smoking places were given on pages 187-189 of the Annual Report for 1912. There were at the end of 1913 80 fried fish shops and 14 fish-smoking places in the borough. Bakehouses and restaurant kitchens are referred to under the heading- of W orkshops (see page 78). 88 Slaughter-Houses. There were 16 licensed slaughter houses in the borough at the end of 1913, there having been 110 alteration in the list during the year. The list was set out on page 177 of last year's Annual Report. 048 visits to slaughter-houses were made by the food inspectors during 1913. THE RAG FLOCK ACT, 1911. This Act which was passed to check the use of flock made from dirty rags came into operation 011 1st July, 1912. It makes it an offence for any person to sell flock manufactured from rags, or to use such flock for the purpose of making upholstery, cushions, or bedding, unless the flock conforms to such standard of cleamliness as may be prescribed bv Regulations to be made by the Local Government Board. The penalty provided for the offence is £10 in the case of a first offence and £50 in the case of a subsequent offence. There is a proviso that under certain conditions a warranty is a good defence. Regulations have been made under the Act by the Local Government Board which provides that the standard of cleanliness of the flock shall be that the amount of soluble chlorine, in the forms of chlorides removed by thorough washing with distilled water, under specified conditions, must not exceed thirty parts of chlorine in 100,000 parts of the flock. The Act imposes upon the Sanitary Authority the duty of enforcing the provisions of the Act, and for that purpose gives power to the Medical Officer of Health or Sanitary Inspector or other Officer, if so authorised by the Sanitary Authority to institute and carry on proceedings under the Act, and to enter premises with the object of examining and taking samples for the purpose of analysis of any flock found therein. The Council passed a minute on 17th September, 1913, that the Act was to be put into op ration, and the Food Inspectors, who do analogous work under the Sale of Food and Drugs Acts, were authorised to take samples under the Act. The Public Analyst was appointed to do the analyses. The late Medical Officer of Health obtained information in 1912, through the District Inspectors, as to the firms which used or sold flock, and from this and subsequent information obtained, nine such firms are known. Samples were taken from all of these during 1913. The results are set out below: — No. of Sample. Date of Sampling. Situation of Premises. Result of Analysis. C.l 18th Oct. Ward 1, N.3 2-95 parts Chlorine per 100,000 Rag Flock. C.2 ,, (same premises) 1.47 ,, O.l ,, Ward 7, S.5 8.85 ,, 0.2 ,, Ward 7, S.5 3.05 ,, 0.3 22nd Oct. Ward 8, S.3 1.67 ,, 0.4 27th „ Ward 5, W.4 20.0 ,, 0.5 ,, Ward 7, S.5 13.0 ,, 0.6 ,, Ward 7, S.5 51.0 ,, 0.7 7th Nov. Ward 7, S. 5 13.5 ,, 0.8 17th „ Ward 5, W.3 15.0 ,, 89 It will be seen that only one sample (0.6) was not in compliance with the Regulations. A warning letter was sent in respect of this sample. GENERAL SANITARY WORK. In this section refereuce 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 58,358 inspections were made during 1913 by the staff of Inspectors. These consisted of 29,761 inspections and 28,597 re-inspections (generally after the service of intimation notices). Of these inspections, 44,570 were made by the District Inspectors, 8,813 by the Inspectors of Food and Food-places, and 4,965 by the Women Inspectors. The inspections actually made by each individual Inspector are shown in table 11 on page 113. The work of the District Inspectors and Women Inspectors is set out in detail in tables 8 and 9 on pages 108-111, and that of the Food Inspectors in table 10 on page 112. Intimation Notices. 6,672 intimation notices have been served by the Sanitary Inspectors during 1913. These were made up as follows:— In respect of Nuisances 3,511 In respect of Breaches of the Tenement House By-laws 1,096 In respect of Breaches of Statutes in Factories, Workshops and Work-places 142 In respect of other Breaches of Statutes and By-laws 1,923 6,672 These intimation notices are classified in tables 12, 13, 14 & 15 on pages 114-116. Summonses. The following prosecutions were undertaken in respect of general Sanitary work:— 90 Under the Public Health (London) Act, 1891 (except in respect of food). Situation of Property. Offence. Date of Hearing of Summons. Eesult of Proceedings. 36, Little Clarendon Street. Failing to cleanse part of 28th Feb. Fined £2 and 2s. costs. ,, ,, Failing to remove offensive accumulation. ,, ,, Fined £3 and 2s. costs. 54, Whitfield Street Drain defective 25th April Summons adjourned sinedie. Premises to be demolished. Costs paid to Council, £2 2s. 270, Gray's Inn Road. Defective R.W. pipe, &c. 23rd May Abatement Order. Costs £1 3s. 87, Ossulston Street Defective drain 7th April Abatement Order. Costs £2 2s. 94, Chalton Street Failing to provide proper dustbin. 24th Oct. Fined £1 and 17s. costs. Smoke-Prevention. A register of smoke shafts is kept in the department. At the end of 1913 there were 343 shafts on the register. During the year 550 observations were made and 66 re-inspections after the service of notices. There were no prosecutions. Regulated Trades. Offensive Trades.—There are two licensed premises for such trades in St. Pancras, viz., a tripe-dresser's in Kentish Town Road, and a tallow-melter's in Tudor Place. These have been kept under special observation during the year in consequence of complaints. During October night observations were made in the neighbourhood of the tallow works, and the attention of the owners drawn to the smell arising. Since then there have been no complaints of smells. At the tripe-dresser's certain repairs and improvements were made during the year. Under the Metropolis Management Act, 1855, Sec. 202. Situation of Property. Offence. Date of Hearing of Summons. Result of Proceedings. 164, Camden Street Failing to deposit plans of re-drainage. 19th Dec. Fined 5s. and 2s. costs. 91 Other Businesses giving rise to Effluvia.—lists are kept in the department of the three trades mentioned below. At the end of 1913 there were included in these lists 80 fried fish shops, 14 fish-smoking places, and 38 rag and bone stores. The lists were given in last year's report on pages 187 to 190. 143 inspections and 16 re-inspections were made of these premises during the year. The amended draft of proposed by-laws under the London County Council (General Powers) Act, 1908, in respect of fried fish vendors, fish curers, and rag and bone dealers were again submitted to the Council by the London County Council during 1913 and approved. 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 415 4818 Voluntary drainage work 636 5031 Drains of new buildings 120 1751 1171 12630 The tests which have been applied to drains during 1913 are shown in the following table: — After Infectious Disease. Upon Complaint. Upon systematic Inspection Old Buildings. New Buildings | at completion of work. Total. At commence ment of work. At completion of work. By Grenade. 1. Defects found 121 100 ... ... 9 ... 230 2. No result 682 143 ... ... 26 ... ... 3. Total 801 243 35 1081 By Smoke. 1. Defects localised ... 1 ... ... ... ... 1 2. No result ... ... ... ... 1 ... 1 3. Total ... 1 ... ... 1 ... 2 By Water. 1. Not found water-tight ... ... ... ... 97 10 107 2. Found water-tight ... 2 ... ... 1149 306 1457 3. Total ... 2 ... ... 1246 316 1564 Total 121 101 ... ... 106 10 338 682 145 ... ... 1176 306 2309 803 246 ... ... 1282 316 2647 92 Drainage Register.—The following is an analysis of the Drainage Register during 1913:— Total number of Applications and Plans 705 Number of Applications without Plans 251 Number of Plans 454 Plans—Old Buildings under Notice 192 Plans —Old Buildings, Voluntary 225 454 Plans—New Buildings and additions _37 Water Seryick. The following notices have been received from the Metropolitan Watei Board as to houses from which water has been cut off :— 1.—Demolition 12 2.—Empty 22 3. — Leakage 3 4.—Non-payment of Rates 8 5.—No statement 2 6.—By request 7 54 DISINFECTING AND CLEANSING STATION. Disinfection. The work done during the year by the disinfecting* staff is showm in the following table:— Disease. No. of Cases. No. of Houses. No of Rooms Contents Disinfected or Destroyed. No. of Rooms Sprayed and Fumigated. Scarlet Fever 534 510 559 560 Diphtheria 362 353 388 389 Enteric Fever 44 43 43 — Erysipelas 92 92 91 - Puerperal Fever 11 11 11 - CereDro-Spinal Meningitis 4 4 4 4 Consumption 119 119 112 93 Measles 9 9 11 18 Cancer 34 34 34 5 Ophthalmia Neonatorum 2 2 2 — ' Other Diseases 54 54 51 11 Totals 1265 1231 1306 1080 93 Below is shown the number of articles destroyed or disinfected during the year on account of infectious disease (see also p. 95): — Destroyed. Disinfected. Beds, mattresses and palliasses 78 1527 Bolsters and pillows 36 3171 Sheets, blankets and counterpanes 26 4484 Rugs, mats, cushions, carpets, covers, and curtains 22 1033 Wearing apparel 33 3076 Sundries 61 555 Total 256 13846 The following table shows the number of persons cleansed and disinfected after having been in contact with infectious disease:- Males. Females. Children under 10. Scarlet Fever 7 1 — Diphtheria 3 1 — Puerperal Fever - 7 — There were no persons or families sheltered in the contact shelter. Cleansing Station. The amount of work done here during the year is indicated in the table below. The figures represent the number of attendances. At each attendance the person receives a bath, and his or her clothes are stoved. Slept previous night at . Reason for Cleansing, Adults. Childen. Sum Total Males. Females Total. 