AC434 LON 14 REPORT OF THE MEDICAL OFFICER OF HEALTH OF THE CITY OF LONDON FOR THE YEAR 1920. LONDON: Printed by Charles Skipper & East, 49, Great Tower street, E.C. 3. 1921. REPORT OF THE MEDICAL OFFICER OF HEALTH OF THE CITY OF LONDON For the Year 1920. LONDON: Printed by Charles Skipper & East, 49, Great Tower Street, E.C. 3. 1921. INDEX. page A. Annual Rateable Value 7 Anthrax—Infected Shaving Brushes 28 Area 7 Artizans' Dwellings 51 „ ,, —Birth Rate 52 „ „ —Record of Attendances at Baths 52 B. Bacteriological Examinations 26 Births 12 c. Cleansing of Persons Act, 1897 53 Common Lodging-House—116, Middlesex Street 56 Courts—Limewashing of 58 „ —Summer Flushing of 57 Cremations 29 D. Dairies. Cowsheds and Milkshops Orders 43 Density 7 Disinfection of Clothing prior to Export 53 Drainage Plans 57 E. Exhumation and Re-interment of Bodies at City of London Cemetery 28 F. Factory and Workshops Act, 1901 58 „ „ „ „ „ —Bakehouses—Aboveground 59 „ „ „ „ „ „ —Underground 59 „ „ „ „ „ —Factories 59 „ „ „ „ „ —Outworkers 62 „ „ „ „ „ —Summary of Work Done 60 „ „ „ „ ,, —Workplaces 59 „ „ „ „ „ —Workshops 59 Food Poisoning, Outbreak of 44 Food Supplies 30 „ „ —Condemned at Riverside Wharves 41 „ „ —Discharged at „ „ 39 G. Gullies, Street 57 H. Hairdressers' and Barbers' Shops 30 Housing 8 Human Remains—Removal from St. Alphage Church, London Wall 29 I. Ice Cream—Itinerant Vendors 43 „ „ —Sale and Manufacture of 43 Increase of Rent and Mortgage Interest (Restrictions) Act, 1920 54 Infant Mortality 12 „ Welfare 14 „ „ —Milk (Mothers and Children) Order, 1919 14 Infectious Diseases 14 „ „ —Diphtheria 17 „ „ —Influenza—Prevention of 17 „ „ —Notification of Infectious Diseases (London) Regulations, 1920 18 „ ,, —Public Health (Measles and German Measles) Regulations, 1915—Rescission Order, 1919 15 „ „ —Public Health (Acute Encephalitis Lethargica and Acute Polio-Encephalitis) Regulations, 1919 18 „ „ —Sanitary Defects 57 „ „ —Summary of Cases Notified 16 „ „ —Tuberculosis 18 „ „ — „ and the Spitting Habit 21 Introductory 7 L. Legal Proceedings 57 Lodging-Houses 55 INDEX (continued). M. Meat Inspection 30 „ „ —Aldgate Markets and Slaughterhouses 35 „ „ —Analysis of Supplies 31 ,, „ —Cold Stores 34 „ ,, —Importation 0of Meat from Argentine Republic to U.K. 33 ,, „ — „ „ „ Australia to U.K. 32 „ „ — „ „ „ Brazil to U.K. 33 „ „ — „ „ „ Canada to U.K. 32 „ „ — „ „ „ New Zealand to U.K. 32 „ „ — „ „ „ Patagonia to U.K. 33 „ „ — „ „ „ Rhodesia to U.K. 33 „ „ — „ „ „ South Africa to U.K.. 32 „ „ — „ ,, „ United States to U.K. 33 „ „ — „ „ „ Uruguay to U.K. 33 „ „ —Imported Meat—Amount Imported during the Year 30 „ „ —Leadenhall Market and City Shops 35 „ „ —South American Tongues 33 „ „ —Summary of Deliveries at Central Markets 37 „ „ — „ Unsound Meat Destroyed 36 „ „ —Tuberculosis 33 Medical Examinations 67 Milk (Mothers and Children) Order, 1919 14 Mortality—general 12 „ —Infant 12 Mortuary—Bodies Received, &c 53 „ —Cleansing of Persons Act, 1897 53 „ —Disinfection in Cases of Infectious Disease 53 „ — „ of Conveyances after Carrying Cases of Infectious Disease 53 „ — „ of Garments for Export to South Africa 53 „ —Preservation of Bodies of Unknown Dead 53 O. Overcrowding 57 P. Poisoning—Illness following Consumption of Food at Restaurant 44 Population 7 „ and Housing 8 Preservation of Bodies of Unknown Dead 53 Public Health (Milk and Cream) Regulations, 1912 43 R. Rat Repression 60 Rateable Value 7 Refuse Removal 57 Rent—Increase of Rent and Mortgage Interest (Restrictions) Act, 1920 54 Riverside Wharves—Food Condemned at 41 „ „ —Food Inspection at 30 s. St. Alphage Church, London Wall—Removal of Human Remains 29 Sale of Food and Drugs Act 41 „ „ „ „ —Results of Prosecutions 42 „ „ „ „ —Summary of Administrative Action taken regarding Samples not Genuine 48 „ „ „ „ —Summary of Articles Examined 46 Sanitary Defects and Infectious Diseases 57 „ Inspections 54 Shaving Brushes Infected with Anthrax 28 Smoke and Atmospheric Pollution 26 Staff 5 Statistics—Vaccination 8 „ —Vital 9 T. Turkish Baths—Towels 58 Y. Vaccination 8 Venereal Diseases 23 Vital Statistics 9 w. Water-Closet Bye-laws—Neglect to comply with 56 APPENDICES. Appendix A—Street Lists of Mortality 70 „ B— „ „ „ Infectious Diseases 72 „ C—Register of Houses let in lodgings or occupied by members of more than one family 74 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 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 Tcnbridge, Mrs. Jan., 1917 WOMAN SANITARY INSPECTOR. Wilkinson, Miss 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 Robinson, Ernest S. Feb., 1913 Fowler, George Henry Nov., 1920 SANITARY INSPECTORS AND MEAT INSPECTORS. Sharp, Owen, Senior Inspector May, 1892 Kklland, William C May, 1899 Mettam, Harry Aug., 1903 Davies, Thos. L. Dec., 1903 Bintcliffe,-Charles E. March, 1907 Matson, William S. Dec., 1910 Mitchenkr, William E. Dec., 1910 Jonbs, 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. Steggles, T. (General Duties at Mortuary) Dec., 1918 Powis, B. ( Do. do. ) Feb., 1920 Hastings, T. ( Do. do.) June, 1920 Collins, W. (Gatekeeper at City Mortuary) Nov., 1920 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 1920. To the Right Honourable the Lord Mayor, Aldermen and Commons of the Corporation of London. Public Health Department, Guildhall, E.C., June, 1921. My Lord Mayor and Gentlemen, I beg to present herewith the Report of the Medical Officer of Health of the Corporation of the City of London for the year 1920. INTRODUCTORY. The year has not been a particularly eventful one, and endeavours have been mainly directed towards overtaking arrears of work which accumulated as a consequence of the War, and ensuring that temporary concessions which were granted during the same period were terminated. The vital statistics contained in this Report are probably inaccurate so far as the calculated rates are affected. The population given is probably an under-estimate, but in view of the fact that an accurate record will be available during the present year it was not thought worth while undertaking any extensive enquiry to endeavour to obtain a more accurate basis of calculation. If there is an under-statement of population both the death and the birth rate will be too high. The greater error will be in connection with the death rate, inasmuch as there are debited against the City, records of deaths of many persons who possibly have no connection with the City, but who, having died outside London, have given London as their place of residence. The birth rate is more nearly approximated to accuracy since the births of City residents occurring outside the City boundaries are not accurately adjusted, and this will prove somewhat of a set-off against any calculation based on an under-estimate of the population. 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 (1920). City of London, Registration District, at night 18.01 persons to an acre. ,, ,, ,, ,, during the day *562.3 ,, ,, Registration London, at night 60.5 ,, ,, * 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 £39,829,883 on 6th April, 1920; whilst on the same date the corresponding rateable value of property in the City of London was £5,808,818, or about one-seventh of the whole County. POPULATION. The undermentioned figures are extracted from the Report of the Registrar-General on the Census of England and Wales, 1911 (County of London):— Area, Inhabited Houses. Population. Statute Acres. 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 the 3rd April, 1911. 8 For Registration, Parliamentary and Municipal purposes the boundaries of the City 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:— Imperial Census. City Census. Year. Night Population. 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 There is now only one registration district in the City. This comprises the City Area. and the population therein for the year 1920 is estimated as being 12,200. The Day Census taken in 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 taken. POPULATION AND HOUSING. No official approval has yet been received to the Hutchison Street Area Scheme, which was the subject of an Inquiry by the Ministry of Health in March, 1920. As regards the building proposals of the Corporation, some progress has been made, and at the date at which this Report is written I am informed by the City Engineer that concrete foundations have been put in for 634 houses, brickwork foundations of 220 houses have been completed, first-floor joists have been laid for 194 houses, 132 houses have been roofed in and 36 actually completed, of which the majority are in occupation. The roads and sewers for the whole of the north-west section of the site have been constructed. The Special Housing Committee and the Court of Common Council have at present under consideration the subject of whether the original scheme for the erection of 2,000 houses should be proceeded with, or whether a restricted scheme should not be Substituted, and, if so, the extent of the restriction. I have already directed attention to the fact that in the City the majority of houses not attached to warehouses or institutions have seen their best days, and unless some of the smaller areas are appropriated for building purposes, which is not practicable at the present day owing to restrictive legislation, it will be necessary for your Medical Officer of Health, as soon as the lack of housing accommodation is less acute, to take into consideration the desirability of reporting on some of the smaller areas. VACCINATION. Of the 471 births notified to the Vaccination Officers during 1920, 148 had been successfully vaccinated by the end of the year, 22 had died before the age for vaccination, and in no case was a child reported as insusceptible. Vaccination was postponed by medical certificate in 6 cases, 199 had removed into other districts, or the vaccinations were pending at the end of the year. There were 96 instances of conscientious objection. The Public Vaccinators performed 9 re-vaccinations during the year. 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. 1915 412 33.3 Nil Nil. 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 1919 460 23.7 - „ 10.0 0.7 50.6 15.0 Average previous 5 years 370 29.7 0.04 „ 8.5 0.6 46.9 14.2 1920 471 31.4 Nil „ 4.6 1.2 42.2 20.3 9 VITAL STATISTICS. In the subjoined table comparisons are made between the vital statistics as recorded in the City of London and those recorded in the Metropolis for the year 1920 and the previous five years. No reliable conclusions can be drawn from these comparisons, and they are inserted merely as matters of interest. CITY OF LONDON COMPARED WITH THE METROPOLIS FOR THE YEAR 1920 AND THE PREVIOUS FIVE YEARS. City of London. Birth Rate. Death Rate. Deaths of Children under 1 year to 1,000 Births. Violent Deaths, per cent. of Deaths Registered. Deaths from principal Zymotic Disease per 1,000 of the Population. Estimated Night Population (Imperial Census). Estimated Day Population (Corporation Census). City. Metropolis. City. Metropolis. City. Metropolis. City. Metropolis. City. Metropolis. 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 1919 13,893 377,931 9.6 18.3 14.4 13.4 108 85 10.4 5.9 0.29 2.37 Average previous five years. 14,875 374,477 8.4 19.2 16.6 15.5 115 99 7.3 5.7 0.35 1.44 1920 12,200 379,694 14.9 26.4 15.6 12.6 66 76 7.8 4.7 0.49 1.45 From the tables appended it will be noticed that the death rate for 1920 was 15.6 per 1,000 compared with 12.6 for the Metropolis as a whole. 10 (This Table is prepared in accordance with the requirements of the Ministry of Health.) VITAL STATISTICS OF WHOLE DISTRICT DURING 1920 AND PREVIOUS YEARS. Name of District: CITY OF LONDON. Year. 1 Population estimated to Middle of each Year. 2 Births. Total Deaths Registered in the District. Transferable Deaths.‡ Nett Deaths belonging to the District. Uncorrected number. 3 Nett. Number. ♦ 6 Rate. 7 of Nonresidents registered in the District. † 8 of Residents not registered in the District. † 9 Under 1 Year of Age. At all Ages. Number. † 4 Rate. 5 Number. * 10 Rate per 1,000 nett Births. 11 Number. 12 Rate. 13 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 1920 12,200 470 182 14.9 842 69.01 728 77 12 66 191 15.6 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 he 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 be 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.bv 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-Genera), 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. Tor 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 (J) below. The Medical 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 confihement 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, V. Vol.). 11 (This Table is prepared in accordance with the requirements of the Ministry of Health.) CAUSES OF, AND AGES AT, DEATH DURING THE YEAR 1920. 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 "non- "Residents " in institutions in the district' (b). All ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 16 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 and upwards. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. All causes Certified (c) 191 12 1 3 6 5 30 67 68 710 Uncertified ... ... ... ... ... ... ... ... ... ... 1. Enteric Fever 1 ... ... ... ... ... ... 1 ... ... 2. Small-pox ... ... ... ... ... ... ... ... ... ... 3. Measles 1 ... 1 ... ... ... ... ... ... ... 4. Scarlet Fever ... ... ... ... ... ... ... ... ... ... 5. Whooping Cough 1 1 ... ... ... ... ... ... ... 5 6. Diphtheria and Croup 1 ... ... 1 ... ... ... ... ... 10 7. Influenza 8 ... ... ... ... 1 1 4 2 12 8. Erysipelas ... ... ... ... ... ... ... ... ... 4 9. Phthisis (Pulmonary Tuberculosis) 20 ... ... ... ... 1 9 5 5 16 10. Tuberculous Meningitis ... ... ... ... ... ... ... ... ... 10 11. Other Tuberculous Diseases 2 ... ... ... 1 1 ... ... ... 5 12. Cancer, malignant disease 26 ... ... 1 ... ... 3 14 8 88 13. Rheumatic Fever 2 ... ... ... ... ... ... ... ... 6 14. Meningitis 1 ... ... ... ... ... ... 1 ... 7 15. Organic Heart Disease 17 ... ... ... ... ... 2 11 4 44 16. Bronchitis 15 2 ... ... ... ... ... 4 9 17 17. Pneumonia (all forms) 10 ... ... ... ... ... 3 6 1 72 18. Other diseases of respiratory organs 2 ... ... ... ... ... ... 2 ... 12 19. Diarrhœa and Enteritis 2 2 ... ... ... ... ... ... ... 9 20. Appendicitis and Typhlitis 1 ... ... ... ... ... 1 ... ... 14 21. Cirrhosis of I.iver 1 ... ... ... ... ... ... ... 1 4 21A. Alcoholism ... ... ... ... ... ... ... ... ... ... 22. Nephritis and Bright's Disease 5 ... ... ... ... ... ... 2 3 19 23. Puerperal Fever ... ... ... ... ... ... ... ... ... 4 24. Other accidents and diseases of Pregnancy and Parturition ... ... ... ... ... ... ... ... ... 1 25. Congenital Debility and Malformation, including Premature Birth 3 3 ... ... ... ... ... ... ... 24 26. Violent Deaths, excluding Suicide 12 2 ... 1 ... ... 6 2 2 64 27. Suicide 3 ... ... ... ... ... 2 1 ... 4 28. Other Defined Diseases 53 1 ... ... 2 2 4 12 32 246 29. Diseases ill-defined or unknown 4 1 ... ... ... ... ... 2 1 13 Totals 191 12 1 3 5 5 30 67 68 710 12 BIRTHS. During the year 1920, 470 births were registered in the City, 323 of which however, did not belong thereto. To the remaining 147 must be added the births of 35 children born to Citizens temporarily residing outside the City boundary. The number of births, therefore, on which the rate should be calculated is 182. The annual birth rate was 14.9 per 1,000 persons of all ages, compared with a quinquennial mean rate of 8.4 per 1,000. In the Metropolis the birth rate in 1920 was 26.4 per 1,000. MORTALITY. During the year under review, 842 deaths were registered in the District, including 728 persons dying in the City, but not belonging thereto. See Table, p 11, for details. Deducting these latter, 114 deaths remain, to which must be added those of 77 persons who died in Institutions in outside districts, where they were registered; the total, therefore, on which the City death rate is calculated is 191. The death rate for 1920 was 15.6 per 1,000 per annum of the population (the previous year being 14.4), whilst that for the whole of the Metropolis was 12.6. DEATHS FROM VIOLENCE.—Of the City deaths, 7.8 per cent. were caused by injuries or violence, as compared with 4.2 in 1918 and 10.4 in 1919. This is 0.5 above the average for the previous five years. PERCENTAGE Of REGISTERED DEATHS FROM VIOLENCE. Year. City of London. Metropolis. Per cent. Per cent. 1915 6.0 7.3 1916 9.9 4.0 1917 6.2 5.9 1918 4.2 5.6 1919 10.4 5.7 Average previous five years 7.3 5.7 1920 7.8 4.7 DEATH RATES, PER 1,000 PER ANNUM. Year. City of London. 96 Great Towns of England and Wales. Metropolis. 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 1919 14.4 13.8 13.4 Average previous five years 16.6 15.3 15.5 1920 15.6 12.5 12.6 The death rate from zymotic disease per 1,000 of the population was 0.49 compared with 1.45 in the Metropolis. The deaths from Phthisis correspond to a rate of 1.6 per 1,000 of the population, as compared with 1.05 in the Metropolis. INFANT MORTALITY. The deaths of children under one year of age were at the rate of 66 per 1,000 births, as against 75 for the whole of London. The table of infantile mortality on p. 13 shows the deaths of children under one year arranged according to monthly age periods. From this it will be seen that no less than 58.4 per cent. of these deaths occurred in the first month, 75 per cent. within the first three months, and 83.3 per cent. during the first six months of existence. The usual preventive measures have continued in force, and include the holding of a Mothers' Meeting weekly at St. Bartholomew's Hospital, where the weighing of children is undertaken and advice given to parents. In the case of illness assistance in obtaining medical advice is offered, and milk is distributed in necessitous cases. 13 (This Table is prepared in accordance with the requirements of the Ministry of Health.) CITY OF LONDON. INFANTILE MORTALITY DURING THE YEAR 1920. 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 6 ... 1 ... 7 2 1 2 ... 12 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... 1 ... ... ... 1 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis . ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... • •• ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... Convulsions 1 ... ... ... 1 ... ... ... ... 1 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... 1 ... 1 ... ... 2 Pneumonia (all forms) ... ... ... ... ... ... ... ... ... ... Diarrhœa ... ... ... ... ... ... ... ... ... ... Enteritis ... ... ... ... ... ... ... 1 ... 1 Gastritis ... ... ... ... ... ... ... ... ... 1 Syphilis ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... Suffocation (overlying) ... ... ... ... ... ... ... ... ... ... Injury at Birth 2 ... ... ... 2 ... ... ... ... 2 Atelectasis 1 ... ... ... 1 ... ... ... ... 1 Congenital Malformations ... ... ... ... ... ... ... 1 ... 1 Premature Birth ... ... ... ... ... ... ... ... ... ... Atrophy, Debility and Marasmus ... ... ... ... ... ... ... ... ... ... Other Causes 2 ... ... ... 2 ... ... ... ... 2 6 ... 1 ... 7 2 1 2 ... 