AC 434 LON 34 Corporation of London. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE CITY OF LONDON for the year 1901, Wm. COLLINGRIDGE, M.A., M.D., D.P.H., LL.M., medical officer of health for the city of london, late medical officer of health for the port of london, fellow of the sanitary institute, fellow of the incorporated society of medical officers of health. LONDON: Printed by Charles Skipper & East, 49, Great Tower Street, E.C. 1902. HM D.billianm minpidfe compliment Public Health Department Gildhall London El REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE CITY OF LODON For the Year 1901, BY Wm. COLLINGRIDGE, M.A., M.D., D.P.H., LL.M., medical officer of health for the city of london, late medical officer of health for the port of london, fellow of the sanitary institute, fellow of the incorporated society of medical officers of health. LONDON: Printed by Chakleb Skipper & East, 49, Great Tower Street, E.C. 1902. DIMSDALE, Mayor. A Common Council holden in the Chamber of the Guildhall of the City of London, on Thursday, the 29th day of May, 1902. THE Sanitary Committee did this day deliver into this Court a Report in writing under their hands, submitting the Annual Report of the Medical Officer of Health for the year 1901; and recommending that the same be printed and circulated amongst the Members as usual, and a copy be forwarded to the Local Government Board and the London County Council. Agreed to, and Ordered accordingly. PRIOR GOLDNEY, Officiating Town Clerk. CONTENTS. page. Sanitary Staff 5 Area 9 Density 9 Rateable Value 9 Population 9 Census Returns 10 Births 11 Vaccination 12 Mortality 12 Deaths in City Institutions 13 „ from Violence 14 Vital Statistics 14 Meteorology and Death Rates 17 Notification of Infectious Disease 17 Shelter for Temporary Accommodation 19 Small-pox and Vaccination 20 Vaccination in City Ward and Parochial Schools 28 „ „ „ Board Schools 29 „ „ „ Artizans' Dwellings 29 Tuberculosis, or Consumption 30 „ Voluntary Notification of 32 „ Precautions for Prevention of 32 „ Relation between Human and Bovine 33 „ in Cattle—Local Government Board Recommendations 34 Artizans' Dwellings, Houndsditch 37 „ „ Vital Statistics 38 Disinfection 40 Mortuary Returns 40 Post-mortem Room 40 Disinfectants, Manufacture of 40 Sanitary Inspections 41 Insanitary Dwellings 43 House Refuse Removal 44 Tenement Houses 44 Factory and Workshop Act, 1891 46 Woman Sanitary Inspector 48 Factories and Workshops—Defects reported by Home Office 51 Workshops, Sanitary Conveniences in 53 Bakehouses 53 Disinfection of Public Roadways 55 Leadenhall Market 55 Summer Flushing of Courts, &c. 56 Limewhiting of Courts 58 Skips foe House Refuse 59 Railway Stations, Sanitary Conveniences at 59 Public W.C's and Underground Conveniences 61 Ice Cbeams 61 „ „ Regulations for Sale of 62 Milk and Infectious Disease 66 Dairies and Milk Shops Regulations 75 Food Inspection at Riverside Wharves78 Unsound Fruit, Vegetables, Tinned Food 79 Aldgate Slaughterhouses 80 Meat Supplies 81 „ „ Sources of Origin of 83 „ Inspection and Condemned Meat 86 Diseased Meat Prosecutions 89 Tuberculosis in Pigs 90 Unsound Frozen Rabbits 91 Fish Supplies 92 „ Seizures 93 Sale of Food and Drugs Acts 94 „ „ „ „ „ Prosecutions 96 Milk Regulations—Board of Agriculture Rules 99 Cheese Poisoning (Tyrotoxismub)101 APPENDICES. Appendix A—Street Lists of Mortality. „ B— „ „ „ Infectious Disease. „ C—Tenement Houses. Spot Map of the City showing Infectious Diseases. SANITARY STAFF, 19 0 1. medical officer of health. Date of Appointment Collingridge, Wm., M.A., M.D., D.P.H April, 1901 sanitary clerk. Turner, Howard Blake, F.I.C June, 1877 sanitary inspectors. Hills, Arthur Reginald 1st Class, April, 1888 Gathercole, Wm. Henry Joseph „ „ May, 1891 May, William Hussey „ „ May, 1891 Simmons, Edward John 2nd Class, June, 1892 Robbins, Francis Joseph „ ,, Sept., 1892 Ralph, William Holden „ „ July, 1898 Benson, John May, 1890 inspectors of slaughterhouses and meat. Terrett, George Patrick(Senior) May, 1881 Leeson, John Dec., 1890 Sharp, Owen May, 1892 Jenkins, Harry April, 1896 Down, William Edward July, 1896 Eglin, William July, 1896 Kelland, William C May, 1899 matron in charge of the shelter, golden lane. Mrs. A. R. Hills Dec., 1900 keeper of the mortuary and engineer in charge. McDonnell, John Feb., 1896 labourer. Lee, Robert (General Duties) Oct., 1894 Skinner, Henry (Meat Shed) June, 1901 REPORT OF MEDICAL OFFICER OF HEALTH FOR THE CITY OF LONDON, 1901 ' ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1901. To the Right Honourable the Lord Mayor, Aldermen commons of the Corporation of London. Gentlemen, I have the honour to present herewith a Report for 1901, giving details of work carried out in my Department. area. The City of London Registration District comprises an area of 672.1 acres (excluding tidal water and foreshore), or 1.05 miles, equal to a square of 1.0247 miles to a side. The area of "Registration London" is 74,672 acres (excluding tidal water and foreshore), or 116.7 square miles, equal to a square of 10.8 miles to a side. density (1901). City of London, Registration District, at night 40.8 persons to an acre. „ „ „ „ during the day 519.6 „ „ Registration London, at night 60.8 „ „ „ „ during the day not known. No Imperial Day Census has yet been taken. annual rateable value. The assessed rateable annual value of property within the administrative county of London was £39,779,956 in 1901—whilst the corresponding rateable value of property in the City of London, including Temples, was £4,864,543 in 1901, or nearly one-eighth of the whole County. population. The undermentioned figures are abstracted from the Preliminary Report— Census of England and Wales, 1901. The "City of London" may mean either of the following:— Parliamentary Borough. Municipal City. Registration District. 10 TABLE A. Area. Statute Acres. Inhabited Houses. Population. 1891. 1901. 1891. 1901. Parliamentary Borough or Municipal City. 671 5,340 3,875 37,705 26,897 Registration District 672.1 5,408 3,946 38,481 27,639 For Parliamentary, Municipal, Police, and School Board purposes the boundaries of the City are co-terminous. These figures represent the population on the night of the 1st April, 1891 and 1901. A Day Census—the number of persons actively engaged in the City during the daytime—has been taken on three occasions, viz., in 1866, 1881, and 1891. It is a matter for regret that no Day enumeration was made in the City during the last Imperial Census year. TABLE B. CENSUS RETURNS. Year. Imperial Census. Night Population. City Census. Day Population. 1861 112,063 — 1866 - 170,133 1871 75,983 — 1881 51,405 261,061 1891 37,705 301,384 1901 27,639 — The City District, or Union, is co-extensive with the municipal City of London within and without the walls, with the following exceptions, viz.— the municipal City includes the Middle Temple*, part of Staple Inn [four houses]† part of Furnival's Inn [five houses], and a part of the Parish of Whitechapel [five houses], which for Poor Law and Registration purposes are comprised respectively in the Strand, Holborn and Whitechapel Districts, while the "Liberty of Glasshouse Yard," with the exception of a few houses occupied by sixty-five persons, although not forming part of the municipal City §, is included in the Parish of St. Botolph Without, Aldersgate, * Vide Census of England and Wales, 1891. The Middle Temple has since been constituted a separate Sanitary Authority. † The ground floors only are in the City. § A new delimitation of this portion of the City is now under consideration. 11 in the London City Registration District. This 'Liberty' contained in 1891 69 inhabited houses, occupied by 779 persons, and in 1896 only 733 persons, according to the Imperial Census. All deaths in Glasshouse Yard are included by the Registrar-General as occurring in the City, but the Corporation is responsible only for the sanitary condition of the area comprised in the "municipal" City of London, from which this Yard, with the exceptions above mentioned, is excluded. For statistical purposes, in the following pages the " Registration" District is referred to when speaking of the "City." This consists of 113 parishes, divided into three sub-districts, as under, viz.:— St. Botolph including 17 parishes. Allhallows Barking „ 85 „ St. Sepulchre „ 11 „ The populations of the above, calculated on the last Census Returns at the middle of 1901, were:— St. Botolph 10,910 Allhallows Barking 7,811 St. Sepulchre 8,690 Total 27,411 The Night population, therefore, of the City of London Registration District at the middle of 1901, is taken at 27,411, and it is upon this figure that all vital statistics in this Report have been calculated. The Day population at the middle of 1901 was estimated at 349,180. The Day Census taken in May, 1891, proved that 1,186,000 persons and 92,000 vehicles entered and left the City on the day the counting was made. births. During the year 1901, 377 births were registered in the City. The annual birth rate was at the rate of 13.7 per 1,000 persons of all ages, compared with a quinquennial mean rate of 15. 8 per 1,000. The birth rates last year in the Sub-Districts were— St. Botolph 18.1 per 1,000 St. Sepulchre 12.5 „ Allhallows 8.9 „ In the Metropolis the birth rate in *1900 was 28.6 per 1,000, being the lowest hitherto recorded therein; while in England and Wales the rate for the same year was 28.9, and the decennial mean rate 30.1. This decline in the birth rate has been in operation since 1871 or 1872, and is common to nearly all European countries. * The figures for the Metropolis in 1901 are not yet published. 12 vaccination. Of the children born in 1901, 258 had been successfully vaccinated by the end of the year, and 49 had died before the age for vaccination. Vaccination was postponed by medical certificate in 16 cases, 2 infants were reported to be insusceptible to vaccination, 34 had removed into other districts, 12 vaccinations were pending at the end of the year, and there were 10 cases of conscientious objection. Vaccination Statistics in the City of London. Year. Number of Births. Successfully Vaccinated. Insusceptible. Had Small-pox. Died before Vaccination. Vaccination Postponed. Removed or unaccounted for at the end of the year. Conscientious Objections. per cent. per cent. per cent. per cent. per cent. per cent. per cent. 1896 534 64.6 .19 Nil. 8.4 4.5 22.30 — 1897 491 59.3 .20 „ 6.9 5.5 28.10 — 1898 468 45.3 Nil. „ 8.1 5.4 34.20 7.0 1899 430 62.8 .46 „ 9.5 5.3 19.52 2.3 1900 403 60.5 .99 „ 12.6 4.4 19.30 1.9 Average previous 5 years 465 58.5 .37 Nil. 9.1 5.0 24.7 3.7* 1901 381 67.7 .52 Nil. 12.8 4.2 12.0 2.6 * Average for three years. mortality. During the year under review, 974 deaths were registered in the District, including *633 persons dying in the City, but not belonging thereto. See Table I. for details. Deducting the latter we have to deal with 341 deaths, to which we must add 115 persons who died at City Institutions in outside districts, where they were registered. The mortality, therefore, upon which our death rate is calculated is 456. The death rate for 1901 was 16.6 per 1,000 per annum of the population (the previous year being 19.4), whilst that for the whole of the Metropolis for 1901 was 17.1. These figures are not corrected for sex and age distribution. Death Rates, per 1,000 per Annum. Year. City of London. 33 Great Towns of England and Wales. Metropolis. 1896 17.8 18.9 18.6 1897 19.3 19.1 18.2 1898 16.3 19.0 18.7 1899 18.5 20.2 19.8 1900 19.4 19.5 18.8 Average previous five years 18.3 19.3 18.8 1901 16.6 18.6 17.1 In comparing the above with the Registrar-General's Returns, some discrepancies will be observed, due to the fact that I have not been * Most of these deaths occurred in St. Bartholomew's Hospital. 13 furnished with the number of citizens who died in Institutions other than those with which the City is connected. The deaths from zymotic disease per 1,000 of the population was 0.51 compared with 2.22 in the Metropolis. The deaths of children under 1 year of age to 1,000 births come out 160, against 148 for the whole of London. Deaths in City Institutions. During 1901, 115 persons died in City Workhouses, Workhouse Infirmaries, or Lunatic Asylums, or no less than 25.2 per cent. of the whole City mortality the corresponding figure for the Metropolis (1900) being 18.3 per cent. This high percentage is caused in the City by the excessive proportion the number of inmates in these places (exclusive of officers and their families) bears to our population, the ratio being about 1:25, as compared with 1:101 in the Metropolis (Census 1891). In other words, these figures represent that 1 in every 25 citizens is an inmate of either a Workhouse, Workhouse Infirmary or a Lunatic Asylum, in comparison with 1 in every 101 inhabitants of the Metropolis. Percentage of Deaths occurring in Workhouses, Workhouse Infirmaries and Lunatic Asylums to total Deaths in the City of London and the Metropolis respectively, for 1901, compared with the average for the previous five years:- Year. City of London. Metropolis. per cent per cent 1896 29.9 15.4 1897 25.7 16.4 1898 28.8 16.8 1899 29.9 17.8 1900 27.9 18.3 Average of previous five years 28.4 16.9 1901 25.2 Figures not yet published. It will be seen that in 1901 25.2 per cent., or 1 in every 3.9, deaths in the City occurred in one of the above-named Institutions, compared with 18'3 per cent., or about 1 in 5.4, in the Metropolis (1900) under analogous circumstances. It is satisfactory to observe that the figures for the City show a marked decrease, being 3.2 below the average for the preceding five years, but they are, nevertheless, far too high, and compare very unfavourably with the past in this respect. For instance, in 1862 it was stated that the previous ten years showed that of every 100 deaths in the City 14.5, or about 1 in every 7 only, were paupers who died in City workhouses. 14 Deaths from Violence. Of the City deaths, 7.45 per cent. were caused by injuries or violence (as compared with 7.44 in 1900), being 0'48 below the average for the previous five years. In the City of London, the ratio of deaths from violence to deaths from all causes, which had regularly diminished during the years 1896-7-8-9, have shown a tendency to rise during the past two years (1900-1). The large proportion of deaths from violence within the City as compared with the rest of London, though striking, is easily accounted for by the enormous concentration of vehicular traffic in crowded streets, and the greatly increased danger resulting therefrom. It is probably only due to the excellent management of the traffic by the City Police that this mortality is not much larger. PERCENTAGE OF REGISTERED DEATHS FROM VIOLENCE. Year. City of London. Metropolis. Per cent. Per cent. 1896 9.56 4.12 1897 9.07 4.29 1898 7.02 4.19 1899 6.56 4.19 1900 7.44 4.27 Average previous five years 7.93 4.21 1901 7.45 Not yet published. vital statistics, 1901. City of London compared with the Metropolis, previous 5 years. City of London. Birth Rate. Death Rate. Deaths of Children under 1 year to 1,000 Births. Violent Deaths, per cent. of Deaths Registered. Deaths from principal Zymotic Disease per 1,000 of the Population. Night Population (Imperial Census). Day Population (Corporation Census). City. Metropolis. City. Metropolis. City. Metropolis. City. Metropolis. City. Metropolis. 1896 31,412 324,600 17.0 30.2 17.8 18.6 133 161 9.5 4.1 1.05 3.14 1897 30,245 329,290 16.2 30.0 19.3 18.2 109 158 9.1 4.3 1.35 2.56 1898 29,121 334,050 16.1 29.5 16.3 18.7 118 167 7.0 4.2 0.62 2.79 1899 28,039 338,850 14.8 29.4 18.5 19.8 135 167 6.6 4.2 1.03 2.48 1900 26,998 343,790 14.9 28.6 19.4 18.8 179 160 7.4 4.3 1.44 2.22 Average previous five years. 29,363 334,116 15.8 29.5 18.2 18.8 135 162 7.9 4.4 1.10 2.64 1901 27,411 349,180 13.7 * 16.6 17.1 160 148 7.4 * 0.51 2.22 * Figures not yet published. 15 (This Table is prepared in accordance with the requisitions of the Local Government Board.) Vital Statistics of Whole District during 1901 and Previous Years. Name of District: CITY OF LONDON. year. Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Total Deaths in Public Institutions in the District. Deaths of Nonresidents registered in Public Institutions in the District. Deaths of Residents registered in Public Institutions beyond the District. Nett Deaths at all Ages belonging to the District. Number. Rate.* Under 1 Year of Age. At all Ages. Number. Rate.* Number. Rate per 1,000 Births registered. Number. Rate.* 1 2 3 4 6 6 7 8 9 10 11 12 13 1894 34,831 520 14.9 82 157 993 28.5 570 562 169 600 17.2 1895 33,823 552 16.3 81 147 1,057 31.2 629 627 189 619 18.3 1896 31,412 534 17.0 72 133 1,066 33.9 677 672 164 558 17.8 1897 30,245 491 16.2 58 118 1,046 34.6 615 608 146 584 19.3 1898 29,121 468 16.1 55 118 957 32.9 620 615 132 474 16.3 1899 28,039 416 14.8 56 135 1,011 36.0 649 642 149 518 18.5 1900 26,998 403 14.9 72 179 987 36.6 625 609 146 524 19.4 Averages for years 1894-1900 30,638 483 15.7 68 140 1,016 33.1 626 619 156 554 18.1 1901 27,411 377 13.7 60 160 974 35.5 644 633 115 456 16.6 * Rates in Columns 4, 8, and 13 calculated per 1,000 of estimated population. Note.—The deaths included in Column 7 of this Table are the whole of those registered during the year as having actually occurred within the district or division. The deaths included in Column 12 are the number in Column 7, corrected by the subtraction of the number in Column 10 and the addition of the number in Column 11. By the term "Non-residents" is meant persons brought into the district on account of sickness or infirmity, and dying in public institutions there; and by the term "Residents" is meant persons who have been taken out of the district on account of sickness or infirmity, and have died in public institutions elsewhere. Area of City of London Registration District in acres (exclusive of area covered by water) 672 Total population at all ages 27,639 Number of inhabited houses 3,946 Average number of persons per house 7.0 At Census of 1901. 16 (This Table is prepared in accordance with the requisitions of the Local Government Board.) Causes of, and Ages at, Death during Year 1901. Deaths in or belonging to whole District at subjoined ages. Deaths in or belonging to localities at all ages. Total Deaths in Public Institutions in the District. All ages. Under 1. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. St. Botolph. Allhallows. St. Sepulchre. * 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 1. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... 2. Measles 1 ... ... 1 ... ... ... ... 1 ... ... ... 3. Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... 4. Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... 5 Epidemic Influenza 2 ... ... ... ... 2 ... ... 2 ... ... ... 6. Whooping Cough 2 ... 1 1 ... ... ... 1 ... 1 ... ... 7. Diphtheria and Membranous Croup 4 1 2 1 ... ... ... 2 1 1 ... 16 8. Croup ... ... ... ... ... ... ... ... ... ... ... ... 9. Enteric Fever 1 ... ... ... ... 1 ... ... ... 1 ... 9 10. Asiatic Cholera ... ... ... ... ... ... ... ... ... ... ... ... 11. Diarrhœa, Dysentery 6 3 ... ... ... 2 1 4 1 1 ... 10 12. Epidemic or Zymotic Enteritis ... ... ... ... ... ... ... ... ... ... ... ... 13. Enteritis 6 2 1 ... ... 1 2 3 1 1 1 4 14. Other Continued Fevers ... ... ... ... ... ... ... ... ... ... ... ... 15. Erysipelas ... ... ... ... ... ... ... ... ... ... ... 2 16. Puerperal Fever 1 ... ... ... ... 1 ... 1 ... ... ... 2 17. Other Septic Diseases ... ... ... ... ... ... ... ... ... ... ... 14 18. Intermittent Fever and Malarial Cachexia. ... ... ... ... ... ... ... ... ... ... ... ... 19. Tuberculosis of Meninges 5 4 1 ... ... ... ... ... 1 4 ... 18 20. Tuberculosis of Lungs 43 ... 1 ... 6 34 2 18 8 15 2 21 21. Other Forms of Tuberculosis 4 2 2 ... ... ... ... 1 1 2 ... 18 22. Alcoholism 3 ... ... ... 1 1 ... 2 1 ... ... 2 23. Cancer 25 ... ... ... ... 12 13 8 3 12 2 75 24. Premature Birth 10 10 ... ... ... ... ... 6 1 3 ... 1 25. Developmental Diseases 17 13 4 ... ... ... ... 10 5 2 ... 9 26. Old Age 30 ... ... ... ... 1 29 9 2 16 3 1 27. Meningitis 1 ... 1 ... ... ... ... 1 ... ... ... 12 28. Inflammation and Softening of Brain ... ... ... ... ... ... ... ... ... ... ... 2 29. Organic Diseases of Heart 16 ... 1 ... 2 8 5 8 5 2 1 12 30. Acute Bronchitis 20 4 1 ... ... 11 4 8 3 9 ... 6 31. Chronic Bronchitis 27 ... ... ... ... 6 21 10 3 12 2 4 32. Lobar (Croupous) Pneumonia 1 ... ... ... ... 1 ... ... 1 ... ... 2 33. Lobular (Broncho-) Pneumonia 23 10 5 1 1 3 3 5 7 10 1 34 34. Diseases of Stomach 3 ... ... ... 1 2 ... 1 1 1 ... 11 35. Obstruction of Intestines 4 ... ... ... ... 4 ... ... ... 3 1 19 36. Cirrhosis of Liver 11 ... ... ... ... 11 ... 4 2 4 1 7 37. Nephritis and Bright's Disease 14 ... ... ... 1 10 3 6 5 2 1 20 38. Tumours and Other Affections of Female Genital Organs. ... ... ... ... ... ... ... ... ... ... ... 2 39. Accidents and Dis. of Parturition ... ... ... ... ... ... ... ... ... ... ... ... 40. Deaths by Accident or Negligence 22 4 ... 2 2 14 ... 6 12 4 ... 88 41. Deaths by Suicide 12 ... ... ... 1 8 3 3 4 5 ... 9 42. Deaths from Ill-defined Causes 2 ... ... ... ... ... 2 ... 1 1 ... 3 43. All other Causes 140 7 2 2 6 75 48 50 34 45 11 211 Total all Causes 456 60 22 8 21 209 136 167 106 157 26 644† * Residents dying in City Institutions. City address not stated on certificate of death, † Including 11 Citizens, distributed in Columns 1 to 11. 17 METEOROLOGY at Greenwich, and DEATH RATES recorded in London and the City respectively for each year from 1894 to 1901. METEOROLOGY, 1901. Year 1894 1895 1896 1897 1898 1899 1900 1901 Registered Sunshine in Hours 1052 1225 1016 1540 1415 1708 1506 Returns not yet published. Mean Temperature 49°.9 49°.3 50º.1 50°.3 51º.3 50º.6 50°.4 Degree of humidity Saturation — 100 81 78 79 79 78 77 79 Rainfall in inches 26.9 19.7 22.4 22.1 18.9 22.3 22.3 Mean hourly horizontal movement of the air. 12.4 miles 11.6 miles 11.4 miles 12.2 miles 11.8 miles 11.5 miles 12.1 miles Annual Rate of Mortality per 1,000. London 17.8 19.8 18.6 18.2 18.7 19.8 18.8 17.1 City of London 17.2 18.3 17.8 19.3 16.3 18.5 19.4 16.6 NOTIFICATION OF INFECTIOUS DISEASE. In the following Tables will be found particulars of the cases of infectious disease notified under Sections 55 and 56 of the Public Health (London) Act, 1891, during 1901, and information as to the removal of patients to hospitals, &c. :— NATURE OF DISEASE. Number of Certificates received. Treated at Home. Removed to the Metropolitan Asylums Board Hospitals. Removed to the London Fever Hospital. Treated at other Hospitals and Infirmaries. Duplicate Certificates received. Diagnosis incorrect. Small-pox 8 — 7 — — — 1 Diphtheria 71 9 31 4 18 7 2 Membranous Croup 4 - 2 — — 2 — Scarlet Fever 132 11 63 31 3 24 — Typhus „ — — — — — — — Enteric „ 24 5 6 — 10 3 — Continued „ — — — — — — — Relapsing „ — — — — — — — Puerperal „ 1 1 — — — — — Cholera — — — — — — — Erysipelas 13 12 — — 1 — — Totals 253 38 109 35 32 36 3 It will be seen from the above that during the year 253 certificates were received, including 36 "duplicates," and 3 in which the diagnosis was subsequently found to be incorrect. 18 Table C shows that of the 214 cases of notifiable infectious disease occurring, 82.2 per cent, were removed to hospital for treatment, the remaining 17.8 per cent, being nursed at their own homes. Removed to Hospital. Per cent. Treated at Home. Per cent. Scarlet Fever - 89.8 - 10.2 Diphtheria 85.5 - 14.5 Enteric Fever 76.2 - 23.8 Erysipelas 7.7 - 92.3 Small-pox 100.0 - - Exclusive of Erysipelas 87.1 per cent, went to hospital, against 78.5, 83.9, 77.5, 73.6 and 79.1 in the five preceding years. It will be noted that these figures are a material improvement over those recorded in recent years. TABLE C. Return of infectious disease occurring in the City of London, with the percentage of such cases removed to hospital or treated at home during 1901, compared with the average for the previous five years:— Year. Number of cases reported. Per cent, of cases reported. Removed to Hospital. Treated at Home. 1896 312 72.1 27.9 1897 208 63.9 36.1 1898 158 79.1 20.9 1899 235 60.5 39.5 1900 196 79.1 20.9 Average for previous five years. 222 70.9 29.1 1901 214 82.2 17.8 In addition to the foregoing statutory notifications, 16 certificates relating to Chicken-pox were received. Seven cases of Small-pox amongst "non-residents" were also reported in the City, six of which were discovered at Cannon Street Railway Station amongst returning hop-pickers. In each instance the patients were detained and promptly removed to hospital. In the meantime the Medical Officer of Health in the several districts in which the sufferers resided were acquainted with the facts. 19 City of London. Cases of Infectious Disease notified during the Year 1901. Disease. Cases notified in Whole District. Total Cases notified in each Locality. No. of Cases removed to Hospital from each Locality. At all Ages. At Ages—Years. St. Botolph. Allhallows. St. Sepulchre. St. Botolph. Allhallows. St. Sepulchre. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 65. 65 and upwards. Small-pox 7 1 - - 2 4 - 3 1 3 3 1 3 Cholera Nil. — — — — — — — — — — — — Diphtheria 62 2 21 24 7 8 — 32 9 21 26 7 20 Membranous Croup 2 — 1 1 - - - 2 - - 2 - - Erysipelas 13 — — — 2 7 4 6 1 6 — — 1 Scarlet Fever 108 3 22 41 35 7 — 49 31 28 44 27 26 Typhus „ Nil. - - - - - - - - - - - - Enteric „ 21 — 1 2 4 14 — 7 3 11 6 2 8 Relapsing „ Nil. - - - - - - - - - - - - Continued „ Nil. - - - - - - - - - - - - Puerperal „ 1 - — — — 1 — 1 — — — — — Plague Nil. - - - - - - - - - - - - Totals 214 6 45 68 50 41 4 100 45 69 81 37 58 This Table is prepared in accordance with the requisitions of the Local Government Board. SHELTER FOR TEMPORARY ACCOMMODATION DURING DISINFECTION. The establishment at Golden Lane, Barbican, was utilized for the first time on the 11th March, 1901. This Shelter is not intended for the use of the poor only. Any person residing in the City is entitled to accommodation there whilst his home is being disinfected, a provision of great value in preventing the spread of infection. Seventeen families, comprising 27 adults and 38 children, total 65 persons, were received and provided with lodging, food, and attendance during the disinfection and cleansing of their houses after— Scarlet Fever from 5 families Diphtheria „ 6 ,, Small-pox „ 6 „ 17 families One family came from a home consisting of five rooms, 4 of four rooms each, 1 of three rooms, 7 of two rooms, and 4 of one room. 20 In every instance the accommodation provided has been greatly appreciated, and no difficulty has arisen from the conduct of those admitted. Under the provisions of the Public Health (London) Act, 1891, the local authority are bound to provide shelter and accommodation for persons temporarily dispossessed of their houses during disinfection after cases of infection have occurred therein. The question as to whether the provision of food for the inmates of a shelter was obligatory was an open one until the Local Government Board recently decided it in the affirmative. In this connection it is well to state that both the Corporation of London and the late Commissioners of Sewers had from the first establishment of their Shelter taken a liberal interpretation of the wording of the Act and supplied food for those accommodated. SMALL-POX. Small-pox has for so long been practically absent from London that the necessity of vaccination and re-vaccination as a means of obtaining immunity has not unnaturally been lost sight of, with the result that a large proportion of our population—practically one-third—were absolutely unprotected even in infancy. There can be but little doubt, moreover, that the effect of the recent Vaccination Act, with its "Conscientious Objector" Clause, tended greatly to this neglect of reasonable precaution. It was felt by many that the Government of the day must have had weighty reasons for allowing a person to evade the vaccination of his children on so flimsy a pretext, and that if the Legislature were in doubt as to the value of this protection, the individual had a right to his own opinion on the subject, and to base his action thereon. Doubtless there were other considerations to account for the course the Government took, but unfortunately these were mainly political, and in no sense scientific, or in accordance with the generally received opinion of the medical profession. Happily the experiment is fixed for a certain definite period of time, and the experience so far gained is not likely to lead to its extension. There are several points, however, with regard to vaccination which still require urgent attention. Firstly.—It is not sufficient that primary vaccination of every child should be insisted upon within the first few months of its life; provision must also be made for re-vaccination at the age of puberty. No reasonable person can deny the effect of primary vaccination during early childhood, but this rapidly tends to diminish after the age of 10—12, and thus, as will shortly be shown, the actual result of vaccination has been to transfer the incidence of Small-pox from an early to a later age. At this period it is essential that the individual be again protected. 21 Secondly.—"Efficient" vaccination must be defined by law, and a certain standard laid down as a minimum means of protection. There is no reason why every medical practitioner should not act as a public vaccinator, the results of the operation being in every case supervised and inspected by a specially appointed medical officer entrusted with the duty of accepting or refusing the certificate as "successful" vaccination. Thirdly.—There should be no question as to the quality of the lymph. As the Law requires vaccination, the State should provide the vaccine, or at any rate guarantee its being of a standard quality. Much of the opposition to vaccination, especially from the lower classes, arises from a distrust as to the quality of the material employed, and an imaginary danger of transmission of disease thereby. If the State provided all the vaccine required, and prohibited the use of that from any other source, one serious difficulty would be removed. During the first half of the present year there was practically no Small-pox in the Metropolis, 11 cases only being notified. During July and August a few cases occurred, but at the end of the latter month it was evident that an outbreak had to be reckoned with. The "vitality" of the epidemic was shown by the fact that within a few weeks cases had occurred in every district in London, and that the rate of mortality was unusually high. Before the end of the year, 1,017 cases had been removed to the Metropolitan Asylums Board's Hospitals, and their Report, published early in January, gives some interesting and instructive figures. The gross mortality is given as 24.28 per cent. The total mortality rate per cent, of vaccinated cases was 14.21, of doubtful cases 65.08, and of unvaccinated cases 50.52. Startling as these figures are, they by no means represent the actual facts. "Vaccinated" in this Report means "cases having visible cicatrices," without any reference as to the number, and area of such cicatrices. " Doubtful" includes (a) " cases stated to have been vaccinated, but bearing "no visible evidence thereof," and (b) "cases in which no statement was made, "but in which the eruption prevented any reliable observation as to cicatrices." With regard to (a) it is obvious that if the slightest value is to be placed on efficiency of vaccination, the whole of these cases must obviously be considered as unvaccinated; while with reference to (b) experience shows 22 that practically only in confluent and hæmorrhagic cases, which are always in the minority, is there any difficulty in deciding as to the presence, or absence, of vaccination. With regard to age periods it is pointed out that under" the age of 10 "there were only 12 vaccinated cases, and no deaths; 6 'doubtful' cases, all "of whom died; and 95 unvaccinated cases, of whom 52 died, a percentage "of 54.74." "Under 20 there were 161 vaccinated cases, of whom 3 died, a percentage "of 1.87; 12 'doubtful' cases, of whom 7 died, a percentage of 58.33; and "161 unvaccinated cases, of whom 79 died, a percentage of 49.07." "There appears to be a distinct diminution in the protective power "afforded by primary vaccination after the age of 20 years, the death rate "rising from 9.85 in vaccinated cases between 20 and 25 years of age to "28.95 in cases between 35 and 40." Special attention is also called to the heavy incidence of the disease on public officials and other persons brought, while in the performance of their duties, into contact with Small-pox cases. During the year no fewer than 21 persons employed in disinfecting were admitted into hospital suffering from Small-pox, not one of whom had been re-vaccinated. Two sanitary inspectors, two dustmen, one undertaker, one medical officer, and three other persons who had been in contact with the disease were also admitted. All these persons ought to have been protected by re-vaccination. As a contrast to this, the Managers call attention to the fact that "of 2,198 "persons employed at the Small-pox Hospitals between 1884 and 1900 "inclusive, in which period 17,900 Small-pox cases were received into the "hospitals, only 17 persons contracted Small-pox, of whom 13 were not "re-vaccinated until after they had joined the ship, and four were workmen "who escaped medical observation." "From the year 1881 to the end of 1901 there have been employed in the "ambulance service of the Board 1,282 persons. Four of these persons "contracted Small-pox, of whom one escaped vaccination when appointed— "he died; one was unsuccessfully re-vaccinated on joining the service, and the "operation was not repeated—she died; the two others had been re-vaccinated, "and recovered." The Borough Councils were from the first fully alive to the serious danger which threatened them, and the arrangements to cope with it were on a more complete and thorough scale than London has ever previously seen. 23 A special Circular was issued by the Local Government Board in September, as under:— LONDON. Memorandum on the steps specially requisite to be taken in places where Small-pox is prevalent. 