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such excess has been due to age.sex.distribution of the population, but there are other factors
which require elucidation. The subject is worth close study, and I hope to be able at an early
date to examine the data collected.
The infantile mortality rate was slightly higher last year than in 1912, but was, nevertheless,
fairly low and in striking contrast with the rates recorded ten to fifteen years ago. Diarrhcea
was more prevalent last year, but at an unusual time, namely, in the autumn, not in the summer.
In the section dealing with "Health Visiting" there is a table—necessarily much condensed—
showing the distribution of still.births and miscarriages in relation to frequency of pregnancy.
(See Table 48.) The agreement between the proportions of still.births deduced from that table
and from the notification of births records is very remarkable and quite contrary to expectation.
The increased and increasing proportion of deaths recorded in institutions has been, and is,
a very prominent feature in the statistics of recent years. Whether such feature is altogether
satisfactory is open to question. It implies that the sick are more ready to take advantage of
the opportunity afforded to them of obtaining the most skilled treatment, but, on the other hand,
it is also an indication of a growing disinclination to care for the sick in their homes, the origins
of which disinclination cannot be dealt with here. It has, however, to be recognised
that there is a tendency to urge on behalf of the community at large hospital isolation and/or
treatment for many diseases for which isolation was not thought necessary in the past.
The "Administration" section of the report give a very inadequate account of the work of
your Public Health Department. The real test of the value of such work and of the success
attending the activity of the Department should be sought in the vital statistics of successive
years.
At the present moment the housing question bulks large in the mind of the public. While
there is much that needs improvement in the Borough, my view is that there is no need for a
housing "campaign." Writing quite generally, the houses are structurally good, and where unsatisfactory
conditions prevail they are most commonly the result of the occupancy in tenements
of premises designed for single families. Careful watch is maintained for individual houses
requiring to be dealt with under the Housing Acts, and when found they are dealt with promptly.
I cannot attempt to allocate the blame for insanitation between landlords and tenants, but my
experience has led me to attach almost more importance to the domestic habits of tenants than
to the sins of omission and commission of landlords, or rather of landlords. agents. Dirty conditions
have long been recognised as factors inimical to health and have ranked as "nuisances."
The time has come for verminous conditions to be placed in the same category.
I cannot regard with equanimity the conversion of the larger private houses into maisonettes
or flats which is going on. It is very desirable that such conversion should be subject
to the supervision and control of the Health Authority as well as of the District Surveyor.
Questions of storage and collection of house refuse are intimately associated with the conversion
here referred to. The accommodation for the storage of such refuse is only too frequently
inadequate not only in converted houses, but in all classes of flats. Moreover, owing in part to
the predilection for flats, and in part to the difficulty of obtaining domestic servants, gas cooking
stoves are replacing coal ranges. Such change makes it impossible to destroy putrescible refuse in
the house. Hitherto one collection a week has been the rule in the Borough, but I think it would
be a great boon to the inhabitants if a regular half.weekly collection were established, more
especially during the warmer months, when the accumulation of vegetable refuse is always large.
The only conclusion which is possible from the results of the work under the Sale of Food
and Drugs Acts (see Analytical Work) is that those Acts are inadequate to secure a pure food
supply. The warranty defence (in the milk trade at least) makes it impossible to bring home to
the responsible party the blame for watering or abstracting fat from milk, and the appeal to the
cow has sterilised the " presumptive " standard of milk composition. The addition of preservatives
to many descriptions of food.stuffs cannot be controlled—and still less stopped—under
the present law. The time is ripe for the public to demand that they shall be supplied with
foods which are not only what they are reputed to be, but are also free from drugs. It is
questionable, however, whether the public generally either know or care about the composition
or purity of their food supply.
I have the honour to be,
Mr. Mayor, Ladies and Gentlemen,
Your most obedient servant,
m.a., m.b., d.p.h., f.s.s.,
Public Health Department, Medical Officer of Health.
Town Hall, Paddington, W.
21 st July, 1914.