12 Nett Births in the year legitimate 166 illegitimate 16 Nett Deaths in the year of legitimate infants 12 illegitimate infants 0 14 INFANT WELFARE. MILK (MOTHERS AND CHILDREN) ORDER, 1919. In accordance with the practice which has been in operation for a considerable number of years, the Corporation again authorised the expenditure of a sum of money for the provision of milk to necessitous nursing mothers, and dried milk for necessitous mothers who were unable to nurse their own children. This grant was not made as a direct result of public legislation, but was a voluntary grant made by the Corporation as a part of its Infant Welfare work. The Miik (Mothers and Children) Order, 1918, the forerunner of the one now in operation, came into force in 1918, and gave authorisation to expenditure on these lines. The Corporation at that time did not determine their original arrangement, but granted a separate sum under the powers thus conferred. Experience, however, has proved the desirability of meeting the expenditure incurred out of a common fund, and it has been decided that the future charges in this connection shall be paid out of a single grant and administered on lines conformable with the Milk (Mothers and Children) Order, 1919. The amount of money authorised to be annually expended is £300. INFECTIOUS DISEASES. Very few comments are necessary with reference to the incidence of infectious disease during the year 1920. Diphtheria was prevalent to the extent of 30 cases as compared with 21 in .1919. The number of Scarlet Fever cases was 37. Erysipelas showed an increase from two to five, and there was one case of Cerebro-spinal Meningitis. No case of Measles was notified, as compared with 18 notified in 1919. Chicken-pox was not so prevalent as in the previous year, in the proportion of six cases to 13. One case of Ophthalmia Neonatorum was notified. The percentage of cases removed to hospital was somewhat higher than in 1919. During 1920 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 57. No case of Small-pox, Cholera, Plague, Typhus, Enteric, Eelapsing, Continued or Puerperal Fever, Anthrax or Acute Polio-myelitis has 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 forwarded under Sections 55 and 56 of the Public Health (London) Act, 1891, and information as to the removal of patients to hospitals, infirmaries, &c.:— 15 NAME OF DISEASE. Number of Certificates received. Treated at Home. Removed to the Metropolitan Asylums Board Hospitals. Removed to the London Fever Hospital. Treated at other Hospitals and Infirmaries. Duplicate Certificates received. Diagnosis subsequently found to be incorrect. Net number of Cases. Small-pox ... ... ••• ... ... ... ... ... Diphtheria 34 ... 21 4 5 2 2 30 Scarlet Fever 37 ... 34 3 ... ... ... 37 Enteric „ 1 ... ... ... ... ... 1 ... Puerperal „ ... ... ... ... ... ... ... ... Erysipelas 5 5 ... ... ... ... ... 5 Cerebro-spinal Meningitis 1 ... 1 ... ... ... ... 1 Acute Polio-myelitis ... ... ... ... ... ... ... ... Ophthalmia Neonatorum 1 1 ... ... ... ... ... 1 Measles ... ... ... ... ... ... ... ... Rubella ... ... ... ... ... ... ... ... Malaria contracted abroad 1 1 ... ... ... ... ... 1 Pneumonia 10 6 ... ... 4 ... ... 10 Totals 90 13 56 7 9 2 3 85 Chicken-pox 6 6 ... ... ... ... ... 6 Totals 96 19 56 7 9 2 3 91 It will be seen from the foregoing that during the year, excluding Chicken-pox, 90 Certificates were received, including two duplicates and three 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 79, as compared with 41 last year; and, as stated, the number of cases of Scarlet Fever reported was 37. 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 1920 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 1915 112 94.6 5.4 1916 70 94.3 5.7 1917 51 94.1 5.9 1918 42 88.1 11.9 1919 41 90.2 9.8 Average for the five years 63.2 92.2 7.7 1920 74 91.9 8.1 THE PUBLIC HEALTH (MEASLES AND GERMAN MEASLES) REGULATIONS, 1915. RESCISSION ORDER, 1919. The Public Health (Measles and German Measles) Regulations, 1915, provided for the notification and treatment of Measles and German Measles. There was not a general acceptance of their value, and the Ministry of Health have now decided that the continuance of the requirement of notification is not the best method of dealing with the Measles problem, and have accordingly issued the above Order rescinding the notification Order of 1915. In a circular letter accompanying the rescinding Order, the Ministry of Health state that they wish it to be understood that it is not intended to impose any check on action which local authorities may take to combat mortality from Measles. The withdrawal of the Order still leaves the Local Authority free to organise its own methods in the matter. In the City a sum of money has been set aside to provide nursing assistance in complicated City cases, but so far there has been no necessity to make any demand upon the sum so allocated. 16 OASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1920. {The following table is prepared in accordance with the requirements of the Ministry of Health.) CITY OF LONDON. Number of Cases Notified. ♦Total Cases removed to Hospital. At all Ages. At Ages—Years. Under 1. 1 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 years and upwards. Small-pox — — — — — — — — — Cholera — — — — — — — — — Plague — — — — — — — — — Diphtheria 30 — 3 10 7 10 — — 30 Erysipelas 5 — — — — 2 3 — — Scarlet Fever 37 — 4 22 7 4 — — 37 Typhus „ — — — — — — — — — Enteric „ — — — — — — — — — Relapsing „ — — — — — — — — — Continued „ — — — — — — — — — Puerperal ,, — — — — — — — — — Polio-myelitis — — — — — — — — — Cerebro-spinal Meningitis 1 — — — — 1 — — 1 Pulmonary Tuberculosis 29 — — 3 3 12 10 1 24 Other forms of Tuberculosis — — — — — — — — — Ophthalmia Neonatorum 1 1 — — — — — — — Measles — — — — — — — — — Rubella — — — — — — — — — Malaria(contracted abroad) 1 — — — — 1 — — — Pneumonia 10 1 — — — 4 5 — 4 Totals 114 2 7 35 17 34 18 1 96 * Metropolitan Asylums Board Hospitals, London Fever Hospital, City of London Infirmary, St. Bartholomew's Hospital, City Police Hospital, &c. 17 PREVENTION OF INFLUENZA. In the early part of the year the Ministry of Health issued a Circular Letter and Memorandum respecting precautionary measures which it was considered desirable should be taken in advance of the appearance of any possible Influenza epidemic. The Memorandum set out certain administrative action, which included:— (1) Notification of medical practitioners. (2) The publication of precautionary posters. (3) The issue of precautionary leaflets. (4) The provision of skilled nursing in cases with complication. (5) The provision for medical treatment if the patient is not under the care of a doctor, and (6) Free distribution by the Local Authority of Influenza vaccine. With the approval of the Sanitary Committee a letter was addressed to medical men practising in the City, informing them that a supply of prophylactic vaccine would be kept at Guildhall, and stating that, although it did not appear necessary to make such extensive preparation in the City in respect of treatment and nursing as would be desirable in larger and more densely populated areas, appropriate action would be taken in respect of such as were reported as requiring either special treatment or nursing. A copy of the pamphlet of the Ministry of Health was distributed at all houses and offices in the City, and a supply given to the Head Masters of the schools for distribution to pupils with instruction to take them home to their parents. A poster was also prepared and circulated in places of business, and also exhibited in conspicuous positions throughout the City. The Sanitary Committee further authorised the expenditure of a sum of £30 in connection with the provision of medical assistance and nursing attendance. DIPHTHERIA. In the early part of the year the Metropolitan Asylums Board's accommodation for infectious diseases was severely taxed as a consequence of the large number of cases seeking admission, and although every effort was made to admit promptly all cases the Board were asked to receive, some little delay occurred in certain instances. The Board, when directing the attention of local authorities to the possibility of delay in admission to hospital of persons suffering from Diphtheria, called particular attention to the necessity in these circumstances of the prompt administration of anti-toxin in sufficiently large doses. From experience gained they were of opinion that recovery of patients was prejudiced by delay in the use of anti-toxin, and by its administration in doses which were altogether inadequate. Having regard to the importance of this point, the following letter was, with the approval of the Sanitary Committee, addressed to medical men practising in the City:— " Dear Sir, "The Clerk of the Metropolitan Asylums Board has directed the attention of the Corporation of London to the fact that at the present moment the demand for hospital beds for the treatment of Diphtheria is so considerable that occasional delay in the removal of patients arises as a consequence. The Medical Superintendents of the Asylums Board have directed attention to the fact that recovery of patients is prejudiced by delay in the use of anti-toxin and by its administration in doses which are altogether inadequate. "In these circumstances it is suggested that I should inform Medical Practitioners in the City that there is this probability of delay in removal of patients, and that they should therefore take steps to ensure that anti-toxin is administered as early as possible. "It may be of interest to state that the minimum commencing dose given in the Board's Fever Hospitals is rarely less than 8,000 units. " Yours faithfully, " Medical Officer of Health." 18 PUBLIC HEALTH (ACUTE ENCEPHALITIS LETHARGICA AND ACUTE POLIO-ENCEPHALITIS) REGULATIONS, 1919— GENERAL ORDER. The above-mentioned Order extends the operation of the Public Health (Acute Encephalitis Lethargica and Acute Polio-Encephalitis) Regulations, 1918, which required the notification by Medical Practitioners of cases of these diseases throughout England and Wales during 1919. This new Order requires the continuation of notification until the Ministry of Health otherwise directs. NOTIFICATION OF INFECTIOUS DISEASE (LONDON) REGULATIONS, 1920. The above Eegulations, which came into operation on the 1st May, 1920, extend the provisions of Section 55, Sub-section 4 of the Public Health (London) Act, 1891, to embrace those infectious diseases known as Acute Primary Pneumonia, Acute Influenzal Pneumonia, Malaria, Dysentery, Trench Fever, Acute Encephalitis Lethargica and Ophthalmia Neonatorum. It is now, therefore, necessary that a copy of each certificate or notification of cases of these diseases be sent to the Metropolitan Asylums Board within twelve hours after receipt by the Medical Officer of Health. The Metropolitan Asylums Board will repay to the Local Authority the fee usually paid in respect of such notification. TUBERCULOSIS. 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 204 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 244, 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 17 44 2 ... 19 44 Non-Residents— Working in the City 21 35 3 1 32 28 Not working in the City 68 48 5 ... 44 77 106 127 10 1 95 149 244 244 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 17 18 58 93 Disease of other Organs (Lungs not apparently affected) ... 3 10 13 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. 19 The undiagnosed cases are thus accounted for:— Residents:— Both are still under observation. Non-residents working in City:— Three are still under observation. One has ceased to attend in spite of letter requesting him to do so. Non-residents not working in City:— All are still under observation. 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 until arrangements had been made for their treatment locally, either at a dispensary in their area or otherwise This has worked satisfactorily, and under these provisions 121 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 208, divided thus:— Insured. Not insured. Totals. Residents 29 25 54 Non-residents—Working in City 54 29 83 Not working in City 30 41 71 208 Of these, 106 were new patients this year, while 24 attended for the first time in 1919, 27 for the first time in 1918, 15 for the first time in 1917, 12 for the first time in 1916, 22 for the first time in 1915, and two for the first time in 1914. TOTAL ATTENDANCES.—The number of attendances of patients at the Dispensary, including first attendances, was 2,587, divided thus:— Insured. Not insured. Totals. Residents 408 500 908 Non-residents—Working in City 804 363 1,167 Not working in City 182 330 512 2,587 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, 1920, was 188, divided thus:— Insured. Not insured. Totals* Residents 24 75 99 Non-residents—Working in City 52 22 74 Not working in City 6 9 15 188 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 33, divided thus:— Insured. Not insured. Totals. Residents 3 6 9 Non-residents—Working in City 7 10 17 Not working in City 2 5 7 33 Included in the above are two persons who were operated upon, 11 who were examined by X-rays, and five who received dental treatment. In addition to these a number of persons were seen by physicians attached to the Hospital. 20 PATHOLOGICAL EXAMINATIONS.—Specimens of sputum examined for the Tubercle Bacillus:— Positive 28 Negative 119 147 In addition to the above one other pathological examination was made. TREATMENT IN SANATORIA.—The number of patients who were recommended for admission to Sanatoria was 37, viz.:— Residents recommended to:— (a) London County Council 6, of whom 5 were admitted; for 1 (an advanced case) accommodation was not immediately available, hospital treatment was obtained through a voluntary agency. (b) London Insurance Committee 9, all of whom were admitted. (c) Voluntary Agencies 4, all of whom were admitted. Non-residents, working in the City, recommended to:— (a) London County Council 4, of whom 3 were admitted, the result in 1 case being unknown. (b) London Insurance Committee 8, all of whom were admitted. (c) Voluntary Agencies 2, both of whom were admitted. Non-residents, not working in the City, recommended to:— (a) London Insurance Committee 3, of whom 1 was admitted, the result in 2 cases being unknown. (b) Voluntary Agencies 2, both of whom were admitted. THE TUBERCULOSIS NURSE.—The work of the Tuberculosis Nurse has continued on the same lines as in former years. Of patients attending the Dispensary 72 have been visited at their homes and 700 visits were made in connection with after-care and following up. In addition nine patients have been nursed in their own homes, the nurse working under the direction of the practitioners attending the patients. Seven of these persons were in an advanced stage of the disease and four of them died at home, while one was admitted to a voluntary institution where she died. One, an ex-soldier, who was acutely ill, was removed to St. Bartholomew's Hospital, and later transferred to a sanatorium where he made a good recovery. For nursing purposes 123 visits were made. The following information is supplied in accordance with the requirements of the Ministry of Health. The paragraph numbers correspond with those in Circular 168, and where a number is omitted the subject matter does not concern City work :— (i.) The Tuberculosis Dispensary is at St. Bartholomew's Hospital; the Tuberculosis Officer is Dr. H. B. Gibbins; one Tuberculosis Nurse is engaged in the work. Treatment in residential institutions is provided by the London County Council and the London Insurance Committee. (iii.) Patients are referred to the Tuberculosis Dispensary from hospitals, school clinics and other institutions, with all of which there is close co-operation. The services of the Staff and all the resources of St. Bartholomew's Hospital are available for diagnosis and treatment. Many patients are referred to departments of the Hospital for these purposes. (iv.) The Tuberculosis Officer is in constant consultation and communication with general practitioners, so that there is close co-operation between them and the Dispensary. The London Insurance Committee request practitioners to provide reports periodically on insured patients under domiciliary treatment, and these are supplied. (v.) When the diagnosis is in doubt and the patient is under the care of a practitioner, arrangements are made with him for re-examination; in other cases arrangements are made with the patient, but should he fail to attend, either the Tuberculosis Nurse calls upon him or he is reminded of the appointment in writing. 21 (vi.) The Tuberculosis Officer explains to the patients the importance of the examination of home contacts, and in addition to the necessary visits of the Sanitary Inspectors the Tuberculosis Nurse visits the homes of City residents periodically for the same purpose, and arranges for the attendance of the contacts at the Dispensary at times convenient to them. Among City residents since the establishment of the Dispensary in 1914, the majority of adult contacts have been examined, and all except six of the infants and children of school age who are home contacts. The supervision of these contacts, and the re-examination of suspects among them, is secured by the home visits periodically made by the Nurse. (vii.) X-ray photographs of 11 patients have been taken during the year, and have proved of value as an addition to the usual methods of diagnosis. No special methods of treatment have been adopted in the Dispensary. Tuberculin is rarely used. (viii.) Experience shows that when the disease is active, residence in an institution more quickly and certainly brings about arrest than when treatment is attempted at home on sanatorium lines, and that the lessons learnt in the sanatorium are sometimes put into practice by the patient on his return home to his permanent advantage. (ix.) Dental treatment is provided by the Dental Department of St. Bartholomew's Hospital, and the Corporation defrays the whole or part of the cost of artificial dentures for necessitous cases. (x.) Nursing in their own homes of patients resident in the City is one of the duties of the Tuberculosis Nurse. Milk is provided for uninsured necessitous persons requiring extra nourishment. (xi.) Patients suffering from Non-pulmonary Tuberculosis receive advice and treatment from the Surgeons of St. Bartholomew's Hospital, to whom they are referred from the Dispensary. Treatment in residential institutions is provided by the London County Council and the London Insurance Committee. The Corporation has supplied surgical apparatus free of cost for necessitous residents in the City. (xii.) The arrangements for "care" and "after care" are carried out by a sub-committee of the Sanitary Committee, on which two ladies are co-opted members. It receives detailed reports on all cases of Tuberculosis occurring among City residents. (xiii.) No local arrangements exist for providing employment for patients. Ex-service men have been offered training in suitable trades in institutions approved by the Ministry of Pensions, but as this has involved absence from home no City resident has yet availed himself of the offer. (xiv.) No opportunity has arisen for the use of a shelter, but arrangements would be made for any suitable case if a site were available. (xv.) No special points have been noted as to the incidence of Tuberculosis; the records do not show that the disease is specially prevalent among any class of workers in the City. (xvi.) The usual methods for preventing the spread of infection are adopted, and pocket sputum flasks are provided free of cost. (xvii.) The principal difficulty encountered occurs on the discharge of a patient from a sanatorium with the disease arrested. The home environment to which he returns is often unsatisfactory, suitable occupation near his home may be practically unobtainable, even when remuneration is not the main consideration, and the very considerable benefit gained is in some cases soon lost and the treatment in the sanatorium largely wasted. CONSUMPTION—SPITTTNG.—The objectionable habit of spitting in the streets and other public places, and also the corridors of large buildings occupied by a number of different firms, is still a source of nuisance, and during the past year the demand for copies of the precautionary notice issued by the Corporation drawing attention to this practice has necessitated a reprint of such notices. These notices, which in the past were supplied on enamelled tin, have in the interests of economy been reprinted on stiff card, and are distributed to bonâ-fide applicants. 22 TUBERCULOSIS. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary of Notifications during the period from the 1st January to the 31st December, 1920, in the City of London. Age-periods Notifications on Form A. Notifications on Form B. † Number of Notifications on Form C. Number of 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 Total Primary Notifications. Under 5 5 to 10 10 to 16 Total Primary Notifications. Pulmonary Males — — 1 — — 1 4 3 5 5 — 19 23 — — — Nil. Nil. Nil. 9 „ Females — — 1 1 1 1 4 1 — — 1 10 22 — — — „ „ „ 7 Non pulmonary Males — — — — — — — — — — — — — — — — „ „ „ — „ „ Females — — — —- — — — — — — — — — — — — „ „ „ 1 Col. (1) (2) (3) (4) (5) (6) (7) (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 have been included among the "pulmonary" returns only. All notifications on Form D have been 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 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, have been included in these columns. Col. 14. The object of this column is to show the extent to which duplicate notification of the same case occurs on Form A, and all notifications on Form A, whether duplicate or not, are 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, have been 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, have been included in this column. Col. 21. Only notifications on Form C made by the Medical Officers of Sanatoria, as defined in the Tuberculosis Regulations, have been entered in this column. 