REPORT OF THE MEDICAL OFFICER OF HEALTH OF THE CITY OF LONDON FOR THE YEAR 1919 BY WILLIAM J. HOWARTH, C.B.E., M.D., D.P.H. medical officer of health of the city of london LONDON: Printed by Drake, Driver & Leaver. Ltd., Rosebery Avenue, E.C. 1920. * . REPORT OF THE MEDICAL OFFICER OF HEALTH OF THE CITY OF LONDON For the Year 1919. BY WILLIAM J. HOWARTH, C.B.E., M.D., D.P.H. medical officer of health of the city of london LONDON: Printed by Drake Driver & Leaver. Ltd.. Rosebery Avenue, E.C1 1920. INDEX. A pace. Anthrax—Infected Shaving Brushes Appendices 77 Area 8 Artizans' Dwellings 62 „ Birth Rate 63 „ „ Record of Attendances at Baths 63 Atmospheric Pollution 32 B Bacteriological Examinations 30 Barbers' Shops, Hygiene at 37 Births 15 Bodies—Exhumation and Re-interment at City of London Cemetery 37 Building Proposals of Corporation 11 C Cleansing of Verminous School Children 31 Common Lodginc House—116, Middlesex Street 67 Courts—Summer Flushing 68 Limewashing 68 Cremations 36 D Dairies, Cowsheds and Milkshops Orders 50 Density 8 Disinfection at City Mortuary 64 Disinfectants 64 Drainage Plans 67 E Exhumation and Re-interment of Bodies at City of London Cemetery 37 F Factory and Workshop Act, 1901 69 „ „ „ Bakehouses—above ground 69 „ „ „ under ground 69 Factories 69 „ „ „ Workshops 69 „ „ Workplaces 69 „ Summary of Work Done 70 „ , „ Outworkers 72 Fish — Supplies 46 „ Deliveries and Condemnations 47 Contaminated Mussels 47 Food Supplies 38 „ Inspected at Riverside Wharves 48 „ Condemned „ „ „ 50 „ Control Committee's Work 60 G Gullies, Street 67 H Hairdressers' and Barbers' Shops 37 House, Trade and other Refuse Removal 68 Housing—Population 9 „ Problem in the City 10 Corporation Building Proposals 11 Human Remains, Removal from 32/33, Farringdon Street 68 I Index - Introductory 7 Infant Mortality 16 Infectious Diseases 18 „ „ Summary of Cases Notified 20 „ Tuberculosis 21 Public Health (Influenza) Regulations 24 ,, Influenza 25 „ „ Public Health (Acute Encephalitis Lethargica and Acute Polio Encephalitis) Regulations .. 25 „ (Pneumonia, Malaria and Dysentery) Regulations 25 Metropolitan Asylums (Trench Fever, Malaria and Dysentery) Order 26 „ „ Rabies 26 Venereal Diseases 27 and Sanitary Defects 68 / INDEX (continued.). L pace. Legal Proceedings 68 Lodging Houses 66 M Meat—Handlinc of 38 „ Importations from Australia 40 „ „ „ New Zealand 40 .. „ „ Argentina 41 Uruguay 41 .. „ „ Brazil 41 „ „ ., S. Africa 41 „ South American Tongues 41 „ Tuberculosis 42 „ Cold Storace 42 „ Leadenhall Market and City Shops 43 „ Aldgate Market and Slaughterhouses 44 „ Summary of Unsound Meat Destroyed 44 Summary of Deliveries at Central Markets 46 Medical Examinations 76 „ Treatment 30 Milk—Examination of Samples Delivered at Railway Stations 50 Milk and Cream—Public Health Regulations—Articles Examined 59 Mortality 15 (Infant) 16 Mortuary, Disinfection at 64 Mussels, Contaminated 47 O Overcrowdinc 68 P Population and Housing 8 Preservation of Bodies of Unknown Dead 65 Prosecutions, Sale of Food and Drugs Act 52 D.O.RA 53 „ Food Control Orders 61 Public Health—Milk & Cream Regulations—Summary of Articles Examined 59 R Rabies 26 Rag Flock Act 37 Rat Repression 36 Rateable Value 8 S Sale of Food & Drugs Act 51 „ „ „ Prosecutions 52 „ „ Summary of Action taken regarding Samples not Genuine 53 „ „ Summary of Articles Examined 58 Sanitary Inspections 65 Sanitary Defects and Infectious Diseases 68 School Children, Cleansing of 31 Shaving Brushes infected with Anthrax 33 Shell Fish—Contaminated Mussels 47 Smoke and Atmospheric Pollution 32 Staff T Tenement Houses 66 Tuberculosis 21 Dispensary 21 V Vaccination 12 Venereal Diseases 27 Verminous School Children, Cleansinc of 31 Vital Statistics 12 W Water-closet Bye-laws, Neglect to comply with 67 Wharves, Food Inspected at 48 „ „ Condemned at 50 APPENDICES. Appendix A—Street Lists of Mortality 78 „ B— Infectious Diseases 81 „ C— Register of Houses let in lodgings or occupied by members of more than one family 82 SANITARY STAFF. MEDICAL OFFICER OF HEALTH. Date of Appointment. HOWARTH, WM. J., C.B.E., M.D., D.P.H Dec., 1912 VETERINARY SURGEON. YOUNG, T. DUNLOP, O.B.E., M.R.C.V.S., D.V.S.M. Nov., 1909 CLERICAL STAFF. Lowe, George Sanitary Clerk Nov., 1902 Gray, Charles M March, 1911 Knott, Basil W. May, 1917 Lee, W. J Oct., 1915 Pallett, Frank J Nov., 1914 Spalding, C. A March, 1918 Baker, H. J April, 1918 Beckles, Miss Virgine Jan., 1907 Chapman, Miss B. R Feb., 1920 Tunbridge, Mrs. Jan., 1917 WOMAN SANITARY INSPECTOR. Wilkinson, Annie M June, 1909 SANITARY INSPECTORS. Hills, Arthur Reginald April, 1888 Gathercole, Wm. Henry Joseph May, 1891 May, William Hussey May, 1891 Simmons, Edward John June, 1892 Robbins, Francis Joseph Sept., 1892 Ralph, William Holden July, 1898 Dunworth, James Jan., 1902 Robinson, Ernest S Feb., 1913 SANITARY INSPECTORS AND MEAT INSPECTORS. Sharp, Owen, Senior Inspector May, 1892 Kelland, William C May, 1899 Mettam, Harry Aug., 1903 Davies, Thos. L. Dec., 1903 Bintcliffe, Charles E. March, 1907 Matson, William S Dec., 1910 Mitchener, William E. Dec., 1910 Jones, J April, 1914 Slatter, C. May, 1908 King, George G. April, 1910 INSPECTOR OF SLAUGHTERHOUSES AND MEAT. Eglin, William July, 1896 ASSISTANT INSPECTORS OF SLAUGHTERHOUSES AND MEAT. Murray, Samuel B Sept., 1911 Penman, T. July, 1913 Mellish, Cyril E Feb., 1912 KEEPER OF THE MORTUARY. Oakley, J. E Feb., 1909 DISINFECTOR. McDonnell, R. J. April, 1903 LABOURERS. T. Steggles (General Duties at Mortuary) Dec., 1918 Adams, T. C. (Meat Shed) May, 1905 Ludgate, G. (Meat Shed) Oct., 1906 PORTERS, CENTRAL MEAT MARKET. Potter, R. March, 1914 Strong, S. R March, 1914 ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1919. To the Right Honourable the Lord Mayor, Aldermen and Commons of the Corporation of London. Public Health Department, Guildhall, E.C., June, 1920. My Lord Mayor and Gentlemen, I beg to present herewith the report of the Medical Officer of Health for the Corporation of the City of London for the year 1919. introductory. The following record is practically my first annual report during seven years of tenure of office. Previous summaries have consisted of abbreviated tabulations of statistics and scant references to work done during the year. The report for the year 1913 was the joint effort of my predecessor and myself, and in consequence was more in the nature of a connecting link. The year 1914 marked the commencement of the great war which continued down to the armistice in the autumn of 1918. During the war period, work was materially interfered with and ordinary routine as well as normal development were replaced by efforts mainly of expediency. The annual report of the Medical Officer of Health should be a document in which not only results and records are set out, but in which this officer is able to bring to the notice of his Authority the arguments for and against current proposals, and in which he is permitted reasonable latitude to state his own views thereon. An expression of opinion of this character does not necessarily commit the Authority but it furnishes members with information to enable them to consider the situation and partially to be in a position to criticise, vary, or support the policy which the Medical Officer of Health may subsequently submit for consideration or adoption. In the case of the City of London this requirement is as necessary as in other districts, for although the resident population has decreased to practically insignificant numbers it occupies the position of an Authority which has a tradition behind it, centuries old, of interest in all matters which concern the welfare of the inhabitants of this country in general and those of its citizens in particular. If ever the Corporation takes the view that its responsibilities are limited to safeguarding the health of the few thousands of resident inhabitants, then indeed will its interest and action in public health affairs approach the parochial. Fortunately there is neither indication nor danger of this state of affairs developing for the Corporation continues to take the keenest interest not only in the night population but in the welfare of those who return daily to the square mile to earn their livelihood. It must be acceded, as suggested above, that in many matters relating to later developments in State Medicine, the direct interest of the City is slight. These developments more and more emphasise the fact that the individual unit must play an important part if future improvement is to result. In this connection the influence of the Corporation can be most effective. The very freedom of the City from direct interest enables it to give a decision on policy which is free from suspicion of ulterior motive. Its judgments become those of a body influenced only by the consideration of what is most advantageous to the many. Historical records show that from the earliest days of this country's development the City interested itself not only in public health matters but also in curative medicine and in organisations of direct professional concern. The Letter Books of the Corporation, which continue to be issued at intervals, throughout their pages illustrate instances of the Aldermen and Court of Common Council exercising authority. Preventive measures adopted during the plague period have proved the basis of many modern developments. Interest in the medical treatment of the poor was shown when the Corporation undertook responsibility for the administration of St. Bartholomew's Hospital in the sixteenth century, and the development 8 of the controlling colleges of both physicians and surgeons have followed on the interest which the Corporation took in the profession at the instance of members of the early Guilds. My apology for referring to these matters, if any be necessary, is briefly to direct attention to what would appear to me to be the unfortunate effect of any interference with the autonomy of the Corporation which might cripple its initiative, or subordinate its authority. Whatever developments result in public health administration in London, and such are undoubtedly necessary, I am satisfied that the City may advantageously be left as a separate authority subject only to the controlling power of the Ministry of Health. Tradition demands it, and respect for past services justifies it, but apart from these perhaps sentimental reasons, the practical effect of a small, powerful independent body existing alongside of the larger body and possessed of concurrent powers and equal liberty of action, can hardly fail to be of advantage in the future. To justify such freedom the Corporation will require to continue to take the most active interest in all public health work, and to consider, and if necessary, define and express its own opinions on matters of general policy. area. The City of London Registration District comprises an area of 675.2 acres (excluding tidal water and foreshore), or 1.051 square miles, equal to a square of 1.0252 miles to a side. The area of "Registration London" is 74,817 acres (excluding tidal water and foreshore), or 116.9 square miles, equal to a square of 10.81 miles to a side. density (1919). City of London, Registration District, at night 20.5 persons to an acre. during the day 559.7 Registration London, at night 51.4 ,, ,, * This figure refers only to persons " actively engaged in the City during the daytime," and is based upon a Census taken in May, 1911. annual rateable value. The rateable value of property within the administrative county of London (excluding the City) was £39,739,171 on 6th April, 1919—whilst on the same date the corresponding rateable value of property in the City of London was £5,812,728, or about one-eighth of the whole County. population. The undermentioned figures are abstracted from the report of the RegistrarGeneral on the Census of England and Wales, 1911 (County of London). Area. Statute Acres. Inhabited Houses. Population. 1901. 1911. 1901. 1911. City of London 672.7 3,865 2,784 26,923 19,657 These figures represent the population on the nights of the 1st April, 1901, and 3rd April, 1911. For Registration, Parliamentary and Municipal purposes the boundaries of the Citv are co-terminous. The following table shows the progressive decline which has taken place since 1861 in the number of inhabitants who reside within the City boundaries, and the progressive increase in the number of workers who are daily employed in the City:— 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 26,923 – 1911 19,657 364,061 9 For statistical purposes, in the following pages the "Registration" District is referred to when speaking of the "City." This consists of one registration district and the population at the middle of 1919 as estimated by the Registrar-General is as follows:— For the death rate 13,893 For the birth rate 14,472 As the smaller of these estimates is based upon the rationing returns, and in my opinion more closely approximates the actual night population of the City, this figure is used in calculating all vital statistics other than the birth rate. The Day Census taken in May, 1911, showed that the day population was 364,061 persons, and also that 1,077,155 persons and 94,095 vehicles entered and left the City on the day the count was made. population and housing. The day population of the City is now estimated to be something under 14,000. These persons live in a few more or less well-defined areas such as the Corporation Dwellings, the houses round about Hutchison Street, a few collected houses off Fetter Lane, Chancery Lane, Long Lane, Fleet Street and other less important centres. The remainder of the population resides in warehouses as caretakers and a lesser number in institutions. The progressively declining population has been due to the absorption of the sites, on which houses stood, for trade and commercial purposes, and this fact has brought in its train difficulties which are apparently being increasingly felt owing to similar advances in areas outside the City. The population within the City is totally inadequate to serve the day requirements of established businesses. This is obvious from the fact that over 300,000 people are probably engaged in the City during the daytime. As a consequence workers mainly reside in the outer London area. It is clear that as businesses increase in number and encroach upon the housing accommodation, the number of employees residing near their work decreases. Transport difficulties arise both in connection with the conveyance of workers and traders by rail, and in street traffic by the additional demands for the delivery and removal of goods. This results in enormous waste of time. In the streets progress is retarded to that of the most slowly moving vehicle, and on the railway travelling becomes a source of irritation, not only as a consequence of discomfort and rush, but from the tendency to reduce the general tone of travellers by the hours available for recreation being reduced owing to the time taken in going backwards and forwards to work. These objections must affect the nervous organisation of many, and in this way uncontrolled business encroachments—using the term "business" in its widest sense—contribute considerably to housing and associated difficulties and prejudicially affect the health and well-being of the working community. It is not easy to suggest how present-day difficulties can be avoided for the future, but it does seem desirable that Local Authorities should be given reasonably wide powers to town-plan built-on or partially built-on areas. It has long been recognised that there is a maximum size of town consistent with maximum efficiency of local administration and general well-being of the inhabitants. Possibly the future will show that populations of 200,000 or even less, on the restricted area which is usually associated with a town, represent this maximum, but local advantages, whether of geographical situation, natural resources or otherwise, may prove too strong factors to limit excessive extensions of certain industrial areas. Even in these instances it will always be found that some trades need not have been established in these centres, and to prevent future inroads on available area being extreme, unnecessary trades might be refused the right to be there established. The principle of developing satellite towns seems worthy of consideration in this connection, but if industrial concerns, which might rightly claim the right to establishment, interfere prejudicially with the available housing by calling for the demolition of residential property, it seems right to require that the purchase of land scheduled as a residential area should involve the purchaser in contribution 10 to the Local Authority to enable that Authority to contend with the problem which is certain to arise. It might be urged that any such policy would effect violent changes in ground values, but such changes would require to be widespread and productive of great hardship to prove a valid contrary argument. Greatly increased powers to Local Authorities to control the use to which land is put within their areas seems to me, therefore, one of the essential requirements if future housing difficulties are to be limited. the housing problem in the city. Although the number of houses in the City is small the position is not free from difficulty. With the exception of a few more modern block dwellings practically none of the older houses may be expected to have more than a few years of existence. Some of these are already far from satisfactory and one group of about 150, which comprise what is known as the Hutchison Street Area, has already been scheduled for acquirement by the Corporation. Many of the remaining smaller groups of houses will have to be dealt with at no distant date. For the present, these may not be demolished without the consent of the Corporation, and here I venture the opinion that but for this restriction, increasing knowledge of the effect of Section 9 of the Housing, Town Planning, &c., Act of 1919, would have resulted in these properties being demolished in the near future and the sites sold for business purposes. Section 9 contains the provision as to the assessment of compensation in respect of schemes promoted by local authorities to deal with insanitary areas. The section is difficult to understand, but it appears that the compensation to be paid differs according to the decision whether the cleared land shall be used for the erection of dwellings or for the erection of business premises, the lesser amount being paid in the former instance. As I have suggested, this differential assessment will tend to make owners of doubtful property sell the sites as business sites, rather than wait for local authorities to take action. A further problem arises in respect of the Hutchison Street Area. In submitting the proposal to the Ministry of Health for the acquisition of the area, the Corporation pointed out that even if the Ministry of Health approved the representation of the Medical Officer of Health that this area was an insanitary area, and ought to be acquired it would be an impossible policy to proceed forthwith to demolish the houses and clear the site. On the other hand if this difficulty were to prevent the Corporation proceeding with the scheme it would necessitate the insanitary conditions being dealt with by notice (and perhaps closing and demolition orders in respect of some), a position which would result in unsatisfactory half measures being adopted, since landlords could not afford to spend the necessary money to maintain the property in a satisfactory condition at existing rents. The policy submitted, therefore, was (a) the area to be declared an insanitary area, (b) immediate acquisition of all interests with compensation on the basis that the site is not to be used for re-housing purposes, (c) demolition of some 20 or 30 houses to be effected as soon as the present tenants can find accommodation elsewhere—these demolitions to be the minimum consistent with admitting into the area the minimum amount of light and ventilation necessary, (d) remaining property to be put in tenantable repair and to be managed by the Corporation, (e) the power so to manage to be authorised for a stated period of years with power to apply for an extension of time, if necessary, (f) the scheme to form part of the Corporation's greater building scheme and to be subject to similar financial provisions, and (g) the site when cleared to be used for such purposes as may seem desirable in the interests of the Corporation. This policy assumes that the Corporation will accept responsibility for managing and controlling certain insanitary property. It is forced into this position because to remove the tenants at once will involve neighbouring authorities in increased overcrowding. The period of this management and control will depend upon local conditions and circumstances, and mainly upon the date when the present occupants can find accommodation elsewhere. To assist in this it is hoped the Corporation's building scheme will help. 11 the corporation's building proposals. The Corporation is the local authority under the Housing Acts and as such has decided to erect dwellings in accordance with the requirements of the Housing Town Planning, &c., Act, 1919. In view of the fact that the City is mainly used by large business firms for administrative purposes such as banks, various exchanges, large insurance offices and shipping and other concerns, it was considered advisable that such houses as the Corporation did erect should in the main be intended for persons in clerical employ, and that in making provision the requirements of the younger married clerk who can only afford a small house, or perhaps part of a house, should not be overlooked. As such employees do not in general require to be in the City before 9 o'clock, or even more generally between the hours of 9 and 10 o'clock, the Corporation was enabled to select a site some few miles away from the City with the knowledge that it would be practicable for residents so employed to afford the time necessary to go to and from their business. After consideration of several sites a position at Ilford was finally selected on which to build some 2,000 houses, and at the same time various properties owned by the Corporation within the area of the Administrative County were considered on which to house a number of persons of a different class, namely those who would find it necessary to live nearer to their work. The proposal is to build mainly separate houses at Ilford and self-contained flats on three storeys on the Hercules Road and Old Kent Road sites. Forty-eight flats will be erected forthwith on the Old Kent Road site and a similar number on the Hercules Road site. A further 104 flats are also contemplated on the former site. It is hoped that the occupation of houses at Ilford will result in the removal of certain families resident at present within the greater London Area to this outer site, and that the wave thus created may affect even the City area, and that when both the Corporation and County Council schemes are completed there may be sufficient vacant houses in the centre to allow of the residents in the Hutchison Street finding accommodation in close proximity to their present homes. In addition the Housing Committee have decided that any resident in the Hutchison Street Area shall have a preferential claim to accommodation in Hercules Road or Old Kent Road, and even to a house at Ilford, if so desired. The interest of your Medical Officer of Health in this scheme has been mainly concerned with the suitability of the site for housing and with general approval of some of the proposals from a sanitary point of view. At the present time consideration is being given to the question of centralising on the Ilford site all services connected with recent medical developments and social hygiene, with the object of giving practical effect to certain of the principles laid down by the Ministry and Committees associated with the Ministry. vaccination. Of the 460 births notified to the Vaccination Officers during 1919, 109 had been successfully vaccinated by the end of the year, 46 had died before the age for vaccination, and in no case was a child reported as insusceptible. Vaccination was postponed by medical certificate in 3 cases, 233 had removed into other districts, or the vaccinations were pending at the end of the year. There were 69 instances of conscientious objection. The Public Vaccinators performed 25 re-vaccinations during the year. 12 VACCINATION STATISTICS IN THE CITY OF LONDON. Year. Number of Births notified to Vaccination Officer. Successfully Vaccinated. Insusceptible. Had Small-pox. Died before Vaccination. Vaccination postponed. Cases pending or removed at the end of the year. Conscientious Objections. per cent. per cent. per cent. per cent. per cent. per cent. per cent. 1914 464 32.3 Nil. Nil. 8.2 1.2 40. 1 18.2 1915 412 33.3 „ „ 8.0 0.2 46.9 11.6 1916 415 29.6 0.20 „ 8.2 0.5 45.6 15.9 1917 254 39.3 Nil. „ 5.9 0.8 37. 1 16.9 1918 312 22.7 „ „ 10.5 0.7 54. 5 11.6 Average previous 5 years 371 31.4 0.04 „ 8.2 0.7 44.8 14.8 1919 460 23.7 – „ 10.0 0.7 50. 6 15.0 VACCINATION ACT, 1907.—It will be seen that the number of conscientious objectors is increasing. This is doubtless due to the Vaccination Act of 1907, which is a direct encouragement to persons not to take advantage of a means which it is known reduces the susceptibility of their children to an attack of smallpox. vital statistics. The various tables required by the Ministry to be inserted in Annual Reports are attached herewith, but the value of the statistics, particularly of the birth and death rates, and perhaps of the incidence of tuberculosis, is not very considerable. It appears to be the practice of many persons without fixed abode, no matter to what part of the country they migrate, to claim London as their permanent place of residence, and in cases of death where such insufficient record of previous residence is the only information available, the death is debited against the City statistics. It is of little use protesting or asking for further information, and to this extent many deaths and many cases of tuberculosis are assigned to the City which with more careful investigation would have resulted in some other allocation. This fact should be borne in mind when a comparison is made between the City vital statistics and those of other districts. As a built-on area the City is undoubtedly healthy; it is well scavenged, the streets are of material which does not easily pulverise, and are impervious, and are regularly washed; the sewers are undergoing continual improvement; there are no cess-pools, and the water supply, like that of the rest of London, is satisfactory. For residential purposes the objections exist that streets in many situations are narrow, buildings are high, the noise of traffic is distracting, particularly in the early hours f the morning in districts near the large markets, and the majority of the houses are old. Caretakers with families suffer the disadvantage that their children have little room for recreation inasmuch as they occupy a few rooms, generally at the top of the building. This however, is the common lot of caretakers in anv large centre. CITY OF LONDON COMPARED WITH THE METROPOLIS FOR THE YEAR 1919 AND THE PREVIOUS FIVE YEARS. City ofondon. 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. Estimated Night Population (Imperial Census). Estimated Day Population (Corporation Census). City. Metropolis. City. Metropolis. City. Metropolis. City. Metropolis. City. Metropolis. 1914 17,129 369,384 10.0 24.3 13.5 14.4 100 104 5.7 4.2 0.53 0.21 1915 16,334 371,059 9.2 22.6 17.4 16.1 121 112 6.0 7.3 0.62 1.58 1916 15,531 372,750 8.1 21.6 15.0 14.3 128 89 9.9 4.0 0.13 0.94 1917 14,720 374,459 7.9 17.5 15.6 15.0 69 103 6.2 5.9 0.24 1.02 1918 13,900 376,186 7.3 16.1 20.9 18.9 148 107 4.2 5.6 0.50 1.31 Average previous 5 years. 15,523 372,767 8.5 20.4 16.5 15.7 113 103 6.4 5.4 0.40 1.01 1919 13,893 377,931 9.6 18.3 14.4 13.4 108 85 10.4 5.9 0.29 2.37 From the tables appended it will be noticed that the death rate for 1914 was 14.4 per thousand compared with 13.4 for the metropolis as a whole. 13 (This Table is prepared in accordance with the requirements of the Ministry of Health.) VITAL STATISTICS OF WHOLE DISTRICT DURING 1919 AND PREVIOUS YEARS. Name of District: CITY OF LONDON. Year. Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Transferable Deaths. Nett Deaths belonging to the District. Uncorrected number. Nett. Number. * Rate. of Nonresidents registered in the District. † of Residents not registered in the District. † Under 1 Year of Age. At all Ages. Number. † Rate. Number. * Rate per 1,000 nett Births. Number. * Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 1914 17,129 450 171 10.0 856 49. 98 750 125 17 100 231 13.5 1915 16,334 414 149 9.2 805 49.29 674 153 18 121 284 17.4 1916 15,531 414 125 8.1 760 48.93 659 132 16 128 233 15.0 1917 14,720 253 115 7.9 705 47.88 602 126 8 69 229 15.6 1918 13,900 314 101 7.3 637 45.82 517 171 15 148 291 20.9 1919 13,893 453 139 9.6 780 56.14 681 101 16 108 200 14.4 Notes.