1.—BY BOARDS OF GUARDIANS. As it is by vaccination that the spread of small-pox can most effectually be prevented, Boards of Guardians, as soon as any case of that disease is brought into or occurs in their respective unions or parishes, should see that measures are promptly taken to secure, as far as is necessary and practicable under the law relating to vaccination, the vaccination (or, as the case may be, re-vaccination) of all such persons as are especially exposed to the danger of the infection. Under sect. 7 of the Vaccination Act, 1898 (61 and 62 Vict. c. 49), the Local Government Board may by Order, if in their opinion it is expedient by reason of serious risk of outbreak of small-pox, or of other exceptional circumstances, require any Board of Guardians to provide vaccination stations for the vaccination of children with glycerinated calf lymph, or such other lymph as may be issued by the Board, and modify as respects the area to which the Order applies, and during the period for which it is in force, the provisions of that Act requiring the public vaccinator to visit the home of the child, otherwise than on request of the parent; and it will be for Boards of Guardians to make application to the Local Government Board for the issue of such an Order whenever local circumstances appear to them to demand the exercise of the power conferred on the Board by the section in question. It is also provided under sect. 13 of the Vaccination Act, 1871 (34 and 35 Vict. c. 98), that District Medical Officers in attendance upon any person suffering from small-pox shall be entitled to payment from the Guardians for vaccinating or (as the case may be) re-vaccinating any person who is resident in the same house as the sick person, and who could lawfully be vaccinated or (as the case may be) re-vaccinated by a Public Vaccinator at the public expense. These provisions, promptly applied in the event of serious risk of an outbreak of small-pox, will in general be found adequate to stop the spread of the disease; but if from neglect of them, or from any other circumstance, cases of small-pox spread in the district, special measures should be taken to expedite, as far as practicable, the vaccination of all unvaccinated persons in the district and to promote the re-vaccination of adults and adolescents who have not already been successfully re-vaccinated. 24 In order that speedy discovery may be made of all unvaccinated persons, whether born in the district, or newly arrived there, it will frequently be desirable that some temporary assistance be given to Vaccination Officers, in the manner provided in Article 10 (2) of the Vaccination Order, 1898. This Memorandum is intended to afford information on the measures and arrangements referred to above. A.—Special Instructions to Vaccination Officers. 1. On the occurrence of any prevalence of small-pox the Vaccination Officer should give his first and special attention to the particular localities in which the infection exists. 2. In order that for this purpose he may have the earliest possible information of the occurrence of cases of the disease, the Guardians should invite the Medical Officer of Health to give information to the Vaccination Officer of each case of small-pox as soon as it is notified, and, with the same object, the co-operation of persons who visit among the poor should be secured. They should also instruct their District Medical Officers to give the Vaccination Officer immediate notice of every fresh case of small-pox which comes under their care, and should arrange with the Registrars of Deaths to forward to him immediate notice of each death registered from small-pox. For convenience of transmitting such notices, each District Medical Officer and Registrar should be supplied with forms duly stamped for post, or with post-cards adapted for the purpose. Private medical practitioners may be invited to give similar information. 3. In each locality in which the infection exists, the Vaccination Officer should, with the utmost possible dispatch, personally ascertain what children are unprotected by vaccination, and should use his utmost exertions to obtain the prompt vaccination of all such children. Generally speaking, his own judgment and local knowledge will guide him as to the manner in which his inquiries can best be made; but in infected courts or alleys, as well as in certain kinds of streets, inquiries from house to house, and, in tenement houses, from room to room, will be indispensable. 4. Where any child (between the ages of six months and 14 years) who has not already had small-pox, or has not been duly certified as insusceptible of vaccination, or has not come within the terms of exemption under section 2 of the Vaccination Act, 1898, or whose vaccination is not at the time standing postponed under medical certificate, is found to be unvaccinated, the Vaccination Officer should take steps to procure the vaccination of the child with all practicable speed. With regard to unvaccinated children, not yet six months old, who may be in infected localities, the Vaccination Officer should advise the parents not to incur the unnecessary risk of waiting for the child to reach that age before 25 having its vaccination performed. In no house in which there is small-pox ought any child to remain unvaccinated, unless on medical examination it is pronounced unfit to be vaccinated. 5. All representations made as above should be accompanied with information as to the existing arrangements for vaccination, including any special temporary provisions which may have been made under section 7 of the Vaccination Act, 1898, for Public Vaccination in the district. 6. The Vaccination Officer should make it well known that the Public Vaccinator is at liberty to re-vaccinate all persons who shall not be less than ten years old and shall not have been previously re-vaccinated within a period of ten years, who apply to him for that purpose; and that persons not vaccinated since childhood, who are likely to be exposed to contagion, ought to be re-vaccinated without delay. Above all, this is necessary for persons whose original marks of vaccination are imperfect. 7. In the event of many artizans requiring re-vaccination, and being unwilling to lose part of their working day for the purpose of securing the desired protection, it may be expedient that the Vaccination Officer should confer with the Guardians as to attendances being given by the Public Vaccinator at some specified hour in the evening. 8. Generally, the Vaccination Officer should take every means to ensure that the vaccination of his whole district is as complete as possible. He should make frequent examination of his birth lists; and deal, as soon as practicable, with every case of default as it arises; and he should be prompt and diligent in his inquiries respecting the other children to whom his duties extend under Section 7 of his " Instructions," as issued by the Local Government Board. 9. The Vaccination Officer should give immediate information to the local Sanitary Authority of any house in which small-pox has appeared, and of which no information has reached him from the Medical Officer of Health, in order that needful means of isolation and disinfection may be taken. II.—BY SANITARY AUTHORITIES (LONDON). The Sanitary Authority of any district into which a case of small-pox may be brought, or in which it may occur, should immediately, on obtaining information of the occurrence, instruct their Medical Officer of Health to give notice to the Vaccination Officer of the Board of Guardians (the Local Authority for Vaccination purposes), in order that all practicable measures in regard to vaccination may be taken. The Sanitary Authority should also instruct their officers to assist in the administration of the Vaccination Acts by spreading a knowledge of the advantages of vaccination and re-vaccination, and by giving to the Vaccination Officer any information they may obtain as to children and others unprotected by vaccination. 26 The Sanitary Authority themselves should, on any appearance of small-pox within their district, at once proceed (under the powers of the Public Health (London) Act, 1891) to see that proper means to prevent the spread of the disease by ISOLATION OF THE SICK AND BY DISINFECTION OF INFECTED HOUSES AND THINGS, are adopted. Any extension of the disease from the house first infected, or, any fresh importation of it, needs to be dealt with in the same way. And as, from the extreme infectiousness of small-pox, every new case is a fresh source of danger, it is of the first importance towards preventing the spread of the disease that the necessary measures of the kind above-mentioned should be taken in each case at the earliest possible moment. Hence it is important for every Sanitary Authority to see that their Medical Officer of Health is kept informed, as completely and promptly as possible, of all cases of small-pox occurring in the district. The knowledge obtained through notifications received under Section 55, Public Health (London) Act, 1891, should be supplemented by information procured by house to house inquiry in each locality invaded as to cases of modified small-pox that may have escaped recognition or treatment, and by immediate notice from the District Registrars of all deaths from small-pox* The hospital treatment of small-pox cases in London under ordinary circumstances devolves upon the Metropolitan Asylums Managers, who, under Section 80, Public Health (London) Act, 1891, subject to such regulations and restrictions as the Local Government Board prescribe, may admit any person who is reasonably believed to be suffering from small-pox into a hospital provided by the Managers. The expenses incurred by them for the maintenance of any such person are to be paid by the Board of Guardians of the Poor Law Union from which he is received, but are repayable to the Board of Guardians out of the Metropolitan Common Poor Fund. The admission of a person suffering from an infectious disease into any hospital provided by the Metropolitan Asylums Managers, or his maintenance there, is not to be considered parochial relief, alms, or charitable allowance, and does not entail loss of any right or privilege, or involve any disability or disqualification. The Metropolitan Asylums Managers are also empowered by Section 79 of the Act to provide ambulances for the removal of patients. The following are the measures which Sanitary Authorities should take:— 1. It is of great importance that all persons suffering from small-pox, and so lodged that the isolation of them from healthy persons cannot be secured * It must always be remembered that small-pox is liable to be spread by infection, not only from well-marked and easily recognised cases, but also, as indeed frequently happens, from cases of which the nature is not at first evident, especially to medical men unfamiliar with the disease. Such attacks may be, on the one hand, mild and modified cases, which may be mistaken for chicken-pox or other comparatively slight disorder ; or, on the other hand, they may be hemorrhagic or other malignant and rapidly fatal forms in which death may occur before the characteristic rash has had time to develop itself. 27 without their removal, should as speedily as possible be removed to some special hospital or place for the reception of the sick. Section 66 of the Public Health (London) Act, 1891, gives power to a Justice to order such removal*; and resort should be had to this provision wherever such a measure seems necessary to prevent the spread of the disease. Similar powers for the necessary detention in hospital of persons suffering from infectious disease are obtainable under Section 67 of the same Act. Section 2 of the Public Health (London) Act, 1891, including within the term "nuisance" such overcrowding of a house or any part of a house as is injurious or dangerous to the health of the inmates, whether or not members of the same family, should also receive the special attention of the Sanitary Authority with a view to the abatement of the nuisance under Sections 4 and 5 whereever any infectious disease is or threatens to become prevalent in the district. The powers given in Sections 72, 73, 74, and 89 of the same Act of 1891 should, if necessary, be exercised with regard to the bodies of persons who die of small-pox. 2. After the removal or death of a patient suffering from small-pox, it is desirable that the remaining inmates of the house, and other persons who are known to have come into contact with infection, should be kept under observation during a period of not less than 14 days, in order that, in the event of any of them contracting the disease, it may be recognised at an early stage, and thus prompt measures may be taken for preventing its further spread. 3. All houses or rooms and things infected with small-pox should be disinfected under skilled direction, and with as little delay as possible after the removal, convalescence, or death of the patient, and for this provision is made in Sections 59.65 of the Public Health (London) Act, 1891. To secure the disinfection of houses or rooms being properly performed it will be desirable that it should, in as many cases as possible, be done by the servants of the Sanitary Authority, and to the satisfaction of the Medical Officer of Health. Under Section 60 (4) of that Act, temporary shelter or house accommodation is to be provided for the members of any family in which infectious disease has appeared, and who are compelled to leave their dwellings for the purpose of enabling such dwellings to-be disinfected by the Sanitary Authority. The Authority are also required by Section 59 to provide proper premises, with the requisite apparatus and attendance, for disinfection (preferably by steam) of articles (whether bedding, clothing, or other) which have become infected by any dangerous infectious disease. Often it will be better, instead of disinfecting infected articles (such as bedding and clothing), to destroy them ; •In the case of Warwick v. Graham L.R. [1899] 2 Q.B. 191 ; 68 L.J. Q.B. 1001 ; 80 L.T. n.s. 778 ; 63 J.P. 599, where it was proved that a person suffering from a dangerous infectious disorder had proper lodging and accommodation, so far as he himself was concerned, at his father's house, but that he could not be properly isolated, and there would be danger of infection to the other inmates of the house if he remained there, it was held that there was evidence that he was "without proper lodging or accommodation" within the meaning of Section 124 of the Public Health Act, 1875 (corresponding to Section 66 of the Public Health (London) Act, 1891), Mr. Justice Bay remarking that the section referred to is clearly directed not only to the protection of the sick person himself but to the protection of other persons from infection. 28 and the Sanitary Authority have power, under Sections 60 and 61 of the Public Health (London) Act, 1891, to do this, and to make compensation for the articles destroyed. 4. As infectious diseases may be spread by the use of public carriages for the conveyance of the sick, the Sanitary Authority should bear in mind the provisions of Section 70 of the Public Health (London) Act, 1891, and should provide suitable means of disinfecting public vehicles which may have been unwittingly or negligently used for the conveyance of persons suffering from small-pox. 5. The Sanitary Authority should also bear in mind their powers under Section 9 of the Housing of the Working Classes Act, 1885, as to dealing with infectious diseases in any tent, van, shed, or similar structure. 6. Public notice should be given of the penalties to which persons are liable on account of the exposure of small-pox patients, the use without proper precautions of public carriages for the conveyance of persons suffering from small-pox, or of the bodies of those who have died therefrom, the letting of infected houses or rooms, the sale or sending about of infected things, or the throwing into ashpits of infectious rubbish; and proceedings should be taken by the Sanitary Authority in every case in which the provisions with respect to the above matters are disobeyed. (See Public Health (London) Act, 1891, Sections 63-65, 68-70, and 74.) W. H. POWER, Medical Officer. Local Government Board, September, 1901. All the above measures were already being carried out in the City, with the exception of those mentioned in paragraph 6. On this point I advised that such notification was unnecessary and likely to create considerable alarm, which in itself was a source of danger. The whole of the Ward Schools, Infant Schools, Parochial and Private Schools were inspected by your Medical Officer, and the names of all those found to be inefficiently protected were forwarded to the various governing bodies of these Institutions, with a request that they would obtain the parent's consent to re-vaccination, a copy at the same time being sent to the Vaccination Officer. In only one case was any difficulty raised. The result of this inspection was most satisfactory, inasmuch as it showed that only 16.6 per cent, were unvaccinated, or only about half the percentage for the whole Metropolis. 29 The actual figures for the Ward and Parochial Schools were : protected 1,507, unprotected 302, present at the time of inspection. Owing to the vigorous action of the Authorities, 354 vaccinations were performed, so that practically the whole of the scholars may now be considered as immune to Small-pox. The large Public Schools took the matter up, and parents were called upon to have their children protected forthwith. The Board Schools, unhappily, are in a totally different position. Application was made to the London School Board to allow the scholars to be inspected by your Medical Officer, but, unfortunately, this was only allowed in the case of those whose parents did not object, after notice had been sent to them, a course which practically amounted to a suggestion to refuse. The result, as might have been expected, was unsatisfactory. Many of the parents signed without realizing the meaning of the document, this being obviously the case with foreigners, a large proportion of whom were unable to read a circular letter drawn up in English. The results of inspection were as follows :— Present. Inspected. Objected. Unprotected. Gravel Lane Board School 1,135 771 364 46 Swan Street „ - 606 430 176 28 Greystoke Place ,, - 200 140 60 20 Total - - 1,941 1,341 600 94 That is, more than one-third of the parents are represented as objecting even to inspection, while only 7 per cent, of those inspected were found to be unprotected. Obviously the same evil influence extended to the vaccination of those who were found to require, and only 55 of the 94, or 58 per cent., agreed to the operation. The London School Board further declined to allow the Public Vaccinators to make use of the Schools for the purpose of vaccination. It is scarcely possible to conceive any system better calculated to hinder the adoption of the only known preventive of Small-pox than that carried out by the Education Authority of London. In the Artizans' Dwellings there are at present 916 persons living, of whom 388 are under the age of 16; and 19 only unprotected by vaccination. 30 Taking into consideration the special facilities in such dwellings for the spread of Small-pox, from the use in common of staircases, playground, wash-houses, &c., your Medical Officer urged the necessity of vaccination, and it was resolved that in future no persons should be accepted as tenants who were not protected by efficient vaccination and re-vaccination. A system of daily notification of all cases of Small-pox within the Metropolitan area, and the names, addresses, and occupation of all "contacts" was organised by the Incorporated Society of Medical Officers of Health, and has been found of great value. A very large number of such "contacts" are employed in the City, which is therefore exposed to danger of infection to a far greater extent than exists in any other district in the County of London. This naturally entails an enormous amount of work in visiting such persons, urging upon their employers the necessity for protecting their whole staff, and in forwarding the lists of those willing to submit, to the Vaccination Officer. For this purpose the services of a special temporary Inspector were engaged, and, in consequence, by the end of the year 5,848 persons had been re-vaccinated by the Public Vaccinators, in addition to the large numbers operated upon by private practitioners. So far there have been but few cases of Small-pox actually occurring within the City, vide pp. 17 et seq. TUBERCULOSIS. The subject of Tuberculosis has of late years been prominently before the public, and attention has been called to the preventive measures practicable by the community to an extent that must in the near future bring about a considerable and increasing diminution in the terrible toll that this disease still exacts. The direction which must be taken is that of using all means in our power to bring home to the people that the question is, in the main, one for them, and that whatever legislation may be able to effect, and whatever Health Authorities may carry out, the real measures of prevention are those which should be effected in our homes and in our habits. To in some measure place this before the public, the British Conference on Consumption was held in London in July, to which Mr. Alderman Crosby, M.D., and your Medical Officer were appointed as delegates by the Corporation. So valuable and practical were the proceedings, that it seems desirable to report briefly thereon, dealing only with the principal divisions of the subject. Heredity.—It was clearly shown by all who read papers that the influence of heredity may absolutely be ignored as the chief factor in the causation of 31 the disease. With the discovery of the tubercle bacillus came the fact that Phthisis is an infectious disease, and can therefore be combatted on the same lines as other diseases of a like nature. There is no reason why the offspring of tuberculous parents should become tuberculous if proper measures be taken to guard from the risk of infection. The fact that consumption "runs in families" is due to the great risk of home infection, a fact which is well expressed by the saying, "There is more danger in the family house than there is in the family tree." Tuberculous Sputum.—On no one single point was there greater agreement than on the potent influence of the sputa of the tuberculous patient in spreading the disease. Filthy and disgusting as is the practice of indiscriminate expectoration in the streets, and in public conveyances, this is the least objection to it. The pathogenic bacilli are always present in the sputa of infected persons in enormous numbers, and, when dried, are carried into the air, and liable to infect any person who furnishes a suitable soil for their development. The sputa of tuberculous persons must be regarded as the main factor in the spread of the disease, and hence it follows that the loathsome habit should be sternly repressed by special legislation. There seems no reason why one excretion more than another should be freely deposited in our public places, even if healthy ; but, if infected, such deposition should certainly be treated as a crime. Already, in some countries, the offence is so considered, and heavy penalties inflicted upon offenders. Alcoholism and Consumption.—It was also plainly demonstrated that Alcoholism and Tuberculosis are closely allied, and it is now generally admitted that the influence of alcoholism on consumption is a very powerful one, especially in cases where persons lead a sedentary life. Prevalence of the Disease.—As an encouragement to the general movement, it is well to note the fact that the disease has already shown a marked tendency to diminish in every age group in both sexes during the years 1851-1899. Notification.—While compulsory notification is urged by many Authorities, there is still considerable difference of opinion upon the subject. Many towns have already adopted voluntary notification, and with good results. 32 In July voluntary notification was adopted in the City of London, the following circular letter and memorandum of precautions being sent to every medical practitioner:— Corporation of London. Public Health Department, Guildhall, E.C., 10th July, 1901. VOLUNTARY NOTIFICATION OF TUBERCULOSIS. Sir, The Corporation of London has decided to invite all Medical Practitioners in the City to voluntarily notify to the Medical Officer of Health, at the Guildhall, any cases of Phthisis occurring within the City of London, with the object of limiting the danger of infection by means of disinfection of rooms, &c. I am instructed to ask you to co-operate, and to inform you that the fee (2s. 6c?.) payable under the Public Health (London) Act, 1891, for infectious diseases will be paid in respect of any cases of Tuberculosis so notified. The ordinary procedure in such cases will be that on receipt of a notification, the house will be visited, disinfection will be offered and a leaflet (prepared by the Medical Officer of Health) giving simple advice left with the friends. I append a copy of such leaflet for your consideration. I am, Sir, Your obedient Servant, JOHN B. MONCKTON. PRECAUTIONS FOR THE PREVENTION OF INFECTION OF TUBERCULOSIS, OR CONSUMPTION. 1. Consumption is a Contagious disease, and is mainly conveyed from one person to another by means of the dry expectoration, or sputum. 2. No healthy person should be allowed to sleep with a consumptive person. 3. Consumptive persons should live in well-ventilated rooms. 33 4. Such persons should use paper handkerchiefs, into which they can spit, the handkerchiefs being burned before they become dry. 5. Indoors, a spittoon containing a little water should be used. Out of doors, a small spit bottle. Both spittoon and bottle should be cleansed with boiling water. 6. On no account should the filthy practice of spitting in streets, public conveyances or on floors be allowed either for healthy or consumptive persons. 7. Rooms inhabited by consumptive persons should be cleansed with damp dusters and sprinkled with water or damp tea leaves before sweeping. 8. Sunlight and fresh air are the best disinfectants. W. COLLINGRIDGE, Medical Officer of Health for the City of London. Fourteen cases have been notified, and whenever consent could be obtained, the rooms, bedding, &c., of the patient were disinfected by your Staff. Unfortunately, in several instances our good offices were declined, but such cases will become rarer as the public become educated to the advantages attending proper disinfection. But probably to the Corporation, with its large Markets, the most important point discussed was that of the Relation between Human and Bovine Tuberculosis, involving, as it does, the question of the risk of infection from tuberculous meat and milk. Professor Koch, in his paper, stated that he had come to the conclusion, as the result of experiments, that while animal tuberculosis was easily communicable from beast to beast, human tuberculosis was not capable of being so conveyed, and that, further, from indirect evidence, he was unable to accept the possibility of infection of man from animals. The evidence given in support of this latter position at present appears, to most scientists, as inconclusive and unsatisfactory. His argument is that milk and butter often contain large numbers of bacilli, and that if these were capable of conveying the disease (as is generally believed) the majority of cases in children would take the form of primary tuberculosis of the intestine, and that, as a matter of fact, this is comparatively rare (Koch). Further, as cattle (according to the Professor) cannot be infected by human tubercle, it is possible to determine whether bacilli found in a deceased tuberculous person are human or bovine simply by injecting them into cattle. 34 He concluded by stating that, while it may not yet be decided that man is absolutely immune to bovine tuberculosis, yet the susceptibility is so slight that it is not worth while to take any measures of prevention. Practically, in this country Professor Koch has at present no adherents, and, while it is generally admitted that his opinion demands respect and enquiry, there must be no relaxation of our present precautions until the question has been definitely settled. While the figures of the City Veterinary Inspector show that out of 500 cows examined after slaughter 46.8 per cent, were tuberculous*, it would be folly to accept the views of Koch without absolute confirmation. The Government wisely decided to thoroughly investigate the matter, and a Royal Commission was appointed to inquire and report whether tuberculosis in animals and man is one and the same disease; whether animals and man can be reciprocally infected with it; under what conditions, if at all, the transmission of the disease from animals to man takes place, and what are the circumstances favourable or unfavourable to such transmission. The great defect in all our legislation dealing with unsound or diseased meat is that the onus of detecting it rests upon the Sanitary Authority, and that at present therefore it can only be thoroughly carried out in large markets where a staff of skilled inspectors can be kept. If all meat were compelled to be inspected before being removed from the slaughterhouse, it would tend to prevent the possibility of diseased meat finding its way into consumption, and would eventually lead to the desirable result of having all cattle intended for food of man killed in public slaughterhouses under municipal control. The following Circular Letter, issued by the Local Government Board in September, defines the existing position, and strengthens the hands of the Corporation by confirming its present procedure:— Circular. TUBERCULOSIS. Local Government Board, Whitehall, S.W., 6th September, 1901. Sir, I am directed by the Local Government Board to state that at the recent Congress on Tuberculosis Professor Koch called in question the correctness of the opinion that tuberculosis can be transmitted from animals to man. The views expressed by Professor Koch on this subject have not received the general assent of scientific men; but, having regard to the great * Vide Report presented to the Cattle Markets Committee, 10th April, 1902. 