23 VENEREAL DISEASES. In the last Annual Report the fact that the Centre for the Treatment of Venereal Diseases required reorganisation and extensions was commented upon. Progress has been made in this direction, and a full scheme with estimates has been submitted to the Sanitary Committee. The matter is at present the subject of conference between the Ministry of Health and the Committee. I also referred last year to the increased contribution to. the Hospital Authorities, and during the year under review the cost of the Centre was £2,925, as compared with £2,100 in the previous year. At the beginning of the year 933 males and 324 females were registered on the books as receiving treatment, which compares with 273 males and 123 females in the previous year. Of these patients 367 males and 145 females were under treatment for Syphilis, and 526 males and 168 females for Gonorrhoea. New patients admitted during the year totalled 1,053, as compared with 861 previously. The ailments from which these new patients suffered were as under:— Syphilis. Gonorrhœa. Soft Chancre. Conditions other than Venereal. Male. Female. Male. Female. Male. Female. Male. Female. 298 129 469 199 ... ... 32 6 I have already directed attention to the difficulty which is observed in the treatment of cases of Syphilis, that patients do not continue sufficiently long under treatment to ensure that the disease is certainly cured. 91 men and 20 women discharged themselves before completing the course of treatment, and 95 men and 29 women completed the treatment, but ceased attendance before final tests were applied. The total number of attendances at the Clinic was 21,689, which 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. 6,556 3,864 ... ... 8,882 2,349 32 6 15,470 6,219 A few beds are provided at the Institution for in-patiept treatment, and the number of days of such treatment totalled 416. In the laboratories associated with the Institution 6,005 specimens were examined. Of these 4,307 were examined at the Centre and 1,688 at an approved laboratory. 76 examinations were made for Spirochetes and 2,697 for Gonococci. 3,172 examinations for the Wassermann reaction were undertaken. As regards the places of residence of patients coming under treatment, it is reported that patients resided in the following Counties :— London 979 Essex 25 Hertfordshire 14 Middlesex 12 Surrey 11 Kent 5 Hampshire 4 Buckinghamshire 3 The substitutes for salvarsan used, the number of doses of salvarsan substitutes which constitute a course, the nature of the tests applied in deciding as to the discharge of the patient are set out in the attached table. 24 RETURN RELATING TO ALL PERSONS WHO WERE TREATED AT THE TREATMENT CENTRE AT 20, GOLDEN LANE, DURING THE YEAR ENDED 31st DECEMBER, 1920. Syphilis. Soft Chancre Gonorrhœa. Conditions other than Venereal. Total. Males. Females. Males. Females. Males. Females. Males. Females. Males. Females 1. § Number of persons who, on the 1st January, 1920, were under treatment or observation for:— (See notes on p. 25.) 367 145 3 ... 526 168 37 11 933 324 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 298 129 ... ... ... ... ... ... 298 129 Soft chancre only ... ... ... ... ... ... ... ... ... ... Gonorrhœa ... ... ... ... 469 119 ... ... 469 119 §Syphilis and soft chancre ... ... ... ... ... ... ... ... ... ... §Syphilis and gonorrhœa 22 19 ... ... 22 19 ... ... 44 38 §Gonorrhœa and soft chancre ... ... ... ... ... ... ... ... ... ... §Syphilis, soft chancre and gonorrhœa ... ... ... ... ... ... ... ... ... ... Conditions other than venereal ... ... ... ... ... ... 32 6 32 6 Total—Item 2 298 129 ... ... 469 119 32 6 799 254 Total—*Items 1 and 2 665 274 3 .•• 995 287 69 17 1,732 578 3. § Number of persons who ceased to attend the out-patient Clinic (a) before completing a course of treatment for 91 20 ... ... 323 87 ... ... 414 107 (b) after completion of a course of treatment, but before final tests as to cure of (See notes on p. 25). 95 29 ... ... ... ... ... ... 95 29 4. †Number of persons transferred to other Treatment Centres after treatment for (See notes on p. 25.) 26 10 ... ... 25 15 ... ... 51 25 5. §Number of persons discharged from the out-patient Clinic after completion of treatment and observation for:— (See notes on p. 25.) 48 17 ... ... 186 48 ... ... 234 65 6. §Number of persons who, on the 1st January, 1921, were under treatment or observation for:— 405 198 3 ... 461 137 69 17 938 352 Total*—Items 3, 4, 5 and 6 665 274 3 ... 995 287 69 17 1,732 578 7. §§Total attendances of all persons at the out-patient Clinic who were suffering from:— 6,556 3,864 ... ... 8,882 2,349 32 6 15470 6,219 8. Aggregate number of "In-patient days" of treatment given to persons who were suffering from:— 48 15 ... ... 320 30 ... 3 368 48 For detection of For Wassermann 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 76 2,645 C.S.F. 1 1,592=4,317 C.F.T. 3 (b) Specimens from persons attending at the Treatment Centre which were sent for examination to an approved laboratory ... 51 C.S.F. 5 1,580=1,688 =6,005 C.F.T. 1 § 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, so far as Syphilis, Soft Chancre and Gonorrhœa are concerned. † These persons should not be included in Items 3 (a) or 3 (6). §§ These figures should include all attendances made by patient?, 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. 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. Bucks. Hants. 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 398 10 5 5 4 2 l 2 427 †Soft chancre ... ... ... ... ... ... ... ... ... †Gonorrhœa 550 12 7 6 7 2 2 2 588 Conditions other than venereal 31 3 ... 1 2 1 ... ... 38 Total 979 25 14 12 11 5 3 4 1,053 B. § Total number of attendances at the outpatient Clinic of all patients residing in each area 21,428 100 37 32 49 20 10 13 21,689 C. § Aggregate number of "In patient days " of all patients residing in each area 371 20 19 5 1 ... ... ... 416 D. Number of doses of Salvarsan substitutes given in the:— 1. Out-patient Clinic 3,408 90 42 66 33 18 6 11 3,674 2. In-patient Dept. 16 ... ... ... ... ... ... ... 16 to patients residing in each area. E. Give the names of Salvarsan substitutes used in the treatment of syphilis and the usual initial and final doses Billon. Silver 606. Intra-muscular 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 97%. 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. V21.) E. W.R. every 3 months. After completion of a course for 2 years. Supervision monthly for 1 year after last course. Gonorrhœa. M.T.— i.e. 3 tests at intervals, cultures and slides from urethra and prostate after massage. C.F.T. urethroscope examination. Females— 3 tests, cultures and slides from urethra, cervix and Bartholin's glands after menstrual period. 25 February llth, 1921. KENNETH 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. † If a persou 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 (6) 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. Attention is drawn to the accompanying Memorandum (V21) which was prepared by the Ministry of Health for the guidance of the Medical Officers of V.D. Treatment Centres in December, 1919. 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 incases 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, with negative Wassermanu 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 te ts 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. 26 Form 2 sets out the annual return of pathological examinations made at St. Bartholomew's Hospital in connection with the various patients who came under treatment. The costs of this work are included in the annual contribution paid to the Hospital. Form 2— Annual Return from Pathological Laboratories.— All pathological examinations made in the St. Bartholomew's Hospital Laboratory, 20, Golden Lane, during the year ending on the 31st December, 1921, relating to persons residing in the Counties and County Boroughs as set out below:— Nature of Test. r of Tests. For detection of spirochetes For Treatment Centre London. Essex. Herts. Middx. Surrey. Kent. Bucks. Hants. 76 ... • • • • • • • • • ... ... ... For Practitioners • • • • • • ... • • • ... ... ... ... For detection of gonococci For Treatment Centre 2,539 60 10 8 8 12 4 4 For Practitioners 51 ... ... ... ... ... ... ... For Wassermann reaction For Treatment Centre 1,534 20 8 12 12 3 1 2 For Practitioners and St. Bart's. 1,580 ... ... ... ... ... ... ... Other examinations For Treatment Centre C.S.F. 1 ... ... ... ... ... ... ... C.F.T. 3 ... ... ... ... ... ... ... For Practitioners C.S.F. 56 ... ... ... ... ... ... ... C.F.T. 1 ... ... ... ... ... ... ... Total 6,005 February 9th, 1921. N. S. BONARD, Pathologist. 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 29.2 per cent.of these cases. Result. Specimen. Disease suspected. Positive. Negative. 19 Swabbings from throats Diphtheria 6 13 5 Sputum Tuberculosis 1 4 Of the 19 swabbings from throats, 10 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. SMOKE AND ATMOSPHERIC POLLUTION. Eleven 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. 27 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 at the Archbishop's Park, Lambeth, by the London County Council are added. Summary of Monthly Observations and Reports during the Year 1920. Month of the Year 1920. Place. 3 4 5 6 7 8 9 10 11 12 Rainfall in millimetres. Metric tons of deposit per square kilometre during month. Insoluble matter. Soluble matter. Total solids. Included in soluble matter. Tar. Carbonaceous other than tar. Ash. Loss on ignition. Ash. Sulphate as (SO3). Chlorine (CI). Ammonia (NH3). January City of London 49 0.06 2.18 3.52 0.98 3.33 10.07 1.51 0.73 0.08 Lambeth 60 0.09 2.27 2.79 0.72 3.78 9.65 1.44 0.70 0.06 February City of London *- - - - - - - - - - Lambeth 16 0.09 0.98 1.29 4.10 1.93 8.39 0.99 0.29 0.05 March City of London 33 0.07 3.30 5.15 0.79 2.75 12.05 1.06 0.81 0.14 Lambeth 31 0.12 3.36 4.82 1.56 3.50 13.35 1.66 0.42 0.10 April City of London 69 0.02 2.81 3.98 0.83 3.86 11.50 1.21 0.57 0.11 Lambeth 67 0.15 1.96 2.32 1.94 4.52 10.89 2.47 0.75 0.15 May City of London 12 0.02 2.15 3.29 0.79 1.83 8.08 0.51 0.41 0.10 Lambeth 13 0.16 2.79 4.88 1.20 2.29 11.32 0.77 0.67 0.35 June City of London 40 0.04 2.82 3.66 1.61 2.73 10.86 0.70 1.65 0.22 Lambeth 33 0.11 2.87 6.84 2.18 3.38 15.38 0.32 1.66 0.06 July City of London 79 0.04 3.51 4.30 1.26 4.73 13.83 1.41 2.07 0.22 Lambeth 88 0.18 3.46 4.98 0.93 3.37 12.92 1.23 1.80 0.11 August City of London 44 0.01 1.84 2.51 1.05 2.27 7.79 0.57 1.02 0.09 Lambeth 46 0.12 1.34 1.62 1.19 1.21 5.48 0.51 0.79 0.04 September City of London 65 0.08 4.53 4.43 2.32 6.97 18.33 3.04 2.60 0.34 Lambeth 83 0.36 5.48 12.55 1.66 3.06 23.11 1.36 1.20 0.12 October City of London 31 0.09 3.07 4.24 1.14 3.68 12.22 1.56 0.73 0.13 Lambeth 26 0.09 9.23 1.42 1.38 3.28 15.40 1.55 0.72 0.12 November City of London 25 0.09 2.63 3.74 1.29 3.69 11.44 1.66 0.70 0.18 Lambeth 23 0.12 1.97 3.26 2.32 4.07 11.74 2.22 0.69 0.13 December City of London 50 0.09 3.54 1.84 2.19 4.78 14.78 2.10 1.17 0.24 Lambeth 49 0.77 3.57 4.06 2.41 3.53 14.74 2.53 0.80 0.17 * There were no returns during February, the standard gauge being under repair. The foregoing table shows the rainfall for the months of January to December of the year 1920, 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 2.56 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. 28 In examining the foregoing table it will be appreciated that in the month of September only the amount of deposit registered as falling in the City amounted to 18.33 tons per square kilometre, which is equal (estimating the City as having an area of one square mile) to no less than about 47 tons avoirdupois. Of this mass of dirt, approximately 23¾ tons were soluble, and included the chemicals mentioned, and 23¼ 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 January until the 31st December the amount of the impurity at noon has varied from half a milligramme to six milligramme's 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. Work in connection with the supervision of infected shaving brushes has continued during the year under review. This has mainly been in the direction of ascertaining whether certain brushes were still stored and encouraging destruction in bulk. So far over 13,000 brushes have been destroyed, and it may interest other Medical Officers of Health to know that the pattern numbers of such brushes were as follows:— 5238, 1736, 5024, 7065, 9011, 9013,1223, 1224, 1224a, 5907. A suggestion was made during the year that certain brushes, presumablv of Japanese origin, were being displayed for sale on stalls and barrows in the City. Continued observation, however, has failed to justify this suggestion, and the observations of the Inspector, with like results, extended also to stalls and barrows which he noted outside the Citv boundaries. In another case brushes, not of Japanese origin, were mistaken for such brushes, but as no identification mark was available, specimen brushes were taken in a few instances and submitted to bacteriological examination with negative result. Japanese shaving brushes are now prohibited by Order from entering this country, either by direct or circuitous route, and the Ministry of Health have issued a Letter to all Medical Officers of Health describing the course of action which should be taken. It seems futile to disinfect brushes subsequent to manufacture, as no method would appear to be available on which complete confidence could be based without exposing the brush to risk of such damage that it becomes unsaleable. With suitable qualification and warning the Circular. Letter referred to describes a method of partial disinfection, namely:— (a) Thoroughly wash brush with soap and warm water containing a little washing soda, then allow to stand for half-an-hour in warm water containing a little soda. (b) Place in a warm solution of formaldehyde (one part of 40 per cent. formalin and 16 parts water— a 2½ per cent. solution of formaldehyde) for half-an-hour. (c) Allow to dry. EXHUMATION AND RE-INTERMENT OF BODIES AT THE CITY OF LONDON CEMETERY. During the year the bodies of seven persons buried at the City of London Cemetery at Ilford have been exhumed. Six of these were re-interred in other parts of the same cemetery, and one was removed to Nunhead 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 your Medical Officer of Health. 29 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:— ST. AT PHAGE CHURCH, LONDON WALL.— On the 21st April, 1920, I received from the Home Secretary a copy of a Licence authorising the removal of all human remains interred beneath St. Alphage Church, London Wall, with the exception of those of Sir Rowland Hayward, late Lord Mayor of London. One of the conditions attaching to the Licence was that the removal was to be effected under my supervision and to my satisfaction. Exhumations were commenced on the 7th June, and in all 78 cases, 33 of which contained lead coffins and 45 loose bones, were removed from the site and re-interred at the City of London Cemetery at Ilford. The work was completed on the 18th August. From the condition in which the majority of the bones were found it would appear that the site had been previously excavated. CREMATIONS IN THE UNITED KINGDOM. 36 Years—1885-1920. 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 1 ... ... ... ... ... ... ... ... ... ... ... 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 1 ... ... ... ... ... ... ... ... 445 1902 275 81 20 54 13 2 1 5 ... ... ... ... ... ... 451 1903 143 92 24 35 18 1 5 158 1 ... ... ... ... ... 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 1 ... 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 1920 149 203 80 69 30 18 32 851 72 26 58 32 20 156 1,796 Totals 4,696 3,248 979 1,118 495 211 337 9,501 751 336 582 307 220 715 23,496 * "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. 30 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. The following is a list of those proprietors at present on the Register:— Walter Hartley, trading as the Army and Navy Toilet Club, 35, Bucklersbury. Kingston and Hubbard, 8 and 10, Ludgate. Chas. Lehman, 8 and 9, Aldermanbury Postern. Martin Longman, 75, Mark Lane. Thos. W. Monk, 5, Angel Court. Marsh and Priner, 36, Coleman Street. Pierre Pozzi, 16, Lawrence Lane. Harry G. Wicks, trading as Arthur and Co., 42a, Old Broad Street. The Hairdressers' establishments formerly conducted at No. 3, Mason's Court, 60, Fore Street, and 39, Basinghall Street, have been discontinued. FOOD SUPPLIES. No new action of an administrative character has been operative during the past year. Your Medical Officer of Health has served on a Departmental Committee appointed to consider the question of meat inspection, and the Report of this Committee will shortly be issued. The following Report is submitted by Mr. T. Dunlop Young, your Veterinary Surgeon. IMPORTED MEAT FOR THE YEAR 1920.— According to the Board of Trade Returns, the total weights of the various descriptions of frozen and chilled meat imported into the United Kingdom during the past four years, and the values of the 1920 arrivals, were as follows, viz.:— From 1917. 1918. 1919. 1920. Australia 80,191 tons. 28,888 tons. 69,044 tons. 154,743 tons. New Zealand 99,768 „ 84,715 „ 121,209 „ 197,305 „ Argentine 157,098 „ 135,717 „ 242,128 „ 364,808 „ Uruguay 13,014 „ 13,375 „ 21,322 „ 41,774 „ United States 46,906 „ 179,179 „ 42,809 „ 11,233 „ Other Countries 36,231 „ 47,462 „ 31,842 „ 40,552 „ Totals 433,203 tons. 489,336 tons. 528,354 tons. 810,415 tons. Comparison 1920-1919. Increase or Decrease. Import Value 1920. Value Per Ton. Australia 85,699 tons. £12,575,209 £81 New Zealand 76,096 „ 16,278,809 82 Argentine 122,680 „ 33,842,101 93 Uruguay 20,452 „ 3,807,627 91 United States 31,576 „ 1,124,367 100 Other Countries 8,710 „ 3,887,031 96 Totals 282,061 tons. £71,515,144 £88 The importations of beef, mutton and lamb from all sources in 1920, viz., 810,415 tons, valued at £71,515,144, greatly exceeded those of any other year in the history of the trade, the highest figures previously recorded being an aggregate of 720,661 tons in 1913, and a valuation of £48,590,200 in 1919. 31 Analysis of Supplies. Chilled Beef. Frozen Beef. Frozen Mutton. Frozen Lamb. Fresh-killed Beef. Mutton. Cwts. Qrs. Carcases. Carcases. Cwts. Cwts. Argentina 960,397 3,120,820 918,171 294,152 — — Australia — 483,076 3,035,650 1,441,224 — — Brazil — 193,542 — — — — Canada — 90 — — — — Continental — — — — 3,238 58,222 New Zealand — 418,002 4,043,006 1,927,663 — — Patagonia — — 598,894 166,146 — — United States — 59,820 — — — — Uruguay 54,104 533,665 46,149 7,710 — — Other Countries — 62,475 8,339 25 — — Totals 1,014,501 4,871,490 8,650,209 3,836,920 3,238 58,222 Summary of Supplies of Beef, Mutton and Lamb. Home Grown. Fresh-killed. Chilled. Frozen. Total. Tons. Tons. Tons. Tons. Tons. Beef 788,190 162 50,727 442,205 1,281,282 Mutton and Lamb 250,790 2,911 — 317,485 571,186 Totals 1,038,980 3,073 50,725 759,690 1,852,468 Of the above 34,562 tons were re-exported. SMITHFIELD MARKETS.— It will be observed from the following table, kindly supplied by the Clerk and Superintendent, that the gross weight of foodstuffs deposited in the Markets (not including fish) was 365,920 tons, an average of over 1,000 tons for every day throughout the year, or, if non-working days are excluded, an average of about 1,500 tons per day. Home supplies represented only 21 per cent., being a decrease of 13.2 per cent. compared with 1919. The proportion of home-killed for the whole of the country is estimated at about 56 per cent. Analysis of Supplies at Smithfield in 1919-1920. Source of Supply. Beef and Veal. Tons. Mutton and Lamb. Tons. Pork and Bacon. Tons. Poultry, Game, &c. Tons. Total. Tons. 1919. 1920. 1919. 1920. 1919. 1920. 1919. 1920. 1919. 