— this Table is arranged to show the gross births and deaths in the district, and the births and deaths properly belonging to it with the corresponding rates. For years before 1911 some of the corrected rates probably will not be available. The rates should be calculated per 1,000 of the estimated gross population. In a district in which large Public Institutions for the sick or infirm seriously affect the statistics, the rates in columns 5 and 13 may be calculated on a nett population, obtained by deducting from the estimated gross population the average number of inmates not belonging to the district in such institutions. * In Column 6 are to te included the whole of the deaths registered during the year as having actually occurred within the district. In Column 12 is to be entered the number in Column 6, corrected by subtraction of the number in Column 8 and by addition of the number in Column 9. Deaths in Column 10 are to be similarly corrected by subtraction of the deaths under 1, included in the number given in Column 8, and by addition of the deaths under 1 included in the number given in Column 9. † The Medical Officer of Health will be able from the returns made to him by the local Registrar of Deaths, as well as from the quarterly lists furnished by the Registrar-General, to fill in Column 8 in accordance with the rule in the next paragraph below. The Registrar-General, either directly or through the County Medical Officer of Health, will supply the Medical Officer of Health with the particulars of deaths to be entered in Column 9 ; and all such deaths must be included in this Column, unless an error is detected, and its correction has been accepted by the Registrar-General. For Column 4 the Registrar-General will furnish to the Medical Officer of Health a statement of the number of births needing to be added to or subtracted from the total supplied by the local Registrar. ‡ "Transferable Deaths" are deaths of persons who, having a fixed or usual residence in England or Wales, die in a district other than that in which they resided. The deaths of persons without fixed or usual residence, e.g., casuals, must not be included in Columns 8 or 9, except in certain instances under 3 (b) below. The Medipal Officer of Health will state in Column 8 the number of transferable deaths of "non-residents" which are to be deducted, and will state in Column 9 the number of deaths of "residents" registered outside the district which are to be added in calculating the nett death-rate of his district. The following special cases arise as to Transferable Deaths:— (1) Persons dying in institutions for the sick or infirm, such as hospitals, lunatic asylums, workhouses, and nursing homes (but not almshouses) must be regarded as residents of the district in which they had a fixed or usual residence at the time of admission. If the person dying in an institution had no fixed residence at the time of admission, the death is not transferable. If the patient has been directly transferred from one such institution to another, the death is transferable to the district of residence at the time of admission to the first Institution. (2) The deaths of infants born and dying within a year of birth in an Institution to which the mother was admitted for her confinement should be referred to the district of fixed or usual residence of the parent. (3) Deaths from Violence are to be referred (a) to the district of residence, under the general rule; (b) if this district is unknown, or the deceased had no fixed abode, to the district where the accident occurred, if known ; (c) failing this, to the district where death occurred, if known; and (d) failing this, to the district where the body was found. Area of City of London Registration District in acres (land and inland water) 672.7 Total population at all ages 19,657 Number of inhabited houses 2,784 Average number of persons per house 7 At Census of 1911 cf. Census, Vol. V.). 14 (This Table is prepared in accordance with the requirements of the Ministry of Health.) CAUSES OF, AND AGES AT, DEATH DURING THE YEAR 1919. Causes of Death. Nett Deaths at the subjoined ages of "Residents" WHETHER OCCURRING WITHIN OR WITHOUT THE DISTRICT (a). Total Deaths WHETHER OF "Residents" or "nonresidents" in Institutions in the District (b). All ages Under 1 year. 1 and under years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 and upwards. All causes Certified (c) 2 200 3. 15 4. 3 5. 2 6. 4 7. 11 8. 28 9. 70 10. 67 11. 663 Uncertified 1. Enteric Fever ... ... ... ... ... ... ... ... ... ... 2. Small-pox ... ... ... ... ... ... ... ... ... ... 3. Measles ... ... ... ... ... ... ... ... ... ... 4. Scarlet Fever ... ... ... ... ... ... ... ... ... ... 5. Whooping Cough 1 1 ... ... ... ... ... ... ... ... 6. Diphtheria and Croup 2 ... 1 ... 1 ... ... ... ... 4 7. Influenza 8 ... ... ... ... 2 6 ... ... 20 8. Erysipelas ... ... ... ... ... ... ... ... ... ... 9. Phthisis (Pulmonary Tuberculosis) 12 ... ... ... ... 2 6 4 ... 20 10. Tuberculosis Meningitis 1 ... ... ... 1 ... ... ... ... 24 11. Other Tuberculous Diseases 2 ... 1 ... ... ... 1 ... ... 8 12. Cancer, malignant disease 15 ... ... ... ... 1 ... 11 3 90 13. Rheumatic Fever ... ... ... ... ... ... ... ... ... 2 14. Meningitis (see note (d) ) ... ... ... ... ... ... ... ... ... 10 15. Organic Heart Disease 27 ... ... ... ... 1 1 15 10 38 16. Bronchitis 23 1 ... ... ... ... 2 9 11 26 17. Pneumonia (all forms) 10 1 ... ... 1 ... 2 3 2 46 18. Other diseases of respiratory organs 1 ... ... ... ... ... ... 1 ... 3 19. Diarrhœa and Enteritis (see note (e)) 1 1 ... ... ... ... ... ... ... 12 20. Appendicitis and Typhlitis ... ... ... ... ... ... ... ... ... 13 21. Cirrhosis of Liver ... ... ... ... ... ... ... ... ... 1 21a.Alcoholism ...... ... ... ... ... ... ... ... ... ... 22. Nephritis and Bright's Disease 6 ... ... ... ... ... ... 1 5 19 23. Puerperal Fever ... ... ... ... ... ... ... ... ... ... 24. Other accidents and diseases of Pregnancy and Parturition 1 1 ... ... ... ... ... ... ... 4 25. Congenital Debility and Malformation, including Premature Birth 4 4 ... ... ... ... ... ... ... 28 26. Violent Deaths, excluding Suicide 17 1 ... ... 1 2 3 7 3 62 27. Suicide 3 ... ... ... ... 1 2 ... ... 4 28. Other Defined Diseases 66 5 1 1 ... 2 5 19 33 229 29. Diseases ill-defined or unknown ... ... ... ... ... ... ... ... ... ... 200 15 3 2 4 11 28 70 67 663 15 BIRTHS. During the year 1919, 453 births were registered in the City, 352 of which, however, did not belong thereto. To the remaining 101 must be added the births of 38 children born to Citizens temporarily residing outside the City boundary. The number of births, therefore, on which the rate should be calculated is 139. The annual birth rate was 9.6 per 1,000 persons of all ages, compared with a quinquennial mean rate of 8.5 per 1,000. In the Metropolis the birth rate in 1919 was 18.3 per 1,000. This decline in the birth rate has been in operation in this country since 1876, and is common to nearly all European countries. mortality. During the year under review, 780 deaths were registered in the District, including 681 persons dying in the City, but not belonging thereto. See Table, p. 14, for details. Deducting these latter, 99 deaths remain, to which must be added those of 101 persons who died in Institutions in outside districts, where they were registered; the total, therefore, on which the City death-rate is calculated is 200. The death rate for 1919 was 144 per 1,000 per annum of the population (the previous year being 20.9), whilst that for the whole of the Metropolis was 13.4. DEATHS FROM VIOLENCE.—Of the City deaths, 10.0 per cent. were caused by injuries or violence, as compared with 62 in 1917 and 4.2 in 1918. This is 36 above the average for the previous five years. PERCENTAGE OF REGISTERED DEATHS FROM VIOLENCE. Year. City of London. Metropolis. Per cent. Per cent. 1914 5.7 4.2 1915 6.0 7.3 1916 9.9 4.0 1917 6.2 5.9 1918 4.2 5.6 Average previous five years *6.4 5.4 1919 10.0 5.9 DEATH RATES, PER 1,000 PER ANNUM. Year. City of London. 96 Great Towns of England and Wales. Metropolis. 1914 13.5 15.0 14.4 1915 17.4 15.9 16.1 1916 15.0 14.4 14.3 1917 15.6 14.6 15.0 1918 20.9 18.2 18.9 Average previous five years 16.5 13.6 13.7 1919 14.4 13.8 13.4 The death rate from zymotic disease per 1,000 of the population was 0.29 compared with 2.37 in the Metropolis. The deaths from phthisis correspond to a rate of 0.9per 1,000 of the population, as compared with 1.12in the Metropolis. 16 infant mortality. The deaths of children under one year of age were at the rate of 108 per 1,000 births, as against 85 for the whole of London. The Table of infantile mortality on p. 17 shows the deaths of children under one year arranged according to monthly age periods. From this it will be seen that no less than 60.0 per cent. of these deaths occurred in the first month, 73.3 per cent. within the first three months, and 86.6 per cent. during the first six months of existence. Attempts are made, and, I believe, with some degree of success, to assist parents in successfully bringing up children born within the City boundaries. Infant mortality was at the rate of 108 per 1,000 and the tables indicate the number and causes of death, none of which require special comment. The chief variation in past work is in consequence of the passing of the Maternity and Child Welfare Act, 1918, the following sections of which make it essential that Local Authorities should consider what action they will take in respect to Maternity and Child Welfare work:— "Any local authority within the meaning of the Notification of Births Act, 1907, "may make such arrangements as may be sanctioned by the Local Government Board "for attending to the health of expectant mothers and nursing mothers, and of "children who have not attained the age of five years, and are not being educated in "schools recognised by the Board of Education." "Provided that nothing in the Act shall authorise the establishing by any local "authority of a general domiciliary service by individual practitioners." Certain responsibilities are attached to the above authorisations :— (i.) That any scheme shall be approved by the Local Government Board, and (ii.) That the constitution of the Committee administering such scheme shall include at least two women. If these requirements are complied with the Local Government Board will contribute up to 50 per cent. of the approved expenditure. Under the terms of the Act the following matters may be included in the scope of any work undertaken in this connection:— Hospital treatment for children up to five years of age. Lying-in homes. Home helps. Provision of food for expectant and nursing mothers, and for children under five years of age. Creches and Day Nurseries. Convalescent Homes. Homes for the children of widowed and deserted mothers, and for illegitimate children. Experimental work for the health of expectant and nursing mothers, and of infants and children under five years of age. Before arriving at a decision as to what work in addition to that already undertaken by the City Corporation in this direction should be carried on, the Sanitary Committee gave special and careful consideration to the needs of this district. The population of the City consists largely of adults without children. Charitable institutions which distribute doles to necessitous persons exist on a scale probably in excess of that in any similar sized population in the country, and these institutions minister to the needs of whatever poor there may be in the City. As regards the necessity for medical attendance, the population is again favoured by having in close proximity to any City residence one or more hospitals of importance, at which medical assistance can be obtained if the services of a private medical man cannot be paid for. 17 (This Table is prepared in accordance with the requirements of the Ministry of Health.) CITY OF LONDON. INFANTILE MORTALITY DURING THE YEAR 1919. Nett Deaths from stated Causes at Various Ages under One Year of Age. causes of death Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks, Total under 4 Weeks. 4 Weeks and under 3 Months. 3 Months and under 6 Months. 6 Months and under 9 Months. 9 Months and under 12 Months Total Deaths under 1 Year. All Causes Certified 7 2 .... .... 9 2 2 l l 15 Uncertified .... .... .... .... .... .... .... .... .... .... Small-pox .... .... .... .... .... .... .... .... .... .... Chicken-pox .... .... .... .... .... .... .... .... .... .... Measles .... .... .... .... .... .... .... .... .... .... Scarlet Fever .... .... .... .... .... .... .... .... .... .... Whooping Cough .... .... .... .... .... .... .... .... l l Diphtheria and Croup .... .... .... .... .... .... .... .... .... .... Erysipelas .... .... .... .... .... .... .... .... .... .... Tuberculous Meningitis .... .... .... .... .... .... .... .... .... .... Abdominal Tuberculosis .... .... .... .... .... .... .... .... .... .... Other Tuberculous Diseases .... .... .... .... .... .... .... .... .... .... Meningitis (not Tuberculous) .... .... .... .... .... .... .... .... .... .... Convulsions .... .... .... .... .... .... .... .... .... .... Laryngitis .... .... .... .... .... .... .... .... .... .... Bronchitis .... 1 .... .... 1 .... .... .... .... l Pneumonia (all forms) .... .... .... .... .... .... .... 1 .... l Diarrhœa .... .... .... .... .... 1 .... .... .... 1 Enteritis .... .... .... .... .... .... .... .... .... .... Gastritis .... .... .... .... .... .... 1 .... .... l Syphilis .... .... .... .... .... 1 .... .... .... l Rickets .... .... .... .... .... .... .... .... .... .... Suffocation (overlying) .... .... .... .... .... .... .... .... .... .... Injury at Birth 1 .... .... .... 1 .... .... .... .... l Atelectasis 1 .... .... .... 1 .... .... .... .... l Congenital Malformations .... .... .... .... .... .... .... .... .... .... Premature Birth 3 1 .... .... 4 .... .... .... .... 4 Atrophy, Debility andMarasmus .... .... .... .... .... .... .... .... .... .... Other Causes 2 .... .... .... 2 .... 1 .... .... 3 7 2 .... .... 9 2 2 1 l 15 Nett Births in the year legitimate 127 illegitimate 12 Nett Deaths in the year legitimate infants 15 illegitimate infants 0 18 In view of these conditions, it seemed therefore unnecessary to promote any definite scheme making provision for any of the before-mentioned items, other than those referring to foods for infants and assistance to nursing and expectant mothers. The provision of food for expectant and nursing mothers, and for children under five years of age, has been approved, and a sum of £150 per annum has been set aside for that purpose. This sum is in addition to an annual grant of £120 which is made by the Corporation for the supply of milk to necessitous mothers who breast-feed their infants, and a grant of £20 per annum for the supply of dried milk for the infants of mothers who are unable to breast-feed their children. In addition to the above, a "Mothers Welcome" is established, and this is held Weekly at St. Bartholomew's Hospital, where two rooms have been reserved for the purpose by the authorities of the hospital. In addition to the above, a sum of £25 has been set aside for the provision of expert home nursing in complicated cases of measles. It was at first decided to authorise the Maternity and Child Welfare work to be carried out by the Sanitary Committee, which Committee also carried out the work in connection with the Tuberculosis After-Care. In the early part of 1920, however, it was decided that the Sanitary Committee should delegate their responsibilities with regard to both the Maternity and Child Welfare work and the Tuberculosis After-Care to a special Sub-Committee of seven members, two of whom were to be ladies, which Sub-Committee should report from time to time to the Sanitary Committee as may be necessary. This Committee has been duly appointed and approved, and on the Lady Mayoress (Lady Cooper) and Miss Crosby is the distinction conferred of being the first lady members attached to a Standing Committee of the Corporation. infectious diseases. Very few comments are necessary with reference to the incidence of infectious disease during the year 1919. Diphtheria was prevalent to the extent of 21 cases as compared with 18 in 1918 The number of scarlet fever cases was 16, exactly the same as in the previous year. Erysipelas showed a decrease from seven to two, and there was one case of poliomyelitis. Only 18 cases of measles were reported, as compared with 82 notified in 1918; and 17 cases of rubella were recorded. Chicken-pox was not so prevalent as in the previous year, in the proportion of 13 cases to 44. The percentage of cases removed to hospital was somewhat higher than in 1918. During 1919 cases of small-pox were reported at different times in various neighbourhoods. No cases were reported in the City; numerous contacts, however, with outside cases came to my knowledge. These were visited and kept under observation, and where necessary, vaccination was advocated. In each instance of notified disease a detailed examination is made of the sanitary condition of the premises where the case occurred, and a summary of defects found by the District Inspector is given on page No case of small-pox, cholera, plague, typhus, relapsing, continued or puerperal fever, anthrax, cerebro-spinal meningitis or ophthalmia neonatorum have been reported. Fuller information is set out in the tables appended. NOTIFICATION OF INFECTIOUS DISEASES.—In the following tables will be found particulars of certificates relating to cases of infectious disease 19 forwarded under Sections 55 and 56 of the Public Health (London) Act, 1891, and information as to the removal of patients to hospitals, infirmaries, etc.:— Name of Disease. Number of i 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 subsequently found to be incorrect. Net number of cases. Small-pox .... .... .... .... .... .... .... .... Diphtheria 23 1 18 1 1 .... 2 21 Scarlet Fever 17 2 12 1 1 1 .... 16 Enteric Fever 1 .... .... .... 1 .... .... 1 Puerperal Fever .... .... .... .... .... .... .... .... Erysipelas 2 1 .... .... 1 .... .... 2 Cerebro-spinal Meningitis .... .... .... .... .... .... .... .... Acute Polio-myelitis 1 .... .... .... 1 .... .... 1 Ophthalmia Neonatorum .... .... .... .... .... .... .... .... Measles 18 12 .... 4 2 .... .... 18 Rubella 17 16 .... 1 .... .... .... 17 Malaria contracted abroad 17 12 .... .... 5 .... .... 17 Pneumonia 7 4 .... .... 3 .... .... 7 Totals 103 48 30 7 15 1 2 100 Chicken-pox 13 13 .... .... .... .... .... .... Totals 116 61 30 7 15 1 2 113 It will be seen from the foregoing that during the year, excluding chicken-pox, 103 Certificates were received, including one duplicate and two in which the diagnosis was subsequently found to be incorrect. The total number of notifiable infectious diseases, excluding tuberculosis, measles, rubella, malaria, pneumonia and chicken-pox, was 41, as compared with 42 last year; and, as stated, the number of cases of scarlet fever reported was the same as the previous year. The following is a Return of infectious diseases notified in the City of London, exclusive of tuberculosis, measles, rubella, malaria, pneumonia and chicken-pox, with the percentages of such cases removed to hospitals for treatment or nursed at home during 1919 compared with the figures for the previous five years:— Year. Number of cases reported. Per cent. of cases reported. Removed to Hospital. Treated at home. 1914 128 93.8 6.2 1915 112 94.6 5.4 1916 70 94.3 5.7 1917 51 94.1 5.9 1918 42 88.1 11.9 Average for the five years 80.6 93.0 7.0 1919 41 90.2 9.8 20 CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1919. (The following table is prepared in accordancc with the requirements of the Ministry of Health.) CITY OF LONDON. NUMBER OF CASES NOTIFIED At Ages—Years Total Cases Removed to Hospitals At all Ages Under i i and under 5 5 and under 15 years 15 and under 25 years 25 and under 45 years 45 and under 65 years 65 years and upwards Small-pox .... .... .... .... .... .... .... .... .... Cholera .... .... .... .... .... .... .... .... .... Plague .... .... .... .... .... .... .... .... .... Diphtheria 21 .... 6 11 4 .... .... .... 20 Erysipelas 2 .... .... .... .... 1 1 .... 1 Scarlet Fever 16 .... 3 10 3 .... .... .... 14 Typhus „ .... .... .... .... .... .... .... .... .... Enteric „ 1 .... .... .... 1 .... .... .... 1 Relapsing „ .... .... .... .... .... .... .... .... .... Continued „ .... .... .... .... .... .... .... .... .... Puerperal „ .... .... .... .... .... .... .... .... .... Polio-myelitis 1 .... .... .... 1 .... .... .... 1 Cerebro-spinal meningitis .... .... .... .... .... .... .... .... .... Pulmonary Tuberculosis 16 .... .... 2 2 10 2 .... .... Other forms of Tuberculosis 3 .... .... 3 .... .... .... .... .... Ophthalmia neonatorum .... .... .... .... .... .... .... .... .... Measles 18 .... 5 9 1 2 1 .... 6 Rubella 17 2 14 1 .... .... .... .... 1 Malaria 17 .... .... .... 4 13 .... .... 5 Pneumonia 7 .... .... 1 1 4 1 .... 1 119 2 28 37 17 30 5 .... 50 •Metropolitan Asylum Board Hospitals, London Fever Hospital, City of London Infirmary, St. Bartholomew's Hospital, City Police Hospital, etc. 21 TUBERCULOSIS. I have already referred to the probability that the number of cases of tuberculosis reported in the City is higher than is actually a fact, and from the table on page 22 it will be observed that 19 new cases of tuberculosis were reported, and that of those, 16 were of the pulmonary variety and three non-pulmonary. These cases have been visited as in the past and assistance has been rendered where practicable. On the whole it will be seen that the Tuberculosis Dispensary established by the Corporation at St. Bartholomew's Hospital has been of considerable utility, and I submit herewith a report which has been prepared by Dr. Gibbins, Tuberculosis Officer, giving full details. TUBERCULOSIS DISPENSARY.—The Tuberculosis Dispensary has been open for the reception of new patients and for the attendance of old cases on Tuesdays and Fridays from 12.30 to 2.30 and on Thursdays from 6 to 7 ; also for the attendance of old cases on Mondays from 5 to 7. In all, the Dispensary has been open 203 times during the year. NEW PATIENTS.—The number of persons, including contacts, who were examined for the first time at or in connection with the Dispensary, was 237, divided thus :— Diagnosed as Suffering from Tuberculosis. Diagnosed as Not Suffering from Tuberculosis. Undiagnosed. Total Number Examined. Still under Observation. Not still under Observation. Insured. Uninsured. Residents 15 41 3 .... 19 40 Non-residents— Working in the City 20 31 4 .... 33 22 Not working in the City 58 56 4 5 54 69 93 128 11 5 106 131 237 237 Persons diagnosed as suffering from Tuberculosis may be thus classified :— Residents. Non-Residents. Totals. Working in City Not working in City. Disease of the Lungs 12 20 46 78 Disease of other organs (lungs not apparently affected) 3 .... 12 15 Many of the persons diagnosed as not suffering from Tuberculosis were found to be suffering from other diseases, for which they were advised to seek treatment elsewhere. The undiagnosed cases are thus accounted for :— Residents:— All are still under observation. Non-residents working in City:— All are still under observation. Non-residents not working in City :— 4 are still under observation. 2 were referred to the Dispensaries of the areas in which they reside. 1 was advised to return to his home in the country. 2 have ceased to attend in spite of letters requesting them to do so. Applicants unconnected with the City either as residents or workers were examined, and if found to be suffering from Tuberculosis, the fact was notified to the Medical Officer of Health of the area in which they resided. Treatment was continued to be given until arrangements had been made for their treatment 22 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912, and Public Health (Tuberculosis) Regulations (No. 2), 1918. Summary of Notifications during the period from the 1st January, 1919, to the 31st December, 1919, in the City of London. AGE-PERIODS notifications on form a notification on form B † Number of Notifications on Form c Number of Primary Notifications * Total Primary Notifications Total Notifications on Form a Number of Primary Notifications * Total Notifications on Form B Poor Law Institutions Sanatoria 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards Under 5 5 to 10 10 to 15 Total Primary Notifications Pulmonary Males .... .... .... .... 1 .... 4 5 1 .... .... 11 16 .... .... .... .... .... l 6 „ Females .... .... 1 1 1 .... .... 1 .... .... 1 5 12 .... .... 1 l l l 5 Non-pulmonary Males .... .... 1 2 .... .... .... .... .... .... .... 3 3 .... .... .... .... .... .... .... „ „ Females .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Col. (1) (8) (3) («) (5) (6) (?) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) Patients notified as suffering from both pulmonary and non-pulmonary disease should be included among the " pulmonary " returns only. All notifications on Form D should be disregarded in preparing this return. * Primary notifications relate to patients who have not previously been notified in this or former years, either on Form A or on Form B, in the area to which the return relates. Any additional notification of a case which has been previously notified in the area is to be regarded as duplicate. (Note-—No primary notifications should be made on Form C ) † A School Medical Inspector, or the Medical Officer of Health of a county, county borough, or other district, if acting as a School Medical Inspector, is required to notify on Form B all cases of tuberculosis discovered in the course of inspection of children attending public elementary schools whether or not these have previously been notified. Cols. 2-13. Only those cases which have been notified for the first time during the year on Form A in the area concerned, and which have never previously been notified in the area, either on' Form A or on Form B, should be included in these columns. Col. 14. The object of this column is to show the extent to which duplicate notification occurs on Form A, and all notifications on Form A, whether duplicate or not, should be included in this column. Cols. 15-18 Only those cases which have been notified for the first time during the year on Form B in the area concerned, and which have never previously been notified in the area, either on Form A or on Form B, should be included in these columns. Col. 19. All notifications which have been made during the year on Form B in the area concerned, whether the cases have previously been notified in the area, or not, either on Form A or on Form B, should be included in this column. Col. 21. Only notifications on Form C made by the Medical Officers of Sanatoria, as defined in the Tuberculosis Regulations of 1912, should be entered in this column. 23 locally, either at a Dispensary in their area or otherwise. This has worked satisfactorily, and under these provisions 123 persons have received advice or treatment during the year. PERSONS TREATED, &c.—The number of persons diagnosed to be suffering from Tuberculosis, who were treated or supervised at, or in connection with, the Dispensary, was 188, divided thus :— Insured. Not Insured. Totals. Residents 25 21 46 Non-residents—Working in City 57 25 82 Not working in City 34 26 60 188 Of these, 93 were new patients this year, while 33 attended for the first time in 1918, 19 for the first time in 1917, 18 for the first time in 1916, 22 for the first time in 1915, and 3 for the first time in 1914. TOTAL ATTENDANCES.—The number of attendances of Patients at the Dispensary, including first attendances, was 2,250, divided thus :— Insured. Not Insured. Totals. Residents 294 443 737 Non-residents—Working in City 924 296 1,220 Not working in City 151 142 293 2,250 PERSONS UNDER TREATMENT, &c„ AT END OF YEAR.—The number of persons who were under treatment, supervision or observation at or in connection with the Dispensary on December 31st, 1919, was 190, divided thus :— Insured. Not Insured. Totals. Residents 33 67 100 Non-residents—Working in City 57 29 86 Not working in City 1 3 4 190 PATIENTS REFERRED TO THE HOSPITAL.—The number of persons who were referred to various departments of St. Bartholomew's Hospital for diagnosis or treatment was 43, divided thus :— Insured. Not Insured. Totals. Residents 4 15 19 Non-residents—Working in City 5 5 10 Not working in City 8 6 14 43 Included in the above are 5 persons who were operated upon, 25 who were examined by X-rays and 3 who received dental treatment. In addition to these a number of persons were seen by Physicians attached to the Hospital. PATHOLOGICAL EXAMINATIONS.—Specimens of Sputum examined for the Tubercle Bacillus :— Positive 14 Negative 103 117 In addition to the above, two other pathological examinations were made. TREATMENT IN SANATORIA.—The number of patients who were recommended for admission to Sanatoria was 28, viz. :— Residents recommended to— (a) London County Council 4, all of whom were admitted. (b) London Insurance Committee 11, of whom 10 were admitted, while 1 decided to go to his mother's home in the country instead of to a sanatorium. 24 Non-residents, working in the City, recommended to— (a) London County Council 2, both of whom were admitted. (b) London Insurance Committee 2, both of whom were admitted. (c) Voluntary Agencies 2, both of whom were admitted. , Non-residents, not working in the City, recommended to— (a) London County Council 2, the result is not known in either case. (b) London Insurance Committee 4, of whom 3 were admitted, the result in 1 case being unknown. (c) Voluntary Agency 1, the result is not known. THE TUBERCULOSIS NURSE.—The work of the Tuberculosis Nurse has continued on the same lines as in former years. Of patients attending the Dispensary 56 homes have been visited and 461 visits made in connection with after-care and following up. In addition to this 8 patients have been nursed in their own homes, the nurse working under the direction of the practitioners attending the patients ; one of these persons was in an advanced stage of the disease and died at home, while one was admitted to St. Bartholomew's Hospital, where he died. For nursing purposes 71 visits were made. FUTURE POLICY.