35 importance of the matter, His Majesty's Government have thought it right to accede to a request made by the Congress that there should be an inquiry with respect to it. A Royal Commission has accordingly been appointed to inquire and report whether tuberculosis in animals and man is one and the same disease; whether animals and man can be reciprocally infected with it; under what conditions, if at all, the transmission of the disease from animals to man takes place; and what are the circumstances favourable or unfavourable to such transmission. The Board are desirous, however, of impressing upon the local authorities concerned that pending the investigations and report of the Royal Commission there should be no relaxation on their part or on that of their officers in the taking of proper measures for dealing with milk from tuberculous cows and with tuberculous meat which may be intended for the food of man. It is, in the opinion of the Board, of much importance that these measures should continue to be taken, and they rely on this being done. At the same time the Board may observe that representations have been made to them to the effect that the action of the officers of local authorities in the seizing of tuberculous meat is not uniform. The Royal Commission on Tuberculosis, in the report which they made in 1898, referred to the degree of tubercular disease which should cause a carcase, or part thereof, to be seized. They stated as follows:— "We are of opinion that the following principles should be observed in the inspection of tuberculous carcases of cattle:— (a) When there is miliary tuberculosis of both lungs (b) When tuberculous lesions are present on the pleura and peritoneum The entire carcase and all the organs may be seized. (c) When tuberculous lesions are present in the muscular system, or in the lymphatic glands embedded in or between the muscles (d) When tuberculous lesions exist in any part of an emaciated carcase The entire carcase and all the organs may be seized. (а) When the lesions are confined to the lungs and the thoracic lymphatic glands (b) When the lesions are confined to the liver (c) When the lesions are confined to the pharyngeal lymphatic glands (d) When the lesions are confined to any combination of the foregoing, but are collectively small in extent The carcase, if otherwise healthy, shall not be condemned, but every part of it containing tuberculous lesions shall be seized. 36 "In view of the greater tendency to generalisation of tuberculosis in the pig, we consider that the presence of tubercular deposit in any degree should involve seizure of the whole carcase and of the organs. "In respect of foreign dead meat, seizure shall ensue in every case where the pleura have been ' stripped.' " The Board drew attention to this matter in the circular letters which they addressed to the Councils of Boroughs and Urban and Rural Districts on the 11th March, 1899, and they desire again to refer to it and strongly to urge upon the Council to direct those of their officers who are employed as Meat Inspectors to act in accordance with the principles laid down by the Royal Commission. It is also of much importance that a person who is to act as a Meat Inspector should possess proper qualifications for the office. He should, as was pointed out by the Royal Commission, be acquainted with— (a) The law of meat inspection. (b) The names and situations of the organs of the body. (c) Signs of health and disease in animals destined for food, both when alive and after slaughter. (d) The appearance and character of fresh meat, organs, fat and blood, and the conditions rendering them, or preparations from them, fit or unfit for human food. The Board trust that in making appointments of officers on whom will devolve the duty of acting as Meat Inspectors, the Council will satisfy themselves that the person appointed possesses adequate knowledge on these subjects. The Board may at the same time draw attention to Article 19 (7) of their General Order of the 23rd March, 1891, with respect to the duties of an Inspector of Nuisances in relation to the inspection and seizure of meat. There is a similar provision in Article 19 (6) of the Order in force in London, viz., the Sanitary Officers (London) Order, 1891. Any Inspector of Nuisances or Sanitary Inspector to whom either of these Orders applies is required in any case of doubt in connection with the inspection and seizure of meat to report the matter to the Medical Officer of Health, with the view of obtaining his advice thereon. The Board think it desirable that any such Inspector of Nuisances or Sanitary Inspector should be reminded of his duty in this respect. 37 ARTIZANS' DWELLINGS, HOUNDSDITCH. These buildings, erected by the late Commissioners of Sewers during 1884-1885, were opened in January of the latter year. . They stand upon ground formerly the site of Mount Court, Wood Green Court, Ebenezar Square, Meeting House Yard, Angel Court, Coak's Buildings, George Court, and Petticoat Square, in the Ward of Portsoken. There are five "blocks," severally named King's—Queen's—Prince's— North—and South, of dwellings, designed for occupation by persons of the artizan class. Some of the ground floors are let as shops. Exclusive of the shops and cellars, they contain 539 rooms, arranged in 260 tenements, and are occupied by 916 persons. Fifty-eight per cent. are adults and forty-two per cent. children (under 16 years). The total cost of the buildings and land upon which they stand was £202,242, which are now maintained at an annual expenditure of about £1,850. The income derived from letting the tenements is £5,550, being 1.83 per cent. interest on the capital outlay. They are much sought after, and the rooms are rarely empty. The rent varies from 4s. 6d. to 9s. per week. The death rate for 1901 was 14.2 per 1,000 per annum [of which 53.8 per cent. was of children under 5 years of age]. Deaths of children under one year to 1,000 births were 224, as against 160 for the City generally. The number of births was 31, viz.:16 males and 15 females. The birth rate has fallen from 38.4 in 1900 to 33.8 in 1901; being again much below the average for the previous five years, viz., 41.2 per 1,000 per annum. There has only been one illegitimate birth in these buildings since 1894, a fact that speaks well for the morality of the inhabitants, who are mostly Jews. 38 ARTIZANS' DWELLINGS, STONEY LANE. Vital Statistics 1901, compared with previous five years. YEAR. Death rate per 1,000. Deaths of children under 5 years of age. Deaths of children under 5 years of age per 1,000 births. Birth rate per 1,000. Number of illegitimate children born in the Buildings. Deaths from Infectious Diseases. 1896 11.2 Per cent. 60.0 40 46.9 Nil. 2 (Measles) 1897 16.9 27.8 93 40.3 Nil. 2 1898 8.4 66.6 65 43.1 1* 1 (Measles) 1899 15.0 18.8 75 37.5 Nil. 1(Whooping Cough) 1900 17.8 52.6 146 38.4 Nil. 1 (Scarlet Fever) Average for previous five years. 13.8 45.1 84 41.2 — 1.4 1901 14.2 53.8 226 33.8 Nil. 1 (Puerperal (Septicaemia) * The mother is reported to have been of weak intellect, and a mere child. 1901. NAME OF BLOCK. North. South. King's- Queen's. Prince's. Total. Number of Births 11 4 5 7 4 31 Number of Deaths 4 4 1 3 1 13 Deaths of Children under five years of age 1 3 — 2 1 7 Deaths of Children under one year of age 1 1 — 2 1 5 Number of illegitimate Children born - - - - - Nil. Deaths from Infectious Diseases — — 1 — — 1 Your Medical Officer reported on several serious sanitary defects in connection with these dwellings. At the time these were erected, nearly twenty years ago, the sanitary fittings were of the most approved type at that day, but during the period that has elapsed much experience has been gained, and the fittings now in use have become obsolete and unfitted for the purpose. They are insanitary in themselves, and it is, moreover, impossible to keep them clean and in decent condition. It has been decided to remove all the existing water-closets, and replace them by others of a modern pattern. There is, further, no provision for baths—a most serious defect. People of the class inhabiting these dwellings should certainly have every inducement to keep themselves clean, and while it is not needful to supply every flat with a bath (which would practically mean rebuilding), it is perfectly feasible to supply a certain number of baths, to be under the charge of an attendant, and available for each family in rotation. Plans have been prepared by the Engineer, approved by the Committee, and are now before the Court for sanction. City of London. Table of BIRTHS OCCURRING AT THE ARTIZANS' DWELLINGS, STONEY LANE, HOUNDSDITCH, DURING THE YEAR 1901, to which are added the DEATHS registered during the same period classified according to Diseases, Ages, and Localities. Name of Block. Births. mortality from all causes at subjoined aces. Mortality from subjoined Causes, distinguishing Deaths of Children under Five Years of Age. At all ages. under 1 year. 1 and under 5 5 and under 15 15 and under 25 25 and under 60 60 and upwards. Small-pox. Scarlatina. Diphtheria. Membranous Group. Fevers. Cholera. Erysipelas. Measles. Whooping Cough. Diarrhoea and Dysentery. Rheumatic Fever. Ague. Phthisis. Bronchitis, Pneumonia, and Pleurisy. Heart Disease. Violent Deaths. Injuries. All other Diseases. Totals. Typhus. Enteric or Typhoid. Continued. Relapsing. Puerperal. Male. Female. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. NORTH BLOCK 6 5 4 1 ... ... ... 1 2 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 4 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 3 SOUTH 4 ... 4 1 2 ... ... ... 1 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 2 3 4 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 KING's „ 1 4 1 ... ... ... ... 1 ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 5 upwds. ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 QUEEN'S „ 2 5 3 2 ... ... ... ... 1 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 3 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 PRINCE'S „ 3 1 1 1 ... ... ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... TOTALS 16 15 13 5 2 ... ... 2 4 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 5 7 13 5 upwds. ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... 4 6 40 DISINFECTION, &c., AT CITY MORTUARY. 5,527 articles of bedding, clothing, furniture, &c., were received at Golden Lane and disinfected. 111 bodies were received at the Mortuary, pending interment; the number for the three preceding years being 108, 102, 298. Number of Articles disinfected, bodies received at the Mortuary, and Inquests held at the Coroner's Court in the City during 1901, compared with the average for the previous five years. Year. Articles of Bedding, &c., disinfected. Bodies received at the Mortuary. Inquests held on bodies. Inquests held on Fires. 1896 6,055 94 61 2 1897 5,075 131 68 3 1898 5,349 108 59 2 1899 9,175 102 49 Nil. 1900 4,100 98 61 Nil. Average for previous five years 5,951 107 59 1.4 1901 5,527 111 77 1 POST-MORTEM ROOM. The Post-mortem Room at the City Mortuary, erected nearly twenty-five years ago, having become obsolete and unfitted for the purpose, I submitted plans for its re-organisation. These involved the tiling of the walls, relaying the floor with Mosaic paving, providing new Post-mortem table, slabs, weighing apparatus, hot-water supply, sinks, &c. These were sanctioned, and carried out by the Engineer. There now only remains the addition of the electric light to bring the Post-mortem fully up to modern requirements. Sundry alterations and improvements were at the same time carried out in the Coroner's Office and Court. DISINFECTANTS. No less than 55,288 gallons of disinfectants (including 765 gallons in stock at the end of 1900) were manufactured at Golden Lane, and distributed for various purposes throughout the City. 41 SANITARY INSPECTIONS. The following is a Statement of the work of the Sanitary Inspectors in their several Districts during each month of the year :— WEST DISTRICT. (Inspector - - F. J. Robbins.) Date of Report. Premises Inspected. Orders Issued. Notices served. Works completed. January 419 24 25 35 February March 257 3 61 27 April . 268 1 164 12 May 356 5 4 38 June 402 4 35 107 July 190 25 29 45 August 240 7 33 32 September October 206 19 21 19 November 248 16 33 22 December 286 23 33 29 Totals 2,872 127 438 366 MIDDLE DISTRICT. (Inspector - - E. J. Simmons.) Date of Report. Premises inspected. Orders issued. Notices served. Works completed. January 302 42 21 47 February March 175 8 51 15 April 122 8 20 9 May 261 10 26 41 June 348 25 37 43 July 183 10 39 40 August 416 19 41 61 September October 269 18 53 34 November 264 18 31 41 December 287 27 52 47 Totals 2,627 185 371 378 42 EAST DISTRICT. (Inspector - - W. H. Ralph.) Date of Report. Premises inspected. Orders issued. Notices served. Works completed. January 342 37 25 54 February March 205 16 30 25 April 293 13 146 19 May 455 9 26 80 June 417 13 14 97 July 271 20 33 39 August 524 14 48 77 September October 305 22 29 28 November 413 37 37 29 December 404 44 69 27 Totals 3,629 225 457 475 The foregoing are summarised as under:— District. Number of Inspections made. Orders issued. Notices served. Improvements effected. West 2,872 127 438 366 Middle 2,627 185 371 378 East 3,629 225 457 475 Special 708 2 20 160 Totals 9,836 539 1,286 1,379 43 Sanitary Inspections During 1901, compared with previous five years. Year. Inspections made. Sanitary Improvements effected. Notices served. 1896 9,410 1,278 947 1897 8,733 1,109 944 1898 7,444 1,141 1,221 1899 8,087 1,470 1,397 1900 9,221 1,447 1,125 Average previous five years ... 8,579 1,289 1,127 1901 9,836 1,379 1,286 Compared with last year, the figures for 1901 show an increase of 615 in the number of inspections made, while the number of "Notices served" and "improvements effected " are above the average. Full details of this and every other branch of departmental work are laid before each meeting of the Sanitary Committee. INSANITARY DWELLINGS. 1 and 2, Sandy's Row, Middlesex Street, 3, 4, 5 and 6, Heneage Lane, Aldgate.—Condemned on 27th February, 1900; reported pulled down in June, 1901. 2, 3 and 4, Three Herring Court, Redcross Street.—Condemned on 18th July, 1901; reported demolished 19th September, 1901. 4 and 5, Beech Street, Barbican, and 18, 20 and 22, Fann Street.— Notice having been served to effect extensive repairs, the several owners pulled down the houses rather than comply with the Sanitary Committee's requirements, which would have involved more expenditure than the property was worth. 13 and 15, Moor Lane.—In this case the owners failed to comply with an order to abate a nuisance caused by a defective drain, and were summoned at the Guildhall Justice Room, where the offence having been proved, a fine of 10Z. and 21. 2s. costs was imposed, and an order made to abate the nuisance within fourteen days. 44 HOUSE REFUSE REMOVAL. The Superintendent of Cleansing reports that the refuse removed from the City in 1901 consisted of 30,115 cartloads of street sweepings and slop, and 44,975 loads of house and trade refuse; total, 75,090. Of this bulk, 22,657 loads were consumed by the Destructor at Letts' Wharf, being 1.9 per cent. below the average for the previous five years. Refuse Dealt with during 1901 and previous Five Years. Year. Street Sweepings and slop. House and Trade Refuse. Total. No. of Loads Cremated in Destructor. Per Cent. Cremated. Loads. Loads. Loads. 1896 29,943 43,341 73,284 24,285 33.1 1897 30,065 43,725 73,790 23,750 32.2 1898 29,745 43,960 73,705 23,836 32.3 1899 29,577 45,044 74,621 22,481 30.1 1900 28,708 44,841 73,549 24,121 32.8 Average of previous five years: 29,607 44,182 73,789 23,694 32.1 1901 30,115 44,975 75,090 22,657 30.2 TENEMENT HOUSES. The houses let in lodgings or occupied by members of more than one family have been re-surveyed. Those now on the Register are:— District. No. of Houses on Register. No. of Lodgers. No. of Tenements. Average No. of Persons per Tenement. Sanitary Notices Served. West 195 1,535 676 2.27 302 Middle 50 .338 113 2.90 124 East 158 1,183 494 2.39 247 Total 403 3,056 1,283 2.38 673 The houses in question are frequently inspected, and in April of each year their owners called upon to undertake a thorough cleansing of them, in accordance with the provisions of your Bye-laws. This necessitated the service of a total of 673 Notices [or, 302, 124, and 247 during the year, in the West, Middle, and East Districts respectively]. 45 In addition to the foregoing there are eleven Blocks of dwellings let out in tenements, but not placed on the Register for the reason that each holding is "self-contained," it having been decided in a Court of Law that under these circumstances they are not subject to the Bye-laws for houses let in lodgings, or occupied by members of more than one family:— Situation. No. of Tenements. No. of Inhabitants. "Artizans Dwellings," Stoney Lane, Houndsditch 260 1,066 Nos. 21 and 22, Albion Buildings, Bartholomew Close 20 66 Bartholomew House, Cloth Fair 17 47 Barker's Buildings, Catherine Wheel Alley 24 71 Blomfield House Buildings, King Street, Snow Hill 24 82 Bridgewater House, Fann Street 12 50 City Buildings, Moor Lane 31 111 Dean Street, Fetter Lane 37 113 St. Ann's Chambers, Broadway 41 107 Nos. 1 and 2, Fleur-de-Lis Court, Carter Lane 3 8 Nos. 1 and 2, Took's Court, Furnival Street. 12 48 Total 481 2,769 Average number of persons to each tenement, 5.75. TENEMENT HOUSES. Closed or Demolished during 1901. WEST DISTRICT. No. 49, Fetter Lane 1 No. 144, do. 1 Nos. 1 to 35, Bull Inn Chambers, Holborn 35 Total 37 MIDDLE DISTRICT. Nos. 18, 20 and 22, Fann Street 3 No. 10, Hare Court, Aldersgate 1 Nos. 2, 3, and 4, Three Herring Court, Redcross Street 3 Nos. 4 and 5, Beech Street 2 Total 9 EAST DISTRICT. Nos. 3, 4, 5 and 6, Heneage Lane 4 Nos, 1 and 2, Sandy's Row 2 Total 6 A full list of Tenement Houses still on the Register is given in the Appendix. 46 FACTORY AND WORKSHOP ACT, 1901. This Act received the Royal Assent on the 17th August, and came into force on the 1st January, 1902. It was initiated by the Government with a view of consolidating with amendments the numerous Factory and Workshop Acts now in force, and will doubtless prove a useful piece of legislation. The Bill is divided into ten parts, with sub-headings to each as under, viz.: — Part 1 deals with " Health and Safety "— (1) Health. (2) Safety. (3) Accidents. Part 2 deals with " Employment." (1) Hours and Holidays. (2) Special exception as to hours and holidays, including overtime, night work, and intermittent employment. (3) Fitness for employment. Part 3 deals with "Education of Children." Part 4 deals with "Dangerous and Unhealthy Industries"— (1) Special provisions. (2) Regulation for dangerous trades. Part 5 deals with "Special Modifications and Extension"— (1) Tenement factories. (2) Cotton, cloth, and other humid factories. (3) Bakehouses. (4) Laundries. (5) Docks. (6) Buildings. (7) Railways. Part 6 deals with "Home Work." Part 7 deals with "Particulars of Work and Wages." Part 8 deals with "Administration "— (1) Inspection. (2) Certifying surgeons. (3) Local Authorities. (4) Special orders. (5) Notices, registers, and returns—miscellaneous provisions 47 Part 9 deals with " Legal Proceedings." Part 10 is supplementary, dealing with— (1) Application and definitions. (2) Application of the Act to Scotland and Ireland. (3) Repeal of existing Acts, &c. There are six Schedules that apply to the following subjects, viz.:— 1. Provisions as to arbitrations. 2. Factories and workshops in which overtime is allowed. 3. Regulations as to grinding in tenement factories. 4. Cotton, cloth factories. Table showing the maximum limit of humidity of the atmosphere allowed at given temperatures. 5. Fee of certifying surgeons. 6. List of factories and workshops. Part 1. Non-textile factories. Part 2. Non-textile factories and workshops. The foregoing will give a general idea of the scope of the new Act. As in former statutes dealing with similar subjects, it contains many sections dealing with questions of sanitation, the administration of which will be carried out by your Medical Officer of Health and Sanitary Inspectors. This Act will obviously add very seriously to the work and responsibilities of your Medical Officer and Inspectors, and I propose shortly to submit a Report calling attention to these in detail, and advising as to the increase of of staff required for the purpose. The first point to consider will undoubtedly be the compilation of the register of workshops and workplaces within the City, and to this, in the first place, the attention of your officers must be directed. A list has been obtained from His Majesty's Inspectors and special registers prepared. Each of these places must be visited, inspected, measured, and all sanitary conditions noted, and duly entered in the register. The length of time which this will require must depend upon the staff available, but I am of opinion that it would be reasonable to expect it to be completed within the next two years. This systematic house-to-house inspection has already been commenced, and fair progress made therein. 48 In September I reported as follows:— An analysis of the work already done shows that women only were employed in 39 per cent. of the workshops, while no less than 72 per cent. of the total number of workers employed in these houses were women. WOMAN SANITARY INSPECTOR. A consideration of these facts has led me to the conclusion that the time has arrived when it would be well to follow the practice now adopted by many of the leading towns in this country and employ female inspectors to supplement the work of the existing staff. The employment of women for this purpose was, in the past, looked upon by local authorities with some misgiving, but the test of experience has shown that the originators of the proposal were justified in advocating the system. It is obvious that there are many questions in connection with the sanitary surroundings of female workers in factories that can only be properly investigated by one of their own sex ; moreover, the legislature has of late years insisted upon the observance of many regulations in places where women are engaged which men are ill-fitted to conveniently control. The figures quoted above emphasise the necessity for a further new departure in the methods of inspection of factories and workshops now obtaining in the City of London, and I therefore recommend the immediate appointment of at least one duly qualified woman sanitary inspector. The duties of the person appointed should be entirely separate from the work done by your male officers, and her part would be strictly confined to visiting those establishments where women are employed, and any question involving structural alterations or drainage work would be dealt with by the Sanitary Inspector of the District. It has been found advisable that women chosen for such an office should hold a statutory qualification as Sanitary Inspectors and be duly appointed as such under the Public Health (London) Act, 1891, for the purpose of acquiring the "right of entry," and power to serve preliminary notices, and sign certificates in case of dirty workrooms. The following Metropolitan Boroughs have already appointed such Officers: Kensington, St. Pancras, Islington, Hackney, St. George the Martyr, and Battersea. In the three first-mentioned, the women inspectors' duties are confined to places where females are employed at work; in Hackney they have, in addition, to visit the houses of out-workers; in St. George the Martyr they 49 inspect houses registered under the bye-laws for houses let in lodgings, in addition to visiting workshops where women are employed; while in Battersea they visit schools and laundries, and other places where females are employed. From inquiries made in the Provinces, I learn that Nottingham has appointed a woman inspector for workshops, Salford has six, while Birmingham has no less than eight "Health Visitors." Liverpool, again, has eight women inspectors for house-to-house visitation and workshops where women are employed, and Sheffield has also two women sanitary inspectors. In order to illustrate the advantage accruing from such appointments, 1 cannot do better than direct your attention to Dr. Orme Dudfield's experience in Kensington, where the employment of women started eight years ago has been found an unqualified success. This is referred to in the Minority Report of the Labour Commission, where the signatories made the following recommendation:— "That the number of women factory inspectors should be increased, "and that local authorities might advantageously be urged by "the Local Government Board to follow the example of the "Kensington Vestry in appointing women sanitary inspectors "with the special object of enforcing the Sanitary Law in "women's workshops." That the Local Government Board has adopted this view, and encourages such appointments, is shown by their approval of those officers already selected for such work in the several places referred to in these observations. A further reason for the employment of women inspectors may be advanced in view of the fact that the number of girls employed in offices in the City for type-writing and clerical work is constantly increasing. Very many of these are well-born, delicately nurtured ladies, forced by circumstances to earn their own living, who would naturally shrink from discussing with a man details of matters affecting their sanitary welfare. Moreover, it would be advantageous to employ women instead of male inspectors for the purpose of reporting from time to time upon the condition of the sanitary accommodation provided for women in the large number of railway stations and ladies' refreshment rooms throughout the City. This Report was approved of by your Worshipful Committee, and the appointment of a woman sanitary inspector was sanctioned by the Court. The following amplified list of duties drawn up by your Committee has been submitted to the Local Government Board, and approved:— (1.)—She shall perform, either under the special directions of the Sanitary Authority, or (so far as authorised by the Sanitary Authority) under the 50 directions of the Medical Officer of Health (or, in cases where no such directions are imposed upon a Sanitary Inspector by any Statute or Statutes, or by the Orders issued by the Local Government Board, so far as the same apply to her office). (2.)—She shall attend all Meetings of the Sanitary Authority when so required. (3.)—She shall by inspection of her district, both systematically at certain periods, and at intervals as occasion may require, keep herself informed in respect of the nuisances existing therein that require abatement. (4.)—On receiving notice of the existence of any nuisance within her district, or of the breach of any bye-laws or regulations made by the Sanitary Authority for the suppression of nuisances, or of any bye-laws made by the London County Council which it is the duty of the Sanitary Authority to enforce, she shall, as early as practicable, visit the spot, and inquire into such alleged nuisance or breach of bye-laws or regulations. (5.)—Whenever it appears to her that the intervention of the Medical Officer of Health is necessary in connection with any nuisance, she shall forthwith inform such officer thereof. She shall also, subject to the directions of the Sanitary Authority, attend to the instructions of the Medical Officer of Health with respect to any measures which can be lawfully taken by a Sanitary Inspector under the Public Health (London) Act, 1891, or under other Statute or Statutes. (6.)—She shall enter from day to day, in a book to be provided by the Sanitary Authority, particulars of her inspections and of the action taken by her in the execution of her duties. She shall also keep a book or books, to be provided by the Sanitary Authority, so arranged as to form, as far as possible, a continuous record of the sanitary condition of each of the premises in respect of which any action has been taken under the Public Health (London) Act, 1891, or under any other Statute or Statutes, and shall keep any other systematic records that the Sanitary Authority may require. (7.)—She shall at all reasonable times, when applied to by the Medical Officer of Health, produce to him her books, or any of them, and render to him such information as she may be able to furnish with respect to any matter to which the duties of Sanitary Inspector relate. (8.)—She shall, if directed by the Sanitary Authority to do so, superintend and see to the due execution of all works which may be undertaken under their directions for the suppression or removal of nuisances within her district. (9.)—In matters not specifically provided for in the Sanitary Officers (London) Order, 1891, she shall observe and execute any instructions issued by the Local Government Board, and the lawful orders and directions of the Sanitary Authority applicable to her office. 51 (10.)—She shall, under the direction of the Sanitary Authority, carry out any special duties which may be required in connection with workshops, laundries, and other places where female labour is employed. In September a systematic inspection of workshops and workplaces in the City was initiated on my suggestion in anticipation of the requirements of 1901, and as a result, 745 workrooms were inspected, measured, &c., involving some 1,190 inspections (including re-inspections). In 73 cases workrooms were found to need cleansing, whitewashing, &c., and on my certificate these were ordered to be cleansed and purified as was found necessary. Numerous defects of a structural character were also discovered, and the owners or occupiers called upon to provide a remedy, but as this work was not completed during the year, the subject will be further dealt with in my next Annual Report. DEFECTS IN FACTORIES AND WORKSHOPS NOTIFIED BY H.M. INSPECTOR OF FACTORIES. The following are the particulars of defects found in factories and workshops, and reported to me by H.M. Inspectors; also the steps taken by my Department to effect improvement. Fifty-one cases were thus notified in the course of the year, compared with forty-nine in 1900, fifty-five in 1899, sixty-five in 1898, and thirty-four in 1897, distributed as under:— Situation of Premises. Result of action taken. 18, Albion Buildings Walls and ceilings cleansed and whitewashed. Playhouse Yard (McKinley and Co.) Separate w.c. accommodation provided. 5, Paternoster Buildings Defect in soil pipe remedied. 31, King Street Workroom cleansed. 35a, King Street Walls and ceilings of workroom cleansed and whitewashed. 21, Castle Street Workshop cleansed. 5a, Heneage Lane Two workshops cleansed. 2, Fetter Lane Workshop cleansed and whitewashed and pan of w.c. cleansed. 5, Old Bailey No cause of complaint at time of visit; workrooms ventilated. 29, Fetter Lane Walls and ceilings cleansed and whitewashed. 15, Carter Lane Workshops cleansed. 52 Situation of Premises. Result of action taken. 8-10, Golden Lane Workshops and staircase cleansed. 21, Paper Street Walls and ceilings cleansed. 6, Ludgate Square Workshops cleansed and whitewashed. 11, Bread Street Hill One additional w.c. provided for females. B Block, Dean Street Washhouse cleansed and whitewashed. 1, Three Falcon Court Workroom cleansed and whitewashed. 48, Jewin Street Workrooms cleansed and whitewashed and roof repaired. 6, Manchester Avenue Walls and ceilings cleansed and whitewashed and new w.c. constructed. 18, Bridgewater Square Workshop limewashed. 22, Bishopsgate Street Without Female employes discharged. 37, Primrose Street Additional w.c. provided. 48, Old Bailey Workroom ventilated. 3, Hutchison Street Roof repaired and w.c. supplied with water. 196, Aldersgate Street Workroom cleansed. Bouverie Street ("Black and White," Ltd.). w.c's and urinals cleansed and repaired and ventilation of w.o's improved. 19 and 20, Old Bailey Flushing apparatus to w.c. repaired. 119, Minories.Two workrooms cleansed, whitewashed, &c. 46, Knightrider Street Additional w.c. for females provided; walls and ceilings of workroom cleansed. 5, Lovell's Court Walls and ceilings of workshop cleansed and whitewashed. 16, Whitecross Street Flushing cistern to w.c. repaired. 19 and 20, Aldgate w.c., third floor, provided for men only, and w.c., fourth floor, for women only. 1-3, Golden Lane Drain tested—no defect revealed. 16, Aldgate Avenue (Room 54) Workroom cleansed and whitewashed. 39^, Fetter Lane Premises could not be found; H. M. Factory Inspector informed. 110, Cheapside Separate w.c. accommodation provided for females. I, Aldgate Avenue w.c. accommodation improved. 93, Aldersgate Street Tailoring Co.). (American Gas stove removed. 93, Aldersgate Street (H. Braliam and Co.). Iron hood tixed over gas stove. 139, Fleet Street Three new w.c's provided for men. 22, Australian Avenue Walls and ceilings of workrooms, w.c's and staircase on third and fourth floors cleansed and whitewashed. 38, Barbican w.c. cleansed. 75, Little Britain Walls and ceilings of workshops cleansed, &c., roof repaired and w.c. cleansed. 19, Castle Street Workroom on third floor cleansed; w.c. ventilated. 48, Knightrider Street w.c. reconstructed and ventilated; drain relaid, trapped and ventilated. 11, Hare Court Walls and ceilings of workshop cleansed. 96, Newgate Street Walls and ceilings of six rooms on third floor cleansed. 14, Giltspur Street w.c. repaired and walls and ceilings of workshop cleansed. 14, Knightrider Street w.c's cleansed and flushing apparatus repaired ; partition between male and female w.c's re-constructed. 65, Moorgate Street Walls and ceilings of workrooms on second and third floors cleansed and whitewashed. Sadler's Buildings, Fann Street Premises in Holborn—complaint forwarded. 