1920. United Kingdom 66,261 51,465 23,186 16,728 1,902 5,531 15,431 15,110 106,780 88,834 Australia and South Africa 11,724 15,860 47,166 103,320 16 76 4,343 5,499 63,249 124,755 South America 68,361 118,059 16,362 10,610 1,195 3,048 138 66 86,056 131,783 North America 28,265 4,148 69 139 4,752 4,371 4,350 2,334 37,436 10,992 Other Countries 343 1,794 — 8,295 11 2,210 1,169 2,257 1,523 9,556 Totals 174,954 191,326 86,783 134,092 7,876 15,236 25,431 25,266 295,044 365,920 GENERAL REMARKS.— The quality of the meat exposed for sale in the Markets has shown an improvement, due no doubt to the amount of old stock in cold stores being gradually cleared out and the new imported meat more quickly put on the market. There has been a reduction in the numbers of the "Telescoped" type of mutton carcases, with a corresponding decrease in the amount of mould-infected mutton condemned. Bacon of the "C'est la Guerre" type has apparently all been disposed of, and good Danish bacon become more plentiful. Dutch pork of the usual useful type has reappeared on the Market and been in great demand. United States of America pig carcases have arrived in considerable numbers and made good prices. For a short time Irish beef, produced on the same methods as the South American and Colonial big firms adopt, made its appearance on the Market; the meat was well dressed and showed a great improvement on the usual Irish method of handling meat and offals. Unfortunately, for some reason, the firm has temporarily closed its works, due, perhaps, to the unsettled state of Ireland. 32 Home-killed meat has been better in quality, but very scarce and very high in price. The large quantities of chilled meat that will arrive after control ceases will no doubt bring those high prices down, as few people will pay 2s. per pound for home-killed meat when they can purchase good chilled meat for half the price. Wholesale prices have gradually come down, but retail prices have not generally been reduced correspondingly, so that the public has not benefited to a great extent. There is still a considerable quantity of meat sent to the Markets from the country districts in such a condition that it is evident there does not exist any systematic system of supervising slaughterhouses or inspection of meat. It is strange that as pigs are so often affected with Tuberculosis causing great loss to their owners—and the cause is so well known, viz., the feeding with milk, and especially slime, from separators containing tubercle baccilli—some steps have not been taken to sterilise the food before it is given to the animals. In Denmark the fresh milk sent to the creameries is separated, the cream retained, the milk sterilised and returned and the slime destroyed. In the interests of the public and the owners of the pigs, it might be worth the attention of the Ministry of Agriculture to consider some legislation to compel sterilisation of pig food derived from milk. The following notes* show the animal statistics in the various countries from whence the Market derives the supplies which the Meat Inspectors have to supervise as to their fitness for human food:— UNITED KINGDOM. Cattle.—The total number recorded was 11,770,800, a reduction of 721,127, or 5.8 per cent. compared with 1919. The decrease was chiefly in cattle under two years of age, caused by a continuous control on beef but not on veal, with the result that the prices obtained for this article tempted farmers to sell calves instead of feeding them. Sheep.—The total number given was 23,407,100, showing a decrease of 1,712,120, or 6.8 per cent., due to a flat-rate price whereby it paid better to sell ewes than to keep them for breeding purposes. AUSTRALIA. The number of cattle is estimated at 12,286,000 head, being an increase of 286,000 compared with 1919. Sheep are reported to number 76,285,000, compared with 85,000,000 in 1919. The number of freezing works is given as 49, with a total capacity of 6,600 cattle, 60,000 sheep and 70,000 lambs per day. NEW ZEALAND. Cattle in this country are estimated to number 3,059,445, against 3,035,478 in 1919, or an addition of 23,967 head. The number of sheep is given as 23,914,506, a decrease of 1,914,048 compared with 1919. The number freezing works now number 45, with a combined freezing capacity of 4,000 cattle, 132,000 sheep and lambs per day. CANADA. In view of the agitation of the opening of the ports for the entrance of store cattle from Canada, it is interesting to note that the number of cattle in the Dominion is reported to be 9,477,380, against 10,085,011 in 1919. The decrease is stated to be due to heavy deliveries of cattle to the United States, which numbered 550,000, as compared with 249,000 in 1918. The number of sheep is reported to show an increase from 3,421,958 in 1919 to 3,720,783 in 1920. The amount of meat sent to us by Canada during 1920 was only 6,076 tons, and consisted mostly of boned beef, &c., thus Canada need not be counted as a source of imported meat supply. Fat cattle from the Dominion are now on the water. It will be interesting to watch if this trade, about to re-open, will continue. SOUTH AFRICA. The amount of meat imported from South Africa during 1920 was only 5,645 tons, compared with 19,942 tons in 1919. The Union has lately sent a Veterinary Officer to Argentina to study the meat trade and meat inspection there. He returned via London, and spent some time noting the quality and condition of meat arriving from other countries. It would appear that the breeders and feeders require educating as to the type of cattle necessary, and the dressing of the carcases leaves much to be desired in order to secure a good name in Smithfield. The number of freezing works is stated to be 20, with a capacity of 850 head of cattle per day. The latest live stock returns (1919) show 5,575,488 head of cattle and 28,491,500 sheep in the Union of South Africa. * Partly extracted from Messrs. Weddel and Co.'s Report. 33 RHODESIA. The figures given are : cattle 1,331,284, and in South-West Africa 300,000. ARGENTINE REPUBLIC. The estimate numbers of cattle, sheep and pigs are 30,000,000, 60,000,000 and 4,500,000 respectively, as compared with 29,000,000, 55,000,000 and 2,900,000 in 1919. In the Province of Buenos Aires alone the number of sheep shows an increase of 2,864,000 in four years. URUGUAY. The latest figures given (in 1916) are: cattle 7,802,000 and sheep 11,473,000, but there is said to be a considerable increase since that year. There are three large freezing works, capable of turning out 1,000 tons per day. BRAZIL. The number of cattle in Brazil is estimated to be 30,705,400, and the sheep 10,549,930. In the region of Rio Grande the prospects are said to be good, and we may expect considerable quantities of good beef from there. The number of freezing works in Brazil is now increased to ten, with a killing capacity of 6,000 cattle per day. PATAGONIA. The number of sheep is not available, but the shipments during 1920 were the heaviest on record, amounting to 26,060 tons, compared with 18,295 tons in 1919. UNITED STATES. The latest estimate of live stock shows a decrease in both cattle and sheep. The figures given are: 66,191,000 cattle and 45,067,000 sheep. Only 11,642 tons of meat were landed here from the United States of America, against that we observe 44,000 tons of mutton and lamb were imported into the United States from New Zealand and 7,853 tons from the River Plate, so that we need not consider the United States of America a source of supply, although at present we are receiving a considerable number of frozen pig carcases, and it is proposed to re-open the exportation of live cattle to Britain. 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 5,040 430 5.0 B 65,880 53 .08 C 5,304 16 .30 D 1,380 Nil — E 5,040 16 .30 TUBERCULOSIS.— There is a considerable decrease in the amount of meat and offal seized under this heading. The decrease is apparently due to doubtful carcases which, under "Control," were sent to the Markets for decision as to their fitness for human food, being sent elsewhere. TUBERCULOUS MEAT SEIZED AT THE CENTRAL MARKETS DURING 1920. BEEF. PORK. VEAL. Carcases. Qtrs. Pieces. Carcases. Qtrs. Pieces. Carcases. Qtrs. Pieces. 1920 75 110 75 205 4 38 2 ... ... 1919 133 783 114 99 ... 13 13 ... 2 Increase ... ... ... 106 4 25 ... ... ... Decrease 58 673 39 ... ... ... 11 ... 2 OFFAL. Heads. Tongues. Lungs. Hearts. Livers. Stomachs. Spleens. Mesenteries. Intestines. Kidneys. 1920 164 162 80 35 86 6 22 7 ... 45 Oxen 708 ... 154 77 88 ... 1 8 ... 4 Pigs 1 ... 6 ... ... ... ... ... ... ... Calves 1919 260 212 123 ... 121 11 31 9 9 51 Oxen 190 ... 141 ... 73 ... 6 ... ... ... Pigs 4 ... 11 ... 7 ... 2 ... ... 4 Calves Total weight for 1919 56 tons, 11 cwts., 2 qrs., 14 lbs. „ „ „ 1920 38 „ 14 „ 3 „ 11 „ Decrease 17 tons, 16 cwts., 3 qrs., 3 lbs. 34 COLD STORES.— So far as I am aware, the number of cold stores in the United Kingdom is as follows:— In London. In the Provinces. No. Capacity. No. Capacity. *33 13,363,000 cubic feet 69 20,902,000 cubic feet Under construction 78,000 „ ,, Under construction 980,000 „ „ * 15 in the City area with a capacity of 25,000 tons. In addition, there is a large number of cold stores throughout the country, with a capacity of less than 100,000 cubic feet, not included in the above. In will be observed that the quantity of unsound food taken out of the cold stores is much greater than in 1919. This is accounted for by the clearance of stocks which had accumulated during the War, and which the owners, store proprietors and Inspectors could not examine, due to the "ship style" of storing. Much of the meat &c., was found unwholesome, due to moulds associated with decomposition. COLD STORES. Article. Number. How packed. Origin. Cause for destruction. Tons cwts. qrs. lbs. Bacon (Pieces) - - U.S.A. Moulds & Decomposition 0 1 0 27 Beef (Quarters) 295 - Various „ 29 7 0 20 ,, (Pieces) - Bags Australia „ 103 8 2 20 „ (Boneless) 66 „ ,, „ 1 9 2 11 „ (Crops) 103 - „ „ 2 17 1 5 „ (Tins) 144 Cases S.A. „ 0 7 2 24 Calves (Carcases) 30 - British „ 0 13 1 13 „ (Livers) 14 Cases „ „ 0 10 0 5 „ (Tongues) 56 Bags „ „ 1 9 0 12 „ (Stomachs) - Cases „ „ 0 3 2 0 Fish (Various) - Boxes „ „ 15 5 1 22 Fowls - - „ „ 0 4 1 17 Fruit (Tins) - Cases Australia „ 1 7 2 21 Game - - British „ 0 3 1 22 Glands 5 Boxes - „ 0 1 1 8 Hares 25 - British „ 0 0 3 8 Lambs (Carcases) 672 - Australia „ 13 2 0 21 „ (Hearts) 45 Bags „ „ 1 2 1 27 „ (Livers) 766 Cases „ „ 15 15 2 23 „ (Pieces) - - „ „ 4 19 1 3 „ (Plucks) 583 Cases „ „ 13 16 1 21 Mutton (Carcases) 3,897 - Argentine „ 87 18 1 23 „ (Pieces) - - „ „ 28 10 0 24 Ox (Cheeks) 10 Bags „ „ 0 6 1 6 „ (Diaphragms) 100 „ „ „ 2 11 1 20 „ (Hearts) 20 „ „ „ 0 18 3 20 „ (Kidneys) - Cases „ „ 2 7 2 19 „ (Livers) - „ „ „ 30 14 1 1 „ (Tails) 76 „ „ „ 1 16 1 24 „ (Tongues) 756 Bags „ Diseased 2 7 2 1 Ox Tongue (Tins) 22 Cases „ Decomposition 0 1 0 22 Peel 1 Cask - „ 0 2 0 23 Poultry (Various) 131 Cases British „ 9 12 3 1 Pork (Pieces) - - „ „ 0 7 1 7 Rabbits 3,478 Cases Australia „ 121 8 0 1 Plucks (Sheep's) 1,620 „ Argentine „ 40 9 2 6 Tripe - Boxes „ „ 1 14 2 20 Veal (Pieces) - - British „ 0 2 1 16 Venison (Pieces) - - „ „ 0 1 1 4 537 17 2 8 Total for the Year 1920 537 tons, 17 cwts., 2 qrs., 8 lbs. „ „ „ 1919 261 „ 17 „ 1 „ 3 „ Increase 276 tons, 0 cwts., 1 qr., 5 lbs. 35 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:— Article. Quantity. Article. Quantity. Apples (Tins) 60 Offal (Tongues—Ox) 4 Bacon (Sides) 3 „ (Hearts—Sheep) 204 Beef (Carcases) 1 „ (Hearts—Ox) 12 „ (Tins) 5,207 „ (Hearts—Pigs) 20 Black Game 15 „ (Lungs—Sheep) 138 Bloaters (Boxes) 36 „ (Lungs—Pigs) 20 Capercailzies 30 „ (Lungs—Ox) 62 Chickens 194 „ (Livers—Pigs) 20 Curlew 1 „ (Livers—Sheep) 70 Cheese (Cream) 196 „ (Livers—Rabbits) 120 Ducks 349 „ (Kidneys—Ox) 20 Eggs (In tins) 4 „ (Kidneys—Pigs) 2 „ (Fowls') 6,367 „ (Tails—Ox) 18 „ (Ducks') 814 „ (Tripe—Ox) 2 „ (Plovers') 160 Partridges 480 Fish (In tins) 3,432 Ptarmigan 958 Fowls (Various) 6,597 Pheasants 320 Fruit (Tins) 4,416 Pigeons 865 Game (Unclassified) 201 Plovers 156 Geese 142 Pork (Carcases) 6 Goats (Carcases) 95 „ (Pieces) 17 Grouse 161 Quail 406 Guinea Fowls 14 Rabbits 59,700 Hams 1 Salmon 28 Hares 513 „ (Tins) 2,695 Hazelhens 12 Sardines (Tins) 200 Lambs (Quarters) 1 Snipes 277 „ (Pieces) 2 Teals 85 Milk (Tins) ... 14,924 Turkeys 167 Mutton (Carcases) 8 Veal (Pieces) 12 „ (Quarters) 6 Venison (Carcases) 14 „ (Pieces) 33 „ (Pieces) 6 Offal (Boxes) 1 Widgeons 18 „ (Heads—Pigs) 12 Woodcocks 10 „ (Heads—Ox) 3 Total Weight for the Year 1919 83 tons, 3 cwts., 3 qrs., 7 lbs. „ „ „ 1920 81 „ 16 „ 0 „ 14 „ Decrease 1 ton, 7 cwts., 2 qrs., 21 lbs. ALDGATE MARKET AND SLAUGHTERHOUSES.— The control of the homekilled meat trade was removed in July and the killing of animals resumed. Foot and Mouth Disease, which has been prevalent throughout England, has restricted the movement of animals, so that only a small number have been killed at Aldgate. The following figures show the species:— 1920. 1919. Bulls 19 — Calves 13,332 10,644 Cows 10 3 Goats 62 110 Heifers (1,850 under two years old) 7,232 89 Oxen (288 under two years old) 5,866 856 Sheep 6,233 964 32,754 12,666 Of the heifers it is interesting and regrettable to note that 1,850 were under two years of age. As the price of store cattle is still very high, it is difficult to understand why those young females were sent to the butcher. It may be that the butchers offered more than the feeders, who probably anticipate a decrease in the price of home-killed meat after "Control" is taken off imported meat, for, doubtless, prices will come down as soon as " chilled meat " arrives in greater quantities on the Markets. 36 PERCENTAGE OF TUBERCULOUS ANIMALS FOUND. Animals Slaughtered. Affected. Whole Carcases Condemned. Bulls 19 2, or 10 per cent. 5.00 per cent. Calves 13,332 63, „ 4 „ .09 „ Cows 10 8, „ 80 „ 30.00 „ Heifers 7,232 31, „ 4 „ .07 „ Oxen 5,866 123, „ 2 „ .1 „ * Includes animals under two years of age. 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 ... ... ... ... 8 ... ... ... ... ... Emaciation and Hydræmia 1 ... ... ... ... ... ... ... ... ... Hydræmia ... ... ... ... 2 ... ... ... ... ... Immaturity ... ... ... ... 2 ... ... ... ... ... Injury ... ... ... ... ... 2 ... ... ... ... Joint Ill ... ... ... ... 1 ... ... ... ... ... Parasitic Disease and Pneumonia ... ... 1 ... ... ... ... ... ... ... Pleurisy and Pneumonia ... ... 1 ... 2 ... ... ... ... ... Pleurisy ... ... ... 7 ... ... ... ... ... ... Tuberculosis 8 ... ... ... 19 ... ... ... ... ... Totals for 1920 9 ... 2 7 34 2 ... ... ... ... Totals for 1919 ... 1 1 31 35 3 13 ... 1 ... RECORD OF ORGANS SEIZED AT ALDGATE FOR 1920. 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 ... ... 43 ... 195 2 ... ... ... ... 1 ... 41 ... 22 ... ... ... ... ... Actinomycosis 28 70 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cirrhosis ... ... ... ... 11 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Decomposition and Unwholesome 1 2 1 60 99 72 35 1013 1013 2 3 3 ... 25 33 4741 22 121 121 4 Distomatosis ... ... 9 ... 676 ... ... ... ... ... ... ... ... ... 71 ... ... ... ... ... Melanosis ... ... 8 ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... Nephritis ... ... ... ... ... ... ... ... ... 6 ... ... ... ... ... ... ... ... ... ... Pleurisy ... ... 303 ... ... ... ... ... ... ... ... ... 28 ... ... ... ... ... ... ... Pneumonia ... ... 266 ... ... ... ... ... ... ... ... ... 62 ... ... ... ... ... ... ... Parasitic Disease ... ... 347 1 267 ... ... ... ... ... ... ... 329 ... 380 ... ... ... ... ... Tuberculosis 101 36 107 ... 108 25 ... 44 44 29 ... ... ... ... ... ... ... ... ... ... Totals for year 1920 130 108 1084 61 1356 99 35 1057 1057 37 4 3 460 26 507 4741 22 121 121 4 Totals for year 1919 24 11 91 15 119 70 15 636 660 71 ... ... 251 55 172 1635 52 ... ... ... CALVES. GOATS. Abscess ... ... 13 ... 71 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Actinomycosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cirrhosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Decomposition and Unwholesome 16 16 160 115 249 21 88 9020 9020 ... ... ... ... 1 ... 1 ... 37 37 ... Distomatosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... Melanosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Nephritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pleurisy ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... Pneumonia ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... Parasitic Disease ... ... ... ... ... ... ... ... ... ... ... ... 3 ... 1 ... ... ... ... ... Tuberculosis 19 20 78 ... 84 16 ... 22 22 ... ... ... ... ... ... ... ... ... ... ... Total for year 1920 35 36 251 115 404 37 88 9042 9042 ... ... ... 6 1 3 1 ... 37 37 ... Totals for year 1919 65 52 292 97 278 38 95 6130 11631 74 13 13 23 17 15 26 15 67 79 26 Summary of Unsound Food Destroyed. Tons. cwts. qrs. lbs. Central Markets, Smithfield 1,439 3 2 5 Cold Stores 537 17 2 8 Leadenhall Market and City Shops 81 16 0 14 Aldgate Market and Slaughterhouses 82 19 2 1 Total for the year 1920 2,141 16 8 0 Total for the year 1919 2,068 18 3 0 Increase 72 18 0 0 37 UNSOUND MEAT.— The meat, &c., seized during the year by your Inspectors as unfit for food is classified as under:— 1920. 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 35 13 1 15 170 18 2 14 51 7 0 25 63 14 0 9 133 9 1 23 1 4 0 2 456 6 3 4 Second „ 24 8 1 11 270 18 1 10 25 9 1 0 143 15 3 22 117 16 0 27 1 1 3 21 583 10 0 7 Third „ 16 12 3 27 300 2 3 27 8 0 2 4 41 18 3 19 150 4 3 2 9 14 0 16 526 14 1 11 Fourth „ 23 17 1 5 344 7 0 19 10 10 0 16 90 1 0 13 67 16 3 27 0 6 2 16 536 19 1 12 Total 100 12 0 2 1086 7 0 14 95 7 0 17 339 10 0 7 469 7 1 23 12 6 2 27 2,103 10 2 6 CENTRAL MARKETS, SMITHFIELD. *Table showing the average deliveries at the Central Meat Market, and other details for successive quinquennial periods during the past 47 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 1919-1920 330,483 0 0 2,080 15 3 .629 *The sources of origin of the Central Markets Supplies during the past five years are here expressed in terms per cent. of the total annual deliveries. British. † Foreign Killed. American. Australian and New Zealand. Country Killed. Town Killed. Home Killed. American Killed.‡ Per cent. Per cent. Per cent. Per cent. Per cent. Per cent. 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 1920 17.6 6.7 2.6 - 39.0 34.1 † Includes "General Foreign Meat and Produce." ‡Includes South American imports. *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:— 1916. 1917. 1918. 1919. 1920. Tons. Tons. Tons. Tons. Tons. Average daily delivery into the Markets 1,077 922 688 964 1,192 ‡Minimum delivery on any one day 139 135 61 107 101 Maximum delivery on any one day 2,780 2,397 1,668 2,101 3,103 The heaviest weight previously recorded on any one day (22nd December, 1913) was 4,398 tons. ‡ The minimum deliveries relate to Saturdays when practically no wholesale business at the Market is carried out. One ton in every 174 tons of meat paying toll in the Central Markets, Smithfield, was condemned last year, as compared with one ton in 142 in 1919. * I am indebted to the Clerk and Superintendent of the Central Markets for the figures relating to the market supplies, sources of origin, &c. 38 The percentages of meat seized under the various headings of the above table during 1920 and for the preceding five years, classed as diseased, unsound and unwholesome, were as follows:— Year. Diseased. Unsound.* Unwholesome. Per Cent. Per Cent. Per Cent. 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 1919 12.3 82.8 4.9 Average for 5 years 11.1 85.5 3.4 1920 4.7 90.7 4.6 * Includes poultry, offal and fish. Table showing Weight of Meat delivered, and Meat delivered to Contractors as unsound, during each Month of the Years 1919 and 1920. Month. Meat delivered at the Market, 1919. Unsound Meat delivered to Contractors, 1919. Meat delivered at the Market, 1920. Unsound Meat delivered to Contractors, 1920. Tons cwts. qrs. Tons cwts. qrs. Tons cwts. qrs. Tons cwts. qrs. January 24,134 0 0 175 14 2 30,428 0 0 160 9 1 February 20,186 0 0 124 19 2 26,613 0 0 101 17 1 March 23,041 0 0 132 2 1 31,315 0 0 224 19 1 April 22,920 0 0 136 14 1 28,439 0 0 158 7 1 May 26,690 0 0 183 7 2 28,517 0 0 184 18 3 June 22,882 0 0 104 10 1 27,543 0 0 223 4 1 July 25,276 0 0 137 14 3 30,944 0 0 142 7 3 August 22,543 0 0 189 17 1 28,700 0 0 147 14 2 September 26,079 0 0 168 8 0 32,103 0 0 233 6 1 October 27,006 0 0 270 13 3 32,309 0 0 165 17 1 November 25,815 0 0 219 12 3 34,736 0 0 205 5 2 December 28,572 0 0 225 4 0 34,275 0 0 144 5 2 Totals 295,044 0 0 2,068 18 3 365,922 0 0 2,092 12 3 FISH SUPPLIES. 