AC434 LON47 REPORT OF THE MEDICAL OFFICER OF HEALTH OF THE CITY OF LONDON FOR THE YEAR 1921 LONDON Printed by Drake, Driver & Leaver, Ltd., Rosebery Avenue, E.C.I. 1922. REPORT OF THE MEDICAL OFFICER OF HEALTH OF THE CITY OF LONDON For the Year 1921. LONDON Printed by Drake, Driver & Leaver, Ltd., Rosebery Avenue, E.C.I. 1922. INDEX. A. page. ANNUAL RATEABLE VALUE 8 ANTHRAX INFECTED SHAVING BRUSHES 32 AREA 7 ARTIZANS' DWELLINGS 59 ATMOSPHERIC POLLUTION 29 B BACTERIOLOGICAL EXAMINATIONS 29 BACTERIOLOGICAL EXAMINATION OF MILK ARRIVING AT RAILWAY STATIONS 57 BAKEHOUSES ABOVE GROUND AND UNDER GROUND 67 BASEMENT WORKROOMS, LIGHTING AND VENTILATION OF 72 BIRTHS 13 c. COMMON LODGING HOUSE, 116 MIDDLESEX STREET 64 COMPOUND LARD 50 CONDENSED MILK, IMPORTED SKIMMED 51 CONTRACT, CONDEMNED MEAT, METHOD ADOPTED FOR DISPOSAL 45 COURTS, SUMMER FLUSHING OF 65 LIME WASHING OF 66 CREMATIONS 34 CZECHO-SLOVAK MEDICAL COMMISSION, VISIT 31 D. DAIRIES, COWSHEDS AND MILKSHOPS ORDERS 57 DENSITY 8 DISINFECTANTS, RESOLUTION ROYAL SANITARY INSTITUTE 62 DISINFECTION OF CLOTHING OF EMIGRANTS TO U.S.A. 61 DISPOSAL OF UNSOUND FOOD (METHOD ADOPTED) 45 DRAINAGE PLANS 65 E. EGG YOLK IMPORTED 50 ENTERIC FEVER IN SHELLFISH 33 EXAMINATION FOR PATHOGENIC BACTERIA 29 EXAMINATION OF MILK ARRIVING AT RAILWAY STATIONS 57 EXHUMATIONS AND REINTERMENT OF BODIES AT CITY OF LONDON CEMETERY 33 F. FACTORY AND WORKSHOP ACT, 1901—ABOVE GROUND BAKEHOUSES 67 ,, ,, ,,—FACTORIES, WORKSHOPS AND WORKPLACES ON REGISTER 66 ,, ,, ,,—KITCHENS OF RESTAURANTS 75 ,, ,, ,,—LIGHTING AND VENTILATION OF BASEMENT WORKROOMS 72 ,, ,, ,,—OUTWORKERS 69 ,, ,, ,,—SUMMARY OF INSPECTIONS 66 ,, ,, ,,—SUMMARY OF WORK DONE UNDER FACTORY & WORKSHOP ACT AND PUBLIC HEALTH (LONDON) ACT 68 ,, ,, ,,—UNDERGROUND BAKEHOUSES 67 ,, ,, ,,—USE OF PUBLIC CONVENIENCES BY OCCUPIERS OF BUSINESS PREMISES 70 FISH DELIVERIES 44 ,, SEIZURES 44 ,, SUPPLIES 44 FLEET STREET, 184, REMOVAL OF HUMAN REMAINS 66 FLY NUISANCE 66 FOOD AT CITY WHARVES 48 FOOD ORDER, SALES OF, 1921 56 FOOD POISONING 47 FRUIT PULP, PRESERVATIVES IN 51 G. GULLIES, STREET 65 H. HAIRDRESSERS' AND BARBERS' SHOPS 33 HOUSE, TRADE AND OTHER REFUSE REMOVAL 65 HOUSING 8 HUMAN REMAINS, REMOVAL OF, 184, FLEET STREET 66 I. ICE CREAM 59 INFANT MORTALITY 13 INFANT WELFARE WORK 15 INFECTIOUS DISEASES 16 ,, ,, ,,—ENCEPHALITIS LETHARGICA 19 ,, ,, ,,—EPIDEMIC DIARRHCEA 19 ,, ,, ,,—ISOLATION ACCOMMODATION, No. 6, BRIDGEWATER SQUARE 20 ,, ,, ,,—PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1921 23 ,, ,, ,,—SANITARY DEFECTS 65 ,, ,, ,,—TUBERCULOSIS 20 ,, ,, ,,—VENEREAL DISEASES 25 INSPECTION OF FOOD AT CITY WHARVES 48 INTRODUCTORY 7 K. KITCHENS OF RESTAURANTS 57 INDEX (continued). page. LARD, COMPOUND 50 LEGAL PROCEEDINGS 65 LIGHTING AND VENTILATION OF BASEMENT WORKROOMS 72 LIQUIDS SOLD AS DISINFECTANTS 62 LODGING HOUSES —REGISTERED 63 —COMMON, 116, MIDDLESEX STREET 64 M. MARGARINE, SALE OF 56 MEAT INSPECTION 38 ,, ,, —ALDGATE MARKET AND SLAUGHTERHOUSES41 ,, ,, —AMOUNT OF IMPORTED MEAT FOR 1921 38 ,, ,, —ANALYSIS OF SUPPLIES42 ,, ,, —CHILLED BEEF 39 ,, ,,—EXAMINATION OF SOUTH AMERICAN TONGUES 39 ,, ,,—FOOD CONDEMNED AT COLD STORES 40 ,, ,,—FROZEN BEEF 39 ,, ,,—LEADENHALL MARKET AND CITY SHOPS 41 ,, ,,—METHOD OF DISPOSAL OF UNSOUND FOOD 45 ,, ,,—MUTTON AND LAMB 39 ,, ,,—SUMMARY OF MEAT SEIZED AT ALDGATE 42 ,, ,,—SUMMARY OF UNSOUND MEAT DESTROYED 42 ,, ,,—TUBERCULOUS MEAT SEIZED 41 ,, ,,—VISIT OF INSPECTOR KELLAND TO NEW ZEALAND 34 MEDICAL EXAMINATIONS 85 METROPOLITAN NURSING ASSOCIATION 20 MILK, IMPORTED CONDENSED 51 MILK AT RAILWAY STATIONS, BACTERIOLOGICAL EXAMINATION 57 MORTALITY 13 ,,—INFANT 13 MORTUARY, DISINFECTION, INQUESTS, &c. 61 O. OVERCROWDING 65 P. POPULATION AND HOUSING 8 PUBLIC CONVENIENCES, USE OF OCCUPIERS OF BUSINESS PREMISES 70 PUBLIC HEALTH (MILK AND CREAM) REGULATIONS 52 & 57 PRESERVATIVES IN IMPORTED EGG YOLK 50 FRUIT PULP 51 R. RAT REPRESSION 82 REFUSE REMOVAL 65 REMOVAL OF HUMAN REMAINS, 184, FLEET STREET 66 RESTAURANT KITCHENS 75 S. SALE OF FOOD AND DRUGS ACTS 54 ,, ,, ,,—BUTTER 54 ,, ,, ,,—DRUGS 54 ,, ,, ,,—RESULTS OF PROSECUTIONS 54 ,, ,, ,,—SAMPLES REPORTED NOT GENUINE, ADMINISTRATIVE ACTION 55 ,, ,, ,,—SUMMARY OF ARTICLES EXAMINED UNDER SALE OF FOOD & DRUGS ACTS AND PUBLIC HEALTH (MILK & CREAM) REGULATIONS 52 SALE OF FOOD ORDER, 1921 56 SALE OF MARGARINE 56 SANITARY ACCOMMODATION IN BUSINESS PREMISES—USE OF PUBLIC CONVENIENCES 70 SANITARY DEFECTS AND INFECTIOUS DISEASE 65 SANITARY INSPECTIONS 62 SANITARY STAFF 5 SHAVING BRUSHES AND ANTHRAX 32 SHELLFISH AND ENTERIC FEVER 33 SMOKE 29 SPITTING 23 STREET GULLIES 65 T. TETANUS IN VASELINE 31 TUBERCULOSIS 20 ,,—PUBLIC HEALTH REGULATIONS, 1921 23 U. U.S.A. EMIGRANTS, DISINFECTION OF CLOTHING 61 V. VACCINATION 10 VASELINE 31 VENEREAL DISEASES 25 ,, ,,—OCCUPATION OF PATIENTS 28 VENTILATION AND LIGHTING OF BASEMENT WORKROOMS 72 VITAL STATISTICS 10 W. WATER-CLOSET ACCOMMODATION IN BUSINESS PREMISES—USE OF PUBLIC CONVENIENCES 70 ,, ,,—BYE-LAWS, NEGLECT TO COMPLY WITH 65 WHARVES, FOOD INSPECTION 48 WORKROOMS, BASEMENT, LIGHTING AND VENTILATION 72 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 Baldwin, Harold J. March, 1921 Lee, W. J. Oct., 1915 Pallett, Frank J. Nov., 1914 Spalding, C. A. March, 1918 Baker, H. J. April, 1918 Chapman, Miss B. R. Feb., 1920 Tunbridge, Mrs. Jan., 1917 Jarvis, Miss E. S., M.B.E. May, 1921 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 (died 13th October, 1921) 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 Kelland, William C. May, 1899 Mettam, Harry Aug., 1903 Davies, Thos. L. Dec., 1903 Bintcliffe, Charles E. March, 1907 Matson, William S. Dec., 1910 Mitchener, William E. Dec., 1910 Jones, J. April, 1914 Slatter, C. May, 1908 King, George G. April, 1910 INSPECTOR OF SLAUGHTERHOUSES AND MEAT. Eglin, William July, 1896 ASSISTANT INSPECTORS OF SLAUGHTERHOUSES AND MEAT. Murray, Samuel B. Sept., 1911 Penman, T. July, 1913 Mellish, Cyril E. Feb., 1912 KEEPER OF THE MORTUARY. Oakley, J. E. Feb., 1909 DISINFECTOR. McDonnell, R. J. April, 1903 MESSENGERS. Pinkney, Robert W. Oct., 1921 Peacock, Percy L. Oct., 1921 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 CLEANERS. Whaley, Mrs. E. A. Oct., 1921 Wright, Miss G. I. Oct., 1921 Graham, Mrs. L. (Bath Attendant and Cleaner). April, 1918 ■ • annual report of the medical officer of health for the year 1921. To the Right Honourable the Lord Mayor, Aldermen and Commons of the Corporation of London. Public Health Department, Guildhall, E.C. 16th March, 1922. My Lord Mayor and Gentlemen, I beg to present herewith the report of the Medical Officer of Health for the Corporation of the City of London for the year 1921. INTRODUCTORY. In my last report I drew attention to the fact that the statistics for the year were probably inaccurate and this presumption was proved to be well founded by the returns of the Census which was taken on the evening 19th /20th June in that year. The estimated population in 1920 was taken as 12,000, but the Census showed that the actual population for 1921 was 13,706 of which 6,716 were males and 6,990 females, a decrease in 1921 compared with 1911 of 5,951, the ratio of the populations being 70 to 100. Some time will elapse before an analysis of the figures is available. The present report contains an account of the activities of the Health Department during 1921. On