53 SANITARY CONVENIENCES IN WORKSHOPS. On the 14th June, a Notice was received from the Home Office Inspector that a workshop where three women were employed was without separate closet accommodation. The workshop was visited by your Medical Officer, and Notice served in accordance with the Act. The owner dismissed the only actual woman worker, but questioned the right to compel the provision of accommodation for the two other women, who were not constantly employed upon the premises, being mainly engaged in collecting accounts, &c. This was reported to the Home Office Inspector, who relying upon the case of Bennet v. Harding, contended that separate accommodation should still be provided. [In the case alluded to, it was held that stables with a stable-yard were "a workplace'' within the meaning of section 38 of the Public Health (London) Act, 1891, and that the cab drivers were "in attendance" there although they were there as customers, and that sanitary conveniences must be provided for them.] The owner stated that he had endeavoured to arrange this with his landlord, but failed. He also offered to pay his clerk and collector the expense of using a public lavatory, otherwise he would have been compelled to dismiss them both in order to comply with the law. This is an instance of how the law, if pressed, would have absolutely defeated its own purpose, and I therefore submitted the facts for the consideration of the Sanitary Committee. Personally I was of opinion that the owner's position was a hard one, and that his offer should be accepted, and the Home Office notified accordingly, and this view was confirmed, on consideration of the facts. Another case of a similar character occurred in the same sanitary district. In this instance, the landlords, a large Railway Company, declined to spend the money for the necessary alterations on the ground that the cost would be prohibitive, and the tenants were reluctantly compelled to discharge two female employés. BAKEHOUSES. The Bakehouses, which are workshops under the Factory Acts, have been duly inspected and found generally to be in fair condition as regards cleanliness, &c. A more detailed examination is now needed, as after January, 1904, no underground Bakehouse will be permitted to be used as such unless a certificate of fitness is first obtained from the Corporation, in accordance with the Factory and Workshop Act, 1901. Of the 41 Bakehouses existing, 34 are situated underground, that is to say, the floor is more than 3 feet below the surface of the ground adjacent. (See diagram.) Possibly additions may have to be made to the list of Bakehouses, as the Act includes the manufacture of biscuits, confectionery, &c., as well as bread. 54 The following is a list of the Bakehouses in existence, in the City, during 1901:— Ref. No. in Diagram. Situation. No. of Bakehouses. 1 188, Aldersgate Street 1 2 26, Aldgate High Street 1 3 107, Bishopsgate Street Within 1 4 81, ditto Without 1 5 90, ditto ditto 1 6 59 to 61, ditto ditto 4 7 4, Broadway 1 8 95, Cannon Street 1 9 8, Copthall Avenue 1 10 15, Duke Street 1 11 28, Fore Street 1 12 85, ditto 1 13 67, Farringdon Street 1 14 88, ditto 1 15 93, Fetter Lane 1 16 12, Gracechurch Street 1 17 9 and 10, Hart Street 1 18 21, Holborn 1 19 16, Ludgate Hill 1 20 18, Long Lane 1 21 37, Middlesex Street 1 22 61, ditto 1 23 63, ditto 1 24 85, ditto 1 25 28, New Broad Street 1 26 31, Newbury Street 1 27 3, Pancras Lane 1 28 7, Sparrow Corner 1 29 21 (late 10), Stoney Lane 1 30 68, St. Mary Axe 1 31 112, Shoe Lane 1 32 75, St. Paul's Churchyard 1 33 194, Upper Thames Street 1 34 13, Widegate Street 1 35 31, ditto 1 36 25, Warwick Lane 1 37 5, Whitefriars Street 1 38 8, Lambeth Hill 1 Total number of Bakehouses existing 41 Tho Bakehouses at the following premises have ceased to be used as such :— 5, Middlesex Street. 81, Minories. 42, Fish Street Hill. 48, Beech Street. 35 to 38, New Bridge Street. City of London 1901. BAKEHOUSES Diagram showing positions of floor & ceiling with respect to the foot way level. NOTE. An "Underg round" Bakehouse is defined by Sec 101 of the Factory & Workshop Act 1901. The dotted line A---A indicates the "3 feet limit " below footway &c. The floor of any Bakehouse below this line is therefore an underground Bakehouse under the Act. † See list of Bakehouses page, 54. No. of Underground Bakehouses, 34 (Coloured Pink) ,, ,, Bakehouses above ground, 7 (Coloured Blue) Total 41 55 THE DISINFECTION OF PUBLIC ROADWAYS. The systematic washing and cleansing of streets is an important factor in the preservation of the public health. Owing to the enormous traffic in the City, this cannot be continuous, but must be carried out in accordance with the conditions obtaining. The addition to the water used for flushing and washing the sides of the streets of a cheap, but effective, disinfectant and deodorizer, is of great benefit. After many experiments it was found that a mixture of a soluble form of creosote was the most suitable material to use, and during the hot weather this was sent out in a concentrated form with every water cart, the charges being made up in tin cans carried on the top of the cart. The result was most satisfactory. The roadways remained damp for a much longer period, and thus less dust was evident, while at the same time for the usual unpleasant smell of horse droppings, and other decomposing organic matter, was substituted the pleasant odour of creosote. The cost was exceedingly small, amounting only to £88 16s. for the year. LEADENHALL MARKET. During the hot weather in August and September complaints were made as to the offensive smells in the Market generally. On investigation it was found that some amount of nuisance was caused by the late removal of refuse and offal, and the irregularity of removal of fat, bones, &c., by the contractor. It was arranged with the Superintendent of Cleansing to collect in the Corporation vans all refuse matter before 9 a.m., disinfecting the same as it was placed in the carts, and to water the roadway regularly with a disinfectant solution whenever necessary. Notice was given to the contractor to remove all fat, bone3, &c., from the shops before 9 a.m., or after 6 p.m., and the Markets Committee were advised to compel the tenants to provide properly covered metal drums or receptacles for storing such materials, pending collection, and under their direction the following Notice was issued :— 23 rd October, 1901. Complaints having been made to the Corporation, as the Sanitary Authority, of offensive smells from the Market generally, the Medical Officer of Health for the City recently causei a special survey to be made, 56 with a result that improved arrangements have now been arrived at as regards the removal of refuse by the Corporation vans, and notice has been given to the contractor to remove all fat, bones, &c., daily before 9 a.m., or after 6 p.m. The Bye-laws governing the Market provide for the deposit by the Tenants of all offal, &c., and rubbish of any kind, from the shops in a basket or box for daily removal; and, while a strict observance of this provision is essential, the Billingsgate and Leadenhall Markets Committee now deem it necessary as a sanitary precaution that properly covered metal drums or receptacles should be used for the purpose. I am accordingly to request that all Tenants will give effect to the suggestion of the Medical Officer, and the desire of the Committee, by providing and using such closed receptacles for the deposit of offal and rubbish for daily collection. Yours obediently, JOHN B. MONCKTON. To all Tenants in Leadenhall Market. SUMMER FLUSHING OF COURTS, &c. The flushing of the more thickly-populated and poorer parts of the City during the hot months was carried on as usual, followed by the use of deodorants in the channels running through the courts and alleys, &c. In this service, but including the streets, your Engineer informs me that 39,708,690 gallons of water were used. Many thousand gallons of disinfectants were also employed. Forty-seven places were so treated in the East District; thirty-six in the Middle District; and eighty-four in the West District. Total 167. The entrances to forty-one courts were cleansed and lime-washed, viz.: twelve in the East District; four in the Middle District; and twenty-five in the West District. A list of places dealt with is subjoined. In Lower Thames Street, and especially in the neighbourhood of Billingsgate Market and the Custom House, road flushing was freely employed and deodorants subsequently used at least twice in twenty-four hours, it being always difficult to keep the place free from nuisance caused by the leakages from the fish carts, which rapidly decompose and cause great annoyance to the public unless promptly dealt with. 57 FLUSHING OF STREETS, COURTS, &c. In the subjoined lists the places marked * * * were flushed every twentyfour hours, those marked * * twice a week, those marked * once a week. EAST DISTRICT. *** Montague Court ** Rose Alley * Cock Hill ** Sandy's Row ** White Rose Court ** Swedeland Court ** Artillery Lane ** George and Catherine Wheel Alley *** Catherine Wheel Alley ** Mason's Court Bishopsgate ** Cavendish Court * Carter Street * Exchange Buildings ** Gravel Lane Houndsditch ** New Street Gravel Lane ** Hutchison Street ** Hutchison Avenue ** Ellison Street ** Providence Place ** Middlesex Street ** Garden Place Middlesex Street ** Wrestler's Court Camomile Street * Brown's Buildings St. Mary Axe ** Heneage Lane Bevis Marks ** Golden Fleece Court Minories. * Little George Street * New Square Minories *** Harrow Alley ** Church Row (Houndsditch end of) * Black Horse Yard * Little Somerset Street ** Aldgate Avenue Aldgate ** Northumberland Alley * Church Court ** Back Alley *** French Ordinary Court Fenchurch Street Rose Court *** St. Mary-at-Hill Lower Thames Street *** Lower Thames Street (especially in front of Billingsgate Market and H.M''s Custom House) *** Pudding Lane *** Botolph Lane * Botolph Alley Eastcheap * Church Passage * ** Love Lane *** Fish Street Hill *** King's Head Court Fish Street Hill *** Waterman's Steps *** London Bridge Steps MIDDLE DISTRICT. ** Honeysuckle Square Milton Street *** Three Herring Court Redcross Street ** Hart's Court Fann Street *** Hare Court *** Shaftesbury Place ** Maidenhead Court *** Lauderdale Buildings *** Cotton Street Passage *** Cotton Street ** Australian Avenue * Fann Street Aldersgate * Jacob's Well Passage Barbican * Bra ime's Buildings Beech Street ** Upper Thames Street. St. Benet's Church to King William Street * Friar's Alley ** Brook's Yard ** Huggin Court and Lane Upper Thames Street ** St. James's Place ** Sugar Loaf Court Garlick Hill ** Three Nuns Court St. George's Avenue George Yard Aldermanbury * Mason's Avenue * Church Alley * Moorgate Street Buildings * Copthall Buildings Basinghall Street * Union Court Old Broad Street * Peahen Coart * Helmet Court ** Cripplegate Churchyard *** Gun Yard Bishopsgate ** Miles Lane London Bridge * Sermon Lane Doctors' Commons * Foster Lane * Carey Street Cheapside * Gutter Lane * Goldsmith Street ** Sun Court, Swan Alley, Moorgate Street (leading to Cross Key Court). 58 WEST DISTRICT. ** Bishop's Court * Prujean Square Old Bailey Evangelist Court Pilgrim Street ** Dolphin Court ** Horse Shoe Court * Pilgrim Street *** Cob's Court, Broadway * Boy Court Ludgate Hill * Johnson's Court * Red Lion Court * Bolt Court * Pleydell Court * Hind Court * Wine Office Court * Crown Court * Poppin's Court * St. Bride's Avenue Fleet Street * Glasshouse Alley Tudor Street ** Bell's Building's Salisbury Square ** George Yard ** Ashentree Court ** Britton's Court Whitefriars Street ** Fleur-de-Lis Court * Trinity Passage ** Nevill's Court * Greystoke Place * Plough Court Fetter Lane ** Gunpowder Alley ** King's Head Court ** Robin Hood Court Shoe Lane * Castle Court Poppin's Court *** Back Court *** Back Passage ** Barley Mow Passage ** Sun Court ** New Court *** East Passage *** Red Lion Passage ** Cloth Fair Cloth Fair *** Half-Moon Passage Aldersgate * Three Tuns Passage * King's Head Passage Ivy Lane * Paul's Alley * Cannon Alley * Lovell's Court * Panyer Alley * London House Yard * Stationers' Hall Court * Paternoster Buildings Paternoster Row * Amen Corner * Queen's Head Passage Newgate Street ** Seacoal Lane ** Fleet Lane * Harp Alley * New Court *** Holborn Viaduct Steps Farringdon Street ** Green Dragon Court ** Currier's Row * Ireland Yard * Cloisters Court St. Andrew's Hill ** Blomfield House Yard Snow Hill * Took's Court Furnival Street * Queen's Head Court * Ball Court Giltspur Street ** Dorset Court * Sugar Loaf Court ** Hanging Sword Alley Dorset Street ** Upper Thames Street, between Blackfriars and St. Benet's Church * Crown Court Chancery Lane ** Holborn Buildings ** Middle Street ** Kinghorn Street ** Cloth Street ** Montague Court ** Little Montague Court ** Cox's Court Little Britain * Bartholomew Close ** Middlesex Passage ** Westmorland Buildings ** Albion Buildings ** Cockerell's Buildings * Fenton's Buildings ** Bartholomew Place Bartholomew Close As heretofore, this process has been assiduously carried on in the neighbourhood of Billingsgate Market and the Custom House. In this part of Lower Thames Street deodorants are necessary at least twice in twenty-four hours in the Summer, it being difficult to keep the place free from nuisance caused by the leakages from the fish carts, which then rapidly decompose, and stink abominably, LIMEWHITING OF COURTS. The walls of the following courts were cleansed and limewhited, and where the same are approached by a covered way, the ceiling treated in a similar manner. EAST DISTRICT. Montague Court Rose Alley Catherine Wheel Alley (entrance) Hutchison Avenue (Stoney Lane entrance) Providence Place Garden Place Middlesex Street White Rose Court Widegate Street Rose Court Beer Lane New Square (entrance) Minories French Ordinary Court Fenchurch Street Harrow Alley Butcher Row Black Horse Yard Aldgate Sussex Place Leadenhall Street 59 MIDDLE DISTRICT. Three Herring Court Redcross Street Gun Yard Bishopsgate St. James's Place Garlick Hill Friar's Alley Upper Thames Street WEST DISTRICT. Cloister Court St. Andrew's Hill King's Head Court Gunpowder Allev Shoe Lane Fleur-de-Lis Court Carter Lane Nevill's Court Greystoke Place Fleur-de-Lis Court Fetter Lane Boy Court Ludgate Hill Half-Moon Passage Aldersgate Middlesex Passage Bartholomew Place Bartholomew Close Montague Court Little Montague Court Little Britain Britton's Court Crown Court Whitefriars Dorset Court Dorset Street Ball Court Giltspur Street Holborn Buildings Holborn Evangelist Court Pilgrim Street Took's Court Furnival Street Red Lion Court East Passage Back Passage Sun Court Back Court Cloth Fair SKIPS. This skip system for house refuse removal, which commenced in 1892, has been extended as circumstances demanded, and much benefit has accrued to the persons for whose relief the method was adopted. The public dust-bins, which were, from their misuse, a nuisance and constant source of trouble, have been abolished. Up to the end of the year 877 of these skips had been supplied in the poorer neighbourhoods without charge, and 607 were paid for by ratepayers: total 1,484. SANITARY CONVENIENCES AT RAILWAY STATIONS. A careful inspection was made of the above throughout the City during July, when numerous defects were found to exist. There are in all twenty-one Stations, and in the case of all except Bishopsgate, Broad Street and Liverpool Street, serious sanitary defects were discovered, all of which have since been remedied. MIDDLE DISTRICT. Cannon Street (South Eastern and Chatham Railway Company).—Urinals of an obsolete pattern, giving rise to constant nuisance. Entirely reconstructed. Cannon Street (Metropolitan Railway Company).—Eleven new Urinal Stalls constructed to replace obsolete pattern. 60 Bank (South London Railway).—Closets throughout cleansed, and the ventilating fan, which was formerly employed intermittently only, kept in constant work. Bank (Central London Railway).—Most defective ventilation to Closets for both men and women. Some considerable difficulty was experienced in devising plan for dealing with this on account of the distance to be traversed, and limited space at disposal. Mansion House Station.—A ventilating pipe placed in an unsuitable position has been carried through the roof to the external air. EAST DISTRICT. Aldgate High Street.—Water supply was laid on to the Urinals in the Lavatory provided for the employes, the public W.C's and Urinals examined and cleansed, and the Water Cisterns supplied with covers. Monument and Mark Lane.—At both these Stations the old-fashioned pan Closets were removed, and modern type substituted. WEST DISTRICT. Holborn Viaduct.—The Urinals in Lavatory platform were cleansed, ladies' second class Lavatory ventilated, and walls and ceilings cleaned. The staff W.C's and walls and ceilings throughout were cleaned: Cisterns cleaned. Ludgate Hill Station.—The ladies' first class Lavatory was ventilated into the open air, cleaned and Cistern covered. Ladies' second class Lavatory provided with ventilation, and Cistern covered. The men's Lavatory Cistern covered, and one defective Closet repaired. Two of the Urinals were reconstructed. The walls and ceilings throughout were cleaned. Snow Hill.—The ladies' Lavatory was ventilated. The platform Closets and Urinals, which were in very bad condition, were thoroughly cleaned and ventilated. Aldersgate Street.—Ladies' Lavatory ventilated, walls and ceiling cleaned. Men's Lavatory, walls and ceiling cleaned. St. Paul's.—Two W.C's used by the staff were repaired, and the walls and ceilings cleaned. A defective Manhole Cover sealed. Post Office (Central London Railway).—The ventilation of men's Lavatory improved. 61 Blackfriars.—The walls and ceilings of both men's and women's Lavatories were cleaned, and a modern Closet substituted for an old container in the women's Lavatory. The Inspector in each district will in future report periodically on the Stations in his charge. PUBLIC WATER-CLOSETS AND UNDERGROUND CONVENIENCES. During the year no addition has been made to the 32 Underground Conveniences in the City, of which eight are provided for the use of women. They contain 267 urinal compartments and 181 water-closets. During week days the majority are open until 11 or 12 p.m. On Sundays three are closed all day, the one at Billingsgate is closed at 2 p.m., and, with two exceptions, the remainder are open until 11 p.m. Both at Golden Lane and Farringdon Street free accommodation is provided for women, a boon that is unquestionably much appreciated by females of the poorer classes. THE SALE OF ICES AND ICE CREAMS. Much evidence has been accumulated during the last few years as to the dangers to health involved in the unrestricted sale and manufacture of the above and similar delicacies. The danger is a real one, and is mainly due to the insanitary and filthy habits of the manufacturers and vendors of these articles as sold in the streets and small shops. Manufactured from pure and wholesome materials, in cleanly premises, and stored in proper receptacles, there can be no objection to the use of these products. But, unfortunately, with the majority of small, and especially of street vendors, such conditions do not obtain. Too often the premises where they are made are dirty and insanitary in the extreme, and the materials of which they are composed unfit for food. The care which should be taken in their production is wanting, and storage is found in small, crowded, and ill-ventilated dwelling rooms. No wonder, then, that ill-effects have been constantly known to follow their consumption, especially when eaten by the poorly-fed and ill-nourished children who mainly constitute the customers of the "Hokey-Pokey" man. 62 In July last I brought this matter forward, and after pointing out the dangers and the action that had been taken by other Authorities, notably Brighton, Glasgow, Liverpool, Scarborough, Manchester, Salford, Stockport, Southport, Newcastle, Oldham, Halifax, throughout the country, urged upon the Corporation the necessity of obtaining powers to regulate this business. Attention was called to a Report, issued by the Public Health Committee of the London County Council, as follows:— 4th July, 1901. Proposed Legislation as to Sale of Ice Creams. 2.—On 18th June the Council, on our recommendation, instructed the Parliamentary Committee to seek legislation in the next Session of Parliament with regard to infectious diseases attributable to milk. The Medical Officer has since called our attention to the desirableness of endeavouring to obtain, at the same time, further powers with regard to the preparation and sale of ice creams in London. So long ago as 1897 a letter was received from the Strand District Board of Works, asking the Council to obtain powers for the registration or regulation of places in which food is sold or prepared for sale. It appeared that 19 of the London Sanitary Authorities concurred with the Strand District Board as to the need for these powers. Dr. Hamer was instructed to inquire as to the conditions existing in London, and his report showed that there would be advantage if sanitary authorities had the power to require the removal from places in which food was prepared for sale, of conditions which might be regarded as exposing such food to risk of contamination. With respect to places where ice cream was prepared, the fact that outbreaks of disease had occurred from the consumption of this commodity justified a claim for more complete control than could be shown in the case of other articles of food. In reporting to the Council on the subject in March, 1899, we stated that we proposed to consider the question in connection with amendments of the Public Health (London) Act. It may be mentioned that in 1895 the Glasgow Corporation obtained powers to extend to ice creams the provisions of the Dairies, Cowsheds and Milkshops Order relating to milk, and in 1898 Liverpool, which had had experience during 1897 of the spread of enteric fever by ice cream, much in the same way as occurred in Deptford in 1891, obtained sanction 63 of Parliament to the inclusion in the Liverpool Corporation Act of 1898 of the following provisions— 1. Any person being a manufacturer of, or merchant or dealer in, ice creams or other similar commodity who within the City— (a) Causes or permits ice creams or any similar commodity to be manufactured, sold, or stored in any cellar or room in which there is an inlet or opening to a drain; or (b) In the manufacture, sale, or storage of any such commodity does any act or thing likely to expose such commodity to infection or contamination or omits to take any proper precaution for the due protection of such commodity from infection or contamination; or (c) Omits on the outbreak of any infectious or contagious disease amongst the persons employed in his business to give notice thereof to the Medical Officer of Health for the City; shall be liable for every such offence on summary conviction to a penalty not exceeding forty shillings. The Liverpool Corporation Bill of 1898 contained provisions requiring the registration of all itinerant persons selling articles of food, but this proposal had to be abandoned. We are advised that the provisions of the Dairies, Cowsheds and Milkshops Order cannot, without special legislation, be made to apply to this business. In Scotland an attempt of the Glasgow Corporation to make them apply was defeated on appeal. A number of Boroughs have obtained by local Acts powers similar to those of Liverpool stated above, viz., Manchester, Salford, Stockport, and Newcastle in 1899, and in 1900 Halifax, Oldham, Scarborough and Southport, and a number of other towns. The great difficulty has been as regards registration, several towns having included in their local Bills provisions requiring registration, which were rejected by Committees of Parliament, apparently for the reason that such registration would apply to the numerous confectioners, hotels, &c. No sufficiently precise definition of the particular class of ice cream with which it was intended to deal has been formulated. As a matter of fact, the Officers of a Sanitary Authority must in practice know where the itinerant ice cream vendors in their own district obtain their ice creams, and we believe it would meet all practical purposes if every itinerant vendor were required to exhibit on his barrow a notice showing the name and address of the person from whom he obtains his ice creams. 64 We limit, therefore, our proposals for legislation to the Liverpool provisions and to the requirement that the vendor shall exhibit the notice above referred to, and we think that these provisions should be administered by the Metropolitan Borough Councils. Under the terms of the Standing Order we have consulted the Solicitor, who thinks that, though the question is not free from doubt, upon the whole the Council has power to spend money in promoting legislation in the direction indicated. If the Council adopts our recommendations the Parliamentary Committee will no doubt carefully consider whether any or all of the powers desired can be obtained by a Clause in one of the Council's Bills, or whether a Public Bill would be necessary to give effect to our proposals. Before the Council can consider the question it will be necessary to suspend the Standing Order, which requires proposals for legislation next Session to be brought before the Council at its first meeting in June. In submitting our proposals we have to point out that we have not yet had time to consult the Borough Councils with regard to them. We hope to enlist the sympathy and support of these bodies, and accordingly suggest that a copy of this report be sent to each, with an intimation that any suggestions they may make will be considered. This Report seemed to be the most reasonable plan of dealing with the subject, and I therefore advised that the London County Council be informed that the Corporation would be prepared to co-operate with them in obtaining a Bill for the purpose, on the understanding that within the City they (the Corporation) should be the sole Authority for exercising the powers thereunder. This was agreed to, and the County Council were informed accordingly. The London County Council (General Powers) Bill was subsequently prepared, and contains, inter alia, the following Clauses:— Any person being a manufacturer of or merchant or dealer in ice creams or other similar commodity who within the County— (a) Causes or permits ice creams or any similar commodity to be manufactured, sold, or stored in any cellar, shed, or room in which there is any inlet or opening to a drain, or which is used as a living room or sleeping room; (b) In the manufacture, sale, or storage of any such commodity does any act or thing likely to expose such commodity to infection or contamination, or omits to take any proper precaution for the due protection of such commodity from infection or contamination; or (c) Omits on the outbreak of any infectious or contagious disease amongst the persons employed in his business or living, or working in, on, or about the premises in or on any part of which any such 65 commodity as aforesaid is manufactured, sold, or stored, to give notice thereof forthwith to the Medical Officer of the Sanitary District in which such business is carried on or such premises are situate; shall be liable for every such offence on conviction in a Court of Summary Jurisdiction to a penalty not exceeding forty shillings. Every itinerant vendor of any such commodity as aforesaid shall, if not himself the manufacturer thereof, exhibit in a legible manner on a conspicuous part of his barrow a notice stating the name and address of the person from whom he obtains such commodity, and if such vendor is himself the manufacturer of such commodity he shall in the same manner exhibit his own name and address. Every such itinerant vendor who shall fail to comply with the provisions of this Section shall be liable for each offence on conviction as aforesaid to a penalty not exceeding forty shillings. Proceedings for the recovery of the penalties imposed by the two last preceding Sections of this Act shall be instituted by the Sanitary Authority for the District in which the offence was committed or of the District to the Medical Officer of which such notification as aforesaid ought to have been made, or in which such itinerant vendor as aforesaid shall offer any such commodity as aforesaid for sale as the case may be. Provided always that if any Sanitary Authority omit to institute such proceedings the Council may institute the same as if such omission were a default within the meaning of Section 100 of "The Public Health (London) Act, 1891," and the provisions of that Act relating to any such default and the consequences thereof shall apply with respect to such proceedings. To all of these, except the last, there is no objection, and they are certainly calculated to protect the public health. Provisions by the Metropolitan Borough Councils. Under the Public Health Act, Section 133, Sub-section (d), it is expressly enacted that The powers of the County Council under this Act to proceed "in case of default of a Sanitary Authority shall not extend to the "Commissioners of Sewers." It is therefore important to ensure this exemption being continued in any fresh legislation, as there is no possible justification for the County Council to control or override the Corporation. 66 Proposed Legislation with regard to Infectious Diseases attributable to MlLK. Another very important question was raised by the County Council with reference to the above. The Reports of the Public Health Committee, dated 9th May, 1901, and 11th June, 1901, are as follows:— Report of the Public Health Committee. 9th May, 1901. 1.—We have received from the medical officer an interim report concerning an outbreak of scarlet fever, mainly in the East of London, occurring in the last few days of April and early part of May. On Wednesday, 1st May, the medical officer was informed by Dr. Bryett, medical officer of health of Shoreditch, that a number of cases of scarlet fever had been notified to him on the preceding day, and that most of the persons attacked had obtained their milk from two local vendors, one in Shoreditch, the other in Bethnal Green. He had also heard from Dr. Bate, medical officer of health of Bethnal Green, that cases of scarlet fever associated with a particular milk supply had been notified in that borough, and that in both districts the milk was obtained from a contractor who received it from various farms in the country. While inquiries as to the source of the supply of milk distributed to persons who were attacked were being made by the medical officers of health of the districts concerned, the circumstances of this contractor's business were investigated by the Council's medical officers, and these circumstances pointed to the conclusion that the milk which was operative came from one of a very limited number of farms among the forty or more on the list supplied by the contractor to the medical officer. The medical officer had already communicated with the medical officers of health of districts in which a number of the farms were situated, and on Saturday morning, the 4th instant, he received a letter stating that in one of the farms, to the milk of which suspicion especially attached, cases of throat illness suggestive of scarlet fever had occurred. The medical officer, in view of the information which had been obtained, wrote to the contractor that the milk from this farm ought not to be supplied, and he at once acted on this advice. Dr. Hamer, who had left in the early morning for Staffordshire, to make enquiry at certain farms, was able later in the day to satisfy himself that the disease on the particular farm above referred to was in all probability scarlet fever, a conclusion subsequently confirmed by the desquamation of one of the patients. 