251,488 tons of fish, of which 231,866 were land-borne and 19,622 water-borne, were received at or near Billingsgate Market during the year. This was an increase of 73,540 tons in the land deliveries, and an increase of 10,268 tons in the deliveries by water. MONTHLY FISH RETURNS, 1920. 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 1920. 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. cwts. qrs. Per cent. January 16,058 1,064 17,122 317 7 3 1 ton in 53.949 tons, or 1.853 February 20,429 1,267 21,696 272 10 2 1 „ 79.908 „ „ 1.251 March 21,729 995 22,724 164 5 0 1 138.350 „ „ 0.722 April 20,296 1,466 21,762 213 3 3 1 „ 102.082 „ „ 0.979 May 18,567 1,610 20,177 381 5 1 1 „ 52.923 „ „ 1.889 June 18,279 1,859 20,138 263 13 3 1 „ 76.374 „ „ 1.309 July 19,700 1,741 21,441 261 16 1 1 „ 81.896 „ „ 1.221 August 19,012 2,090 21,102 243 1 3 1 „ 86.808 „ „ 1.151 September 18,766 2,057 20,823 216 14 2 1 „ 96.082 „ „ 1.040 October 20,308 2,109 22,417 243 9 2 1 „ 92.074 „ „ 1.086 November 20,072 1,526 21,598 72 4 3 1 „ 298.987 „ „ 1.334 December 18,650 1,838 20,488 71 4 3 1 „ 287610 „ „ 0.347 Total 231,866 19,622 251,488 2,720 17 2 1 „ 92.425 „ „ 1.081 * Compiled from the Monthly Returns furnished to the Corporation by the Fishmongers' Company. 39 Monthly Deliveries of Fish at London Central Markets, Smithfield, 1920. Tons cwts. qrs. January 118 12 0 February 178 15 0 March 137 15 0 April 132 18 0 May 123 18 0 June 140 18 0 July 104 7 0 August 82 8 0 September 109 15 0 October 118 12 0 November 122 6 0 December 115 0 0 Total 1,490 4 0 Of the above, 12 tons 6 cwts. 2 qrs. 27 lbs. were seized as unsound by your Officers, and those of the Fishmongers' Company. This equals 0.83 per cent. of the whole, or 1 ton in 120 tons. Weight of Fish Delivered, Fish seized as Unsound, and percentage of Fish Condemned to that Delivered, at or near Billingsgate Market during 1920 and the five years 1915-1919. year. Weight of Fish Delivered. Total. Weight of Fish Condemned. Ratio of Fish Condemned to that Delivered. By Land. By Water. Tons. Tons. Tons. Tons cwts. qrs. 1915 125,031 17,942 142,973 951 16 2 1 ton in 150 tons, or 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 „ 1919 158,326 9,360 167,686 3,079 16 2 1 „ 54.444 „ 1.837 „ Average (5 years) 126,088 7,121 133,209 1,826 6 3 1 ton in 72.951 tons, or 1.370% 1920 231,866 19,622 251,488 2,720 17 2 1 ton in 92.425 tons, or 1.081% SUMMARY OF FOOD DISCHARGED AT CITY WHARVES FOR THE YEAR 1920. Description of Total Number General Range of Weight Artlole Where from. Packages. of Packages. of Packages. Butter Holland Casks 40,082 100 lbs. Bacon Do. Bales 429 3 cwt. Cheese Holland & New Zealand Single Cheeses 124,981 6 lbs,—80 lbs. Do. Do. Packages 73,760 28 lbs.-160 lbs. Eggs Holland Cases 3,975 1 cwt.—1 cwt. 2 qrs. Margarine Do. Packages 26,889 24 lbs.—56 lbs. Cereals— Barley Do. Bags 1,608 100 lbs. Beans Do. Do. 2,882 1 cwt. 3 qrs. Peas Holland and India Do. 2,548 1 cwt.—2 cwt. Lentils India Do. 1,420 2 cwt. Rice Japan and India Do. 500 1 cwt.—2 cwt. Farina Holland Do. 3,159 2 cwt. Coffee Africa & South America Do. 72,610 56 lbs.—1 cwt. 2 qrs. Cocoa & Chocolate Ceylon and Holland Bags and cases 38,664 28 lbs.—2 cwt. Fruit (Soft)— Apricot3 Holland Packages 40 6 lbs. Apples Do. Do. 74,107 40 lbs.—2 cwt. Plums Do. Do. 3,685 40 lbs. Peaches Do. Do. 214 6 lbs. Pears Do. Do. 19,857 40 lbs.—1 cwt. Currants Do. Do. 6,835 7 lbs.—40 lbs. Gooseberries Do. Do. 12,234 7 lbs.—1 cwt. Strawberries Do. Do. 163,246 7 lbs.—28 lbs. Bilberries Do. Do. 756 7 lbs. Cranberries Do. Do. 2,274 28 lbs. Cherries Do. Do. 19,550 12 lbs.—28 lbs. Rhubarb Do. Do. 273 1 cwt. 40 Article. Where from. Description of Total Number General Range of Weight Packages. of Packages. of Packages. Fruit (Dried)— Currants Greece Cases and bags 201,388 40 lbs.—2 cwt. Raisins South Africa, Australia , and Spain Do. 94,132 8 lbs.—2 cwt. Sultanas Smyrna, Greece and Afghanistan Do. 223,660 28 lbs.—2 cwt. Plums California Cases 189,676 24 lbs.—56 lbs. Apricots Do. Do. 50,014 24 lbs.—56 lbs. Pears Do. Do. 11,323 24 lbs.—56 lbs. Peaches Do. Do. 15,423 24 lbs.—56 lbs. Dates Egypt and Persia Do. 2,394 28 lbs.—1 cwt. 1 qr. Figs Smyrna, Greece & Spain Cases and bags 83,586 14 lbs.—56 lbs. Evaporated Apples California Cases 5,070 56 lbs. Fruit (Green)— Oranges Italy and Spain Packages 235,190 56 lbs.—2 cwt. Lemons Do. Do. 123,938 56 lbs.—1 cwt. 1 qr. Grapes Holland and Spain Do. 27,783 10 lbs.—56 lbs. Melons Do. Do. 10,798 28 lbs.—100 lbs. Pomegranates Spain Do. 427 1 cwt. Vegetables— Cauliflowers Holland Do. 8,638 25 lbs.—56 lbs. Cucumbers Do. Do. 40,425 10 lbs.—56 lbs. Cabbages Do Do. 12,478 1 cwt. Carrots Do. Do. 7,474 30 lbs.—2 cwt. Lettuces Do. Do. 7,971 14 lbs.—28 lbs. Horseradish Do. Do. 139 56 lbs. Potatoes Do. Bags 273,709 100 lbs. Turnips Do. Packages 686 56 lbs. Onions Do. Bags 142,610 100 lbs. Sprouts Do. Do. 268 56 lbs. Tomatoes Do. Packages 174,381 7 lbs.—40 lbs. Beetroot Do. Bags 1,011 100 lbs. Radishes Do. Baskets 210 50 lbs. Peas Do. Bags 72 56 lbs. Sugar Chile and U.S.A. Do. 15,227 2 cwt. 2 qrs. Tinned Goods— Apricots Australia and California Cases 3,375 48 lbs.—70 lbs. Apples Canada Do. 50 50 lbs. Fruit Pulp Holland and Spain Do. 9,533 100 lbs. Vegetables Holland and Italy Do. 4,861 90 lbs.—2 cwt. Tomatoes Italy Do. 36,095 50 lbs.—72 lbs. Pears California Do. 1,131 48 lbs. Peaches Do. Do. 3,325 48 lbs. Jam Australia and S. Africa Do. 19,500 70 lbs.—1 cwt. Tongues South America Do. 700 96 lbs. Corned Beef Do. Do. 4,550 48 lbs. Condensed Milk Holland Do. 424,788 48 lbs. Crayfish South Africa Do. 810 48 lbs. Salmon Canada and Japan Do. 10,316 48 lbs. Sardines Portugal Do. 2,963 50 lbs.—I cwt. Macaroni Canada Do. 15,606 28 lbs. Nttts (Various) Spain and Italy Bagsandcases 19,216 28 lbs.—2 cwt. Milk Powder Holland Cases 2,560 50 lbs.—1 cwt. Milk Sugar Do. Do. 1,361 100 lbs. Ginger (Preserved) Do. Cases and casks 9,075 30 lbs.—3 cwt. 2 qrs. Vegetables in Brine Do. Casks 6,210 3 cwt. Miscellaneous— Albumen & Egg Yolk China Cases and casks 780 80 lbs.—5 cwt. Caraway Seeds Holland Bags 1,564 1 cwt. 1 qr. Desiccated Cocoanut Ceylon Cases 1,981 1 cwt. 2 qrs.—2 cwt. Cloves India Bags 491 1 cwt.—1 cwt. 2 qrs. Peel (preserved) Holland Cases 825 56 lbs.—1 cwt. Fruit (preserved) France Do. 2,468 1 cwt.—2 cwt. 2 qrs. Hops Do. Bales 1,918 2 cwt.—5 cwt. Confectionery U.S.A. Pails and cases 5,288 56 lbs.—1 cwt. Liquorice Italy Cases 670 1 cwt.—3 cwt. Chillies India Bags 148 56 lbs.—2 cwt. Cocoa Butter Holland Cases 1,006 1 cwt.—1 cwt. 3 qrs. Pepper India Bags 694 1 cwt. 1 qr. Cocoa Nuts (loose) Ceylon Single Nuts 20,000 1 lb. to 2 lbs. 41 Miscellaneous (continued)— Article. Where from. Description of Total Number General Eange of Weight Packages. of Packages. of Packages. Salmon in Brine Canada Casks 79 3 cwt. Lemon Juice Italy Do. 20 5 cwt. Lemon Peel in Brine Do. Do. 59 5 cwt. Biscuits (various) France Do. 710 50 lbs.—100 lbs. Cherries in Brine Italy Do. 500 3 cwt. Extract o£ Meat South America Cases 1,136 100 lbs. Anchovies Spain Casks & barrels 300 1 cwt.—1 cwt. 2 qrs. Olive Oil Do. Casks 200 2 cwt.— 3 cwt. CONDEMNATION OF FOOD INSPECTED AT RIVERSIDE WHARVES. As a result of the daily Inspection of City Wharves, 226 loads of unsound food were removed from these places during the year 1920 by the Cleansing Department. The material so disposed of comprised:— Tons. Cwts. Qrs. Tinned Fruit. Vegetables and Fish 69 12 2 Condensed Milk (removed at request of Owners) 4 3 3 Fruit Pulp 23 9 2 Fruit (Various) 103 18 1 Vegetables (Various) 46 6 0 Miscellaneous 26 1 2 Totals 273 11 2 A portion of the above was removed at the request of the owners. SALE OF FOOD AND DRUGS ACT. During 1920, 908 samples were submitted to the Public Analyst for examination. Of this number 656 were taken as test samples without the formality of the Act being observed, 62 of these were found to be adulterated, made up as follows:— 8 of Milk out of 164 samples taken. 46 of Butter out of '221 samples taken. 2 of Malt Vinegar out of 28 samples taken. 4 of Drugs out of 92 samples taken. Of the formal samples, 35 out of 252 were found to be adulterated, made up as follows:— 7 of Milk out of 173 samples taken. 25 of Butter (spread on bread) out of 75 samples taken. 1 of Drugs out of 2 samples taken. 1 of Coffee out of 1 sample taken. 1 of Malt Vinegar out of 1 sample taken. The percentage of Milk adulteration of both formal and informal samples together is 4.3 per cent., as compared with 6.3 per cent., which was the figure for 1919. Both these may be taken as being percentages above the actual, on account of the many samples taken in duplicate. Of the 15 adulterated samples of Milk, eight were informal samples, seven of which preceded the taking of official samples, all of which led to prosecution and conviction of the offenders, and the other was a sample taken at the railway station in transit, a duplicate sample of which was found to be genuine. In no case was Milk sold at a Registered Milk Shop found to be adulterated. The seven adulterated formal samples were obtained as follows: Two samples from men selling in the street, one from a coffee-house selling glasses of Milk and four from small confectioners' shops selling glasses of Milk. The percentage of adulteration varied from 10 to 29 per cent, of added water. BUTTER.— During the year no case of adulteration was discovered where Butter was purchased in bulk, the whole of the sophistication occurring where the article was asked for as Bread and Butter or Roll and Butter; and if this particular form of fraud had not been persistently followed up in the City, the percentage of adulteration of all articles submitted would have been exceptionally low. 42 DRUGS.— Five Drugs were reported against, four of these being Calomel Ointment and one Compound Liquorice Powder. Two of the Calomel Ointments were deficient in Calomel, one was compounded with Paraffin Ointment, and one contained an excess of Calomel. In the case of the Compound Liquorice Powder, the same was compounded on a " war time " formula. The vendors were in each instance cautioned. POTTED LOBSTER AND SHRIMPS.— The two cases of Potted Lobster and Shrimps reported as adulterated can scarcely be considered as adulterated articles, the articles being reported as such by reason of the presence of boric acid preservative. SALE OF FOOD AND DRUGS ACTS. 1875-1907. RESULTS OF PROSECUTIONS, 1920. First Quarter. Sample. Nature and Extent of Adulteration. Result. 15 Milk 25 per cent. added water £10 and £1 1s. costs. 143 Butter (on Bread) 90 per cent. margarine £10 and 17s. 6(2. costs. Second Quarter. 445 Milk 12 per cent. added water £10 and £1 1s. costs. 454 Butter (on Bread) 90 per cent. margarine Summons withdrawn on payment of £2 2s. costs. 505 „ „ 90 per cent. margarine £5 and £2 2s. costs. 506 „ „ 90 per cent. margarine £2 and £1 1s. costs. Third Quarter. 591 Coffee 19 per cent. chicory £5 and £l 1s. costs. 604 Butter (on Bread) 100 per cent. margarine £10 and £1 1s. costs. 603 „ ,, 100 per cent. margarine £2 and £1 1s. costs. 605 „ „ 100 per cent. margarine £2 and £1 1s. costs. 657 „ „ 95 per cent. margarine £1 and £1 3s. costs. 659 „ „ 100 per cent. margarine £1 and £1 1s. costs. 660 „ „ 100 per cent. margarine £5 and £l 1s. costs. Fourth Quarter. 661 Butter (on Bread) 100 per cent. margarine £2 and £1 1s. costs. 675 „ „ 100 per cent. margarine £5 and £1 1s. costs. 704 „ „ 100 per cent. margarine Ordered to pay £3 3s. costs. 743 „ „ 100 per cent. margarine £2 and £1 1s. costs. 744 Milk 18 per cent. added water and 15 per £10 and £1 1s. costs. cent. fat abstracted. 706 Butter (on Bread) 90 per cent. margarine £2 and £1 1s. costs. 707 Milk 29 per cent. added water and 24 per £5 and £1 1s. costs. cent. fat abstracted. 747 „ 16 per cent. added water £5 and £1 1s, costs. 758 Butter (on Bread) 90 per cent. margarine 10s. and £1 1s. costs. 757 „ „ 90 per cent. margarine £5 and £1 1s. costs. 843 „ „ 100 per cent. margarine £5 and £1 1s. costs. 844 „ „ 100 per cent. margarine £5 and £1 1s. costs. 841 Malt Vinegar Vinegar, other than malt vinegar, £1 and 17s. 6d. costs. deficient in acetic acid 10 per cent. 861 Butter (on Bread) 90 per cent. margarine £1 and 17s. 6d. costs. 885 Milk 10 per cent. added water £2 and 17s. 6d. costs. 884 „ 15 per cent. added water £5 and £1 1s. costs. SUMMARY. £ s. d. £ s. d. First Quarter : Fines 20 0 0 Costs 1 18 6 Second Quarter „ 17 0 0 „ 6 6 0 Third Quarter „ 26 0 0 „ 7 7 0 Fourth Quarter „ 55 10 0 „ 18 7 6 Total Fines £118 10 0 Total Costs £33 19 0 PROSECUTION UNDER D.O.R.A. (Profiteering.) Lime Water Selling same at excess rate Fined £5 and £2 2s. costs. 43 THE PUBLIC HEALTH (MILK AND CREAM) REGULATIONS, 1912. During the year 1920 samples of Milk, Cream and Preserved Cream have been purchased with a view to ascertaining to what extent the provisions of the Regulations were complied with. The following is a summary of results:— 1. Milk and Cream not sold as Preserved Cream:— Number of samples examined Number in which a for the presence of a Preservative was Preservative. found to be present. Milk 845 0 Cream 11 9 2 Cream sold as Preserved Cream:— (a) Instances in which samples have been submitted for analysis to ascertain if the statement on the label as to preservative were correct— i. Correct statement 6 ii. Incorrect statement 1 7 (b) Determination made of Milk Fat in Cream sold as Preserved Cream— i. Above 85 per cent.7 ii. Below 85 per cent. Nil Total 7 (c) Instances where (apart from analysis) the requirements as to labelling or declaration of Preserved Cream have not been observed— One instance— "Preserved Cream" labelled not exceeding 0.5 per cent. boric acid, instead of 0.4 per cent. boric acid. Vendor cautioned. (d) Particulars of each case in which the Regulations have not been complied with and action taken— Four of the nine samples of Cream found to contain preservatives were duplicate formal samples. In each instance the vendors were cautioned. In the other instance, the duplicate formal sample taken was correctly labelled. In the case of Preserved Cream "incorrect statement," the sample was labelled not exceeding 0.4 per cent. boric acid, but contained •78 per cent. A duplicate formal sample of this brand could not be obtained. SALE AND MANUFACTURE OF ICE CREAM.— Practically no Ice Cream was on sale at the small confectioners' shops in the City during 1920. ITINERANT ICE CREAM VENDORS.— These unwelcome and unnecessary traders have again reappeared, perambulating the already congested City thoroughfares. They are. almost without exception, aliens, and bear a street traders' badge, issued since the City of London Street Traders Act (Traffic), 1909, came into operation on 1st October. 1912. This year the number of men whose utensils, &c., have been inspected do not quite come up to pre-war numbers, being 19, as against 26 in 1914. The commodity vended by these persons was manufactured in every case at places outside the City of London, and letters were sent to Medical Officers of Health of the districts where the manufacture was carried out. The replies received showed that the manufacture was carried out in a satisfactory manner (with one exception), and that the addresses given were correct. DAIRIES, COWSHEDS AND MILKSHOPS ORDERS. Two applications only for registration have been received during the year, the Orders still being temporarily superseded bv 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. 44 The number of persons registered is 121, as compared with 118 in 1919, 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 ensure the cleanly storage and sale of Milk and of the proper hygienic surroundings being maintained. CASE OF SUGGESTED FOOD POISONING. On December 5th it was reported to me that several persons who had partaken of fried fish had been seized with illness within a short time of consuming it. The report referred to 17 persons who were engaged by a City firm, and the following day the Commissioner of Police for the City of London further notified me of the outbreak, and also intimated that five other persons engaged with another City firm were ill, and that a third firm had reported five girls ill due to the same cause. As a consequence of the illness some of the patients were taken to St. Bartholomew's Hospital and some to Guy's Hospital. The symptoms in all cases were those of pains in the stomach. After treatment at the Hospital all were sent home. It appears that all these persons had partaken of fried fish which had been prepared and cooked at a shop in the Minories. All had partaken of skate, and in one instance, plaice in addition. The majority of the patients had returned to work on Saturday morning, and on Monday morning all had returned. Enquiries were made at the place where the fish was cooked. This is a fried fish shop in which cooked fish is sold from a long narrow shop on the ground floor. The fish is prepared in the basement, where also potatoes are stored. Utensils are washed in the yard, where there is a boiler. CONDITIONS AND PREPARATION FOR SALE.—The basement runs under the footway to the extent probably of about 8 or 10 feet, and at the street level there is an open grid, which supplies a way for dust from the street to reach the cellar. There is also a window in the basement which projects some two feet above the ground level and some four feet below. The panes in this window are broken, and by this again the means is provided for dust to reach the cellar. In this vault potatoes and fish are prepared for sale, and for washing purposes three round wooden vats are provided. The fish, after being washed and cut up, is kept in two galvanised iron pails, and paper is used to cover them. The scraps which fall off the table after cooking are kept in a tub, and one or two empty wooden boxes are stored in the vault. The water used for washing the fish and potatoes is contained in a galvanised cistern of about 40 gallons capacity. This cistern is provided with a stop-tap, it is uncovered, placed about a foot below the roof, and into it street dust can gain access. There is no direct supplv from the main. In a cellar adjoining this vault is placed a cooking stove, a table to receive the cooked fish, which table consists of a shutter covered with paper. One or two boxes used for various purposes were placed on or by the table, and these were not clean. Potatoes are stored in sacks near the wall, one sack deep, which prevented the cellar being kept in a cleanlv order. The yard contained, as stated, a boiler, and this is supplied with water from a galvanised iron cistern about 40 gallons capacity, furnished with a wooden cover. Again, there is no supply of water direct from the main. 45 SOURCE OF ILLNESS.— It should be noted that the fish was eaten at mid-day, and that in an hour or so the persons partaking of it were ill. Such as were treated recovered sufficiently to go home by five o'clock. The circumstances pointed not to bacterial infection but to acute gastric irritation. This may have been due to some inherent quality of the fish or to something contained in the materials used. The flour was the same as used the previous day, as also was the oil. It will be noticed that all ate skate, which may sometimes cause extreme irritation. I am inclined to the opinion that the skate, without contamination, was the cause of illness. ACTION TAKEN.—Several matters required attention without delay. The proprietor has been notified of these, and they are enumerated as follows:— 1. In the shop all shelves and floors must be periodically scraped and thoroughly cleansed with hot water and soap. 2. The water supply cisterns in both yard and basement require to be cleansed. 3. A separate supply of water should be arranged for from the rising mains in both cellar and basement. 4. The walls and ceilings of the basement and approaches thereto require to be limewashed and the floors scraped and cleansed. 5. Suitable covered metal vessels should be provided in which to store washed and cut fish. 6. Receptacles to receive refuse and waste should be of metal and covered. 7. Empty fish boxes should not be stored in the cellar. 8. All appliances, tables and washing vats should be kept clean. These matters all received immediate attention. The circumstances were reported to the Ministry of Health. 