certain occasions careful consideration has been given as to future lines of action and I would refer you to the difficult subject of the lighting and means of ventilation of basement workrooms (p. 72) ; the use of public conveniences where there is an absence of sufficient or separate water closet accommodation in business premises (p. 70). These two reports have been prepared by Mr. Fowler. The question of the hygiene of kitchens has received attention by Mr. Gathercole and the work of rat repression has been conducted by Mr. Mayne. In both these instances the inspectors concerned have given me considerable assistance in the preparation of my report (p.p. 75 and 82). I also desire to direct your attention to the report on the disposal of unsound food products (p. 45), in which a description of the premises erected by the Smithfield Animal Products Company, Ltd., is set out. An interesting report is also presented by Mr. Kelland on meat inspection work in Australia and New Zealand (p. 34). Mr. Kelland was granted leave of absence for six months on account of illness and proceeded on a journey to these countries. He used his period of leave to inspect the various meat centres which were on the route of his travels. During the year some further progress has been made in connection with the Hutchison Street area. The Ministry of Health have now intimated approval of the declaration of this area as insanitary and a draft of the proposed scheme has been submitted for the consideration of the Court. In addition a small area known as the Vine Street Minories Area has been reported upon and progress is being made in this connection. Improvements have been found necessary at the Centre for the treatment of venereal disease but owing to reasons of economy it is not considered desirable to proceed with the work of extension, but rather to carry on with existing facilities until the financial position of the country is less acute. In all directions due regard is being paid to financial circumstances and no new expense is being incurred except in connection with matters of real urgency or need. AREA. The City of London Registration District comprises an area of 678 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 1081 miles to a side. b 2 8 DENSITY (1921). City of London, Registration District, at night 20.2 persons to an acre. ,, ,, ,, ,, during the day *562.1 ,, ,, Registration London, at night 59.8 ,, ,, * 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 £48,708,751 on 6th April, 1921 ; whilst on the same date the corresponding rateable value of property in the City of London was £6,255,361 or about one-eighth of the whole County. POPULATION. The undermentioned figures are extracted from the Preliminary Report of the Registrar-General on the Census of England and Wales, 1921 :— Area, Inhabited Houses Population. Statute Acres 1911. 1921. 1911. 1921 City of London 678 2,784 —†19,657 13,706 These figures represent the population on the nights of the 3rd April, 1911, and the 19th June, 1921. For Registration, Parliamentary and Municipal purposes the boundaries of the Citv are co-terminus. The following table shows the progressive decline which has taken place since 1861 in the number of inhabitants who reside within the City boundaries, and the progressive increase in the number of workers who are daily employed in the City :— Year. Imperial Census. Night Population. City Census. Day Population. 1861 112,063 — 1866 — 170,133 1871 75,983 — 1881 51,405 261,061 1891 37,705 301,384 1901 26,923 — 1911 19,657 364,061 1921 13,706 — There is now only one registration district in the City. This comprises the City Area, and the population therein for the year 1921 is 13,706. 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. † No. of Inhabited Houses not included in Preliminary Report. POPULATION AND HOUSING. No new observations are called for in respect of housing other than that a systematic inspection is now being made of every house and a higher standard of efficiency is now being demanded than was the case during the war and immediately after the armistice. The chief difficulty in the City is that houses are sub-let to persons of no financial standing who farm them out room by room and make a profit which in some cases is the main income of the person, and when cleansing is called for it becomes a matter of difficulty to get the work carried out. I am strongly of opinion, in view of the fact that the Corporation has no control over the owner and the letting, that where houses are farmed out in this manner, the owner should be made responsible in cases where his tenant fails to comply with the byelaws. The existing byelaws relating to sanitary conveniences and appliances are now under consideration and it is hoped that in a short time modifications will be submitted which may remove many of the difficulties which now exist. In addition,byelaws under section 26 of the Housing, Town Planning Act, 1919, are under consideration. These to a certain extent will, it is hoped, improve the conditions of sub-let houses. 9 The attached table contains particulars required by the Ministry of Health. HOUSING CONDITIONS. STATISTICS. Year ended 31st December, 1921. 1.—GENERAL. (1) Estimated Population 13,706 (2) General death-rate 11.5 (3) Death-rate from tuberculosis of the lungs 0.95 (4) Infantile mortality 93 (5) Number of dwelling-houses of all classes 1,980 (6) Number of working-class dwelling-houses 1,454 (7) Number of new working-class houses erected Nil. 2.—UNFIT DWELLING-HOUSES. I.—Inspection. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 759 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 357 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil. (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 7 II.—Remedy of Defects without Service of Formal Notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 120 III.—Action under Statutory Powers. (a) Proceedings under Section 28 of the Housing, Town Planning, &c., Act, 1919. (1) Number of dwelling-houses in respect of which notices were served requiring repairs Nil. (2) Number of dwelling-houses which were rendered fit Nil. (a) by owners Nil. (b) by Local Authority in default of owners Nil. (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close Nil. (b) Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 352 (2) Number of dwelling-houses in which defects were remedied— (a) by owners 337 (b) by Local Authority in default of owners Nil. (c) Proceedings under Sections 17 and 18 of the Housing, Town Planning, &c., Act, 1909. (1) Number of representations made with a view to the making of Closing Orders Nil. (2) Number of dwelling-houses in respect of which Closing Orders were made Nil. (3) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit Nil. (4) Number of dwelling-houses in respect of which Demolition Orders were made Nil. (5) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil. 3.