—The chief matter to bring to your notice is the question of the provision for the treatment of this disease. Members of the Sanitary Committee will recollect that some few years ago, before each sanitary authority in London had provided a centre for the treatment of tuberculosis, the Corporation decided to establish at St. Bartholomew's Hospital a clinic to which not only City residents might have the right of entrance, but also City workers. It was considered that this facility, in view of the fact that there was only limited provision outside the City, would be to the advantage of the workers in general. Conditions have now changed. In practically every district ample provision is made for the treatment of tuberculous persons, and as a consequence the number of City workers availing themselves of the hospital clinic becomes fewer in number each year, and the tendency now is, not for employers to send doubtful cases of illness to the City clinic, but to advise the worker to attend the clinic established within his own area. In these circumstances, and in view of the fact that sanatorium benefit has now been removed from the administration of Insurance Committees, it seems desirable the City Corporation should reconsider its position in this matter. I have refrained from making any report on the subject, and will hesitate still a little longer until the Ministry of Health, in view of the transfer of administration, publishes information as to the lines on which a tuberculous person, whether insured or otherwise, is to be provided for in the future. PUBLIC HEALTH (INFLUENZA) REGULATIONS, 1918. PUBLIC HEALTH (INFLUENZA) REGULATIONS (NO. 2), 1918. The first of the above-mentioned regulations provided that no entertainment should be carried out in any place of public entertainment for more than three hours consecutively, and that there should be an interval of not less than 30 minutes between any two entertainments, during which interval such place of public entertainment should be effectually and thoroughly ventilated. Provision was made for relaxation of the requirements on the approval of the Medical Officer of Health. The second of these regulations extended the period of continuous entertainment at a Cinematograph Exhibition from three hours to four hours, and provided that wherever notice was given to the proprietor of such an exhibition to the effect that a public elementary school in the district, or any contributory place to the district, was temporarily closed on account of the prevalence of influenza, children were not to be admitted to the exhibition during the continuance of the closure of any such school. 25 These regulations did not materially affect the City as there are few, if any, places of public entertainment, within the meaning of the definition, in the City. There are, however, one or two Public Institutions in the City where entertainments are sometimes given, and although it was doubtful whether they could be regarded as coming within the scope of the regulations, the Authorities at each readily acquiesced in the suggestions which I made with a view to preventing the spread of influenza. The regulations were revoked by a General Order dated 6th May, 1919. INFLUENZA. PRECAUTIONARY MEASURES.—Energetic action was taken in the early part of the year throughout the whole country to prevent, if possible, any recurrence of the widespread epidemic of Influenza of 1918. Education played an important part in these measures, and practically all local health authorities endeavoured to inform the public, by means of leaflets, posters or notices, of the nature and gravity of the malady, how to prevent infection, and the procedure to be observed in case of attack. In the City a pamphlet with this object was prepared and distributed to all houses, tenements, wharves, factories, shops, etc., and with the permission of the Commissioner of Police, was exhibited at all the City police stations. PUBLIC HEALTH (ACUTE ENCEPHALITIS LETHARGICA AND ACUTE POLIO ENCEPHALITIS) REGULATIONS, 1918. The above Regulations, which came into operation on the 1st January, 1919, were framed with the object of securing the notification of cases of an obscure infectious disease which occurred in epidemic form in the spring of 1918 and which was first referred to as Botulism. An investigation made by the Medical Inspectors of the Local Government Board in conjunction with the Medical Research Committee, established the fact that the disease in question was not Botulism, but that its clinical manifestations appeared to be those of an infectious disease which has been termed Encephalitis Lethargica. The notification of this disease, together with the notifications of acute Polio Encephalitis was therefore deemed desirable, and the Regulations above named were issued accordingly and were to remain in operation for one year. Action taken under the Regulations has given such satisfactory results that it has been decided to continue their operation until such time as the Ministry of Health otherwise directs [vide Public Health (Acute Encephalitis Lethargica and Acute Polio Encephalitis) Regulations, 1919]. Steps have been taken to direct the attention of all medical men practising within the City to the Regulations, and a copy has been forwarded to each. PUBLIC HEALTH (PNEUMONIA, MALARIA, DYSENTERY, ETC.) REGULATIONS, 1918. The Public Health (Pneumonia, Malaria, Dysentery, etc.) Regulations, 1918, which came into operation on the 1st March, 1919, impose on medical practitioners the duty of notification of each case of Malaria, Dysentery, Trench Fever, Acute Primary Pneumonia, or acute Influenzal Pneumonia which may come to their notice. The notification is to be forwarded to the Medical Officer of Health of the district in which the patient resides. Notification is not required in cases of Malaria, Dysentery or Trench Fever if the case has, to the knowledge of the Medical Practitioner, already been notified within the period of six months immediately preceding the date on which he first became aware of the disease in that particular patient. The attention of all medical men practising in the City was directed to the regulations and a copy forwarded to each. 26 METROPOLITAN ASYLUMS (TRENCH FEVER, MALARIA, AND DYSENTERY) ORDER, 1919. In accordance with the powers vested in them by Section 80 of the Public Health (London) Act, 1891, the Local Government Board issued the above regulations empowering the Managers of the Metropolitan Asylums Board to admit into their hospitals any person, not being a pauper, who is reasonably believed to be suffering from Trench Fever, Malaria or Dysentery. The regulations are contained in four articles of which the following is a brief summary :— Article 1. Ensures priority being given to pauper patients. Article 2. Provides (a) For the admission of persons to whom this order applies, only on the recommendation of the Medical Officer of Health for the district of the Sanitary Authority in which such person is residing at the time when the question of the patient's removal to hospital arises. (b) For recommendation of Medical Officer of Health to be accompanied by such information as the Metropolitan Asylums Board may reasonably require. (c) For admission by the Clerk of the Metropolitan Asylums Board in emergency, of any person to whom the order applies, without recommendation of Medical Officer of Health. Article 3. Provides that the interests of the public health are to be considered when any question of priority of admission arises Article 4. Title of Order. RABIES. In April, 1919, the Local Government Board issued a memorandum on the procedure recommended to be followed in the event of persons being bitten by dogs suspected to be rabid. In June, 1919, a revised memorandum was issued of which the following is a brief resume :—When a person is bitten by a dog in any area in which rabies in dogs is suspected, the wound should be treated as soon as possible with undiluted carbolic acid, undiluted Izal or some similar disinfectant. The disinfectant should be allowed to come into contact with all parts of the wound which should then be washed out with water or dilute disinfectant. If no disinfectant of the kind is available, the wound should be thoroughly washed and irrigated with hot or cold water. When it is possible to get the immediate services of a doctor, the treatment should be placed in his hands. Provision is made for notification to all the authorities concerned. If upon examination, diagnosis of rabies in the dog is confirmed, the person bitten is urged to secure specific anti-rabic treatment as soon as possible, irrespective of what local treatment has been applied to the bite. This specific anti-rabic treatment can be administered at a number of centres ; that for London is the Department of Pathology, St. Thomas's Hospital, Westminster Bridge, S.W. The following is a summary of the principles which should guide a Medical Officer of Health in recommending specific anti-rabic treatment :— (a) There should be evidence that the bite penetrated the skin and caused bleeding. (b) Treatment should be strongly urged on all persons who have been bitten by animals which are in the view of the Board of Agriculture and Fisheries affected with rabies. (c) As regards persons bitten by animals captured and killed or kept under observation in which there is no clinical or post mortem evidence of rabies, treatment should, as a rule, be dispensed with as unnecessary. (d) As regards the treatment of persons bitten by untraced stray dogs or other animals, distinction should be made between :— (i) Cases occurring in the scheduled or immediately adjoining areas where presumably there is a greater risk of the dog being rabid—to cases in this category, treatment should be recommended. (ii) Those occurring outside the scheduled areas—here treatment should be offered but not pressed. 27 If a Medical Officer of Health is satisfied that any person who needs anti-rabic treatment cannot afford to stay at the Centre at his own expense for the two or three weeks necessary for the completion of the course, financial assistance may be rendered by the District Council. In this connection the Corporation authorised the Chairman of the Sanitary Committee to make whatever monetary grants might prove necessary. VENEREAL DISEASES. The Centre for the treatment of venereal diseases, which was established by the Corporation at the City Shelter in Golden Lane, and which was administered and worked by the authorities and staff of St. Bartholomew's Hospital, is still doing an excellent and an increasing amount of work. The details of the scheme have already been submitted to the Sanitary Committee, but at the present moment, owing to the demands on the existing accommodation, its very success is liable to prove prejudicial as it becomes increasingly difficult to secure the necessary privacy. Proposals are now being worked out to effect some amount of re-organisation so as to provide additional facilities. During the year the original contribution to the Hospital Authorities of £1,800 a year was increased to £2,100. This amount will probably be required to be doubled within the near future. At the beginning of the year 273 males and 123 females were registered on the books as receiving treatment; of these 135 males and 63 females were under treatment for syphilis, and 127 males and 57 females for gonorrhoea. New patients admitted during the year totalled 861, as under :— Syphilis. Gonorrhoea. Soft Chancre. Male. Female. Male. Female. Male. Female. 232 82 399 111 3 The chief difficulty which is observed in the case of treatment of syphilis is that patients do not continue sufficiently long under treatment to ensure that the disease is satisfactorily cured. This is an important difficulty and is receiving the attention of the Ministry of Health. 43 men and 22 women discharged themselves before completing the course of treatment, and 10 men and 19 women ceased to attend after completion of the course of treatment, but before final tests as to cure were applied. In the case of gonorrhoea 216 men and 47 women completed the course. The total attendances of persons at the clinic numbered 15,269 ; this total is made up as follows :— Syphilis. Soft Chancre. Gonorrhoea. Non-venereal conditions. Total Attendances. Male. Female. Male. Female. Male. Female. Male. Female. Male. Female. 3,896 2,356 3 6,978 2,002 26 8 10,903 4,366 A few beds are provided at the Institution for in-patient treatment and the number of days of such treatment totalled 558. In the laboratory attached to the Institution 2,485 specimens were examined. Of these 643 referred to patients under treatment in the Centre and 1,216 to patients under the treatment of general practitioners and in the hospital. 33 examinations for spirochete were made and 487 for gonococci. As regards the places of residence of patients coming under treatment, it is reported that patients resided in the following counties :—London, Essex, Hertfordshire, Middlesex, Surrey, Kent, Bedfordshire, Buckinghamshire, Sussex, Hampshire, Dorsetshire, and Gloucestershire. The salvarsan substitutes which were used are Nov-Arseno-Billon and Galyl. Six doses of salvarsan substitutes are given in a full course and salvarsan substitutes are used in all cases in the treatment of syphilis. The tests which were applied to decide as to the discharge of patients are, in the case of syphilis, Wasserman re-action every three months and supervision monthly for one year after the last course ; in the case of gonorrhoea, three tests are applied at intervals by means of culture and examination of slides of material expressed by urethroprostatic massage. The urethroscope is also used. 28 RETURN RELATING TO ALL PERSONS WHO WERE TREATED AT THE TREATMENT CENTRE AT 20, GOLDEN LANE DURING THE YEAR ENDED THE 31st DECEMBER, 1919. 1 Syphilis. Soft Chancre. Gonorrhoea Conditions other than Venereal Total. Males Females Males Females Males Females Males Females Males Females 1. §Number of persons who, on the 1st January, 1919, were under treatment or observation for :— (See notes on back.) 135 63 .... .... 127 57 11 3 273 123 2. Number of persons dealt with during the year at or in connection with the out-patient Clinic for the first time and found to be suffering from :— Syphilis 232 82 .... .... .... .... .... .... 232 82 Soft chancre only .... .... 3 .... .... .... .... .... 3 Gonorrhoea .... .... .... .... 399 111 .... .... 399 111 §Svphilis and soft chancre .... .... .... .... .... .... .... .... .... .... §Syphilis and gonorrhoea 21 19 .... .... 21 19 .... .... 42 38 §Gonorrhoea and soft chancre .... .... .... .... .... .... .... .... .... .... §Syphilis, soft chancre and gonorrhoea .... .... .... .... .... .... .... .... .... .... Conditions other than venereal .... .... .... .... .... .... 26 8 26 8 Total—Item 2 232 82 3 .... 399 111 26 8 660 201 Total*— Items 1 and 2 367 145 3 .... 526 168 37 11 933 324 3. §Number of persons who ceased to attend the out-patient Clinic (a) before completing a course of treatment for 43 22 .... .... .... .... .... .... 43 22 (b) after completion of a course of treatment, but before final tests as to cure of (See notes on back). 10 19 .... .... 216 47 .... .... 226 66 4. †Number of persons transferred to other Treatment Centres after treatment for (See notes on back.) 19 23 .... .... .... .... .... .... 19 23 5. §Number of persons discharged from the out-patient Clinic after completion of treatment and observation for:— (See notes on back.) 14 10 .... .... 36 14 .... .... 50 24 6. §Number of persons who, on the 1st January, 1920, were under treatment or observation for :— 281 71 3 .... 274 107 37 11 595 189 Total*—Items 3, 4, 5, & 6 367 145 3 .... 526 168 37 11 933 324 7. §§Total attendances of all persons at the out-patient Clinic who were suffering from :— 3,896 2,356 3 .... 6,978 2,002 26 8 .... 15269 8. Aggregate number of " In-patient days" of treatment given to persons who were suffering from: 121 95 .... .... 240 86 16 .... 558 For detection of For v\ assermann Reaction. Spirochetes. Gonococci. Other Organisms. 9. Examinations of Pathological material:— (a) Specimens which were examined at, and by the Medical officer of, the Treatment Centre b) Outside Practice and Hospital 33 469 18 88 C.S.F. 18 1 643 ,216 = 2 1,233 1,252 .485 § The number of persons suffering from two or more venereal diseases should be entered under the heading of each disease in the vertical column. * The total of Items 1 and 2 should agree with the total of Items 3, 4, 5 and 6. † These persons should not be included in Items 3 (a) or 3 (6). §§ These figures should include all attendances made by patients, including those made for irrigation, local applications, &c., under general medical supervision, during the intervals between the days on which the ordinary out-patient Clinics are held. 29 Date, February \(Sth, 1920. (Signed) K. M. WALKER, Medical Officer of the Treatment Centre. * A list of the Administrative Counties and County Boroughs in England and Wales is given on the back of this form. t If a person has been treated for both syphilis and gonorrhoea, he should be included under both diseases, and similarly for other combinations of venereal diseases. § The totals in Item A should agree with the corresponding totals in Item 2 on the previous page, and the totals in Items B and C should agree with the respective totals in Items 7 and 8 on the previous page. NOTES. Item 1. The number to be inserted here is the number of persons who in the period preceding the year under report were dealt with at or in connection with the out-patient Clinic and who, at the end of that year, had not been discharged after completion of treatment and observation or had not been marked off as having ceased to attend under circumstances described in Items 3 (a), 3 (b) or 4. Item 3 (a) or (b). Patients should not be marked off as having ceased to attend until after efforts have been made by letter or otherwise to induce them to continue attendance. Patients who do not return to the Clinic within two months of the last of such efforts may be regarded as having ceased attendance. Item 4. In this Item will be included patients removing to other districts, to whom Form V15 or Form V15A should have been given. Item 5. The accompanying Memorandum (V21) has been prepared by the Ministry of Health for the guidance of the Medical Officers of V.D. Treatment Centres. The Memorandum is based on suggestions which have been made to the Ministry by certain Medical Officers of V.D. Treatment Centres as to the tests which in their opinion should be applied before discharging a person who has suffered from syphilis or gonorrhoea, as having completed the course of treatment and observation. Medical Officers are asked to give careful consideration to the Memorandum, but it is not intended to suggest the invariable adoption of the methods indicated. As regards Syphilis, the following circumstances would justify discharge on completion of treatment and observation in cases coming under treatment in the secondary stage, or in the late primary stage with positive Wassermann reaction :— Two years' freedom from all signs of the disease, either clinical or serological, after suspension of all medical treatment, and notwithstanding "provocative" injections of arsenobenzol compounds, a Wassermann test being taken not less frequently than every three months. In cases of primary infection, w;th negative Wassermann reaction, a period of two years' observation from commencement of treatment would suffice. As regards Gonorrhoea, it will be noted that in the Memorandum certain tests are regarded as essential, while others (e.g., culture tests and complement fixation test) are regarded rather as supplementary. Medical Officers are requested to indicate in paragraph H of this Return the tests which have been applied on discharge of patients from treatment. Statement showing the services rendered at the Treatment Centre during the year, classified according to the areas in which the patients resided. *Name of County or County Borough (or Country in the case of persons residing elsewhere than in England and Wales) to be inserted in these headings. London. Essex. Herts. Middlesex. Surrey. Kent. Croydon. Beds. Bucks. Sussex. Hants. Dorset. Gloucester. |Somerset. Total A.§Number of persons from each area dealt with during the year at or in connection with the out-patient Clinic for the first time and found to be suffering from :— †Syphilis 245 19 5 12 5 9 .... 4 8 4 2 .... l .... .... 314 †Soft chancre 3 .... .... .... .... .... .... .... .... .... .... .... .... .... .... 3 † Gonorrhoea 407 25 4 14 14 21 3 4 3 5 2 6 2 .... .... 510 Conditions other than venereal 19 5 2 .... 4 2 2 .... .... .... .... .... .... .... .... 34 Total 674 49 11 26 23 32 5 8 11 9 4 6 3 .... .... 861 B.§Total number of attendances at the out-patient Clinic of all patients residing in each area 13,210 506 123 268 290 415 60 22 161 62 114 17 21 .... .... 15,269 C.§Aggregate number of " Inpatient days " of all patients residing in each area 402 12 .... 14 25 37 .... .... 27 .... 41 .... .... .... .... 558 D. Number of doses of Salvarsan substitutes given in the :— 1. Out-patient Clinic 2. In-patient Dept 1,234 110 54 70 58 124 12 40 72 15 23 6 12 .... .... 1,730 to patients residing in each area 33 33 E. Give the names of Salvarsan substitutes used in the treatment of syphilis and the usual initial and final doses. Nov.-Arseno-Billon. Galyl. F. State the number of doses of Salvarsan substitutes usually given in a full course of treatment. 6 in each course. G. State in what proportion of cases, approximately, Salvarsan substitutes are used in the treatment of syphilis. In all. H. State the nature of tests applied in deciding as to discharge of patients referred to in Item 5 on previous page. (See notes on back and Memo. V. 21) Wassermann re-action every 3 months after completion. Supervision monthly for 1 year after last course. Gono. Marriage test—3 tests at intervals. i.e., Cultures and si des from urethre prostate after massage. Urethrosconis. 30 EXAMINATION FOR PATHOGENIC BACTERIA. Any medical practitioner desiring examinations of specimens for Pathogenic Bacteria in cases of suspected infectious disease occurring amongst their patients residing in the City, should forward them to the Medical Officer of Health at the Guildhall. Arrangements have been made for free examination, and the results obtained are communicated as speedily as possible. During the year, the following specimens were so dealt with. It will be seen that positive results were obtained in 81 per cent, of these cases. Specimen. Disease suspected. Result— Positive. Negative. 65 Swabbings from throats Diphtheria 2 63 1 „ „ „ Cerebro-spinal Meningitis 1 8 Sputum Tuberculosis 4 4 Of the 65 swabbings from throats, 59 were received from the Central Foundation School for Girls, Spital Square, E.C. These swabs were sent to the City Pathologist in accordance with the arrangements between the City Corporation and the London County Council. This school is situate partly in the City and partly in the Metropolitan Borough of Shoreditch, and pupils attend from many parts of the East and North-East of London, and also Boroughs and Urban districts in Essex and Middlesex. It is obvious that in the event of an outbreak of Diphtheria at this school, local investigations are facilitated if the school medical officer is able to obtain examination of swabbings from one area only, instead of having to submit such swabbings to each area from which children attend, and, in view of this fact, the Corporation decided to undertake the examination of all swabbings from this school without charge to the school authorities. MEDICAL TREATMENT. Provision for medical treatment is becoming increasingly the responsibility of Public Health Authorities, and Sir George Newman's valuable report on the principles to be observed in co-ordinating the two great divisions of medicine— preventive and curative—has aroused great interest in medical and administrative circles. This report, and an equally important contribution to work in this connection, namely, the Maclean report on the transfer of functions of Poor Law Authorities in England and Wales, has received the attention of the Sanitary and Special Committees respectively. The first result of Sir George Newman's report has been the reference to the Consultative Council on Medical and Allied Services under the chairmanship of Lord Dawson " To consider and make recommendations as to the scheme or schemes requisite for the systematised provision of such forms of medical and allied services as should be available for the inhabitants of a given area." This committee has now reported to the Ministry of Health, and the resulting document is of considerable interest. It was hardly to be expected that any strikingly original idea would be put forward, and its great use lies in the fact that it has considered all existing suggestions and has selected the best elements in these, and with additions has framed an ideal scheme outlining the final organisation which should be aimed at to secure that the best medical treatment shall be available for persons requiring it. Criticism of the report is unnecessary since it is suggested that it only deals with principles. On broad lines it is acceptable, but it would appear to lack the practical touch, and expense alone would prevent any attempt to put the scheme into immediate operation. The time has now arrived when the important aspect of progressive development should be considered. It is, of course, essential that medical treatment shall be so co-ordinated that the many specialised branches of treatment may form one piece of smooth running administrative machinery, but if the machinery provided is to be of the greatest service, it is equally necessary that the means which will ensure the masses availing themselves of the facilities shall also exist. Future organisation must be such that will encourage cases of early illness to come under treatment in the more certain remediable stages, and if treatment is to be a helpmate of 31 prevention the medical practitioner must be educated in the fuller appreciation and the real import of early symptoms, and also in drawing conclusions from the nature of the illnesses which are observed in the group of patients for which he is responsible. It would be easy to enlarge upon this theme, but I limit myself to suggesting that consideration should be given to the following points:— What is the most practical method which will ensure that persons will seek medical treatment early, or that incipient disease will be recognised at an earlier date than is now the case ? Ought the principles of national insurance to be extended, and, if so, to what extent, and how should the cost of such extended facilities be met ? How can the poor, who are not now included in the Insurance scheme, be brought into a scheme of national treatment and still remain free from the stigma of pauperisation and free from risk of involvement in invidious distinctions ? How can the activities, knowledge and experience of general practitioners be best utilised in preventive work ? How can existing institutions be adapted to help in the development of the system ? Is it necessary that the National Insurance Committee should accept responsibility both for medical treatment and for sickness and disablement benefits ? Can existing local authorities be vested with the power of providing national treatment, and the medical profession, which is so intimately concerned in this work, be given a share of the responsibility ? Other suggestions could be introduced, but these appear to me to be of the most pressing importance, and any practical scheme using existing machinery, modified and extended as the circumstances seem to require, is the immediate essential. Any alteration in the matter of the treatment of the indigent poor which is at the present time undertaken by the Poor Law Authorities, would appear to me to be premature and undesirable until the details of future development have been considered and decided upon. Variations, whatever they may be, should be on lines which will ensure that they fit in the new programme. If they do not radical change will again be necessary in the near future. It has been suggested that the visitation of sick poor by the staff of the Medical Officer of Health should be undertaken. This, I submit, would be a duty which is outside the scope of the Medical Officer's functions. These are mainly administrative, and even if the proposal were put into effect as a temporary measure there would still be the sentimental objection which attaches to charitable relief, and that objection would exist so long as an individual requiring relief is singled out for special consideration. With the extension of national insurance it does not seem an impracticable proposition to provide for the poor as well as for those who are able to pay weekly contributions. CLEANSING OF VERMINOUS SCHOOL CHILDREN. The arrangement, which has existed for some years between the Corporation and the London County Council under which the former undertook to cleanse school children suffering from verminous infection, has been subjected to revision. When first undertaken, the arrangement was confined to children residing in the City and attending public elementary schools provided or maintained by the London County Council. A subsequent extension provided similar facilities for children not residing in the City but attending schools situated in the City. At the request of the London County Council a further extension has now been made to include in the arrangement, subject to certain limitations as regards numbers, non-resident children attending schools outside the City area. It will be seen, therefore, that the facilities of the Corporation's Disinfecting Station at Golden Lane are available for the cleansing of any child attending any public elementary school maintained or provided by the London County Council, subject only to certain limitations as to numbers submitted. 32 SMOKE AND ATMOSPHERIC POLLUTION. Nine instances of smoke nuisance or annoyance from chimneys were dealt with during the year. Some of these were of a temporary character and did not recur, others were abated upon the service of the usual form of notice upon the offenders and there has been no occasion to take further action. As mentioned in previous reports, the annoyance and the evil from coal smoke cannot satisfactorily be dealt with by law until the enactments at present in force are strengthened or amended. The dirt and discomfort from smoke continues, although in a lesser degree than in former years, and for which the enormous numbers of the chimneys in surrounding Greater London are largely responsible. Difficulties in the way of obtaining suitable coal and skilled labour are still a fruitful source of trouble. A critical examination of the air in the City was commenced in the year 1914, in conjunction with the Committee for the Investigation of Atmospheric Pollution, appointed by the International Exhibition and Conference in London, 1912, and an apparatus consisting of a large rain gauge is mounted upon the roof of one of the Corporation's buildings in Golden Lane, and the rain.water from a known area of surface is collected monthly. This rain.water, containing the soot, grit and dust washed from the air, has been submitted for examination to the Public Analyst and the results tabulated. For comparison the results obtained from similar observations made upon the Thames Embankment by the London County Council are added. SUMMARY OF MONTHLY OBSERVATIONS AND REPORTS DURING THE YEAR 1919. Month of the Year 1919. Place. 