46 47 SALE OF FOOD AND DRUGS ACTS, 1875-1907, AND THE PUBLIC HEALTH (MILK AND CREAM) REGULATIONS. Articles examined during each Quarter of the year 1920. Articles submitted for Analysis. Quarter ending 31st March. Quarter ending 30th June. Quarter ending 30th September. Quarter ending 31st December. Total for 1920. No. of Samples taken. No. Genuine. No. Adulterated. Percentage of adulteration. No. of Samples taken. No. Genuine. No. Adulterated. Percentage of adulteration. No. of Samples taken. No. Genuine. No. Adulterated. Percentage of adulteration No. of Samples taken. No. Genuine. No. Adulterated. Percentage of adulteration. No. of Samples taken. No. Genuine. No. Adulterated. Percentage of adulteration. Milk 147 146 1 0.6 1 ... 1 100.0 21 20 1 4.7 4 ... 4 100.0 173 166 7 4.0 Butter (on Bread) 1 ... 1 100.0 55 50 5 8.9 13 ... 13 100.0 6 ... 6 100.0 75 50 25 33.3 Drugs 2 1 1 50.0 ... ... ... ... ... ... ... ... ... ... ... ... 2 1 1 50.0 Coffee ... ... ... ... 1 ... 1 100.0 ... ... ... ... ... ... ... ... 1 ... 1 100.0 Malt Vinegar ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 100.0 1 ... 1 100.0 Total Formal Samples 150 147 3 2.0 57 50 7 12.3 34 20 14 41.0 11 ... 11 100.0 252 217 35 13.8 Informal— Milk 7 5 2 28.5 62 61 1 1.6 ... ... ... ... 103 98 5 4.8 172 164 8 4.6 Butter 100 80 20 20.0 66 45 21 31.8 35 31 4 11.4 20 19 1 5.0 221 175 46 20.8 Malt Vinegar 15 15 ... ... 3 3 ... ... ... ... ... ... 10 8 2 20.0 28 26 2 7.1 Drugs 51 48 3 ... ... ... ... ... 20 20 ... ... 21 20 1 4.7 92 88 4 4.3 Cheese 11 11 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11 11 ... ... Dripping 10 10 ... ... ... ... ... ... 1 1 ... ... 3 3 ... ... 14 14 ... ... Mustard 9 9 ... ... 7 7 ... ... 4 4 ... ... 3 3 ... ... 23 23 ... ... Cocoa 4 4 ... ... 7 7 ... ... 9 9 ... ... 5 5 ... ... 25 25 ... ... Self-Raising Flour 4 4 ... ... ... ... ... ... ... ... ... ... 1 1 ... ... 5 5 ... ... Ground Ginger 4 4 ... ... ... ... ... ... ... ... ... ... 1 1 ... ... 5 5 ... ... Olive Oil 4 4 ... ... 1 1 ... ... ... ... ... ... 3 3 ... ... 8 8 ... ... Coffee 3 3 ... ... 6 6 … … 9 9 … ... 5 5 … … 23 23 … … Baking Powder 3 3 … … … … … … … … … … 2 2 … … 5 5 … … Oatmeal 3 3 ... ... ... … … … … … … ... 2 2 … ... 5 5 … … Ground Rice 3 3 ... ... … … … … … … … ... 2 2 … … 5 5 … ... Vinegar 2 2 ... … ... … … … … … … … 1 1 … … 3 3 … ... Salmon and Shrimp Paste 1 1 ... ... 1 1 … … ... ... … ... … … … … 2 2 … ... Lard 1 1 ... ... … ... … … 1 1 … … 4 4 … … 6 6 … … Potted Lobster 1 … 1 100.0 … … … … … … … ... ... … … ... 1 … 1 100.0 Potted Shrimps 1 … 1 100.0 … … … … … … … … … … … … 1 … 1 100.0 Whisky ... ... ... ... 1 1 ... … ... ... ... ... ... ... … ... 1 1 ... ... Total Informal Samples 237 200 27 11.4 154 132 22 14.3 79 75 4 5.0 186 177 9 4.8 656 594 62 9.4 Totals 387 357 30 7.7 211 182 29 13.7 113 95 18 16.0 197 177 20 10.1 908 811 97 10.6 48 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 ending 31st March, 1920. Butter 2 25 per cent. Foreign Fat ... … Vendor cautioned. * „ 11 50 „ „ „ … … „ „ * „ 20 90 „ „ „ ... … „ „ * „ 24 90 „ „ „ ... ... „ „ * „ 42 90 „ „ „ ... ... „ „ * „ 51 90 „ „ „ ... ... „ „ * „ 77 90 „ „ „ ... ... „ „ * „ 97 90 „ „ „ ... ... „ „ * „ 100 90 „ „ „ ... ... „ „ * „ 103 90 „ „ „ ... ... „ „ * „ 117 90 „ „ „ ... ... „ re-sampled. Same Vendor as No. 143. * „ 123 90 „ „ „ ... ... Vendor cautioned. „ 143 90 „ „ „ Fined £10 and 17/6 Costs. ... * „ 153 90 „ „ „ ... ... Vendor re-sampled ... Subsequent official sample No. 253 genuine. * „ 182 90 „ „ „ ... ... „ cautioned. * „ 223 90 „ „ „ ... ... „ „ * „ 275 90 „ „ „ ... ... „ „ * „ 276 90 „ „ „ ... ... „ re-sampled ... Subsequent official sample No. 327 genuine. * „ 355 90 „ „ „ ... ... „ cautioned. * „ 380 90 „ „ „ ... ... „ „ * „ 381 90 „ „ „ ... ... „ „ *† Milk 14A 18 „ added Water ... ... „ re-sampled. Same Vendor as No. 15. † „ 15 25 „ „ „ Fined £10 and £1 1s. Costs. *† „ 336 11 „ „ „ ... ... Vendor re-sampled ... Subsequent official sample No. 339 genuine. * Potted Lobster 179 0.48 „ Boric Acid ... ... „ cautioned. * „ Shrimp 180 0.80 „ „ „ ... ... „ „ *Calomel Oint. 306 42 „ deficient in Calomel. ... ... „ re-sampled ... Subsequent official sample 79.75 „ Semi-solid Mineral Oil. No. 374 genuine. * „ „ 346 Compounded with Paraffin Ointment. ... ... „ cautioned. * „ „ 367 50 per cent. deficient in Calomel. ... ... „ re-sampled. Same Vendor as No. 388. „ „ 388 45 „ excess of Calomel. ... ... Vendor cautioned. Quarter ending 30th June, 1920. * Butter 389 90 „ Margarine ... ... Vendor cautioned. * „ 410 90 „ „ ... ... „ „ * „ 417 90 „ „ ... ... „ „ * Samples taken informally. † All samples free from boric acid and formalin. 49 Name of Article. Identification No. given to the sample in the Quarterly Report. Result of Analysis. If auy legal pro ceedings wore instituted uuder the Sale of Food & Lirugs Acts, state result, showing fine? and costs separately. If any legal proceedings were instituted uuder 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 auy point of special interest. *Butter ... 421 90 per cent. Margarine ... ... Vendor re-sampled Same Vendor as No. 454. *Milk ... 435 12 „ added Water ... ... Vendor re-sampled Same Vendor as No. 445. ,, 445 12 ,, ,, ,, Fined £10 and£l Is. Costs. ... *Butte ... 450 90 ,, Margarine ... ... ... ... Margarine declared on two subsequent visits. ,, ... 454 90 „ „ Summons withdrawn on payment of Costs, £2 2s. . * ,, ... 459 90 „ ,, ... ... Vendor cautioned. * ,, ... 460 90 ,, ,, ... re-sampled. ... Subsequent * ,, ... 461 90 „ ,, ... ... Vendor re-sampled. Same Vendor as No. 494. samples genuine. * ,, ... 469 90 ,, ,, ... ... Vendor re-sampled. Same Vendor as No. 495. * ,, ... 472 90 „ ,, ... ... Vendor re-sampled. ... Subsequent samples genuine. * ,, ... 481 90 „ ,, ... ... ,, ,, Same Vendor as No. 505. * ,, ... 490 90 ,, ,, ... ... Vendor cautioned. *,, ... 493 90 ,, ,, ...0 ... ,, re-sampled. Same Vendor as No. 506. ,, ... 494 90 ,, ,, . . . ... Vendor cautioned. ,, ... 495 90 ,, ,, ... ... „ re-sampled. ... Margarine notice now exhibited. ,, ... 505 90 „ ,, Fined £5 and £2 2s. Costs. ,, ... 506 90 „ ,, Fined £2 and £1 Is. Costs. * ,, ... 512 90 ,, ,, ... ... Vendor cautioned. * ,, ... 515 90 ,, ,, ... ... ,, ,, * ,, ... 519 90 „ ,, ... ... ,, ,, * ,, ... 555 90 ,, ,, ... ... ,, ,, * ,, ... 562 90 ,, ,, ... ... „ re-sampled. ... Margarine notice exhibited on subsequent visit. * ,, ... 573 90 „ ,, ... ... if Same Vendor as No. 605. * ,, ... 574 90 „ ,, ... ... Vendor re-sampled. Same Vendor as No. 658. * ,, ... 576 90 ,, ,, ... ... Vendor re-sampled. Same Vendor as Coffee ... 591 19 ,, Chicory Fined £5 and 21$ Costs. ... No. 606. * Samples taken informally. All samples free from boric acid and formalin. 50 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 t liun the Side of Food <fc 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 ending 30th September, 1920. Butter 602 90 per cent. Margarine ... ... Vendor cautioned. ,, ... 603 100 ,, ,, Fined £2 and £1 Is. Costs ,, ... 604 100 ,, ,, Fined £10 and £ 1 Is. Costs ... ... Second Offence. ,, ... 605 100 ,, ,, Fined £2 and £1 Is. Costs ,, ... 657 95 ,, ,, Fined £1 and £1 Is. costs „ ... 658 95 ,, ,, ... ... Sample taken from Coffee Stall outside ,, ... 659 100 ,, ,, Fined £1 and 17/6 Costs City Boundary. No action taken. ,, ... 660 100 ,, ,, Fined £5 and £1 Is. Costs ,, ... 661 100 ,, ,, Fined £2 and £1 Is. Costs ,, ... 663 30 ,, ,, ... ... Vendor re-sampled. Same Vendor as No. 675. ,, ... 675 100 ,, ... Fined £5 and £1 Is. Costs *,, 676 30 „ ,, ... ... Vendor re-sampled. ... Subsequent official sample * ... 097 100 ,, ,, ... ... ,, ,, Same Vendor as No. 704. genuine. * ,, 703 100 ,, ,, ... ... Vendor re-sampled. Same Vendor as No. 704. ,, ... 704 100 ,, ,, Ordered to pay Costs £3 3s. ... ... ,, ... 705 90 ,, ,, ... ... ... ... Summons could not be served. Vendor disappeared. ,, ... 706 90 ,, ,, Fined £2 and £1 Is. Costs Milk 707 29 „ added Water 24 „ original Fat abstracted Fined £5 and £ 1 Is. Costs Quarter ending 31st December, 1920. Milk ... 728 18 „ added Water ... ... Vendor re-sampled. Same Vendor as No. 744. Butter ... 742 100 „ Margarine ... ... Vendor re-sampled. ... Subsequent ,, ... 743 100 ,, ,, Fined £2 and £1 Is. Costs samples genuine. * Samples taken informally. All samples free from boric acid and formalin. 55 EAST DISTRICT— Inspector W. H. Ralph. Month. Premises inspected. Orders issued. Notices served. Improvements effected. January 110 11 15 18 February 257 1 6 20 March 247 3 6 18 April 295 1 G5 28 May 249 16 9 29 June 283 19 4 26 July 147 3 17 35 August 298 9 15 20 September 274 1 19 43 October 175 4 17 21 November 207 4 9 24 December 875 22 19 38 Totals 2,917 94 201 320 THE FOREGOING ARE SUMMARISED AS UNDER:— District. Number of inspections made. Orders issued. Notices served. Improvements effected. West 3,005 68 280 354 Middle 2,928 46 93 341 East 2,917 94 201 320 Totals 8,850 208 574 1,015 REGISTERED LODGING-HOUSES. Public Health (London) Act, 1891, Sec. 94. The Corporation, as the Sanitary Authority in the Citv, 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 Bve-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 Bve-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. 1920. 1900. 1920. 1900. 1920. 1900. 1920. 1900. 1920. 1900. Wes 85 183 418 1,502 194 656 2.1 2.3 110 239 Middle 4 55 24 363 17 130 1.4 2.8 4 66 East 64 158 366 1.186 157 488 2.3 2.5 89 176 Total 153 396 808 3,051 368 1,274 2.1 2-6 203 481 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 Bve-laws. This necessitated the service of 203 Notices during 1920. 56 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 "selfcontained," 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 Artizan6' Block Dwellings. No. of Tenements. No. of Inhabitants. One Room. Two Rooms. Three Rooms. Four Rooms. Five Rooms or more. WEST DISTRICT. Albion Buildings, No. 21, Bartholomew Close ... 9 ... ... ... 19 Albion Buildings, No. 22, Bartholomew Close ... 10 ... ... ... 19 Bartholomew House, Bartholomew Close 16 2 ... ... ... 35 Dean Street Blocks, Fetter Lane— ... ... ... Block A 3 4 ... 1 ... 30 „ B 2 5 ... ... ... 29 „ c 6 3 ... ... ... 28 „ D 2 5 ... ... ... 22 „ E o 5 ... ... ... 21 „ F ... 4 ... 1 ... 19 St. Ann's Chambers, Ludgate Hill 4 8 ... 2 1 28 Bloomfield House, Snow Hill ... 20 ... ... ... 52 Total 35 75 ... 4 1 302 MIDDLE DISTRICT. Bridgewater House, Fann Street 12 ... ... ... 13 City Buildings, Moor Lane ... 20 12 ... ... 90 Total •• 32 12 ... ... 103 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 ... ... 160 King's 8 16 16 ... ... 158 Barker's Buildings, Catherine Wheel Alley, Bishopsgate 12 10 3 ... ... 57 Total Two "Blocks " 35 186 45 ... ... 937 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 utilised during the War as a Soldiers' 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 generallv 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 water-closet 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. 51 Name of Article. Identification No. given to the sample in the Quarterly Report. Result of Analysis. If any legal prcceodings were instituted under the Sale of Food & Drugs Acts, state resnlt, showing fines and costs separately. If any U*gal procetdings were instituted under Acts other than the S:ilc 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. †Milk 744 16 per cent, of added Water and 12 „ original Fat abstracted Fined £10 and£l Is. Costs *† ” 745 12 added Water ... ... Vendor re-sampled. Same Vendor as No. 747. † „ 747 16 „ added Water Fined £5 and £1 Is Costs Butter 757 90 „ Margarine Fined £5 and £1 Is. Costs „ 758 90 „ Margarine Fined 10s. and £1 Is. Costs *Malt Vinegar 800 Vinegar other than Malt ... ... Vendor re-sampled. Same Vendor as No. 841. *Compound Liquorice Powder. 781 48 per cent. added Starch ... ... Cautioned. *Malt Vinegar 795 Vinegar other than Malt ... ... ... ... Subsequent visit. Wood Vinegar declared. „ „ 841 „ „ „ „ 10 per cent, deficiency in Acetic Acid Fined £1 and 17/6 Costs Butter 843 100 per cent. Margarine Fined £5 and £1 Is. Costs „ 844 100 „ „ Fined £5 and 21s. Costs „ 861 90 „ „ Fined £1 and 17/6 Costs *†Milk 872 20 ,, added Water ••• ... Vendor re-sampled, Same Vendor as Nos.881 and 884. *† „ 874 5 „ „ „ and 3 „ of original Fat abstracted ... ... V endor re-sampled, Same Vendor as No. 885. *† „ 881 18 „ added Water ... ... Vendor re-samp)ed, Same Vendor as *† „ 884 15 „ „ „ Fined £5 and £1 Is Costs Nos. 872 and 884. *† „ 885 10 „ „ „ Fined £2 and 17/6 Costs *Samples taken informally. †All samples free from boric acid and formaliu. 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 rooms, arranged in 241 tenements, and are occupied by 805* persons, compared with 799 in 1919. 71 per cent, are adults and 29 per cent, children (under 14 years). * persons sleeping on the premises. 52 The number of births was 16, viz., nine males and seven females. The birth rate was 19.8 per 1,000, which is 2.8 per 1,000 below the average for the previous five years. The death rate for 1920 was 6.2 per 1,000 per annum. The number of deaths of children under one year, per 1,000 births, was 125, as against 60 for the City generally. TABLE OF BIRTHS AND DEATHS OCCURRING AT THE ARTIZANS' DWELLINGS, STONEY LANE, HOUNDSDITCH, DURING THE YEAR 1920. Name op BCock. Births. Mortality from all Causes at subjoined Ages. At all ages. Under 1 year. l and under 5 5 and under 1& 15 and under 25 25 and under 65 65 and upwards. Male. Female. NORTH BLOCK 2 ... ... ... ... ... ... ... ... SOUTH „ 3 2 1 ... ... ... ... 1 ... KING'S „ 2 3 3 2 ... ... ... ... 1 QUEEN'S „ 2 1 1 ... ... ... ... ... 1 PRINCE'S „ ... 1 ... ... ... ... ... ... ... Totals 9 7 5 2 ... ... ... 1 2 The birth rate in these Dwellings reached a maximum of 46*9 per 1,000 in 1896, and has since been falling, as shown by the following figures:— BIRTH RATE, ARTIZANS' DWELLINGS. 1896 46.9 1909 29.6 1897 40.3 1910 32.9 1898 43.1 1911 29.5 1899 37.5 1912 33.4 1900 38.4 1913 29.7 1901 33.8 1914 36.3 1902 45.8 1915 28.8 1903 31.2 1916 22.6 1904 30.1 1917 29.3 1905 29.1 1918 13.8 1906 26.1 1919 18.7 1907 35.0 1920 19.8 1908 31.5 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 1920 being 11,369, of whom 4,127 were males and 7,242 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 129 212 158 297 796 February 90 173 123 316 702 March 89 205 151 328 773 April 160 143 155 358 816 May 95 226 200 534 1,055 June 83 259 211 451 1,004 July 67 292 277 557 1,193 August 68 253 240 551 1,112 September 278 334 260 433 1,305 October 78 303 236 397 1,014 November 59 217 186 327 789 December 75 239 192 304 810 Totals 1,271 2,856 2,389 4,853 11,369 53 CITY MORTUARY. DISINFECTION—TRADE.—In accordance with the requirements of the South African Authorities, the disinfection of second-hand clothing prior to export to that country has been carried out as usual. In July last the charge for this work was increased from 10s. to £1 per operation. A fee of one guinea was also fixed for the issue of duDlicate certificates. he following table gives the details or this work :— Number of Certificates issued. Number of articles disinfected. Fees received by the Corporation. 1,079 523,694 £1,118 19s. DISINFECTION—INFECTIOUS DISEASES:— Articles disinfected after cases of infectious disease 26,135 BODIES RECEIVED-POST-MORTEMS AND INQUESTS Bodies received at the Mortuary to await burial 172 Post-mortem examinations made 80 Inquests held on bodies 158 Inquests held on fires 9 CLEANSING OF PERSONS ACT, 1897 Number of verminous persons bathed 21 NUMBER OF ARTICLES DISINFECTED, BODIES RECEIVED AT THE MORTUARY, AND INQUESTS HELD AT THE CORONER'S COURT IN THE CITY DURING 1920, COMPARED WITH THE PREVIOUS FIVE YEARS. Year. Articles of Bedding, &c., disinfected. Bodies received at the Mortuary Iuquests held on bodies. Inquests held on Fires. 1915 861,879 199 176 9 1916 438,426 169 151 2 1917 295,144 234 213 1 1918 179,990 158 130 0 1919 207,935 170 150 4 Average for previous five years 296,674 186 164 3 1920 549,829 172 158 9 PRESERVATION OF BODIES OF UNKNOWN DEAD.—The De Rechter apparatus for the preservation of the dead, installed at the City Mortuary in March, ]909. was fully described in the Annual Report for that year. During the year under review three bodies were placed in the apparatus. 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 1920:— Inquest held on Name of Premises. Date of Fire. 1. 9th February, 1920 28-32, Hutton Street, E.C. 29th January, 1920. 2. 24th February, 1920 159, Queen Victoria Street, E.C. 17th February, 1920. 3. 2nd June, 1920 Dowgate Wharf, Dowgate 21st May, 1920. 4. 23rd Jnne, 1920 4 to 9, Bishopsgate Avenue, E.G. 11th June, 1920. 5. 4th November, 1920 24 and 26, Mitre Street, Aldgate 25th October, 1920. 6. 11th November, 1920 11, Fore Street Avenue 4th November, 1920. 7. Ditto 23, Moor Lane, E.C. Ditto. 8. 17th and 25th Nov., 1920 14, Carthusian Street, E.C. Ditto. 9. 2nd December, 1920 56, Lower Thames Street, E.C. 21st November, 1920. 10. 23rd December, 1920 1 to 6, Printing House Square, E.C. 12th December, 1920. In addition to the above the City Coroner personally inquired into 178 "nonfatal" City fires reported to him during the year. DISINFECTION OF CONVEYANCES AFTER CARRYING CASES OF INFECTIOUS DISEASE.—Three electric ambulances, which had been used to convey patients suffering from infectious diseases to hospital, have been disinfected at the City Disinfecting Station, Golden Lane, E.C. 54 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 "denaturalising" condemned meat, disinfecting public conveniences (urinals, &c.). B. Disinfecting roadways, street gullies, &c. C. Disinfecting premises, &c., after infectious disease, drain testing and sundries. INCREASE OF RENT AND MORTGAGE INTEREST (RESTRICTIONS) ACT, 1920. Under the terms of the above-mentioned Act, if a tenant is required to pay increased rental, he may, if he considers the premises are not in all respects reasonably fit for human habitation, or otherwise not in a reasonable state of repair, submit to the County Court a report of the Sanitary Authority to prove that his application for release from the increased rental is well founded, and for this purpose he may apply to the Sanitary Authority for such certificate, for which a fee of Is. has to be paid. In some areas this new requirement has probably thrown a considerable amount of extra work on the Officers of the Sanitary Authority. In the City of London, however, which has only a small resident population, I have only been called upon once during 1920 to make an examination and submit a certificate under this Act. SANITARY INSPECTIONS. The following is a statement of the work of the Sanitary Inspectors in their several Districts during each month of the year:— WEST DISTRICT— Inspector F. J. Robbins. Month. Premises inspected. Orders issued. Notices served. Improvemeats effected. January 126 4 11 32 February 223 6 9 27 March 237 2 6 26 April 308 5 97 44 May 263 16 68 24 June 278 12 4 10 July 321 2 30 28 August 192 2 20 30 September 330 2 16 35 October 136 8 3 13 November 240 3 6 37 December 351 6 10 48 Totals 3,005 68 280 354 MIDDLE DISTRICT— Inspector E. J. Simmons. January 109 3 18 17 February 244 4 9 29 March 256 3 7 23 April 271 6 6 22 May 287 3 6 31 June 270 3 8 39 July 238 1 5 27 August 211 2 6 21 September 253 3 3 32 October 184 5 4 24 November 214 8 8 32 December 391 5 13 44 Totals 2,928 46 93 341 57 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:— 70, Vine Street. In the course of routine inspection it was ascertained that two water-closets had been constructed in the cellars of these premises. The work was not carried out in accordance with the terms of the Corporation's Bve-laws, and after careful consideration of all the circumstances, it was determined that the installation must be abolished. This was accordingly effected. DRAINAGE PLANS.—In the course of the year 277 plans were submitted with regard to proposed reconstruction of water-closets or drains in the City. Of these, 252 were approved, 16 revised and approved, and nine 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-to-date design will, I hope, eventually lead to a complete abatement of the evil. 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 three 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 106 cases so investigated in 1920, it was found necessary to reconstruct the sanitary system in two instances, and to make amendments to soil and waste pipes, water-closets, &c., in 39 others. HOUSE, TRADE AND OTHER REFUSE REMOVAL.