—UNHEALTHY AREAS. Areas represented to the Local Authority with a view to Improvement Schemes under (a) Part I., or (b) Part II., of the Act of 1890 :— (1) Name of Area, Queen's Court, Vine Street, Minories. (2) Acreage, about ¼ acre. (3) Number of working-class houses in area 7 (4) Number of tenements in these houses 25 (5) Number of working-class persons to be displaced 72 (4) Number of Houses not complying with the building bye-laws erected with consent of Local Authority under Section 25 of the Housing, Town Planning, &c., Act, 1919 Nil. (5) Staff engaged on housing work with, briefly, the duties of each officer. The three District Inspectors are responsible for the inspection of the houses in their respective areas. Each house is registered on a card and subsequent visits noted thereon. 10 VACCINATION. Of the 341 births notified to the Vaccination Officers during 1921, 67 had been successfully vaccinated by the end of the year, 32 had died before the age for vaccination, and in no case was a child reported as insusceptible. Vaccination was postponed by medical certificate in 2 cases, 170 had removed into other districts, or the vaccinations were pending at the end of the year. There were 70 instances of conscientious objection. The Public Vaccinators performed 4 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. 1916 415 29.6 0.20 Nil. 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 1920 471 31.4 Nil. ,, 4.6 1.2 42.2 20.3 Average previous 5 years. 382 29.3 0.04 ,, 7.8 0.7 46.0 15.9 1921 341 19.6 Nil. ,, 9.4 0.6 49.9 20.5 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 1921 and the previous five years. No reliable conclusions can be drawn from these comparisons, and thev are inserted merely as matters of interest. CITY OF LONDON COMPARED WITH THE METROPOLIS FOR THE YEAR 1921 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. 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 73 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 1920 12,200 379,694 14.9 26.4 15.6 12.6 66 76 7.8 4.7 0.49 1.45 Average previous 5 years. 14,049 376,204 9.6 20.0 16.3 14.8 104 92 7.7 5.2 0.33 1.42 1921 13,706 381,083 9.4 22.3 11.5 12.4 93 80 5.7 4.2 0.22 0.14 From the table appended it will be noticed that the death rate for 1921 was 1T5 per 1,000 compared with 124 for the Metropolis as a whole. 11 (This Table is prepared in accordance with the requirements of the Ministry of Health.) VITAL STATISTICS OF WHOLE DISTRICT DURING 1921 AND PREVIOUS YEARS. Name of District: CITY OF LONDON. Year. Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Transferable Deaths ‡ Nett Deaths belonging to the District. Uncorrected number. Nett. Number. * Rate. of Nonresidents registered in the District. † of Residents not registered in the District. † Under 1 Year of Age. At all Ages. Number. † Rate. Number. * Rate per 1,000 nett Births. Number. * Rate. 1 2 3 4 5 6 7 8 9 10 11 2 13 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 1921 13,706 336 129 9.4 785 57.27 705 78 12 93 158 11.5 Notes.—This Table is arranged to show the gross births and deaths in the district, and the births and deaths properly belonging to it with the corresponding rates. For years before 1911 some of the corrected rates probably will not be available. The rates should be calculated per 1,000 of the estimated gross population. In a district in which large Public Institutions for the sick or infirm seriously affect the statistics, the rates in Columns 5 and 13 may be calculated on a nett population, obtained by deducting from the estimated gross population the average number of inmates not belonging to the district in such institutions. * In Column 6 are to 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 by subtraction of the deaths under 1, included in the number given in Column 8, and by addition of the deaths under 1 included in the number given in Column 9. † The Medical Officer of Health will be able from the returns made to him by the local Registrar of Deaths, as well as from the quarterly lists furnished by the Registrar-General, to fill in Column 8 in accordance with the rule in the next paragraph below. The Registrar-General, either directly or through the County Medical Officer of Health, will supply the Medical Officer of Health with the particulars of deaths to be entered in Column 9 ; and all such deaths must be included in this Column, unless an error is detected, and its correction has been accepted by the Registrar-General. For Column 4 the Registrar-General will furnish to the Medical Officer of Health a Statement of the number of births needing to be added to or subtracted from the total supplied by the local Registrar. ‡" Transferable Deaths " are deaths of persons who, having a fixed or usual residence in England or Wales, die in a district other than that in which they resided. The deaths of persons without fixed or usual residence, e.g., casuals, must not be included in Columns 8 or 9, except in certain instances under 3 (b) below. The 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 confinement should be referred to the district of fixed or usual residence of the parent. (3) Deaths from Violence are to be referred (a) to the district of residence, under the general rule ; (b) if this district is unknown, or the deceased had no fixed abode, to the district where the accident occurred, if known; (c) failing this, to the district where death occurred, if known ; and (d) failing this, to the district where the body was found. Total population at all ages 13,706 At census 1921 Area of City of London Registration District in acres (land and inland Number of inhabited houses †— water) 678 Average number of persons per house — † No. of Inhabited Houses not yet reported by Census Authorities 12 (This Table is prepared in accordance with the requirements of the Ministry of Health.) CAUSES OF, AND AGES AT, DEATH DURING THE YEAR 1921. Cause 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 (6). All ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years 45 and under 65 years. 65 and up wards 1 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. All causes Certified (c) Uncertified 158 12 — — 4 10 17 40 75 691 1. Enteric Fever ... ... ... ... ... ... ... ... ... ... 2. Small-pox ... ... ... ... ... ... ... ... ... ... 3. Measles ... ... ... ... ... ... ... ... ... ... 4. Scarlet Fever ... ... ... ... ... ... ... ... ... ... 5. Whooping Cough ... ... ... ... ... ... ... ... ... 2 6. Diphtheria and Croup 1 ... ... ... 1 ... ... ... ... 9 7. Influenza ... ... ... ... ... ... ... ... ... 1 8. Erysipelas ... ... ... ... ... ... ... ... ... 1 9. Phthisis (Pulmonary Tuberculosis) 13 ... ... ... ... 3 4 4 2 23 10. Tuberculous Meningitis ... ... ... ... ... ... ... ... ... 13 11. Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... 6 12. Cancer, malignant disease 17 ... ... ... ... ... 2 10 5 83 13. Rheumatic Fever 1 ... ... ... ... ... ... ... 1 7 14. Meningitis (See Note (d)) ... ... ... ... ... ... ... ... ... 13 15. Organic Heart Disease 32 ... ... ... ... ... 5 8 19 38 16. Bronchitis 15 ... ... ... ... ... .... 2 13 16 17. Pneumonia (all forms)0 12 1 ... ... ... 2 ... 4 5 63 18. Other diseases of respiratory organs 3 ... ... ... ... ... ... 1 2 12 19. Diarrhoea and Enteritis (See Note (e)) 2 2 ... ... ... ... ... ... ... 32 20. Appendicitis and Typhlitis ... ... ... ... ... ... ... ... ... 16 21. Cirrhosis of Liver ... ... ... ... ... ... ...... ... ... 4 21A. Alcoholism ... ... ... ... ... ... ... ... ... 4 22. Nephritis and Bright's Disease 5 ... ... ... 1 ... ... 1 3 24 23. Puerperal Fever ... ... ... ... ... ... ... ... ... 1 24. Other accidents and diseases of Pregnancy and Parturition 2 ... ... ... ... 