67 We do not propose at this moment to give further details of this outbreak, but we intend later to present to the Council a final report by the medical officer on the subject. It will now suffice to state that scarlet fever associated with milk from the same dealer was found by the medical officers of health of Finsbury, Islington and St. Pancras to have occurred in these districts, and that all the evidence has tended to confirm the conclusion provisionally arrived at. Moreover, the stoppage of the milk from this particular farm, after allowing for the period of incubation of the disease, was followed by the subsidence of the outbreak in the several districts concerned. The total number of persons attacked may, however, exceed 300. The medical officer has brought under our notice the position of the law in London in relation to the subject of limiting the spread of dangerous infectious disease by milk. Medical officers of health in London possess powers for this purpose under section 71 of the Public Health (London) Act. On finding evidence that any person in his district is suffering from dangerous infectious disease attributable to milk supplied from any dairy situated either within or without his district, or that the consumption of milk from such dairy is likely to cause such infectious disease, the medical officer of health, if authorised by an order of a justice having jurisdiction in the place where the dairy is situated, may inspect the dairy, and if accompanied by a veterinary surgeon, may inspect the animals therein. If, on such inspection, he is of opinion that any such infectious disease is caused by the consumption of the milk supplied from such dairy, he is required to report thereon to his authority, and his report must be accompanied by any report furnished to him by the veterinary surgeon. The sanitary authority is then empowered to serve on the dairyman notice to appear before them within not less than 24 hours, and, if he fails to show cause why an order should not be made, they may make an order requiring him not to supply any milk from the dairy within their district. This procedure, if strictly followed, involves considerable delay. In the outbreak which has recently been investigated, a considerable number of persons were daily infected during the period in which the infective milk was being supplied, and had the supply of this milk been continued pending the carrying out of the procedure above indicated, numerous cases which ought to and might have been prevented would have occurred. Moreover, when milk from a particular source has been found to be producing disease in one district, and even when it transpires that cases traceable to the same supply of milk are occurring in other districts, it would be necessary for the medical officer of each of these other districts separately to inspect the particular dairy from which the milk was supplied and comply with the other requirements of the section before the 68 implicated milk could be excluded from his district. It seems obvious that when disease has been traced to a particular milk supply the sale of such milk should be altogether stopped, and not merely that it should be •excluded from the district in which the outbreak occurred. The County Council has no power to exclude from London even a particular milk known to be the cause of disease. Moreover, when a sanitary authority in London excludes from its district the milk from a particular farm, notice is required to be given to the council of the county in which the farm is situated, but we know of no power of the county council to stop the sale of the milk. In the recent outbreak the milk supplied in the districts affected was procured through a middleman, who obtained the milk from a number of farms in various parts of the country and distributed it to the local vendors direct from the railway stations to which it was sent by the farmers. It does not appear to be a general practice in the milk trade to keep such a record as would enable the origin of the milk supplied to particular local vendors to be readily traced. We think such a record should be kept, and that a medical officer of health should be able to procure information as to the sources of supply of milk distributed in his district. We may point out that authorities in Scotland have much wider powers and duties in this connection than those of authorities in London. Thus, under section 60 (2) of the Public Health (Scotland) Act, 1897, if the medical officer of any district has evidence that any person in the district is suffering from an infectious disease attributable to milk from any dairy without the district, or that the milk from any such dairy is likely to cause any such disease to any person residing in the district, such medical officer shall forthwith intimate the same to the local authority of the district in which such dairy is situate, and such other local authority shall be bound, forthwith, by its medical officer, to examine the dairy and the persons aforesaid, and by a veterinary surgeon to examine the animals therein, previous notice of the time of such examination having been given to the local authority of the firstmentioned district, in order that its medical officer or veterinary surgeon may, if they so desire, be present at the examinations referred to, and the medical officer of the second-mentioned local authority shall forthwith report the results of his examination, accompanied by the report of the veterinary surgeon, if any, to that local authority. Sub-section 3 of the same section requires the local authority of the district in which the dairy is situate to meet forthwith and consider the reports and any other evidence by parties concerned, and either to make an order requiring the dairyman not to supply any milk from the dairy until the order has been withdrawn by the local authority, or to resolve that no such order is necessary. 69 Under sub-section 5 the local authority may, if the dairy is within the district, require the dairyman not to supply milk either within or without the district, and shall give notice of the fact to the local authority of any district within which they believe the milk to be supplied from such dairy. Provision is made in sub-section 7 for appeal to a sheriff by any local authority or dairyman aggrieved, and for the order to remain in force pending the disposal of such appeal. Section 61 enables the local authority in cases where infectious disease is attributable to milk supplied by any dairyman, whether wholesale or retail, or to milk supplied by one or other of several such dairymen, whether wholesale or retail, to require such dairyman, whether within or without its district, to furnish a full and complete list of the names and addresses of all his customers within the district on payment at the rate of 6d. for every 25 names, and also a full and complete list of the farmers, dairymen or other parties from whom, during a period to be specified, the milk or any part of the milk which they sell or distribute was obtained, and, if required, to produce and exhibit to the medical officer, or person deputed by him, all invoices, pass-books, accounts or contracts connected with the consignment or purchase of milk during such period. We think there would be great advantage if these or similar powers were given to authorities in Great Britain and Wales, and that there is urgent need for legislation on the subject. So far as London is concerned we have instructed the officers to report as to the form of the legislation necessary, with a view to the Council, if possible, introducing a Bill on the subject. In the meantime we think the attention of the Local Government Board should be called to the matter, and we recommend— That the Local Government Board be informed of the facts set forth in the foregoing report as illustrating the need for an amendment of the law with regard to infectious diseases attributable to milk. Adopted. Report of the Public Health Committee. llth June, 1901. 3.—On 21st May last we reported to the Council the circumstances of a serious outbreak of scarlet fever, mainly in the east of London, and we pointed out that they illustrated the unsatisfactory position of the law with regard to infectious diseases attributed to milk. We stated that so far as London was concerned we had instructed the officers to report as to the form of legislation required, with a view to the Council, if 70 possible, introducing a Bill on the subject. In the meantime we recommended the Council to call the attention of' the Local Government Board to the facts as evidence of the necessity for an amendment of the law. The Council adopted our recommendation, and a letter was accordingly addressed to the Local Government Board. We have now received reports from the officers, and after carefully considering them We are of opinion that the following powers are urgently required, viz.:— 1. Power to require a dairyman to supply to the medical officer of the district a list of his customers on payment of a small sum for the service. 2. Power to require a dairyman to furnish to the medical officer of the district a list of the sources of his supply. 3. Power to the sanitary authority to compensate a milk vendor whose milk supply is stopped at the request of the authority on account of suspicion that it is infective, and whose milk is as the result of further inquiry subsequently determined not to have been infective. As to (1) provision should be made for the requirement to apply (a) to the supply to retail vendors by wholesale vendors, (b) to the supply to consumers by retail vendors. As to 2 it would be requisite to provide machinery by which milk distributed to consumers could, if necessary, be traced to the farm from which the milk is received. It would probably suffice, in cases in which the retail vendor receives milk through a middleman, for the middleman to keep a register of the sources from which he supplies the retail vendor. In the same way, one vendor selling to another should be required to keep a record of such transactions and the source from which the supply is derived. As already pointed out, there is no power to exclude an infective milk supply from London as a whole, inasmuch as the Council has no power in the matter, and each of the 29 sanitary authorities can only exclude the milk from its own district, and that after adopting a procedure involving considerable loss of time. Such power should be given to the County Council, and along with it the necessary powers of inspection of dairies and cattle outside as well as inside London. The Council should also be enabled to exercise the powers numbered 1, 2 and 3, should it find it necessary to do so for the purpose of dealing with some widespread prevalence of disease involving more than one district. The necessity for the sanitary authority to obtain a magistrate's order before making an inspection of a dairy and of cows ought to be obviated; at any rate it might be provided that this should be unnecessary unless demanded by the dairyman. The loss of time in obtaining an order may mean loss of life among the consumers. 71 Again, the procedure provided in section 71 of the Public Health (London) Act, by which a meeting of the sanitary authority is needed before the supply of milk within its district from a particular dairy can be stopped, may lead to serious loss of time. The procedure adopted in connection with the closure of a school under the Education Code, by which any two members can act on the advice of the medical officer of health, is much more convenient. It might be well to provide for appeal. Loss of time in connection with the settlement of an appeal as to money is of small moment compared with loss of time in stopping the distribution of an infective milk supply. Coming now to the question of milk from cows affected with tubercular disease of the udder, we may remind the Council that on 29th March, 1900, we reported the results of the bacteriological examination of 97 samples of country milk imported into London for human consumption. As many as seven of these samples contained tubercle bacilli. The Council, on our recommendation, sent a copy of our report to the Local Government Board and Board of Agriculture, and expressed the hope that some steps would be taken to render the periodical inspection of the udders of cows by veterinary surgeons obligatory throughout the country. No Bill having been introduced for this purpose, we wish to draw the attention of the Council to the powers recently obtained for dealing with tuberculous milk by a number of municipalities, including Liverpool, Manchester, Leeds, Halifax, Hastings, West Bromwich, Southport, Scarborough, Blackpool, Derby, Stockport, Salford, Bootle, and Darwen. These powers may be briefly stated as follows— Samples of milk are examined, and, if found to contain tubercle bacilli, the medical officer of health is authorised, after obtaining a magistrate's order, to inspect the farm from which the milk comes, and, if accompanied by a veterinary surgeon, to inspect the cattle. The local authority is then empowered to exclude from its district the milk from such farm if it finds it necessary to do so. We think if this power were possessed by the London County Council, the owners of cows and the authorities of districts outside London might possibly be led to institute a periodical examination of cows, and thus, by the early exclusion from the milk supply of the milk of a particular cow suffering from tubercular disease of the udder, to obviate the risk ot the whole milk supply of the farm being prohibited from coming into London. Some of the special Acts referred to contain other provisions which would be useful in this connection. Thus, the Dairies, Cowsheds and Milkshops Order of 1899, which is in London enforced by the County Council, makes it illegal to sell milk from a cow having a tubercular udder only after that disease has been certified by a veterinary surgeon. In Manchester, however, a dairyman is liable to a penalty if he knowingly sells milk from a cow which is suffering from this disease, and 72 if he does not properly isolate such cow, irrespective of whether the disease has been certified. Further, dairymen are required under the Manchester Act to notify to the medical officer of health any cow affected with, or suspected of, or exhibiting signs of, tuberculosis of the udder. In connection with the administration of the Dairies, Cowsheds and Milkshops Order of 1899 in London, additional power is needed by the Council, viz., that of seizing cows which the veterinary inspector is of opinion are suffering from tubercular disease of the udder, and of requiring such cows to be at once slaughtered. The Royal Commission on Tuberculosis recommended that, if the veterinary surgeon's opinion is found to be incorrect, the owner should receive the full value of the animal; but that, if the veterinary surgeon's opinion is found to be correct, then the owner should receive the value of the carcase only. In this view we concur. Under the terms of the standing order we have consulted the solicitor, who thinks that, though the question is not free from doubt, upon the whole the Council has power to spend money in promoting legislation in the direction indicated. If the Council adopts our recommendation the Parliamentary Committee will no doubt carefully consider whether any or all of the powers desired can be obtained by a clause in one of the Council's Bills or whether a Public Bill would be necessary to give effect to any or all of our proposals. The matter is, in our opinion, one of great moment as affecting the health of the consumers of milk in London, and in which it is desirable to proceed without delay. It is necessary under the standing order for proposals for legislation next session to be brought before the Council at its first meeting in June. We accordingly now submit our proposals, but we have not yet had time to consult the borough councils with regard to them. We hope to enlist the sympathy and support of these bodies, and accordingly suggest that a copy of this report be sent to each, with an intimation that any suggestions they may make will be considered. We recommend— (a) That, the Parliamentary Committee be instructed to seek legislation in the next session of Parliament to give effect to the proposals contained in the foregoing report. (b) That a copy of this report be sent to each of the metropolitan borough councils, with an intimation that any suggestions they may make thereon will receive consideration. [Adopted. These two Reports having been submitted by the London County Council to the Corporation for their consideration, and suggestions were referred to your Medical Officer, who reported as follows:— 22nd August, 1901. With reference to the circular letter of the London County Council, enclosing copies of Reports of their Public Health Committee on the 73 subject of proposed legislation with regard to infectious disease attributable to milk, expressing the hope that Metropolitan Borough Councils will support their recommendations, I beg to report as follows:— Report of the Public HealthCommittee of the London County . Council, dated 9th May, 1901. The question here involved is a very important one. It is not necessary to discuss in any way the question as to the possibility or probability of conveyance of infection by diseased milk. In spite of recent pronouncements on the question, it must be held that there is sufficient evidence that certain diseases can be conveyed by milk, although to what extent this may occur is certainly problematical. As the Public Health Committee of the London County Council point out, the Medical Officer of Health of any district has power to deal with a dairy, whether within or without his district, if he has reason to suspect that any person within his district is suffering from any infectious disease attributable to milk bought from this particular dairy, and the power and procedure is set forth in Section 71 of the Public Health (London) Act, 1891. This section clearly gives definite and sufficient power to protect any individual district from disease communicated from any dairy. But the Report of the Committee goes on to point out that this protection is not sufficient, inasmuch as although the Medical Officer of Health of any district has power to exclude milk, which he believes to be dangerous to the public health, from being sold in his own district, he has no power to prevent such milk being sold in other districts, and the Council seeks for power to occupy this position. It is true that if any Medical Officer of Health were aware of the extent of disease, he could circularise the Medical Officers of Health of the other districts, but this does not seem a reasonable way of dealing with the question, and it would appear that some central authority should have the power of dealing with London as a whole, provided always that whatever power the County Council or other central authority might obtain for dealing with London as a whole, the City should retain equal power and jurisdiction. Report of the Public Health Committee of the London County Council, dated 11 th June, 1901. In this Report it is pointed out that the following statutory powers are urgently needed:— (1.) Power to require a dairyman to supply to the Medical Officer of Health of the district a list of his customers, on payment of a small sum for the service. There is ample precedent for such power being obtained. 74 (2.) Power to require a dairyman to furnish to the Medical Officer of the district a list of the sources of his supply. This is an important item, and one which might be very useful in tracing any epidemic supposed to be due to diseased milk. (3.) Power to the Sanitary Authority to compensate a milk vendor whose milk supply is stopped at the request of the authority on account of suspicion that it is infective, and whose milk is, as the result of further inquiry, subsequently determined not to have been infective. This is obviously a proper provision. This Report further points out the unavoidable loss of time involved by the procedure laid down in Section 71, requiring a meeting of the Sanitary Authority in order to forbid and stop the supply of milk from any particular dairy. It is suggested that, to avoid delay as far as possible, a procedure should be adopted similar to that applied to the closure of schools under the Education Code. This is as follows:— Under ordinary circumstances the Order is made by the Authority, but, in case of emergency, any two members may act on the advice of the Medical Officer of Health, reporting to the Sanitary Authority at its next meeting. Taken generally, then, I am of the opinion that there would be no objection to the London County Council obtaining the powers in the direction they indicate, and the Committee would probably be prepared to approve of the action they are taking, and support them so far as possible, provided always that similar powers were given to the Corporation within its limits. A further point which was suggested by the consideration of the above question was the anomalous position of your Public Health Department as regards the Dairies and Milkshops Order, the powers under which at the present time are delegated to the Inspectors of Weights and Measures. This Order was in the hands of the Cattle Markets Committee from 1885 to 1891, when it was transferred to the County Purposes Committee. The provisions of the Order are purely sanitary, and can only be efficiently carried out by properly qualified officers. I have, therefore, to recommend that these duties be transferred from the existing Authority and placed under the sole control of your Public Health Department. 75 These places are at the present time necessarily periodically visited by your Sanitary Inspectors, and, in addition, are constantly seen by your Food Inspector. It is difficult, therefore, to see what advantage can accrue from the inspection by a third officer who is not trained in sanitary matters. In these circumstances, it seems advisable to reproduce the regulations made by the Corporation. 41 and 42 Vict., Ch. 74, and the Dairies. Cowsheds, and Milk-shops Order of 1885. Regulations as to Milk-stores and Milk-shops, &c., and as to precautions against the infection and contamination of Milk in the City of London and the Liberties thereof. Contained in the "Dairies, Cowsheds, and Milk-shops Order of 1885," and the Regulations made thereunder by the Corporation of London. Registration. 1.—Every Purveyor of Milk, Dairyman or Cowkeeper, carrying on his trade in the City of London and the Liberties thereof, must be registered as such by the Corporation of London. Application for Registration must be upon the form provided for the purpose, to be obtained at the Town Clerk's Office, Guildhall. Contamination of Milk. 2.—It shall not be lawful for any person following the trade of Cowkeeper, or Dairyman, or Purveyor of Milk, or being the occupier of a Milk-store or Milk-shop—(a) to allow any person suffering from a dangerous infectious disorder, or having recently been in contact with a person so suffering, to milk cows, or to handle vessels used for containing milk for sale, or in any way to take part or assist in the conduct of the trade or business of the Cowkeeper, or Dairyman, Purveyor of Milk, or occupier of a Milk-store, or Milk-shop, so far as regards the production, distribution, or storage of Milk; or—(b) if himself so suffering or having recently been in contact as aforesaid, to milk cows, or handle vessels used for containing Milk for sale, or in any way to take part in the conduct of his trade or business, so far as regards the production, distribution, or storage of Milk—until in each case all danger therefrom of the communication of infection to the Milk or of its contamination has ceased. 3.—It shall not be lawful for any person following the trade of Cowkeeper or Dairyman, or Purveyor of Milk, or being the occupier of a 76 Milk-store or Milk-shop, after the receipt of notice of not less than one month from the Local Authority, calling attention to the provisions of this Article, to permit any water-closet, earth-closet, privy, cesspool, or urinal to be within, communicate directly with, or ventilate into, any Dairy, or any room used as a Milk-store or Milk-shop. 4.—It shall not be lawful for any person following the trade of Cowkeeper or Dairyman, or Purveyor of Milk, or being the occupier of a Milk-store or Milk-shop, to use a Milk-store or Milk-shop in his occupation, or permit the same to be used as a sleeping apartment, or for any purpose incompatible with the proper preservation of the cleanliness of the Milk-store or Milk-shop, and of the milk-vessels and Milk therein, or in any manner likely to cause contamination of the Milk therein. 5.— It shall not be lawful for any person following the trade of Cow- keeper or Dairyman, or Purveyor of Milk, to keep any swine in any Cowshed or other building used by him for keeping cows, or in any Milk-store or other place used by him for keeping Milk for sale. Milk of Diseased Cows. 6.—If at any time disease exists among cattle, the Milk of a diseased cow— (a) shall not be mixed with other milk; and (b) shall not be sold or used for human food; and (c) shall not be sold or used for food of swine, or other animals, unless and until it has been boiled. Regulations for securing the cleanliness of Milk-stores, Milkshops, and Milk-vessels used for containing Milk for Sale by persons following the trade of Cowkeepers or Dairymen. 25.—Every Milk-store and Milk-shop, as well as all fixtures and tables therein, used in connection with the keeping or sale of Milk, shall at all times be kept in a cleanly condition. 26.—All utensils and vessels used for the reception, storage, or delivery of Milk shall be thoroughly cleansed with steam or scalding water as frequently as may be necessary for keeping such utensils and vessels perfectly clean and sweet, and only clean water shall be used for the purpose. 27.—Every person following the trade of Cowkeeper or Dairyman shall at all times employ such means and adopt such precautions as may be necessary for keeping the utensils and vessels used by him for containing Milk in a clean and wholesome condition, so as to preserve the purity of such Milk. 77 Regulations prescribing precautions to be taken by Purveyors of Milk and persons selling Milk by retail against infection or contamination. 28.—Every Purveyor of Milk, or person selling Milk by retail, shall, immediately on any outbreak of infectious or contagious disease within the building or upon the premises in which he keeps Milk, or amongst the persons employed in his business, give notice of such outbreak to the Town Clerk of the City of London, at his Office in Guildhall. 29.—Every Purveyor of Milk, or person selling Milk by retail, shall, immediately on such outbreak coming to his knowledge, remove all Milk for sale, and all utensils for containing Milk for sale, from such building; and shall cease to keep Milk for sale or to sell Milk in such building until the same has been disinfected and declared by the Medical Officer of Health for the City of London to be free from infection. 30.—Every Purveyor of Milk, or person selling Milk by retail, shall not keep Milk for sale in any place where it would be liable to become infected or contaminated by gases or effluvia arising from any sewers, drains, gullies, cesspools, or closets, or by any offensive effluvia from putrid or offensive substances, or by impure air, or by any offensive or deleterious gases or substances. 31.—Every Purveyor of Milk, or person selling Milk by retail, shall only keep Milk for sale in clean receptacles; and all utensils used in connection with the keeping or sale of such Milk shall be at all times kept clean. 32.—Every Purveyor of Milk, or person selling Milk by retail, shall at all times employ such means, and adopt such precautions, as may be necessary for preserving the purity of Milk, and for protecting it against infection or contamination. NOTE.—Sections 60 and 61 of the 41st and 42nd Victoria, Ch. 74, provide that any person who does anything in contravention of an Order in Council or of a regulation of a Local Authority is guilty of an offence against the Act, and is liable to a Penalty not exceeding Twenty Pounds. During the year 1901 Chief Inspector A. J. Street reports that 448 Dairies and Milkshops were dealt with, being 31 more than in 1900. Of the total number, 368 were registered at Guildhall, 64 were unregistered, and 16 were either closed or demolished. 78 INSPECTION OF FOOD AT RIVERSIDE WHARVES. This question, which had been under consideration for some time, was carefully enquired into by your Medical Officer. It was found that there was no difficulty in carrying this out with your present staff of Inspectors. It is unnecessary, as well as impracticable, to examine every consignment received at the wharves in detail, and it is quite sufficient that periodical visits be made and samples taken from various consignments and inspected on the spot, all cases of doubt being referred to your Medical Officer for decision. This is the practice followed under similar circumstances by the Port Authority, and is found to answer all requirements. Instructions have been therefore given to your Inspectors to make such systematic examination of food stuffs deposited at the wharves within their several districts, and to keep a record of the same. Information as to the arrival of consignments is obtained from Customs Bill B, which is delivered daily at the Guildhall. It will scarcely ever become necessary to take proceedings against the owners, who are able to protect themselves by procedure under Section 47, Sub-section 8, of the Public Health (London) Act, 1891, which enacts that: "Where a person has in his possession any article which is unsound or un"wholesome, or unfit for the food of man, he may, by written notice to the "Sanitary Authority, specifying such article, and containing a sufficient "identification of it, request its removal, and the Sanitary Authority shall "cause it to be removed as if it were trade refuse," i.e., at the cost of the owner or person having possession of it. This action is most important, for, although the owners of wharves in the City would not be likely to make use of such material, there is undoubtedly a market for food however unfit it may be, and unless destroyed under the supervision of a Sanitary Authority, there is always the danger of its falling into the hands of unscrupulous persons, and being " re-processed " or dealt with in such a way that it can be disposed of as food. DISPOSAL OF UNSOUND FOOD. While on this question it may be as well to refer to the serious question of the method of disposal of unsound food seized by your Officers. At present this is dealt with by a firm who have held the contract for some years, and who, without doubt, have done their work honestly and well. The condemned meat from the Markets, while awaiting removal, is placed in large tanks containing an antiseptic solution. As the result of careful experiment I have succeeded in obtaining a fluid which, while preserving the meat for a considerable time without nuisance, imparts to it a brilliant violet colour, which cannot be removed, and renders it unsaleable. 79 It does not, however, seem right that meat once seized by an Authority as unfit for food should ever be allowed to again leave its hands, and I would strongly urge the adoption of a system by which the Corporation should itself undertake the destruction and utilization of such material. If a firm of contractors can afford to pay for the meat and make a profit, it is probable that the Authority could do the same, and, in any case, the possibility of condemned food finding its way into consumption would be finally obviated. Inasmuch as the Cattle Markets, the Meat Markets, the Poultry Markets, and the Port Sanitary Authority all have large quantities of such material to dispose of, the difficulty in organising a system can only be one of detail. In view of the importance of your Department being informed from time to time as to the likelihood of unsound frozen meat, or other food, being found amongst consignments from the Docks, arrangements have been made whereby the Port Sanitary Authority notifies the City in the event of any seizures on board refrigerating ships in the Port, or of any suspicious cargoes being met with. This system has already been found of value in several instances. In June your Medical Officer recommended the construction of an additional van for the removal of condemned meat, and, with the sanction of your Committee, this has since been carried out. In several respects the details have been improved, in accordance with the suggestions of your Senior Inspector of Meat. UNSOUND FRUIT, VEGETABLES, TINNED FOOD. &c. Two hundred and fifty-three cartloads of unsound food were removed by the Cleansing Department and destroyed as trade refuse at Letts' Wharf, at the written request and expense of the owners. The material so disposed of comprised:- Vegetables and Fruit 167 loads Condensed Milk 20 ,, Fish and Tinned Meat 10 „ Cheese 1 „ Miscellaneous 55„ Total 253 loads 80 The number of loads dealt with in the years 1898, 1899 and 1900 were 250, 452 and 312 respectively. The above included:— 21,327 Tins of Condensed Milk. 480 „ Fish. 13,180 „ Fruit. 1,208 Gallon Tins of Fruit Pulp. 22,554 Tins Miscellaneous. 274 Baskets of Cherries. 40 Bags of Potatoes. 63 Cases of Lemons. 160 Boxes of Tomatos. 83 Bags „ 41 Boxes of Apples. 6 Cases of Pears. 2 Vanloads of Grapes. 128 Barrels of Grapes. 