—The City Engineer informs me that the refuse removed from the City in 1920 consisted of 19,267 cartloads of street sweepings and slops, and 41,969 loads of house and trade refuse, a total of 61,236 loads. The total for the year 1919 was 50,645. 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 574 notices have been served by the District Inspectors at the order of the Sanitary Committee, and in one case only, 70, Vine 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. This case is referred to above. 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 40,875,876 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. 58 Disinfectants are also freelv 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. TURKISH BATHS—TOWELS.—In January, the County Purposes Committee of the City Corporation, who are charged with the duty of registration of establishments for massage and special treatment, resolved that '' The attention of the Sanitary " Committee be called to the condition of towels, sheets, &c., in use in Turkish Baths, " with the suggestion that the Medical Officer of Health for the City should report " thereon to them." In accordance with the Resolution, enquiries were made at the onlv two Turkish Baths situate in the City. Both baths are owned by the same firm, and have similar arrangements and appointments. One is said to have accommodation for 27 bathers, and the other, accommodation for 32 bathers. The number of bathers using the baths at one time, however, is almost invariably below their capacity. The staff of the smaller bath consists of a manager, four operators and two boys, and the staff of the larger bath of a manager, five operators and three boys. At both baths clean and fresh towels and enveloping sheets are provided for each customer, and these articles are boiled on the premises before being re-used. The water in the plunge bath was clean, and the baths, which are of a superior class, appear to be conducted with every care and attention. FACTORY AND WORKSHOP ACT, 1901, &c. FACTORIES, WORKSHOPS AND WORKPLACES.—The premises upon the Register number 3,772, in which are included 7,732 workrooms, &c. There is a slight increase in the number of premises on the Register. There were served 2,143 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 933 3,341 WORKSHOPS 1,874 2,921 WORKPLACES:— Kitchens of Restaurants, Tea Rooms, &c. 798 1,116 Stables , 28 31 Other places 139 323 3,772 7,732 The following is a Summary of Inspections of separate workrooms, &c., during the year:— Workshop Inspectors. Women Inspectors. s. FACTORIES 866 — 866 WORKSHOPS 731 — 731 WORKPLACES 618 — 618 59 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 1920 866 — 866 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 1920 731 — 731 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 1920 618 — 618 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:— ABOVEC.ROUND BAKEHOUSES. †280, Bishopsgate. †45, Fish Street Hill, †Great Eastern Railway Hotel. *61, Middlesex Street. *85, Middlesex Street. †*37, Middlesex Street. *63 to 65, Middlesex Street. †*122, Middlesex btreet. 3, Pancras Lane. †21, Stoney Lane. 68, St. Mary Axe. *75, St. Paul's Churchyard. 194, Upper Thames Street. UNDERGROUND BAKEHOUSES. 188, Aldersgate. 262, Bishopsgate. *4, Broadway. 8, Copthall Avenue. 15, Cornhill. †*67, Farringdon Street. *93, Fetter Lane. 48, Knightrider Street. SUMMARY. Aboveground Bakehouses 5 Underground Bakehouses 16 21 *These have been established at least 34 years. †factory Bakhouses Qpower is used) 60 SUMMARY OF WORK DONE UNDER THE FACTORY AND WORKSHOP ACT, 1901, AND THE PUBLIC HEALTH (LONDON) ACT, 1891, &c. INSPECTIONS. Men Inspectors. Women Inspactors. Special. Inspector Gathercole. East District. Inspector Duuworth. West District. Inspector Robinson. West District. Miss East District. Miss Wilkinson. Totals. Factories, Initial Inspections (Tenancies) 2 ... 72 ... ... 74 Do. Initial Inspections (Workrooms) 2 ... 180 ... ... 182 Do. Periodical Inspections (Tenancies) 5 ... 179 ... ... 183 Do. Periodical Inspections (Workrooms) 81 ... 653 ... ... 684 Do. Re-inspections (Sanitary Works, &c., in hand) 3 ... 268 ...... ... 271 Workshops, Initial Inspections (Tena-ncies) 7 ... 168 ... ... 175 Do. Initial Inspections (Workrooms) 15 ... 224 ... ... 239 Do. Periodical Inspections (Tenancies) 2 ... 355 ... ... 357 Do. Periodical Inspections (Workrooms) 2 ... 490 ... ... 492 Do. Re-inspections (Sanitary Works, &c., in hand) 33 ... 372 ... ... 405 Workplaces, Initial Inspections (Tenancies) 31 ... ... ... ... 31 Do. Initial Inspections (Workrooms) 68 ... ... ... ... 68 Do. Periodical Inspections (Tenancies) 309 ... ... ... ... 309 Do. Periodical Inspections (Workrooms) 550 ... ... ... ... 550 Do. Re-inspections (Sanitary Works, &c., in hand) 798 ... ... ... ... 798 Bakehouses, Inspections 25 ... ... ... ... 25 Do. Re-inspections (Sanitary Works, &c., in hand) 14 ... ... ... ... 14 DEFECTS FOUND. Factories, Workshops and Workplaces, &c.— Want of Cleanliness 124 ... 76 ... ... 200 Want of Ventilation 19 ... 9 ... ... 28 Overcrowding ... ... 4 ... ... 4 Want of Drainage of Floors ... ... ... ... ... ... Other Nuisances, &c. 27 ... 177 ... ... 204 Kitchens. - Storage Cistern defective ... ... ... ... ... ... Accommodation for Refuse 7 ... . . , ... ... 7 Accumulation of Refuse 6 ... . . , ... ... 6 Sanitary Accommodation. Insufficient (Tenancies) ... ... 2 ... ... 2 Usuitable (Do.) ... ... 13 ... ... 13 Defective (Do.) 69 ... 187 ... ... 256 Do. (No. of Conveniences)* 79 ... 373 ... ... 452 Not separate for Sexes (Tenancies) 5 ... 20 ... ... 25 Total Defects found 257 488 ... 745 DEFECTS REMEDIED. Factories, Workshops and Workplaces, &c.— Want of Cleanliness 140 ... 70 ... ... 210 Want of Ventilation 16 ... 12 ... ... 28 Overcrowding ... ... 7 ... ... 7 Want of Drainage of Floors ... ... ... ... ... ... Other Nuisances, &c. 35 ... 219 ... ... 254 Kitchens. Storage Cistern defective ...... ... ... ... ... ... Accommodation for Refuse 1 ... ... ... ... 1 Accumulation of Refuse 3 ... ... ... ... 3 Sanitary Accommodation. Insufficient (Tenancies) ... ... ... ... ... .... . . Unsuitable (Do.) ... ... 11 ... ... 11 Defective (Do.) 57 ... 188 ... ... 245 Do. (No. of Conveniences)* 84 ... 361 ... ... 445 Not separate for Sexes (Tenancies) 5 ... 22 ... ... 27 Total Defects remedied 257 ... 529 ... ...... 786 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. 61 Special. Inspector Gathercole. Men Inspectors- Women Inspectors. East District. Inspector Dun worth. West District. Inspector Robinson. West District. Miss East District. Miss Wilkinson. Totals. SPECIAL INSPECTION WOEK— (continued). Outworkers' Premises, 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 ... ... ... ... ... ... Offices, Inspections (Tenancies) ... ... ... ... l 1 Do. Initial Inspections (Rooms) ... ... ... ... l 1 Do. Re-inspections (Sanitary Works, &c., in hand) ... ... ... ... ... ... Do. Defects found ... ... ... ... l l Do. Defects remedied ... ... ... ... ... ... London County Council (General Powers) Act, 1904, Inspections of Premises after Cleansing of Children ... ... ... ... 5 5 Do. Do. Re-inspections (Sanitary Works, &c., in hand) ... ... ... ... 1 1 Do. Do. Defects found ... ... ... ... ... ... Do. Do. Defects remedied ... ... ... ... ... Children Act, 1908 (Nurse Children), Inspection of Premises ... ... ... ... 11 11 Do. Do. Re-inspections (Sanitary Works, &c., in hand) ... ... ... ... ... 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 ... ... ... ... ... ... Do. (Do.) Re-inspections (Sanitary Works, &c., in hand) ... ... ... ... ... ... Do. (Do.) Defects found ... ... ... ... ... ... Do. (Do.) Defects remedied ... ... ... ... ... ... Notification of Births Act, 1907, Visits ... ... ... ... 316 316 Number of attendances of Mothers at the City Shelter ... ... ... ... 736 736 Special Visits ... ... ... ... 116 116 OUTWORKERS. Lists received from City Firms 1,359 ... ... ... ... 1,359 Names and Addresses, &c., received from other Authorities 809 ... ... ... ... 309 Names and Addresses transmitted to other Authorities 13,102 ... ... ... ... 13,102 Notices served on Employers 1,736 ... ... ... ... 1,736 Letters written 1,517 ... ... ... ... 1,517 Firms visited 143 ... ... ... ... 143 Workshops notified by H.M. Inspector ... ... 84 ... ... 84 General complaints received 6 ... 2 ... ... 8 ACTION TAKEN. Matters referred to H.M. Inspector— Want of Cleanliness ... ... 9 ... ... 9 Want of Ventilation ... ... 2 ... ... 2 Overcrowding ... ... ... ... ... ... Want of Drainage of Floors ... ... ... ... ... ... Failure to affix Abstract ... ... 49 ... ... 49 Other Nuisances ... ... 12 ... ... 12 Action taken in matters referred by H.M. Inspector— Notified by H.M. Inspector 10 ... 48 ... ... 58 Reports sent to H.M. Inspector 10 ... 44 ... ... 54 Other matters ... ... ... ... ... ... Notices served— Factories—Intimation ... ... 36 ... ... 36 Statutory ... ... 16 ... ... 16 Workshops—Intimation 6 ... 122 ... ... 128 Statutory 5 ... 69 ... ... 74 Workplaces, &c.—Intimation 116 ... ... ... ... 116 Statutory 37 ... ... ... ... 37 62 Men Inspectors. Women Inspectors. Spocial. Inspector Gatliercole, East District. Inspector Duuwortli. West District. Inspector Jiobinson. West District. Miss East District. Mis-i Wilkinson. rotaK ACTION TAKEN—(continued). Orders required from Sanitary Committee 54 ... 49 ... ... 103 Certificates for Cleansing issued by Medical Officer of Health 81 ... 15 ... ... 46 Matters referred to District Inspectors 1 ... 8 ... l 10 Matters referred to Women Inspectors ... ... ... ... ... ... Matters referred to Workshop Inspectors ... ... ... ... ... ... 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 Citv. Three contacts with Scarlet Fever and one with Measles were 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 of Lists received. Outworkers Employed in City. Outworkers Employed outside City. Total number of Outworkers. 1902 ... 17 3,752 3,769 (Note.—First 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 1920 1,359 802 13,102 13,904 68 THIS TABLE WAS ISSUED BY THE LOCAL GOVERNMENT BOARD BY REQUEST OF THE SECRETARY OF STATE. FACTORIES, WORKSHOPS, WORKPLACES AND HOMEWORK. 1 .9 2 O . 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) 866 52 — Workshops (including Workshop Laundries) 731 202 — Workplaces (other than Outworkers' premises included in Part 3 of this Report.) 618 153 — Total *2,215 407 — 2.—DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Particulars. (1) Number of Defects. Number of Prosecutions (5) Found. (2) Remedied. (3) Referred to H.M. Inspector. (4) Nuisances under the Public Health Acts:—† Want of cleanliness 200 210 9 — Want of ventilation 28 28 2 — Overcrowding 4 7 — — Want of drainage of floors — — — — Other nuisances 217 258 8 — Sanitary accommodation insufficient 2 — — — unsuitable or defective 269 256 — — not separate for sexes. 25 27 — — Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (S. 101) — — — — Breach of special sanitary requirements for hakehouses(S S. 97 to 100) — — — — Other offences (excluding offences relating to outwork which are included in Part 3 of this Report) — — — — Total 745 786 19 — * 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. 64 65 3.—HOME WORK. NATURE OF WORK. * OUTWORKERS LISTS, SECTION 107. Notices served on occupiers as to keeping or sending Lists. Prosecutions. OUTWORK IN UNWHOLESOME PREMISES, SECTION 108. OUTWORK IN INFECTED PREMISES, SECTIONS 109, 110. Lists received from Employers. 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.t Outworkers, f List?. Outworkers. Contractors. Workmen. Contractors. Workmen. (1) (2) (3) (4) f5) (6) (7) (8) of lists. (9) (10) (11) (12) (18) (14) (15} (16) Wearing Apparel— making, &c. 1,132 3,045 8,736 37 50 147 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) 92 231 352 3 7 Cables and Chains Anchors and Grapnels 1,736 Cart Gear Locks, Latches and Keys Umbrellas, &c. 54 41 427 1 8 Artificial Flowers 32 ... 478 ... ... ... Nets, other than Wire Nets Tents Sacks Racquet and Tennis Balls. Paper, &c., Boxes, Paper Bags 8 9 64 ... ... ... 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 1,318 3,326 10,057 41 58 154 1,736 Nil. Nil Nil Nil. Nil. Nil. Nil. Nil. * If 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 class only, but the outworkers should be assigned in columns 3 and 4 (or 6 and 7) into their respective classes. A footnote should be added number of workers in each class of work, the list should be included among those in column 2 (or 5 as the case may be) against the principal † The figures required in columns 2, 3 and 4 are the total number of the lists received from those employers who comply strictly with the to show that this has been done, be even numbers as there will be two lists for each employer—in some previous returns odd numbers have been inserted. The figures in statutory duty of sending two lists each year and of the entries of names of outworkers in those lists. The entries in column 2 must necessarily and August lists of the same employer the same outworker's name will often be repeated. columns3 and 4 will usually be (approximately) double of the number of individual outworkers whose names are given, since in the February 4.—REGISTERED WORKSHOPS. Workshops on the Register (S. 131) at the end of the year. Number. (1) (2) Important classes of workshops, such as workshop bakehouses, may be enumerated here. General Workshops 2,900 Bakehouses (including Factory Bakehouses) 21 Total number of Workshops on Register *2,921 5.—OTHER MATTERS. Class. Number. (1) (2) Matters notified to H.M. Inspector of Factories :— Failure to affix Abstract of the Factory and Workshop Act (S. 133, 1901) 49 Action taken in matters referred by H.M. Inspector Notified by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (S. 5, j Reports (of action taken) sent to H.M. ' Inspector 59 55 Other 8 Underground Bakehouses (S. 101) :— Certificates granted during the year Nil. In use at the end of the year 16 ° These figures indicate separate work-rooms inspected. Note—The Factory and Workshop Act, 1901 (S. 132), requires the Medical Officer of Health in his Annual Report to the District much of it as deals with this subject, to the Secretary of State (Home Office). If the Annual Report is presented otherwise than in print, it homework. The duties of Local Authorities, and the Medical Officer of Health under the Act of 1901 are detailed in the Home Omce Date, 31 December, 1920. (Signature) W. J. HOWARTH, Medical Officer of Health. Council to report specifically on the administration of that Act in workshops and workplaces, and to send a copy of his Annual Report, or so Memorandum March 19l2 Copy sent to the home office the portions which do not relate to factories, workshops, workplace, or 66 RAT REPRESSION. The Eats and Mice (Destruction) Act, 1919, became operative on 1st January, 1920, and involved the Corporation, the Citizens and the Occupiers of Premises within the City in responsibilities in connection with the suppression of rats. Instructions have been given by posters and the free distribution of pamphlets. The Press has shown much interest in the matter, and frequent reference, both serious and humorous, has been made to the subject in nearly all papers. It may consequently be stated that all responsible persons are now aware that their premises may no longer legally harbour rats. The Report which I presented to the Court at the beginning of the year dealt very fully with the whole question of rat repression in the City, and it will now suffice if I call attention to paragraph 5, which reads as follows:— "Although probably not every premises in the City harbour rats, I do not "consider that there is any part of the City area which can be reasonably deemed to "be free from rat infestation. Such buildings as are generally free are exposed to intermittent infestation as consequence of rats gaining access in the ways already "described. Two problems present themselves:— "(1) The riddance of buildings of rats, and "(2) The riddance of the district as a whole." That the work may be both systematic and co-operative is the ideal now being aimed at. House-to-house inspection in defined areas has been instituted with a view to co-operation amongst occupiers for the suppression of the rat nuisance, and to impress upon occupiers of infested premises who are not taking action the necessity for doing so, in the interest of themselves and of their neighbours. Advice is given as to the best methods to be adopted in each case, and the premises are revisited to ascertain whether this advice is being acted upon and with what results. An indexing system has been installed for the purpose of registering infested premises and premises which structurally are likely to harbour the rodents. The accompanying table gives a summary of the work carried out during the year, but the systematic inspection of areas was only inaugurated in November last, when two Inspectors in addition to the one already engaged were put on to this particular work. In making these house-to-house visits the Inspectors are instructed to point out to all occupiers that the responsibility of rat suppression devolves upon them, but that the Department is anxious to give all possible assistance in the work and to obtain a measure of co-operation among occupiers where a particular locality is affected. It was found during the house-to-house inspections that frequently neglected premises harbouring rodents were a cause of reinfestation of premises where reasonable measures to stamp out the nuisance had already been taken, thus proving the need for detailed routine inspection. As an example, I may mention, that a basement in Farringdon Street, in which a very large number of cheeses were stored, was found to be the cause of the rat infestation of a considerable surrounding area. The owner of the basement was called upon to take repressive measures, and was advised to use varnish traps, by which means over 200 rats were caught in three weeks. In addition, all rat holes were stopped, and most of the cheeses removed, with the result that the nuisance in that area is practically abated for the time. The number of rats caught (shown in the column under that heading) represents only a very small proportion of the total, as these are merely the results of preliminary trapping under the actual instruction of the Inspectors. Trapping is being continued in almost every case by the occupiers concerned at regular intervals. It is almost a matter of impossibility, however, to get them to send in their returns. All the rats shown as trapped were caught on varnish. There is no doubt that for indoor work the Varnish Trap is a reliable contrivance. Throughout the City a number of professional rat catchers and poisoners are engaged regularly in trapping and poisoning in large business premises. I consider it desirable that these professionals should work in conjunction with the official Eat Officer, so that the latter should know the premises in which they are operating and the results of their efforts, and I think, later, an attempt should be made to formulate a scheme of registration of ratcatchers by the City Authorities. Such a system would probablv benefit ratcatchers as a whole, since it would, to some extent, be a guarantee of their bona fides. It is important that the Authorities should be able to obtain certain information from them, e.g.:— (a) A list of the premises at which they are employed. (b) The methods they use and the success of each method. (c) The number of rats caught or destroyed. (d) The amount and kind of poison used at each place. 