1 1 ... ... 2 25. Congenital Debility and Malformation, including Premature Birth 6 6 ... ... ... ... ... ... ... 34 26. Violent Deaths, excluding Suicide 7 1 ... ... ... ... 1 3 2 52 27. Suicide 2 ... ... ... ... ... 1 ... 1 9 28. Other Defined Diseases 38 2 ... ... 1 4 2 7 22 224 29. Diseases ill-defined or unknown 2 ... ... ... 1 ... 1 ... ... 2 Totals 158 12 ... ... 4 10 17 40 75 691 13 BIRTHS. During the year 1921, 336 births were registered in the City, 242 of which however, did not belong thereto. To the remaining 94 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 129. The annual birth rate was 9.4 per 1,000 persons of all ages, compared with a quinquennial mean rate of 11.9 per 1,000. In the Metropolis the birth rate in 1921 was 22.3 per 1,000. MORTALITY. During the year under review, 785 deaths were registered in the District, including 705 persons dying in the City, but not belonging thereto. See Table, p. 11. for details. Deducting these latter, 80 deaths remain, to which must be added those of 78 persons who died in Institutions in outside districts, where they were registered ; the total, therefore, on which the City death rate is calculated is 158. The death rate for 1921 was 11.5 per 1,000 per annum of the population (the previous year being 15.6), whilst that for the whole of the Metropolis was 12.4. DEATHS FROM VIOLENCE.—Of the City deaths, 5.7 per cent, were caused by injuries or violence, as compared with 10.4 in 1919 and 7.8 in 1920. This is 2.0 below the average for the previous five years. PERCENTAGE OF REGISTERED DEATHS FROM VIOLENCE Year. City of London. Metropolis. Per cent. Per cent. 1916 9.9 4.0 1917 6.2 5.9 1918 4.2 5.6 1919 10.4 5.7 1920 7.8 4.7 Average previous five years 7.7 5.2 1921 5.7 4.2 DEATH RATES, PER 1,000 PER ANNUM. Year. City of London. 96 Great Towns of England and Wales. Metropolis. 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 1920 15.6 12.5 12.6 Average previous five years 16.3 14.7 14.8 1921 11.5 12.3 12.4 The death rate from zymotic disease per 1,000 of the population was 022 compared with 014 in the Metropolis. The deaths from Phthisis correspond to a rate of 0 95 per 1,000 of the population, as compared with 105 in the Metropolis. INFANT MORTALITY. The deaths of children under one year of age were at the rate of 93 per 1,000 births, as against 80 for the whole of London. The table of infantile mortality on p. 14 shows the deaths of children under one year arranged according to monthly age periods. From this it will be seen that no less than 66.6 per cent, of these deaths occurred in the first month, 75 per cent, within the first three months, and 91.6 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 c 14 (This Table is prepared in accordance with the requirements of the Ministry of Health.) CITY OF LONDON. INFANTILE MORTALITY DURING THE YEAR 1921. Nett Deaths from stated Causes at Various Ages under One Year of Age. causes of death. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 4 Weeks. 4 Weeks and under 3 Months. 3 Months and under 6 Months. 6 Months and under 9 Months. 9 Months and under 12 Months. Total Deaths under 1 Year. All Causes. Certified 7 ... 1 ... 8 l 2 ... 1 12 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... Convulsions ... ... ... ... ... ... ... ... ... ... Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... ... ... ... Pneumonia (all forms) ... ... ... ... ... ... 1 ... ... 1 Diarrhoea ... ... ... ... ... ... ... ... 1 1 Enteritis 1 ... ... ... 1 ... ... ... ... 1 Gastritis ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... Suffocation (overlying) ... ... ... ... ... l ... ... ... 1 Injury at Birth 1 ... ... ... 1 ... ... ... ... 1 Atelectasis ... ... ... ... ... ... ... ... ... ... Congenital Malformations 1 ... ... ... 1 ... ... ... ... 1 Premature Birth 4 ... ... ... 4 ... ... ... ... 4 Atrophy, Debility and Marasmus ... ... ... ... ... ... ... ... ... .... Other Causes ... ... l ... 1 ... l ... ... 2 7 ... l ... 8 l 2 ... l 12 legitimate 119 legitimate infants 11 Nett Births in the year Nett Deaths in the year of illegitimate 10 illegitimate infants 1 15 INFANT WELFARE WORK. MILK AND FOOD FOR MOTHERS AND CHILDREN.—For some years past is has been the practice of the City Corporation to make an annual grant to provide milk for necessitous nursing mothers and dried milk for necessitous mothers who are unable to nurse their own children. This grant was not made as a direct result of any public legislation, but was purely an ex gratia grant made by the Corporation as a part of its policy of infant welfare supervision. This grant was fixed at a total sum of £150 per annum. When the Milk (Mothers and Children) Order came into operation in 1919 and gave official authorisation to expenditure on these lines, the Corporation granted an independent sum of £50 per annum in accordance with the powers given by the Order. Later, as a result of experience gained it did not seem desirable that these grants should be made independently of each other. The expenditure under both headings was incurred in direct connection with Infant Welfare work, and was moreover authorised by the Order to which I have already referred. After consideration the Corporation decided that the two grants be merged, and increased to £300 per annum, and that the charge in respect thereof be met out of the grant made under the Milk (Mothers and Children) Order. In the early part of April the Ministry of Health issued a Circular to Local Authorities on the question of the supply of milk for expectant and nursing mothers, and for infants. This Circular among other things drew attention to the heavy expenditure incurred in the administration of this service, and stated that it had been considered essential for the Ministry of Health to impose restrictions, and insist on the observance of certain conditions in order that the grant in aid of the expenditure incurred might be received by the responsible Local Authorities. It was suggested that the benefits intended could be produced by an expenditure considerably less than that which was being incurred. In connection with the repayment of the grant from the Ministry it was pointed out that schemes would have to be framed somewhat on the following lines :— (1) SUPPLY OF MILK AT LESS THAN COST PRICE.—Such supplies may only be made in necessitous cases to :— (a) Nursing Mothers, and then only if they are actually suckling their children. (b) Expectant Mothers in the last three months of pregnancy, and (c) Children up to three years of age and exceptionally to children between three and five years of age. (2) THE AMOUNT OF MILK SO SUPPLIED.—The amount of milk supplied at less than cost price must not exceed one pint per day per person, except that one pint and a half per day may be given to infants between three and eighteen months, provided a special medical certificate is submitted to justify the supply. Dried milk may be substituted for fresh milk, and the amount of such milk should be such as would approximate to the quantity of fresh milk which would have been given. (3a) CONTROL OF FREE SUPPLIES.