10 to 15. 5—10 0-5 Total. M. F. Private Addresses Pediculosis of the —Head - - - 4 87 45 1 137 137 —Body 22 9 31 154 14 131 1 300 331 —Both — — — 605 £35 1036 6 2482 2482 Rowton Houses — Body 154 — 154 — — — — — 154 Common Lodging Houses —Body 615 6 621 - - - - - 621 Salvation Army Shelter - - - - - - - — — In the open —Body 254 29 288 283 Total Pediculosis of the Head - - - 4 87 45 1 137 137 „ —Body 1045 44 1089 154 14 131 1 300 1389 ,, —Both - - - 605 835 1036 6 2482 2482 Doubtful... - - - 19 — 15 — 34 34 Scabies .. 2 - 2 42 83 49 — 174 176 Totals 1047 44 1091 824 1019 1276 8 3127 4218 94 In addition to the foregoing work, the following cleansings were carried out in respect of bedfellows of these: — Vermin. AGES. Total. 15 and over. 10—15. 5-10. Under 5. Pediculosis—Head ... 6 8 3 17 „ —Body ... 8 33 4 45 —Both 1 133 448 20 602 Doubtful ... 3 1 ... 4 Scabies—Acari ... 10 72 ... 82 Totals 1 160 562 27 750 The school children included in the first of the foregoing two tables have been brought to the cleansing station by officials of the London County Council as the Education Authority under the powers conferred upon them by their General Powers Act, 1904, Sec. 36, and the Children's Act, 1908, Sec. 122. The children are those found to be verminous upon examination in the Public Elementary Schools, and a sum of two shillings for one month's course of cleansings for every child is paid by the County Council to the Borough Council, according to an agreement between the two Authorities. During 1913 the existing agreement terminated, and the County Council then asked the Borough Council to exteud the arrangement at the same rate of payment to children attending schools outside the Borough within one mile of the Cleansing Station. This the Borough Council agreed to do on condition that every public elementary school in the Borough was included in the scheme. Prior to this a number of schools in the north of the Borough were not dealt with. The County Council therefore made special arrangements for the verminous children in the northern schools to be brought to the Cleansing Station, and a new agreement on these terms was signed between the two authorities on the 4th December, 1913, for a period of three years ending 20th May, 1916. Daring the year the children for whom a month's treatment was paid for by the London County Council numbered 1,256. The health-visitor, Miss Smith, has devoted part of her time to visiting the homes of these verminous children, and helping the families to rid themselves of these verminous conditions. For this purpose the bedding and bedfellows in the household have been cleansed in many instances. The visits paid by Miss Smith for this purpose have numbered 400, but the female staff is quite inadequate to deal with this problem effectively. 95 The work done in cleansing verminous clothing, etc., is shown in the following table: — Destroyed. Disinfected Beds, mattresses and palliasses 10 32 Bolsters and pillows 1 31 Sheets, blankets, and counterpanes 1 79 Rugs, mats, cushions, carpets, covers, and curtains 3 26 Wearing apparel 17 273 Sundries 13 99 Total 45 540 PUBLIC MORTUARIES AND CORONERS' COURT. Number of bodies deposited in the General Mortuary during 1913 416 „ ,, Infectious ,, „ 7 Total 423 Inquests hf.i.d during 1913— In the Coroner's Court—General Cases 370 ,, „ Poor Law „ 52 Elsewhere in St. Pancras — Total 422 BACTERIOLOGICAL EXAMINATIONS. The following work has been done by the Lister Institute of Preventative Medicine, Chelsea Gardens, S.W., at the expense of the Borough in respect of St. Pancras persons: — Total. Positive. Negative.[/##] Examinations of swabs for B. diphtheria 266 97 169 ,,sputum for B. tuberculosis 198 40 158 „ blood for Widal reaction (typhoid) 31 17 14 CLERICAL WORK. The following- figures gve an indication of the clerical work done during* 1913. Much other clerical work (such as the vital statistics, and the eeping of notification and other accounts) is also done by the clerical staff. No. of complaints received (communications 1744 ,, notifications of dangerous infectious disease received 1308 ,, ,, reported in daily returns to Metropolitan Asylums Board 1308 ,, ,, ,, ,, School teachers 1470 ,, ,, „ ,, St. Pancras Library 1263 ,, advisory notices sent to householders in respect of above notifications 1308 „ statutory notices served requiring disinfection 1308 ,, certificates of disinfection forwarded 1170 96 No. of cases of tuberculosis notified (received : Forms A, B, C & D) 2150 ,, „ ,, reported in weekly returns to London County Council 2150 ,, advice-cards sent to notified cases of tuberculosis 1158 ,, notices of voluntary drainage work received 225 ,, drainage plans received 454 ,, birth notifications received 4749 ,, ,, reported in weekly returns to London County Council 4749 ,, advice-cards re infants' nurture sent to mothers 4749 ,, general letters received (other than complaints and notices of drainage work) 2520 ,, letters, etc., despatched 4565 ,, intimation notices served 3701 ,, statutory ,, 1780 ,, summonses applied for 64 ,, hearings and adjournments 63 ,, mtetings of Council 14 ,, ,, Public Health Committee and Sub-Committees 48 STAFF. The death of the late Medical Officer of Health in 1913, and the appointment of his successor, have been mentioned elsewhere in this report. Sanitary Inspector Mr. C. H. Johnston died on 3rd October, 1913. after an illness which had prevented him carrying out his duties for six months. Mr. R. C. Akers, formerly Foreman of the Disinfecting Station, was appointed as Sanitary Inspector on 17th December, 1913, to fill the vacancy thus caused. Mr. Akers was allotted the Endleigh division of Ward 7 for his district, and Mr. Dillon transferred to Ward 3. As has been already mentioned Miss Mary Giles was appointed as Temporary Woman Inspector from 30th December, 1912, to 3rd May, 1913, and again from 12th July onwards. No other changes have taken place in the staff during 1913. The list of officers will be found on pages 7 and 8. APPENDIX. 98 Table No. 1. VITAL STATISTICS OF WHOLE DISTRICT OF ST. PANCRAS DURING 1913 AND PREVIOUS YEARS. Year Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Transferable Deaths Nett Deaths belonging to the District. Uncorrected Number. Nett. of Nonresidents registered in the District. of Residents not registered in the District. Under 1 Year of Age. At all Ages. Number. Rate per 1,000 Nett Births. Number. Rate. Number. Rate. Number. Rate. 1908 237158 5546 — 23.4 — — — — 638 115 3555 15.0 1909 237247 5238 — 22.1 3668 15.4 738 591 570 108 3521 14.8 1910 237178 5385 — 22.7 3415 14.4 710 562 580 107 3267 13.8 1911 23'129 5135 5555 23.4 3418 14.4 673 611 623 112 3356 14.1 1912 220353 5003 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 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.), 99 Table No. 2. Deaths Registered from all Causes for the Year 1913. 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 dbeyond the limits of the Borough are included. Cause of Death. 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 b5 85 and upwards. Totals. ; 1.—General Diseases. 1. Enteric Fever ... ... ... ... ... ... 1 2 3 ... ... ... ... ... 6 2. Typhus ,, ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3. Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4. Malaria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5. Small Pox— (a) Vaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (6) Not Vaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (c) Doubtful ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6. Measles 10 14 8 32 3 ... ... 1 ... ... ... ... ... ... 36 7. Scarlet Fever 1 ... 2 3 3 ... ... ... ... ... ... ... ... ... 6 8. Whooping Cough 12 12 11 35 1 ... ... ... ... ... ... ... ... ... 36 9, (a) Diphtheria 1 2 10 13 5 1 ... ... ... ... ... ... ... ... 19 (6) Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10. Influenza ... ... ... ... ... ... 2 5 3 7 8 9 6 2 42 11. Miliary Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 12. Asiatic Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 13. Cholera Nostras ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 14. Dysentery ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 15. Plague ... ... ... ... ... ... ... ... 2 1 2 1 ... ... 6 16. Yellow Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 17. Leprosy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 18. Erysipelas 3 ... ... 3 ... ... ... ... ... 2 2 2 ... 1 10 19. (a) Mumps ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (b) German Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (c) Varicella l ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 (d) Other Epidemic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 20. (a) Pygemia ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 (b) Septicemia 1 ... ... l ... ... ... 1 ... ... ... ... ... ... 2 (c) Vaccinia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 21. Glanders ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 22. Anthrax (Splenic Fever) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 23 Rabies ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 24. Tetanus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 25. Mycoses ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 26' Pellagra ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 27. Beri-Beri ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 28. (a) Pulmonary Tuberculosis 5 2 3 10 1 2 32 46 51 63 34 12 1 ... 