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held that the causes of an epidemic outburst were to be found in the meteorological conditions prevailing
at, or immediately before the time of the epidemic. The meteorological records do not,
however, furnish any evidence in support of that postulate. It may be surmised that the effective
cause lies in the life.history of the organism or in the co.incident development of another organism
which reacts on the causal organism in such a way as to give it greatly increased infectivity.
The absence of cases of enteric fever among adult males continues to be a notable feature of the
records of this disease in the Borough.
While there was a reduction in the number of cases of tuberculosis notified last year, the mortality
last year was slightly higher than that recorded in 1921. At the same time there has been a very
notable fall in the mortality during the thirteen years 1910.1922. As regards notification of this
disease there is evidence that there are defects in the present system, too many cases being unheard
of until after death, and too many patients dying at very short intervals after notification. The
proportion of " contacts " examined during the year (78 per cent.) was very satisfactory.
The mortality from malignant disease (cancer) during the past year showed an unusual feature in
that the mortality among males increased and that among females decreased.
The administrative work of the Department continues to increase, and great difficulty has been
experienced in relation to housing questions. With the continued shortage of new houses the need of
repairs to existing houses, especially of those occupied by more than one family, becomes more urgent.
Great expectations were based on the provisions of Section 28 of the Housing Act of 1919 (Repairs of
Houses), but the enforcement of those provisions has been found to bristle with difficulties. It is in
consequence of those difficulties, which can only be solved by decisions of the Courts, that so little use
was made of the Section last year. In consequence of action taken under that Section in 1920, one
freeholder initiated successful proceedings in the autumn of last year under Section 30 of the Act, by
which he obtained an Order giving him possession of the house. There is no doubt that freeholders
could render great assistance to the Council in securing the repair of existing houses if they would resort
to proceedings under Section 30.
It is to be regretted that more attention has not been given to tenement houses. It is impossible
for the two Inspectors detailed for this work to inspect every house on the Register each year. The
District Inspectors have so much to do now that they cannot render assistance in this work as they did
before 1914. Unless the Bye.laws under Section 26 of the Housing Act of 1919 are brought into
operation at an early date, it will be necessary to remodel the Bye.laws made by the Council under
Section 94 of the Public Health (London) Act, 1891, to meet the changes in rents.
I cannot close without an expression of thanks to the Chairman and Members of the Public
Health, Special Housing and Maternity & Child Welfare Committees for their continued co.operation
in the work of the Department. My acknowledgments are [due to the Staff of the Department
generally who have worked loyally, a special word being due to Mr. Gower, the Chief Clerk, and to
Mr. Potter, the Chief Sanitary Inspector.
I have the honour to be,
Mr. Mayor, Ladies and Gentlemen, .
Your obedient servant,
O.B.E., M.A., M.B., D.P.H.,
Medical Officer of Health.
Public Health Department,
Paddington, W. 2.
May, 1923.