—The control should be by a special Committee which may be a Sub-Committee of the Maternity and Child Welfare Committee—in the City Corporation this is a Sub-Committee of the Sanitary Committee, on which two ladies have been appointed. This Committee should lay down a definite procedure for dealing with applications for milk and review all applications for supply. It is suggested that each application should be considered by at least one member of the Committee, preferably the Chairman, the Medical Officer of Health, and a responsible financial officer before a supply is authorised. The Committee should also meet at frequent intervals to review the cases authorised. (b) In order to determine whether applicants are genuinely necessitous it was suggested that a scale of income should be adopted suitable to the locality. This of course would result in a hard and fast line being drawn, which perhaps c 2 16 might be an advantage and even a necessity in certain cases, though in other instances, especially in a community like the City, occasional hardship would result. (c) Applications for milk at less than cost price have to be made on a printed form, signed by one member of the family. The Minister of Health is advised that persons deliberately making false statements as to their income for the purpose of obtaining milk at less than cost price are liable to prosecution for obtaining or attempting to obtain goods by false pretences. Reasonable steps are to be taken by Local Authorities to satisfy themselves that the particulars of income given by the applicants are correct. (4) It is suggested that milk should be supplied through the Maternity and Child Welfare Centre. The Committee gave their careful consideration to all the facts bearing on this matter and ultimately decided not to apply for the grant in aid. The City, with its small population, is somewhat peculiarly situated. The homes and general social status of families likely to apply for free, cost price, or under cost price milk are well known to the officers of the Corporation who are responsible for the administration of the scheme. Of course, in some areas where the distribution of milk assumes considerable proportions, it is obviously essential that some such scheme as that above indicated should be in operation, but in the City it has been considered sufficient to decide the amount of money which the Corporation will spend on free milk, and to allow the Medical Officer of Health some latitude in the decision. INFECTIOUS DISEASES. Very few comments are necessary with reference to the incidence of infectious disease during the year 1921. Diphtheria was prevalent to the extent of 33 cases as compared with 30 in 1920. The number of Scarlet Fever cases was 89, Erysipelas showed an increase from five to six, 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 two cases to six. Two cases of Ophthalmia Neonatorum were notified. The percentage of cases removed to hospital was somewhat higher than in 1919 and 1920. During 1921, 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 advised. 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 9. No case of Small-pox, Cholera, Plague, Typhus, Enteric, Relapsing, Continued or Puerperal Fever, Anthrax, Cerebro-spinal Meningitis 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. :— 17 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 43 ... 16 9 8 9 l 33 Scarlet Fever 95 l 82 3 3 4 2 89 Enteric Fever 1 ... 1 ... ... ... ... 1 Puerperal Fever ... ... ... ... ... ... ... ... Erysipelas 6 3 ... ... 3 ... ... 6 Cerebro-spinal Meningitis ... ... ... ... ... ... ... ... Acute Polio-myelitis ... ... ... ... ... ... ... ... *Ophthalmia Neonatorum 2 1 ... ... 1 ... ... 2 Measles ... ... ... ... ... ... ... ... Rubella ... ... ... ... ... ... ... ... Malaria contracted abroad 3 2 ... ... 1 ... ... 3 Acute Primary Pneumonia 8 1 ... ... 6 1 ... 7 Acute Influenzal Pneumonia ... ... ... ... ... ... ... ... Totals 158 8 99 12 22 14 3 141 Chicken-pox 2 2 ... ... ... ... ... 2 Totals 160 10 99 12 22 14 3 143 It will be seen from the foregoing that during the year, excluding Chicken-pox, 158 Certificates were received, including 14 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 141, as compared with 79 last year; and, as stated, the number of cases of Scarlet Fever reported was 89. 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 1921 compared with the figures for the previous five years :— Year. Number of cases reported. Per cent. of cases reported. Removal to Hospital. Treated at home. 1916 70 94.3 5.7 1917 51 94.1 5.9 1918 42 88.1 11.9 1919 41 90.2 9.8 1920 74 91.9 8.1 Average for the five years 55.6 91.7 8.3 1921 131 95.4 4.6 * In one .of these cases the patient died at the Hospital to which it was removed for treatment. The other case was a mild one and the patient suffered no impairment of vision 18 CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1921. (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 33 2 5 12 10 4 ... ... 33 Erysipelas 6 ... ... ... l 4 l ... 3 Scarlet Fever 89 ... 13 60 10. 6 ... ... 88 Typhus ... ... ... ... ... ... ... ... ... Enteric 1 ... ... ... 1 ... ... ... 1 Relapsing ... ... ... ... ... ... ... ... ... Continued ... ... ... ... ... ... ... ... ... Puerperal ... ... ... ... ... ... ... ... ... Polio-myelitis ... ... ... ... ... ... ... ... ... Cerebro-spinal Meningitis ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis 22 ... ... 2 6 10 3 l 14 Other forms of Tuberculosis 1 ... ... ... 1 ... ... ... ... Ophthalmia Neonatorum 2 2 ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... Rubella ... ... ... ... ... ... ... ... .... Malaria (contracted abroad) 3 ... ... ... ... 3 ... ... 1 Acute Primary Pneumonia 7 ... ... ... 3 1 2 l 6 Acute Influenzal Pneumonia ... ... ... ... ... ... ... ... ... Totals 164 4 18 74 32 28 6 2 146 * Metropolitan Asylums Board Hospitals, London Fever Hospital, City of London Infirmary, St. Bartholomew's Hospital, City Police Hospital, &c. 19 ENCEPHALITIS LETHARGICA. In January, 1919, Encephalitis Lethargica was added to the list of notifiable infectious diseases, because of the considerable incidence of this disease since the year 1917. In the early part of the present year the Ministry of Health, in view of the necessity of co-operation between Officers of the Ministry, Medical Practitioners and Medical Officers of Health, issued a memorandum which was doubtless of considerable assistance in disseminating information as to diagnosis, treatment, infectivity, etc., of cases. It also clearly stated what action was to be taken by Medical Officers of Health on receipt of notifications. The following suggested precautions against infection are I think of sufficient importance to warrant their inclusion in this report :— " The other occupants of a house in which a case of encephalitis has occurred or is being " treated may be assured that the disease is one of low infectivity, and that very slight risk " is run by association with the patient. At the same time it is desirable that such " association should be limited to what is necessary for proper care and nursing, and the " patient should be well isolated in a separate room. " School children in the affected household may be kept from school as a precautionary " measure, for three weeks after the isolation of the patient. " There is no necessity to place restrictions on the movements of other occupants pro" vided they are frequently examined and remain