3 4 5 6 7 8 9 10 11 12 Rainfall in millimetres. Metric tons of deposit per square kilometre during month. Insoluable matter. Soluable matter. Total solids Included in soluble matter. Tar. Carbonaceous other than Tar. Ash. Loss on ignition. Ash. Sulphate as <S03). Chlorine (CI). Ammonia (NH3). January City of London 66 0.14 2.84 3.24 1.59 4.23 12. 04 2.05 1.08 0.19 Embankment Gardens, L.C.C. 43 0.12 2.68 5.64 4.12 6.24 18.80 3.86 0.82 0.13 February City of London 59 0.10 5.36 6.49 1.88 4.95 18.79 2.55 0.94 0.21 Embankment Gdns 29 0.16 2.79 9.02 3.43 5.76 21.15 3.37 0.69 0.06 March City of London 82 0.07 2.95 3.81 2.47 4.28 13.58 2.49 0.99 0.17 Embankment Gdns 62 0.11 19.06 12.33 5.92 7.50 44.93 4.55 1.52 0.17 April City of London 74 0.23 322 5.15 1.48 4.45 14.53 204 0.92 0.15 Embankment Gdns 62 0.30 4.51 11.31 7.06 8.40 31.50 4 77 1.24 0.43 May City of London 15 0.04 1.97 3.60 0.61 1 .41 7.52 0.77 0.25 0.07 Embankment Gdns 12 0.23 2.93 7.78 1.25 216 14.35 117 0.26 0.06 June City of London 33 0.03 1.86 2.89 0.93 2.25 7.96 1.19 0.64 0.25 Embankment Gdns 32 0.18 4.20 10.91 2.25 3.31 20.84 1.93 0.67 0.15 July City of London 56 0.06 2.53 4.51 1.80 315 1205 1.88 0.61 0.32 Embankment Gdns 51 0.13 2.31 7.41 2.79 4.44 17.08 2.94 0.62 0.12 August City of London 45 0.05 2.48 4.25 1.64 4.37 12.78 2.16 0.54 2.83 Embankment Gdns 39 0.10 2.82 8.94 1.36 1.65 14.88 1.32 0.37 0.12 September City of London 24 0.07 1.60 3.92 0.66 2.46 8.70 1 19 0.26 0. 12 Embankment Gdns 31 0.23 4.17 8.82 1.06 2.63 16.90 1.39 0.28 0 .11 October City of London 18 0.06 2.43 3.69 1.41 2.82 10.41 1.59 0.62 015 Embankment Gdns 17 0.27 3.07 8.11 1.79 3.42 16.67 2.05 0.46 0.09 November City of London 39 0.09 3.60 5.62 2.53 4.74 16.57 2.30 0.93 0.40 Embankment Gdns 23 0.17 2 .77 7.66 1.45 3.44 15.49 1.81 0.62 0. 09 December City of London 71 0.04 2.07 2.68 2.28 4.27 11.33 2.13 0.91 0.21 Embankment Gdns 81 0.15 2.64 6 .03 2.08 5.07 15.97 2.40 0.89 0.17 33 The foregoing table shows the rainfall for the months of January to December of the year 1919, and the amounts found of insoluble matter, tar, soot and dust, also the soluble matter, together with the sulphates, ammonia and chlorine in the volume collected. The results as given by the Public Analyst have been re-calculated into metric tons per square kilometre during each month. One metric ton per square kilometre is equivalent approximately to 9 lbs. per acre, or 256 tons per square mile. Although the presence of much impurity in the atmosphere has been long known the figures given represent a definite record of the facts. In examining the foregoing table it will be appreciated that in the month of February only the amount of deposit registered as falling in the City amounted to 1879 tons per square kilometre, which is equal (estimating the City as having an area of one square mile) to no less than 48 tons avoirdupois. Of this mass of dirt, 17| tons were soluble, and included the chemicals mentioned, and 3(H tons were insoluble and consisted of tar, carbon and grit. In addition to the foregoing, a daily observation has been made at mid-day at the Guildhall of the purity of the air by a modern dry method, by which the suspended matter can be readily demonstrated. From the 1st of January until the 31st December the amount of the impurity at noon has varied from half a milligramme to five milligrammes per cubic metre of air; this latter figure includes times when there has been a fog. It is interesting to compare the results of similar observations made at other places, as for example, Malvern and Sheffield, where results are widely divergent. The value of the work being carried on in connection with the examination of the atmosphere in the City is evident and the details recorded indicate the necessity of its continuation. ANTHRAX-INFECTED SHAVING BRUSHES. At the end of October I was informed by the Medical Officer of Health of one of the Metropolitan Boroughs that a patient in his area had been notified as suffering from Anthrax. Subsequent enquiry appeared to indicate that the source of infection was a shaving brush of a cheap pattern imported from Japan. The bulk from which the shaving brush used by the patient was obtained was supplied by a City firm of wholesalers. Further reports of cases of Anthrax attributable to the use of Japanese shaving brushes were received, and more than twelve persons are reported to have suffered from Anthrax contracted in this manner. In at least three instances, I regret to say that the illness terminated fatally. As a result of investigations continuing for several months it has been found that fifteen different patterns of brushes have in one place or another been proved to have been infected with Anthrax. Of this number five were discovered in the City. ACTION TAKEN.—Enquiries were made with the object of tracing back the brushes to the original consignment, and from each trader, through whose business infected brushes had passed, additional information was obtained as to their sale. Traders were notified that particular patterns were infected, and they were instructed to stop the further sale of such brushes, and to obtain the possession of those which might remain unsold. The Medical Officers of Health of the various districts concerned were likewise communicated with and information forwarded to them respecting such facts as had been elicited. ACTION TAKEN IN RESPECT OF BRUSHES.—Certain consignments of brushes were found to be infected with Anthrax, and as it is impossible without a separate examination to indicate which brush is free, it was necessary to regard each consignment from which an infected brush had been taken as one completely infected. The disease being notifiable in London under Section 60 of the Public Health (London) Act, 1891, it would have been possible to certify that the disinfection of these brushes would tend to prevent or check the spread of a dangerous infectious disease. Notice- could then have been served upon the owners by the 34 Sanitary Authority calling upon them to disinfect. In case the owners failed to disinfect or destroy—and it does not seem probable that large quantities of brushes such as these in question would have been destroyed at the simple request of the Local Authority—the duty would have fallen upon the Local Authority to carry out the disinfection, in which latter case they would have been responsible for any unnecessary damage and have been required to pay compensation if articles were destroyed by them. To disinfect these brushes satisfactorily meant practically destruction. I found it, therefore, necessary to ask the Sanitary Committee whether I should undertake this disinfection and perhaps render the Corporation liable to compensation, or deal with them otherwise as by re-exportation. A third alternative was to leave these brushes in the hands of the retailers, at any rate for the present, after having warned them that the consignment was infected and, therefore, could only be traded in under risk of subsequent legal proceedings. If in these circumstances a trader asks for disinfection, and brings the brushes to the Disinfecting Station, which the Local Authority must of necessity provide, there seems to be no requirement under Section 59 for compensation to be paid if the brushes are damaged in this procedure. The question arises in this connection whether any compensation would be payable, since one may reasonably ask " What is the value of a shaving brush infected with Anthrax ? " Surely nil, for no one would be willing to purchase such a brush. The only difficulty is that it could not be proved that each separate brush was infected. Difficulties in the way of requiring re-exportation of brushes to Japan also arose, inasmuch, as neither the importers nor intermediate traders would in certain instances accept the return of the brushes, and that, of course, was necessary before re-exportation could be effected. The Sanitary Committee were informed as to the possible extent of the liability foreshadowed above, and the following details of each consignment as known to me at the time were reported to them :— SHAVING BRUSHES PATTERN No. 2590.—Samples of this pattern brush on examination in the City were found to be negative, but I was informed by the Authorities at Glasgow that samples of this brush gave positive results in that City. I have ascertained that one City firm held about 80 dozen. SHAVING BRUSHES PATTERN No. 119/146.—Samples of this brush taken in the City gave positive results. SHAVING BRUSHES PATTERN No. 1022.—Samples of this brush proved positive on examination in the City. I have not been able to trace the origin of this brush or any facts connected with its distribution other than that a City firm held two dozen in stock. SHAVING BRUSH PATTERN No. 1736.—This brush was apparently heavily infected, and, I believe, gave rise to two or more cases of Anthrax. The one sample of this brush found in the City gave negative results, but a positive result was obtained in Glasgow in three instances, and, I believe, in other places also. SHAVING BRUSH PATTERN No. 1073.—Ten gross of these brushes were imported by an outside firm. Of this consignment only two dozen could be traced as being in the possession of a City trader. SHAVING BRUSHES PATTERN No. 5238.—Samples of this brush have been examined and found to be infected with Anthrax, in the City of London, the City of Glasgow, and the City of Liverpool. Infection was very heavy in the City samples. It is a common pattern and it has been found impossible to differentiate the consignments of brushes of this pattern so as to indicate from which particular consignment a positive sample was taken. As a consequence, all consignments of Pattern No. 5238 have been regarded as infected. This brush was imported by a City firm, and had been distributed all over the country and abroad. The main intermediate dealer purchased considerable supplies for the Red Cross Society. These were, however, received too late to be delivered, and were, therefore, sold to different traders. 35 SHAVING BRUSH PATTERN No. 2592.—Two out of the three samples of this brush on examination were found to be positive. Three different City traders were associated with the distribution. SHAVING BRUSH PATTERN No. 1040.—This brush was returned positive by the Ministry of Health. Only 4½ dozen passed through the City. SHAVING BRUSHES PATTERN No. 12918.—Brushes of this pattern were found to be positive in Shoreditch. The samples were taken from an original consignment which had not been distributed. Brushes from consignments of the following patterns were examined by the Ministry of Health, and reported as being infected with Anthrax:— Pattern No. 2641 ,, ,, 801 „ „ 065 „ „ 066 „ „ 073 „ „ 074 I believe in all these cases the brushes were recent importations and had not been the subject of extensive commercial transactions. I must direct your attention to the fact that I believe that the traders, who have given me every facility in conducting a rather complicated and certainly tiresome investigation, purchased these brushes in good faith. In certain instances the brushes were packed with a printed note to the following effect:— "FREE FROM ANTHRAX." "The hair in this brush has been disinfected by the Osaka Prefectural Government "and is free from Anthrax." One trader also submitted to me an officially sealed and attested certificate of disinfection by the Osaka Prefectural Government. It seemed then to be rather a hardship that any loss incurred as a consequence of this particular trading transaction should fall upon the trader or the City Corporation, or any other Corporation. I discussed the position with the officials of the Japanese Government in this country, and I pointed out that in the interests of the Japanese trade, it would be well if arrangements could be made for indemnification of traders in respect of these infected brushes. I further emphasised the necessity for uniformity of supervision in Japan, as I was informed that, although these brushes in some instances were certified as having been disinfected, certification in Japan is not invariably a Government concern. There should be no ambiguity on the point, and only one class of certificate should be granted, and that a State Certificate. I mentioned a further point, that if future improvement in regard to disinfection were arranged in Japan, it would seem desirable before the trade under such improved conditions were commenced, that all existing Japanese brushes in this country should be called in, lest by coincidence some brush which might now be infected should later be sold and give rise to disease when the new requirements were in operation, in which event the confidence created by the improved regulations would be impaired. The before-mentioned facts were reported to the Ministry of Health, and on the 9th of February, 1920, the Anthrax Prevention (Shaving Brush) Order, 1920, was made, which prohibited the importation into the United Kingdom of shaving brushes manufactured in or exported from the Empire of Japan. The Order applied to such shaving brushes whether exported direct to the United Kingdom or otherwise. I had several conferences with members of the trade on this matter, and, after careful consideration, it was decided to permit the return to Japan of such brushes as were in the hands of City traders, or, at their request, to destroy and issue a certificate of destruction, of which the following is a copy:— "TO ALL CONCERNED. "Messrs of "having delivered to the Sanitary Authority for the City of London certain articles, "TO WIT Shaving Brushes of Pattern No samples from the "bulk of which had been found by bacteriological examination to be infected with "Anthrax, the same were destroyed at the City Disinfecting Station on the "day of it being impossible to disinfect without rendering "the articles unsaleable." 36 Up to the date of writing this report (28th July, 1920) over 2,756 dozen brushes have been returned to Japan, and the Ministry of Health duly notified of each consignment, and 689 5 /12th dozen suspected shaving brushes have been destroyed. When the matter is finally closed, a fuller report on the subject will be submitted to the Sanitary Committee. The main part of this work has been conducted during the present year and not in the year under review. RAT REPRESSION. A special report on this subject has recently been presented to the Sanitary Committee and to the Court of Common Council. It is not necessary, therefore, to enlarge upon this subject, other than to state that in accordance with the decision of the Court it has been decided to appoint two inspectors, in addition to the one now engaged on the work, for supervisory purposes and to enable observations to be made on rat repression and to consider the results of any action taken. In six months' time a full report will be submitted containing the results of experience gained and probably suggesting that a self-supporting scheme, having for its object the control and execution of rat repressive measures, may with advantage be undertaken under the aegis of the Corporation. CREMATIONS IN THE UNITED KINGDOM, 35 Years—1885-1919. YEAR. Woking.* Manchester. Glasgow. Liverpool. Hull. Darlington. Leicester. Golder's Green. Birmingham. Leeds City of London. Sheffield. Bradford. W. Norwood. No. of Cremations each year. 1885 3 .... .... .... .... .... .... .... .... .... .... .... .... .... 3 1886 10 .... .... .... .... .... .... .... .... .... .... .... .... .... 10 1887 13 .... .... .... .... .... .... .... .... .... .... .... .... .... 13 1888 28 .... .... .... .... .... .... .... .... .... .... .... .... .... 28 1889 46 .... .... .... .... .... .... .... .... .... .... .... .... .... 46 1890 54 .... .... .... .... .... .... .... .... .... .... .... .... .... 54 1891 99 .... .... .... .... .... .... .... .... .... .... .... .... .... 99 1892 104 3 .... .... .... .... .... .... .... .... .... .... .... .... 107 1893 101 30 .... .... .... .... .... .... .... .... .... .... .... .... 131 1894 125 47 .... .... .... .... .... .... .... .... .... .... .... .... 172 1895 150 58 l .... .... .... .... .... .... .... .... .... .... .... 209 1896 137 52 10 2 .... .... .... .... .... .... .... .... .... .... 201 1897 173 51 16 10 .... .... .... .... .... .... .... .... .... .... 250 1898 240 62 12 27 .... .... .... .... .... .... .... .... .... .... 341 1899 240 88 16 23 .... .... .... .... .... .... .... .... .... .... 367 1900 301 83 20 40 .... .... .... .... .... .... .... .... .... .... 444 1901 273 96 18 40 17 l .... .... .... .... .... .... .... .... 445 1902 275 81 20 54 13 2 l 5 .... .... .... .... .... .... 451 1903 143 92 24 35 18 1 5 158 l .... .... .... .... .... 477 1904 138 98 19 40 20 7 8 220 19 .... .... .... .... .... 569 1905 95 97 35 35 15 4 16 252 22 16 9 7 l .... 604 1906 140 90 44 46 17 13 12 298 25 15 23 6 14 .... 743 1907 108 98 30 34 29 8 12 290 33 16 18 18 13 .... 707 1908 119 116 28 32 37 6 14 364 18 24 19 12 6 .... 795 1909 105 106 30 46 15 9 19 421 30 19 24 18 13 .... 855 1910 106 114 28 37 21 9 16 415 38 12 22 8 14 .... 840 1911 114 124 39 50 25 12 13 542 44 17 20 10 13 .... 1,023 1912 125 149 44 52 27 15 14 591 40 24 32 12 9 .... 1,134 1913 128 172 49 66 23 11 11 602 59 16 21 15 15 .... 1,188 1914 124 184 57 48 16 11 7† 671 53 28 42 20 18 .... 1,279 1915 153 165 63 53 34 16 22 730 45 20 45 21 12 10 1,389 1916 125 179 65 58 25 9 23 633 63 22 44 13 11 70 1,340 1917 129 178 65 62 22 14 30 719 50 17 68 25 10 118 1,507 1918 142 197 74 69 43 17 42 820 64 34 70 50 20 153 1,795 1919 181 235 84 89 46 26 36 919 76 30 68 41 31 169 2,031 Total 4547 3045 899 1049 465 193 305 8650 679 310 524 275 200 559 21,702 * "Viscount Cross in the year 1879 forbade the practice of cremation there (Woking) under the threat of passing an Act to make it illegal ". . . . But in 1884 appeared the well-known judgment of Mr. Justice Stephen, which, in the case of a child's body having been burned by its "father contrary to the order of the coroner, determined cremation to be a legal act, provided no nuisance be caused thereby to others."—Extract from speech made by the late Sir Henry Thompson at the opening of Golder's Green Crematorium, 22nd November, 1902. Vide " Transactions of Cremation Society of England, 1903." p. 31. † Closed for reconstruction from August, 1913, to July, 1914. 37 EXHUMATION AND RE-INTERMENT OF BODIES AT THE CITY OF LONDON CEMETERY. During the year the bodies of twelve persons buried at the City of London Cemetery at Ilford have been exhumed. All of these were re-interred in other parts of the same Cemetery. In accordance with the terms of the Licences issued by the Home Secretary in respect of these cases the work of removal and re-interment was carried out in the early morning under the supervision of the Medical Officer of Health. HYGIENE OF HAIRDRESSERS' AND BARBERS' SHOPS. The Registered Hairdressers' establishments throughout the City remain under the supervision of your officers, and there are now ten proprietors of these places who hold certificates and have undertaken to comply with the Regulations of the Corporation for the conduct of their business. During the war in conformity with the desire of the Sanitary Committee certificates were not renewed to hairdressers who employed enemy aliens. Enquiries by the City Police Authorities established the fact that no such persons were employed in the saloons where renewals were granted. In the present circumstances with the sanction of the Committee the enquiries as to the nationality of those engaged in the business will be discontinued. The following is a list of those proprietors at present on the Register:— The Exors. of the late Mr. Smellie, trading as the Army and Navy Toilet Club, 35, Bucklersbury. Frank Steele, trading as Fore's Paragon Toilet Club, 60, Fore Street. Kingstone & Hubbard, 8 & 10, Ludgate Arcade. Chas. Lehman, 8 & 9, Aldermanbury Postern. Martin Longman, 75, Mark Lane. Thos. W. Monk, 5, Angel Court. Marsh & Prince, 36, Coleman Street. Pierre Pozzi, 16, Lawrence Lane. Harry G. Wicks, trading as Arthur & Co., 42a, Old Broad Street. Frederick George, 8, Mason's Avenue. RAG FLOCK ACT, 1911. On the 26th May, 1919, the Local Government Board addressed a circular letter to Local Authorities directing attention to complaints that had been made to them with regard to the lack of uniformity displayed in the administration of the Rag Flock Act, 1911, which Act and the Regulations made thereunder prohibit the sale and use for the purpose of the manufacture of any article of upholstery, cushions, or bedding, flock manufactured from rags unless the flock conforms to a certain standard of cleanliness, i.e., where the amount of soluble chlorine, in the form of chlorides removed through washing with distilled water at a temperature not exceeding 25 degrees centigrade from not less than 40 grammes of a wellmixed sample of flock, does not exceed 30 parts of chlorine in 100,000 parts of flock. The powers conferred by this Act are of little moment in the City of London where the use of rag flock is rarely, if ever, used by upholsterers. Such firms as deal in bedding and bedding materials, do so mainly by description or samples. As regards the re-making of bedding and upholstered furniture, when orders for such are received by City houses, the articles are almost invariably sent elsewhere for manipulation. In the few cases when such repairs are undertaken on the premises, materials other than rag flock are used. In May last I received a complaint with regard to the sale of rag flock alleged to contravene the provisions of the Rag Flock Act. It was stated that some 20 tons of rag flock were being offered for sale which, upon analysis, had been found to contain 57.4 parts of chlorine per 100,000 parts of flock. The place of sale was unknown. I caused enquiries to be made and found that samples only of rag flock were being brought into the City, the bulk being deposited elsewhere. It was apparently the intention of the merchants to obtain orders on their samples on view in the City, and arrange for deliveries to be made direct from the manufacturers outside the City. A specimen of the 38 samples deposited was submitted to chemical examination and found to contain soluble chlorine to the extent of 10 parts only per 100,000 of flock. It would appear, therefore, that the complaint was not well founded, or that there was no connection between the rag flock complained of and the samples deposited in the City. In the course of this enquiry I ascertained that a number of mattresses which were filled with rag flock were being offered for sale by Government Departments, and that directions had been given that all flock in the possession of the Surplus Government Property Disposal Board was to be sold under a guarantee from the buyers that it would only be used as waste for manure. A similar provision is made in connection with the sale of soiled mattresses. FOOD SUPPLIES. HANDLING OF MEAT.—A considerable responsibility rests upon the Sanitary Committee to ensure that the food passing through the City is of a satisfactory character, and the following matters are of interest. Meat is purchased at Smithfield by butchers from all parts of Greater London, and even from districts outside. It is removed from the market either in the purchaser's own carts, or in vans belonging to the numerous carriers who attend the market. From the stalls in the market it is carried to the waiting carts either by the purchasers or by market porters. The meat is either conveyed in trucks which are provided, or on the backs and shoulders of these persons. The number of carts in waiting to receive meat is so considerable that during the busier hours they form practically a continuous barricade round the market. The rear parts of the carts are brought up to the edge of the causeway. These vans and carts carry a considerable amount of meat, in the form of quarters or cuts of larger or smaller size and offal. The division of the meat facilitates increased loading. It often happens that the supply arrives at the carts more quickly than it can be packed, and, as a consequence, it is allowed to stand about on the trucks for a longer time than is desirable. During this waiting period the meat is sometimes deposited on the footway. It should be noted that the sectioning of meat results in large areas of muscular tissues being exposed, and as the cut surface is moist, dust readily settles on it with the resulting disadvantages which are common to dust deposition; dust is excessive in dry weather as the streets in the loading-up areas are fouled by the large number of horses which stand about. As regards the pavement, I need only mention that there is considerable fouling of the surface by blood and particles of fat, etc., which are trodden into a hard layer mixed with street refuse. The further risk of contamination by animals is obvious. I have had occasion officially to complain of one more than usually gross instance of piling meat on the ground. In this case the meat was separated from the wet ground by a layer of coarse sacking, the edge of the cover being also practically flush with the sides of the pile. The surroundings were foul. As regards the carts, the general practice is to cover the bottom of the cart with straw. In other cases a kind of sacking is used with or without an under layer of straw, and in exceptional cases white calico or some similar matter is used. Some of the carts do not come to the market in a thoroughly clean condition. They are certainly washed at times but not every day. The straw may be clean but it is not a suitable material on which to place the cut sections of meat. The cloths I have seen used day after day, being washed, in some cases, not oftener than once a week. Blood-stained cloths should be washed before being used again. White cloths are more desirable, as staining and dirt readily show and this results in greater care being displayed. The procedure during packing is open to criticism. I have often seen, even on wet days, men, whose boots were soiled with road dirt, get into the cart to fill the front part. In doing so they soil the straw or cloth at the rear and on this soiled part meat is afterwards laid. If a white cover were used this would probably be rolled up at the back, whilst the front was being packed, and it would be straightened out as the packing progressed. I have seen a dog in a cart in which uncovered joints of meat were lying, and the dog would have been driven away in the cart if I had not objected. My protest 39 in this and other cases was received badly. This is simply mentioned as an instance of disregard of an obvious precautionary essential. I have seen men stretching over uncovered meat to reach the front of the cart, and in exceptional cases have seen them with their feet on it. I have also noticed, at times, meat soiled with roadway dirt. As regards the transfer of meat from the stalls to the cart, I take exception to the infrequency of change of overalls by the porters, and to meat being carried on a man's head when he is wearing a cap which has done duty for weeks without being washed. Meat is not allowed to be placed on the floor of the stalls inside the market, and practically every trader has slightly raised wooden benches. There are no such facilities outside the market, nor are there any powers to require them to be provided. It seems strange that whilst in the slaughterhouses due regard must be paid to the observance of cleanliness, and in the markets the traders recognise the advantage of cleanliness and order, and further that butchers at their shops encourage brightness and cleanliness as is evidenced by good lighting, clean benches, bright brass and steel fittings, and clean-looking tiles to line the shop, so little regard should be paid to the elementary rules of cleanliness in the interval which elapses between purchase from the wholesale dealer and the reception of the meat at the shop. I beg to repeat the recommendations which I have previously made:— 1. Carts and vans used for the removal of meat should be thoroughly cleansed after use. 2. When used for the removal of meat, the floor of the vehicle should be covered with some suitable washable material, preferably white or grey in colour. Straw is an unsuitable material to use unless covered with some suitable fabric. 3. A clean cloth should be used to protect the meat from coming into contact with the sides of the cart, and also to cover the top of the consignment. 4. The surface of the meat should not come into direct contact with any tarpaulin, and tarpaulins should be kept in as cleanly a state as possible. 5. No driver should be allowed to sit on the consignment of meat even if the meat is adequately covered. 6. The various joints of meat should, as far as may be practicable, be covered on the cut section with grease-proof paper. 7. It would be an advantage if sides of beef were covered with a layer of some material similar to that used for imported meat. This would avoid soiling by the clothing of porters, who cannot prevent their overalls being fouled in the course of a morning's work. 8. In the transfer of meat from the stalls to the vans, meat should not be allowed to rest on the uncovered head of the porter, nor on the cap which he regularly wears. A washable head-cover should be used by those men who have to carry such large amounts that the meat must touch the uncovered head. 9. Meat should not be placed on the ground whilst waiting to be packed in the cart, even though a covering has been first put down to receive it. 10. Wet offal should not be placed in contact with quarters, sides; or other portions of meat without adequate protection against soiling by the moisture exuding from the offal. The subject is one, which in my opinion, is worthy of careful consideration as it is obviously desirable that the handling of meat in course of transit should be subject to some form of approved regulations. In January of 1919, the Sanitary Committee again considered the reports of the Medical Officer of Health dated 27th April, 1915, and 25th March, 1916, on the subject, and after careful consideration and in view of Section 1 of the Public Health (Regulations as to Food) Act, 1907, which confers on the Local Government Board "the power of making regulations authorising measures to be taken for the prevention of danger arising to public health from the importation, preparation, storage, and distribution of articles of food or drink (other than drugs or water) intended for human consumption," decided to recommend the Court of Common Council to approach the Local Government Board on the matter. Accordingly the Court of Common Council on the 6th February passed a resolution that the Local Government Board be asked to make regulations with regard to the handling and conveyance of meat through the streets. Although there does not appear to be any concrete results from this representation, which, I believe, was one of several on the subject sent to the Government by Local Authorities, I am informed that the whole question of the transport and handling of meat is under the consideration of the Ministry of Health. 