67 I am informed that one well-known ratcatcher has about 260 contracts in the City alone. There is no doubt that these men are doing extremely useful work. It is worthy of some consideration, whether this Department should not actually undertake contracts, and so assist the work in becoming to some extent self-supporting. Many firms would prefer to entrust the work of rat repression to the Corporation at a reasonable annual cost rather than engage the services of private and unregistered men. We have now the nucleus of a staff qualified to carry out such work, which would not be undertaken with the object of doing away with the private ratcatcher or of interfering with his contracts, but rather as a supplementary aid in rat repression. There will continue to be enough work for all. This idea is being fully considered. Considering the large number of premises in which food is stored in the City, some control of supervision over the distribution of dangerous poisons or viruses pathogenic to human beings is, in my opinion, a necessity. To illustrate this requirement I may mention the fact that at a large food warehouse where a rat poisoner was engaged, quantities of bait in cake form were laid about. One of these cakes, which was composed of a starchy meal as a basis, was taken away for analysis. The cake weighed two ounces and contained 330 grains of arsenic. Large quantities of arsenic are being used in the City. A representation is shortly to be made to the Government for the inclusion of a financial clause in the Eats and Mice (Destruction) Act, 1919, to enable Local Authorities to make charges for work done; but several Authorities, including the Middlesex County Council, are already making contracts for rat repression work and receiving payments, although the legality of such arrangement is doubted by some. The point should be decided by definite authority being stated. RAT REPRESSION WORK. Summary of Inspections made for the Year ended 31st December, 1920. Number of buildings inspected, house-to-house 409 * Number of buildings inspected arising out of complaints 232 Total buildings inspected 641 Average number of firms per building 3 Number of premises rat infested 381 Number of buildings rat infested at which no action has been taken at the first inspection 33 Number of buildings at which rat-proofing has been carried out 26 Total number of rodents caught by Department in preliminary trappingsf — Rats 4,782 Mice 828 Drainage Repairs 5 † "Preliminary trappings " means the first trappings after instruction, ‡ At one premises the drains were entirely relaid throughout. 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, 57 persons were examined by the Medical Officer of Health during 1920, four of these persons were reported as physically unfit for office. Eleven officers were also medicallv examined with a view to their retirement, nine of whom ;were reported to be unfit for duty. I have the honour to be, Gentlemen, Your obedient Servant, Medical Officer of Health for the City of London. Public Health Department, Guildhall, E.C. APPENDICES. PAGE Appendix A—Street Lists of Mortality 70 „ B— „ „ Infectious Diseases 73 „ C—Register of Houses let in lodgings or occupied by members of more than one family 75 70 APPENDIX A—STREET LISTS OF MORTALITY. STREET OR PLACE. No. of House. Sex. Age. Date of Death. Cause of Death. Remarks. Aldersgate Street 53 M 71 10 Feb. Heart Failure „ „ 188 F 47 17 July Carcinoma of Pylorus Aldgate 28 M 44 7 August General Paralysis of Insane „ 30 M 30 12 April Haemorrhage, &c. „ High Street 27 M 84 19 August Bronchitis—Cardiac Failure „ Three Nuns Hotel — M 45 21 March Bronchitis Ansel Court 14 M 63 1 ,, Paralysis Agitans Artillery Lane 20 M 53 3 May Carcinoma of Stomach „ „ 21 F 9 17 Dec. Acute Rheumatism Austin Friars 22 F 83 29 Oct. Cerebral Thrombosis Barker's Buildings, Room 22 F 75 14 „ Syncope—Valvular Disease of Heart P.M., Natural. Bishopsgate ... 26 M 61 24 Nov. Syncope—Chronic Disease of Heart „ 162 M 32 14 Feb. Lobar Pneumouia „ 191 M 4 23 August Sarcoma of Jaw „ Fire Station — M 22 1 March Sacra Abscess „ Great Eastern Hotel M 69 22 August Valvular Disease of Heart Bridgewater Street 4 M 2 24 Jan. Diphtheria „ „ S F 18 hours 12 April Convulsions Inquest, P.M. Broadway, Ludgate Hill, 117. St. Ann's Chambers M 70 7 Nov. Carcinoma of Tongue Brushfield Street 10 F 52 28 „ General Paralysis of Insane Cannon Street 53 M 36 31 Dec. Lobar Pneumonia „ „ 84 M 16 4 April Syncope and Broncho-Pneumonia P.M. „ „ 88 M 65 29 June Broncho-Pneumonia and Cardiac Failure P.M. „ „ 109 M 49 29 „ Pleurisy—Pyo-pneumothorax P.M. „ „ 121 M 73 22 Nov. Cerebral Haemorrhage |i „ „ Hotel — M 68 9 Dec. Acute Cholecystitis Carter Lane, Choir House. — M 29 27 Feb. Influenza—Pneumonia Cavendish Court, Bishopseate • ... F 67 16 „ Senile Decay Cloak Lane Police Station — F 80 5 Mar. Valvular Disease of Heart Cloth Fair 45 F 76 24 Jan. Syncope—Advanced Disease of Coronary Arteries. „ Bartholomew House M 62 10 April Morbus Cordis Cornhill 78 M 3 m'ths 4 Feb. Bronchitis Crown Court 3 M t>6 3 „ Gangrene of Leg Crown Place, Aldgate 3 M 60 6 May Chronic Gastric Ulcer Dean's Court, Old Bailey 31 F 76 4 Mar. Senile Debility Devonshire Square — H* 81 10 „ Dorset Street 4 M 65 11 Oct. Valvular Disease of Heart „ „ 7 M 80 8 Jan. Senile Decay Duke Street, Aldgate 32 F 55 1 April Acute Bronchitis „ „ 46 F 59 17 Jan. Influenza—Pneumonia Dyer's Buildings 6 F 80 24 July Misadventure—Fall in a Market Essex Court, Temple 5 M 60 7 Jan. Cerebral Haemorrhage Farringdon Street 18 M 57 17 July Syncope—Disease of Heart r.M. Inquest, Natural. Fenchurch Street 51 M 63 22 April Influenza—Pulmonary Tuberculosis „ „ 51 F 66 18 June Chronic Interstitial Nephritis Fetter Lane 40 F 43 15 Sept. Pulmonary Tuberculosis „ „ 42 F 67 12 Dec. Arterio-Sclerosis „ „ 108 M 35 15 April Appendicitis Abscess—Phthisis Finsbury Circus, River Plate House F 18 19 May Pulmonary Tuberculosis Finsbury Pavement 63 F 1 m'th 5 April G astro-Enteritis Fleet Lane 29 F 79 9 Feb. Syncope, due to Valvular Disease of Heart P.M. Fleet Street 44 M 40 20 March Valvular Disease of Heart „ „ 53 F 59 27 „ „ „ „ Pulmonary Tuberculosis „ „ 95 M 48 16 July Fore Street 114 XI 35 12 Dec. Asphyxia, Monoxide Poison Suicide, unsound mind „ „ 116 M 45 18 Oct. Sub-acute Bacterial Endocarditis Garden Court, Temple 2 U 58 17 April Enteric Fever Garden Place 9 M 42 26 Sept. Pulmonary Tuberculosis Great Eastern Hotel M 46 8 Jan. Broncho-Pneumonia „ „ M 58 10 June Heart Failure—Pleurisy Great New Street 2 F 78 9 Dec. Bronchitis „ „ 3 F 77 27 „ „ „ „ 20 F 73 29 Feb. „ Great St. Helen's 26 F 50 8 May Intestinal Obstruction Goring Street 2 M 70 20 March Coma—Cerebral Apoplexy Inquest, P.M. Gutter Lane 23 F 36 14 Feb. Tuberculosis of Lung and Larynx Holborn Circus, T. Wallis. — F 57 27 August Carcinoma of Bladder Holborn Viaduct 29 F 68 10 Sept. Cardiac Disease „ „ Station, In train. — M Newly born. 4 April Rupture—Want of attention Houndsditch 8 M 68 10 Feb. Pneumonia „ 95 F 9 m'ths 4 Dec. Burns from Clothes on fire-guard Inquest, Accident. Hutchison Avenue 3 F 66 19 Oct. Morbus Cordis „ „ 18 M 8 28 Nov. Syncope—Pericarditis „ „ 20 M 65 21 May Syncope—Chronic Heart Disease Inquest, P.M. „ „ — M 72 17 June Carcinoma of Tongue Hutchison Street 16 M 53 28 August Valvular Disease of Heart Hutton Street 37 M 2 15 June Measles—Bronchitis John Street, Minories 13 M 64 25 May Melancholia—Cerebral Hemorrhage King's Block, Stoney Lane 30 F 6 m'ths 7 Nov. Gastric Enteritis „ „ 36 F 69 31 Jan. Gangrene of Foot „ „ 38 M 2 m'ths 8 Feb. Whooping Cough Kingf Street, Snow Hill 18 F 58 27 May bronchitis King William Street 31 M 69 19 Dec. Chronic Interstitial Nephritis 71 STREET LISTS OF MORTALITY—continued. STREET OR PLACE. No. of House. Sex. Age. Date of Death. Cause of Death. Remarks. Knightrider Street 61 M 4 5 May Shock : Hemorrhage—Run over, motor P.M., Inquest. Laurence Pountney Hill 18 M 49 24 August Suicide, Unsound Mind Leadenhall Street 96/ M 64 5 May Rupture of Heart 98 „ „ 101 M 15 6 Nov. Shock : Haemorrhage—Fracture of Skull Crushed in lift well. Little Britain 25 M 54 1 May Diabetes—Chronic Nephritis P.M., Accidental. Little College Street 3 F 67 2 June Cerebral Thrombosis Liverpool Street StationCloak Room — F Newly born. 28 May Suffocation, strangulation—Tape tied round neck. P.M., Inquest, Murder. G.E.R. Hotel — M 58 10 June Heart Failure Railway Station — F Newly born. 30 August Inattention at Birth Unknown. Long Lane 74 M 75 8 Jan. Embolism of Lungs „ 75 M 74 21 May Cerebral Haemorrhage—Fall from window „ Vincent Hotel... — M 65 15 June Actinomycosis—Diabetes Ludgate Hill 4 M 46 24 Dec. Valvular Disease of Heart Mansell Street 30 M About 20 mins. 27 April Heart Failure Mark Lane 36 M 43 18 July Syncope, following fall from window Metal Exchange Buildings — M 46 24 May Lympho-sarcoma of Media Middlesex Street 33 M 6 30 July Diabetes Mellitus „ „ 95 F 6 24 Nov. Epithelioma of Vulva Middlesex Street- Salvation Army Shelter — M 57 28 Feb. Meningitis „ „ M 76 3 March Bronchitis „ „ — M 66 3 April Influenza—Bronchitis „ In Ambulance near 116 M about 60 16 „ Heart Failure. Disease of Coronary Arteries Salvation Army Shelter M 64 16 „ Morbus Cordis „ „ — M 68 25 May Epithelioma of Lip „ „ — M 54 5 July Acute Lobar Pneumonia „ „ — M 39 31 „ Pulmonary Tuberculosis „ „ — M 82 29 Nov. Chronic Bronchitis Middle Street 2 F 8 8 August Chronic Suppurative Otitis Media „ „ 4 M 48 21 Oct. Periproctitis— Isehio-rectal Abscess „ „ Bartholomew Close 2 M 74 14 March Bronchitis Milk Street 5 M 73 9 May Thyroiditis P.M. Minories 54 F 71 20 Feb. Tubercular Gland in Neck and Lung „ 76 F 73 26 August Carcinoma of Breast „ Central Hotel — M 39 18 Sept. Epithelioma of Tongue Mitre Street, Fleet Street 1 M 61 IE Feb. „ „ „ Monkwell Street, Barker's Hall F 65 20 Nov. Cancer of Rectum Montague Court 3 F 39 27 May Syncope— Degeneration of Heart Moor Lane Chambers 3 M 83 10 Feb. Coma—Tubercular Disease of Lung „ „ 20 F 79 25 March Senile Decay New Broad Street 39-41 M 70 30 August Cerebral Haemorrhage—Heart Failure Newgate Street 50 M 67 8 March Cerebral Hemorrhage „ „ City Central Hall _ M 75 26 „ Influenza New Street 6 F 65 11 June Pulmonary Tuberculosis „ „ Houndsditch 14 M 37 21 „ Tubercular Disease in Pulmonary Artery „ „ Aldgate 31 F 47 21 .. Tumour of Uterus—Intestinal Paralysis „ „ 37 M 57 19 March Pulmonary Tuberculosis Noble Street, The Coachmakers' Hall M 56 29 Dec. Myocardial Defeneration Old Bailey 25 M 32 18 March Septic Pneumonia „ „ — M 68 14 April Bronchitis Old Broad Street 56 F 03 23 Jan. Carcinoma „ „ — M 65 2 Nov. Syncope—Ruptured Left Ventricle of Heart P.M., Natural Paper Bldgs., Inner Temple 4 F 60 7 „ Chronic Nephritis Paper Street 7 M 5l 13 May Carcinoma—Operation Shock Plowden Buildings I M 46 8 August Pernicious Anaemia Police Buildings, Rose Alley 14 M 6 m'ths 27 May Congenital Heart Disease Providence Place 7 F 63 22 August Pulmonary Tuberculosis Queen's Block, Stoney Lane 46 M 69 28 Jan. Acute Bronchitis Queen's Court 2 M 63 13 August Acute Tuberculosis— Broncho-Pneumonia Queen Victoria Street 46 F 52 3 May Syncope due to Rupture of Fatty Heart Found Dead, Inq. P.M. „ „ 114 M 80 17 Nov. Arterio-Sclerosis „ „ „ 146 M 47 16 Jan. Pernicious Anaemia „ „ „ 171 F 84 26 „ Senility—Bronchitis „ „ „ College of Arms F 17 10 Sept. Bronchitis River Thames— Near Custom House — M 54 28 Jan. Drowning—no Evidence P.M., Inquest. Old Swan Pier — E 29 29 March „ „ „ 11 11 Southwark Bridge — M about 30 3 April Asphyxia from Drowning—no Evidence Near London Bridge — M 41 10 June „ „ „ „ „ „ 11 „ „ „ — M about 30 25 Sept. Drowning—Killed himself „ „ Unsound Mind Dowgate Wharf — M 42 27 June Suffocation— Drowning „ ,. Accidental Wheatsheaf Wharf — M about 32 28 Sept. Asphyxia—Drowning P.M., no Evidence River Thames — M 55 8 October Asphyxia from Drowning P.M. St. Bartholomew's Hospital F 51 20 March Pneumonia P.M. „ „ — M 52 4 May 2 ,i h The College — M 22 3 August Pyo-nephrosis St. Bride Street 7/9 M 78 28 October Senile Decay St. Mary-at-Hill 16 M 61 24 April Influenza—Bronchitis St. Mary Axe 1 F 58 5 October Syneope—Chronic Interstitial Nephritis P.M., Inquest „ „ „ 54 F 13 21 Nov. Rheumatic Fever and Pericarditis St. Paul s Churchyard 47 M 44 11 June Pulmonary Tuberculosis 72 STREET LISTS OF MORTALITY -continued. STREET OR PLACE. No. of House. Sex. Age. Date of Death. Cause of Death. Remarks. Salisbury Square 10 F 56 13 Feb. Carcinoma—Hepatitis Seething Lane 15 M 48 1 May Pulmonary Tuberculosis Shoe Lane 113 M 62 24 April Morbus Cordis—Acute Dyspepsia „ „ (in) — M 66 28 Nov. Heart Disease Stoney Lane 29 F 48 23 March Broncho- Pneumonia South Block, Stoney Lane 27 M 44 1 Sept. Tabes Dorsalis—Septic Arthritis Stoney Lane 10 M 49 9 April Influenza—Pneumonia Thavies Inn 18 M 1 month 13 Feb. Bronchitis „ „ 18 F 63 22 March „ „ „ 18 F 75 11 Julv Senile Decay Trump Street 10 M 70 18 Feb. Carcinoma of Colon Upper Thames Street 93 M 79 19 October Cerebral Effusion—Cardiac Failure Walbrook 18 M 29 20 May Cancer of Pancreas „ „ 36 M 56 2 Dec. Carcinoma of Larynx Wardrobe Place, Ye Olde Belle Hotel M 77 16 June Arterio-Sclerosis West Smithfield 66 F 25 9 Dec. Fracture of Skull—Fall from Window P.M., Accidental Whitecross Street, City Green Yard F 44 3 „ Carcinoma of Uterus Widegate Street 21 F about 88 26 May Senile Decay Wood Street 1 M 64 16 Nov. Chronic Bronchitis „ „ 97 F 84 7 May Carcinoma of Large Intestine Wrestler's Court 11 F 95 26 April Senile Decay—Bronchitis APPENDIX B.—LIST OF CASES OF INFECTIOUS DISEASE OTHER THAN TUBERCULOSIS, 1920. STREET LISTS.—Compiled from Notifications received. Street or Place. No. of House. Sex. Age. Disease. Date of Notification. 1920. Aldgate High Street 9 to 13 M 43 Pneumonia 11th May. America Square 14 F 16 Scarlet Fever 27th September. Austin Friars 24 F 21/2 Chicken-pox 26th July. Ditto 24 F 5 Ditto 9th July. Bishopsgate 146 M 4 Diphtheria 2nd March. Ditto Fire Station — M 30 Pneumonia 7th February. Ditto Ditto — M 32 Ditto 7th February. Ditto Ditto — M 31 Ditto 7th February. Ditto Police Hospital M 41 Cerebro-spinal Meningitis 15th January. Bridgewater Street 4 M 21/2 Diphtheria 11th January. Ditto — F 34 Ditto 15t,h January. 7th February. The Broadway, Ludgate Hill, St. Ana's Chambers 23 M 50 Pneumonia Carter Lane 6 F 11 Scarlet Fever 3rd October. Ditto 36 M 91/2 Chickeu-pox 23rd September. Ditto 36 F 16 Scarlet Fever 9th November. Catherine Wheel Alley, Barker's Buildings 18 F 10 Scarlatina 17th October. Coleman Street 65 M 1 Ohicken-pox Scarlet L'ever 12th January. Copthall Avenue 15 M 12 8th July. Copthall Court 11 F 3 Chicken-pox 11th January. Cross Lane 3 F 10 Scarlet Fever 6th December. Dean Street, A Block 1 F 8 Diphtheria 21st October. Ditto ditto 4 M 121/2 Ditto 4th October. Ditto D Block 4 M 22 Ditto 31st January. Devonshire Square 14 M 11 Scarlet Fever 18th September. Eldon Street 15 F 13/4 Ditto 8th May. 73 LIST OF CASES OF INFECTIOUS DISEASE, ko.—continued. Street or Place. No. of House. Sex. Age. Disease. Date of Notification. 1920. Fenchurch Street 51 M 62 Pneumonia 7th February. Ditto 107 F 9 Chicken-pox 27th January. Ditto 112 F 12 Diphtheria 24th December. Fen Court 5 M 54 Pneumonia 7th February. Fish Street Hill 38 M 17 Scarlet Fever 29th January. Ditto — F 50 Erysipelas 6th April. Fleet Street 22 F 28 Diphtheria 22nd April. Ditto 85 M 5 Ditto 7th October. Ditto 162 to 165 M 36 Malaria 11th March. Furnival Street 39 F 5 Scarlet Fever 8th November. Great New Street 20 F 12 Ditto 5th October. Grey stoke Place 8 M 49 Erysipelas 19th September. Ditto 9 F 9 Diphtheria 16th October. Harrow Alley 35 F 13 Scarlatina 15th October. Houndsditch 46 F 11 Scarlet Fever 15 th December. Hutchison Avenue 4 M 5 Ditto 30th November. Hutchison Street 4 M 11/2 Ophthalmia Neonatorum 31st October. Hutton Street 37 F 19 Scarlet Fever 11th November. King William Street 39c F 7 Diphtheria 17th December. Leadenhall Street 145 F 15 Ditto 6th April. Lime Street Square 2 M 6 Scarlet Fever 3rd July. Liverpool Street 15 F 31 Diphtheria 16th June. Long Lane 80 F 7 Scarlet Fever 3rd December. Mansell Street 3 M 13 Diphtheria 11th December. Middlesex Street 97 F 56 Pneumonia 19th March. Ditto 116 M 40 Diphtheria 21st July. Ditto 116 M 54 Pneumonia 27th July. Minories 31 M 16/2 Ditto 24th January. New Street, Bishopsgate 12 F 34 Erysipelas 3rd August. New'Street, Gravel LaDe 17 F 9 Scarlet Fever 17th September. Ditto 22 M 9 Ditto 27th September. Ditto 31 M 6 Diphtheria 21st January. North Block, Stoney Lane 30 F 3 Scarlet Fever 8th March. Paternoster Square 19 M 6 Ditto 27th September. Prince's Block 35 F 1 Ditto 4th December. Prince's Street 6 F 17 Diphtheria 30th August. Robin Hood Court Infirmary — M 19 Scarlet Fever 26th October. Rose Alley, Bishopsgate 21 F 4 Diphtheria 3rd February. Ditto 26 F 7 Scarlet Fever 13th December. Ditto 40 F 9 Diphtheria 7th December. St. Bartholomew's Hospital — — — Diphtheria 9 cases, Scarlet Fever 6 cases St. Dunstan's Alley 4 F 13 Diphtheria 23rd December. St. Dunstan's Hill 14 M 37 Scarlatina 23rd October. Ditto 14 F 9 Ditto 11th October., St. Mary Axe 22 M 5 Scarlet Fever 27 th October. Salisbury Court 137 F 19 Diphtheria 16th November. Salisbury Square 10 F 56 Erysipelas 19th January. Shoe Lane 36 M 12 Scarlet Fever 29th September. South Block 40 F 5 Ditto 9th February. Ditto — M 7 Ditto 10th February, Swan Street, Minories 8 F 6 Ditto 23rd October. Throgmorton Street 8 F 35 Erysipelas 18th March. 74 APPENDIX C—REGISTER OF HOUSES LET IN LODGINGS 0?. OCCUPIED BY MEMBERS OF MORE THAN ONE FAMILY. WEST DISTRICT. Situation of Premises. Name and Address of Landlord. Tenements. Lodgers. 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 Office. 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. and 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 3 5 5, do. H. Fenlon, 8, Tudor Street Office. 7, do. E. King, 23, Whitefriars Street 1 9 10, East Harding Street Eyre and Spottiswoode 3 7 11, do. Do. 3 7 12, do. Do. 4 8 2, Evangelist Court 1, Fenton's Buildings Morris & Co., 99, Shepherdess Walk, City Road 2 4 Thos. Matthews, 85, liavensdale Road,Stamford Hill 2 4 2, do. Do. do. do. 2 5 3, do. 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 9 30, do. Do. do. do. 2 6 31, do. Do. do. do. 4 7 1, Great New Street Mrs. J. Barnsley, 1, Great New Street 5 8 2, do. Do. do. 4 10 3, do. Do. do. 7 9 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, Heme 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. 1 2 6, do. C. Fleming, 6, Green Dragon Court 1 4 7, do. 6, Greystoke Place Smith, Oakley & Gerrard, 4 & 5, Charles Street, W. 1 4 W. G. Cass, 6, Greystoke Place 1 4 7, do. W. Read, 102, Fetter Lane 4 9 8, do. Do. do. 3 8 9, do. Do. do. 3 8 2, Gunpowder Alley T. Richardson, 2, Gunpowder Alley 1 6 7, 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 25a, 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 1 2 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 Carried forward 135 285 75 WEST DISTRICT—continued. Situation of Premises. Name and Address of Landlord. Tenements. Lodgers. Brought forward 135 285 2, Middle Street F. B. Westacott, 74, Camden Road, N.W. 1 4 do. Do do. 1 5 ' & 5, do. J. Hull & Sons, Bartholomew Close . 6 12 6, do. J. Marks, 19, Ludgate Hill ... ... .. 3 4 20, do. T. Green, 20, Middle Street . One family. 1, Montague Court Mrs. Joyce, 1, Montague Court 3 7 2, do. Mr. Hanlan, 2, do. 2 5 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 Laue 1 6 8, do. Do. do. 4 7 9, do. • Do. do. 3 8 10, do. Do. do. 6 14 11, do. Goldsmiths' Company, Goldsmiths' Hall 4 8 12, do. Do. do. 5 9 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 1 4 14, do. Do. do. 2 5 16, do. Do. do. .. 1 4 17, do. Do. do. 2 3 Total . 194 418 Average number of lodgers to each occupied tenement: 2*1. Houses demolished :— 3, viz., 10, 11 & 12, Newbury Street, pulled down. Tenement houses on Register ... ... 85 Cleansing Notices served ... ... 110 MIDDLE DISTRICT. 1 and 2, Huggin Court ... City Parochial Charities Trustees, 3, Temple Gardens... 6 12 9, Huggin Lane ... H. Belcherv 8, Martin's Lane, E.C. 5 5 10, do. ... H. Willis, 10, Huggin Lane 5 6 15, Swan Lane ... H. Postlewaithe, 15, Swan Lane ... ... ... 1 1 Total 17 24 Average number of lodgers to each occupied tenement: 1*4. 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 6, George Street, Minories B. Marks, 6, George Street 1 1 Carried forward... 57 137 76 EAST DISTRICT—continued. Situation of Premises. Name and Address of Landlord. Tenements. Lodgers. Brought forward 57 137 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. J. Sietta, 51, New Road, Whitechapel 1 3 7, do. do. do. 1 2 9, do. 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, 22, 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. Soloman, 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 Buildings, 2, Hutchison Street. A. Blum, 3, Homerton Row, E. 3 7 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 157 366 Average number of persons to each occupied tenement: 2*3. Houses demolished or closed in 1920 Nil. Tenement houses on Register 64 Cleansing Notices served 89 Charle6 Skipper and East, Printers, 49, Great 'lower Street, E.C. 3.