well. Those in contact with the case, " however, should be advised to use antiseptic nasal syringes or douches and to gargle the " throat with solutions such as those advised for Influenza. " For example any of the following :— (1) " One per cent. solution peroxide of hydrogen. (2) " Two per cent. solution of permanganate of potash, 1 in 5,000 in 0.8 per cent. " solution of chloride of sodium (common salt). (3) "Liquor sodæ chlorinate 0.5 per cent. " The solutions can be used as ordinary throat gargles or snuffed up through the nostril " or applied by an efficient spray. " Any person in the infected household who suffers from sore throat or other symptoms " suggesting an abortive attack should be treated from this point of view and isolated so " far as possible until they have recovered. " The sick room should be thoroughly cleansed and disinfected at the end of the illness." Some years ago the Court of Common Council approved the expenditure of £25 per annum for providing nursing assistance in complicated cases of measles. It has never been necessary to use any part of this grant and the Court therefore authorised the use of so much of it as was necessary for nursing cases of Encephalitis Lethargica. PREVENTION OF EPIDEMIC DIARRHOEA. Having regard to the possibility of an increase in the death rate from infantile Diarrhoea which might arise from the hot summer which was experienced in 1921, the Ministry of Health in July issued a Circular Letter to Local Authorities carrying out Maternity and Child Welfare work in England and Wales, suggesting that preparations should be made immediately for dealing with an epidemic of Diarrhoea should it occur. Mortality from Diarrhoea is almost entirely confined to children under the age of five years, and the fact that young children, who are most quickly and acutely influenced by the condition of the home are those affected by Diarrhoea emphasises the importance of home cleanliness as a primary factor in determining the occurrence of the disease. Not only is it important to insist upon domestic cleanliness, but also to ensure that all accumulations of dust, refuse and filth about dwelling houses are removed at short intervals. The Corporation, by means of a Circular Letter which was widely distributed throughout the City, directed attention to the necessity of observing such a precaution. The special precautions suggested by the Ministry in the event of Diarrhoea threatening to become seriously epidemic are briefly summarised below :— (a) The attention of mothers of young children should be directed to the importance of breast feeding during the hot weather, the methods of preserving and storing milk and other food, and protecting it from flies, and the detection of early symptoms of illness and the desirability of medical advice. 20 (b) Directs attention to the provision of milk, fresh or dried, under the Maternity and Child Welfare arrangements. (c) Suggests voluntary notification— (i. ) by parents and health visitors and (ii.) by medical practitioners in serious outbreaks. (d) Arrangements for domiciliary nursing, and instructions to mothers in methods of carrying out the treatment advised by medical practitioners in charge of the case. It also authorises the provision of disinfectant solution in which the soiled clothing of the patient may be placed on removal. (e) Hospital accommodation should be supplied as far as possible for children who are seriously ill. The small resident population of the City presents no serious difficulty in matters of this nature, and I am able to report that despite the hot weather experienced during the summer, no serious outbreak of Diarrhoea was recorded. METROPOLITAN NURSING ASSOCIATION. The Metropolitan Nursing Association, which was instituted for providing trained nurses for the sick poor, has during the past year done quite a large amount of work among the poor in the City, some of which I am of opinion can well be regarded as public health work. In view of this fact the Corporation gave favourable consideration to an appeal for assistance which was made by the Association, and a grant of five guineas per annum was approved by the Court of Common Council on the 6th October last. TEMPORARY ISOLATION ACCOMMODATION AT No. 6, BRIDGEWATER SQUARE. In 1918 the Corporation made provision for suitable accommodation for the isolation and observation of small-pox contacts. This accommodation was secured by the leasing. and partial equipment of premises known as 6, Bridgewater Square. This matter was again before the Sanitary Committee for consideration, and although it has not been necessary to take advantage of the facilities that have been made available, the Committee decided that the continuance of the arrangements was essential in the interests of public health. The lease of the premises was accordingly renewed. 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 only on Mondays from 5 to 7. In all the Dispensary has been open 201 times during the vear. NEW PATIENTS.—The number of persons, including contacts, who were examined for the first time at or in connection with the Dispensary was 275, 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 14 55 3 ... 23 49 Non-Residents— Working in the City 20 32 l l 27 27 Not working in the City 77 62 2 8 65 84 111 149 6 9 115 160 275 275 21 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 14 18 70 92 Disease of other Organs (Lungs not apparently affected ... 2 7 9 Many of the persons diagnosed as not suffering from Tuberculosis were found to be suffering from other diseases, for which they were advised to seek treatment elsewhere. The undiagnosed cases are thus accounted for .— Residents :— All are still under observation. Non-residents working in City :— One is still under observation. One has been referred to the Tuberculosis Dispensary of the area in which he resides. Non-residents not working in City :— One is still under observation. Four have been referred to the Tuberculosis Dispensaries of the areas in which they reside. Four have ceased to attend in spite of letters requesting them to do so. Applicants unconnected with the City, either as residents or workers, were examined, and if found to be suffering from Tuberculosis the fact was notified to the Medical Officer of Health of the area in which they resided. Treatment was continued 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 149 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 Dispensarv, was 213, divided thus :— Insured. Not insured Totals. Residents 30 26 56 Non-residents—Working in City 48 31 79 Not working in City 40 38 78 213 Of these, 111 were new patients this year, while 21 attended for the first time in 1920, 17 for the first time in 1919, 23 for the first time in 1918, 11 for the first time in 1917, 10 for the first time in 1916, 18 for the first time in 1915, and 2 for the first time in 1914. TOTAL ATTENDANCES.