40 1919. SMITHFIELD AND OTHER MARKETS.—The following is Mr. T. Dunlop Young's summary of the actual meat inspection work. The supplies deposited for sale within the Central Markets, Smithfield, for the year ending 31st December, 1919, as shown by the Annual Report of the Market Superintendent, were as follows: Source of Supply. Tons of Beef and Veal. 1918 1919 Tons of Mutton and Lamb. 1918 1919 Tons of Pork and Bacon. 1918 1919 Tons of Poultry, Game, etc. 1918 1919 Tons. Totals. 1918 1919 United Kingdom 49,456 66,260 24,590 23,186 2,648 1,902 13,838 15,431 90,532 106,779 Australia and South Africa } 4,656 11,724 16,622 47,166 6 16 5,351 4,343 26,635 63,249 South America 23,953 68,362 8,493 16,364 147 1,195 274 138 32,867 86,059 North America 50,145 28,265 38 69 6,786 4,752 2,807 4,350 59,779 37,436 Other Countries 10 343 1 .... 15 11 1,251 1,169 1,277 1,523 Totals 128,220 174,954 49,744 86,785 9,605 7,876 23,521 25,431 211,090 295,046 1913 231,811 138,614 35,634 26,052 432,111 For comparative purposes, the year 1913 (being the last complete pre-war year) has been taken. It will be observed that there is a decrease of 137,065 tons and reference to the Board of Trade figures for the same periods shows a decrease of 193,000 tons of frozen and chilled meat imported during 1919. We are, therefore, far from being back to normal conditions. Again referring to the Board of Trade figures it will be observed that 528,354 tons of frozen and chilled meat were imported, and of that quantity 178,267 tons or about 34 per cent. passed through the Central Markets. GENERAL REMARKS.—The quality of the imported meat passing through the Market has been "very fair" but "condition" has caused a considerable amount of extra work to the Inspectors. Those remarks apply chiefly to mutton. Under "Control," only arranged quantities of each class of food were marketed daily. This resulted in quantities of mutton, which in normal times would have been marketed with all its bloom, arriving in the Market Cold Stores, etc., in a mouldy and decomposing condition, necessitating careful examination, much "trimming" and also increased condemnation. The practice of cutting carcases of mutton into two portions and enclosing the one within the other, has added to the amount of meat condemned; no doubt in time this practice will cease, to the benefit of the consignors. Bacon also gave the Inspectors extra work, and large quantities of this food were found unfit for human consumption, while much of it, passed as fit for food, was far from being satisfactory. The meat derived from the United Kingdom was not generally of so high a quality as in pre-war years. This was due to a number of causes, but chiefly to the fact that animals were graded and sold at a fixed rate according to grade, and as feeding stuffs were costly there was no inducement to farmers to produce exceptionally high quality cattle. The foregoing conditions are the aftermath of the war, and as more normal conditions return, we may expect better "quality," better "condition," and more food supplies at the Markets. IMPORTATIONS FROM AUSTRALIA.—While some of the meat imported from Australia was up to the usual standard, quantities of mutton arrived which, judged by its quality, came from the districts where the drought was considered the worst on record. The carcases were so devoid of fat as to be unsuitable for freezing and subsequent defrosting, and quantities had to be taken as unmarketable. These carcases in the fresh condition in the abattoirs, looked very fair, but after being frozen, then defrosted and handled, appeared unmarketable and would not be recognised by the original owner or the inspector of the abattoirs. The total amount of frozen meat imported from Australia during 1919 appears to be 121,168 tons, of which 85,930 tons were mutton and lamb and 52,097 tons were beef. NEW ZEALAND.—Mutton and lamb arriving from New Zealand maintained its usual high standard of quality, and the demand for "Canterbury 41 Lamb" has been far greater than the "Control" would allow to be met. At the close of the year large quantities were held in Cold Stores. The total quantity of meat imported from New Zealand during 1919 was 121,209 tons. ARGENTINA.—The quality of the meat from Argentina, not only maintained its high standard but goes on steadily improving. Some of the consignments were as nearly perfect as possible, and to those who can remember what the exporters only a few years ago considered as "ideal" carcases, viz., as big and as fat as possible, the improvement is proof of what can be done by those who are willing to learn. The total quantity of meat imported during the year 1919 was 237,137 tons. SOUTH AMERICAN TONGUES.—The 5 per cent. examination of Ox Tongues was continued during the year and resulted as follows:— Owners. No. of Tongues Examined. No. of Tongues Seized. Percentage. A 17,268 597 3.4% B 17,016 8 .04% C 41,976 31 .07% D 25,260 13 .05% E 177,984 272 .2% It will be observed that the consignments from one place shows a much higher percentage than the others. This variation is at present unexplained, but it is being carefully considered in Argentina by the owners and the Government Officials. URUGUAY.—The consignments from this country which reached the Market were few. The quality was good and the improvement may be said to follow on the same lines as in the Argentine. NEW MEAT EXPORTING COUNTRIES.—In the report submitted in 1914 it was stated, in discussing new exporting countries, that Brazil would, in about ten years' time, become one of the sources of our meat supply. This forecast has proved correct. In a special pamphlet issued by Mr. Simonsen the progress made since 1914 is stated to be as follows:— 1914 5 Carcases. 1915 32,870 „ 1916 133,001 „ 1917 286,878 „ 1918 221,840 „ For 1919 the figures are not available, but there was certainly a reduction. This is probably only temporary. The animal Census taken in 1916 showed that the total number of cattle in Brazil was over 30,000,000, thus exceeding the number in Argentina (28,000,000) and of pigs the number is given as 15,000,000. Mr. Simonsen estimates that Brazil could export 1,000,000 beef carcases per annum. There are at present eight "Packing Houses" or "Frigorificos" built or being built in Brazil. The improvement in the quality of the meat arriving is on the upward grade, and as the cross of the native breed of animals with pedigree British Bulls is being carried on, we may look to Brazil as becoming, a few years hence, an important source of meat supply. SOUTH AFRICA.—In the report previously mentioned, South Africa was also quoted as a future prospective source of meat supply, and the difficulties of climate and disease amongst imported pedigree stock referred to as a hindrance to quick progress. Only small quantities of beef arrived from South Africa during 1919, and though free from disease, some of it was poor in quality and lacked the clean preparation shown on the South American meat; nevertheless, from improved breeding from the right type of bulls, and the South American system of grading and handling, improvements will no doubt follow, and South Africa prove a valuable source of meat supply, though limited in comparison with the South American States. 42 TUBERCULOSIS.—As in previous years a special note has been made of seizures in the Central Markets, under this heading. The increase is due to carcases and offal being sent direct from "Control Slaughterhouses" for examination and decision by the City Inspectors. TUBERCULOUS MEAT SEIZED AT THE CENTRAL MARKETS DURING THE YEAR 1919. Carcases. BEEF. Qrtrs. Pces. Carcases. PORK. Qrtrs. Pces. Carcases. VEAL. Qrtrs. Pces. 1919 133 783 114 99 .... 13 13 .... 2 1914 12 79 91 431 19 61 3 .... 2 Increase 121 704 23 .... .... .... 10 .... .... Decrease .... .... .... 332 19 48 .... .... .... OFFAL. Heads. Tongues. Lungs. Hearts. Livers. Stomachs. Spleens. Mesenteries. Intestines. Kidneys. 1919 260 212 123 .... 121 11 31 9 9 51 Oxen 1919 190 .... 141 .... 73 .... 6 .... .... .... Pigs 1919 4 .... 11 .... 7 .... 2 .... .... 4 Calves 1914 37 53 17 2 12 l 3 1 1 2 Oxen 1914 1,785 .... 153 .... 160 .... .... 37 .... 9 Pigs 1914 .... .... 1 .... 1 .... .... .... .... .... Calves Total weight for 1919=56 Tons, 11 Cwts., 2 Qrs., 14 lbs. „ „ „ 1914=50 „ 2 „ 2 „ 7 „ Increase=6 „ 9 „ 0 „ 7 „ COLD STORES.—There are now 15 Cold Stores within the City Area with a total capacity of 34,070 tons stored "ship style" or about 25,000 tons "store style" which at present has had to be abandoned due to excessive supplies on hand. The work of the Inspectors is always difficult in Cold Stores because it is impracticable to open chambers and to examine their contents. It therefore follows that a responsible duty falls upon the proprietors of Cold Stores, to report at once to the Sanitary Authority any food of a doubtful nature belonging to them or in their possession. It would appear desirable that Official Regulations should be framed so that the exact measure of responsibility for meat contained in Cold Stores may be assessed. The length of time of deposit in stores, questions associated with removal and re-admission, of cleanliness of Cold Stores, and of registration of products deposited are matters which should also be dealt with. COLD STORES. Article. No. How Packed. Origin. Cause for Destruction. Tons. Cwts. Qrs. lbs. Bacon (Sides) .... Cases America Decomposed 0 9 1 23 Beef (Quarters) 72 .... S. America .... 9 2 1 13 „ (Pieces) .... Bags „ „ 39 5 0 3 ,, (Boneless) 55 „ .... „ 6 10 2 25 „ (Tins) .... Cases S. A. „ 0 4 1 12 „ (Suet) .... Crates U.S.A. „ 7 9 1 3 Brains (Ox) .... „ S. A. „ 9 1 2 23 Cheese .... Boxes .... „ 0 6 0 25 Fish (Bloaters) .... „ British „ 1 14 3 20 ,, (Kippers) .... „ „ „ 6 15 0 0 „ (Cod) .... „ „ „ 0 1 3 4 ,, (Herrings) .... „ „ „ 1 18 3 20 ,, (Salmon) .... „ „ „ 0 0 0 16 ,, (Skate) .... „ „ „ 0 6 1 18 Grouse .... Cases „ „ 0 0 1 8 Hams .... „ U.S.A. „ 28 2 3 8 Horse Flesh .... .... British „ 0 6 2 14 Lambs .... Sheets Argentine „ 23 0 1 20 Mutton (Carcases) .... „ „ „ 14 2 0 10 „ (Pieces) .... „ „ „ 39 7 2 12 Milk (Tins) .... Cases U.S.A. „ 0 1 1 10 Offal (Tongues—Ox) „ Bags Argentine Diseased 1 16 2 18 „ „ „ .... „ „ Lymph. Glds. exised 0 8 0 20 43 COLD STORES (continued). Article. No. How Packed. Origin. Cause for Destruction. Tons. Cwts. Qrs. lbs. Offal (Tongues—Ox) .... Bags Argentine Decomposed 0 0 0 24 ,, (Kidneys—Ox) .... Cases „ „ 3 19 0 8 „ (Cheeks—Ox) 600 Bags „ „ 1 15 1 25 „ (Tails—Ox) .... ,, „ „ 13 15 2 26 „ (Hearts—Ox) .... Cases „ „ 1 0 2 24 „ (Tripe—Ox) .... Boxes „ „ 0 2 3 11 „ (Various—Ox) .... Bags „ „ 1 15 0 25 „ (Plucks—Sheep) .... Cases „ „ 0 14 0 0 Pheasants .... „ British „ 0 2 3 7 Poultry .... „ „ „ 0 12 3 1 Pork (Carcases) .... Sheets S. A. „ 0 2 1 3 „ (Pieces) .... „ „ „ 0 2 0 3 Rabbits .... Cases & Loose Australia „ 29 9 1 18 Rabbits (Tins) .... Cases „ „ 0 0 0 6 Sausages .... „ .... „ 0 4 2 0 Venison (Crs.) .... .... British „ 1 3 0 0 Total for the year 1919 = 261 Tons, 17 Cwts., 1 Qr., 3 lbs. „ „ „ „ 1918=235 „ 10 „ 2 „ 9 „ Increase=26 „ 6 ,, 2 „ 22 ,, LEADENHALL MARKET AND CITY SHOPS.—The Leadenhall Market and City Shops have been carefully Inspected during the year and the following table shows the amount and variety of unsound food dealt with:— AMOUNT AND DESCRIPTION OF UNSOUND FOOD DESTROYED. Article. Quantity. Article. Quantity. Bacon (Sides) 12 Offal (Tongues—Ox) 17 Bacon (Pieces) 3 „ (Tongues—Pigs) 3 Beef (Carcases) 1 „ (Tongues—Sheep) 30 „ (Pieces) 86 „ (Hearts—Sheep) 227 „ (Tins) 9,051 „ (Hearts—Ox) 61 Blackbirds 1 „ (Hearts—Pigs) 15 Black Game 1 „ (Lungs—Sheep) 865 Chickens 82 ,, (Lungs—Pigs) 18 Curlew 1 ,, (Lungs—Ox) 12 Cheese (Cream) 50 „ (Livers—Pigs) 22 Ducks 900 ,, (Livers—Sheep) 54 Eggs (Fowls) 18,052 ,, (Livers—Ox) 27 ,, (Ducks) 532 ,, (Livers—Rabbit) 540 „ (Plovers) 206 ,, (Livers—Goats) 3 ,, (Gulls) 182 ,, (Kidneys—Ox) 38 Fowls (Various) 5,175 „ (Kidneys—Sheep) 168 Fruit (Tins) 1,014 „ (Spleens—Sheep) 8 Game (Unclassified) 44 „ (Tripe—Ox) 4 Geese 72 „ (Tripe—Pieces) 2 Goats (Carcases) 45 Partridges 579 „ (Quarters) 14 Ptarmigan 2 Grouse 268 Pigeons 535 Gulls 6 Pigeons (Wood) 339 Guinea Fowls 3 Pork (Carcases) 4 Haddock (Boxes) 42 „ (Quarters) 3 Hares 333 „ (Pieces) 10 Hazelhens 125 Rabbits 62,847 Kids (Carcases) 143 Rooks 1,190 Lambs (Quarters) 2 Salmon 4 „ (Pieces) 2 Salmon (Tins) 700 Landrail 3 Snipes 86 Milk (Tins) 7,950 Teals 12 Mushrooms (Tins) 2 Trout 25 Mutton (Carcases) 7 Tongues (Tins) 22 „ (Quarters) 22 Turkeys 111 „ (Pieces) 28 Veal (Pieces) 2 Offal (Boxes) 1 Venison (Carcases) 2 „ (Feet—Calves) 32 „ (Quarters) 12 „ (Heads—Pigs) 11 „ (Pieces) 7 „ (Heads—Sheep) 2 Widgeons 3 „ (Heads—Ox) 7 Woodcocks 31 Total weight 1919=83 Tons, 3 Cwts., 3 Qrs., 7 lbs. „ „ 1918=43 „ 6 „ 0 „ 0 „ Increase for 1919=39 ,, 17 ,, 3 ,, 7 ,, 44 ALDGATE MARKET AND SLAUGHTERHOUSES.—The great reduction in the number of animals slaughtered at Aldgate is accounted for by the continuation of the "Control" whereby cattle are graded and killed at the Metropolitan Market, Islington. As it is proposed to De-Control after July, 1920, it is probable that the trade at Aldgate will then gradually resume its normal condition. No additional hours of duty were performed under Bye-Law No. 19. The following table shows the number of animals slaughtered compared with 1914:— 1919. 1914. Bulls .... 166 Calves 10,644 8,340 Cows 3 109 Stirks (Bull) 814 .... Stirks (Heifer) 69 .... Heifers 20 145 Oxen 42 10,865 Sheep 964 15,968 Goats 110 .... 12,666 35,657 Of the 928 Bovines (not including Calves) killed, 24 or 2.4 per cent. were found affected with Tuberculosis, and of the 10,644 Calves, 39 or 0.3 per cent. showed lesions of the same disease. NUMBER OF CARCASES AND QUARTERS SEIZED AND DESTROYED AT ALDGATE. Cause for Destruction BEEF. MUTTON. VEAL. GOAT. PORK. Carcases. Quarters. Carcases. Quarters. Carcases. Quarters. Carcases. Quarters. Carcases. Quarters. Asphyxia .... .... .... .... 10 .... .... .... .... .... Decomposition .... .... .... 21 .... .... .... .... .... .... Hydraemia .... .... .... .... .... .... 13 .... .... .... Inmaturity .... .... .... .... l .... .... .... .... .... Myositis .... .... l .... .... .... .... .... .... .... Nephritis and Hydraemia .... .... .... .... 3 .... .... .... .... .... Pleurisy .... .... .... 10 2 3 .... .... l .... Pneumonia .... .... .... .... 3 .... .... .... .... .... Tuberculosis .... l .... .... 16 .... .... .... .... .... Total for 1919 .... l l 31 35 3 13 .... l .... „ „ 1914 21 13 51 16 23 9 1 .... l .... RECORD OF ORGANS SEIZED AT ALDGATE FOR 1919. Cause for Destruction. OXEN. SHEEP. Heads. Tongues. Lungs. Hearts. Livers. Stomachs. Spleens. Mesenteries. Intestines. Kidneys. Heads. Tongues. Lungs. Hearts. Livers. Stomachs. Spleens. Mesenteries. Intestines. Kidneys. Abscess ... ... 3 ... 9 ... ... ... ... ... ... ... 25 ... 19 ... ... ... ... ... Actinomycosis 9 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cirrhosis ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Decomposition 2 ... 8 15 ... 67 15 631 655 63 ... ... ... 55 2 1635 52 ... ... ... Distomatosis ... ... ... ... 69 ... ... ... ... ... ... ... 2 ... 50 ... ... ... ... ... Melanosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Nephritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pleurisy ...... ... 16 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Parasitic Disease (various) ... ... 47 ... 16 ... ... ... ... ... ... ... 217 ... 101 ... ... ... ... ... Tuberculosis 13 7 17 ... 24 3 ... 5 5 8 ... ... ... ... ... ... ... ... ... ... Unwholesome ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals for the year 1919 24 11 91 15 119 70 15 636 660 71 ... ... 251 55 172 1635 52 ... ... ... Totals for the year 1918 311 243 1337 215 2044 140 185 232 676 174 28 57 703 144 572 299 203 35 67 62 CALVES. GOATS. Abscess 2 2 16 ... 67 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Actinomycosis 8 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cirrhosis ... ... ... ... 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Decomposition 32 31 24 97 132 21 94 6114 11615 70 ... ... ... 4 ... 13 2 54 66 ... Distomatosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Melanosis ... 1 2 ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Nephritis ... ... ... ... ... ... ... ... ... 4 ... ... ... ... ... ... ... ... ... ... Pleurisy ... ... 46 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Parasitic Disease(various) ... ... 166 ... 58 ... ... ... ... ... ... ... 10 ... 2 ... ... ... ... ... Tuberculosis 23 16 38 ... 16 16 ... 16 16 ... ... ... ... ... ... ... ... ... ... ... Unwholesome ... ... ... ... ... ... ... ... ... ... 13 13 13 13 13 13 13 13 13 26 Totals for the year 1919 65 52 292 97 278 38 95 6130 11631 74 13 13 23 17 15 26 15 67 79 26 Totals for the year 1918 49 37 185 77 123 56 52 154 1464 60 ... ... ... ... ... ... ... ... ... ... 45 SUMMARY OF UNSOUND FOOD DESTROYED. Tons. Cwts. Qrs. lbs. Central Markets, Smithfield 1,668 13 3 13 Cold Stores 261 17 1 3 Leadenhall Market and City Shops 83 3 3 7 Aldgate Market and Slaughterhouses 55 3 3 5 Total for the year 1919 2,068 18 3 0 .. .. .. .. 1918 1,709 19 1 17 Increase 358 19 1 11 UNSOUND MEAT.—The meat. &c., seized during the year by your Inspectors as unfit for food is classified as under:— 1918. Diseased. Unsound. Unwholesome. 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 109 7 3 27 131 9 1 27 20 11 2 13 41 3 3 11 68 1 0 24 4 13 2 21 375 7 3 11 Second .. 44 19 2 7 192 6 1 18 28 17 0 2 30 4 3 5 127 5 0 10 0 11 2 3 424 4 1 17 Third .. 31 9 3 3 177 1 0 12 13 15 2 22 41 18 0 24 216 11 2 0 2 1 0 18 482 17 1 23 Fourth „ 60 11 0 1 290 4 2 21 35 7 2 3 141 2 0 1 194 5 2 3 0 16 1 21 722 7 0 22 Total 246 8 1 10 791 1 2 22 98 11 3 12 254 8 3 13 606 3 1 9 8 2 3 7 2004 16 3 17 CENTRAL MARKETS. SMITHFIELD. *Table showing the average deliveries at the Central Meat Market. and other details for successive quinquennial periods during the past 41 years:— Quinquennium. Annual Average General Supply. Seizures by Inspectors. % of Unsound Meat. Tons cwts. qrs. Tons cwts. qrs. 1874-1878 178,373 10 0 192 18 2 .108 1879-1883 218,200 12 3 282 11 2 .129 1884-1888 249,580 19 2 248 1 2 .099 1889-1893 304,986 5 1 461 15 1 .151 1894-1898 372,440 12 2 749 3 3 .201 1899-1903 410,456 18 1 1.082 13 2 .263 1904-1908 414,906 11 1 1.584 19 3 .382 1909-1913 427,146 0 0 1.520 2 3 .356 1914-1918 324,715 0 0 1.370 11 2 .422 1919- 295,044 0 0 2.068 18 3 .7012 *The sources of origin of the Central Market Supplies during the past five years are here expressed in terms per cent. of total annual deliveries. British. Foreign Killed. Per cent. American. Australian and New Zealand. Per cent. Country Killed. Per cent. Town Killed. Per cent. Home Killed. Per cent. American Killed.‡ Per cent. 1915 22.5 12.2 6.1 ... 29.0 30.2 1916 29.4 15.9 1.9 ... 30.3 22.5 1917 35.7 16.9 1.8 ... 33.1 12.5 1918 31.8 11.1 0.6 ... 43.9 12.6 1919 24.8 11.4 0.5 ... 41.9 21.4 † Includes "General Foreign Meat and Produce." ‡ Includes South American imports. 46 *Some idea of the amount of the work of your Inspectors of Slaughterhouses and Meat may be obtained from the following figures supplied by the Superintendent of the Market:— 1915 1916 1917 1918 1919 Tons. Tons. Tons. Tons. Tons. Average daily delivery into the Markets 1,220 1,077 922 688 964 §Minimum delivery on any one day 227 139 135 61 107 Maximum delivery on any one day 3,220 2,780 2,397 1,668 2,101 The heaviest weight previously recorded on any one day (22nd December. 1913) was ... ... 4,398 § The minimum deliveries relate to Saturdays when practically no wholesale business at the Market is carried out. One ton in every 142 tons of meat paying toll in the Central Markets. Smithfield. was condemned last year. as compared with one ton in 122 in 1918. * I am indebted to the Clerk and Superintendent of the Central Markets for the figures relating to the market supplies. sources of origin. etc. The percentages of meat seized under the various headings of the above Table during 1919 and for the preceding five years. classed as diseased. unsound and unwholesome. were as follows:— Year. Diseased. Per Cent. Unsound.* Per Cent. Unwholesome. Per Cent. 1914 10.0 80.0 10.0 1915 11.0 84.0 5.0 1916 13.4 84.1 2.5 1917 8.7 88.9 2.4 1918 10.1 87.7 2.2 Average for 5 years 10.6 84.9 4.4 1919 12.3 82.8 4.9 * Includes poultry. offal and fish. Table showing Weight of Meat delivered. and Meat delivered to Contractors as unsound. during each Month of the Years 1918 and 1919. Month. Meat delivered at the Market. 1918. Unsound Meat delivered to Contractors. 1918. Meat delivered at the Market. 1919. Unsound Meat delivered to Contractors. 1919. Tons. cwts. qrs. Tons. cwts. qre. Tons. cwts. qrs. Tons. cwts. qrs. January 16,921 0 0 85 1 0 24,134 0 0 175 14 2 February 14,752 0 0 111 19 2 20,186 0 0 124 19 2 March 15,518 0 0 49 18 0 23,041 0 0 132 2 1 April 18,054 0 0 30 19 1 22,920 0 0 136 14 1 May 17,387 0 0 63 19 0 26,690 0 0 183 7 2 June 17,492 0 0 84 18 3 22,882 0 0 104 10 1 July 18,051 0 0 347 6 1 25,276 0 0 137 14 3 August 17,681 0 0 216 3 0 22,543 0 0 189 17 1 September 15,718 0 0 218 14 0 26,079 0 0 168 8 0 October 18,929 0 0 169 14 1 27,006 0 0 270 13 3 November 20,042 0 0 176 13 0 25,815 0 0 219 12 3 December 20,543 0 0 175 4 2 28,572 0 0 225 4 0 Totals 211,088 0 0 1,30 11 0 295,044 0 0 2,068 18 3 FISH SUPPLIES. 167.686 tons of fish. of which 158.326 were land-borne and 9.360 water-borne. were received at or near Billingsgate Market during the year. This was an increase of 37.056 tons in the land deliveries. and an increase of 9.207 tons in the deliveries by water. 47 MONTHLY FISH RETURNS. 1919. Table showing Weight of Fish Delivered. Fish seized as Unsound. and percentage of Fish Condemned to that Delivered. at or near Billingsgate Market. and on board boats lying off that place. during each month of the year 1919. † Month. Weight of Fish Delivered. Total. Weight of Fish Condemned. Ratio of Fish Condemned to that Delivered. By Land. By Water. Tons. Tons. Tons. Tons cwt. qrs. Per Cent. January 7,646 90 7,736 75 16 2 1 ton in 102.016 tons or 0.990 February 10,970 40 11,016 108 2 0 1 „ 101.909 „ 0.981 March 13,43 104 13,534 63 13 0 1 „ 212.631 „ 0.470 April 13,199 143 13,342 300 0 0 1 „ 44.473 „ 2.248 May 14,909 324 15,233 508 15 0 1 „ 29.943 „ 3.330 June 11,045 550 12,195 172 18 2 1 „ 70.520 „ 1.418 July 14,015 679 14,694 496 12 3 1 „ 29.587 „ 3.379 August 15,251 705 15,956 493 12 3 1 „ 32,323 „ 3.093 September 14,577 1,507 16,084 399 3 1 1 „ 40,293 ,, 2.481 October 9,300 3,443 12,803 271 15 2 1 „ 47.108 „ 2.122 November 18,797 997 19,794 105 7 0 1 ,, 187.888 „ 0.532 December 14,527 772 15,299 84 0 1 1 „ 182.099 ,, 0.549 Total 158,326 9,360 167,686 3,079 16 2 1 „ 54.444 „ 1.837 † Compiled from the Monthly Returns furnished to the Corporation by the Fishmongers' Company. Monthly Deliveries of Fish at London Central Markets. Smithfield, 1919. Tons cwts. qrs. January 110 19 0 February 142 4 0 March 123 17 0 April 115 14 0 May 155 19 0 June 119 14 0 July 119 19 0 August 106 0 0 September 111 4 0 October 128 3 0 November 126 18 0 December 117 10 0 Total 1,478 10 0 Of the above. 8 tons 2 cwts. 3 qrs. 7 lbs. were seized as unsound by your Officers. and those of the Fishmongers' Company. This equals .547 per cent. of the whole. or 1 ton in 182 tons. Weight of Fish Delivered, Fish Seized as Unsound, and percentage of Fish Condemned to that Delivered, at or near Billingsgate Market during 1919 and the five years 1914-1918. 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 cwt. qrs. 1914 165,379 43,644 209,023 1,349 17 1 1 ton in 155 tons or .646% 1915 125,031 17,942 142,973 951 16 2 1 „ ,, 150 „ ,, .666% 1916 114,268 4,529 118,797 1,183 5 0 1 „ „ 100 „ „ .996% 1917 111,548 3,623 115,169 1,750 6 3 1 „ „ 66 „ 1.520% 1918 121,270 154 121,424 2,166 9 1 1 „ „ 56.047 „ „ 1.784% Average (5 years] 127,499 13,978 141,477 1,480 6 3 1 „ „ 95.576 „ „ 1.046% 1919 158,326 9,360 167,686 3,079 16 2 1 „ „ 54.444 „ „ 1.837% CONTAMINATED SHELLFISH (MUSSELS).—In May I was informed by the Commissioner of Police that a man had been taken to St. Bartholomew's Hospital on the 10th May suffering from fish poisoning. and that another man. who had accompanied the patient to Hospital. complained of illness on arrival there. I caused enquiries to be made and learned that both these men had partaken of a meal of cooked mussels on the day on which the illness occurred at an Oyster Bar in the City. Shortly afterwards one of the patients commenced to be ill. and when he arrived at St. Bartholomew's Hospital. the House Physician stated that the patient "appeared cyanosed with marked respiratory distress. and gave a history of having eaten two plates of mussels two hours previously. The pulse was uncountable. running and of small volume. He complained of no pain beyond the feeling of constriction across the chest; previous to arrival he had vomited. Six drams of Vinum Ipecac were administered at once; this was returned at once 48 and followed by a vomit of about one pint. The vomit was yellow, and contained solid yellowish material." The patient was given an injection of strychnine, and was admitted into one of the wards, where his temperature was found to be 96° and his pulse uncountable. Other treatment consisted of inducing vomiting, inhalation of oxygen, and administration of brandy and strychnine. He improved at night, and was discharged from Hospital on May 12th. I learned that the consignment of mussels from which those supplied to the two patients were taken, came from the beds in the South Deep, River Swale, and had been relaid for seven days on Fowley Island in the owner's private pits. Enquiries were made at the Fishmongers' Hall as to whether anything was known of the source from which these particular mussels had been taken. I was furnished with a copy of the certificate signed by Dr. Klein and dated February 6th, 1919, which stated that raw mussels taken from this source at that date were satisfactorily clean. Samples taken on the 14th May were likewise clean, but cooked samples which were sent on the same date and taken from the same source were not satisfactorily clean. This information is of some interest since it shows that mussels satisfactorily clean in the bed may be subsequently contaminated by inadequate or unsatisfactory cooking. The illness, however, is probably not to be attributed directly to infection by Bacillus Coli Communis, but is more likely to be one of Mytilotoxism. I cannot definitely state that there is a relationship between the development of the poisonous substance mytilotoxin in the mussel and contamination of the water from which it is taken, but it is stated that mussels taken from stagnant water are more especially likely to develop this poison. SUMMARY OF FOOD INSPECTED AT RIVERSIDE WHARVES FOR THE YEAR 1919 Article. Description of Package. Total Packages. General Range of Weight of Packages. Butter Casks 1,250 1 cwt. Cheese Single Cheeses 1,235 6 lbs.—80 lbs. Do Packages 5,354 28 lbs.—160 lbs. Eggs Half Cases 130 60 lbs. Lard Cases 941 1 cwt. Margarine Packages 28,095 24 lbs.—56 lbs. Cereals— Beans Bags 328 2 cwt. Peas Do. 4,434 1 cwt.—2 cwt. Rice Do. 725 1 cwt.—2 cwt. Lentils Do. 1,470 1 cwt.—2 cwt. Tapioca Do. 30 1 cwt. Wheat Do. 11,350 1½ cwt. Rolled Oats Bags and Cases 35,819 56 lbs.—1 cwt. Flour Bags 10,745 100 lbs.—2 cwt. Coffee Do. 63,442 56 lbs.—1 cwt. 2 qrs. Cocoa and Chocolate Bags and Cases 21,926 28 lbs.—2 cwt. Fruit (Soft)— Apples Packages 4,840 40 lbs.—2 cwt. Plums Do. 21,911 40 lbs. Pears Do. 14,858 40 lbs.—1 cwt. Currants Do. 11,927 7 lbs.—40 lbs. Raspberries Do. 112 7 lbs.—28 lbs. Strawberries Do. 139,382 7 lbs.—28 lbs. Gooseberries Do. 13,955 28 lbs.—1 cwt. Cherries Do. 28,253 12 lbs.—28 lbs. Cranberries Do. 3,037 28 lbs. Bilberries Do. 678 7 lbs. Fruit (Dried)— Currants Bags and Cases 431,258 40 lbs.—2 cwt. Raisins Do. Do. 142,634 8 lbs.—2 cwt. Sultanas Do. Do. 159,071 28 lbs.—2 cwt. Plums Cases 24,719 24 lbs.—56 lbs. Apple Rings Do 26,882 56 lbs. Apricots Do 6,101 24 lbs.—56 lbs. Peaches Do 649 24 lbs.—56 lbs. Pears Do 1,613 24 lbs.—56 lbs. Figs Do 3,213 14 lbs.—28 lbs. Dates Do 19,453 28 lbs.—75 lbs. 49 Article. Description of Package. Total Packages. General Range of Weight of Packages. Fruit (Green)— Oranges Cases 282,209 56 lbs.—2 cwt. Lemons Do. 109,911 56 lbs.—1 cwt. 1 qr. Grapes Packages 53,067 10 lbs.—56 lbs. Bananas Crates 3,700 56 lbs.—1 cwt. 2 qrs. Melons Cases 17,524 84 lbs. Pomegranates Do. 1,396 1 cwt. Vegetables— Cauliflowers Packages 18,928 25 lbs.—56 lbs. Carrots Do. 88,592 30 lbs.—2 cwt. Cabbage Do. 7,807 1 cwt. Cucumbers Do. 72,600 10 lbs.—56 lbs. Lettuce Do. 75,708 14 lbs.—28 lbs. Asparagus Do. 30 25 lbs. Potatoes Bags 21,006 1 cwt. Peas Do. 32 56 lbs. Onions Cases and Bags 267,809 40 lbs.—1 cwt. 1 qr. Garlic Baskets 50 14 lbs.—56 lbs. Tomatoes Packages 327,248 7 lbs.—40 lbs. Sprouts Bags 1,881 56 lbs. Radishes Baskets 4,867 50 lbs.—1 cwt. Beans Bags 957 90 lbs. Spinach Do. 206 56 lbs. Sugar Bags and Cases 99,286 1 cwt.—2 cwt. 3 qrs. Tinned Goods— Apricots Cases 21,883 48 lbs. Apples Do. 510 100 lbs. Fruit Pulp Do. 16,245 100 lbs. Vegetables Do. 9,483 90 lbs.—2 cwt. Tomato Pulp Do. 1,901 50 lbs.—100 lbs. Tomatoes Do. 53,834 56 lbs.—1 cwt. Plums Do. 425 50 lbs. Pears Do. 7,938 48 lbs. Pines Do. 14,914 48 lbs. Peaches Do. 13,899 48 lbs. Cherries Do. 88 50 lbs.—100 lbs. Condensed Milk Do. 259,796 48 lbs. Baked Beans Do. 3,539 50 lbs. Sardines Do. 8,505 50 lbs.—1 cwt. Salmon Do. 39,419 48 lbs. Crab Do. 606 48 lbs. Raspberries Do. 379 48 lbs. Corned Beef Do. 2,100 72 lbs. Macaroni Do. 5,889 28 lbs. Nuts (various) Cases and Bags 26,802 28 lbs.—2 cwt. Milk Powder Cases or Casks 9,735 1 cwt.