252 (b) Phthisic (not defined as Tuberculosis) ... ... ... ... ... ... 5 18 26 11 9 4 ... ... 73 29. (a) Acute Phthisis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (b) Acube Miliary Tuberculosis ... 2 3 5 ... ... ... ... ... ... 1 ... ... ... 6 30. Tuberculous Meningitis 5 8 9 22 12 1 l ... ... ... ... ... ... ... 36 31. (a) Tabes Mesenterica 2 1 1 4 ... ... ... ... ... ... ... ... ... ... 4 (b) Other peritonpal and intestinal tubercle ... 1 2 3 1 3 ... 1 ... 1 ... 1 ... ... 10 32. Tuberculosis of Spinal Column 1 ... ... 1 1 ... ... ... ... ... 1 ... ... ... 3 33. Tuberculosis of Joints ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... 2 34. (a) Lupus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (b) Scrofula ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (c) Tuberculosis of other Organs ... 1 ... 1 1 ... 1 ... ... ... 1 1 ... ... 5 35. Disseminated Tuberculosis ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 36. Rickets, Softening of Bones ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... 1 37. Svphilis 14 1 ... 15 ... 1 ... ... ... 2 ... ... ... ... 18 38. Other Venereal Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 39. Cancer of the Buccal Cavity ... ... ... ... ... ... ... 2 l 4 11 9 5 ... 32 40 ,, Stomach, Liver, &c. ... ... ... ... ... ... ... 1 4 9 27 27 5 ... 73 41 ,, Peritoneum. Intestines, and Rectum ... ... ... ... ... ... ... 2 3 11 22 17 11 1 67 42. ,, Female Genital Organs ... ... ... ... ... ... ... 1 3 8 14 8 6 ... 40 43. ,, Breast ... ... ... ... ... ... ... 1 2 3 5 11 3 ... 26 44. „ Skin 1 ... ... 1 ... ... ... ... ... 1 1 2 1 ... 6 45. Cancer of other or unspecified Organs ... 1 ... 1 ... ... 2 1 4 10 9 11 3 ... 41 46. Other Tumours (situation undefined) ... ... ... ... ... ... ... ... 1 ... 3 1 1 ... 6 47. Rheumatic Fever ... ... 1 1 1 ... 1 ... 2 ... 1 ... ... 6 100 Deaths Registered from all Causes for the Year 1913—continued. Cause of Death. 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 1. General Diseases—con. 48. (a) Chronic Rheumatism ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (b) Osteo-Arthritis ... ... ... ... ... ... ... 2 1 ... 2 2 1 ... 8 (c) Gout ... ... ... ... ... ... ... ... ... ... ... 1 ... ... | 1 49. Scurvy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 50. Diabetes ... ... ... ... ... ... ... 3 5 5 10 1 1 ... 29 51. Exopthalmic Goitre ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 52. Addison's Disease ... i ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 53. Leucocythæmia Lymphadenoma ... 2 2 4 ... ... ... 2 ... ... ... 2 ... ... ... 54. Anæmia, Chlorosis ... ... 1 1 ... ... 1 1 2 1 3 ... ... ... 9 55. (a) Diabetes insipidus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (b) Purpura ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (c) Haemophilia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (d) Other General Diseases ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... 2 56. Alcoholism (acute or chronic) ... ... ... ... ... ... ... 1 3 2 3 ... ... ... 9 57. (a) Occupational Lead Poisoning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (b) Non-occupational Lead Poisoning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 58. Other Chronic Occupational Poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 59. Other Chronic Poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2. Diseases of the Nervous System and of the Organs of Special Sense. 60. Encephalitis ... ... ... ... ... 2 2 1 ... ... ... ... ... ... 5 61. (a) Cerebro-Spinal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (6) Posterior Basil Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (c) Meningitis, other forms 8 1 5 14 3 2 1 2 3 2 1 ... ... ... 28 62. Locomoter Ataxy ... ... ... ... ... ... ... ... ... ... 1 1 ... ... 2 68. Orher Diseases of the Spinal Cord ... ... 1 1 ... ... ... 1 2 ... 4 4 ... ... 12 64 Cerebral Hæmorrhage, Apoplexy 2 ... ... 4 ... 1 1 1 5 16 14 17 24 4 87 65. Softening of Brain ... ... ... ... ... ... ... ... ... 5 2 1 1 ... 9 66. Paralysis without specified cause 1 ... ... 1 ... ... ... ... 2 1 8 8 6 ... 26 67. General Paralysis of the Insane .. ... ... ... ... ... ... ... 2 9 8 3 ... ... ... 22 68. Other forms of Mental Alienation ... ... ... ... ... ... ... 3 4 2 1 ... ... ... 10 69. Epilepsy ... ... l 1 ... 1 5 2 4 4 6 4 ... 27 70. Convulsions (Non-puerperal; 5 years and over) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 71. Infantile Convulsions (under 5 years) 16 l 2 19 ... ... ... ... ... ... ... ... ... ... 19 72. Chorea ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 73, Hysteria, Neuralgia, Neuritis ... ... ... ... ... ... ... 1 2 1 ... ... ... ... 4 74. Other Diseases of the Nervous System ... ... ... ... ... 1 ... 2 1 2 1 ... ... ... 7 75. Diseases of the Eyes and Annexa ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 76. (a) Mastoid Disease ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 (b) Other Diseases of the Ears ... 2 ... 2 ... ... ... ... ... ... ... 1 ... ... 3 3. Diseases of the Circulatory System. 77. Pericarditis ... ... ... ... 2 1 3 1 1 ... 2 ... ... ... 10 78. Acute Myocarditis and Endocarditis ... ... ... ... 1 1 4 5 3 4 3 4 4 ... 29 79. (a) Valvular Disease ... ... ... ... 1 1 10 7 16 17 15 27 6 2 102 (b) Fatty Degeneration of the Heart ... ... ... ... ... ... ... ... 4 9 13 28 12 2 68 (c) Other Organic Disease of the Heart ... ... ... ... 2 ... 3 2 12 22 22 26 16 1 106 80. Angina Pectoris ... ... ... ... ... ... ... 1 ... ... ... 2 1 ... 4 81. (a) Aneurysm ... ... ... ... ... ... ... ... 1 6 5 1 ... ... 13 (6) Arterial Sclerosis ... ... ... ... ... ... ... ... ... 2 6 1 4 5 18 (c) Other Diseases of Arteries ... ... ... ... ... ... ... ... ... 1 1 ... ... ... 2 82. (a) Cerebral Embolism and Thrombosis ... ... ... ... ... 1 ... l ... 2 8 10 4 3 29 (b) Other Embolism and Thrombosis ... ... ... ... ... ... 1 ... ... ... 3 1 2 ... 7 83. Diseases of the Veins (Varices, Haemorrhoids Phlebitis, etc.) ... ... ... ... ... ... ... ... 2 ... ... ... ... ... 2 84. (a) Statue Lymphaticus ... ... 1 1 ... ... ... ... ... ... ... ... ... ... 1 (b) Other Diseases of the Lymphatic System ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 85. Hæmorrhage; other Diseases of the Circulatory System ... ... ... ... ... ... ... ... 3 ... 1 1 1 ... 6 4. Diseases of the Respiratory System, 86. Diseases of the Nasal Fossae ... ... 1 1 ... ... ... ... ... ... ... ... ... ... 1 87. Diseases of the Larynx ... ...• 1 ... ... ... ... ... ... ... ... ... ... ... 1 88. Diseases of t he Thyroid Body ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 101 Deaths Registered from all Causes for the Year 1913—continued. Cause of Death, AGES. 0 to 1 1 to 2 2 to 5 Total under 5 vears. 5 to 10 10 to 15 15 to 25 25 to 35 35 to 45 45 1 to 55| 55 to 65 65 to 75 75 to 85 85 and upwards Totals. 4. Diseases of the Resparatory System—con. 89. & 90. Bronchitis 26 10 1 37 1 ... 2 7 10 44 53 96 70 18 338 91. Broncho-Pneumonia 79 49 19 147 2 ... 1 1 3 7 8 11 4 1 185 92. (a) Lobar Pneumonia 2 3 8 8 2 2 4 9 12 18 12 11 4 1 83 (b) Pneumonia (type not stated) 7 2 5 14 3 ... ... 6 14 11 14 14 8 1 85 93. Pleurisy ... ... ... ... ... 1 1 2 3 3 2 ... ... 12 94. Pulmonary Congestion, Pulmonary Apoplexy 1 ... ... 1 ... ... 1 1 ... 2 2 2 1 ... 10 95. Gangrene of the Lung ... ... ... ... ... ... ... ... 2 ... ... ... ... ... 2 96. Asthma ... ... ... ... ... ... ... ... ... 1 1 1 ... ... 3 97- Pulmonary Emphysema ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 98. (a) Fibroid Disease of the Lung ... ... ... ... ... ... ... ... 1 1 ... ... ... ... 2 (b) Other Diseases of the Respiratory System ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 2 5. Diseases of the Digestive System 99. (a) Diseases of the Teeth and Gums ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (b) Other Diseases of the Mouth and Annexa ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 100. Diseases of Pharynx, Tonsillitis ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... 1 101. Diseases of Œsophagus ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... 2 102. Perforating Ulcer of Stomach ... ... ... ... ... ... ... 5 5 5 2 ... 1 ... 18 103. (a) Inflammation of Stomach 4 ... ... 4 ... ... ... ... ... 1 2 ... 2 ... 9 (b) Other Diseases of Stomach 2 ... ... 2 ... ... ... ... 1 1 1 ... ... ... 5 104 & 105. (a) Infective Enteritis 15 1 1 17 ... ... ... ... ... ... ... 1 ... ... 18 (b) Diarrhœa (not returned as infective) 22 4 2 28 ... ... ... ... ... 1 1 2 1 2 35 (c) Enteritis (not returned as infective) 40 13 7 60 ... 1 ... 2 1 ... 2 2 2 ... 70 (d) Gastro-Enteritis (not returned as infective) 18 3 1 22 ... ... 1 ... ... 1 ... ... ... 1 25 (e) Dyspepsia (under 2 years of age) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (f) Colic ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (g) Ulceration of Intestines ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 (h) Duodenal Ulcer ... ... ... ... ... ... 1 1 1 1 1 ... ... ... 5 106. Ankylostomiasis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 107. Other Intestinal Parasites ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 108. Appendicitis ... ... 1 l ... 2 2 2 1 8 3 1 1 ... 16 109. (a) Hernia ... ... ... ... ... ... ... 1 1 ... 2 5 4 1 ... 14 (b) Intestinal Obstruction 2 ... 1 3 ... 1 1 3 ... 3 2 3 2 ... 