—The number of attendances of patients at the Dispensary, including first attendances, was 2,404, divided thus :— Insured. Not insured. Totals. Residents 420 540 960 Non-residents—Working in City 636 287 923 Not working in City 219 302 521 2,404 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 180, divided thus :— Insured. Not insured. Totals. Residents 27 69 96 Non-residents—Working in City 46 26 72 Not working in City 4 8 12 180 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 42, divided thus :— Insured. Not insured. Totals. Residents 7 10 17 Non-residents Working in City 9 6 15 Not working in City 5 5 10 42 D 22 Included in the foregoing are 30 patients who were examined by X-rays and four who received dental treatment. In addition to these a number of persons were seen by Physicians attached to the Hospital. For one patient an artificial denture was provided by the Corporation. PATHOLOGICAL EXAMINATIONS.—Specimens of sputum examined for the Tubercle Bacillus :— Positive 16 Negative 148 164 TREATMENT IN SANATORIA.—The number of patients who were recommended for admission to Sanatoria was 30, viz. :— Residents recommended to :— (a) London County Council 14, of whom 11 were admitted ; 1 declined to avail himself of sanatorium treatment before the arrangements were completed ; for 2 (both advanced cases) no accommodation was available, of these, 1 who was already in St. Bartholomew's Hospital remained there and the other, who had previously been treated in a sanatorium, died at home. (b) London Insurance Committee 2, both 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) Voluntary Agencies 2, both of whom were admitted. Non-residents, not working in the City, recommended to :— (a) London County Council 6, of whom 1 was admitted, the result in 5 cases being unknown. (b) London Insurance Committee 1, who was admitted. (c) Voluntary Agencies 1, who was admitted. The small number of persons recommended to the London Insurance Committee is accounted for by the fact that on and after May 1st the responsibility for providing treatment in sanatoria for insured persons was transferred from the London Insurance Committee to the London County Council. THE TUBERCULOSIS NURSE.—The work of the Tuberculosis Nurse has continued on the same lines as in former years. Of patients attending the Dispensary 70 homes have been visited and 671 visits made in connection with aftercare and following up. In addition seven patients have been nursed in their own homes, the nurse working under the direction of the practitioners attending the patients. Six of these persons were in an advanced stage of the disease and three of them died at home. For nursing purposes 81 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. To April 30th, treatment in residential institutions was provided for the insured by the London Insurance Committee and for the uninsured by the London County Council, since that date it has been provided by the latter for all persons. (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. He reminds them when reports are due on insured patients under domiciliary treatment and provides them with copies of the form with names and addresses inserted. (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. 23 (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. 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 30 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 has been used for a few cases. (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 has been provided for necessitous persons requiring extra nourishment and in this connection the sum of £28 has been expended. (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 as for pulmonary cases. The Corporation supplies surgical apparatus free of cost for necessitous residents in the City. (xii.) The arrangements for " care " and " after care " are carried out by a subcommittee 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. (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—SPITTING.—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. Precautionary notices issued by the Corporation drawing attention to this practice are distributed to bona-fide applicants. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1921. The issue of Public Health (Tuberculosis) Regulations, 1921, which amend in certain respects the Public Health (Tuberculosis) Regulations, 1912, was necessitated by the passing into law of the National Health Insurance Act of 1920, in accordance with the provisions of which sanatorium benefit under the National Insurance Act, 1911, ceased as from the 30th April, 1921. Treatment of both Insured and Uninsured patients in a Sanatorium is now the responsibility in London of the London County Council. The first article of the new Regulations consists of the citation and date of operation, and the second is confined to the alteration of definitions of " Tuberculosis Dispensary " and " Sanatorium." The effect of Article 3 is to enable the Medical Officer of the Tuberculosis Dispensary to have access to the register of notifications which the Medical Officer of Health of the district is required to keep under Article XI. (2) of the Regulations of 1912. Article 4 requires that every Medical Officer of Health shall from time to time, but not less often than once in every quarter, revise the register by removing from it the entries relating to notifications in respect of persons who have to his knowledge died or ceased permanently to reside in his district. In an area such as the d 2 24 TUBERCULOSIS. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary of Notifications during the period from the 1st January to the 31st December, 1921, in the City of London. 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. AGE-PERIODS 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 15 Total Primary Notifications Pulmonary Males ... ... 2 ... 2 2 2 3 3 ... l 15 21 ... ... ... Nil. Nil. Nil. 5 „ Females ... ... ... ... 1 1 3 2 ... ... ... 7 11 ... ... ... ,, ,, ,, ... Non-pulmonary Males ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ,, ,, ,, ... „ „ Females ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ,, ,, ,, 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 beer 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. 25 City of London with its small resident population, no difficulty is experienced in keeping this work up.to.date. The method suggested in the Circular accompanying the Regulations, whereby returns of deaths can be obtained from the Registrar of Births and Deaths by the Sanitary Authority on payment of a fee, has been in operation in the City for many years and the necessary information with regard to the deaths of tuberculous persons is obtained from this source. Article 5 requires that every Medical Officer of Health on becoming aware that a person suffering from tuberculosis, who has been resident in his district and has permanently changed his address, shall notify the Medical Officer of Health of the district to which the patient has removed and furnish him also with all relevant details of the case such as are contained in the register of notifications. This also has been the City's practice. The suggestion which was made in the memorandum accompanying the Regulations, to the effect that to ensure the close co.operation of the Medical Officer of Health and the Tuberculosis Officer, the latter officer should be made an officer of the Sanitary Authority, received very careful consideration. It did not, however, seem necessary to adopt the suggestion, since the Tuberculosis Officer, although an Officer approved by the Ministry of Health, is actually an Officer of St. Bartholomew's Hospital, which