6 Bushels of Walnuts. And 48 Tons, 4 cwts., 1 qr. of unclassified articles. ALDGATE SLAUGHTERHOUSES. No further action has been taken with reference to the abolition of these slaughterhouses, which, though a most objectionable feature within the City, are, as a general rule, kept in a clean and decent condition. They are visited daily by an Inspector, and any infraction of the Bye-laws at once dealt with. In one case, where the right of slaughter had lapsed, it was found that killing had recommenced. The premises had changed hands, and there was some evidence to show that the new owner believed that he had acquired the property with rights of slaughtering. This having been reported, the occupier was warned in writing of his liability for slaughtering in unlicensed premises. On the 22nd and 25th November, the owner of one of the slaughterhouses in Aldgate had certain beasts consigned to him, some of which were in a doubtful condition. It was arranged that they should be inspected after slaughter, with the result that, on the 26th one carcass and offal was seized, two on the 27th, and two on the 28th. 81 On the 28th, a third consignment of eight cows and two bulls arrived. One of the cows was dead or dying at the time of inspection, and the carcass and offal were seized. Of the others, one cow had a large swelling on the right jaw. Having examined this with your Senior Inspector, I thought it would be wise to have it specially reported upon by a veterinary surgeon, and arranged for Professor Pemberthy to see the animal while alive. His report was as follows:— '' November 30th, 1901. "In compliance with your request, I have to-day examined, at a slaughter"house in Aldgate, a red cow with an extensive swelling at the lower jaw. "As, under the condition obtaining, it was not possible to say during life "whether this swelling be due to tuberculosis", actinomycosis, suppuration "following a mechanical injury, or whether any other parts of the animal's "body are similarly affected, I think it will be advisable to allow the animal to "be slaughtered, and the carcass and viscera subjected to post-mortem inspection. "Though this cow is not in prime condition, there is probably a consider"able amount of nutritious flesh which you may deem fit for consumption, but "under any circumstances, it is my opinion that the head should be regarded "as unfit for human food. (Signed) "JOHN PEMBERTHY, F.R.C.V.S., "Professor of Medicine The animal was slaughtered on the Sunday (December 1st, 1901), when it was evident upon inspection that the lesion was one of simple character, and the carcass was passed as fit for human food, the head only being destroyed. Especial care has been taken in dealing with this case on account of the difficulty that will always arise with regard to these slaughterhouses from the want of special veterinary inspection of animals during life. While your food inspectors are charged with the inspection and control of dead meat, a veterinary inspector should certainly be consulted in the case of living animals. MEAT SUPPLIES. The total quantity of meat delivered at the Corporation Markets, Smithfield, during 1901 amounted to 415,510 tons 15 cwts. 2 qrs., against 410,380 tons 1 cwt. in the previous year, being an increase of 1.25 per cent. The corresponding percentages for 1899 and 1900 were 1.33 and 1.20 respectively. * *The figures relating to the Central Market supplies are compiled from the Annual Report of the Superintendent of the Market. •4 82 Table showing the annual deliveries and other details during the past 28 years :— MEAT SUPPLIES, 1874 TO 1901. Year. General Supply, Seizures by Inspectors. % of Bad Meat to Good. 1874 Tons 157,628 cwts. 18 qrs. 1 Tons 193 cwts. 18 qrs. 2 .123 1875 164,450 8 0 153 1 1 .093 1876 176,162 17 0 238 2 2 .135 1877 197,631 16 2 198 19 0 .100 1878 195,993 10 2 180 18 0 .092 1879 212,987 14 0 258 4 3 .121 1880 218,790 6 3 262 19 3 .120 1881 224,677 19 3 503 12 3 .224 1882 211,461 15 0 175 16 0 .083 1883 223,085 8 0 212 4 1 .095 1884 230,873 1 1 260 7 3 .113 1885 243,296 14 3 214 0 2 .088 1886 250,831 12 1 276 8 2 .110 1887 259,383 12 3 261 8 1 .101 1888 263,519 16 1 228 0 1 .086 1889 276,429 4 2 234 18 1 .085 1890 299,733 15 0 419 2 3 .139 1891 307,519 19 3 476 12 1 .155 1892 323,085 6 0 569 13 3 .176 1893 318,163 1 1 608 9 3 .193 1894 340,956 16 2 430 0 2 .126 1895 347,283 3 0 598 19 0 .173 1896 380,543 11 1 914 14 3 .243 1897 393,307 2 0 918 3 3 .233 1898 400,112 9 3 884 1 0 .221 1899 405,456 9 2 1,172 5 2 .289 1900 410,380 1 0 961 19 1 .234 1901 415,510 15 2 1,271 1 1 .306 /#-% [i I X I % 21 JUL w 83 The monthly deliveries during 1901 and the two preceding years are here given. Monthly Deliveries at the Corporation Markets, Smithfield. month. 1899. 1900. 1901. Tons cwts. qrs. Tons cwts. qrs. Tons cwts. qrt. January 35,892 15 3 38,319 3 3 38,097 7 2 February 31,608 17 1 32,814 7 2 32,746 10 3 March 35,258 1 1 38,125 6 1 34,912 7 3 April 33,026 11 0 32,786 15 1 34,032 0 3 May 34,421 13 3 35,108 12 0 35,927 11 0 June 33,504 7 1½ 32,646 5 1 32,562 3 2 July 30,587 16 2½ 29,554 1 3 32,655 13 2 August 30,225 5 2½ 32,293 10 3 32,092 16 0 September 33,977 7 2½ 30,475 10 3 31,631 2 0 October 34,171 19 3 36,180 0 0 37,407 10 2 November 36,290 10 3 36,216 16 2 36,390 18 3 December ... 36,491 2 3 35,859 11 1 37,054 15 2 Total 405,456 9 2 410,380 1 0 415,510 15 2 The sources of origin during the past six years are here expressed in terms per cent, of total annual deliveries. 1896. 1897. 1898. 1899. 1900. 1901. Per cent. Per cent. Per cent. Per cent. Per cent. Per cent. *Country killed 30.8 28.2 27.8 27.3 25.2 25.7 †Town „ 20.4 20.1 19.7 15.5 14.6 13.1 ‡ Foreign „ 11.2 12.9 12.6 14.2 15.1 14.4 American „ 20.1 18.8 19.0 23.0 23.2 25.5 Australian and New Zealand. 17.5 20.0 20.9 20.0 21.9 21.3 * Including American meat killed at Birkenhead. † This includes American and Continental cattle slaughtered at Deptford. ‡ Includes " General Foreign Meat and Produce." These figures are shown in a graphic form on the accompanying Chart. 84 It will be noted from the foregoing that of the food passing through the Central Markets in 1901, only 38.8 per cent. was "home grown," the remaining 61.2 per cent. being supplied from abroad. The Chart shows clearly enough that the foreign and Colonial producer is steadily capturing a trade formerly entirely in the hands of the English grazier. As a very large business is done at Smithfield in imported fresh meat, I append a summary of such imports into the United Kingdom during the past two years, the details of which are abstracted from the Meat Trades Review. This imported fresh meat was valued as under :— Beef£8,906,839 Mutton ,597,780 Pork 1,715,633 Total £17,220,252 If we add to this the value of imported live stock, viz. :— Cattle £8,817,064 Sheep 582,969 £9,400,033 we find that no less a sum than £26,620,285 was paid to foreigners for imported Jresh meat and live stock alone in one year, viz., 1901. These figures are significant, and are still more impressive when we bear in mind that they are ever growing, £1,605,473 being the increase in 1901 over the amount for the previous year. Fresh Meat Imports into United Kingdom during 1901. UNITED STATES. Beef. Pork. 1900 143,362 tons. 1900 - 1901 159,014 „ 1901 17,446 tons. Increase 15,652 tons. Increase 17,446 tons. HOLLAND. Mutton. Pork. 1900 16,566 tons. 1900 19,459 tons. 1901 15,814 „ 1901 18,853 „ Decrease 752 tons. Decrease - 606 tons. 85 BELGIUM. Pork. 1900 2,576 tons. 1901 2,024 „ Decrease 552 tons. ARGENTINE REPUBLIC. Mutton. 1900 55,739 tons. 1901 63,582 „ Increase 7,843 tons. AUSTRALASIA. Beef. Mutton. 1900 36,237 tons. 1900 96,662 tons. 1901 23,573 „ 1901 100,342 „ Decrease 12,664 tons. Increase - 3,682 tons. OTHER COUNTRIES. Beef. Mutton. Pork. 1900 26,811 tons. 1900 674 tons. 1900 12,734 tons. 1901 42,849 „ 1901 671 „ 1901 1,251 „ Increase - 16,038 tons. Decrease - 3 tons. Decrease- 11,483 tons. TOTAL IMPORTS OF FRESH MEAT. Year. Beef. Year. Mutton. Year. Pork. 1900 206,406 tons 1900 169,642 tons 1900 34,769 tons 1901 225,437 „ 1901 180,411 „ 1901 39,575 „ Increase 19,031 tons Increase 10,769 tons Increase - 4,806 tons TOTAL IMPORTS OF LIVE STOCK. Year. Cattle. Year. Sheep. 1900 495,134 1900 382,822 1901 494,225 1901 381,481 Decrease 909 Decrease 1,341 86 Some idea of the magnitude of the work of your Inspectors of Slaughterhouses and Meat may be obtained from the following figures copied from the Annual Report of the Market Superintendent :— 1899. 1900. 1901. Loads. Loads Loads. Number of loads weighed during the year upon the Market Weighbridges for the purpose of ascertaining the amount of Toll due thereon 210,332 201,848 206,807 Tons. Tons. Tons. Average daily delivery into the Markets 1,325 1,336½ 1,355 Minimum on any one day 296½ 341¼ 244½ Maximum delivery 2,941 2,712¼ 2,948 The heaviest weight brought in on any one day was on the 21st December, 1896. 4,159 tons. One ton in every 327 tons of meat paying toll in the Central Markets, Smithfield, was condemned last year, as compared with one ton in 427 in 1900, which affords satisfactory testimony to the improved quality of the consignments, owing to the vigilance and efficiency of the Staff. MEAT INSPECTION. The seizures of diseased and unsound meat amounted to *1,271 tons 1 cwt. 1 qr., against 961 tons 19 cwts. 1 qr. in 1900. Month. 1899. 1900. 1901. Tons cwts. qrs. Tons cwts qrs. Tons cwts. qrs. January 26 18 0 31 16 1 37 7 0 February 33 16 1 53 0 2 30 16 2 March 38 0 1 84 10 3 46 3 3 April 37 8 3 59 4 2 86 10 2 May 60 17 1 79 9 1 122 15 3 June 114 4 0 81 5 3 85 5 2 July 95 0 2 197 5 1 127 8 1 August 120 6 1 114 4 2 283 9 1 September 189 2 0 87 2 2 114 19 3 October 162 7 0 66 11 2 113 17 1 November 205 2 0 60 4 2 112 10 0 December 89 3 1 47 4 0 109 17 3 Totals 1,172 5 2 961 19 1 *1,271 1 1 * The heaviest total recorded. 87 UNSOUND MEAT, 1901. The 1,271 tons 1 cwt. 1 qr. 0 lbs. seized by your Inspectors as unfit for the food of man, were classified as under:— 1901. Diseased. Putrid. Animals killed by accident. Poultry. Offal. Fish. Total. tons. cwts. qrs lbs. tons. cwts qrs. lbs. tons. cwts. qrs lbs. tons. cwts. qrs. lbs. tons. cwts qrs. lbs. tons. cwts. qrs. lbs. tons. cwts. qrs. lbs. First Quarter ... 22 19 3 7 51 4 0 20 12 15 0 10 15 6 2 7 10 9 1 8 0 2 0 20 112 17 0 16 Second „ 22 7 3 8 224 4 1 27 7 18 3 18 10 6 3 24 30 12 3 26 0 0 2 24 295 11 3 15 Third „ 21 9 2 9 250 2 0 15 4 12 1 27 195 18 2 14 58 4 0 18 - 530 6 3 27 Fourth „ 36 8 3 17 236 15 2 7 11 16 1 6 17 8 2 19 29 11 1 14 0 4 1 19 332 5 0 26 Total 103 6 0 13 762 6 1 13 37 2 3 5 239 0 3 8 128 17 3 10 0 7 1 7 1,271 1 1 0 The percentages of Meat seized under a summary of the various headings of the above table and for the preceding five years, were as follows :— Year. Diseased. Putrid.* Unsound from accident or other causes. Per Cent. Per Cent. Per Cent. 1896 12.0 83.0 5.0 1897 11.0 84.0 5.0 1898 15.0 80.7 4.3 1899 8.1 88.2 3.7 1900 10.1 85.9 4.0 Average for 5 years 11.2 84.3 4.4 1901 8.1 89.0 2.9 * Including poultry, offal and fish. 88 CENTRAL MARKETS, SMITHFIELD. Table showing Weight of Meat delivered, seized as unsound, and proportion condemned to that delivered during each Month of the Year 1901. Month. Meat delivered at the Market. Meat seized by tbe Inspectors. Ratio of Meat condemned to that delivered. Tons. cwts. qrs. Tons cwts. qrs. January 38,097 7 2 37 7 0 1 ton in 1,020 tons, or .098 °/o February 32,746 10 3 30 16 2 ,, 889 „ .094 „ March 34,912 7 3 46 3 3 ,, 756 „ .133 „ April 34,032 0 3 86 10 2 ,, 393 „ .254 „ May 35,927 11 0 122 15 3 ,, 292 „ .342 „ June 32,562 3 2 85 5 2 ,, 382 „ .262 „ July 32,655 13 2 127 8 1 ,, 256 „ .390 „ August 32,092 16 0 283 9 1 ,, 113 „ .883 „ September. 31,631 2 0 114 19 3 ,, 275 „ .363 „ October 37,407 10 2 113 17 1 ,, 329 „ .304 „ November 36,390 18 3 112 10 0 ,, 328 „ .309 „ December 37,054 15 2 109 17 3 ,, 338 „ .296 „ Totals 415,510 15 2 1,271 1 1 1 ton in 327 tons, or "306 % 89 DISEASED MEAT PROSECUTIONS, 1901. Date. Where heard. Before whom. Occupation of Person Summoned. Defendant's Place of Business. Result. 1901. Jan. 14 Guildhall Ald. Sir J. V. Moore Poulterer Central Market Fined £15 and 10s. expenses. Mar. 19 Do. Do. Farmer Stourton, Wilts - Fined £50 and £6 6s. expenses. Aug. 1 Do. Mr. Ald. H. C. Morris Provision Dealers Central Market Fined £2 and £2 expenses. Nov. 1 Do. Ald. Sir J. V. Moore Manager Fore Street, Edmonton Dismissed. „ 1 Do. Do. Provision Merchant Do. do. Do. „ 21 Do. Mr. Ald. G. W. Truscott Cattle Dealer Inverury, Aberdeen Fined £50 and £15 15s. expenses. (Expenses one witness disallowed.) „ 27 Clerkenwell Mr. Bros - Provision Dealer Addlestone Fined £10 and 2s. expenses. Dec. 9 Guildhall Mr. Ald. Strong - Farmer Crockford Bridge Fined £25 and £2 14s. expenses. „ 13 Do. Mr. Ald. Vaughan Morgan Pig Dealer Bardwell, Suffolk Fined £10 and £4 expenses. „ 16 Do. Mr. Ald. Alliston Cattle Dealer Kelso - Case dismissed. „ 19 Do. Do Butcher Ayton, Berwickshire - Two months' imprisonment with hard labour „ 19 Do. Do. Carpenter, &c. Sproughton, Suffolk Fined £2. Total fines and expenses £195 7s. 90 TUBERCULOSIS IN PIGS. On the 25th July, the Senior Inspector of Meat reported that he had discovered in the Central Meat Market the carcasses of thirty pigs, which a close examination showed to have suffered severely from tubercular disease. Upon looking over these pigs it was found that the thyroid glands in each carcass were enlarged and tuberculous, and that in some instances the glands throughout the animals were more or less similarly affected. It was ascertained that they were a portion of a consignment of 74 sent to Smithfield by a dealer who had purchased them in Ipswich Market on the 23rd July. They were slaughtered on his own farm at East Acton on the 24th, and sent by him to London on the following day. Seventy-two "offals" were also dispatched with them, of which 49 plucks fats and spleens were condemned, 30 being tubercular and 19 putrid. These pigs had only been " pitched " in the shops a few minutes before your Officers detected their condition. The term " detected" is used advisedly, as before the carcasses were cut up, the nature of the disease was only apparent to the eye of an expert. So much importance was attached by the trade to this seizure, that in their own interest, and with a view of learning the best means of noting the presence of tuberculosis in pork, a meeting was organised by some of the leading members to hear an address on the subject five days later, at the Memorial Hall, Farringdon Street, by Professor Pemberthy, Lecturer on Medicine to the Royal Veterinary College, at whose request I sent portions of the glands, lungs, &c., of the condemned pigs for exhibition. The Chairman, in his opening remarks, made the following observations :— " Those meats (the pigs in question), I must admit, would have passed "muster with a very large number of us without being in any way judged " unsound, and it would require a most expert man to detect it. I say this, " because we ought to let it be known that we have in the Meat Market men " who really know their business—men who have been placed there by the " Authorities—and it is really a safeguard to the many millions of London to " know that the thousands of tons of meat that pass through that Market are " looked after by such men as Mr. Down, who is so expert that he can detect " disease at the first glance." Professor Pemberthy, in speaking of the question of meat inspection, stated :— " I was extremely glad to hear our Chairman say that there was so little " cause for complaint in the Metropolis. It is my candid opinion that where " the inspection is guided by education and intelligence and uniformity with " the trade, there is nothing to fear, and the public might be perfectly secure " about being protected." 91 The meeting was largely attended, and the Professor fully explained the nature of the disease and the best means of discovering it in the carcass. In the circumstances this is not a case, in my opinion, where legal proceedings would have been warrantable, but it is an apt illustration how important it is that breeders, dealers, and all persons engaged in the meat trade, should acquire a fuller knowledge of the indications of tuberculosis in meat in general, and pork in particular, failing which it is not too much to say that it will be difficult to effectively carry out the recommendation of the Royal Commission on the subject, especially in rural districts where expert opinion cannot usually be readily commanded. While on this subject it may be permissible to suggest that some of the money available throughout the country for the promotion and popularisation of technical education might be profitably applied for the purpose of the more general extension of knowledge of the prevailing characteristics, both in health and disease, of material intended for human food. UNSOUND FROZEN RABBITS. On the 31st July, information was received from the Medical Officer of Health for the Port of London, that a portion of a consignment of frozen rabbits, ex s.s. "Duke of Sutherland," were then on their way in barges to some Cold Air Stores in the City. Your Inspectors detained the rabbits on their arrival at the wharf, and 6,328 crates of the 7,731 landed were condemned as unfit for food. Another lot of 60 crates, part of the same shipment delivered by the Midland Railway, were also inspected ; from these your Officers seized 795 rabbits out of 1,450. They were shipped from Australia, and had probably deteriorated on the voyage in consequence of faulty stowage or failure of refrigerating apparatus. Your Officers were afforded every facility by the wharfingers for examining the goods. On the 9th instant, another parcel of 140 crates of imported frozen rabbits were removed from a poultry dealer's shop in the Central Markets, the contents being mouldy and unfit for food. Upon enquiry they were found to be part of a consignment of about 1,500 crates purchased from a firm in Tooley Street, the remainder being stored at riverside Cold Air Stores in Southwark. These facts were reported to the Sanitary Authority of that District, by whom they were seized and condemned. 92 FISH SUPPLIES. 196,190 Tons of fish, of which 157,072 were land-borne and 39,118 water-borne, were received at or near Billingsgate Market during the year. Of the above, 148,356 tons were consigned to Billingsgate Market, the remainder, viz., 47,834, being delivered at the salesmen's shops in the neighbourhood of the Market. Year. Fish Delivered at Billingsgate Market. Fish Delivered in the neighbourhood of Billingsgate Market. Total Deliveries. Tons. Tons. Tons. 1900 *144,049 43,635 187,684 1901 *148,356 47,834 196,190 4,307 4,199 8,506 increase. increase. increase. The 8,506 increase is mainly due to land deliveries, which are 21,026 above the average for the previous five years. Respecting deliveries by water, which last year showed a heavy falling off, a slight rise is noted over the figures for 1900, but they are still 4,671 below the average for the previous five years. * Extracted from the Annual Report of the Clerk of the Market. 93 MONTHLY FISH RETURNS, 1901. Table showing Weight of Fish Delivered, Fish seized as Unsound, and percentage of Fish Condemned to that Delivered, at or near Billingsgate Market, during each month of the year 1901. Month. Weight of Fish Delivered.* Total. Weight of Fish Condemned. Ratio of Fish Condemned to that Delivered. By Land. By Water. January Tons. 12,189 Tons. 2,340 Tons. 14,529 Tons. 10 cwt. 18 qrs. 3 1 in 1,328 tons, or '075 per cent. February 13,926 2,731 16,657 10 1 3 1 „ 1,651 ,, .061 „ March 15,960 3,004 18,964 24 19 0 1 „ 760 „ .131 „ April 12,129 3,184 15,313 137 7 1 1 „ 111 „ .897 „ May 14,671 4,016 18,687 86 15 3 1 „ 215 „ .465 „ June 18,005 3,193 16,198 65 11 1 1 „ 247 „ .405 „ July 12,252 4,096 16,348 197 9 0 1 „ 83 „ 1.208 „ August -14,307 3,674 17,981 117 18 0 1 „ 152 „ .656 „ September 13,083 3,903 16,986 88 19 2 1 „ 191 „ .524 „ October 12,918 3,918 16,836 93 15 3 1 „ 179 „ .557 „ November 11,853 2,814 14,667 32 4 1 1 „ 455 „ .220 „ December 10,779 2,245 13,024 22 16 0 1 „ 572 „ .175 „ Total 157,072 39,118 196,190 ' 888 16 1 1 in 220 tons, or .456 per cent. * Compiled from the Monthly Returns furnished to the Corporation by the Fishmongers' Company. ■Weight of Fish Delivered, Fish seized as Unsound, and percentage of Fish Condemned to that Delivered, at or near Billingsgate Market during 1901 and the five years 1896-7-8-9-1900. Year. Weight of Fish Delivered. Total. Weight of Fish Condemned. Ratio of Fish Condemned to that Delivered. By Land. By Water. Tons. Tons. Tons. Tons cwts. qrs. 1896 134,479 39,212 173,691 1,211 13 2 1 ton in 144 tons, or .70% 1897 130,975 44,276 175,251 958 12 0 1 „ 183 „ .55 „ 1898 135,093 46,874 182,567 1,068 5 0 1 „ 170 „ .59 „ 1899 129,469 50,514 179,983 750 0 2 1 „ 240 „ .42 „ 1900 '149,615 38,069 187,684 769 13 3 1 „ 244 „ .41 „ Average (5 years) 136,046 43,789 179,835 951 13 0 1 ton in 189 tons, or .53% 1901 157,072 39,118 196,190 888 16 1 1 ton in 220 tons, or .45% The figures are slightly in excess of those for last year, and are 62 tons, 16 cwts., 3 qrs. under the average for the previous five years. 94 SALE OF FOOD AND DRUGS ACTS. t In April, 1901, Dr. Teed was appointed Public Analyst for the City, and the new system at once allowed of proper attention being given to this important department. The amount of adulteration has been found by experience to be to a great extent dependent upon the risk of detection, and the severity of punishment on conviction. Wherever the Acts are carried out strictly, it is also found that the proportion of articles found to be sophisticated rapidly falls. The Act requires to be carried out with the greatest care, in every detail, at every stage, and the slightest mistake or omission may lead to a summons being dismissed. It was therefore deemed expedient to entrust the working of the Acts, so far as the obtaining samples and preparation of evidence for the Solicitor is concerned, to one individual, and Mr. W. H. May was accordingly charged with this duty. His work is carried out under the instructions of your Medical Officer on a carefully arranged system. Special attention has been, in the first place, directed to the two important articles of milk and butter, which, while being the two most liable to sophistication, are also those in which adulteration is the most dangerous to the health of the community. It is only necessary for me to summarise with a few short notes the results which are periodically submitted to you by your Public Analyst. The total number of samples taken during the year was 854, of which 742 were found to be genuine and 112 adulterated, equals 13.11 per cent. adulteration. The number of milk samples taken 392 Found genuine 209 Found adulterated 83 Equals 21 per cent, adulteration. The number of butter samples 238 • Found genuine 224 Found adulterated 14 Equals 5.8 per cent. adulteration. The following Table shows the total number of samples in each Quarter (the first two Quarters being taken together), together with the results and percentage of adulteration :— 95 SALE OF FOOD AND DRUGS ACTS. Articles submitted for Analysis. Half-year ending 30th June. Quarter ending 30th September. Quarter ending 31st December. Total for 1901. No. of Samples taken. No. Genuine. No. Adulterated. Percentage of Adulteration. No. of Samples taken. No. Genuine. No. Adulterated. Percentage of Adulteration. No. of Samples taken. No. Genuine. No. Adulterated. Percentage of Adulteration. No. of Samples taken. No. Genuine. No. Adulterated. Percentage of Adulteration. Milk 59 38 21 35.6 103 66 37 35.9 230 205 25 10.86 392 309 83 21.2 Butter 28 25 3 10.7 63 57 6 9.52 150 144 6 4.0 241 226 15 6.2 Coffee 5 4 1 20.0 ... ... ... ... 6 6 0 0 11 10 1 9.0 Pepper ... ... ... ... 16 15 1 6.25 8 8 0 0 24 23 1 4.0 Mustard ... ... ... ... 16 13 3 18.75 7 7 0 0 23 20 3 13.0 Jam, Honey, & Golden Syrup ... ... ... ... 8 8 0 0 ... ... ... ... 8 8 0 0 Malt Vinegar ... ... ... ... 6 6 0 0 ... ... ... ... 6 6 0 0 Olive Oil ... ... ... ... 3 3 0 0 ... ... ... ... 3 3 0 0 Arrowroot ... ... ... ... 2 2 0 0 ... ... ... ... 2 2 0 0 Cheese ... ... ... ... 1 1 0 0 1 1 0 0 2 2 0 0 Bread and Flour ... ... ... ... 24 24 0 0 ... ... ... ... 24 24 0 0 Ground Almonds ... ... ... ... 1 0 1 100.0 ... ... ... ... 1 0 1 100.0 Drugs ... ... ... ... 1 1 0 0 110 102 8 7.27 111 103 8 7.2 Cocoa ... ... ... ... ... ... ... ... 1 1 0 0 1 1 0 0 Sweets ... ... ... ... ... ... ... ... 4 4 0 0 4 4 0 0 Sterilized Milk ... ... ... ... ... ... ... ... 1 1 0 0 1 1 0 0 854 742 112 13.11 96 Table II. RESULTS OF PROSECUTIONS. First and Second Quarters. Sample. Nature and Extent of Adulteration. Result. 4 Milk 7 per cent. of added water £10 and 21s. expenses. 14 Butter 27 per cent. of fat abstracted 10s. and 21s. expenses. 20 „ 14 per cent. of fat abstracted 20s. and 21s. expenses. 37 Milk 12 per cent. of added water £5 and 17s. 6d. expenses. 40 „ 8 per cent. of added water £2 and 12s. 6d. expenses. 45 Butter 100 per cent. of margarine £2 and 12s. 6d. expenses. 50 Milk 28 per cent. of fat abstracted £1 and 17s. 6d. expenses. 53 „ 24 per cent. of fat abstracted 10s. and 12s. expenses. 55 Coffee 65 per cent. of chicory £1 10s. and 12s. expenses. 59 Milk 9 per cent. of added water £5 and £1 4s. expenses. 72 Butter 100 per cent. of margarine 10s. and 17s. 6d. expenses. 75 Milk 13 per cent. of added water £5 and 12s. expenses. 77 Butter 90 per cent. of margarine £4 and £1 1s. expenses. 86 Milk 19 per cent. of fat abstracted 2s. 6d. and 17s. 6d. expenses. Third Quarter. 101 Black Pepper 16 per cent. of common salt 10s. and 17s. 6d. expenses. 116 Milk 5 per cent. of added water 40s. and 17s. 6d. expenses. 129 „ 25 per cent. of original fat abstracted 10s. and 17s. 6d. expenses. 130 „ 5 per cent. of added water 40s. and 25s. expenses. 132 „ 14 per cent. of original fat abstracted 5s. and 17s. 6d. expenses. 133 „ 34 per cent. of original fat abstracted 20s. and 19s. 6d. expenses. 134 Butter 100 per cent. of margarine 40s. and 17s. 6d. expenses. 138 Milk 24 per cent. of added water £5 and 17s. 6d. expenses. 141 „ 9 per cent. of added water £3 and 17s. 6d. expenses. 143 „ 11 per cent. of added water £3 and 17s. 6d. expenses. 145 „ 29 per cent. of original fat abstracted Expenses 17s. 6d. 150 Bread and Butter Bread and margarine Summons dismissed on payment of expenses 17s. 6d. and undertaking. 243 Mustard 28 per cent. of added starch £5 and 21s. 6d. expenses. 247 Butter 100 per cent. of margarine 10s. and 17s. 6d. expenses. 249 Milk 6 per cent. of added water 5s. and 16s. 6d. expenses. 251 „ 21 per cent of added water, and 24 per cent. of original fat abstracted. £3 and 21s. 6d. expenses. 252 „ 25 per cent. of original fat abstracted 10s. and 17s. 6d. expenses. 255 „ 9 per cent. of original fat abstracted 1s. and 17s. 6d. expenses. 256 „ 39 per cent. of original fat abstracted Defendant paid expenses, 17s. 6d. 257 „ 16 per cent. of original fat abstracted 20s. and 17s. 6d. expenses. 258 „ 8 per cent. of original fat abstracted Defendant paid expenses, 17s. 6d. 272 „ 12 per cent. of added water £2 and 21s. 6d. expenses. 277 „ 18 per cent. of added water Defendant paid expenses, 17s. 6d. 282 „ 43 per cent. of original fat abstracted 2s. 6d. and 17s. 6d. expenses. 317 „ 22 per cent. of added water 10s. and 17s. 6d. expenses. 318 „ 11 per cent. of added water Defendant paid expenses, 17s. 6d. 97 Fourth Quarter. Sample. Nature and Extent of Adulteration. Result. 363 Milk 22 per cent. of added water £5 and 17s. 6d. expenses. 368 „ 30 per cent. of original fat abstracted £l and 21s. 6d. expenses. 370 „ 24 per cent. of original fat abstracted 10s. and 17s. 6d. expenses. 384 „ 32 per cent. of added water Summons dismissed. Vendor stated she had given name of brother as owner in error. 390 „ 17 per cent. of original fat abstracted Dismissed. N0 intent to defraud. 408 „ 10 per cent. of added water 20s. and 21s. 6d. expenses. 411 Butter 100 per cent of margarine £3 and 17s. 6d. expenses. 419 Almond Oil 100 per cent. of oil other than almond 5s. and 32s. expenses. 444 Milk 10 per cent. of added water £20 and 40s. 6d. expenses. (Second conviction.) 452 „ 10 per cent. of added water £10 and 18s. 6d. expenses. (Second conviction.) 507 Boric Acid Ointment 20 per cent. of boric acid deficient 40s. and 19s. 6d. expenses. 517 Butter 100 per cent. of margarine 10s. and 2s. expenses. 518 Milk 13 per cent. of added water 40s. and 17s. 6d. expenses. 519 „ 17 per cent. of added water 40s. and 21s. 6d. expenses. 538 „ 20 per cent. of added water 40s. and 17s. 6d. expenses. 541 „ 15 per cent. of original fat extracted £3 and 17s. 6d. expenses. 606 Almond Oil 100 per cent. of oil other than almond oil. Summons dismissed on question of fact. 611 Boric Acid Ointment 19 per cent. of boric acid deficient 10s. and 14s. 6d. expenses. 638 Milk 22 per cent. of added water £5 and 17s. 6d. expenses. 663 Butter 100 per cent. of margarine £3 and 21s. 6d. expenses. 674 Milk 10 per cent. of added water £3 and 17s. 6d. expenses. 700 ,, 12 per cent. of added water 10s. and 17s. 6d. expenses. 744 Butter 100 per cent. of margarine 40s. and 17s. 6d. expenses. 759 Mercury Ointment 60 per cent. of mercury deficient 40s. and 21s. 6d. expenses. 762 ,, 70 per cent. of mercury deficient 2s. 6d. and 18s. 6d. expenses. 771 Milk 9 per cent. added water £4 and 21s. 6d. expenses. 793 ,, 10 per cent. of added water £5 and 17s. 6d. expenses. 796 ,, 20 per cent. of original fat abstracted 40s. and 21s. 6d. expenses. 803 Butter 100 per cent. of margarine 20s. and 17s. 6d. expenses. SUMMARY. £ s. d. £ s. d. First and Second Quarters: Fines 38 2 6 expenses 11 19 0 Third Quarter „ 32 3 6 „ 23 15 6 Fourth Quarter „ 80 7 6 „ 25 6 0 £150 13 6 £61 0 6 Fifty-six fines were inflicted during the year; the average fine being £2 13s. 10d. 98 The following Table has been partly compiled from the Annual Reports of the Local Government Board, to which is added, by way of comparison, the results of our experience in the City of London: — Year. Total Number of Samples Examined in England and Wales. Number Examined in the City of London. Percentage of Total Number Examined in City of London. Number of Persons to each Sample examined. England- and Wales. City of London. 1881 17,823 162 .92 1,462 318 1882 19,439 197 1.01 1,358 252 1883 19,648 201 1.02 1,363 240 1884 22,951 285 1.24 1,182 164 1885 23,230 206 .88 1,184 221 1886 23,596 188 .79 1,181 235 1887 24,440 294 1.20 1,171 146 1888 26,344 178 .67 1,086 235 1889 26,954 249 .90 964 162 1890 27,465 165 .62 1,071 239 1891 29,028 169 .42 998 227 1892 32,447 123 .38 894 303 1893 37,233 104 .28 779 347 1894 39,516 161 .40 734 216 1895 43,962 266 .60 661 127 1896 45,555 212 .47 636 148 1897 46,856 220 .47 619 138 1898 49,555 230 .46 585 122 1899 53,056 171 .32 547 164 1900 62,858 145 .23 461 186 1901 Return not yet received. 854 - - 32 In my Annual Report for 1900, reference was made to the Report of the Departmental Committee appointed by the President of the Board of Agriculture to consider as to what regulations, if any, should be made under Section 4 of the Sale of Food and Drugs Act, 1899, for determining what deficiency, if any, of the normal constituents" of genuine milk and cream, or what addition of extraneous matter or proportion of water in any sample "of milk or cream, should raise a presumption, until the contrary is proved, " that the milk or cream is not genuine." As a result of the recommendation of this Committee, on the 5th August the following Rules were issued: — 99 BOARD OF AGRICULTURE RULES. (Dated 5th August 1901.) SALE OF MILK REGULATIONS, 1901. THE Board of Agriculture, in exercise of the powers conferred on them by Section 4 of the Sale of Food and Drugs Act, 1899, do hereby make the following Regulations : — MILK. 1. Where a sample of milk (not being milk sold as skimmed, or separated, or condensed, milk) contains less than 3 per cent, of milk-fat, it shall be presumed for the purposes of the Sale of Food and Drugs Act, 1875-1899, until the contrary is proved, that the milk is not genuine, by reason of the abstraction therefrom of milk-fat, or the addition thereto of water. 2. Where a sample of milk (not being milk sold as skimmed, or separated, or condensed, milk) contains less than 8'5 per cent, of milk-solids other than milk-fat, it shall be presumed for the purposes of the Sale of Food and Drugs Acts, 1875 to 1899, until the contrary is proved, that the milk is not genuine, by reason of the abstraction therefrom of milk-solids other than milk-fat, or the addition thereto of water. SKIMMED OR SEPARATED MILK. 3. Where a sample of skimmed or separated milk (not being condensed milk) contains less than 9 per cent. of milk-solids, it shall be presumed for the purposes of the Sale of Food and Drugs Acts, 1875 to 1899, until the contrary is proved, that the milk is not genuine, by reason of the abstraction therefrom of milk-solids other than milk-fat, or the addition thereto of water. EXTENT. 4. These Regulations shall extend to Great Britain. COMMENCEMENT. 5. These Regulations shall come into operation on the First day of September, One thousand nine hundred and one. SHORT TITLE. 