18 110. Other Diseases of the Intestines ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... 2 111. Acute Yellow Atrophy of Liver ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 112. Hydatid of Liver ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 113. (a) Cirrhosis of the Liver (not returned as alclholic) ... ... ... ... ... ... ... ... 4 11 8 ... ... ... ... (b) Cirrhosis of the Liver (returned as alcoholic' ... ... ... ... ... ... ... ... 2 ... ... ... ... ... 2 (c) Diseases formerly classed to " Other Diseases of Liver and Gall Bladder'' ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 114. Biliary Calculi ... ... ... ... ... ... ... ... ... ... 3 2 1 ... 6 115. Other Diseases of the Liver ... ... 1 1 ... ... ... ... 1 l ... 4 ... ... 7 116. Diseases of the Spleen ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 117. Peritonitis (cause unstated) 1 ... 2 3 1 ... 1 ... ... 2 4 ... 1 ... 12 118. Other Diseases of the Digestive System ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 119. Acute Nephritis ... ... ... ... ... ... 1 1 3 6 7 7 1 ... 26 120. Kright.'s Disease ... ... ... ... ... ... 2 1 5 13 20 19 13 12 75 121. Chyluria ... ... ... ... ... ... ... ... ... ... ... ... 9 Diseases of the Kidney aud Annexa ... ... ... ... ... ... ... ... 2 ... ... 1 1 ... 4 123. Calculi of the Urinary Passages ... ... 1 1 ... ... ... ... ... ... ... ... ... ... 1 124. Diseases of the Bladder ... ... ... ... ... ... ... ... ... ... 4 1 ... 5 125. Diseases of the Urethra, Urinary Abscess, &c ... ... ... ... ... ... ... ... ... 1 2 1 ... ... 4 126. Diseases of the Prostate ... ... ... ... ... ... ... ...... ... ... ... 3 3 ... 6 127. Non-Venereal Diseases of Male Genital Organ ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 128. Uterine Hæmorrhage (Non-puerperal) ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 129. Uterine Tumour (Non-cancerous) ... ... ... ... ... ... ... ... ... 2 ... ... ... ... 2 130. Other Diseases of the Uterus ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... 2 131. Ovarian cyst, Tumour (Non-Cancerous) ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... 1 132. Other of the Female Genital Organs ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 133. Non-puerperal Diseases of the Breast (Noncancerous) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 102 Deaths Registered from all Causes for the Year 1913— continued. Cause of Death. 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. 7. L'lie Puerperal State. 134. Accidents of Pregnancy ... ... ... ... ... ... 1 1 ... ... ... ... ... ... 4 13). Puerperal Hæmorrhage ... ... ... ... ... ... ... 1 1 ... ... ... ... ... 2 136. Other Accidents of Childbirth 3 ... ... 3 ... ... ... 3 1 ... ... ... ... ... 7 137. Puerperal Fever ... ... ... ... ... ... 1 1 ... ... ... ... ... ... 2 138. „ Albuminuria and Convulsions ... ... ... ... ... ... ... 2 1 ... ... ... ... ... 3 139. ,, Phlegmasia Alba Dolens, Embolism and sudden death ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 140. ,, Insanity ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 141. ,, Diseases of the Breast ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 8. Diseases of the Skin and of the Cellular Tissue. 142. (a) senile Gangrene ... ... ... ... ... ... ... ... ... ... ... 1 2 1 4 (b) Gangrene (other types) ... ... ... ... ... ... ... ... ... 1 1 ... ... ... 3 143. Carbuncle, Boil ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 144. Phlegmon, Acute Abscess ... ... 1 1 ... ... 1 ... 1 1 ... ... 1 ... 5 145. Diseases of trie Integumentary System ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 9. Diseases of the Bones and of the Organs of Locomotion. 146. Diseases of the Bcnes ... 1 ... 1 ... 2 ... 1 1 1 ... ... ... ... 6 147. Diseases of the Joints ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 148. Amputations ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 149. Other diseases of Locomotor System ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10. Malformations. 150. Congenital Malformations 24 1 ... 25 ... 2 ... ... ... ... ... ... ... ... 27 11. Diseases of Early Infancy. 151. (a) Premature Birth 93 ... ... 93 ... ... ... ... ... ... ... ... ... ... 93 (b) Infatntile Debility, Icterus, and Sclerema 51 4 1 56 ... ... ... ... ... ... ... ... ... ... 56 152. Other Diseases peculiar to early Infancy 14 1 ... 15 ... ... ... ... ... ... ... ... ... ... 15 153. Lack of Care ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 12. Old Aae. 154. (a) Senile Dementia ... ... ... ... ... ... ... ... ... ... 1 3 2 6 (b) Senile Decay ... ... ... ... ... ... ... ... ... 1 ... 40 110 48 199 13. Affections Produced by External Causes. 155 to 163. Suicides ... ... ... ... ... ... 2 4 7 2 8 ... ... ... 23 164. Poisoning by Food ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 165. Other Acute Poisonings 1 ... ... 1 ... ... 1 ... ... ... ... ... ... ... 2 166 Conflagration ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 167. Burns (Conflagration excepted) ... 3 2 5 ... ... ... ... 1 1 ... 3 2 ... 12 168. Absorption of Deleterious Gases (Conflagration excepted) 20 ... ... 20 ... ... 1 ... 1 ... ... ... 1 23 169. Accidental Drowning ... ... ... ... 3 ... ... ... ... 1 ... ... ... ... 4 170 to .76. Injuries ... 2 2 4 5 3 6 7 9 5 9 8 9 10 75 177. Starvation ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 178. Excessive Cold ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 179. Effects of Heat ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 180 Lightning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 181. Electricity (Lightning excepted) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 182 to 184 Homicide 2 1 ... 3 ... 1 ... 2 ... ... ... ... ... ... 6 185 Fractures (cause not specified) 1 ... ... 1 ... 1 ... ... ... ... ... ... ... ... 2 186. Other Violence ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 14. Ill-defined Causes. 187. Dropsy ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 188. (a) Syncope (aged 1 year and under 70) ... ... ... ... ... ... ... ... ... 2 1 ... ... ... 3 (b) Sudden death (not otherwise defined) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 189. (a) Heart Failure (aged 1 year and under 70) ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 (b) Atrophv, Debility, Marasmus (aged 1 year and under 70) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (c) Teething ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... 1 (d) Pyrexia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (e) Other ill-defined Deaths ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... 2 (f ) Cause not specified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 103 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 57 48 53 158 31 10 47 91 117 143 171 125 44 5 942 Diseases of the Nervous System and of the Organs of Special Sense 27 4 11 42 3 7 9 15 32 41 42 36 31 4 262 Diseases of the Circulatory System - - 1 1 6 4 21 17 42 63 79 101 51 13 398 Diseases of the inspiratory System 115 64 30 209 8 2 9 25 45 87 94 187 87 22 725 Diseases of the Digestive System 101 22 16 142 2 4 7 15 17 33 35 25 14 3 297 Non-Venereal Diseases of the Genito-Urinary System and Annexa - 1 1 2 - - 4 3 11 23 29 35 19 2 128 The Puerperal State 3 — — 3 — — 2 8 5 — - - - — 18 Diseases of the Skin and of the Cellular Tissue - - 1 1 - - 2 - 1 3 1 2 3 1 14 Diseases of the Bones and of the Organs of Locomotion - 1 - 1 - 2 - 1 1 1 - 1 - - 7 Malformations 24 1 — 25 — 2 — — — — — — — — 27 Diseases of Early Infancy 158 5 1 164 - - - - - - - - - - 164 Old Age — — — — — — — — — 1 1 43 112 48 205 Affections produced by External Causes 21 6 4 34 8 5 10 13 18 10 17 11 12 10 148 Ill-defined Causes — 1 — 1 — — — 1 — 2 1 3 — - 8 Totals 512 153 118 783 58 36 1ll 189 289 407 470 519 373 108 3343 104 Table No. 4. ST. PANCRAS SANITARY DISTRICT. Showing the number of Deaths at all ages in 1913 from certain groups of Diseases, and the number per 1,000 Population and per 1,000 Deaths from all causes. Divisions. Deaths. Deaths per 1000 of Population at all ages. Deaths per 1000 of Total Deaths at all ages. 1. Principal Zymotic Diseases 257 1.15 76.9 2. Respiratory Diseases 725 3.26 216.9 3. Tubercular Diseases 392 1.76 117.3 Notes. 1. Includes Small-pox, Measles, Scarlet Fever, Diphtheria, Whooping Cough, Typhus, Enteric (or Typhoid) and Simple and Continued Fevers, and Diarrhœa, Enteritis and Dysentery. 2. Includes Laryngitis, Asthma, Emphysema, Bronchitis, Pneumonia, Pleurisy, and other diseases of the Respiratory System. 3. Includes Phthisis, Scrofiila, Tuberculosis, Tabes, and other Tubercular Diseases. 105 Table No. 5.