—2 cwt. Ginger (preserved) Do. Do. 28,780 30 lbs.—3 cwt. 2 qrs. Ginger (dried) Bags 2,117 1 cwt. 1 qr. Vegetables in Brine Casks 3,093 3 cwt.—5 cwt. Miscellaneous— Albumen and Egg Yolk Cases or Casks 12,569 80 lbs.—4 cwt. 3 qrs. Liquorice Cases 1,464 1 cwt.—3 cwt. Biscuits Do. 500 2 cwt. Pepper Bags 1,229 1 cwt. 1 qr. Chillies Bags 411 56 lbs.—2 cwt. Anchovies Barrels 97 1 cwt. 2 qrs. Jam (various) Cases 15,360 48 lbs.—80 lbs. Honey Do. 340 80 lbs. Chewing Gum Do. 700 56 lbs. Lemon Juice Casks 1,334 4 cwt. Cloves Bales 1,070 1 cwt.—1 cwt. 2 qrs. Nutmegs Cases 15 1 cwt. Carraway Seeds Bags 5,209 1 cwt. 1 qr. Dried Orange Peel Cases 57 1 cwt. Cherries in Water Casks 306 3 cwt. 2 qrs. Peel in Brine Do. 35 4 cwt. Cocoa Butter Cases 607 1 cwt.—1 cwt. 3 qrs. Milk Sugar Do. 1,200 1 cwt. Dessicated Cocoanut Do. 441 1 cwt. 2 qrs.—2 cwt. Chutney Casks 25 3 cwt. Sweets (various) Pails and Cases 2,491 56 lbs.—1 cwt. Fruit Pulp Casks 195 3 cwt.—5 cwt. Mixed Candied Peel Cases 500 56 lbs.—1 cwt. 1 qr. 50 CONDEMNATION OF FOOD INSPECTED AT RIVERSIDE WHARVES. As a result of the daily Inspection of City Wharves, 168 loads of unsound food were removed from these places during the year 1919 by the Cleansing Department. The Material so disposed of comprised:- Tons. Cwts. Qrs. Tinned Fruit, Vegetables, and Fish 51 13 2 Miscellaneous Tinned Food 0 18 0 Fruit Pulp 29 16 2 Fruit (various) 14 16 0 Vegetables 69 16 0 Vegetables in Brine 27 8 1 Miscellaneous 1 17 1 Total 196 5 2 A large portion of the above was removed at the request of the owners. DAIRIES, COWSHEDS AND MILKSHOPS' ORDERS. No applications for registration have been received during the year, the orders still being temporarily superseded by the Milk (Amendment) Order, 1917, made under the Defence of the Realm Act, which requires all persons selling milk by retail to be registered with the Ministry of Health. The number of persons so registered is 118, as compared with 124 in 1918, and as against 580 persons whose names appear on the Register of Dairymen and Purveyors of Milk. All premises occupied by persons registered to retail milk have been subjected to periodical inspection and the same conditions have been imposed as required by Regulations made under the Dairies, Cowsheds and Milkshops' Orders, to insure the cleanly storage and sale of milk and of the proper hygenic surroundings being maintained. EXAMINATION OF MILK FOR TUBERCULOSIS AND CONDITIONS AS TO CLEANLINESS. During the months of May and June, 27 samples of milk were collected at the City railway termini and submitted to bacteriological and chemical examinations. These samples were taken from supplies from the following counties:Essex 9, Norfolk 7, Suffolk 6, Cambridgeshire 3, Huntingdonshire 1, Bedfordshire 1. In brief the objects of the enquiry were to ascertain:- (1) whether the milk was clean; (2) whether it was free from pathogenic bacteria, especially the tubercle bacillus, and (3) whether water had been added or fat abstracted. The Bacteriologist reports with regard to (1) and (2) as follows:- MILK SAMPLES TAKEN AT RAILWAY STATIONS: EXAMINED FOR THE CORPORATION OF THE CITY OF LONDON. No. of Sample. Date. Presence of Dirt. Guinea Pig Inoculated. Animal Killed. Result. 1. May 26. Clean. May 27. July 3. Inguinal and iliac glands enlarged and caseous. Tubercle bacilli found. Early tubercles in spleen. TUBERCULOUS. 2. Do. Clean. Do. July 28. Normal. 3. Do. Clean. Do. July 3. Normal. 4. Do. Clean. Do. July 3. Local abscess. Inguinal and iliac glands enlarged and caseous. Tubercle bacilli found. Early tubercles in spleen. TUBERCULOUS. 5. Do. Clean. Do. July 4. Normal. 6. Do. Clean. Do. July 4. Local abscess. Inguinal and iliac glands enlarged and caseous. Tubercle bacilli found. Tubercles in spleen. TUBERCULOUS. 51 No. of Sample. Date. Presence of Dirt. Guinea Pig Inoculated. Animal Killed. Result. 7. May 29. Clean. May 30. July 9. Inguinal glands enlarged. Tubercle bacilli found. Tubercles in spleen and liver. TUBERCULOUS. 8. Do. Clean. Do. July 9. Normal. 9. Do. Clean. Do. July 15. Do. 10. Do. Clean. Do. July 15. Do. 11. Do. Clean. Do. July 15. Do. 12. May 29. Clean. May 30. Dead July 4. Death from Peritonitis. No sign of Tubercle. 13. June 2. Clean. June 3. July 15. Normal. 14. Do. Clean. Do. July 15. Do. 15. Do. Clean. Do. July 16. Do. 16. Do. Clean. Do. July 16. Do. 17. June 5. Clean. June 6. July 23. Do. 18. Do. Clean. Do. July 23. Do. 19. Do. Large trace. Do. July 23. Do. 20. Do. Clean. Do. July 23. Do. 21. Do. Clean. Do. July 23. Do. 22. June 12. Clean. June 13. July 26. Do. 23. Do. Clean. Do. July 26. Do. 24. Do. Large trace. Do. July 26. Do. 25. Do. Clean. Do. July 26. Do. 26. Do. Clean. Do. July 28. Do. 27. Do. Clean. Do. July 28. Do. Percentage of Samples tuberculous, 14 .8%. No Sample could be classed as really dirty, but in two there were large traces. In this series there was a remarkable absence of pyogenic cocci; no acute abscesses arose from the injections. (Signed) F. W. ANDREWES, M.D. July 28th, 1919. St. Bartholomew's Hospital. For comparative purposes the results obtained in previous investigations are here shown. 1904 % 1905 % 1906 % 1907-8 % 19(59 1910 % 1911 % 1912 % 1913 % 1914 % 1915 % 1917 % 1919 % 1st series % 2nd series % Fairly Clean 48.7 68.2 80.0 54.2 43.7 66.6 75.0 28.6 79.9 Clean 83.3 97.9 88.8 75.0 92.6 Unclean 43.6 22.7 12.0 37.5 43.8 33.3 25.0 71.6 20.0 Unclean 16.7 2.1 11.2 25.0 7.4 Tuberculous 7.7 9.1 8.0 8.3 12.5 4.7 6.25 .... 6.6 Tuberculous 10.4 10.2 8.5 4.2 14.8 It is satisfactory to note the decrease in the percentage of unclean samples. Particulars with regard to the source of supply, etc., of these samples, showing the presence of dirt were communicated to the Medical Officer of Health of the area in which the farm was situated. In accordance with the arrangements made with the London County Council details of the tuberculous samples were sent to the Medical Officer of Health of that authority. The public analysist's report with regard to the chemical composition of the samples submitted to him showed them to be satisfactoty. SALE OF FOOD AND DRUGS ACTS. During 1919, 1,010 samples were submitted to the Public Analyst for examination; of this number 810 were taken as test samples without the formality of the Act being observed. 118 of these were found to be adulterated, made up as follows:- 12 of milk out of 146 taken. 90 of butter out of 308 taken. 1 of vinegar out of 19 taken. 2 of margarine out of 5 taken. 13 of drugs out of 91 taken. Of the formal samples, 20 out of 200 (or 10 per cent.) were found to be adulterated, made up as follows:- 5 of milk out of 104 samples taken. 9 of butter out of 85 samples taken. 5 of drugs out of 6 samples taken. 1 of vinegar out of 1 sample taken. 52 The percentage of milk adulteration compares favourably with that occurring in 1918, when the percentage of adulterated milk samples stood at 157. This year the percentage works out at 6.8 on all the milk samples submitted. The degree of sophistication of milk varied between 28 per cent. and 4 per cent. One milk prosecution was instituted, but the defendant escaped on proving warranty, although there were previous convictions against him. Two other vendors were not proceeded against as they had both been supplied on the same day with milk showing practically the same amount of adulteration by a roundsman who absconded. A trace of formalin was found in an informal milk sample purchased at a Dairy. This is a unique offence, there being no record of any such misdemeanour having occurred in the City of London. Another sample was at once obtained at the shop, but this was found to be free from any preservative. The high percentage of butter adulteration is again maintained, being attributable to the fact that the whole of the cases of substitution occurred where bread and butter was asked for and margarine supplied without disclosure being made to the purchaser. There was no case of butter adulteration where the substance was purchased in bulk at a shop. Cautions were in the majority of cases administered to first offenders. Six vendors who disregarded 1he cautions and were found to be still carrying on the same practice were proceeded against and all of them fined by the Justices, the amount of fines varying from £10 and £1 Is. 0d. costs to £1 and £1 1s. 0d. costs. DRUGS.—The percentage of formal drug samples shows the figure of 833, which would be serious, were it not for the fact that 91 samples of drugs had been procured and the knowledge of sophistication discovered thereby led to the success attending the taking of the formal samples, five out of six of which were reported against by the Public Analyst. All of these samples were Calomel Ointment. In three instances proceedings were instituted and the vendors fined £2 and £2 2s. 0d. costs, £10 and £3 3s. 0d. costs, and £10 and £3 3.s. 0d. costs respectively. In one case a satisfactory explanation was given, and in the other a caution was administered. MARGARINE.—The cases of infringements of the Margarine Act were instances where bread spread with margarine was found to contain a greater proportion of butter than 10 per cent. DEFENCE OF THE REALM ACT.—The following samples, although not taken under the Sale of Food and Drugs Acts, have a bearing thereon, and are, therefore, included in this report. 60 samples of spirits were purchased at various Licensed premises in order to ascertain the strength at which the spirits were retailed, and also to discover if the charges were in excess of the proper control prices. As a result seven prosecutions were instituted and fines amounting to £63 inflicted in addition to £12 12s. 0d. obtained for costs (see detailed list). PROFITEERING ACT.—A case of profiteering being noticed in regard to a sample of Lime Water purchased in the ordinary course of Food and Drug sampling, the attention of the Profiteering Committee was drawn to the matter, with the result that the offender was ordered to refund the sum of 8d. overcharge, and was also fined £5 and £2 2s. 0d. costs on his appearing before the Rt. Hon. The Lord Mayor to answer to the charge. SALE OF FOOD AND DRUGS ACTS, 1875-1907. RESULTS OF PROSECUTIONS, 1919. Sample. Nature and extent of adulterations. Result. FIRST QUARTER. 718 Milk 8% added water 17/6 Costs. 815 Almond Oil 55% Mineral Oil £15 and £3/3/0 Costs against the Company and £5 the Assistant. 53 Sample. Nature and extent of adulteration. Result. SECOND QUARTER. 124 Butter 100% Margarine £5 and 17/6 Costs. 294 Calomel Ointment 48% Deficient in Calomel £2 and £2 /2 /0 Costs. 295 „ ,, 47% ,, £10 and £3 /3 /0 Costs. 319 „ ,, 39% ,, £10 and £3 /3 /0 Costs. 347 Milk 13% added water, 4% fat abstracted Dismissed—Warranty proved. THIRD QUARTER. 454 Butter 90% Margarine £3/3/0 and £1/1/0 Costs. 550 „ 100% „ £3 and 15 /6 Costs. 551 „ 95% „ £4 and 15 /6 Costs. 657 „ 90% „ £10 and £1 /1 /0 Costs. FOURTH QUARTER. 801 Butter 90% Margarine £1 and £1/1/0 Costs. SUMMARY. First Quarter Fines £20 0 0 Costs £4 0 0 Second,, „ £27 0 0 ,, £9 5 6 Third „ „ £20 3 0 ,, £3 13 0 Fourth „ „ £ 1 0 0 ,, £ 1 1 0 Total „ £68 3 0 ,, £18 0 0 PROSECUTIONS UNDER THE D.O.R.A., 1919. Sample. Offence. Result. 45 Whiskey Above Control Price £25 and £5 /5 /0 Costs. 53 Gin ,, ,, ,, £25. 46 Whiskey ,, ,, ,, £5. 47 Gin ,, ,, ,, £3. 58 Whiskey ,, ,, ,, £5 and £3 /3 /0 Costs. 59 „ ,, ,, ,, Dismissed. 60 Gin ,, ,, ,, Dealt with under the Probation of Offenders' Act, ordered to pay Costs £4 /4 /0. Total Fines £63. Total Costs £12 /12 /0. CITY OF LONDON.—ADMINISTRATIVE ACTION REGARDING SAMPLES NOT REPORTED TO BE GENUINE. Name of Article. Identification No given to the sample in the Quarterly Report. Result of Analysis. If any legal proceedings were instituted under the Sale of Food & Drugs Acts, state result, showing fines and costs separately. If any legal proceedings were instituted under Acts other than the Sale of Food & Drugs Acts, state result, showing fines and costs separately. If no legal proceedings were instituted, state briefly the course adopted in regard to each sample. Information, if any, as to previous convictions. Remarks on any point of special interest. Quarter ended 31st March, 1919. *Milk 4 17% added water .... .... Vendor re-sampled .... see sample 50. Calomel Oint. 12 16.8% metallic mercury instead of 20% Calomel. .... .... Cautioned. .... .... *Milk 17 12% added water .... .... Vendor re-sampled .... subsequent official sample No. 38 genuine. *Milk 24 28% added water Official sample (No. 347) taken vendor summoned, dismissed, warranty proved. .... .... .... .... *Milk 50 15% added water .... .... Vendor cautioned. .... .... Milk 66 6% added water. .... .... ,, ,, .... .... *Butter 87 100% Margarine .... .... ,, ,, .... .... * Samples purchased informally. 54 Name of Article. Identification No. given to the sample in the Quarterly Report. Result of Analysis. If any legal proceedings were instituted under the Sale of Food & Drugs Acts, state result, showing fines and costs separately. If any legal proceedings were instituted under Acts other than the Sale of Food & Drugs Acts, state result, showing fines and costs separately. If no legal proceedings were instituted, state briefly the course adopted in regard to each sample. Information, if any, as to previous convictions. Remarks on any point of special interest. *Butter 88 100% Margarine .... .... Vendor cautioned. .... .... *Butter 89 100% Margarine .... .... ,, ,, .... .... *Butter 90 100% Margarine .... .... ,, ,, .... .... *Butter 92 100% Margarine .... .... ,, ,, .... .... *Butter 96 100% Margarine See sample 124. .... .... .... .... *Butter 99 100% Margarine .... .... See sample 121. .... .... *Butter 109 100% Margarine .... .... Vendor cautioned. .... .... Butter 121 90% Margarine .... .... ,, ,, .... .... Butter 124 100% Margarine Fined £5 & 17/6 Costs. .... .... .... .... Butter 125 100% Margarine .... .... Vendor cautioned. .... .... *Butter 130 30% Margarine .... .... Vendor re-sampled No. 377. .... subsequent official sample 377 genuine. *Butter 132 100% Margarine .... .... Vendor cautioned. .... .... *Butter 134 90% Margarine .... .... Vendor re-sampled No. 149. .... subsequent official sample 149 genuine. *Butter 156 100% Margarine .... .... Vendor cautioned. .... .... *Butter 159 35% Margarine .... .... ,, ,, .... .... *Butter 160 20% Margarine .... .... ,, ,, .... .... *Butter 162 100% Margarine .... .... ,, ,, .... .... *Butter 171 100% Margarine .... .... ,, ,, .... .... *Butter 172 100% Margarine .... .... ,, ,, .... .... *Butter 174 90% Margarine .... .... ,, ,, .... .... *Butter 181 90% Margarine .... .... ,, ,, .... .... *Butter 183 100% Margarine .... .... ,, ,, .... .... *Butter 196 35% Margarine .... .... ,, ,, .... .... *Butter 197 90% Margarine .... .... ,, ,, .... .... Quarter ending 30th June, 1919 .... *Butter 210 90% Margarine .... .... ,, ,, .... .... *Butter 211 90% Margarine .... .... ,, ,, .... .... *Butter 216 90% Margarine .... .... ,, ,, .... .... *Calomel Oint. 251 50% deficient in Calomel. See sample No. 294. .... .... .... .... *Calomel Oint. 267 50% ,, ,, See sample No. 295. .... .... .... .... Calomel Oint. 294 48% ,, ,, Fined £2 & £2 /2 /0 Csts .... .... .... .... Calomel Oint. 295 47% „ ,, Fined £10 & £3/3/0 Costs. .... .... .... .... *Calomel Oint. 298 13.5% of Zinc Carbonate Calomel absent .... .... .... .... Satisfactory explanation. *Calomel Oint. 300 46½ % deficient in Calomel. See sample 319. .... .... .... .... *Butter 304 100% Margarine .... .... Vendor cautioned. .... .... *Butter 307 90% Margarine .... .... ,, ,, .... .... *Butter 309 100% Margarine .... .... ,, ,, .... .... *Butter 310 90% Margarine .... .... ,, ,, .... .... *Butter 312 100% Margarine .... .... Vendor re-sampled .... subsequent official sample No. 333 genuine. *Butter 315 100% Margarine .... .... Vendor cautioned. .... .... *Butter 318 100% Margarine .... .... .... .... Found, on taking official sample, "Notice" exhibited. * Samples purchased informally. 55 Name of Article. Identification No. given to the sample in the Quarterly Report. Result of Analysis. If any legal proceedings were instituted under the Sale of Food & Drugs Acts, state result, showing fines and costs separately. If any legal proceedings were instituted under Acts other than the Sale of Food & Drugs Acts, state result, showing fines and costs separately. If no legal proceedings were instituted, state briefly the course adopted in regard to each sample. Information, if any, as to previous convictions. Remarks on any point of special interest. Calomel Oint. 319 39% deficient in Calomel. Fined £10 & £3/3/0 Costs. .... .... .... .... *Butter 321 100% Margarine. .... .... Vendor re-sampled .... subsequent official sample genuine, No.385 *Butter 322 100% Margarine. .... .... Vendor cautioned. .... .... *Butter 323 100% Margarine. .... .... ,, ,, .... .... *Butter 325 100% Margarine. .... .... ,, ,, .... .... *Butter 331 100% Margarine. .... .... ,, ,, .... .... Milk 347 13% added water 21% deficient in fat. Dismissed, warranty proved. .... .... 3 previous convictions 24thMarch, 1915, 30th March, 1916 and 25th June, 1918. .... Milk 350 13% added water. .... .... .... .... The vendors of these samples supplied by a milkman who absconded. Milk 351 14% added water. .... .... .... .... *Milk 352 4% added water. .... .... Same vendor as sample No. 356. .... .... *Calomel Oint. 355 8.2% Calomel in excess. .... .... No action taken. .... .... *Milk 356 4% added water. .... .... Vendor re-sampled .... subsequent official sample No.367 genuine. *Butter 373 90% Margarine. .... .... Vendor cautioned. .... .... *Butter 376 90% Margarine. .... .... ,, ,, .... .... *Butter 379 30% Margarine. .... .... Vendor re-sampled .... subsequent official sample No.424 genuine. *Butter 381 90% Margarine. .... .... ,, ,, .... Do. No. 425. *Butter 395 100% Margarine. .... .... Vendor cautioned. .... .... *Butter 399 100% Margarine. See sample 454. .... .... .... .... *Butter 411 100% Margarine. .... .... Vendor cautioned. .... .... *Butter 418 100% Margarine. .... .... ,, ,, .... .... *Butter 419 90% Margarine. .... .... ,, ,, .... .... *Milk 421 6% added water. .... .... Vendor re-sampled .... subsequent sample No. 442 genuine. *Butter 432 100% Margarine. .... .... Vendor cautioned. .... .... *Butter 434 50% Margarine. .... .... ,, ,, .... .... *Butter 437 100% Margarine. .... .... ,, ,, .... .... *Butter 438 60% Margarine. .... .... .... .... On subsequent visit Margarine declared. *Milk 443 5% fat abstracted .... .... .... .... Subsequent official sample No.481 genuine. *Milk 445 6% fat abstracted. .... .... .... .... Do. No. 480. *Butter 449 60% Margarine. .... .... See sample No.478 .... .... Butter 454 90% Margarine. Fined £3 /3 & £1/1/0 Costs. .... .... .... .... *Milk 460 10% fat abstracted. .... .... Vendor re-sampled .... Subsequent official sample genuine. * Samples purchased informally. 56 Name of Article. Identification No. given to the sample in the Quarterly Report. Result of Analysis. If any legal proceedings were instituted under the Sale of Food & Drugs Acts, state result, showing fines and costs separately. If any legal proceedings were instituted under Acts other than the Sale of Food & Drugs Acts, state result, showing fines and costs separately. If no legal proceedings were instituted, state briefly the course adopted in regard to each sample. Information, if any, as to previous convictions. Remarks on any point of special interest. Butter 479 90% Margarine. .... .... Cautioned by City Solicitor. .... .... *Butter 486 100% Margarine. See sample No. 550, next qtr. .... .... .... .... *Butter 492 100% Margarine. .... .... Vendor cautioned. .... .... *Butter 494 30% Margarine. .... .... ,, ,, .... .... *Butter 507 70% Margarine. .... .... ,, ,, .... .... *Butter 516 100% Margarine. .... .... ,, ,, .... .... *Butter 517 100% Margarine. See sample No. 551, next qtr. .... .... .... .... Quarter ending 30th Sept., 1919 *Butter 541 66% Margarine. .... .... Vendor cautioned. .... .... Butter 550 100% Margarine. Fined £3 & 15 /6 Costs .... .... .... .... Butter 551 95% Margarine. Fined £4 & 15/6 Costs .... .... Previously convicted, 13th Dec., 1917. .... *Butter 569 100% Margarine. .... .... .... .... Margarine declared on subsequent visit. *Butter 570 100% Margarine. See sample No. 657. .... .... .... *Butter 581 90% Margarine. .... .... Vendor cautioned. .... .... *Butter 582 100% Margarine. .... .... ,, ,, .... .... *Butter 593 100% Margarine. .... .... ,, ,, .... .... *Butter 596 90% Margarine. .... .... Vendor re-sampled .... Subsequent official sample No.661 genuine. *Butter 600 90% Margarine. .... .... Vendor cautioned. .... .... *Butter 601 100% Margarine. .... .... ,, ,, .... .... *Butter 615 100% Margarine. .... .... ,, ,, .... .... *Butter 639 90% Margarine. .... .... ,, ,, .... .... Butter 657 90% Margarine. £10 & £1/1 Costs. .... .... .... .... *Butter 673 90% Margarine. .... .... Vendor cautioned. .... .... *Milk 680 4% added water, trace of formalin. .... .... Vendor re-sampled .... Subsequent official sample No.695 genuine. *Butter 682 60% Margarine. .... .... ,, ,, .... Subsequent sample taken (No. 814), Margarine Act complied with. *Butter 689 75% Margarine. .... .... Vendor cautioned. .... .... *Butter 691 90% Margarine. .... .... ,, ,, .... .... *Butter 696 90% Margarine. .... .... ,, ,, .... .... *Milk 712 25% added water. .... .... .... .... Subsequent official sample unobtainable. Sale of milk discontinued. † See below. *Calomel Oint. 728 50% deficient in Calomel. .... .... Vendor re-sampled .... See sample 739. *Camphorated Oil 732 10% Mineral Oil .... .... ,, ,, .... Subsequent official sample No.735 genuine. * Sample purchased informally. † Note.—Sale of Milk resumed 1920, when vendor was convicted and fined for similar offence. 57 Name of Article. Identification No. given to the sample in the Quarterly Report. Result of Analysis. If any legal proceedings were instituted under the Sale of Food & Drugs Acts, state result, showing fines and costs separately. If any legal proceedings were instituted under Acts other than the Sale of Food & Drugs Acts, state result, showing fines and costs separately. If no legal proceedings were instituted, state briefly the course adopted in regard to each sample. Information, if any, as to previous convictions. Remarks on any point of special interest. *Camphorated Oil 737 79% Sesame Oil instead of 80% Olive Oil. .... .... .... .... War time concession, further sample unobtainable. Calomel Oint. 739 50% deficient in Calomel .... .... Vendor cautioned. .... .... *Butter 750 15% Margarine. .... .... Vendor re-sampled .... Subsequent official sample No. 800 genuine *Butter Quarter ending 30th Dec., 1919 759 90% Margarine. See sample No. 801 next qtr. .... .... .... .... *Butter 762 90% Margarine. .... .... Vendor re-sampled .... Subsequent sample Margarine declared. *Butter 763 90% Margarine. .... .... ,, ,, .... ,, ,, *Butter 770 30% Margarine. .... .... ,, ,, .... ,, ,, *Butter 807 90% Margarine. .... .... Vendor cautioned. .... .... *Butter 810 90% Margarine. .... .... Vendor re-sampled .... Subsequent official sample No.853 genuine. *Butter 841 90% Margarine. .... .... Vendor cautioned. .... .... *Butter 868 90% Margarine. .... .... ,, ,, .... .... *Butter 869 90% Margarine. .... .... Vendor re-sampled .... Subsequent visit, Margarine declared. *Butter 903 90% Margarine. .... .... Vendor cautioned. .... .... *Butter 909 50% Margarine. .... .... Vendor re-sampled .... Subsequent official sample No.949 genuine. *Butter 915 90% Margarine. .... .... ,, ,, .... Subsequent visit, Margarine declared. *Butter 952 90% Margarine. .... .... Vendor cautioned. .... .... *Butter 953 90% Margarine. .... .... ,, ,, .... .... *Butter 971 30% Margarine. .... .... Vendor re-sampled .... Subsequent official sample No. 2 genuine. *Butter 999 90% Margarine. .... .... Vendor cautioned. .... .... *Margarine 768 35% Butter fat. .... .... Vendor re-sampled .... Subsequent visit, Margarine Act complied with. *Margarine 769 20% Butter fat. .... .... ,, ,, .... ,, ,, *Camph. Oil 775 79% Sesame Oil. .... .... Vendor cautioned. .... .... *Camph. Oil 785 20% Cotton Seed Oil 43% deficient in Camphor. .... .... Vendor re-sampled .... Subsequent official sample No.826 genuine. *Camph. Oil 790 79 7% Sesame Oil .... .... Vendor cautioned. .... .... *Camph. Oil 830 20% Sesame Oil. .... .... Vendor re-sampled .... Subsequent official sample No.876 genuine. *Vinegar 818 24% deficient in Acetic Acid. .... .... See sample No.827 .... .... *Milk 975 5% added water. .... .... Vendor re-sampled .... Subsequent official sample No. 1 genuine. *Light Magnesia 978 17'9% loss on ignition. .... .... Vendor cautioned. .... .... Butter 801 90% Margarine. Fined £1 & £1 /1 costs. .... .... .... .... Vinegar 827 23% deficient in Acetic Acid. .... .... Vendor cautioned. .... .... * Samples purchased informally. 58 SALE OF FOOD AND DRUGS ACTS, 1875-1907, AND THE Articles examined during each Articles submitted for Analysis. Quarter ending 31st March. Quarter ending 30th June. No. of Samples taken. No. Genuine. No. Adulterated. Percentage of Adulteration. No. of Samples taken. No. Genuine. No. Adulterated. Percentage of Adulteration. Purchased, Formally:— Milk 52 50 2 3.6 49 46 3 6.1 Butter 10 7 3 30.0 51 49 2 3.9 Drugs 1 .... 1 100.0 3 0 3 100.0 Cod Liver Oil and Malt .... .... .... .... .... .... .... .... Lard .... .... .... .... .... .... .... .... Coffee .... .... .... .... .... .... .... .... Vinegar .... .... .... .... .... .... .... .... Total Formal Samples 63 57 6 9.5 103 95 8 7.7 Purchased Informally:— Milk 25 22 3 12.0 26 20 6 23.7 Butter 55 33 22 40.0 89 54 35 38.9 Cocoa 3 3 .... .... 19 19 0 .... Coffee 4 4 .... .... 16 16 0 .... Mustard 1 1 .... .... 7 7 0 .... Vinegar .... .... .... .... .... .... .... .... Olive Oil .... .... .... .... 7 7 0 .... Self-Raising Flour 5 5 .... .... .... .... .... .... Baking Powder 5 5 .... .... 4 4 0 .... Rice 4 4 .... .... .... .... .... .... Dripping 6 6 .... .... 6 6 0 .... Lard .... .... .... .... 6 6 0 .... Pepper 3 3 .... .... .... .... .... .... Oatmeal 2 2 .... .... 1 1 0 .... Arrowroot 2 2 .... .... 2 2 0 .... Custard Powder 1 1 .... .... .... .... .... .... Almond Oil .... .... .... .... 19 19 0 .... Margarine .... .... .... .... .... .... .... .... Drugs 1 1 .... .... 27 22 5 18.5 Cod Liver Oil and Malt 13 13 .... .... .... .... .... .... Cod Liver Oil Emulsion 5 5 .... .... .... .... .... .... Ground Ginger 2 2 .... .... .... .... .... .... Mustard Condiment .... .... .... .... 3 3 0 .... Total Informal Samples 137 112 25 17.5 232 186 46 19.5 Totals 200 169 31 15.5 335 281 54 16.0 59 PUBLIC HEALTH (MILK AND CREAM) REGULATIONS, 1912. Quarter of the year 1919 Quarter ending 30th September. Quarter ending 31st December. Total for 1919. 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. 3 3 0 .... .... .... .... .... 104 99 5 4.8 23 20 3 13.0 l .... l 100.0 85 76 9 10.5 2 1 1 50.0 .... .... .... .... 6 1 5 83.3 .... .... .... .... .... .... .... .... .... .... .... .... 2 2 0 .... .... .... .... .... 2 2 .... .... 2 2 0 .... .... .... .... .... 2 2 .... .... .... .... .... .... l .... l 100.0 1 .... 1 100.0 32 28 4 12.5 2 0 2 100.0 200 180 20 10.0 43 41 2 4.6 52 51 1 1.9 146 134 12 8.2 88 70 18 20.4 76 61 15 2.0 308 218 90 29.2 5 5 0 .... 10 10 0 .... 37 37 .... .... 2 2 0 .... 7 7 0 .... 29 29 .... .... 1 1 0 .... 1 1 0 .... 10 10 .... .... 11 11 0 .... 8 7 1 12.5 19 18 1 5.2 .... .... .... .... 12 12 0 .... 19 19 .... .... 3 3 0 .... .... .... .... .... 8 8 .... .... 6 6 0 .... 4 4 0 .... 19 19 .... .... 7 7 0 .... 8 8 0 .... 19 19 .... .... .... .... .... .... 18 18 0 .... 30 30 .... .... 2 2 0 .... 7 7 0 .... 15 15 .... .... .... .... .... .... .... .... .... .... 3 3 .... .... .... .... .... .... .... .... .... .... 3 3 .... .... .... .... .... .... .... .... .... .... 4 4 .... .... .... .... .... .... .... .... .... .... 1 1 .... .... 2 2 0 .... .... .... .... .... 21 21 .... .... .... .... .... .... 5 3 2 40.0 5 3 2 40.0 23 20 3 13.0 40 35 5 12.5 91 78 13 14.2 .... .... .... .... .... .... .... .... 13 13 .... .... .... .... .... .... .... .... .... .... 5 5 .... .... .... .... .... .... .... .... .... .... 2 2 .... .... .... .... .... .... .... .... .... .... 3 3 .... .... 193 170 23 12.0 248 224 24 9.6 810 692 118 14.5 225 198 27 12.0 250 224 26 1.4 1,010 872 138 13.6 60 LOCAL FOOD CONTROL COMMITTEE'S WORK. Owing to the de-control of various food stuffs, the discontinuance of the inspection and checking of food registers by my staff, the fewness of complaints as to the infringements or contraventions of Food Orders, and the revocation of many of these Orders, the Food Control work carried out by my Department during the year was of distinctly less importance than in previous years. In November last I reported to the Food Control Committee that, in view of my own rapidly-increasing work, the Executive Officer considered he could arrange for such matters as then came within my special province to be done by his staff, and I requested the Committee to release me from further responsibility in connection with this work. This the Committee agreed to. INVESTIGATION OF COMPLAINTS.—The total number of complaints alleging breaches of the Food Orders was 19. These complaints referred to:— One case in which improper sale by auction was alleged. One case of food wastage. Thirteen cases in which excessive prices were alleged. Two cases for not selling by Imperial measure. One case in which it was alleged a substitute was being sold for rum. One case in which adulteration of beer was alleged. The following is a brief review of the cases referred to:— THE WHISKEY (RESTRICTION ON SALES) ORDER, 1918, No. 12.— Under this Order one complaint was made. This referred to the sale by auction in the City of spirit lying in America. After considerable correspondence the matter was referred back to the Ministry of Food for prosecution by them should they deem it desirable. THE BEER (PRICES AND DESCRIPTION) ORDER, 1918, No. 103.— There were six complaints made under this Order. All were investigated, and in three instances it was found that no offence had been committed and that the other three were of a very trivial nature. No action was taken. THE SPIRITS (PRICES AND DESCRIPTION) ORDER, 1918, No. 2.