6. These Regulations may be cited as the Sale of Milk Regulations, 1901. In witness whereof the Board of Agriculture have hereunto set their Official Seal this fifth day of August, One thousand nine hundred and one. ©T. H. ELLIOTT, Secretary. 100 These Rules relate to milk only, and it will be observed that they in no way alter the standard that had been previously adopted by your Public Analyst, but obviously gives such standard a legal value. The Departmental Committee appointed by the Board of Agriculture in July, 1899, to inquire into the use of preservatives and colouring matters in the preservation and colouring of food, and to report:— (1) Whether the use of such materials, or any of them, for the preservation and colouring of food in certain quantities is injurious to health, and if so, in what proportion does their use become injurious; (2) To what extent, and in what amounts, are they so used at the present time; having held fifteen sittings, and taken a vast amount of evidence, reported at great length on 16th January, 1901. The following are the recommendations of the Committee:— " RECOMMENDATIONS. "136. Based upon the foregoing conclusions, we beg to make the following "recommendations:— "(a.) That the use of formaldehyde or formalin, or preparations thereof, in "foods or drinks be absolutely prohibited, and that salicylic acid be not used in a. "greater proportion than 1 gr. per pint in liquid food and 1 gr. per pound in " solid food. Its presence in all cases to be declared. "(b.) That the use of any preservative or colouring matter whatever in milk offered tor sale in the United Kingdom be constituted an offence under the Sale "of Food and Drugs Acts. "(c.) That the only preservative which it shall be lawful to use in cream be "boric acid or mixtures of boric acid and borax, and in amount not exceeding "0.25 per cent. expressed as boric acid. The amount of such preservative to be "notified by a label upon the vessel. "(d.) That the only preservative permitted to be used in butter and "margarine be boric acid or mixtures of boric acid and borax, to be used in "proportions not exceeding 0.5 per cent. expressed as boric acid. "(e.) That in the case of all dietetic preparations intended for the use of "invalids or infants, chemical preservatives of all kinds be prohibited. "(f.) That the use of copper salts in the so-called greening of preserved "foods be prohibited. "(g.) That means be provided either by the establishment of a separate "Court of Reference or by the imposition of more direct obligation on the Local "Government Board to exercise supervision over the use of preservatives and "colouring matters in foods, and to prepare schedules of such as may be considered "inimical to the public health. "(Signed) HERBERT MAXWELL, Chairman. "T. E. THORPE. " H. TIMBRELL BULSTRODE. " F. W. TUNNICLIFFE. " Chas. J. Huddart, Secretary." 101 From a public health point of view, these recommendations must appear as at once satisfactory and moderate. For milk, all preservatives and colouring matters are recommended to be prohibited, and their addition to be an offence under the Sale of Food and Drugs Acts. In cream and butter the amount of preservative is to be limited, and the use of copper salt as "greening" to be prohibited. If legislation follows on the lines of these recommendations, it cannot fail to be beneficial to the general health of the country. CHEESE POISONING. (Tyrotoxismus.) I have to report an extremely interesting series of outbreaks of poisoning from Cheese which have taken place in various parts of London during the year, and which have been all traced to one common source. Though, so far as is at present known, no cases have occurred within the City limits, it is an undoubted fact that within your jurisdiction the Cheese causing the trouble was in the first place sold by the importer to two large firms, and again resold by them to various retail shopkeepers. Inasmuch as the actual outbreaks were entirely outside the City, the details are of necessity furnished by the Medical Officers of Health of the Boroughs concerned, to whom I am greatly indebted for much trouble in supplying these. (I.) BETHNAL GREEN Dr. Newman states that on 21st October he was informed by the Medical Officer of Health of the Borough of Bethnal Green that certain cases of illness had occurred which were supposed to have been caused by Dutch Cheese. This Cheese was sold by a retail shopkeeper, who had obtained it from a large firm, A B and C in Finsbury. Nine persons were traced who had eaten this Cheese and had been taken ill. The Bethnal Green Authorities endeavoured to obtain samples of the Cheese, but failed, the remainder of the consignment having been returned to A B and C in Finsbury. (II.) FINSBURY Dr. Newman thereupon sent to Messrs. A B and C for samples of the Cheese, which were at once supplied, and information given that it had been bought from a City firm, D and E. 102 The Cheese appeared to be in excellent condition-it had no unhealthy characteristics as regards colour, odour, or consistence. Dr. Newman ate an ounce or two, and noticed nothing exceptional in the taste but four or five hours afterwards suffered acutely from symptoms similar to those of the other affected persons. On the following day he informed the head of A B and C of what had occurred, who, to demonstrate his belief that these illnesses had no relation to the Cheese in question, ate about six ounces of it himself. On the following day he suffered acutely from similar symptoms; and admitting that the Cheese was the evident cause of his illness, at once handed over the remainder of the consignment. On the 28th October, Dr. Newman was informed of the illness of a man, his wife, and two daughters who had eaten Dutch Cheese bought from a shopkeeper in Finsbury, the symptoms being those of acute poisoning. It was then found that the shopkeeper had bought this Cheese from the same firm, A B and C, and the shopkeeper stated that he and his daughter having eaten some of the same parcel had suffered from poisoning, and had returned the whole consignment to A B and C. There were in all 17 cases of sickness traceable to the same Cheese sold by A B and C. The symptoms of illness in all these 17 cases occurred in from two to eight hoars after eating the Cheese in question. The symptoms were similar in all—epigastric pain, rigors, vomiting, diarrhoea, prostration, and some fever. The degree of sickness did not appear to depend upon the amount of Cheese eaten. There was no death, and in general the symptoms appeared to have passed off in the course of 48 hours. Now a short incubation period suggests that the poison was "available" in the Cheese, as a product of previous changes, possibly bacterial, set up in the Cheese. A long incubation period between eating the food and the symptoms of poisoning would suggest that the persons affected had consumed not the products of bacteria, but the bacteria themselves. In the present case the incubation period was comparatively short, and the acuteness of the symptoms did not appear to have a direct relationship to the amount of Cheese eaten. These two facts in relation to Cheese poisoning at once reminded Dr. Newman of some outbreaks which occurred in Michigan in 1883 and 1884. Three hundred persons in all were affected, and the illness, which was similar to that described, was traced by Professor V. C. Yaughan to a poisonous ptomaine present in the Cheese, and to which he gave the name tyro-toxicon. 103 Samples of the Cheese were therefore handed to Mr. Kear Colwell (Public Analyst for the Borough of Finsbury), who reported as follows:— Chemical Laboratory, Finsbury Town Hall, E.C., November 22nd, 1901. I received from the Medical Officer of Health (Dr.Newman) on the undermentioned dates four samples of Cheese for examination, more particularly with regard to the presence of any substance which would have been likely to cause injury to health, all the samples being part of a consignment which he had reason to suspect. Sample No. Weight. Date of Receipt. I. 1 oz. 23rd October, 1901. II. l½ ozs. 28th October, 1901. III. 6 lbs. 29th October, 1901. IV. 2½ lbs. 8th November, 1901. Sample No. I. was very small in quantit, and consisted of a dry, hard piece of rind, evidently the unconsumed portion of a slice cut from a Dutch Cheese. Sample No. II. was a thin, dry, hard slice of the same kind of Cheese as No. I. There was nothing abnormal in the smell, colour, or taste of either of these samples, nor was I able to detect any mineral or organic poisons after an extremely careful examination. Sample No. III. when handed to me was normal in appearance and fairly moist. It had a peculiar sour smell, as though undergoing slight fermentation. On analysis of this sample, the following results were obtained: — Water 42.60 per cent. Fat 18.83 „ Proteids, &c. 32.29 „ Mineral Matter 6.28 „ These figures are fairly typical of ordinary Dutch Cheese. A careful examination was made for mineral poisons with negative results, but from the cold aqueous extract of some four ounces after treatment with ether and subsequent purification, I obtained a small quantity of a body possessing the characteristics of Tyro-toxicon, a poisonous ptomaine, first isolated from Cheese by Vaughan. Nothing is definitely known as to the exact mode of formation of this body, but it is probably the product of some organism, its production being generally associated with butyric fermentation. Vaughan considers it to be identical with diazo-benzene butyrate, but the evidence in favour of this view is not absolutely conclusive. Exposed to moist air Tyro-toxicon is rapidly decomposed, and it is probably on this account that I failed to isolate it from samples Nos. I. and II., although No. I. had undoubtedly caused illness. Furthermore, it does not appear to be uniformly distributed through the Cheese, as in sample No. III. portions were tested which did not yield Tyro-toxicon. Some authorities consider this to be additional evidence of the fermentative origin of this ptomaine. Sample No. IV., which was similar in composition to No. III. Tyro-toxicon after repeated tests. In the present state of our knowledge with regard to the mode of formation of Tyrotoxicon, no blame or negligence can be attributed to anyone, but in order to facilitate investigation when similar epidemics arise, I venture to suggest that the provisions of 104 Section 7 of the Sale of Food and Drugs Act, 1899, which requires every manufacturer of margarine or margarine-cheese to keep a register showing the quantity and destination of every consignment sent out, should be extended to Cheese, and that not only the representatives of the Board of Agriculture, but the Medical Officer of Health of the Local Sanitary Authority should have an opportunity of inspecting it when necessary. (Signed) J. KEAR COLWELL. Dr. Newman further states that Messrs. A B and C furnished him with a complete record of their transaction in this particular consignment, which showed that they bought altogether 70 or 80 Cheeses, which were sold by them to -firms in Marylebone, Tunbridge Wells, Barking, Islington, Bermondsey, and Finsbury, but that illness occurred only in Finsbury, Bethnal Green, and Bermondsey, with the exception of one doubtful case at Tunbridge Wells. BERMONDSEY Dr. King-Brown, Medical Officer of Health for the Borough of Bermondsey, states that on the 21st November he was informed of the existence of 13 cases of irritant poisoning in his District, which were supposed to be due to Dutch Cheese, and that four other cases had occurred in the Borough of Deptford. The symptoms were, in all cases, vomiting, diarrhoea, abdominal pain, prostration, and feverishness coming on from two to six hours after eating the Cheese, and it was observed that in the same house only those who had eaten it were so attacked. The Cheese had all been bought from one shop, one or two on the 19th November, and the remainder on the 20th. There were no deaths, but in some cases the symptoms persisted for two or three days, one child being seriously ill. By careful enquiry Dr. King-Brown discovered eight other cases of a similar character, and traceable to the same cause. On visiting the shop, the proprietor informed the Medical Officer that he had none of the Cheese for sale, as on account of the complaints of his customers as to its ill-effects he had ceased to sell. Seven Cheeses remained in stock, which he was then having analysed. A sample was taken and submitted for examination to Dr. W. C. Pakes, of Guy's Hospital. This Cheese had been bought from a firm in the City, who had obtained it from the same shipper as supplied Messrs. A B and C. A further consignment of the same Cheese was traced to another retailer in Bermondsey, but on enquiry no complaints had been made respecting it. Dr. King-Brown believed these cases of illness to be the result of ptomaine poisoning The Report of Dr. Pakes is as follows:— 250 grammes of Cheese were extracted for ptomaine; the resulting extract injected into a mouse failed to give any result, that is, the mouse was unaffected. A second 250 grammes were extracted in an exactly similar manner, with exactly the same result. Two mice were fed with portions of the Cheese, and they remained entirely unaffected. 105 The small portion of Cheese which accompanied the larger portion, and which was supposed to be a portion of the Cheese actually consumed by those who were taken ill, was extracted, but no ptomaine was found present. The result of my examination therefore is, that neither by physiological nor chemical tests have I been able to isolate any ptomaine having a harmful action upon mice, the inference being that there was no ptomaine present in the Cheese which would have an injurious effect upon human beings. (Signed) WALTER C. C. PAKES. On receipt of the above information I at once communicated with the two City firms concerned, and found them willing and anxious to assist in every possible way the investigation. The shipper was traced, and also the actual maker of the Cheese in Holland, who came over to London and called upon me in order to give and obtain any information possible. It was thus clearly established that the whole of the Cheese in question was made by one firm, about the same time, and supplied, through the usual trade channels, to all those persons who were known to be attacked. In view of the extreme importance of the case and the widespread nature of the mischief, a sample of the consignment supplied to A B and C, Finsbury, was obtained and submitted to Professor Klein, of St. Bartholomew's, for examination. His report is as follows:— St. Bartholomew's Hospital, e.C., 3rd December, 1901. I beg herewith to report on the bacterioscopic analysis of the Dutch cheese sent here on November 25th, 1901, "A." Cheese. Series I.—From the centre of the Cheese a piece of the material was dug out and used for making the following cultures:— 1. Anaerobic cultures in milk; four tubes each receiving about a gramme of the material, to detect the presence of spores of anaerobic microbes. 2. About 2-3 grammes of the material were broken down and well shaken with a few CC of salt solution; from the turbid milky mixture Agar surface plates and gelatine surface plates were made. 3. From same salt mixture tube cultivations, Agar and gelatine were made. From these cultivations the following results were obtained:— 1. There were no spores of anaerobic microbes in the Cheese. 2. The number of anaerobic microbes was comparatively small. 3. The microbes isolated were: (a) bacillus coli communis, not particularly abundant; (b) bacterium lactis very abundant; (c) a non-mobile cylindrical bacillus forming coherent zooglcea masses. This microbe was not particularly abundant. 106 With recent Agar culture of all three microbes, a, b and c injected guinea pigs, two for each species, using considerable amounts of the cultures. The result was nil, the animals remained well. Series II.—With pieces of the Cheese mixed with a little moistened bread the following animals were fed on two successive days; the amount of cheese eaten by the animals was considerable:— 1. Four mice. 2. Three white rats. 3. Two guinea pigs. 4. Two rabbits. The day after the first feeding all these animals were found perfectly well; the day after the second feeding one rat was found dead. This animal, on post-mortem, showed no change in the internal organs; the viscera were not injected, the spleen and liver and lungs appeared normal, the intestines not injected, but containing much gas. Cultivations were made from the blood of the heart and of the spleen. These cultures remained quite sterile. Of the four mice that were fed with the Cheese one appeared ill two days after the feeding; it was found dead four days after. On post-mortem examination the intestines appeared slightly injected, but the liver, spleen, kidney and lungs appeared normal. Cultivations were made by rubbing a large lump of blood clot of the heart over the surface of gelatine; the result was that five colonies of bacillus coli were obtained. All other animals fed remained well and normal till this day, December 3rd. Series III.—With the turbid, milky, salt emulsion of the cheese injected subcutaneously with considerable amounts:— 1. Three mice. 2. Three rats. 3. Two guinea pigs. 4. Two rabbits. The result was nil; none of the animals showed any illness, local or general. E. KLEIN. CROYDON:— A further outbreak affecting one family only has been since reported by Dr. Richards, Medical Officer of Health for the County Borough of Croydon. This Cheese was bought by a local retailer from a City firm, F & G, who obtained it from the same shippers about the same date as all the previous consignments. 107 To summarise, from the one factory through the same shipper were obtained Cheeses made about the same date, which being sold in Bethnal Green, Bermondsey, Croydon, Deptford, Finsbury, and Tunbridge Wells, their consumption was followed by illness in those who ate them. It thus appears that there was a definite causal relation between this particular consignment of Cheese, and the various outbreaks. It is not at all extraordinary that by one investigator a definite ptomain should be discovered, while its presence failed detection by two others. It was not possible to separate or identify the" batches "or" vats" of Cheese, and the shipping mark in no way assists one in this respect. Assuming that some amount of poisonous material was present, it might be in small quantities, and in all probability would be very unequally distributed throughout the consignment. The maker of the Cheese failed to detect anything unusual in the appearance of the Cheese when ripened ready for shipment. The fact that the Cheese did not produce symptoms in all cases when eaten would further tend to show that the poison was not present in all portions. From time to time, doubtless, such cases occur, and the chief interest in the present outbreak is the fact that it was possible to trace them all to the same shipper, and to a shipment about the same date, though of different marks. The symptoms in all the above cases were similar, and are those usually ascribed to the action of Tyrotoxicon or Tyrotoxin, a ptomain which is sometimes found in poisonous cheese, This is one of a large class of substances formed by the action of bacteria upon nitrogenous compounds, which in the majority of cases produce well-marked symptoms. It is an exceedingly unstable body, being easily destroyed by the action of heat and moisture, and even by exposure to the air; and being present in very small proportions, it has never been isolated in sufficiently large quantities to allow of its composition being definitely determined. Its chemical and clinical actions are precisely identical with those of diazo-benzol, which is simply a transition product of putrefaction. Most of the observations upon this material so far have been made by Professor Victor C. Vaughan, of Ann Arbor, Michigan, who has had the opportunity of investigating several outbreaks caused by it. It appears probable that it occurs in the milk, and it has been suggested as one of the causes of the wide-spread outbreaks of summer diarrhoea among children. 108 Professor Vaughan mentions two outbreaks in Michigan in 1895, when fifty persons were affected by cream, and about twelve by cheese. The toxicogenic germ found was similar in both outbreaks. It grows readily on the ordinary culture media, and also many fruits and vegetables. This latter point is of great interest, as it is well known that milk often produces unpleasant symptoms if it has been kept near unsound and decomposing fruits and vegetables. Although the symptoms are very marked, the result is practically never a fatal one in adults, though a patient may be left in a weak state for some considerable time. Practically the difficulty is that in the manufacture, as the cause is not known, it is impossible to take any steps to prevent the formation of this ptomain; and further, as it imparts no taste nor smell to the cheese, its presence cannot be detected except by analysis. It follows as a matter of course, that neither the makers, shippers or dealers are in any degree to blame for these unfortunate outbreaks, and in view of this no names have been mentioned. I have the honour to be, Gentlemen, Your obedient Servant, W. Mryredfe Medical Officer of Health for the City of London. Public Health Department, Guildhall, E.C., March, 1902. APPENDICES. 111 Appendix A. CITY OF LONDON MORTALITY. 1901. STREET LISTS, Compiled from Weekly Returns of District Registrars. STREET OR PLAOE. No. of House. Sex. Age. Date of Death. Certified Cause of Death. Remarks. Abchurch Lane 13 M 62 9 Feb. 1901 Hemiplegia ,, ,, 34 F 79 8 Mar. „ Bright's Disease ,,, ,, 31 F 3 27 May „ Broncho-Pneumonia ,, ,, 12 F 68 4 Nov. „ Cerebral Haemorrhage Died in St Bart.'s Albion Buildings 21 F 61 27 Jan. „ Acute Bronchitis ,, ,, 21 F 74 20 Sept. „ Heart Disease Aldermanbury 15 F 78 11 Aug. „ Bronchitis Aldersgate Street 126 F 66 27 Jan. ,, Thrombosis „ „ "Manchester Hotel" - M 63 19 Feb. „ Acute Bronchitis ,, ,, ,, ,, - F 60 13 April „ Bright's Disease ,, ,, ,, ,, - M 32 7 May „ Suicide by shooting Inquest Aldgate High Street 36 F 24 27 Feb. „ Asthma (Cardiac) ,, ,, ,, 65 M 44 22 Nov. „ Dilatation of Heart „ Railway Station (Found on the line) — F newly born 22 Dec. 1900 No evidence Inquest „ "Three Nuns Hotel" — M 42 13 Nov. 1901 Syncope caused by excessive drinking Inquest America Square 15 F 52 22 „ „ Rheumatic Fever Angel Court 14 F 1 month 2 May „ Premature Birth Artillery Lane 12 F 68 17 Jan. „ Chronic Bronchitis ,, ,, 5 F 2 22 Mar. „ Broncho-Pneumonia „ „ 7 F 85 15 Oct. „ Cancer of Breast ,, „ 16 M 40 25 „ „ Acute Pneumonia ,, ,, 21 F 61 12 Nov. „ Asthenia Austin Friars 25 F 55 7 Sept. „ Cirrhosis of Liver Ball Court, Giltspur Street 2 F 63 27 Aug. „ Bronchitis Barbican 23 M 59 19 Dec. „ Pulmonary Tuberculosis Barker's Buildings 27 F 68 5 Feb. „ Chronic Bronchitis and Heart Disease Bartholomew Close 35 F 75 11 July „ Hemiplegia „ House 5 F 70 21 Feb. „ Chronic Bronchitis „ Lane 1 M 58 13 „ „ Heart Disease ,, Place 6 M 2 5 April „ Broncho-Pneumonia Basinghall Avenue 2 18 Dec., 1900 Heart Disease and Dropsy „ Street 13 M 26 3 April, 1901 Hœmorrhage of Lungs Inquest ,, ,, 17 M 57 7 Oct. „ Cirrhosis of Liver Beech Street 34 F 16 25 Feb. „ Heart Failure ,, ,, 4 F 76 21 April „ Granular Kidneys Bell's Buildings 10 F 63 28 Mar. „ Phthisis Billiter Street (Found on doorstep) 14 F newly born 24 „ „ Death from violence. No evidence how caused Inquest „ „ 6 M 38 10 June „ Chronic Interstitial Nephritis Bishopsgate Street Within 96 M 40 28 „ „ Heart Disease ,, ,, 106 M 52 14 Oct. „ Cirrhosis of Liver „ „ Without 119 M 90 20 Jan. „ Senile Decay ,, ,, ,, 113 M 75 18 Mar. „ Senile Dementia ,, ,, ,, 98 F 14 m'ths 29 April „ Convulsions ,, ,, ,, 91 M 52 28 „ „ Phthisis ,, ,, ,, 88 M 16 31 July „ Acute Nephritis ,, ,, , 136 F 21 1 Aug. „ Heart failure, due to excessive drinking Inquest ,, ,, ,, 122 M 19 9 ,, ,, Tubercle of Lungs Inquest Bolt Court, Fleet Street (Albert Club) - M 48 6 ,, ,, Cerebral Hemorrhage Bridgewater House 7 M 6 weeks 15 Sept. „ " Overlaid " by mother Inquest „ Square (Tranter's Hotel) — M 28 19 June „ Peritonitis Died in St. Bart.'s Broadway 9 M 42 29 Aug. „ Acute Nephritis Brushfielil Street 3 F 33 20 June „ Suffocation Inquest 112 CITY OF LONDON MORTALITY—continued. STREET OB PLACE. No. of House. Sex. Age. Date of Death. Certified Cause of Death. Remarks. Camomile Street 36 M 37 27 Dec., 1900 Heart Disease Inquest ,, ,, 38 F 74 21 Sept., 1901 Senile Decay Cannon Street 47 M 40 9 Jan. „ Phthisis ,,, ,, 84 M 71 3 Feb. „ Cerebral Hœmorrhage ,,„ „ 119 F 7 months 19 Mar. „ Congenital Debility „ „ Hote — M 72 29 July „ Heart Disease Carmelite Street Fire Station — F 5 weeks 9 Jan. „ Broncho-Pneumonia ,, „ ,„ — F 46 13 May „ Phthisis ,, ,, ,,„ „ - M 7 weeks 7 Dec. „ Broncho-Pneumonia Carter Lane 27 F 27 28 June „ Phthisis „ „ 17 M 2 months 30 Sept. „ Gastro-Enteritis „ Street 17 M 4 20 Mar. „ Acute Endocarditis „ „ 22 M 1½ 17 Dec. „ Convulsions Inquest Castle Street 20 M 65 31 Jan. ,, Suicide by Shooting Inquest Catherine Court 4 M 81 21 „ Broncho-Pneumonia Change Alley — M 64 17 June „ Heart Disease Chapel Street 16 F 50 26 „ ,, Cirrhosis of Liver Cheapside 105 F 1 13 Mar. „ Broncho-Pneumonia „ 45a F 45 6 June „ Pulmonary Tuberculosis Died in St. Bart.'s Christchurch Passage — M 59 28 May „ Influenza Circus Place — M 59 21 Oct. „ Interstitial Nephritis Inquest City Buildings 8 F 10 days 11 Aug. „ Inanition ,, ,, 26 M 2 months 22 Sept. „ Premature Birth „ „ Moor Lane 13 F 38 6 Nov. „ Cerebral Haemorrhage Died in St. Bart.'s Clark's Yard, Rose Alley — F 50 29 Oct. „ Acute Bronchitis Clement's Lane 13 F 34 14 Dec. „ Ch. Kidney Disease Cloth Fair 6 M 54 10 Jan. „ Bronchitis and Heart Disease ,, ,,„ „ 3 F 74 9 Nov. „ Morbis Cordis Cockerill's Buildings 2 M 81 29 Mar. „ Heart Failure ,, ,, 5 F 50 17 May „ Heart Disease „ „ 2 F 12M'ths 9Aug ,, Acute Bronchitis „ „ 7 M 36 21May Phthisis Cornhill 79 M 75 9 April „ Heart Disease Cripplegate Street 57 F 24 17 Jan. „ Heart Disease Inquest Crosby Square 4 M 75 3 Aug. „ Cerebral Hmœorrhage Crutched Friars 6 M 80 15 Feb. „ Heart Disease Inquest , ,,„ „ 42 M 70 23 Sept. „ Suicide by Cocaine Poisoning Inquest Cutler Street Warehouse — M 36 29 April „ Suicide by Hanging Inquest Dean Street 2A F 70 14 Aug. „ Heart Disease , ,, D Block 6 M 56 2AApril Pnenmonia ,, D Bolck 6 M 56 14 Dec. Syncope from lung Disese „ F Block 7 F 5 31 ,, 1900 Syncope from Lung Disease „ F Block 7 M 3 months 10 Feb., 1901 Convulsions Dorset Street 7 F 39 23 Nov. „ Run over by a cab Inquest. Died in St. Bart.'s Duke Street 5 F 77 25 Dec. „ Senile Decay East Harding Street 12 F 74 29 June. Senile Decay Eldon Street 18 M 31 6 Sept. Suicide by Cutting his Throat Inquest Fann Street 14 F 30 hours 27 Oct. „ Premature Birth Inquest Farringdon Street 18 F 9 months 2 Mar. „ Tabes Mesenterica „ „ 27A F 67 8 May „ Pneumonia , ,,„ „ 27a F 38 3 Dec. „ Morbis Cordis Fenchurch Buildings 18 F 81 10 Feb. „ Scirrhus of Breast , ,,„ „ 4 M 67 10 Oct. „ Angina Pectoris „ Street 45 M 56 1 April „ Chronic Nephritis , ,,„ „ 24 M 59 17 July „ Bright's Disease , ,,„ „ 155 M 47 30 Mar,, Aneurism , ,,„ „ 18 M 38 24 April ,, Influenza „ „ L. T. & S. Railway Station. Found dead in a railway - M 48 25 Feb. ,, Heart Disease Inquest carriage. , ,,„ „Railway Station _ M 48 11 April „ Suicide by Shooting Inquest , ,,„ „ , ,,„ „ - M 61 27Sept ,, Suicide by Shooting Fetter Lane 42 M 64 16May Paraplegia , ,,„ „ 83 51 41 24 June „ Haemorrhage into Brain Inquest , ,,„ „ 5 M 76 10 Nov. ,, Heart Disease Finsbury Lane 11 M 53 11 April ,, Carcinoma of œsophagua „ Pavement 63 F 17 4 Oct. „ Phthisis „ (Moorfields Chambers) _- M 10 m'ths 6 Dec. „ Broncho-Pneumonia Fish Street Hill 25 M 44 11 July „ Chronic Alcoholism Inquest Fleet Lane 29 F 75 15 June „ Dropsy „ Street 44 M 64 4 ,,„ „ Cirrhosis of Liver ,,„ „ 141 M 49 23 Dec. „ Cancer of Bladder Fleur-de-Lis Court, Carter Lane 1 F 39 19 Phthisis Fore Street 113 F 16 22 Oct. „ Gastric Ulcer Friday Street 10 M 63 14 Jan. „ Killed by an Injury to Brain Inquest. " No evidence how caused." Furnival Street 31 M 62 4 May „ Carcinoma of Neck 113 STREET OR PLACE. No. of House. Sex. Age. Date of Death. Certified Cause of Death. Remarks. Garden Place 9 M 14 m'ths 30 June, 1901 Meningitis General Post Office (East) — M 35 11 Oct. „ Disease of Kidneys, Heart and Liver Inquest George Yard. Lombard House — F 73 23 June „ Carcinoma of Rectum Glasshouse Chambers 8 F 45 7 Jan. „ Cerebral Haemorrhage ,,„ „ 4 M 50 4 Sept. „ Chronic Bright's Disease „ Yard 7 F 78 27 Jan. „ Bronchitis ,,„ „ 5 F 73 14 Dec. „ Cerebral Apoplexy Inquest Goodman's Yard 18 M 3 23 „ ,, Pneumonia Goswell Road 1 M 3O 3 Nov. „ Pneumonia Great Arthur Street 12 M 7 hours 10 Dec. „ Asphyxia Inquest „ New Street 2 M 73 30 „ 1900 Phthisis ,, ,, ,, 20 F 35 16 June, 1901 Pneumonia „ St. Helen's 20 F 58 16 Jan. „ Acute Bronchitis „ Tower Street 20 M 10 weeks 4 April „ Acute Bronchitis ,,„ „ 50 F 11 m'ths 15 June „ Tubercular Meningitis Green Dragon Court 6 M 62 1 May „ Phthisis Greystoke Place 7 F 57 1 ,,„ „ Carcinoma of Uteri „ ,, Board School - M 37 22 Sept. „ Typhoid Fever Gunpowder Alley 3,4, 5 M 28 31 Dec. ,, Killed by collapse of a floor Inquest Harcourt Buildings 3 M 53 2 Nov. „ Fatty Heart Harp Alley 13 M 49 13 Feb. „ Bronchitis ,,„ „ 13 F 10 m'ths. 5 Dec. „ Broncho- Pneumonia Harrow Alley 37 F 50 10 Mar. „ Heart Disease Inquest Hart Street 3 M 42 20 Dec., 1900 Suicide by Shooting | Inquest. Man murdered his Wife and committed Suicide ,,„ „ 3 F 25 20 ,, „ Shot by her husband | Heneage Lane 1 M 57 1 Aug., 1901 Congestion of Lungs and Heart Disease Inquest Holborn Buildings 6 M 3 months 21 April „ Pneumonia Holborn Viaduct Hotel - M 60 2 „ „ Heart Disease Inquest Hosier Lane 23 F 14 m'ths. 21 Feb. „ Pneumonia Houndsditch 12 M 4 15 ,,„ „ Diphtheria ,,„ 149 F 15 12 Oct. Premature Birth Huggin Court 2 M 44 22 „ Phthisis Hutchison Street 3 F 4 months 12 Sept. „ Infantile Diarrhoea ,,„ „ 17 M 16 days 7 Nov. „ Marasmus ,,„ „ 2 F 49 20 Dec. „ Cerebral Haemorrhage ,,„ „ 4 F 65 20 „ „ Heart Disease Inquest Ivy Lane 15 M 83 10 Jan. „ Cerebral Haemorrhage Johnson's Court 4 M 72 9 Feb. „ Bronchitis King Edward Street 7 m 72 24 Nov. „ Heart Disease King's Head Court, Shoe Lane 16 F 35 9 Aug. „ Pulmonary Tuberculosis ,„ „ ,„ „ 16 M 2 9 Oct. „ Broncho- Pneumonia King William Street 46 M 75 3 Feb. „ Old Age and Bronchitis Lawrence Lane 24 M 34 4 July „ Phthisis ,„ „ 28 M 44 6 Sept. „ Acute Rheumatism Laurence Pountney Lane 19 M 52 1 Aug. „ Chronic Interstitial Nephritis Leadenhall Market M 49 23 Jan. „ Heart Disease Inquest „ Street 45 M 44 5 Mar. „ Acute Gastro-Enteritis ,„ „ 11 F 65 9 Sept. „ Heart Disease ,„ „ 140 M 60 10 „ Heart Disease and Pulmonary Disease Inquest Little Montague Court 2 M 35 28 June „ Phthsis Liverpool Street Railway Station — M 60 19 April „ Serous Apoplexy Inquest „ „ „ „ M 73 18 „ Heart Disease and Fall Inquest ,„ „ „ „ — M novly born 27 „ Strangulation Inquest " Wilful „ „ „ „ — M 25 28 „ Pulmonary Hemorrhage Inquest [Murder" Long Lane 78 F 2 19 July „ Tubercular Meningitis Died in St. Bart.'s Lower Thames Street 77 F 75 30 Mar. „ haemorrhage into Pericardiun Inquest „ „ „ 54 M 7 months 20 June „ Diarrhoea „ „ Custom House — M 69 1 ,, Fatty Degeneration of Heart Inquest Ludgate Hill 16 F 47 20 Jan. „ Bronchitis Mansell Street 15 M 29 12 Aug. „ Phthisis Mark Lane 31 F 64 4 Feb. „ Heart Disease Inquest „ „ 50 M 56 27 Aug. „ Alcoholism „ „ 34 M 60 30 Sept. „ Cerebral Haemorrhage Martin's Lane 28 M 68 9 Dec. „ Bronchitis Masons' Avenue—Masons' Hall Tavern — M 1 month 12 Jan. „ Gastric Enteritis Middlesex Passage 2 F 60 27 Feb. „ Subacute Bronchitis ,,„ „ 5 F 9 months 3 Dec. „ Bronchitis „ Place 5 F 11 „ 15 Mar. ., Broncho-Pneumonia Died in St. Bart.'s ,, Street 99 M 5 weeks 20 Oct. „ Marasmus Middle Street 5 F 91 11 Jan. „ Hemiplegia jj jj 3 M 4 9 April „ Diphtheria Died in St. Bart.'s 114 CITY OF LONDON MORTALITY—continued. STREET OR PLACE. No. of House. Sex. Age. Date of Death. Certified Cause of Death. Remarks. Middle Street 3 F 69 5 June, 1901 Cerebral Hœmorrhage „ „ Cloth Fair 5 F 71 7 Mar. „ Bronchitis Minories 143 M 60 31 Dec., 1900 Heart Disease Inquest „ 143 F 67 1 „ 1901 Morbis Cordis Mitre Court Buildings 1 M 55 21 Feb. „ Heart Disease „ „ Fleet Street 1 M 79 26 Dec. „ Senile Decay Monument Station (found in tunnel) — M 37 3 May „ Suicide by throwing himself in front of a train Inquest Moorgate Street (C. & S.L. Railway Station) — M 50 6 Feb. Apoplexy Moor Lane — M 15 14 May Appendicitis Netherlands Wharf, s.s."Batavia,"P lying off - F 4 months 20 Mar. „ Tubercular Disease of Intestines Inquest Nevill's Court 11 M 60 16 June „ Apoplexy New Bridge Street 14 M 8 months 3 Mar. „ Tubercular Meningitis „ „ „ 32 M 70 21 „ „ Heart Disease New Broad Street 9 M 60 9 Jan. „ Acute Gastritis „ „ „ 10 F 58 3 May „ Acute Bronchitis Newbury Street 12 F 67 25 Feb. „ Bronchitis Newgate Gaol -- M 32 19 „ Hanged for Murder Inquest „ „ — M 23 19 Nov. „ Hanged for Murder Inquest „ Street 36 M 32 13 Sept. Heart Disease Inquest New Street 37 F 15 m'ths 23 General Tuberculosis „ „ Bishopsgate 25 M 59 1 Mar. „ Acute Bronchitis „ „ 24 M 39 17 Oct. „ Aortic Disease Inquest „ „ Gravel Lane 18 F 63 23 Mar. „ Diseased Liver Inquest „ ,, „ 17 M 47 17 Oct. „ Tumour on Brain Inquest „ „ Houndsditch 19 F 82 17 Jan. „ Bronchitis „ „ „ 14 F 94 25 June „ Senile Decay „ „ „ 38 M 5 months 18 Aug. „ Broncho-Pneumonia Nicholas Lane 36 M 10 m'ths 24 Oct. „ Diphtheria Northumberland Avenue—"Saracen's Head" - M 71 8 Jan. „ Heart Disease Inquest Oat Lane (outside No. 8) — M 50 25 „ Fall of a packing case from a crane. Inquest Old Bailey 21 M 17 23 ,, ,, Pneumonia Died in St. Bart.'s 22 F 77 11 April „ Bronchitis Old Jewry 19 F 75 5 June „ Apoplexy Phil's Buildings 7 F 10 m'ths 4 Jan. „ Broncho-Pneumonia Primrose Hill 20 F 24 24 ,, ,, Phthisis ,, „ 20 M 2 days 26 „ Premature Birth Princes Street 2 M 30 2 Feb. „ Pneumonia „ „ Grocers' Hall — F 51 10 Cirrhosis of Liver Queen's Court, Vine Street 8 M 17 m'ths 29 Nov. „ Dentition „ „ „ 8 M 6 days 17 Dec. „ Inanition Queen Street Place 9 M 28 13 Feb. „ Gastric Ulcer „ „ 10,11 M 57 25 May „ Syncope from bursting of an Aneurism Inquest Racquet Court - M 64 20 Mar. „ Phthisis Red Lion Court, Fleet Street 9 M 66 13 , Enteritis "The Red Lion" — M 42 31 „ Apoplexy River Thames, Allhallows Pier — M 12. 