—Showing the Birth rates, Death rates, and Infantile Mortality rates of England and Wales and certain of the large Towns, and of London and the Metropolitan Boroughs for 1913. Population as Estimated by the RegistrarGeneral in the middle of 1913. Birth Rate. Death Rate. Infantile Mortality. Population as Estimated by the RegistrarGeneral in the middle of 1913. Births. Death Bate. (Crude) Infantile Mortality. England and Wales 36,919,839 23.9 13.4 109 County of London 5,518,191 24.5 14.02 105 Birmingham 859,644 27.4 14.6 129 west. Liverpool 756,553 29.9 18.0 131 Paddington 142,210 21.1 13.4 100 Manchester 730,976 26.3 15.3 127 Kensington Hammersmith 171,284 123,745 19.3 21.2 13.7 13.9 112 103 Sheffield 471,662 28.3 15.7 128 Fulham 157,117 26.9 12.5 96 Leeds 457,295 23.6 15.3 133 Chelsea 64,598 19.1 13.9 90 Bristol 361,362 22.5 12.6 96 City of Westminster 154,810 14.2 12.7 96 West Ham 294,223 30.9 14.5 107 north. Bradford 290.540 19.6 14.9 127 St. Marylebone 114,532 19.1 14.0 91 Hull 287,032 28.0 14.7 128 Hampstead 86,346 15.1 10.7 73 St. Pancras 214,330 25.3 15.2 92 Mewcastle-on-Tyne 271,295 27.1 15.0 121 Islington 325,585 25.3 15.1 107 Nottingham 264,735 22.8 11.1 130 Stoke Newington 50,518 22.3 13.6 S2 Portsmouth 241,256 24.6 12.2 90 Hackney 223,353 24.3 13.4 99 Stoke-on-Trent 239,284 31.5 18.7 169 central. Salford 233,849 26.8 15.7 136 Holborn 46,949 16.7 14.6 101 Leicester 230,970 21.8 13.2 119 Finsbury 84,679 29.6 18.3 138 Cardiff 186,554 26.0 13.3 115 City of London 17,016 9.2 15.2 96 Bolton 183,879 21.6 15.6 144 east. Shoreditch 109,654 31.5 18.6 155 Croydon 178,094 22.0 11.4 94 Bethnal Green 127,824 30.8 15.4 118 Willesden 163,655 23.9 10.0 83 Stepney 275,300 29.3 14.9 1)2 Rhondda 162,137 33.3 14.0 139 Poplar 160,913 32.0 16.3 112 Sunderland 152,377 30.9 17.8 134 south. Oldham 149,936 23.2 16.8 139 Southwark 188,487 31.0 17.4 115 Tottenham 145,736 25.7 10.9 89 Bermondsey 124,739 30.7 17.9 132 Lembeth 297,139 23.9 14.3 102 East Ham 142,467 25.0 10.0 64 Batersea 167,464 24.9 13.9 111 Birkenhead 135,557 28.9 14.3 115 Wandsworth 330,395 20.4 10.6 88 Blackburn 333,971 21.8 15.5 117 Camberwell 261,805 25.1 13.7 106 Brighton 133,096 18.0 13.3 117 Deptford 109,280 27.9 15.3 112 Walthamstow 131,636 24.0 9.8 80 Greenwich 96,015 26.0 14.2 103 Leyton 130,922 22.4 10.0 83 Lewisham 168,822 20.5 10.6 78 Derby 125,462 23.7 12.4 100 Woolwich 122,382 23.3 12.6 79 106 Table No. 6. Registration SubDistricts. Number of Inmates. St. Pancras Institutions. No. of Beds. Daily Average No. of Inmates Deaths. Births. Parishioners NonParisli ioners. Total. St. Pancras: West 112 St. Saviour's Hospital for Ladies of Limited Means 27 15 - 3 3 - London Temperance Hospital 100 86 92 45 137 — Homes of Hope 18 11 - — — 30 Infirmary Cleveland Street 267 247 1 127 128 - University College Hospital 305 278 112 233 345 157 Home Hospitals 20 6 — 15 15 - Medical Surgical and Nursing Homes 8 7 - 3 3 - Metropolitan Throat and Ear Hospital 13 4 - 2 2 - South 722 London Skin Hospital 0 0 — — - - Oxygen Home 0 0 — — — — Central London Ophthalmic Hospital 26 17 - — — - Central London Throat and Ear Hospital 30 24 1 19 20 - Royal Eree Hospital 165 139 37 146 183 2 Mount Vernon Hospital (O.P.D.) No Beds - - - - New Hospital for Women 66 58 4 21 25 5 East 1685 St Pancras House 1583 1306 96 9 105 87 Infirmary (South) 400 321 346 15 361 — North West London Hospital O.P.D. of Hampstead Gen. Hos. No Beds 3 — 3 — North 597 St. Margaret's Home 60 39 - - - - Infirmary (North) 542 558 365 12 377 - Totals in Institutions within the Borough 3630 3116 1057 650 1707 281 ,, „ without the Borough — 2403 611 — 611 438 Totals 3630 5519 1668 650 2318 719 107 Table No. 7. METEOROLOGICAL TABLE FOR SAINT PANCRAS, 1913. (Extracted from the Monthly Returns of the Meterological Office.) Deduced from Observations at Camden Square, n.w., under the Superintendence of H. Robert Mill, D.S.C., L .L.d. January. February. March. April. May. June. July. August. September. October. November. December. Barometer. Mean Pressure at 32° F. at Station Level* (Bar 123 ft. above M.S.L.) 29.686 30.064 29.760 29.742 29.790 29.975 29.941 29.950 29.852 29.761 29.800 29.990 Aii- Temperature. Mean of Maximum A. 46.1 46.9 52.1 56.6 67.8 72.3 70.3 7.22 69.0 61.5 54.3 46.2 Minimum B. 36.4 35.4 38.1 40.2 46.9 51.2 52.5 53.2 51.3 47.2 41.3 37.4 Mean of A. and B. 41.3 41.2 45.1 48.4 57.4 61.8 61.4 62.7 60.2 54.4 47.8 41.8 Difference from Average† +2.7 + 1.2 +2.1 —0.1 +3.1 +0.9 —3.0 —0.6 + 1.7 +4.3 + 3.9 + 2.3 Humidity—Morning 93 87 82 75 70 67 77 74 85 89 90 87 Earth Temperature at 4 ft. depth 45.1 43.5 43.4 44.8 49.1 55.2 57.4 58.0 57.4 55.0 51.4 48.1 Bright Sunshine. Total Observed (Daily mean) Hours 0.80 1.59 2.52 3.74 6.10 6.66 3.25 4.53 3.71 2.51 1.82 1.02 Per cent. of total possible 10 16 21 27 39 41 20 32 30 24 21 13 Difference from Average† Hours — — - — — — — — — — — — Rain and other forms of Precipitation. Number of Days 17 12 21 21 11 7 12 11 11 15 17 8 Total Fall Inches 2.57 0.79 2.29 2.72 1.72 0.58 2.31 1.43 1.75 3.11 2.35 0.79 Difference from Average ,, + 0.70 + 0.84 +0.83 + 1.04 —0.03 —1.71 —0.26 -0.96 —0.42 +0.37 —0.01 —1.26 *The hours of observation are 9 a.m. and 9 p.m., local time. †The averages used are obtained from observations extending over 35 years for Rainfall and Temperature and 25 years for Sunshine. 108 Table No. 8. Inspections made by District Inspectors and DUTIES AND PREMISES. N. 1. Highgate. N. 2. St. John's Park. N. 3. Gospel Oak. N. 4. Gratton. N. 5. Maitland Park. Infectious Diseases—Inquiry, removal, disinfection, etc 93 103 93 116 i 128 Subsequent sanitaryinspection, etc. 49 53 66 72 74 Complaints 61 99 109 119 141 Drainage—Under notice. Plans, supervision, etc. 5 27 29 7 18 Voluntary 23 43 29 17 22 New Buildings 16 13 16 3 .. Yards of Mews and Stables 310 89 212 164 291 House-to-House Inspections — Housing, Town Planning, etc., Act, 1909 17(1)- First Inspections . 177 20 44 52 46 Subsequent routine Inspections .. .. .. .. .. Inspections of registered tenement houses other than above 354 9 6 100 3 Other house-to house Inspections 41 .. 2 .. 2 Visits to closed underground rooms .. .. 1 .. •• Smoke Shafts observed .. .. 19 77 10 Factories .. .. 1 3 •• Workshops .. •• •• 2 1 Workplaces .. .. .. 12 1 Bakehouses 10 11 14 18 15 Restaurant Kitchens .. .. .. 3 1 Regulated Trades. Offensive Trades .. .. .. .. .. Rag and Bone dealers •• .. • • 18 3 Fried fish endors .. 5 3 17 28 Fish curers .. .. .. .. .. Other effluvia businesses .. .. .. .. .. Inspections of Market Streets 4 3 7 8 7 Other Duties .. .. 2 5 3 Totals 1143 699 653 813 794 109 Women Inspectors during the Year 1913. E. I. Bartholomew. E. 2. Camden Square. E. 3. College. E. 4, Oakley Square. E.5. Ossulston. W. I. Cabtle. W . 2. Chalk Farm. W . 3. Mornington. W. 4. Regent's Park. W.5. Euston. S. 1. Argyle. S. 2. Mecklenburgh. S. 3. Burton. S. 4. Endsleigh. S. 5. Whitfield. Whole Borough Women. Total for Whole Borough. M.E.B C. I. and Visitors. Miss Giles. 54 62 65 53 44 103 94 113 93 73 68 85 50 37 58 .. .. .. 1590 54 46 48 48 26 79 55 83 74 63 37 33 25 17 55 .. .. .. 1057 25 89 108 193 179 182 150 230 199 147 158 131 165 112 160 .. .. .. 2857 63 47 47 10 14 33 19 22 19 12 5 7 6 11 14 .. .. .. 415 40 11 22 12 21 37 52 31 45 89 25 52 29 17 19 .. .. .. 636 6 .. 3 3 •• •• 4 8 15 .. 6 5 12 7 3 .. .. .. 120 87 45 81 24 369 137 247 167 260 334 103 325 378 259 533 .. .. .. 4615 2 1 4 277 106 42 14 8 31 161 47 57 211 .. 245 .. .. .. 1545 .. .. .. .. .. .. .. .. .. .. .. .. 26 .. .. .. .. .. 26 .. 20 .. 122 375 8 .. 59 22 85 107 16 92 173 138 .. .. .. 1689 .. .. .. .. .. .. .. .. .. .. 9 •• 11 .. .. .. .. .. 5 .. .. .. .. .. .. .. .. .. .. .. .. 8 .. .. .. .. .. 9 .. 1 4 .. 94 3 2 5 1 151 .. 5 58 44 47 .. .. .. 550 .. .. 3 .. .. 2 2 .. .. 1 .. .. .. .. .. .. .. .. 12 .. .. .. .. .. 1 2 2 .. 6 .. 6 5 2 .. 13 .. .. 40 .. .. .. .. .. .. 1 .. .. 4 .. .. 4 .. 1 2 .. .. 25 .. 1 .. 6 12 21 15 14 15 17 11 27 12 4 24 .. .. .. 249 .. .. .. .. .. .. .. .. .. .. 1 3 2 13 118 .. .. .. 141 .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 .. .. .. 2 .. .. .. .. 2 5 5 .. .. .. 1 •• 6 7 .. .. .. .. 47 .. .. .. .. 7 .. .. .. 3 3 1 .. 14 .. 13 .. .. .. 94 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 8 2 .. 44 7 23 6 13 46 9 18 10 52 38 .. .. .. 307 4 1 .. 162 56 1 3 .. .. 4 •• 2 24 14 2 877 1753 1935 4848 444 332 387 910 1349 661 688 748 790 1201 588 772 1148 769 1470 892 1753 1935 20939 Table No. 9. Re-Inspections after Intimations made by the District DUTIES AND PREMISES. N. 1. Highgate. N. 2. St. John's Park. N. 3. Gospel Oak. N. 4. Grafton. N. 5. Maitland Park. Infectious Diseases—Inquiry, removal, disinfection, etc. 14 17 9 6 13 Subsequent sanitary inspection, etc. 1 171 227 87 109 Complaints 365 291 472 330 359 Drainage—Under notice. Mans, Supervision, etc. 171 398 451 101 275 Voluntary 156 399 187 140 196 New Buildings 518 30 .. 107 29 Yards of Mews and Stables .. .. .. .. .. House-to-Housf. Inspections— Housing, Town-Manning, etc., Act, 1909: 17 (1). First Inspections 370 78 158 218 155 Subsequent routine Inspections .. .. .. .. .. Inspections of registered tenement houses other than above 592 .. 4 233 •• Other house-to-house inspections 3 .. .. .. .. Visits to closed underground rooms .. .. .. .. .. Smoke Shafts observed .. 9 1 •• .. Factories .. .. .. 6 .. Workshops .. .. .. .. 1 Workplaces .. .. .. 5 .. Bakehouses 6 15 13 24 15 Restaurant Kitchens .. .. .. .. .. Regulated Trades Offensive Trades .. .. .. .. .. Rag and Bone dealers .. .. .. .. .. Fried fish vendors .. .. .. 2 5 Fish curers .. .. .. .. .. Other effluvia businesses .. .. .. .. .. Inspections of Market Streets .. .. .. .. .. Other Duties .. .. 3 .. .. Totals 2197 1408 1525 1259 1157 110 1ll Inspectors and Women Inspectors during the Year 1913. E. I. Bartholomew. E. 2. Cam Jen Square. E.3. College. E. 4. Oakley Square. E. 5. Ossulston. W. 1. Castle. W. 2. Chalk Farm. w. 3. Mornington. W. 4. Regent's Park. W. 5. Euston. S. 1. Argyle. S. 2. Mecklenburgh. S. 3. Burton. S. 4. Endsleigh. S. 5. Whitfield. Whole Borough Women. Total for Whole Borough. M.E.B. C. L and Visitors. Miss Giles 4 6 6 14 9 15 15 15 5 21 1 7 5 15 28 .. .. .. 225 27 21 24 40 133 70 39 154 203 118 5 .. 49 14 41 .. .. .. 1533 156 I24 109 269 685 445 456 250 282 494 446 330 339 374 471 .. .. .. 7047 393 227 264 124 128 510 295 214 252 135 165 123 121 126 375 .. .. .. 4848 172 77 65 73 138 275 422 154 250 948 145 525 321 254 134 .. .. .. 