— There were nine prosecutions under this Order, viz., seven for selling spirits at an excessive price, two for not selling by Imperial measure. Of the seven instances of overcharging, fines were imposed in five cases, one case was dismissed, and the remaining case was dealt with under the "Probation of Offenders' Act," and the defendant was ordered to pay four guineas costs. Both cases for not selling by Imperial Measure were dismissed. THE SPIRITS (PRICES AND DESCRIPTION) ORDER, 1919, No. 517 AS AMENDED BY No. 788.—In consequence of a complaint received from the Ministry of Food that a substitute for rum was being sold at a City public house, a sample of rum was procured and submitted to the Public Analyist, who certified it to be " pure rum " and no offence was proved. In another complaint under this order in which it was alleged that an excessive price was being charged, a test was made, and no offence was proved. THE WASTE OF FOODSTUFFS ORDER, 1918, No. 212.—In consequence of a complaint that the girls employed by a City firm of printers were in the habit of throwing bread and other food into the roadway, an inspection was made on August the 20th, and the Inspector reported that the complaint was fully justified. On that date he stated that he found the roadway strewn with bread which had evidently been thrown from the windows of the firm's premises. The attention of the Manageress and the Managers of adjoining premises was called to the matter, and the employees were cautioned. A re-inspection was made on August 22nd, and, as the practice had not entirely stopped, the Managers were again interviewed, and the employees again cautioned. This has had the desired effect, and no wastage has been noticed since that date. The individual offenders could not be discovered. 61 Table 1.—Shows the number of investigations and the action taken. Table 2.—Is a classification of the contravention of the Food Orders in which legal proceedings were taken. Table 3.—Is a summary of Tables 1 in the Annual Reports for 1917-18-19. Table 4.—Is a summary of Tables 2 as contained in the Annual Reports for 1917-18-19. TABLE 1.—SHOWING INVESTIGATIONS MADE, CASES ARISING OUT OF INSPECTIONS, AND ACTION TAKEN UNDER VARIOUS ORDERS OF THE FOOD CONTROLLER FROM 1st JANUARY, 1919, TO 31st DECEMBER, 1919. No. of Order. Title of Order. Prosecutions. Cautions. Complaints not justified. Unable to test. Forwarded to Authorities concerned. Reported to Food Controller. Prosecutions not proceeded with. Minor infringements and no action taken. Total Number of Cases. 103 The Beer (Prices and Description) Order, 1919 .... .... .... .... .... .... .... 6 6 2 The Spirits (Prices and Description) Order, 1918 9 .... .... .... .... .... .... .... 9 517 & 788 The Spirits (Prices and Description) Order, 1919 .... .... .... .... .... .... .... 2 2 212 The Waste of Foodstuffs' Order, 1918 .... l .... .... .... .... .... .... 1 12 The Whiskey (Restriction on Sales) Order, 1918 .... .... .... .... .... l .... .... 1 9 l .... .... .... l .... 8 19 TABLE II. PROSECUTIONS TAKEN UNDER THE FOOD CONTROL ORDERS FROM 1st JANUARY TO 31st DECEMBER, 1919. Classification of Contraventions. Order. Offence. Result. The Spirits (Prices and Description) Order No. 2,1918. Selling whiskey at excessive price. Fined £25 and 5 guineas costs. Do. Not selling by Imperial measure. Dismissed. Do. Selling gin at excessive price. Fined £25. Do. Not selling by Imperial measure. Dismissed. Do. Selling whiskey at excessive price. Fined 5 guineas. Do. Selling gin at excessive price. Fined 3 guineas. Do. Selling whiskey at excessive price. Fined £5 and 3 guineas costs. Do. Selling whiskey at excessive price. Dismissed. Do. Selling gin at excessive price. Dealt with under the Probation of Offenders' Act— ordered to pay 4 guineas costs. Total—Fines, £63 /8 /0; Costs, £12 /12 /0. TABLE 3.—SUMMARY OF PROSECUTIONS TAKEN UNDER FOOD CONTROL ORDERS FOR THE THREE YEARS ENDED 31st DECEMBER, 1919. ORDER. Year 1917. Year 1918. Year 1919. Total Prosecutions. Fines including costs. Prosecutions. Fines including costs. Prosecutions. Fines including costs. Prosecutions. Fines including costs. £ s. d. £ s. d. £ s. d. £ s. d. Bacon, Ham and Lard (Provisional Prices) Order 1917, No. 1,162 l 2 1 0 ... ... ... ... l 2 1 0 Beans, Peas and Pulse (Retail Prices) Order, No. 511 l 10 0 0 ... ... ... ... l 10 0 0 Dutch Cheese (Prices) Order, 1917 ... ... l 33 3 0 ... ... l 33 3 0 Margarine (Maximum Prices) Order, 1917, No. 429 2 23 2 0 ... ... ... ... 2 23 2 0 Margarine (Maximum Prices) Order, No. 1,162 ... ... l 12 2 0 ... ... 1 12 2 0 Meat (Rationing) Order, 1918, No. 404 ... ... 2 25 4 0 ... ... 2 25 4 0 do. No. 417 ... ... 1 4 2 0 ... ... 1 4 2 0 Milk (Amendment)Order, 1917, No. 317 ... ... 1 Dismissed ... ... 1 Dismissed 62 TABLE 3.—continued. ORDER. Year 1917. Year 1918. Year 1919. Totals. Prosecutions. Fines including costs. Prosecutions. Fines including costs. Prosecutions. Fines including costs. Prosecutions. Fines including costs. £ s. d. £ s. d. £ s. d. £ s. d. Milk (Winter Prices) Order, 1918, No. 1,165 .... .... l 1 month's imprisonment .... .... .... .... Persian Dates (Retail Prices) .... .... 2 85 5 0 .... .... 2 85 5 0 Public Meals Order, 1917 l Dismissed .... .... .... .... 1 Dismissed 1 1 0 1 1 0 do. Nos. 445 and 664 2 Dismissed .... .... .... .... 2 Dismissed 2 2 0 2 2 0 do. 9 30 6 0 .... .... .... .... 9 30 6 0 Public Meals Orders, 1918, Nos. 445, 664 and 59 .... .... l Dismissed .... .... 1 Dismissed do. .... .... 2 Dismissed .... .... 2 Dismissed 2 2 0 2 2 0 costs costs do. .... .... 1 Dismissed .... .... 1 Dismissed 3 3 0 3 3 0 costs costs do. .... .... 2 4 0 0 .... .... 2 4 0 0 Spirits (Prices and Description) Order, 1918, No. 2 * .... .... .... .... 3 Dismissed 3 Dismissed do. .... .... .... .... 5 71 16 0 5 71 16 0 do. .... .... .... .... 1 Dealt with under Prob. of Offenders' Act 1 Dealt with under Prob. of Offenders' Act 4 4 0 4 4 0 Spirits (Prices and Description) Order, 1918, No. 470 .... .... 1 30 5 0 .... .... 1 30 5 0 Tea (Provisional Prices) Order (No. 2), No. 1,295, 1918 .... .... 2 15 5 0 .... .... 2 15 5 0 Totals 16 68 12 0 18 215 1 0 9 76 0 0 43 359 13 0 TABLE 4.—SUMMARY SHOWING INVESTIGATIONS MADE, CASES ARISING OUT OF INSPECTIONS, AND ACTION TAKEN UNDER VARIOUS ORDERS OF THE FOOD CONTROLLER FOR THE THREE YEARS ENDED DECEMBER 31st, 1919. Year. Prosecutions. Cautions. Complaints not justified. Unable to test. Forwarded to Authorities concerned. Reported to Food Controller. Prosecutions not proceeded with. Minor infringements and no action taken. Total number of cases. 1917 15 17 12 2 2 l 7 55 1ll 1918 18 14 .... .... 4 7 .... 64 107 1919 9 l .... .... .... 1 .... 8 19 Totals 42 32 12 2 6 9 7 127 237 ARTIZANS' DWELLINGS, STONEY LANE, HOUNDSDITCH. These buildings, erected by the late Commissioners of Sewers and opened in January, 1885, stand upon ground formerly the site of several courts and alleys in the Ward of Portsoken. There are five "blocks" of Dwellings, severally named King's—Queen's— Prince's—North—and South, designed for occupation by persons of the artizan class; some of the ground floors being let as shops. The buildings contain 501 63 rooms, arranged in 241 tenements, and are occupied by 799* persons, compared with 720 in 1918. 70.6 per cent, are adults and 294 per cent, children (under 14 years). The number of births was 15, viz. : six males and nine females. The birth rate was 18.7 per 1,000, which is 7.4 per 1,000 below the average for the previous five years. The death rate for 1919 was 62 per 1,000 per annum. The number of deaths of children under one year, per 1,000 births, was 66, as against 108 for the City generally. TABLE OF BIRTHS AND DEATHS OCCURRING AT THE ARTIZANS' DWELLINGS STONEY LANE, HOUNDSDITCH, DURING THE YEAR 1919. Name of Block. Births. Mortality from all Causes at subjoined Ages. Male. Female. At all ages. Under 1 year. 1 and under 5 5 and under 15 15 and under 25 25 and under 65 es and upwards. NORTH BLOCK .... 4 .... .... .... .... .... .... .... SOUTH 3 .... 2 l .... .... .... .... l KING'S .... .... .... .... .... .... .... .... .... OUEEN'S „ 1 3 .... .... .... .... .... .... .... PRINCE'S „ 2 2 3 .... .... .... 2 l TOTALS 6 9 5 l .... .... .... 2 2 * i.e., persons sleeping on the premises. The birth rate in these Dwellings reached a maximum of 469 per 1,000 in 1896, and has since been falling, as shown by the following figures:— BIRTH RATE, ARTIZANS' DWELLINGS. 1896 46.9 1908 31. 5 1897 40.3 1909 29.6 1898 43.1 1910 32.9 1899 37.5 1911 29.5 1900 38.4 1912 33.4 1901 3.8 1913 29.7 1902 45.8 1914 36.3 1903 3.2 1915 28.8 1904 30.1 1916 22.6 1905 29.1 1917 29.3 1906 26.1 1918 13.8 1907 35.0 1919 18.7 The Baths provided for the use of the tenants of these Buildings, which were opened in May, 1904, continue to be extensively used, the number of persons bathing during 1919 being 8,635, of whom 3,079 were males and 5,565 were females. The accompanying Table is compiled from the monthly records of attendances at the Baths:— RECORD OF ATTENDANCES AT THE BATHS, ARTIZANS' DWELLINGS Month. Sex. Total. Males. Females Children. Adults. Children. Adults. January 72 119 120 214 525 February 58 126 93 178 455 March 75 165 98 241 579 April 66 155 124 259 604 May 119 215 223 425 982 June 124 170 181 464 939 July 88 142 185 326 741 August 116 217 202 455 990 September 91 179 182 357 809 October 106 165 144 312 727 November 99 165 132 303 699 December 73 165 108 239 585 Totals 1,087 1,983 1,792 3,773 8,635 64 DISINFECTION, &c., AT CITY MORTUARY. 207,935 articles of bedding, clothing, furniture, &c., were received at Golden Lane and disinfected. Of these 203,005 were disinfected at the request of City firms engaged in exporting second-hand clothing to South Africa, where the authorities will not allow such articles to enter the country unless accompanied by a certificate duly signed by a medical officer of health, vouching for the proper disinfection of each consignment. In all, 566 such certificates were issued during the year. The remaining 4,930 articles were from premises in the City where infectious disease had occurred, or had been sent by the Authorities of the Finsbury Square Military Hospital. 170 bodies were received at the Mortuary pending interment, and 86 postmortem examinations were made. 150 inquests were held on bodies, and four inquests on fires. NUMBER OF ARTICLES DISINFECTED, BODIES RECEIVED AT THE MORTUARY' AND INQUESTS HELD AT THE CORONER'S COURT IN THE CITY DURING 1919, COMPARED WITH THE PREVIOUS FIVE YEARS. Year. Articles of Bedding, &c., disinfected. Bodies received at the Mortuary. Inquests held on Bodies. Inquests held on Fires. 1914 169,452 194 172 5 1915 361,879 199 176 9 1916 438,426 169 151 2 1917 295,144 234 213 1 1918 179,990 158 130 0 Average for previous five years 288,978 191 168 3 1919 207,935 170 150 4 Dr. F. J. Waldo, J.P., Coroner for London and Southwark, has kindly furnished me with the following list of places in the City which were the subject of Fire Inquests held by him during 1919:— 1919. Inquest held on Name of Premises. Date of Fire.  17th March 71 & 72, Aldersgate Street 2nd March, 1919. 22nd May 50, Fenchurch Street 12th May, 1919. 19th November 30, Michael's Alley, Cornhill 11th November, 1919. 16th December 9, Fore Street Avenue 6th December, 1919. In addition to the above the City Coroner personally inquired into 163 "nonfatal " City fires reported to him during the year. DISINFECTION OF CONVEYANCES AFTER CARRYING CASES OF INFECTIOUS DISEASE.—Two public conveyances, which had been used to convey patients suffering from infectious diseases to hospital, and one police litter used by verminous persons, have been disinfected at the City Disinfecting Station, Golden Lane, E.C. DISINFECTANTS.—As heretofore, all the disinfectants used in the Public Health Department were obtained through your Medical Officer of Health. They are used for the following purposes:— A. Deodorising and "denaturalizing" condemned meat, disinfecting public conveniences (urinals, &c.). B. Disinfecting roadways, street gullies, &c. C. Disinfecting premises, &c., after infectious disease, drain testing and sundries. 65 PRESERVATION OF BODIES OF UNKNOWN DEAD.—The De Rechter apparatus for the preservation of the dead, installed at the City Mortuary in March, 1909, was fully described in the Annual Report for that year. During the year under review three bodies were placed in the apparatus. SANITARY INSPECTIONS. The following is a Statement of the work of the Sanitary Inspectors in their several Districts during each month of the year:— Month. Premises inspected. Orders issued. Notices served. Improvements effected. WEST DISTRICT— Inspector F. J. Robbins. January 130 10 20 12 February 245 10 18 60 March Away—Sick-leave. April May 50 1 70 12 June 298 4 37 52 July 125 .... 6 32 August 240 .... 8 40 September 260 6 12 20 October 219 12 15 28 November 314 .... 4 42 December 320 6 7 48 Totals 2,201 49 197 346 MIDDLE DISTRICT— Inspector E. J. Simmons. January 97 6 6 18 February 247 8 26 55 March 256 5 16 44 April 240 3 8 14 May 247 3 10 15 June 282 5 8 38 July 230 2 3 30 August 191 2 5 24 September 210 1 3 20 October 284 5 12 33 November 288 3 8 42 December 364 0 10 38 Totals 2,936 43 115 371 EAST DISTRICT— Inspector W. H. Ralph. January 137 11 23 29 February 285 31 27 38 March 297 15 103 58 April 229 4 7 29 May 285 2 3 26 June 253 4 7 31 July 291 3 8 13 August 279 6 9 20 September 105 5 6 29 October 295 5 11 41 November 357 7 9 36 December 238 4 6 23 Totals 3,051 97 219 373 THE FOREGOING ARE SUMMARISED AS UNDER District. Number of inspections made. Orders issued. Notices served. Improvements effected. West 2,201 49 197 346 Middle 2,936 43 115 371 East 3,051 97 219 373 Totals 8,188 189 531 1,090 Average of previous five years 8,887 255 709 1,613 66 REGISTERED LODGING-HOUSES. Public Health (London) Act, 1891, Sec. 94. The Corporation, as the Sanitary Authority in the City, are required, under the provisions of Sec. 94 of the Public Health (London) Act, 1891, to make and enforce Bye-laws applying to houses let in lodgings or occupied by members of more than one family for the following purposes:— For regulating the number of persons and separation of the sexes. For the registration and inspection of such houses. For enforcing drainage, and promoting cleanliness and ventilation. For the cleansing and limewashing of the premises at stated times. For the taking of precautions in any case of infectious disease. The Bye-laws now in force in the City for this class of property were made by the Court of Common Council on 24th November, 1904, and confirmed by the Local Government Board on the 20th January, 1905. Unfurnished lodgings, when the rent is not less than 10s. a week, and furnished lodgings when the rent is not less than 12s. 6d. a week, are exempt from the operations of the Bye-laws. Particulars relating to the registered Lodging-houses in the City now on the Register are given in the accompanying table, together with the corresponding figures for 1900 :— REGISTERED LODGING-HOUSES. District. No. of Houses on Register. No. of Lodgers. No. of Tenements. Average No. of Persons per Tenement Cleansing Notices Served. 1919 1900 1919 1900 1919 1900 1919 1900 1919 1900 West 91 183 389 1,502 194 656 2.0 2.3 102 239 Middle 4 55 29 363 17 130 1.7 2.8 4 66 East 66 158 378 1,186 161 488 2.3 2.5 87 176 Total 161 396 796 3,051 372 1,274 2.1 2.6 193 481 These houses are periodically inspected, and in April of each year the owners are called upon to carry out a thorough cleansing of them, in accordance with the provisions of the Bye-laws. This necessitated the service of 193 Notices during 1919. 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 in these circumstances they are not subject to the Bye-laws for houses let in lodgings, or occupied by members of more than one family:— Name and situation of Artizans' Block Dwellings. No. of Tenements. One Room. Two Rooms. Three Rooms. Four Rooms. Five Rooms or more. No. of Inhabitants. WEST DISTRICT. Albion Buildings, No. 21, Bartholomew Close 10 22 Albion Buildings, No. 22, Bartholomew Close 10 24 Bartholomew House, Bartholomew Close 16 2 36 Dean Street Blocks, Fetter Lane— Block A 3 4 1 28 „ B 2 5 24 „ C 6 3 30 „ D 2 5 30 „ E 2 5 24 „ F 4 1 18 St. Ann's Chambers, Ludgate Hill 9 10 31 Bloomfield House, Snow Hill 22 1 1 42 Total 40 80 3 1 309 MIDDLE DISTRICT. Bridgewater House, Fann Street 12 11 City Buildings, Moor Lane 20 12 80 Total 32 12 91 67 Name and situation of Artizans' Block Dwellings. No. of Tenements. One Room. Two Rooms. Three Rooms. Four Rooms. Five or more Rooms. No. of Inhabitants. EAST DISTRICT. Harrow Alley and Stoney Lane— North Block 48 8 217 South „ 5 22 13 178 Prince's ,, 5 50 167 Queen's „ 5 40 5 j160 King's „ 8 16 16 158 Barker's Buildings, Catherine Wheel Alley, Bishopsgate 12 10 3 59 Total Two" Blocks" 35 186 45 939 These ten Blocks, contain 434 tenements, and are inhabited by 1,339 persons—an average of 3 08 persons to each tenement. COMMON LODGING-HOUSE, 116, MIDDLESEX STREET.—The above premises, which is known as the " Salvation Army Working Men's Hotel and Shelter," and is the only common lodging-house in the City, was opened on the 7th February, 1906. It was utilized during the war as a Soldier's Hostel, but is now again in use as a common lodging-house. The premises are periodically inspected and always found to be well kept and in a generally satisfactory condition. NEGLECT TO COMPLY WITH WATER-CLOSET BYE-LAWS. In accordance with the Bye-laws with respect to water-closets, &c., made under Section 54 of the City of London (Various Powers) Act, 1900, every person who shall intend to construct a water-closet, or to connect or disconnect any watercloset from any soil pipe or drain, shall, at least seven days before the work is to be commenced, deliver or send to the Corporation at the Guildhall, a plan showing the situation of such water-closet, drawn to scale, together with a section showing the proposed means of ventilation. Under Section 17, every person who shall offend against these Bye-laws renders himself liable to a penalty of £5 for every such offence, and in the case of a continuing offence, to a further penalty of 40s. for each day after written notice of this offence from the Corporation. Any infringement of such Bye-law is a serious matter and may lead to considerable trouble and expense to the owner of the property, inasmuch as it may necessitate the condemnation of a system installed in contravention of the Corporation requirements. One instance of neglect in this respect has occurred during the year under review, and the following is a resume of the facts:— 38, BARBICAN.—In the course of routine inspection it was learnt that a water-closet was in course of removal from one position in this building to another. No notice of this work had been given or plans deposited. A satisfactory explanation, however, was submitted by the Solicitor to the owner, and the work permitted to proceed. DRAINAGE PLANS.—In the course of the year, 254 plans were submitted with regard to proposed reconstruction of water-closets or drains in the City. Of these, 229 were approved, 14 revised and approved, and 11 not approved. STREET GULLIES.—The gradual substitution of properly trapped gullies for those formerly existing, has greatly reduced the number of complaints received of offensive smells arising from those appliances, especially in warm weather. In some cases this nuisance was doubtless due to want of flushing, but in the majority faulty construction was the cause of the trouble. The City Engineer has given special attention to this matter for several years past, and his action in replacing the old pattern gullies with those of a more up-todate design will, I hope, eventually lead to a complete abatement of the evil. 68 OVERCROWDING.—Overcrowding is a nuisance to be dealt with summarily under Section 2, Sub-section 1 (e), of the Public Health (London) Act, 1891, and during the year four cases were reported by your officers. On the service of the statutory notice of abatement the overcrowding was discontinued in each instance. SANITARY DEFECTS AND INFECTIOUS DISEASE.—In every case of notification of infectious disease, the premises involved were inspected with regard to the drainage system, water supply, ventilation, &c.; and of the 140 cases so investigated in 1919, it was found necessary to reconstruct the sanitary system in one instance, and to make amendments to soil and waste pipes, water-closets, &c., in 36 others. HOUSE, TRADE AND OTHER REFUSE REMOVAL.—The City Engineer informs me that the refuse removed from the City in 1919 consisted of 13,848 cartloads of street sweepings and slops, and 36,797 loads of house and trade refuse, a total of 50,645 loads. The total for the year 1918 was 52,036. The use of the Destructor was discontinued in September, 1905, since which date all refuse has been removed by barge from Lett's Wharf to the Corporation land on Hornchurch Marshes, where it is dealt with. The horse manure collected from the street orderly bins is not included in the above, but is dealt with by a contractor, who sells it to market gardeners and others. LEGAL PROCEEDINGS.—During the year 531 notices have been served by the District Inspectors at the order of the Sanitary Committee, and in one case only, i.e., 8, Mitre Street, was it found necessary, in consequence of non-compliance therewith, to refer the matters to the City Solicitor with a view to such steps being taken as he deemed necessary to ensure the required sanitary improvements being effected, and the costs thereof recovered. SUMMER FLUSHING OF COURTS.—There are 279 courts and narrow passages throughout the City which were regularly flushed during the summer months under the direction of the City Engineer, who informs me that in this service and the flushing of the main streets, no less than 47,911,122 gallons of water were used. Of these courts and alleys, 20 were flushed six times a week, 10 five times a week, 2 four times a week, 27 three times a week, 126 twice a week, and 94 once a week. Disinfectants are also freely applied where desirable. The condition of the approaches to Billingsgate Market and the Customs House, as heretofore, required special attention. There has always been a difficulty in keeping the thoroughfares in the immediate vicinity of these places free from the nuisance caused by the drippings from the fish carts, especially during hot weather. LIMEWASHING OF COURTS.—There are 89 courts and narrow passages situated in various parts of the City, the walls of which, unless cleansed frequently, become dirty and unsightly through the constant traffic of passengers or vehicles, together with the action of the smoke-laden atmosphere. These are cleansed or limewashed twice a year under the direction of the City Engineer. Of the places so dealt with during 1919, 24 were situated in the East District, 33 in the Middle District, and 32 in the West District. REMOVAL OF HUMAN REMAINS.—During the year only one instance of the disturbance of human remains in the City has been brought to my notice, and the following is a brief summary of the facts relating thereto :— 32 /33 Farringdon Street.—In the course of excavation in connection with the erection of a new building on the site of that previously known as 32 /33, Farringdon Street, a small quantity of human remains were unearthed. The bones were quite dry and not in an offensive condition. They bore evidence of having been disturbed on some previous occasion. They were re-interred on the site 69 FACTORY AND WORKSHOP ACT, 1901, &c. FACTORIES, WORKSHOPS AND WORKPLACES.—The premises upon the Register number 3,619, in which are included 7,596 workrooms, &c. There is a slight decrease in the number of premises on the Register. There were served 2,419 notices during the year for various purposes under the Acts. The number of Factories, Workshops and Workplaces at present Registered is as follows:— Premises. Workrooms, &c. FACTORIES 862 3,217 WORKSHOPS 1,796 2,911 WORKPLACES:- Kitchens of Restaurants, Tea Rooms, &c. 785 1,072 Stables 28 32 Other places 148 364 3,619 7,596 The following is a Summary of Inspections of separate workrooms, &c., during the year:— Workshop Inspectors. Women Inspectors. Totals. FACTORIES 995 7 1,002 WORKSHOPS 1,069 18 1,087 WORKPLACES 445 41 486 The following is a summary of Inspections of separate workrooms since 1914:— FACTORIES. Workshop Inspectors. Women Inspectors. Totals. 1914 3,025 237 3,262 1915 1,438 319 1,757 1916 1,264 406 1,670 1917 1,501 234 1,735 1918 904 3 907 1919 995 7 1,002 WORKSHOPS. 1914 2,053 658 2,711 1915 1,411 751 2,162 1916 1,224 799 1,960 1917 1,308 347 1,655 1918 783 11 794 1919 1,069 18 1,087 WORKPLACES. 1914 672 138 810 1915 512 164 676 1916 469 173 642 1917 760 124 884 1918 713 72 785 1919 445 41 486 BAKEHOUSES.—Bakehouses are scheduled as Workshops (Part 2, Sixth Schedule), and are required to be registered by the Local Authority (Section 132). Nos. 8 /14, King Street, Snow Hill, ceased to be used as a Bakehouse during the year. The following is a list of Bakehouses registered in the City:— ABOVE-GROUND BAKEHOUSES. † 280, Bishopsgate. †45, Fish Street Hill. †Great Eastern Railway Hotel. *61, Middlesex Street. †*85, Middlesex Street. UNDERGROUND BAKEHOUSES. 188, Aldersgate. 262, Bishopsgate. *4, Broadway. 8, Copthall Avenue. 15, Cornhill. †*67, Farringdon Street. *93, Fetter Lane. 48, Knightrider Street. †*37, Middlesex Street. *63 to 65, Middlesex Street. †*122, Middlesex Street. 3, Pancras Lane. †21, Stoney Lane. 68, St. Mary Axe. *75, St. Paul's Churchyard. 194, Upper Thames Street. SUMMARY. Above-ground bakehouses 5 Underground bakehouses 16 21 * These have been established at least 33 years. † Factory bakehouses (power is used). 70 SUMMARY OF WORK DONE UNDER THE FACTORY AND WORKSHOP ACT, 1901, AND THE PUBLIC HEALTH (LONDON) ACT, 1891, &c. INSPECTIONS. Men Inspectors. Women Inspectors. Special. Inspector Gathercole. East District. Inspector Dun worth. West District. Inspector Robinson. West District. Miss East District. Miss Wilkinson. Totals. Factories, Initial Inspections (Tenancies) l 11 74 ... l 86 Do. Initial Inspections (Workrooms) 3 26 149 ... l 179 Do. Periodical Inspections (Tenancies) 1 36 188 ... 4 229 Do. Periodical Inspections (Workrooms) 3 142 672 ... 6 823 Do. Re-inspections (Sanitary Works, &c., in hand) ... 10 314 ... 2 326 Workshops, Initial Inspections (Tenancies) 20 22 184 ... 1 227 Do. Initial Inspections (Workrooms) 45 24 263 ... 3 335 Do. Periodical Inspections (Tenancies) 6 108 366 ... 8 488 Do. Periodical Inspections (Workrooms) 9 168 560 ... 15 752 Do. Re-inspections (Sanitary Works, &c., in hand) 21 84 749 ... 1 855 Workplaces, Initial Inspections (Tenancies) 18 ... 2 ... 1 21 Do. Initial Inspections (Workrooms) 19 ... 2 ... 3 24 Do. Periodical Inspections (Tenancies) 220 ... ... ... 40 260 Do. Periodical Inspections (Workrooms) 424 ... ... ... 38 462 Do. Re-inspections (Sanitary Works, &c., in hand) 609 ... ... ... ... 609 Bakehouses, Inspections 27 ... ... ... ... 27 Do. Re-inspections (Sanitary Works, &c., in hand) 20 ... ... ... ... 20 DEFECTS FOUND. Factories, Workshops and Workplaces, &c.— Want of Cleanliness 78 65 120 ... 7 270 Want of Ventilation 4 8 16 ... 1 29 Overcrowding ... ... 6 ... ... 6 Want of Drainage of Floors ... ... ... ... ... ... Other Nuisances, &c. 42 74 150 ... 5 271 Kitchens Storage Cistern defective 4 3 ... ... ... 7 Accommodation for Refuse 2 4 ... ... 1 7 Accumulation of Refuse 5 3 ... ... ... 8 Sanitary Accommodation Insufficient (Tenancies) 1 ... 5 ... 1 7 Unsuitable (Do.) 1 1 17 ... ... 19 Defective (Do.) 58 23 215 ... 14 310 Do. (No. of Conveniences)* 83 43 331 ... 14 471 Not separate for Sexes (Tenancies) 11 ... 27 ... ... 38 Total Defects found 206 181 556 ... 29 972 DEFECTS REMEDIED. Factories, Workshops and Workplaces, &c.— Want of Cleanliness 92 5 100 ... 2 199 Want of Ventilation 5 ... 13 ... ... 18 Overcrowding ... ... 4 ... ... 4 Want of Drainage of Floors ... ... ... ... ... ... Other Nuisances, &c. 33 ... 161 ... ... 194 Kitchens Storage Cistern defective 2 ... ... ... ... 2 Accommodation for Refuse 2 ... ... ... ... 2 Accumulation of Refuse 3 ... ... ... ... 3 Sanitary Accommodation Insufficient (Tenancies) ... ... 2 ... ... 2 Unsuitable (Do.) 1 ... 14 ... ... 15 Defective (Do.) 26 5 164 ... 2 197 Do. (No. of Conveniences)* 37 9 316 ... 2 364 Not separate for Sexes (Tenancies) 7 ... 22 ... ... 29 Total defects remedied 171 10 480 ... 4 665 SPECIAL INSPECTION WORK Domestic Workshops—Inspections (Tenancies) ... ... ... ... ... ... Do. Initial Inspections (Workrooms) ... ... ... ... ... ... Do. Periodical Inspections (Tenancies) ... ... ... ... ... ... Do. Periodical Inspections (Workrooms) ... ... ... ... ... ... Do. Re-inspections (Sanitary Works, &c., in hand) ... ... ... ... ... ... Do, Defects found ... ... ... ... ... ... Do. ' Defects remedied ... ... ... ... ... ... * Figures not included in total defects found or remedied. 71 Men Inspectors. Women Inspectors. Special. Inspector Gathercole. East District. Inspector Dunworth. West District. Inspector Robinson. West District. Miss East District Miss Wilkinson. Totals. SPECIAL INSPECTION WORK—(continued). Outworkers' Premises, Inspections (Tenancies) ... ... ... ... 7 7 Do. Initial Inspections (Workrooms) ... ... ... ... 6 6 Do. Periodical Inspections (Tenancies) ... ... ... ... 1 1 Do. Periodical Inspections (Workrooms) ... ... ... ... ... ... Do. Re-inspections (Sanitary Works, &c., in hand) ... ... ... ... ... ... Do. Defects found ... ... ... ... ... ... Do. Defects remedied ... ... ... ... ... ... Offices, Inspections (Tenancies) ... ... ... ... 11 11 Do. Initial Inspections (Rooms) ... ... ... ... 11 11 Do. Re-inspections (Sanitary Works, &c., in hand) ... ... ... ... ... ... Do. Defects found ... ... ... ... 1 1 Do. Defects remedied ... ... ... ... ... ... London County Council (General Powers) Act, 1904, Inspections of Premises after Cleansing of Children ... ... ... ... 38 38 Do. Do. Re-inspections (Sanitary Works, &c., in hand) ... ... ... ... 5 5 Do. Do. Defects found ... ... ... ... ... ... Do. Do. Defects remedied ... ... ... ... ... ... Children Act, 1908 (Nurse Children), Inspection of Premises ... ... ... ... 9 9 Do. Do. Re-inspections (Sanitary Works, &c., in hand) ... ... ... ... 1 1 Do. Do. Defects found ... ... ... ... ... ... Do. Do. Defects remedied ... ... ... ... ... ... Underground Conveniences for Women, Inspections ... ... ... ... ... ... Do. Do. Re-inspections (Sanitary Works, &c., in hand) ... ... ... ... ... ... Do. Do. Defects found ... ... ... ... ... ... Do. Do. Defects remedied ... ... ... ... ... ... Railway Stations (Ladies' Rooms), Inspections ... ... ... ... 