12 Aug. „ Drowned Inq'st. No evidence,&c. „ ,. near Blackfriars Bridge M 45 3 Nov. „ Drowned „ „ off Brewer's Quay F 35 26 July „ Drowned Inquest „ „ off Custom House F 6 3 Oct. „ Drowned Inquest. Misadventure „ „ off Custom House Quay M 35 6 Aug. „ Drowned Inq'st. No evidence, &c. „ „ Dowgate Dock — M 24 hours 3 » ii Inattention at Birth Inquest „ „ near Dowgate Dock — F 32 18 Apr. „ Drowned Inquest „ „ off Nicholson's Wharf — M newly born 19 Oct. „ Inattention at Birth Inquest „ „ found on foreshore at Paul's Wharf — M newly born 31 May „ Inattention at Birth Inquest „ „ off Temple Stairs — F about 47 31 Dec. 1900 Drowned Inq'st. No evidence, &c. St. Andrew's Street 1 F 72 4 April,1901 Carcinoma St. Ann's Chambers, Ludgate Hil 23 F 57 13 Jan. „ Heart Disease St. Dunstan's Hill 19 F 5 26 Mar. „ Measles and Pneumonia St. James' Place, Garlick Hill 1 F 47 9 Aug. „ Rheumatic Fever St. Paul's Churchyard M 49 2 Jan. „ Heart Disease Salisbury Court, Fleet Street 137 F 73 3 April „ Senile Decay „ House — M 40 13 Feb. „ Killed by a falling stone Inquest. Accident. „ Square 12 M 70 6 Mar. „ Apoplexy Sergeant's Inn 12 M 76 19 May „ Cancer of Pancreas Shaftesbury Place 15 F 5 m'ths 27 Dec. 1900 Marasmus and Diarrhoea „ „ 24 M 66 11 Jan. 1901 Congestion of Lungs „ „ 2 F 62 4 April „ Acute Bronchitis „ „ 14 M 51 16 „ „ Phthisis „ „ 5 F 65 21 May „ Cerebral Hœmorrhage „ „ 16 F 55 3 June „ Chronic Bronchitis 115 CITY OF LONDON MORTALITY—continued. STREET OR PLACE. No. of House. Sex. Age. Date of Death. Certified Cause of Death. Remarks. Shaftesbury Place . 10 F 16m'ths 29 Oct., 1901 Tubercular Meningitis Inq'st. Died in St. Bart's. „ „ 20 F 11 m'ths 14 Dec. „ Pneumonia „ „ 13 F 1 month 20 „ Acute Bronchitis Ship Tavern Passage 7a F 64 3 July „ Hœmorrhage into Pericardium Inquest Shoe Lane 3a F 10 m'ths. 25 May Convulsions Inquest Sparrow Corner 4 F 28 1® !! » Phthisis „ „ 10 M 90 4 Nov. „ Cerebral Hœmorrhage Staining Lane 3 F 36 3 Jan. ,, Inanition Stonecutter Street 28 M 7 days 11 Dec. „ Debility from Prematurity Stoney Lane 40 F 5 31 Mar. „ Whooping Cough Sugar Loaf Court, Dorset Street 6 F 65 5 Nov. „ Bronchitis and Gastritis Tan field Court 4 M 23 2 Feb. „ Phthisis „ „ Inner Temple 4 M 51 26 Sept. „ Hepatic Cirrhosis Thavies Inn 10 F 55 24 Feb. „ Cirrhosis of Liver „ „ 22 M 2 m'ths 4 Dec. ,, Broncho-Pneumonia Threadneedle Street 30 M 52 29 April „ Carcinoma of Rectum & Bladder Took's Court 15 M 72 11 Feb. „ Bronchitis „ „ 16 M 23 8 Mar. „ Rickets „ „ 4a M 47 20 July „ Consumption Trinity Square, Tower Hill 13 M 4 m'ths 6 Sept. ,, Congenital Heart Lesion Tudor Street 6 M 77 10 Feb. Bronchitis Union Place, Glasshouse Yard 6 F 78 25 April „ Morbis Cordis Upper Thames Street, Purfleet Wharf — M 36 10 May „ Morbis Cordis „ „ 97 F 3 m'ths. 14 July „ Bronchitis and Pneumonia „ „ 15 M 51 30 Sept. „ Epilepsy Vine Street 8 M 6 m'ths. 8 Jan. „ Acute Bronchitis „ „ 11 F 60 16 July „ Hepatitis „ „ 11 M 64 18 Dec. „ Haemorrhage Inquest Water Lane 16 M 50 29 Mav „ Suicide by Shooting Inquest West Smithfield 59 F 67 29 July ., Cerebral Haemorrhage Whitecross Street 21 M 57 23 „ Acute Tonsilitis „ „ City Green Yard — F 9 8 Aug. „ Diphtheria Died in St. Bart.'s Whitefriars Street 22 M 5 m'ths. 21 June „ Tubercular Meningitis „ „ " The Scotch Stores" — F 21 days 10 Nov. „ Convulsions „ „ 22 F 10 m'ths. 5 Dec. ,, Tubercular Meningitis White Street, Houndsditch 8 F 1 month 10 Aug. „ Marasmus „ „ Moorfields, City of London College. M 72 24 Oct. „ Cerebral Apoplexy Widegate Street 26 M 47 7 Mar. „ Pneumonia Wine Office Court 2 M 75 2 Feb. „ Phthisis Wood Street 94 F 74 27 Jan. „ Carcinoma of Bladder „ „ 119 M 20 15 April „ Pleurisy „ „ 3 F 16 11 ,, .. Heart Disease Inquest ARTIZANS' DWELLINGS-PETTICOAT SQUARE. STREET OR PLACE. No. of House. Sex. Age. Date of Death. Certified Cause of Death. Remarks. King's Block 44 F 36 16 Nov., 1901 Puerperal Septicaemia Queen's Block. 33 M 3 days 7 Jan.1 „ Premature Birth „ „ 22 F 1 month 3 Nov. „ Marasmus „ „ 2 F 64 15 » .. Multiple Neuritis Prince's Block 32 M 14 days 19 April „ Prematurity North Block 46 F 75 30 Mar. ., Senile Decay „ „ 34 25 F M 45 12 hours 2 April „ 18 Sept. „ Diabetes Heart Disease „ „ 62 M 60 22 Dec. „ Cerebral Hasmorrhage South Block 46 M 3 5 Jan. ? „ Pulmonary Tuberculosis „ „ 38 F 63 16 „ Heart Disease „ „ 2 M 2 16 June „ Gastro-Enteritis „ „ 26 M 12 m'ths. 2 Nov. „ Dentition 116 Appendix B. LIST OF INFECTIOUS CASES, 1901. STREET LISTS. Compiled from Notifications received. Street or Place. No. o£ House. Sex. Age. Disease. Aldersgate Street 80 M 12 Scarlet Fever. Ditto 101 F 2 Diphtheria. Aldgate 26 M 50 Small-pox. Aldgate High Street 47 M 20 Diphtheria. Artillery Laiie 7 F 2 Scarlet Fever. Austin Friars 23 F 26 Diphtheria. Ball Court, Griltspur Street 6 F 13 Ditto. Barbican 24 F 52 Scarlet Fever. Bartholomew Close 49 F 7 Ditto. Ditto 80 F 39 Typhoid Fever. Ditto (Bartholomew House) 10 M 2¼ Scarlet Fever. Ditto ditto 10 M 2¼ Diphtheria. Ditto (" Coach and Horses ") « • • F 57 Variola. Bartholomew's Hospital (Nurses' Home) ... F 27 Diphtheria. Ditto ditto ... F 25 Enteric Fever. Ditto ditto F 25 Ditto. Ditto • • • F 21 Scarlet Fever. Ditto ... F 25 Diphtheria. Ditto • •• M 23 Scarlet Fever. Ditto (Wardmaids' Home) • . • F 24 Enteric Fever. Bartholomew Lane 1 F 27 Ditto. Bartholomew Place 5 F 29 Diphtheria. Bartlett's Buildings 20 M 62 Typhoid Fever Basinghall Street (Coopers' Hall) • • • F 14 Diphtheria. Beech Street (" George and Dragon ") • • • F 17 Scarlet Fever. Ditto 4 F 2 Diphtheria. Ditto 4 F 4 Ditto. Bell's Buildings, Salisbury Square 7 M 66 Erysipelas. Birchin Lane 2 F 1018 J l Scarlatina. Ditto 24 F 23 Enteric Fever. Ditto 2 F 14 Scarlet Fever. Ditto Ditto 19 19 M M 6 6 Scarlatina. Varicella. Ditto 19 M 4 Ditto. Bishopsgate Street 130 M 11 Diphtheria. Ditto (Nat. Provincial Bank) M 52 Erysipelas. Bishopsgate Without 124 M 8 Diphtheria. Ditto 124 M 3 Scarlet Fever. Ditto 124 F 10 Ditto. Ditto 131 F 67 Erysipelas. Ditto 71 M 3 Varicella. Ditto 71 M 8 Ditto. Bow Churchyard, Cheapside 8 F 55 Scarlet Fever. Brackley Street 5 M 16 Ditto. Ditto 5 M 20 Ditto. Ditto 5 M 17 Ditto. Brushfield Street 14 F 72 Erysipelas. Cannon Street 4 M 16 Scarlet Fever. Ditto 4 M 16 Ditto. Ditto 4 M 16 Ditto. Cannon Street Hotel Room 46 F 27 Typhoid Fever. 117 Street oh Place. No. of House. Sex. Age. Disease. Carmelite Street 27 M 13 Typhoid Fever. Ditto (Fire Station) ... M 6 Diphtheria. Carter Lane 22 M 21 Ditto. Charterhouse Street 18 M 15 Scarlet Fever. Ditto 18 M 16 Ditto. Ditto 18 M 19 Ditto. Ditto 18 M 15 Ditto. Ditto 18 M 22 Ditto. Christ's Hospital ... M 10 Varicella. Ditto ... M 11 Ditto two cases. Ditto ... M 12 Ditto three cases. Ditto ... M 13 Ditto two cases. Ditto ... M 14 Ditto. Ditto ... F 24 Ditto. Circus, Minories 1 F 6½ Scarlet Fever. Ditto 1 M 2 4/12 Scarlatina. Clement's Lane 9 F 3½ Ditto. Cloth Fair 6 M 45 Diphtheria. Ditto 27 M 22 Scarlet Fever. Cockerill's Buildings 3 F 1½ Ditto. Ditto 3 M 4 Ditto. Ditto 6 F 9 Ditto. Ditto 6 F 7/12 Ditto. Cornhill 33 M 13 Ditto. Currier's Row 12 F 7 Ditto. Cushion Court 2 F 36 Typhoid Fever. Dean Street 4 F 6 Varicella. Ditto Block D 8 M 6 Scarlet Fever. Dyer's Buildings 4 M 14 Ditto. Fann Street (Bridge water House) 4 F 5 Diphtheria. Ditto Ditto 7 F 2½ Scarlet Fever. Ditto Ditto 5 M 12 Diphtheria. Ditto (Welsh Chapel) ... F 6 Ditto. Fenchurch Street 136 F 9 Scarlatina. Ditto 102 F 5 Diphtheria. Fetter Lane 57 M 25 Enteric Fever. Ditto (Greystoke Place Schools) ... M 37 Typhoid Fever. Finsbury Circus 2 F 47 Erysipelas. Finsbury Pavement 28 M 6 Scarlet Fever. Ditto 28 M 3 Ditto. Ditto 28 F 4½ Scarlatina. Fishmongers' Hall • • • F 40 Diphtheria. Ditto ... F 26 Scarlatina. Fleet Street 60 F 20 Erysipelas. Ditto 141 F 5 Scarlet Fever. Ditto 80 F 3½ Diphtheria. Ditto (Anderton's Hotel) ... M 13 Ditto. Friday Street 7 M 15 Scarlet Fever. Ditto 7 M 15 Ditto. George Street, Mansion House Place 15 M 5 Ditto. George Yard (L. & S.W.R.), West Smithfield ... F 7/12 Ditto. Goodman's Yard ("Golden Lion") ... M 32 Enteric Fever. Ditto 2 F 5 Diphtheria. Gravel Lane, King's Block 44 F 37 Puerperal Fever. Great Tower Street 21 M 17 Diphtheria. Green Dragon Court, St. Andrew's Hill 6 F 5½ Scarlet Fever. Greystoke Place, Fetter Lane 9 F 2 Diphtheria. Half-Moon Passage, Aldersgate Street 5 M 13 Scarlet Fever. Harp Alley, Farringdon Street 13 F 5 11/12 Ditto. Hatton Court, Threadneedle Street 1 F 8 Ditto. Holborn Circus 7 M 19 Ditto. 118 Street or Place. No. of House. Sex. Age. Disease. Holborn Circus 7 F 18 Scarlet Fever. Holborn Viaduct 53 F 38 Enteric Fever. Hosier Lane 18 F 54 Typhoid Fever. Houndsditch 12 M 5 Diphtheria. Ditto 41 M 7 Scarlet Fever. Ditto 140 F 7 Ditto. Hutchinson Avenue 6 F 3½ Typhoid Fever. Hutchinson Street 1 F 10 Scarlet Fever. Ditto 1A F 6½ Diphtheria. Kinghorn Street 6 M 69 Erysipelas. King's Head Court 16 F 15 Diphtheria. King Street, Snow Hill 18 M 3½ Ditto. Ditto (Bloomfield House) 24 M 14 Ditto. Knightrider Street 17 F 10 Scarlet Fever. Leadenhall Street 12 F 7 Scarlatina. Lime Street 15 F 13¾ Scarlet Fever. Lime Street Square 6 F 5 Ditto. Little Trinity Lane 30 F 6 Ditto. Liverpool Street (G.E.R. Hotel) .. . F 19 Ditto. Long Lane 19 M 3 Ditto. Ditto 76 F 23 Diphtheria. Ditto 80 M 2 Ditto. Love Lane, Aldermanbury 4 & 5 F 6 Varicella. Ludgate Circus (Albion Hotel) ... M 36 Erysipelas. Ditto ("King Lud ") ... F 19 Scarlet Fever. Maidenhead Court 10 F 2 Diphtheria. Ditto 10 M 5 Ditto. Mansell Street 15 F 7 Scarlet Fever. Ditto 38 F 4 Ditto. Middle Street 6 F 11/12 Diphtheria. Ditto 6 M 4 Ditto. Middlesex Passage 1 M 17 Ditto. Minories ("Woolpack ") ... F 26 Enteric Fever. Moorgate Street 2a M 6½ Diphtheria. Ditto 2a M 2 Ditto. Moor Lane (City Buildings) 7 M 4 Ditto. Ditto 29 F 28 Ditto. New Bridge Street 18 M 16 Ditto. Ditto 35 F 27 Ditto. New Square, Minories 2 F 63 Erysipelas. New Street, Bishopsgate 22 F 9 Scarlatina. Ditto 22 F 4½ Ditto. Ditto 22 F 6 Ditto. Ditto 22 F 7 Ditto. Ditto 22 M 16 Small-pox. New Street, Houndsditch 5 M 5 Diphtheria. Ditto 11 M 1 7/12 Scarlet Fever. Ditto 13 F 51 Erysipelas. Ditto 36 F 2 Membranous Croup. Ditto 37 F 2 Diphtheria. Ditto 38 F 2 Scarlet Fever. Ditto 38 M 4 Ditto. Ditto 38 M 3 Diphtheria. Nicholas Lane 7 F 3 6/12 Ditto. Ditto 36 F 2 Ditto. Ditto 36 M 10/12 Ditto. Old Broad Street 33 F 11 Scarlatina. Ditto 33 M 7 Ditto. Ditto 61 M 5 Diphtheria. Ditto 61 F 4 Ditto. Ditto 61 M 12 Scarlet Fever. 119 Street or Place. No. of House. Sex. Age. Disease. Paternoster Row 46 M 20 Scarlatina. Ditto 46 M 29 Enteric Fever. Petticoat Square (Prince's Block) 46 M 3½ Scarlatina. Punch Tavern, Fleet Street ... F 20 Scarlet Fever. Queen Street Place 6 F 15 Scarlatina. Queen Victoria Street 77a F 6 Scarlet Fever. Ditto 174 M 26 Scarlatina. Redcross Street (Fire Station) ... M 4 Scarlet Fever. Robin Hood Court Infirmary (Shoe Lane) ... M 42 Erysipelas. St. Mary Axe 23 F 21 Scarlatina. St. Paul's Churchyard (Pawson and Leafs) ... M 16 Scarlet Fever. Ditto ditto ... M 20 Ditto. Ditto ditto ... M 19 Ditto. Ditto ditto ... M 15 Ditto. Ditto ditto ... M 22 Ditto. Ditto ditto ... M 16 Ditto. Salisbury Square 18 M 54 Erysipelas. Ditto (Salisbury Hotel) ... F 20 Scarlet Fever. Sandy's Row, Middlesex Street 1 F 17 Typhoid Fever. Shaftesbury Place 27 M 1 8/12 Diphtheria. Sherbourne Lane (Abchurch House) ... F 30 Scarlet Fever. Sparrow Corner 4 M 3 Ditto. Stoney Lane, King's Block 32 M 28 Ditto. Ditto North Block 62 F 5 Diphtheria. Ditto Prince's Block 21 M 22 Enteric Fever. Ditto Queen's Block 6 M 6 Membranous Croup. Ditto ditto 14 M 9/12 Diphtheria. Ditto ditto 15 F 4 Ditto. Ditto ditto 27 F 7½ Scarlet Fever. Ditto South Block 12 M 3½ Scarlatina. Swan Street (Board School) ... F 11/12 Scarlet Fever. Thavies Inn 18 M 41 Small-pox. Throgmorton Avenue 10 M 3½ Scarlet Fever. Took's Court 4a M 39 Variola. Victoria Embankment (De Keyser's H.) ... M 20 Scarlet Fever. Warwick Square 12 M 20 Erysipelas. Ditto 12 M 20 Small-pox. Watling Street 49 F 5 Diphtheria. West Smithfield 16 M 11 Enteric Fever. Ditto 16 M 43 Diphtheria. Ditto 20 M 6½ Scarlet Fever. Ditto 20 F 3½ Ditto. Whitecross Street 12 M 3 Diphtheria. Ditto (City Green Yard) ... M 2 Ditto. Ditto ditto ... F 9 Ditto. Ditto ("The Peacock'') ... M 10 Scarlatina. Ditto ditto ... M 3 Ditto. Ditto ditto ... F 5 Ditto. Ditto ditto ... F 7 Ditto. Widegate Street 17 F 7 Diphtheria. Ditto 17 F 3¼ Scarlatina. Ditto 24 F 3/12 Small-pox. Ditto ("Rose and Grapes ") ... F 36 Scarlet Fever. 120 Appendix C. TENEMENT HOUSES. WEST DISTRICT. Situation of Premises. Name and Address of Owner. Tenements. Lodgers. 4, Burgon Street Lewis Tripp, 1, St. Andrew's Hill 2 5 9, Bell's Buildings James W. Peart, 9, Bell's Buildings 2 4 4, do. Millar, Son & Co., 14, Grafton Street, W. 7 12 8, do. Do. do. 6 12 5, do. Do. do. 2 8 10, do. Do. do. 4 6 7, do. John Lewis, 7, Bell's Buildings 8 18 5, Briton's Court James Hurrel, 5, Briton's Court 2 2 5, Currier's Row Henry Bailey, 5, Currier's Row 3 5 6, do. Arthur Bedford, 5, do. 3 5 7, do. William Bampton, 7, do. 2 14 12, do. Mrs. A. Robinson, 12, do. 4 11 13, do. G. Edmonsey, 13, do. 1 4 1, Chapel Place, Fetter Lane. J. F. Pemsel, 32, Fetter Lane 3 4 2, do. do. Preston Kingsworth, 2, Chapel Place 1 1 1, Church Entry, Carter Lane. Charles Eagle, 1, Church Entry 1 6 5, Dorset Street H. Felton, 5, Dorset Street 5 6 7, do. Mary Davis, 7, do. 3 10 2, Evangelist Court Seaton Brown, 5, Broadway, Ludgate 3 9 10, East Harding Street Caroline White 2 5 11, do. F. S. Appt, 11, East Harding Street 2 10 12, do. Jane Smith, 12, do. 1 1 35, Fetter Lane Weatherall & Green, 22, Chancery Lane 5 15 36, do. Edward Daw, 36, Fetter Lane 5 11 37, do. Harriet Jardine, 37, do. 5 6 38, do. W. A. Hooper, 38, do. 5 6 41, do. Eliza Dorly, 41, do. 1 6 42, do. J. Richards, 42, do. 3 7 57, do. Paul Quartermass, 57, Fetter Lane 3 3 63, do. Louis Bond, 41 and 42, Monkwell Street 3 9 84, do. R. Mellish, 84, 85 and 87, Fetter Lane 7 10 93, do. J. Hook, 106, St. James' Road, Holloway 4 11 39, Furnival Street E. J. Daw, 36, Fetter Lane 2 5 30, do. Elizabeth Boothby, 30, Furnival Street 5 7 29, Fleet Lane Willats & Co., 66, Holborn Viaduct 1 4 30, do. Do. do. 1 2 31, do. Do. do. 1 2 1, Great New Street James Barnsley, 1, Great New Street 4 13 20, do. G. Stanbury, 25, do. 8 24 2, do. Sidney Gardner, 2, do. 7 15 3, do. Do. do. 4 6 16, do. G. Smee, 16, do. 4 7 5, Green Dragon Court Mr. Johnson, 5, Green Dragon Conrt 2 2 6, do. W. F. Hurburt, 6, do. 2 4 7, do. G. Edmondsey, 13, Currier's Row 3 4 Carried forward 152 337 121 WEST DISTRICT—continued. Situation of Premises. Name and Address of Owner. Tenements. Lodgers. Brought forward 152 337 2, Gunpowder Alley Thomas Young, 2, Gunpowder Alley 2 2 8, do. H. Donaldson & Son, 242, Queen's Road, Dalston 2 2 7½, do Do. do. do. 4 16 2, Greystoke Place G. Reveirs, 4, Greystoke Place 3 6 3, do. Michael Flynn, 3, do. 4 4 6, do. William G. Cuss 1 8 7, do. H. Von Joel, 16, Willis Road, Kentish Town 4 15 8, do. W. Hollingsdale, 8, Greystoke Place 2 12 9,Greystoke Place, Fetter Lane. Harriet Evans, 9, do. 4 10 36, Hutton Street Elliot & Co., 40, Chancery Lane 2 4 37, do. James Harvey, 37, Hutton Street 2 2 3, Hosier Lane John B. Fuller 3 5 4, do. John Dugan 1 6 5, do. W. J. Gardner, 6, Hosier Lane 2 7 23, do. James King, 21, West Smithfield 2 7 6, Holborn Buildings Mrs. Cohen, 26, Endsleigh Gardens, N.W. 8 18 7, do. Do. do. 9 18 13, King's Head Court, Shoe Lane. H. Deighton, 54, Great Percy Street, W.C. 4 10 14, do. Do. do. 4 12 16, do. Do. do. 8 16 17, do. Do. do. 5 5 17, King's Head Court, Fetter Lane. Thomas Lambert, 17, King's Head Court 3 10 8, Little New Street Clara Hayhurst, 8, Little New Street 5 9 1, New Court Francis Butler, 17, Farringdon Street 5 5 2 do. Thomas Anstey, 19, do. 3 9 3, do. Martha Stokes, 3, New Court 3 8 5, do. W. Sullivan, Farringdon Street 4 13 8, do. D. Dixon, 15, Charterhouse Street 5 6 10, do. Leonard Voullaine, 10, New Court 3 3 11, do. Mrs. H. Brooks, 11, do. 2 6 13, Newcastle Street, Farringdon Street. Arthur Wilks, 13, Newcastle Street 7 8 15, do. do. Sidball, Saw and King, 19, Paternoster Row 2 7 17, do. do. O. G. Brinstead, 17, Newcastle Street 2 2 5, New Street Hill, and C. Rowsell, 5, New Street 3 6 11, Gunpowder Alley 10, New Street Square Herbert Mogridge, 10, New Street Square 2 6 7, Nevill's Court Charles Ed, 7, Nevill's Court 3 11 8, do. Walter Gulson, 8, do. 3 4 9, do. Kate Hebditch, 9, do. 2 6 10, do. J. F. Pemsel, 34, Fetter Lane 6 10 11, do. Weatherall and Green, 22, Chancery Lane 8 15 12, do. Do. do. 8 15 13a, do. Do. do. 6 20 Carried forward 313 701 122 WEST DISTRICT—continued. Situation of Premises. Name and Address of Owner. Tenements. Lodgers. Brought forward 313 701 14, Nevill's Court Weatherall and Green, 22, Chancery Lane 6 10 3, Pemberton Row J. Young, 1, Pemberton Row 3 11 13, Plumtree Court Edward Smith, 13, Plumtree Court 3 3 19, Primrose Hill Crawley & Smee, 19, Primrose Hill 3 10 20, do. E. Coulson, 20, Primrose Hill 4 10 22, do. Thomas Palmer, 22, do. 3 12 2, Queen's Head Court, Giltspur Street. Thomas Wright, 11, Giltspur Street 5 14 4, Red Lion Court Nevitt Bros., 44 and 45, Kirby Street, Hatton Garden. 5 11 8, do. W. Simpson, 95, Rosebery Square 5 7 11, do. F. Southwell, 11, Red Lion Court 3 8 1, Red Lion Passage, Cloth Fair. J. Vail, 1. Red Lion Passage 2 8 6, Sugar Loaf Court, Dorset Street. Ward, Lock and Co., Warwick House, Dorset Street. 3 4 16, Tudor Street John Evans, 16, Tudor Street 2 10 1 & 2, Took's Court Thurgood & Martin, 27, Chancery Lane 12 42 4a, do. W. J. Ballamy, 9, Furnival Street 6 13 5a, do. E. J. Hopkins 6 2 6, Temple Lane A. Barsht, 106, Cheapside 4 10 7, do. Do. do. 7 20 8, do. Do. do. 7 16 15, Water Street, Tudor Street. George York, 15, Water Street 2 7 5, Water Lane, Ludgate Hill. E. and S. Halcombe, 5, Water Lane 7 7 1, Wine Office Court Ann Gates, 2, Wine Office Court 3 7 2, do. Do. do. 2 4 3, do. A. Parsons, 3, do. 2 4 35, Bartholomew Close E. Haley, 2, Cross Key Court, London Wall 7 11 43, do. Do. do. 3 10 85, do. Elizabeth Parry, 85, Bartholomew Close 3 7 1, Bartholomew Place J. Smith, 1, Bartholomew Place (Closed) 2 — 2 do. E. Haley, 2, Cross Key Court, London Wall (Closed). 3 - 4, do. William Critolph, 4, Bartholomew Place 4 6 6, do. Henry Hoggett, 6, Bartholomew Place 1 3 3, Cloth Fair George Madewell, 3, Cloth Fair 2 5 4, do. J. Edwin Ponder, 103, Aldersgate Street 4 8 6 & 7, do. Charles Randall, 9, White Lion Street, Pentonville 7 15 8, do. Do. do. do. 4 8 9, do. Do. do. do. 6 10 19, do. Thomas Belcher, 19, Cloth Fair 5 7 21, do. Alfred Bannister, 21, do. 4 10 22, do. J. Jackson, 22, do. 3 10 Carried forward 466 1,061 123 WEST DISTRICT—continued. Situation of Premises. Name and Address of Owner. Tenements. Lodgers. Brought forward 466 1,061 25, Cloth Fair Miss Laura Bassey, 25, Cloth Fair 3 7 28, do. Thomas M. James Janes, 191, Aldersgate Street 3 12 29, do. Charles Randall, 9, White Lion Street, Pentonville. 1 3 30, do. R. J. Jackson, 30, Cloth Fair 1 2 31, do. A. H. Price, 31, do. 3 8 43, do. Charles Randall, 9, White Lion Street, Pentonville. 2 6 44, do. Do. do. do. 4 7 45, do. Florence Struthers, 58, West Smithfield 1 7 1, Cockerell's Buildings Margaret Walker, 1, Cockerell's Buildings 2 5 2, do. E. Haley, 2, Cross Key Court 3 12 3, do. Thomas Bate, 3, Cockerell's Buildings 3 5 4, do. James Sard, 4, do. 2 5 5, do. Charles Fox, 5, do. 4 11 6, do. Stanley J. Torkington, 6, do. 4 10 7, do. G. Demaria, 7, do. 2 4 8, do. E. Haley, 2, Cross Key Court 3 3 5, East Passage, Cloth Fair. James T. Deeks, 5, Offerton Square, Clapham 4 8 8, do. Joseph Young, 52, Long Lane 3 6 27, do. James T. Deeks, 5, Offerton Square, Clapham 3 6 1, Fenton's Buildings Thomas Matthews, 110, Milton Road, Stoke Newington. 1 2 2, do. Do. do. do. 3 7 3, do. Do. do. do. 3 10 4, Half-Moon Passage Mr. Collins, 4, Half-Moon Passage 2 3 6, do. Mr. Beckett, 6, do. 2 8 12, Kinghorn Street Catherine Lewis, 12, Kinghorn Street 3 4 13, do. W. Phelan, 20, Cloth Fair 2 4 25, do. Do. do. 3 6 25a, do. Do. do. 4 13 1, Little Montague Court J. Abbott, 103, Aldersgate Street 2 10 2, do. Do. do. 5 17 41, Little Britain Joseph Freeman, 41, Little Britain 3 8 45, do. William F. Retzleff, 45, do. 1 1 54, do. Thomas N. Janes, 101, Aldersgate Street 3 8 60 and 61, Long Lane George W. Rogers, 60 and 61, Long Lane 4 8 79, do. Robert Dyas, 87, Fore Street 3 6 80, do. Mrs. I. Comfort, 80, Long Lane 3 5 86, do. C Daymon, 86, do. 1 4 2, Montague Court, Little Britain. H. T. L. Tucker, 2, Montague Court 2 6 3, do. James Long, 4, do. 3 8 4, do. Do. do. 3 5 5, do. Florence Driscoll, 5, do. 2 4 6. do. Thomas J. Spernick, 6, do. 3 11 Carried forward 588 1,346 124 WEST DISTRICT—continued. Situation of Premises. Name and Address of Owner. Tenements. Lodgers. Brought forward 588 1,346 2, Middle Street Robert N. Galland, 2, Middle Street 3 4 4 and 5, do. J. Hull & Sons, Bartholomew Close 12 18 6, do. E. Haley, 2, Cross Key Court 4 5 20, do. James T. Deeks, 5, Offerton Road, Clapham 2 3 22, do. Joseph Young, 52, Long Lane 3 3 1, Middlesex Passage James Strugnell, 45, Bartholomew Close 4 11 2 and 3, do. Do. do. 11 12 4, do. Robert Warburton, 4, Middlesex Passage 3 5 5, do. Elizabeth Jones, 5, do. 3 4 6, do. J. Sturgeon, 6, do. 3 10 1, Newbury Street J. Hull and Sons, Bartholomew Close 4 12 2, do. A. H. Price, 31, Cloth Fair 3 16 3, do. Mrs. Pike, 3, Newbury Street 3 10 9, do. Mrs. Chissman, 9, do. 1 5 10, do. Heeps, Son and Neve, 4, Old Jewry 2 4 11, do. Do. do. 2 5 12, do. Do. do. 3 8 14, do. J. W. Neighbour, 93, Old Street 4 14 58, West Smith field Rebecca Flower, 58, West Smithfield 6 7 11, Bartholomew Close Ann Clevely, 11, Bartholomew Close 4 7 35½ do. Edward Haley, 2, Cross Key Court, London Wall 6 19 19, do. Mrs. L. Crosswell, 19, Bartholomew Close 2 7 Total 676 1,535 Average number of lodgers to each tenement: 2.27. 125 MIDDLE DISTRICT. Situation of Premises. Name and Address of Owner. Tenements. Lodgers. 100, Aldersgate Street J. B. Robertson, 100, Aldersgate Street 1 1 104, do. William Harris, 158, Kingsland Road 2 2 34, Beech Street Lucy Worland 3 5 48, do. J. W. Hayball, 48, Beech Street 2 11 50, do. John Richards, 50, do. 3 6 51a, do. M. Manns, 51a, do. 3 10 104, Bisliopsgate Street Without. Charles Thomas, 104, Bishopsgate Street Without 3 5 5, Bridgewater Street Mrs. Budgen 3 6 14, Fann Street Holcomb, Betts and Co., 5a, Orchard Street, W. 6 20 1 and 2, Huggin Court, Little Trinity Lane. Charles Pile, 1 and 2, Huggin Court 5 13 9, Huggin Lane Mr. Belcher, 8, Martin's Lane 3 4 10, do. H. Willis, 10, Huggin Lane 5 6 2, Little College Street George Shadbolt, 2, Little College Street 2 5 3, do. Fred. Threadgill, 3, do. 2 4 15, Swan Lane Percy Clarke, 15, Swan Lane 5 6 1, St. Jatnes' Place, Garlick Hill. Charles J. Shears, 2, St. James' Place 4 13 2, do. do. Do. do. 2 10 3, do. do. Messrs. Jones, Lang & Co., King Street 4 8 4, do. do. H. H. Martin, 4, St. James' Place 3 8 1, Shaftesbury Place Mrs. Sarah Turner, 1, Shaftesbury Place 2, do. J. B. Kyffin, 44, Lauriston Road, Hackney 2 4 3, do. Not now a tenement house 1 1 4, do. Joseph Taylor, 4, Shaftesbury Place 2 5 5, do. Sarah Young, 5, do. 1 6 6, do. Samuel Hipperson, 6, do. 3 14 7, do. J. B. Kyffin, 44, Lauriston Road, Hackney 2 8 8, do. Do. do. 3 7 9, do. Do. do. 3 7 10, do. Do. do. 1 3 11, do. Do. do. 3 18 12, do. Do. do. 2 13 13, do. Do. do. 2 15 14, do. Do. do. 2 10 15, do. George Prosser, 15, Shaftesbury Place 1 4 16, do. John Gilman, 16, do. 1 5 17, do. Alfred Shears, 17, do. 1 1 18, do. James Hemming, 18, do. 1 3 19, do. Joseph Perry, 19, do. Carried forward 92 267 126 MIDDLE DISTRICT—continued. Situation of Premises. Name and Address of Owner. Tenements. Lodgers. Brought forward 92 267 20, Shaftesbury Place J. B. Kyffin, 44, Lauriston Road, Hackney 3 14 21, do. Do. do. 3 9 22, do. Do. do. 1 4 23, do. Do. do. 3 4 24, do. Do. do. 3 6 25, do. Do. do. 26, do. Mrs. Emma Henson, 26, Shaftesbury Place 2 9 27, do. J. B. Kyffin, 44, Lauriston Road, Hackney 2 11 28, do. Maria Rowe, 28, Shaftesbury Place 2 6 29, do. J. B. Kyffin, 44, Lauriston Road, Hackney 30, do. The Ramoneur Co., 30, Shaftesbury Place 2 8 Total 113 338 Average number of lodgers to each tenement: 2.90. 127 EAST DISTRICT. Situation of Premises. Name and Address of Owner. Tenements. Lodgers. 27, Aldgate A. L. Poysner, 27, Aldgate 1 2 6, do. — Berry, 6, Aldgate 3 10 9, Artillery Lane W. E. Gill, 21, Artillery Lane 6 14 12, do. E. Quinlin, 25, do. 7 11 14, do. Do. do. 5 8 16, do. Do. do. 6 18 18, do. — Quinlan, 18, do. 2 5 20, do. B. Clements, 20, do. 1 5 21, do. P. Donovan, 25, do. 4 7 22, do. Amos Piggott, 22, do. 3 7 9, Brushfield Street W. H. Recknell, 66, Green Lanes, N. 3 6 10, do. — Smith, 10, Brushfield Street 3 6 12, do. — Walter, 12, do. 5 5 14, do. F. J. Fitch, Bishopsgate Institute (on behalf of the Governors of the Bishopsgate Foundation) 6 9 19, Carter Street, Houndsditch. M. Benjamin, 31, White Lion Street, E. 2 8 2, Cavendish Court A. J. Hawkins, 116, Albion Road, Dalston 3 7 1, Circus, Minories (including upper part of 90, Minories). S. Moses, 65, Mansell Street, Aldgate 5 26 2, Circus, Minories Mrs. Elms, 2, Circus, Minories 2 8 3, do. Eliz. Jones, on behalf of Mrs. Johnson, 66, Watling Street. 1 3 4, do. H. Grapes, 4, Circus, Minories 2 3 5, do. C. Shipman, 5, do. 4 7 7, do. J. Roberts, 7, do. 4 7 12, do. W. Maaser, 12, do. 2 3 11, Clark's Place, Bishopsgate. Laura Wells, 11, Clark's Place 1 1 14, Clark's Yard A. Broom, Westdown House, Westdown Road, Leyton. 4 7 14a, do. Do. do. 2 5 2, Montague Court, Bishopsgate. — Groats, 7, Florence Grove, S.E. 3 3 9, do. H. Stock, 15, Great Chart Street 3 4 10, do. Mary Applin, 10, Montague Court 2 2 11, do. — Blatherwick, 131, Bishopsgate Without 5 5 12, do. Do. do. 6 6 16, do. J. Hushbwayte, 16, Montague Court 2 2 3, Crown Place, Aldgate Ann Evans, 3, Crown Place 4 6 6, do. — Hayland, 6, do. 3 6 do. W. Harper, 7, do. 2 2 13, Cutler Street Sarah Collins, 13, Cutler Street 3 12 5, Duke Street, Aldgate Samuel Joseph, 5, Duke Street 2 2 10, do. J. A. Britton, 16 and 18, Houndsditch 3 8 1 Carried forward 125 256 128 EAST DISTRICT—continued. Situation of Premises. Name and Address of Owner. Tenements. Lodgers. Brought forward 125 256 11, Duke Street, Aldgate A. A. Romain, 453, Mile End Road 5 5 13, do. A. Stinner, 18, Duke Street 2 2 19, do. F. Dyson, 19, do. 1 1 6, George Street, Minories Henry C. Geisler, 6, George Street 1 1 7, do. F. W. Loomes, 7, do. 3 11 117, Gravel Lane — Hunt, 117, Gravel Lane 3 6 118, do. Henry Goulston, 118, do. 4 4 1, Hutchison Avenue Charles Kosti, 35, Houndsditch 1 3 2, do. Do. do. 5 5 3, do. Jacob Kalonaski, 3, Hutchison Avenue 3 8 4, do. Morris Cohen, 4, do. 2 8 6, do. Aaron Jacobs, 6, do. 1 2 7, do. Jacob Abrahams 1 1 9, do. Mr. Woolf, High Street, Whitechapel 4 11 10, do. Do. do. 3 8 12, do. N. Foley, 26, London Street, Fitzroy Square 3 8 13, do. Theresa Ellis, 13, Hutchison Avenue 3 6 14, do. Morris Finklestan, Boot Factory, Aldgate 3 4 15, do. Sevan Goldbung, 15, Hutchison Avenue 2 2 17, do. James Woolf, 18, Grenville Place, Maida Vale 3 8 18, do. Henry Davis, 18, Hutchison Avenue 3 9 21, do. Sarah Aarons, 21, do. 3 8 22, do. Isaac Schwartz, 22, do. 5 11 23, do. Frances Woolf, 18, Grenville Place, Maida Vale 3 18 24, do. Reynolds & Eason, 43, Bishopsgate Street Without. 2 10 26, do. N. Foley, 28, London Street, Fitzroy Square 3 12 5, Hutchison Street Charles Koski, 35, Houndsditch 2 7 6, do. — Soloman 3 5 10, do. S. Marks, 10, Hutchison Street 1 8 12, do. Eleazar Isaacs, 12, do. 1 1 16, do. — Abrahams 3 14 17, do. — Soloman, 17, Hutchison Street 2 5 18, do. — Jacobs, 18, do. 1 4 19, do. Sarah Finklestein, 17, Hounds-ditch 1 2 20, do. David Jacobs, 20, Hutchison Street 1 6 Janes Buildings, Hutchison Street. Emmanuel Woolf, 28, High Street, Whitechapel 3 7 5, Mansell Street, Aidgate. John C. Christie, 3 and 5, Mansell Street 4 16 7, do. Robert Card, 7, do. 2 9 8, do. — Tuck, 31, Finsbury Square 4 11 9, do. John C. Christie, 3 and 5, Mansell Street 3 9 11, do. Do. do. 2 7 13, do. — Tuck, 31, Finsbury Square 5 5 15, do Do. do. 6 10 Carried forward 241 554 129 EAST DISTRICT—continued. Situation of Premises. Name and Address of Owner. Tenements. Lodgers. Brought forward 241 554 16, Mansell Street, Aldgate Chas. W. Harris 3 4 17, do. Albert F. Smith, 3, Medland Street, Ratcliff Cross. 6 10 19, do. K. Phillips, 19, Mansell Street 2 8 28, do. — Woolf, 28, do. 3 7 30, do. — Elburn, 30, do. 2 6 35, do. Rachael Ries, 35, do. 1 3 36, do, Sarah Knight, 36, do. 4 5 38, do. George Outten, 38, do. 2 4 23, Middlesex Street Charles Harford, 23, Middlesex Street 1 9 71, do. Aaron Grun, 71, do. 2 4 126, Minories, and 8, New Square. Francis Pearce, 197, Gt. Dover Street, S.E. 6 31 16 & 17, New Square A. Smith, 28, Finsbury Circus 1 5 18, do. Thomas Crouch, 18, New Square 4 7 28, do. A. Smith, 28, Finsbury Circus 1 4 6,New Street,Gravel Lane Solomon Levy, 6, New Street 2 7 8, do. do. Mrs. Bella Levy, 8, do. 3 3 9, do. do. Jacob Rodsenski 2 16 10, do. do. Moss Hillier 1 1 11, do. do. Morris Jacobs 3 3 12, do. do. Barnet Bengerman 3 12 12a, do. Bishopsgate George Robert Jackson, 12, New Street 3 6 13, do. Gravel Lane William Murray 3 8 14, do. do. Jacob Miller 2 7 15, do. do. Harris Norden 2 3 16, do. do. Simons Levy 3 8 17, do. do. Marks Joseph 2 2 18, do. do. Solomon Kiel, 18, New Street 3 13 19, do. do. Mrs. Goodman, 19, do. 2 6 22, do. Bishopsgate W. V. Broom, Westdown House, Westdown Road, Leyton. 4 11 28, do. do. Ed. Bullen, 24, New Street 6 12 24, do. do. Charlotte Smith, 24, do. 17 17 26&27,do. do. Reynolds & Eason, 43, Bishopsgate Street Without. 11 27 22, do. Gravel Lane Do. do. 1 4 23, do. do. Sarah Pizer, 23, New Street 2 7 24, do. do. Rebecca Raphael, 24, do. 3 6 26, do. do. E. Lazarus, 51, Holywell Street, W.C 3 8 27, do. do. Do. do. 3 12 28, do. do. Do. do. 2 7 30, do. do. Do. do. 3 5 32, do. do. Isaac Van Cleep, 32, New Street 3 14 34, do. do. Abraham Marks, 34, do. 1 1 36, do. do. R. Carpal, 36, do. 4 11 Carried forward 376 898 130 EAST DISTRICT—continued. Situation of Premises. Name and Address of Owner. Tenements. Lodgers. Brought forward 376 898 37,New Street,Gravel Lane M. Islinberg 2 2 40, do. do. Mary Roach, 40, New Street 1 2 1, Queen's Court, Vine John Roberts, 7, The Circus 4 7 Street. 2, do. do. Do. do. 3 10 3, do. do. Do. do. 2 7 4, do. do. Do. do. 2 10 15, Rose Alley, Bishopsgate Street. John Fitzgerald, 15, Rose Alley 3 7 2, Three Crown Court, Jewry Street. Messrs. Smith, Son & Gowland, 11, Jewry Street 4 8 3, do. do. Do. do. 5 8 1, Union Row, Minories A. H. Ridgway, 95, Minories 3 8 2, do. do. L. Dickinson, 2, Union Row 4 10 2, Vine Street, do. B. B. Baker, Smithfield Institute 2 8 3, do. do. Mr. Mellon, 3, Vine Street 7 9 8, do. do. — Roberts, 7, Circus, Minories 6 19 9, do. do. Do. do. 9 24 10, do. do. W. Kirk, "The Woolpack " Tavern, 94, Minories 5 16 11, do. do. J. Whitaker, 101, Marlborough Road, Chelsea 7 19 11, Widegate Street A. Field, 182, Hanbury Street 2 2 20, do. H. Dixon, 20, Widegate Street 2 10 21, do. A. Field, 182, Hanbury Street 5 8 23, do. Do. do. 6 9 24, do. — Crane, 25, Widegate Street 4 11 25, do. Do. do. 3 9 5, White Street, Cutler Street. Isaac Levy, 1, White Street 2 6 2, do. Arthur Volkman, 2, Wrestler's Court 1 1 3, do. W. Adams, 3, do. 1 1 4, do. F. Tyler, 4, do. 1 1 9, do. Henry Thomas Apps 1 1 54, Lower Thames Street Farebrother, Ellis & Co., 29, Fleet Street 5 13 4, Sparrow Corner, Minories. Eliza Shipman, 5, Circus, Minories 4 9 2, Goodman's Yard, Minories. Messrs. Moss & Jameson, 77, Chancery Lane 4 7 7, Artillery Lane Mr. Hart, 1, Wheeler Street, Spitalfields 8 23 Total 494 1,183 Average number of persons to each tenement: 2.39. I -C