5031 60 6 40 81 •• .. 40 1 2 .. 11 65 354 281 126 .. .. .. 1751 •• 5 .. 6 .. 71 20 29 .. 106 .. .. .. .. .. .. .. .. 237 .. .. 11 383 300 33 20 .. 34 574 14O 119 620 .. 449 .. .. .. 3663 .. .. .. .. .. .. .. .. .. .. .. .. 5 .. .. .. .. .. 5 .. 31 .. 70 604 12 .. .. .. 188 407 41 619 356 95 .. .. .. 3663 .. .. .. .. 4 .. .. .. .. .. .. .. 3 .. 2 .. .. .. 5 .. .. .. .. .. .. .. .. .. .. .. .. 10 .. 13 .. .. .. 3252 .. .. .. .. .. .. .. 1 .. .. .. .. 32 .. 23 .. .. •• 66 .. .. 2 .. .. 13 2 .. .. .. .. .. 1 .. 7 .. .. .. 31 .. .. .. .. .. 10 6 1 1 2 .. .. 13 9 51 .. .. .. 94 .. .. .. .. .. .. 1 .. •• 2 .. .. 3 7 15 .. .. .. 33 .. .. .. 6 34 12 10 .. 2 23 11 17 11 5 51 .. .. .. 255 .. .. .. .. .. .. .. .. .. .. .. .. .. 10 69 .. .. .. 79 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. •• .. .. .. .. .. 2 .. .. .. .. .. .. .. .. .. .. .. .. 2 .. .. .. .. .. .. .. .. .. .. .. .. 7 .. .. .. .. •• 14 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. •• .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 3 .. .. .. .. .. .. .. 2 .. 2 .. 68 167 150 395 812 497 521 1069 2035 1468 1326 819 1031 2611 1331 1229 2513 1453 1950 68 167 150 28596 Inspection and Re-Insections and other work of the Special Inspectors during 1913. DUTIES AND PREMISES. Visits and Inspections. Re-Inspections after Intimation Notices, E. 3 & 4. Inspector Auger. N. & E. 1, 3, 5. Inspector Child. W. & S. Inspector Osborne Totals. E. 3 & 4. Inspector Auger. n. & E. 1, 2, Inspector Child, w. & s. Inspector Osborne Totals, Milkshops 136 587 510 1239 1 .. .. 1 Dairies 5 l6 .. 21 .. .. .. .. Cowsheds 21 41 22 84 .. .. .. .. Other Premises of Milk Purveyors 1 24 .. 25 .. .. .. .. Margarine Factories .. .. .. .. .. .. .. .. Butter Factories .. .. .. .. .. .. .. .. Ice Cream Piemi-es 7 182 100 289 .. .. .. .. Slaughter Houses 66 224 258 548 .. .. .. .. Premises where Prepared Meats are made (sausages, pies, tripe, cooked meat, &c.) 11 272 401 684 .. .. .. .. Butchers' Shops 3 89 65 157 .. .. .. .. Fishmongers' Shops 36 58 23 i117 .. .. .. .. Marketing Places 579 1705 2 129 4413 .. .. .. .. Other Piemises where Food or Drugs are sold .. .. .. .. .. .. .. .. Other Visits 61 156 158 375 .. .. .. Total 926 3354 3672 7952 1 .. .. .. SAMPLES, &c., TAKEN. Formal Samples. Informal Samples. No. of Milk samples 56 170 109 395 .. .. .. .. ,, Cream samples .. 8 1 9 .. .. .. .. ,, Butter and Margarine samples 19 80 94 198 .. 4 .. 4 ,, Other samples (specified below)— Lard 4 10 5 19 .. .. .. .. Cheese 1 2 .. 3 .. .. .. .. Coffee 1 14 11 26 .. .. .. .. Rice 4 .. .. 4 .. .. .. .. Demerara Sugar 1 4 2 7 .. .. .. .. Camphorated Oil .. 5 8 13 .. .. .. .. Glycerine .. .. 8 8 .. .. .. .. Arrowroot 1 .. .. 1 .. .. .. .. Mustard 5 6 9 20 .. .. .. .. Oatmeal 1 2 3 6 .. .. .. .. Flower of Sulphur .. 4 2 6 .. .. .. .. Seidletz Powders .. 3 .. 3 .. .. .. .. Pepper 5 6 10 21 .. .. .. .. Jam 2 3 3 8 .. .. .. .. Vinegar .. 3 .. 3 .. .. .. .. Cod Liver Oil .. 5 .. 5 .. .. .. .. Liver .. .. .. .. .. 1 .. 1 Total 100 325 325 750 .. 5 .. 5 Samples taken under the Rag Flock Act .. 2 8 10 .. .. .. .. No, of surrenders of Meat .. 9 1 10 .. .. .. .. Fish 6 2 4 12 .. .. .. .. ,, ,, Shellfish .. .. .. .. .. .. .. .. ..,, ,,Other Foods (specified below")— Fowls .. .. .. 1 .. .. .. .. Condensed Milk .. .. 1 1 .. .. .. .. Tomatoes .. .. 2 2 .. .. .. .. Yeast .. 1 .. 1 .. .. .. .. Fruit .. 3 .. 3 .. .. .. .. Potatoes .. 1 .. 1 .. .. .. .. Rabbits .. 1 1 .. .. .. .. Total 7 16 9 32 .. .. .. .. No. of Seizures— Meat .. 2 •• 2 .. .. .. .. Fruit .. 1 1 2 .. .. .. .. Total .. 3 1 4 .. .. .. .. Inspections of Registered Canal Boats .. .. 69 69 .. .. .. .. Table No. 10 112 113 Table No. 11. Total Number of Inspections and Re-Inspections mad'e by individual Inspectors during the year 1913. Inspector. Area. Inspections. Re-inspections Total. 1. Mr. Rackham N.1 1137 2190 3327 2. „ Brown N. 2, 3 1379 2924 4303 3. ,, Thompson N. 4, 5 1567 2393 3960 4. „ *Johnston E. 1, 2, 3 318 415 733 „ Dillon (from 3rd Oct., 1913) ,, 318 681 999 5. „ Auger E. 4 1072 1442 2514 6. „ James E. 5 1376 2076 3452 7. „ West W. 1, 2 1336 2792 4128 8. „ Lonnon W. 3, 4 1590 1848 3438 9. ,, Adltins W.5 1226 2615 3841 10. ,, Holmes S. 1, 2 1258 2505 3763 11. „ Walker S. 3 1270 2576 3846 12. „ Dillon (to 2nd Oct., 1913) S. 4 994 1553 2547 „ Akers (from 18th Dec., 1913) ,, 31 37 68 13. „ Landen S. 5 1551 2164 3715 14. „ Auger Food and Food premises E. 3, 4 1011 1 1012 15. „ Child N. 1, 2, 3, 4, 5 E. 1, 2, 5 3782 — 3782 16. „ Osborne W. & S. 3965 — 3965 17. Miss Bibby Women Whole Borough 892 68 960 18. „ Smith ,, 1753 167 1920 19. „ Giles (Temporary Woman) ,, 1935 150 2085 Totals - 29761 28597 58358 * Inspector Johnston died on the 3rd October, 1913. Inspector Akers commenced his duties on 18th December, 1913. 114 Table No. 12. Intimations as to Nuisances served by the Sanitary Inspectors daring 1913. A Schedule of Nuisances. Districts and Inspectors. N. 1. G. R. N. 2 & 3 W. L. B. N. 4 & 5. B.H. T. E. 1 2 & 3. C.H. J. &E. J. D. W. 1 & 2. H. G. W. VV. 3 & 4. J. I. L. w. 5. G. W. A. E. 5. R. E. ,T. S. 4 R. C. A. S. 5. J. L, S. 3. A. H. W. S. 1 & 2. E. G. H. Food Inspectors. Whole Borough Women. Totals. E. 4 & part of Wd.3. W.G.A. N. & E. H. K. C. w. & s. J. 0. M. E. B c. s. & Visitors. 1 Part of the house in a dirty condition 7 39 56 64 77 77 77 32 19 29 29 59 8 - - 2 - 575 2 ,, damp ,, 24 11 18 14 12 9 3 30 — 8 10 7 12 - — — — 158 3 Roof defective 13 25 15 16 29 13 11 19 9 9 44 30 9 - — 2 — 244 4 Guttering defective 7 5 2 4 9 — 1 3 2 4 1 4 1 - — — — 43 5 Water fittings defective 12 19 33 3 14 4 6 7 — 10 4 8 12 - — — — 132 6 Water-closet apartment with absence of external ventilation 1 1 4 4 8 11 10 1 — 8 5 7 5 - — — — 65 7 ,, ,, so foul as to be a nuisance or dangerous to health 1 — — 3 6 6 15 1 1 14 2 3 — - - - - 52 8 Water-closet basin foul 1 4 17 2 18 16 13 13 3 23 3 13 3 - — — — 129 9 ,, ,, defective 3 6 5 15 16 13 5 7 3 10 11 6 — - — — — 100 10 ,, ,, choked 7 18 17 3 11 11 12 8 — 10 8 20 32 - — — — 157 11 Urinal in a foul condition — — 2 — 4 1 - — — 4 — — — - — — — 11 11 Privy in a foul condition — — — 1 - — - — — — — — — - — — — 1 13 Soil pipe defective 7 3 1 7 3 2 3 — — 5 1 3 - - - - - 35 14 ,, unventilated 6 7 4 3 11 3 — — — — — 3 1 - — — — 38 15 ,, improperly ventilated 1 4 — 3 — 3 — — — — 1 - - - - - - 12 16 Absence of waste pipe to sink, lavatory or bath — 3 - - - - - - - - 1 - - - - - - 7 17 Waste pipe of sink, lavatory, or bath connected with drain 1 — — — 3 — 1 — 1 5 5 2 2 — — — 20 18 ,, ,, ,, ,, defective 4 8 10 2 9 4 9 2 1 5 3 11 2 - — — — 70 19 „ ,, ,, ,, foul 2 5 2 1 4 4 1 1 1 1 6 8 1 - — — 37 20 Inlet of drain improperly trapped — 1 — 3 5 2 — 2 1 — 2 2 - - - - - 18 21 Drain defective 12 30 25 41 62 29 9 13 1 18 6 28 19 - — — — 299 21 ,, stopped 4 9 14 10 19 10 15 8 5 1 14 18 19 - — — — 146 23 ,, ventilating pipe defective 5 - 3 — 10 5 1 2 1 — 1 9 2 - — — — 39 24 Rain-water pipe in direct communication with drain 3 3 6 5 5 — 2 — 1 1 1 — 1 - — - — 28 25 ,, ,, defective 1 7 10 3 12 15 11 7 2 10 5 5 4 - — — — 92 20 Unpaved condition of roadway - - - - - - - - - - - - - - - - - 1 27 Undrained ,, ,, - - - - 1 - - - - - - - - - - - - 2 28 Area or part unpaved - - - - 1 - 8 - - - - - 2 - - - - 11 29 ,, undrained - - - - - - - - - - - - - - - - - 30 Yard or space unpaved - 3 4 — - — 1 1 1 — 4 1 — — — — 15 31 ,, ,, undrained - 1 1 1 - - - - - - 1 - - - - - - 4 32 Defective condition of washhouse paving 6 8 11 7 12 16 21 10 — — 8 8 8 - — — — 115 33 Dast-bia defective 5 19 29 18 51 18 20 41 2 16 17 22 10 - — 1 — 269 34 ,, in an improper position - - - 1 - 1 - - - 1 — — — - — — — 3 35 Accumulation of stagnant water which is a nuisance dangerous to health - 1 - 2 7 2 - 1 1 6 4 — 2 - — - — 26 36 Accumulation or deposit which is a nuisance dangerous to health 3 7 9 7 20 21 47 7 3 35 13 12 14 - — 1 — 199 37 Animals kept in such a manner as to be a nuisance dangerous to health - 2 9 - 2 - 13 - - 1 — — 2 - — — — 29 33 Part of the house so overcrowded as to be dangerous to health — 7 11 — 7 2 40 2 - 8 1 9 - - — — — 87 39 Space below floor in basement or ground floor insufficiently ventilated 4 2 19 3 - 2 - 1 2 1 - 1 2 - - - - 35 40 Issuing of black smoke in such a quantity as to be a nuisance 41 Discharging sracke in such a manner as to cause part of a building to be a nuisance dangerous to health - - - 2 - - - - 1 - 1 - - - - - - 4 42 Tent, van, shed, or similar structure used as a human habitation which is in such a state as to be injurious or dangerous to the health of the inmates - - - - - - - - - - - - - - - - - - 43 Other nuisances 21 16 13 20 40 7 31 11 4 2 11 10 4 - — — — 196 Totals 161 283 350 268 491 307 386 231 60 249 223 310 177 — - 6 — 3511 115 Table No. 13. Intimations as to Breaches of Statutes and Statutory By-laws served by the Sanitary Inspectors during 1913. B Breaches of Statutes and Statutory By-laws. Districts and Inspectors. N. 1. G. r. N. 2 & 3. w. l. B. n. 4 & 5. b. h. t. e. 1, 2 & 3. C. h. j. & e. j. d. w. 1 &2. h. g. w. w. 3 & 4 j. i. l. w. 5. g. w. a. e. 5. r. e. j. s. 4. e. j. D. a r.c. a. s. 5. J. L. s 3. a. h. w. s. 1 & 2. e. g. h. Food Inspectors. Whole Borough. Women. Totals. E. l& part of Wd.3. W.G. A.i n. & e. h. e. C. W. & S. j.O. m. e. b. c. s. & Visitors. 