2 2 Do. Do. (Ladies' Rooms), Re-inspections (Sanitary Works, &c., in hand .... ... ... ... Do. Do. (Ladies' Rooms), Defects found ... ... ... ... 1 1 Do. Do. (Ladies' Rooms), Defects remedied ... ... ... ... ... ... Notification of Births Act, 1907, Visits ... ... ... ... 252 252 Number of Mothers attending City Shelter for advice at St Bartholomew's ... ... ... ... 261 261 Special Visits ... ... ... ... 82 82 OUTWORKERS. Lists received from City Firms 1,379 ... ... ... ... 1,379 Names and Addresses, &c., received from other Authorities 239 ... ... ... ... 239 Names and Addresses transmitted to other Authorities 12,581 ... ... ... .... 12,581 Notices served on Employers 1,775 ... ... ... ... 1,775 Letters written, &c 1,381 ... ... ... ... 1,381 Firms visited 150 ... ... ... ... 150 Workshops notified by H.M. Inspector 20 11 175 ... ... 206 General complaints received 5 12 13 ... 3 33 ACTION TAKEN. Matters referred to H.M. Inspector— Want of Cleanliness ... 5 12 ... ... 17 Want of Ventilation ... ... 2 ... ... 2 Overcrowding 1 ... 2 ... ... 3 Want of Drainage of Floors ... ... ... ... ... ... Failure to affix Abstract 5 25 60 ... ... 90 Other Nuisances 1 ... 2 ... ... 3 Action taken in matters referred by H.M. Inspector— Notified by H.M. Inspector 9 12 31 ... 10 62 Reports sent to H.M. Inspector 9 12 31 ... 10 62 Other matters 4 7 12 ... ... 23 Notices served— Factories—Intimation ... 8 31 ... ... 39 Statutory ... 1 18 ... ... 19 Workshops—Intimation 28 100 139 4 271 Statutory 14 34 108 ... ... 156 Workplaces, &c.—Intimation 97 ... ... ... 3 100 Statutory 32 ... ... ... ... 32 72 Men Inspectors. Women Inspectors. Special. Inspector Gathercole. East District. Inspector Dun worth. West District. Inspector Robinson. West District. Miss East District. Miss Wilkinson Totals. ACTION TAKEN—(continued). Orders required from Sanitary Committee 74 49 88 ... ... 211 Certificates for Cleansing issued by Medical Officer of Health 33 27 29 ... ... 89 Matters referred to District Inspectors 5 1 12 ... 2 20 Matters referred to Women Inspectors ... ... ... ... ... ... Matters referred to Workshop Inspectors ... ... ... ... 4 4 Cases reported for Legal Proceedings ... ... ... ... ... ... Legal Proceedings taken ... ... ... ... ... ... OUTWORKERS AND HOMEWORKERS.—The provisions of the Act relating to "Outworkers" were carried out as heretofore, and the lists of the names and addresses of workers receiving work from the City firms were duly received without the necessity of legal proceedings. In a number of cases employers neglected to keep lists at their premises and to send copies of the same to the Corporation as required by the Act. Notice in each case was served upon the offender and in all cases complied with. No case of infectious disease was reported in connection with premises occupied by outworkers in the City. In one instance a "contact" with a case of Diphtheria was reported. The necessary enquiries were made and suitable precautions taken. The following figures show the steady increase in the number of Outworkers notified:— Year. Number ot Lists received. Outworkers Employed in City. Outworkers Employed outside City. Total number of Outworkers. 1902 ... ... ... 17 3,752 3,769 (Note.—1st Notice issued to all employers at end of 1904.) 1905 576 236 7,891 8,127 1908 1,506 624 16,909 17,533 1911 1,515 656 16,405 17,061 1912 1,481 709 15,777 16,486 1913 1,523 718 16,025 16,743 1914 1,581 739 15,941 16,680 1915 1,589 807 15,444 16,251 1916 1,481 661 14,766 15,427 1917 1,366 602 13,319 13,921 1918 1,395 607 12,802 13,409 1919 1,379 688 12,581 13,269 73 THIS TABLE WAS ISSUED BY THE LOCAL GOVERNMENT BOARD BY REQUEST OF THE SECRETARY OF STATE FACTORIES, WORKSHOPS, WORKPLACES AND HOMEWORK. 1919. 1.—INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. (1) Number. Inspections. (2) Written Notices. (3) Prosecutions. (4) Factories (including Factory Laundries) 1,002 58 ... Workshops (including Workshop Laundries) 1,087 427 ... Workplaces (other than Outworkers' premises included in Part 3 of this Report) 486 159 ... Total * 2,575 644 ... 2.—DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. a) (2) (3) (4) (5) Nuisances under the Public Health Acts:—† Want of cleanliness 270 199 17 ... Want of ventilation 29 18 2 ... Overcrowding 6 4 3 ... Want of drainage of floors ... ... ... ... Other nuisances 293 201 3 ... Sanitary accommodation insufficient 7 2 ... ... unsuitable or defective 329 212 ... ... not separate for sexes 38 29 ... ... Offences under the Factory and Workshop Act:— ... ... ... ... Illegal occupation of underground bakehouse (S.101) ... ... ... .... Breach of special sanitary requirements for bakehouses (SS. 97 to 100) ... ... ... ... Other offences (excluding offences relating to outwork which are included in Part 3 of this Report) ... ... ... ... Total 972 665 25 ... *These figures indicate separate work-rooms inspected. †Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts 74 75 3. HOME WORK. NATURE OF WORK.* (1) OUTWORKERS' LIST, SECTION 107. OUTWORK IN UNWHOLESOME PREMISES, SECTION 108. OUTWORK IN INFECTED PREMISES, SECTION 109, 110. Lists received from Employers. Notices served on occupiers as to keeping or sending Lists. Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made (S. 110). Prosecutions (Sections 109, 110). Sending twice in the year. Sending once in the year. Failing to keep or permit inspection Failing to send lists. Lists.† Outworkers. Lists.† outworks. Contractors. Workmen. Contractors. Workmen. (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Wearing Apparel— making, &c. 1,178 2,926 8,513 19 17 89 1,775 cleaning and washing Household linen Lace, Lace Curtains and Nets Curtains and furniture hangings Furniture and Upholstery Electro Plate File making Brass and brass articles , Fur pulling (Furriers) 88 266 267 4 9 Cables and Chains Anchors and Grapnels Cart Gear Locks, Latches and Keys Umbrellas, &c. 52 17 383 Artificial Flowers 32 488 Nets, other than Wire Nets Tents Sacks Racquet and Tennis Balls Paper, &c., Boxes, Paper Bags 6 13 42 Brush making Pea picking Feather sorting Carding, &c., of Buttons, &c. Stuffed Toys \ Basket making Chocolates and sweetmeats Cosaques, Christmas Crackers Christmas Stockings, &c. Textile Weaving Total 1,356 3,222 9,693 23 17 98 1,775 Nil. Nil. Nil. Nil. Nil. Nil. Nil. Nil. a ?*/ an occupier gives out work of more than one of the classes specified in column 1, and subdivides his list in such a way as to show the number of workers in each class I _ , _ ^ . v 0_0jr,_f oiocc nmiu H,it tKp nntumrkpre chnnld hp assitmed in columns 3 and 4 (or 6 and 7) into their respective classes. A footnote should be added to show that this has been done. I of work, the list should be included among those in column 2 (or 5 as the case may be) against the principal class only, but the outworkers should be assigned in columns t he figures required in columns 2, 3 and 4 are the total number of the lists received from those employers who comply strictly with the statutory dutv of sending two I , , , ... __ . . . o „„mK«rc *c will hp twn li«st« fnr Parh pmnlovpr —m some previous returns odd numbers have been inserted. The figures in columns 3 and 1 will usually be (approximately) double of the number of individual outworkers I lists each year and of the entries of names of outworkers in those lists. The entries in column 2 must neossarUy benumbers, as there will be two lists for each employer " I whose names are given, since in the February and August lists of the same employer the same outworker s name will often be repeated. 4.—REGISTERED WORKSHOPS. Workshops on the Register (S. 131) at the end of the year. (1) Number. (2) Important classes of workshops, such as workshop bakehouses, may be enumerated here. General Workshops .... 2,890 Bakehouses (including Factory Bakehouses) 21 Total number of Workshops on Register .... * 2,911 •These figures indicate separate work-rooms inspected. Fact,ory and Workshop Act, 1901 (S. 132), requires the Medical Officer of Health in his Annual Report to the District Council to report specifically on the umce). 11 the Annual Report is presented otherwise than in print, it is unnecessary to include in the copy sent to the Home Office the portions which do not relate to factories, oi Aiarcn, i ju. 5.—OTHER MATTERS. Class. (i) Number. (2) Matters notified to H.M. Inspector of Factories Failure to affix Abstract of the Factory and Workshop Act (S. 133, 1901) 90 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but /"Notified by H.M. Inspector .... 62 not under the Factory and Workshop Act (S. 5,' 1901). I Reports (of action taken) sent to H.M. 1. Inspector 62 Other 23 Underground Bakehouses (S. 101) :— Certificates granted during the year Nil. In use at the end of the year 16 Date, 31s2 December, 1919. (Signature) Medical Officer of Health. administration of that Act in workshops and workplaces, and to send a copy of his Annual Report, or so much of it as deals with this subject, to the Secretary of State (Home workshops! workplaMS, or homework The duties of Local Authorities and the Medical Officer of Health under the Act of 1901 are deta.led in the Home Office Memorandum 76 MEDICAL EXAMINATIONS. In accordance with the Standing Order of the Court that no person shall enter the employ of the Corporation or any of its Committees without previously passing a medical examination to the satisfaction of the Committee having cognizance of the appointment, 44 persons were examined by the Medical Officer of Health during 1919, six of these persons were reported as physically unfit for office. Ten officers were also medically examined with a view to their retirement, all of whom were reported to be unfit for duty. I have the honour to be, Gentlemen, Your obedient Servant, Williams. Howorth. Medical Officer of Health for the City of London. Public Health Department, Guildhall, E.C. APPENDICES. page Appendix A—Street Lists of Mortality 78 „ B— „ „ Infectious Diseases 81 „ C—Register of Houses let in lodgings or occupied by members of more than one family 82 78 APPENDIX A.—STREET LISTS OF MORTALITY. STREET OR PLACE. No. of House Sex. Age. Date of Death. Cause of Death. Remarks. Albion Buildings 22 M 64 20th Oct. Bronchitis Aldersgate Street — M 13 2nd Sept. Fracture of Skull—fall from motor lorry. Accidental P.M. ,, ,, 79 M 1 month 26th July Congenital Syphilis ,, ,, 158 M 75 17th Oct. Heart Failure Aldersgate St. Station — M 64 6th Aug. Severe injuries—run over by train Inquest—Unsound mind. Aldgate—Aldgate Hotel — M 59 14th Nov. Strangulated Intestinal Hernia ,, Three Tuns Hotel — M About 44 5th Feb. Bron. Pneumonia ,, 26 F Newly born 15th Oct. No evidence to shew as to where, when or by what means the infant died Inquest. Amen Court 1 F 79 8th March Angina Pectoris America Square 14 F 2 years 5th March Gen. Tuberculosis Angel Court 6 M 76 12th Sept. Cancer of Stomach Artillery Lane 9 F 74 29th March Pneumonia—shock of accidental fall Inquest. 12 F 73 12th Feb. Acute Bronchitis ,, ,, 12 F 58 1st Jan. Carcinoma of Liver ,, ,, 18 M 15mo'ths 9th Nov. Diphtheria ,, ,, 26 M 70 26th May Bronchitis and Senile Debility ,, ,, 28 F 63 20th June Pul. Emphysema Australian Avenue 9 M 57 5th Dec. Angina Pectoris Bank of England — F 43 31st Dec. Cerebral Haemorrhage Barbican M 15 3rd Oct. Ruptures and fractures of various bones— Run over by motor P.M. Accidental. Barker's Buildings 19 F 87 22nd May Cerebral thrombosis—congestion of lungs ,, ,, 22 F 69 26th Nov. Senile Decay ,, ,, 25 F About 67 13th May Morbus Cordis Bartholomew Place 5 F 59 8th Dec. Drowned—throwing herself off London Bridge P.M. Billingsgate Market — F 49 3rd April Gin Peritonitis (Subscription room) Billiter Square 9 M 66 27th April Chronic Nephritis Bishopsgate 107 M 54 12th March Pneumonia and Erysipelas ,, 141 M. 30 mins. 14th Sept. Premature Birth ,, 214 F 73 25th Feb. Carcinoma of Lungs Blackfriars Stn. Met. Rly. — M 35 12th July Shock—run over by train P.M. Suicide, unsound mind. Bolt Court, Fleet Street 6 F 34 23rd Oct. Valvular Disease of Heart Cannon Street, Bush Lane House M 38 20th Dec. Pul. Tuberculosis Carter Lane 36 M 23 7th March Influenza and Pneumonia Chapel Place 1 F 76 17th March Bronchitis Cheapside 52 F 47 9th March Cancer of Uterus Circus, Minories 1 F 51 7th May Found drowned on 7th May Inquest. City of London Infirmary — M 28 23rd Feb. Influenza and Pneumonia ,, ,, — M 79 8th Jan. Senile Decay ,, ,, — F 65 16th Jan. Chronic Nephritis ,, ,, — F 75 4th Feb. Senile Decay ,, ,, — F 32 26th Feb. Phthisis ,, ,, — M 72 21st April Cerebral Haemorrhage ,, ,, — F 85 16th May Senile Decay ,, ,, — M 58 20th Aug. Rodent Ulcer Clark's Place 4 F 53 27th July Valvular Disease of Heart Clement's Lane 34 M 81 7th May Chronic Nephritis Cloth Fair 44 F 79 12th Feb. Chronic Bronchitis Coleman Street 2 F 16 16th Aug. Mitral Valvular Disease ,, ,, — M 53 1st Feb. Chronic Bright's Disease Found wandering Copthall Avenue 4& 6 F 59 14th April Valvular Disease of Heart Crown Office Row 5 M 27 18th July Pneumonia and Influenza Crutched Friars 23 F 79 3rd March Morbus Cordis ,, ,, 42 M 46 19th Nov. Subphreuic Abscess Currier's Row 12 F 77 2nd July Intestinal Colic Cutler Street M 58 18th Jan. Chronic Bronchitis Dean's St., Old Bailey 30 M 69 25th Sept. Cerebral Haemorrhage Dean Street, Fetter Lane 5a F 51 6th Feb. Ch. Endocarditis ,, ,, 6 M 74 18th Jan. Chronic Bronchitis ,, ,, 6f F 38 30th May Pulmonary Tuberculosis ,, ,, 8 M 60 10th Oct. Bronchitis ,, ,, 8a F 24 3rd Feb. Carcinoma Utteri Dorset Street 4 F 81 22nd Oct. General Peritonitis Duke Street, Aldgate 5 M 59 16th June Injuries—thrown under van Accidental—Inquest Eastcheap 4 M 64 27th Feb. Bursa of Leg Operation. Ellison Street 13 M 54 6th Jan. Heart Disease Exchange Buildings, Houndsditch 4 M 6 days 20th Nov. Atelectusis Farringdon Street 62 M 64 6th Dec. Bronchitis Fenchurch Street 21 M 48 28th April Carcinoma of Kidney and Lungs Fenton's Buildings 1 F 72 18th Feb. Acute Bronchitis Fleet Lane 29 F 65 2nd Jan. Bronchitis Fetter Lane 41 F 12 17th Feb. Double Pneumonia ,, ,, 40 M 2 mo'ths 5th Nov. Diarrhoea, etc. ,, ,, M 34 15th Dec. Gen. Paralysis of Insane Found Wandering. Financier Bldgs., Dean St. 56 M 50 29th Dec. Pulmonary Tuberculosis Fleet Street 114 M 30 1st May Tuberculosis of Kidney Fleur-de-lis Court 1 F 49 5th July Carcinoma of Breast George Yard, Lombard Hse 9/10 M 16 2nd Dec. Fracture of Skull—fall from chimney P.M. Accidental Gracechurch Street — M 57 1st Oct. Fracture of Skull—knocked down by motor-bus ,, ,, 79 STREET LISTS OF MORTALITY—continued. STREET OR PLACE. No. of House Sex. Age. Date of Death. Cause of Death. Remarks. Gracechurch Street 94 M 55 3rd June Morbus Cordis Graystoke Place 8 F 71 8th Oct. Morbus Cordis Great New Street 2 M 75 2nd Feb. Valvular Disease of Heart ,, ,, 2 F 62 9th Feb. Chronic Bronchitis Green Dragon Court 5 M 42 2nd March Influenza and Pneumonia Guildhall Yard — M 63 31st Aug. Organic Disease of Brain Harp Lane 23 F 56 17th July Morbus Cordis Harrow Alley 9 F 4 mo'ths 23rd Sept. Intersusception Hatton Court 1 F 50 21st July Carcinoma of Rectum Holborn Circus — F 45 14th July Syncope—fatty degeneration of cardiac muscle P.M. Natural. Hutchison Avenue 6 M 49 24th Jan. Chronic Bronchitis ,, ,, 7 M 78 21st Jan. Senile Decay Hutchison Street 4 F 70 23rd Nov. Morbus Cordis ,, ,, 19 M 53 5th Jan. Fatty Heart and Chronic Dyspepsia India Street 6 F 63 11th Sept. Cerebral Thrombrosis Tewin Street 19 M 68 8th Sept. Bronchitis King Street, Snow Hill Blomfield House — F 27 17th March Diabetes Mellitus King William Street — F 75 5th Aug. Valvular Disease of Heart Liverpool Street, Station — M 71 15th July Syncope—Atheroma of Boronary Arteries P.M. Natural. ,, ,, — M 38 7th Aug. Shock from Injuries—run over by train Inquest. ,, ,, — M 65 26th Nov. Shock from Injuries—run over by train P.M. Suicide. ,, ,, — M 28 31st Dec. Fracture of Skull—run over by engine Inquest. Accident. Lombard Street 21 F 58 14th Feb. Syncope—fainting attack, drowning in bath and scalds P.M. Inquest. Long Lane 71 M 47 9th Oct. Fatty Degeneration of Heart Lower Thames Street 77 F 61 4th Dec. Carcinoma of Arteries Martin's Lane 6 F 60 21st March Syncope—Pulmonary Congestion of of Larynx and Lungs and Influenza Bronchitis Found dead. Inquest. Natural. Middlesex Street 116 M 54 29th Nov. ,, ,, 123 F 36 28th July Pulmonary Tuberculosis ,, ,, 123 M 7 15th Dec. Run over by van P.M. Accidental. ,, ,, — M 80 1st Feb. Arterio Sclerosis Salvation Army Hostel Milk Street 5 F 11 hrs. 2nd Oct. Premature Birth Minories 56a F 39 2nd June Fall from window ,, 99 M 11 30th Oct. Diphtheria ,, 122 M 1 hour 12th Jan. Prematurity Mitre Court 3 F 15 m'ths 8th Dec. Dentition Convulsions Montague Court 4 F 71 22nd Feb. Heart Failure and Bronchitis ,, ,, 5 M 81 30th April Gangrene of both Feet Monument Street 45 F 54 4th Jan. Gen. Paralysis of the Insane Moorgate Street Station — M 45 12th July Fracture of Skull—fall down stairs P.M. Accident. New Street, Houndsditch 17 M 86 23rd April Arterio Sclerosis ,, ,, 23 F 79 10th Nov. Bronchitis ,, ,, 26 F 74 8th April Cerebral Haemorrhage ,, ,,,,, 29 F 61 2nd April Chronic Bronchitis New Bridge Street — M 56 19th Feb. Broncho-pneumonia Northumberland Alley 1 M 64 6th Dec. Bronchitis Paper Buildings 3 M 68 30th Sept. Internal Strangulation by a band ,, ,, 3 M 69 27th Nov. Cardiac Degeneration Princes Block, Stoney Lane 1 M 62 26th Nov. Diabetes Mellitus ,, ,, 30 M 85 24th May Cerebral Hæmorrhage ,, ,, 55 M 37 23rd July Rupture of Arterio Found dead. Queen's Block, Stoney Lane 12 F 68 16th Sept. Valvular Disease of Heart Queen's Court 2 M 11 m'ths 5th April Whooping Cough Queen Street 70 M 32 14th Nov. Chronic Nephritis and Influenza ,, ,, 90 F 4 months 28th Dec. Congenital Gastric Disturbance Queen Street Place 4 F 25 20th Oct. Influenza and Pneumonia Red Cross Street Fire Stn. — F 44 17th Feb. Chronic Bronchitis River Thames — F 40 8th Sept. Asphyxia from Drowning Inquest and P.M. ,, ,, — F 47 7th Nov. ,, ,, ,, ,, ,, ,, — M 42 23rd Dec. ,, ,, ,, ,, — M 49 15th April Suffocation—drowning Inquest. P.M. ,, ,, — M 52 28th May Asphyxia—drowning Inquest. Unsound mind. ,, ,, — M 14 26th June Asphyxia—drowning P.M. Accident. ,, ,, — M 31 30th July ,, ,, P.M. ,, ,, — M 18 13th Sept. ,, ,, P.M. Unsound mind. ,, ,, — F 46 16th Sept. ,, ,, P.M. „ ,, ,, ,, — M 45 2nd Dec. ,, ,, P.M. ,, ,, — M 42 23rd Dec. ,, ,, P.M. Inquest. St. Bartholomew's Hospital — M 60 20th Jan. Mycrocardial Degeneration P.M. ,, ,, — M 51 30th Jan. Chronic Bronchitis ,, ,, — M 25 12th Feb. Influenza and Broncho-pneumonia ,, ,, — M 22 15th Feb. Phthisis ,, ,, - M 60 13th Feb. Arterio Sclerosis ,, ,, — F 24 2nd March Pneumonia ,, ,, — M 4 5th March Broncho-pneumonia ,, ,, — M 62 1st Jan. Mycrocardial Degeneration ,, ,, — F 7 months 14th March Broncho-pneumonia ,, ,, — F 66 2nd April Heart Failure P.M. ,, ,, — M 22 5th April Influenza and Broncho-pneumonia ,, ,, — F 68 3rd May Abscess of Rectum ,, ,, - F 68 7th May Chronic Intestinal Obstruction ,, ,, — M 13 12th May Tuberculous Meningitis 80 STREET LISTS OF MORTALITY—continued. STREET OR PLACE. No. of House Sex. Age. Date of Death. Cause of Death. Remarks. St. Bartholomew's Hospital - F 17 21st May Asphyxia—under anaesthetic P.M. Misadventure. — M 58 2nd Oct. Diabetes ,, ,, - M 24 31st Dec. Acute Rheumatism St. Botolph, Aldgate - F 64 30th Dec. Intestinal Obstruction — M 79 29th June Senile Decay St. Helen's Place 10 F 73 6th March Carcinoma of Stomach St. Mary-at-hill 19 F 79 7th April Cerebral Haemorrhage St. Mary Axe 59 M 13 days 2nd May Acute Bronchitis St. Paul's Railway Station — M newly born 17th Feb. Syncope—inattention at birth Found dead in attache case. Shoe Lane 70-71 F 52 5th Aug. Sarcoma Uteri Simon Court 13 M 16 29th Sept. Pyo-nephrosis P.M. Sion College — M 7 days 26th Dec. Prematurity South Block, Stoney Lane 39 M 6 days 6th Oct. Inanition 2 M 69 13 th March Arterio Sclerosis Swan Street 8 M 3 24th March Gland Disease Inquest. Temple Gardens — F 80 18th Jan. Old Age Thavies Inn 17 F 49 1st July Gastro-enteritis ,, ,, 18 F 79 4th Aug. Senile Decay ,, ,, 18 M 57 27th Oct. Pleurisy Throgmorten Street 33 M 59 26th Feb. Shock—Fracture of Skull Trinity Square 15 F 23 24th Feb. Influenza and Pneumonia Union Court 12 M 43 15th July Asphyxia from Poisoning from coal gas P.M. Unsound mind Wardrobe Place 3 M 26 5th June Fatty Degeneration of Heart P.M. Watling Street — M 59 30th Nov. ,, ,, West Smithfield — M 36 20th Jan. Pulmonary Tuberculosis Found wandering. Whitefriars Street 25 M 62 23rd Nov. Valvular Disease of Heart Widegate Street 24 F 77 18th March Senile Decay Wood Street 76 F 36 19th Feb. Influenza and Pneumonia ,, ,, 97 M 16 3rd Dec. Chronic Suppurative Otitis Media Wormwood Street — M 41 23rd Feb. Leprosy and Pneumonia Found wandering. Y.M.C.A., London Bridge - M 28 14th Dec. Phthisis 81 APPENDIX B.—LIST OF INFECTIOUS DISEASE CASES OTHER THAN MEASLES AND TUBERCULOSIS, MALARIA AND PNEUMONIA, 1919. STREET LISTS.—Compiled from Notifications received. Street or Place. Number of House. Sex. Age. Disease. Date of Notification. Arthur Street 10 F 11 Diphtheria 18th January. Artillery Lane 18 M 1 3/12 ,, 4th October. ,, 18 F 3 ,, 6th October. ,, 23 F 6 ,, 11th October. Billiter Street 22 F 15½ ,, 16th July. Bishopsgate 107 M 54 Erysipelas 25th February. Cannon Street Fire Station F 20 Diphtheria 9th October. Cannon Street Hotel M 42 Erysipelas 23rd December. Cripplegate Street 1 F 13 Diphtheria 6th October. Devonshire Street 21 M 2 Scarlet Fever 21st April. Fenchurch Street 45 F 7 ,, 14th July Finsbury Circus 7, 8, & 9 M 15 ,, 3rd October. Fish Street Hill 16 F 11 Diphtheria 15th December. ,, 46 F 8½ 12th December. Gracechurch Street 22 M 2 3/12 ,, 4th November. Leadenhall Street 12 M 10 Scarlet Fever 1st November. ,, 101 M 12 ,, 17th December. London Wall Buildings 3 F 16 Diphtheria 9th December. Long Lane 81 M 3 Scarlet Fever 16th December. Mansell Street 21 M 5 ,, 13th July. Middlesex Stret, 11 M 1 9/12 Diphtheria 8th December. ,, 57 F 9 Scarlet Fever 23rd February. Minories 99 M 11 Diphtheria 21st October. New Broad Street 15 M 3 Scarlet Fever 24th November. New Bridge Street 6 M 10 Scarlet Fever 23rd December. New Street, Bishopsgate 3 & 4 M 1 9/12 Diphtheria 18th December. New Street, Gravel Lane 17 M 3 ,, 18th November. Newberry Street 14 M 8 ,, 20th November. North Block 25 F 4¾ Scarlet Fever 5th May. Queen Victoria Street 134 M 5 Diphtheria 8th September. St. Bartholomew's Hospital ... ... ... Diphtheria, 2 cases ; Scarlet Fever, 3 cases; Enteric Fever, 1 case ; and Polio myelitis, 1 case. South Block 8 M 6 Scarlet Fever 23rd March. Tokenhouse Yard 6 F 14 Diphtheria 28th November. Tudor Street 6 F 14 ,, 12th January. Water Lane 6 F 4½ Scarlet Fever 7th June. 82 APPENDIX C.—REGISTER OF HOUSES LET IN LODGINGS OR OCCUPIED BY MEMBERS OF MORE THAN ONE FAMILY. Situation of Premises. Name and Address of Landlord. Tenements. Lodgers. WEST DISTRICT. 11, Bartholomew Close A. Clevely, 11, Bartholomew Close Offices. 38, do. E. Haley, Jamaica Buildings, Cornhill 2 5 6, Bartholomew Place Veil, 6, Bartholomew Place One family. 20, Bride Lane A. Green, 24, Leysfield Rd., Shepherd's Bush Mrs. Hurrel, 5, Britton's Court 1 3 5, Britton's Court 1 6 1, Chapel Place Moravian Mission, 32, Fetter Lane 2 5 2, do. Do. do. 1 3 43, Cloth Fair Mr. C. Taylor, 6, Finsbury Square, E.C. 2. 3 8 44, do. Do. do. 1 4 45, do. W. & J. Biggerstaff, 59, West Smithfield 4 10 5, Currier's Row T. Simmons, 5, Currier's Row 2 4 6, do. A. Bedford, 6, Do. One family. 7, do. W. Bampton, 7, Do. One family. 12, do. R. Edwards, 12, Do. 3 4 13, do. Mr. Galler, 13, Do. One family. 4, Dorset Street E. King, 23, Whitefriars Street 1 1 5, do. H. Fenlon, 8, Tudor Street Empty. 7, do. E. King, 23, Whitefriars Street 3 9 10, East Harding Street Eyre & Spottiswoode 3 6 11, do. do. 3 7 12, do. do. 4 9 2, Evangelist Court Morris & Co., 99, Shepherdess Walk, City Road 2 4 1, Fenton's Buildings Thos. Matthews, 85, Ravensdale Road, Stamford Hill 2 4 2, do. do. do. 2 5 3, do. do. do. 3 6 42, Fetter Lane W. Read, 102, Fetter Lane 2 4 93, do. L. B. Hayward, 93, Fetter Lane 4 9 29, Fleet Lane Messrs. Watney, Combe & Reid, Stag Brewery, Pimlico 3 8 30, do. do. do. 3 9 31, do. do. do. 4 8 1, Great New Street Mrs. J. Barnsley, 1, Great New Street 5 8 2, do. do. do. 8 10 3, do. do. do. 7 8 13, do. Mrs. Lee, 12, East Harding Street 4 4 14, do. Mr. A. E. Walker, 14, Great New Street 3 10 15, do. Mrs. A. E. Castleneau, 15, Great New Street 8 9 16, do. J. Day, 16, Great New Street 3 5 20, do. F. Wilson, 51, Frankfort Road, Herne Hill 9 15 21, do. M. Guilty, 21, Great New Street 3 7 5, Green Dragon Court Smith, Oakley & Gerrard, 4 & 5, Charles Street, W. ... ... 6, do. C. Fleming, 6, Green Dragon Court 1 4 7, do. Smith, Oakley & Gerrard, 4 & 5, Charles Street, W. 1 4 6, Greystoke Place W. G. Cuss, 6, Graystoke Place 1 4 7, do. W. Read, 102, Fetter Lane 5 8 8, do. do. do. 3 7 9, do. do. do. 4 8 2, Gunpowder Alley T. Richardson, 2, Gunpowder Alley 1 5 7½, do. T. Townsend, 259, Essex Road, N. 2 6 8, do. do. do. 1 2 3, Hosier Lane H. Long, 3, Hosier Lane Rooms empty. 4, do. A. E. Liverton, 4, Hosier Lane Offices. 5, do. E. Fox & Burnett, 12, Abchurch Street Closed. 36, Hutton Street A. E. Reeves, 36, Hutton Street Empty. 25, Kinghorn Street W. B. Hallett, 11, Queen Victoria Street 3 6 25 a, do. do. do 2 7 1, Little Montague Court J. Madley, 1, Little Montague Court Empty. 2, do. do. 2, do. Empty. 54, Little Britain J. Boni, 54, Little Britain ... ... 79, Long Lane Robert Dyas & Sons, 63, Fore Street 3 5 80, do. L. M. Migliorini, 80, Long Lane One family. 82, do. Mrs. Fairhead, 82, do. One family. 86, do. E. Rees, 86, do. One family. 2, Middle Street L. Meluish, 2, Middle Street Empty. 3, do. do. do. Empty. 4 & 5, do J. Hull & Sons, Bartholomew Close 6 12 6, do E. Haley, Jamaica Buildings, Cornhill 3 4 20, do T. Green, 20, Middle Street One family. Carried forward 145 299 83 WEST DISTRICT—continued. Situation of Premises. Name and Address of Landlord. Tenements. Lodgers. Brought forward 145 299 1, Middlesex Passage J. Strugnell, 8, President Street, Goswell Road Not a living Rm 2 & 3, do. do. do Empty. 1, Montague Court Mrs. Joyce, 1, Montague Court 3 7 2, do. Mr. Hanlan, 2, do. 2 5 3, do. Mr. Long, 3, do. 4 4 4, do. do. do. 3 4 5, do. ... Mrs. Hutchins, 5, do. 2 7 6, do. Mr. F. J. Swain, 6, do. 1 4 7, Nevill's Court Moravian Mission, 32, Fetter Lane 1 6 8, do. do. do. 4 7 9, do. do. do. 3 8 10, do. do. do. 6 12 11, do. Goldsmiths' Co., Goldsmiths' Hall 4 8 12, do. do. do. 5 9 10, Newbury Street Heeps, Son & Neve, 4, Old Jewry Closed. 19/12/18. 11, do. do. do. Closed. 12, do. do. do. Closed. 10, New Street Square Herbert Mogridge, 10, New Street Square One family. 57, West Smithfield T. A. Allen, 57, West Smithfield 4 9 13, Wine Office Court Farebrother, Ellis & Co., 29, Fleet Street 2 4 14, do. do. do. 2 5 16, do. do. do. 1 4 17, do. do. do. 2 3 Total 194 405 Average number of lodgers to each occupied tenement: 2.0 Houses demolished:— 3, viz., 10, 11, & 12, Newbury Street. Tenement houses on register 91. Cleansing Notices served 102. MIDDLE DISTRICT. 1 & 2, Huggin Court City Parochial Charities Trustees, 3, Temple Gardens 5 11 9, Huggin Lane H. Belcher, 8, Martin's Lane, E.C. 5 5 10, do. H. Willis, 10, Huggin Lane 5 7 15, Swan Lane H. Postlewaithe, 15, Swan Lane 2 6 Total 17 29 Average number of lodgers to each occupied tenement : 1.7. Cleansing Notices served 4. Houses on Register 4. EAST DISTRICT. 7, Artillery Lane Clerk to Bishopsgate Institute, Bishopsgate 8 19 9, do. John Tharp, 9, Norton Folgate 6 14 20, do. A. Woolf, 20, Artillery Lane 2 9 21, do. Clerk to Bishopsgate Institute 4 7 10, Brushfield Street J. Shepherd, 106, Eastern Road, Brighton 2 5 12, do. Luke Cohen, 12, Brushfield Street 3 6 14, do. Clerk to Bishopsgate Institute 6 9 1, Circus Minories S. Moses, 65, Mansell Street 5 26 2, do. T. Shaw, 2, Circus Minories 2 8 3, do. W. Lewis, 3, do. 3 6 4, do. W .Wisdom, 4, do. 2 6 5, do. T. Grover, 5, do. 4 7 7, do. Claude M. Levy, 238, Bishopsgate 4 7 3, Crown Place, Aldgate ... W. Harper, 3, Crown Place 3 5 5, Duke Street Imbert Terry & Co., 28a, Basinghall Street 2 2 10, do. J. A. Britton, 16/18, Houndsditch 3 8 6, George Street, Minories B. Marks, 6, George Street 1 1 1, Hutchison Avenue A. J. Hollington, 8, Middlesex Street 1 3 3, do. B. Ereira, 3, Hutchison Avenue 1 1 4, do. Morris Cohen, 4, do. 2 3 6, do. M. Ferguson, 26, Finsbury Square 1 3 7, do. do. do. 1 2 Carried forward 66 157 84 EAST DISTRICT—continued,. Situation of Premises. Name and Address of Landlord. Tenements. Lodgers Brought forward 66 157 9, Hutchison Avenue Barnet Barnet, 9, Hutchison Avenue 1 1 10, do. C. Zeffice 10, do. 1 2 12, do. A. Cohen, 11, do. 3 4 13, do. B. Levy, 13, do. 3 5 14, do. P. Sugarman, 14, do. 1 1 21, do. A. Fuglar, 21, do. 1 1 22, do. B. Dubowski, 21, do. 3 3 23, do. J. Cronie, 23, do. 2 6 24, do. S. Ereira, 24, do. 2 2 25, do. L. Lazarus, 25, do. 1 1 26, do. Lewis Joseph, 26, do. 2 2 5, Hutchison Street J. Silver, 5, Hutchison Street 1 3 6, do. J. Solomon, 6, do. 2 6 10, do. I. Levy, 10, do. 2 5 12, do. N. Webber, 12, do 1 2 17, do. A. Cohen, 17, do. 1 3 18, do. A. Solomon, 18, do. 1 2 20, do. I. Edwards, 20, do. 1 4 Janes Bldgs., 2, Hutchison Street A. Blum, 3, Homerton Row, E. 3 7 12a, New St., Bishopsgate F. Wicks, 12a, New Street, Bishopsgate 1 2 14, New St., Gravel Lane J. Panyer, 14, New Street, Gravel Lane... 1 2 15, do. H. Norden, 15, do. 1 3 16, do. H. Lifman, 16, do. 1 2 22, do. B. Levy, 22, do. 1 3 23, do. E. Dickson, 23, do. 1 4 27, do. E. Marks, 27, do. 2 3 30, do. E. Hassan, 30, do. 3 6 32, do. E. Douglas, 32, do. 1 2 34, do. R. Cohen, 34, do. 2 4 40, do. M. Roche, 40, do. 2 4 1, Queen's Court,Vine St Claude M. Levy, 238, Bishopsgate 4 7 2, do. do. do. 3 10 3, do. do. do. 2 7 4, do. do. do. 2 10 3, Three Crown Court, Jewry Place Mr. Martin, 14, Seething Lane 3 5 4, Vine Street, Minories Claude M. Levy, 238, Bishopsgate 6 16 5, do. do. do. 6 18 17, Widegate Street A. Cohen, 17, Widegate Street 2 6 18, do. S. Franks, 18, do. 2 5 21, do. A. Field, 182, Hanbury Street 4 6 24, do. W. I. Crane, 25, Widegate Street 4 8 25, do. do. do. 3 6 2, Goodman's Yard Charrington Brewers, Mile End Road 2 5 5, Artillery Lane Clerk to Bishopsgate Institute, Bishopsgate 4 15 Total 161 376 Average number of persons to each occupied tenement: 2.3. Houses demolished or closed during 1919 Nil. Tenement houses on register 63. Cleansing Notices served 87. Drake, Driver Leaver, Ltd., Rosebery Avenue London, E.C. I.