1 An occupied house without a proper and sufficient supply of water 13 12 17 1 25 28 89 58 1 41 15 57 7 - - - - 364 2 Water supply used for domestic purposes connected with cistern which is used for flushing the water-closet - 1 - - - - - - - - - - - - - - - 1 3 Water-closet not supplied with a sufficient quantity of water for securing its effective action 8 13 7 16 14 32 25 8 3 10 7 22 23 - - - - 188 4 Tank, cistern, or other receptacle for storing of water used or likely to be used by man for drinking purposes—dirty condition of 2 5 3 2 11 12 13 7 - 16 3 7 5 - - - - 86 5 Tank, cistern, or other receptacle for storing water used or likely to be used by man for drinking purposes—absence of a proper cover to 3 4 1 1 9 5 12 6 - 19 4 7 7 - - - - 78 6 Tank, cistern, or other recsptacle for storing water used or likely to be used by man for drinking purposes placed in an improper position 3 - 1 - - - - - - - - - - - - - - 4 7 Animals so kept as to be likely to pollute the water supply — — — — - — — — — — — — — - - - - - 8 Offensive matters not deposited in manure receptacle — 1 — — - — — — — — — — — - - - — 1 9 Manure not removed at proper intervals — 1 1 - - - - - - - - 3 - - - - - 5 10 Manure—absence of proper receptacle for — — — — 1 — 1 — — 7 4 4 4 — — - - 21 11 Manure receptacle not properly constructed — — 2 — — — — — — 1 — — - - - - 3 12 Sufficient drain to stables or cowshed—absence of a - — — — — — — — — — — — - - - - - 13 Receptacle for house refuse— absence of a proper 26 40 14 12 9 55 16 8 4 25 10 29 51 - 1 - 300 14 Receptacle for house refuse—absence of a proper cover for — - 1 — 6 8 3 — — 4 — — — - — - - 22 15 Yard or open space unpaved 102 — 10 — — — — 1 — — — — — — — - — 113 10 ,, paving defective 23 23 34 13 26 16 37 23 1 6 24 29 9 — — - — 264 17 Insuffcient water-closet accommodation to " lodging house " 2 9 5 3 2 7 8 7 2 5 6 10 - - - - - 66 18 A furnace improperly constructed or negligently used - - - - - - - - - - - - - - - - - — 19 Effluvia arising from premises used for trade, business, or manufacture which is a nuisance dangerous to the inhabitants of the district — - - - - - - - - - - - - - - - - - 20 Offensive matters suffered to run out of trade premises into an uncovered place - - - - - - - - - - - - - - - - - - 21 Dairies and cowsheds—breach of By-laws as to — - - - - - - - - - - - 1 - - - - 1 22 Slaughterhouses—breach of By-laws as to — - - - - - - - - - - - - - - - - - 23 Steam whistle—use of a, without authority — - - - - - - - - - - - - - - - - - 24 Parts of houses infested with vermin requiring stripping, purifying, and cleansing 13 2 21 55 — 17 31 7 10 28 14 47 - — - — 252 25 Articles in an unwholesome condition requiring to be purified or destroyed — — — — — — — — — — — — 1 - — - — 1 26 Underground room illegally occupied as a dwelling — — — 5 — — 14 16 — 1 9 17 3 - — - - 65 27 Other breaches 7 3 6 7 8 23 16 1 3 2 2 9 — 1 — — — 88 Totals 202 114 123 67 166 186 251 166 21 146 113 208 153 1 - 1 — 1923 116 Table No. 14. Intimations as to Broaches of By-lam and Breaches of Statutes served by the Sanitary Inspectors during 1913. C Registered Tenement IIouse3—Breaches of By-Laws. Districts and Inspectors. n. 1. g. k. n. 2 & 3. w. l. b. n. 4 & 5. b. h. t. E. 1, 2 & 3. c. H. J & E. J. D. W. 1 & 2. H. g. W. w. a & 4. j. I. l. w. 5. g. w. a. E. 5. E. E. j. S. 4. E. J. D. & R. C. a. s. 5. j. l. S. 3. A. H. W. S. 1 & 2. f. g. r. Food Inspectors. Whole Borough. Women. Totals. E. 4 &' part of Wd. 3. W.G. A. n.«e. H. R. c. W. & s. J. O. M. E b. O. S. & VisitorS.. 1 Overcrowding - - 2 - - - 14 1 1 - 5 9 3 - - - - 35 2 Inadequate water supply - - - - - - - - - 4 - - - - - — - 4 3 Contaminated water supply - - - - - - - - - - - - - - - - - - 4 Foul closet, basin or trap - - 6 1 - — 1 1 3 2 3 2 - — — 19 5 Want of means of ventilation - - - - - - - - - - - - - - - - - - 6 Want of annual cleansing — - — 2 2 - — — — 69 — 2 — - — - — 75 7 Want of cleansing of the part or parts of premises used in common 10 27 62 4 7 - 29 58 16 25 102 76 33 - — - - 449 8 ,, ,, in sole use 68 33 39 1 7 - 16 62 2 22 96 57 45 - — - - 448 9 Want of cleansing of the room or part of the dwelling — — — 9 — - 2 — 18 24 1 — 4 - — - — 58 10 Animals improperly kept - - - - - - - - - - - 1 - - - - - 1 11 Other breaches 4 — — 2 — — — — — — — 1 — — — - — 7 Totals 82 60 109 18 17 — 61 122 38 147 206 149 87 — — — — 1096 Table No. 15. D Factories, Workshops and Work Places—Breaches of Statutes. Districts and Inspectors. N. J. g. r. n . z & 2. W. L. B. N. 4 & 5. B. H. T. E. 1, 2 & 3. C. H. J. & E. J. D. W. 1 & 2. H. g. W. W. 3 & 4. J. I L. W. 5. G. W. A. E. 5. R. E. J. S. 4. E..J. D. & R. C. A. S. 5. J. L. S. 3. A. H. W. S. 1 & 2. E. G. H. Food Inspectors. Whole Borough. Women. Totals. E. 4 & part of Wd. 3.W.G.A. n. & e H. R. C. w. & S. j. O. M. E. B. C. S. & V Visitors. - - 2 - 2 1 8 1 - 54 7 3 2 - - 5 - 85 2 Want of ventilation — — 1 - - - 1 - - - - - - - - - - 2 3 Want of air space, overcrowding - - - - - - - - - — — — — - — - - — 4 Sanitary accommodation, absent or insufficient 1 — — - 1 - - - - 3 1 — — — — - - 6 5 ,, unsuitable or defective — — — - - 2 3 - - 1 1 — — - — 1 - 8 6 ,. not separate for sexes - - - - - - - - - 3 - 1 - - - 1 — 4 7 Want of drainage of floors - - - - - - - - - - - - - - - - - 2 8 Other nuisances - - 2 - - - 1 - - 1 - - - - - - - 4 9 Illegal occupation of underground bakehouse - - - - - - - - - - - - - - - - - - 10 Breach of special sanitary requirements for bakehouses — — 14 — 3 — — — - — — 5 7 — — - - 29 11 Failure as regards list of outworkers - - - - - - - - - - - - - - - - - - 12 Giving out work to be done in premises which are unwholesome - - - - - - - - - - - - - - - - - - 13 ,, ,, ,, infected - - - - - - - - - - - - - - - - - - 14 Allowing wearing apparel to be made in premises infected by scarlet fever or small-pox - - - - - - - - - - - - - - - - - - 15 Other contraventions - - - 1 - - - - - - - - - - - - - 2 Totals 1 — 19 2 6 3 13 1 — 62 9 10 9 — — 7 - 142 117 NEW LEGISLATION. In former annual reports an account of new public health legislation has been given each year. That of 1913 is given below General Acts. Public Health (Prevention ancl Treatment of Disease) Act, 1913. '2. The Local Government Board shall have power to declare that one of the of the authorities to execute and enforce regulations made by the Board under section one hundred and thirty of the Public Health Act, 1875, with a view to the treatment of persons affected with cholera or any other epidemic, endenic, or infectious disease, and preventing the spread of cholera and such other diseases, shall be the council of a county, and that section shall have effect accordingly as if a county council were an authority within the meaning of that section : Provided that, except in case of emergency, the Local Government Board shall not require the council of a county to execute and enforce any such regulations- without the consent of such council. 8. It shall be lawful for the council of any county or for any sanitary authority to make any such arrangements as may be sanctioned by the Local Government Board for the treatment of tuberculosis: Provided that the power conferred by this section shall be in addition to and not in derogation of any other power. 4. Any expenses incurred under this Act shall, in the case of a sanitary authority, be defrayed as part of the expenses incurred by them in the execution of the Public Health Acts, and in the case of a county council as expenses for general county purposes, or, if the Local Government Board by order so direct, as expenses for special county purposes charged on such part of the county as may be provided by the order. 5. This Act may be cited as the Public Health (Prevention and Treatment of Disease) Act, 1913. National Insurance Act, 1913. This is an Act amending and extending the existing law as to National Insurance. The following sections deal with sickness and public health:— Sees. 10 to 14 deal with medical, sickness and maternity benefits. ,, 32 and 33 deal with medical benefits. 39. Notwithstanding anything in any Act, it shall be lawful for the managers of the Metropolitan Asylums district, with the sanction of the Local Government Board, to enter into agreements with any county council or county borough council or, with the consent of the county council, with any authority in a county for the reception of insured persons and their dependants suffering from tuberculosis or any such other disease as the Local Government Board, with the approval of the Treasury, may appoint under section eight of the principal Act, into hospitals or sanatoria provided by the managers, and for this purpose the managers shall not be deemed to be a poor law authority. Any such agreements may provide that the cost of the treatment of the patients so received, or some part thereof, shall be borne otherwise than as provided by section eighty of the Public Health (London) Act, 1891. 118 Local Acts. London County Council (General Powers) Act, 1913. 15. The Council on the one hand and the managers of the Metropolitan Asylums district the Port of London Authority the metropolitan borough councils and boards of guardians of poor law unions within or adjoining the administrative county of London or any of such authorities on the other hand may enter into and carry into effect agreements for the working and use by the Council or any of such authorities for the purposes of the ambulance service authorised by the Metropolitan Ambulances Act 1909 of ambulances lands premises and appliances used by the Council or any of such authorities in connexion with ambulance services provided by them for purposes other than those of the said Act and for for utilising for the purposes of the ambulance service authorised by the said Act the services of any persons employed by the Council or any of such authorities. Orders. The Tuberculosis Order, 1913, of the Board of Agriculture and Fisheries is administered by the London County Council. It deals with the notice, notification, inspection, examination, detention and isolation of bovine animals suffering from tuberculosis, indinatin, or other chronic disease of the udder, or from tuberculosis with emaciation. It also provides for the slaughter of bovine animals giving tuberculous milk, or suffering from tuberculosis of the udder or tuberculosis with emaciation, and lays down rules for the compensation of the owners of such animals. Sec. 9 prohibits the use or the mixing with other milk of milk produced by any cow which is suffering from chronic disease of the udder or tuberculosis with emaciation until the cow has been examined by a veterinary inspector and enables the local authority or veterinary inspector to apply this restriction to the milk of any cow suspected of giving tuberculous milk. The order also deals with the disinfection of premises occupied by tuberculousbovine animals. By-Laws. London County Council. By-Lax made by the London County Council under the Public Health (London) Act, 1891. By-Laws under Section 39 (1). With respect to water-closets, earth-closets, privies, ash-pits, cesspools, and" receptacles for dung, and the proper accessories thereof, in connection with buildings, whether constructed before or after the passing of this Act. By-law made by the Council defining the person responsible under the by-laws made in pursuance of the provisions of Section 39 (1) of the Public Health (London) Act, 1891, in so far as they relate to the construction of any water closet, earth-closet. privy, ashpit, cesspool, or receptacle for dung, and the proper accessories thereof. 119 Notwithstanding anything contained in the by-laws made by the London County Council in pursuance of the provisions of Section 39 (1) of the Public Health (London) Act, 1891, in the case of the construction of any water-closet, earth-closet, privy, ashpit, cesspool, or receptacle for dung and the proper accessories thereof, the builder shall observe all the requirements contained in the said by-laws, and he shall be liable to the penalties provided for a breach of of the said by-laws. Provided that this by-law shall not remove or interfere with any of the obligations which have been specifically imposed by the said by-laws upon the owner or occupier of any premises. In this by-law "builder" means the builder, contractor, or person actually carrying out the work, but does not include a workman in the employ of such builder, contractor, or person. The foregoing by-law was made by the London County Council on the 15th day of April, 1913, and the common seal of the Loudon County Council was hereunto affixed on the 19th day of .June, 1913. (Sd.)James Bird, Deputy Clerk of the London County Council. Allowed by the Local Government Board the eleventh day of July, 1913 (Sd.) H.C.Monro, Secretary. Acting on behalf of the said Board under the authority of tlieir General Order dotted the twenty-sixth day of May, 1877. LEGAL DECISIONS. Rex r. Pcck & Co., Ltd., and Another. 11 L.G.R. 136. (Before Rowlatt J.) Voluntary surrender of Unsound Fruit. An indictment lies a limited company for the offence created by Section 47, sub-section (3), of the Public Health. (London) Act, 1891, of selling articles of food liable to be seized as unwholesome and unfit for the food of man. But where after such a sale has taken placs, and before any seizure has in fact been made by the medical officer or inspector, the purchaser has voluntarily given up the unsound goods for condemnation by a magistrate, the limited company, who sold them, are not guilty of an offence under Section 47, sub-section (3), because the goods having been voluntarily given up were incapable of seizure. Reg. v. Dennis (1894), 2 Q.B. 458 ; 63 L.J.M.C. 153, followed. Giivell v. Malpas (1906), 2 K.B. 32; 4 L.G.R. 668; 75 L.J.K.B. 647, distinguished. 120 Rex v. Local Government Board, ex parte Arlidge. 11 L.G.R. 1186. (Before Vaughan Williams, Buckley, and Hamilton, L.J.J.) Housing and Town Planning, &c., Act, 1909.—Appeal to Local Government Board. On an appeal by the owner to the Local Government Board, under theHousing and Town Planning, &c., Act, 1909, against the refusal of the local authority to determine a closing order, the appellant has a right to be heard and see the inspector's report on the public local enquiry held by him, and it is not competent to the Board to determine the question before them as to whether or not the closing order should be confirmed or discharged solely upon the report of the inspector who held the public local enquiry provided for by Section 39, sub-section 1 (b), and upon the perusal of the written statements by the parties. So held on appeal, Hamilton L.J. dissenting. Decision of Divisional Court (reported [1913] 1 K.B. 453 ; 11 L.G.R. 242; 82 L.J.K.B. 313) reversed. Ross v. Helm. (Before Lord Alverstone C.J., and Channell and Avery J.J.) Sale of Food and Drugs Acts. — Proof of Inspector's appointment. An inspector appointed by a county council, who was described in the information by his own name and as such inspector, was beginning to give evidence in a prosecution under Section 6 of the Sale of Food and Drugs Act, 1875, when the chairman of the Bench asked him his name. He gave his name, adding "an inspector under ihe Food and Drugs Act." He was not cross-examined as to this statement, but upon his case being closed, objection was taken that he had not produced his appointment as inspector. The justices were of opinion that he should have produced it, and having failed to do so, could not be allowed, after having closed his case to put in further evidence, and they dismissed the summons. Held that the objection should not have been allowed since the inspector had given evidence which prima facie proved that he was an inspector, and in the absence of cross-examination on the point, production of the document appointing him was unnecessary. Per Channell J. and Avery J. Where the charge is one of selling to the prejudice of the purchaser under Section 6 of the Act, justices have the same jurisdiction to deal with the case whether the prosecutor be an inspector or a private individual. Therefore there was no need to prove that the prosecutor was an inspector at all. 121 Gamble v. Jordan. 11 L.G.R. 989. (Before Phillimore, Banks, and Avory J.J.) Rag Flock. Section I, sub-section (1) of the Rag Flock Act, 1911, imposes a penalty on any person having in his possession flock intended to be used for "making bedding which does not conform to the standard of cleanliness prescribed by Regulations made by the Local Government Board in pursuance of the Act. A mattress maker—a workman in the employ of bedding manufacturers— had undertaken, in his spare time and at his own house, to "re-make" a mattress, the property of a relative, for the sum of one shilling. He removed the flock, which did not conform to the required standard of cleanliness, from the cover of the mattress and put the same flock back again into the cover without any addition. This re-stuffing was necessary to secure a more even distribution of the flock in the mattress and add to its comfort. Held, that the re-making or re-stuffing of the mattress with the same flock, which had been taken out of it and put back again without addition, was not the "making " of an article of bedding within the meaning of Section 1, subsection (1) and that the Act had not been contravened. Kershaw v. Smith & Co., Limited. 11 L.G.R. 519. (Before Ridley, Pickford and Avory J.J.) Combined Drainage. In 1884 a builder obtained an order of a Vestry for, and their sanction to plans for a combined system of drainage of a row of houses, but laid the drains in contravention of the approved plans. In 1912 the local authority, successors of the Vestry, discovered the builder's default, and served him with a notice under section 83 of the Metropolis Management Act, 1855, requiring him to alter the drains in conformity with the order of the Vestry, and on his refusal to comply with it entered on the premises and reconstructed the whole system of combined drainage in accordance with the plan as originally approved. This reconstruction was completed on April 4th, 1912. In 1887 the builder had sold one of the houses, which was subsequently assigned to the respondents without notice that the drainage system contravened the approved plan. On April 10th, 1912, the local authority served the respondents with a notice, under section 85 of the Act of 1855 to remedy a nuisance caused by the condition of the drainage under their house. The respondents did not comply, and an information against them for failing to do so was dismissed by the magistrate on the ground that the drainage system carried out by the builder had never been approved by the Vestry, and that inasmuch as the pipe under the respondents' house drained more than one house it was a sewer and not a drain, and therefore the respondents were not liable to repair it. 122 Held (by Ridley and Avory J.,T., Pickford J. dissenting), reversing the magistrate, that although up to April 4th, 1912, the pipe in question was a sewer it became a drain repairable by the respondents after that date, since the approved system of drainage of more than one house by a combined operation had then been carried out. The St. Leonards, Shoreditch Vestry r. Phelan, 1896, 1 Q. B. 533; 65 L.J.M.C. 111, distinguished.