Institution is responsible to the Corporation for the clinical work in connection with the Tuberculosis Dispensary. The agreement between the Corporation and the Hospital Authorities adequately provides for the closest co.operation between the Medical Officer of Health and the Tuberculosis Officer. VENEREAL DISEASES. I have already referred to the fact that the Centre for the treatment of venereal diseases requires to be extended. The scheme which has been prepared cannot be proceeded with at the present time, and for at least another twelve months the view of the Ministry of Health is that the Centre should continue on existing lines. When financial conditions are less urgent doubtless the necessary improvements will be revised and reconsidered. The cost of the Centre during the year under review exceeded £3,000. At the beginning of the year 661 males and 212 females were registered on the books as receiving treatment which compares with 933 males and 324 females in the previous year. Of these patients 350 males and 137 females were under treatment for syphilis and 301 males and 72 females for gonorrhœa. The decrease of patients is most pronounced in connection with the latter disease, the patients under treatment for syphilis number practically the same as in the previous year. New patients admitted totalled 758 as compared with 1,053 in the previous year. Again attention must be directed to the number of patients who cease treatment before completion of the course. 51 males and 19 females suffering from syphilis discharged themselves before completing the first course and 39 males and 14 females after the first course but before completing treatment; 24 males and 3 females completed treatment but no final tests were applied; 29 males and 4 females were transferred to other centres, whilst 19 males and 11 females were discharged after completion of treatment and observation. In the case of gonorrhoea 179 males and 51 females out of the total of 320 and 77 of the respective sexes coming under treatment discharged themselves before completion of the first course of treatment. The total number of attendances of all persons at the Clinic was 18,216, which total is made up as follows:. Syphilis. Soft Chancre. Gonorrhœa. Non.Venereal conditions. Total Attendances. Male. Female. Male. Female. Male. Female. Male. Female. Male. Female 5,849 3,044 . . 7,920 1,353 35 15 13,804 4,412 A few beds are provided at the Centre for in.patient treatment, and the number of days of such treatment totalled 126. In the laboratories associated with the Centre 5,241 specimens were examined, 19 for the detection of spirochetes and 2,489 for gonococci. 2,620 examinations for the Wassermann reaction were undertaken, also 113 other examinations. As regards the places of residence of patients coming under treatment, it is reported that patients resided in the following counties:. London 710 Essex 37 Hertfordshire 4 Surrey 3 Kent 4 26 RETURN RELATING TO ALL PERSONS WHO WERE TREATED AT THE TREATMENT CENTRE AT 20, GOLDEN LANE, E.C. 1, DURING THE YEAR ENDED THE 31st DECEMBER, 1921. 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, 1921, were under treatment or observation for:. 350 137 301 72 10 3 661 212 2. Number dealt with during the year in the out.patient Clinic for the first time and found to be suffering from:. Syphilis only 231 107 231 107 Soft chancre only Gonorrhoea only 320 77 320 77 Syphilis and soft chancre Syphilis and gonorrhœa 30 7 30 7 30 7 Gonorrhoea and soft chancre Syphilis, soft chancre and gonorrhœa Conditions other than venereal 19 4 19 4 Total—Item 2 231 107 320 77 19 4 570 188 Total—Items 1 and 2 581 244 621 149 29 7 1,231 400 3. Number of persons who ceased to attend the out.patient Clinic (a) before completing the first course of treatment for 51 19 179 51 230 70 (b) after one or more courses but before completion of treatment for 39 14 39 14 (c) after completion of treatment, but before final tests as to cure of 24 3 10 2 34 5 4. Number of persons transferred to other Treatment Centres after treatment for 29 4 7 3 36 7 5. Number of persons discharged from the out.patient Clinic after completion of treatment and observation for:— 19 11 59 19 78 30 6. Number of persons who, on the 1st January, 1922, were under treatment or observation for:— 419 193 366 74 29 7 814 774 Total—Items 3, 4, 5, & 6 581 244 621 149 29 7 1,231 400 7. Total attendances of all persons at the out.patient Clinic who were suffering from:. 5,849 3,044 7,920 1,353 35 15 13804 4,412 8. Aggregate number of "In.patient days" of treatment given to persons who were suffering from:. 53 1 64 8 117 9 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 19 2,456 C.F.T. 58 C.S.F. 11 1,322 779 = 4,645 (b) Specimens from persons attending at the Treatment Centre which were sent for examination to an approved laboratory 33 C.S.F. 44 519 = 596 = 5,241 27 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. Surrey. Kent. 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 307 23 3 2 3 338 Soft chancre Gonorrhœa 380 14 1 1 1 397 Conditions other than venereal 23 23 Total 710 37 4 3 4 758 B. Total number of attendances at the out.patient Clinic of all patients residing in each area 18,129 67 10 5 5 18,216 C. Aggregate number of "Inpatient days" of all patients residing in each area 126 126 D. Number of doses of Salvarsan substitutes given in the:. 1. Out.patient Clinic 3,524 20 10 5 5 3,564 2. In.patient Dept. to patients residing in each area. 20 20 E. Give the names of Salvarsan substitutes used in the treatment of syphilis and the usual initial and final doses. Nov..Arsenobenzol. Novarsenobillon. Galyl. (Intramuscular). Silver Salvarsan. Neo..Kharsivan. Sulpharsenol. Eight injections in a course with ten injections of Mercury Grey Oil, Mercurosal, Benzoate, or Cyanide of Mercury. F. State the amount and kind of treatment usually administered to a case of Syphilis of each of the types usually dealt with at the Treatment Centre. E. W.R. every three months after completion of a course for two years. Supervision monthly for one year after last course. G. State the nature of tests applied in deciding as to discharge of patients referred to in Item 5 on previous page. Gonorrhoea.—Three tests at weekly intervals—Each test: Slides and cultures from urethra, thread and prostatic fluid after massage. Urethroscopic examination. (Signed) KENNETH M. WALKER, Medical Officer of the Treatment Centre. 28 OCCUPATION OF PERSONS UNDER TREATMENT FOR VENEREAL DISEASES. In 1919 I submitted to the Sanitary Committee particulars as to the occupations followed by patients under treatment for Venereal Diseases and recommended that it should be made illegal for persons suffering from these diseases to be engaged in such occupations as the preparation of foodstuffs. The list of persons then submitted was only a small one (104 patients) as the Special Treatment Centre had not been long established. In February of this year, however, I was able to prepare a very much more comprehensive list, showing the occupations of over 1,100 patients. This has now been added to by including the occupations of 570 males and 188 females, making a total of 1911. Table showing Occupations followed by 1,469 Males known to be suffering from Venereal Diseases. Occupations. Number. Occupations. Number. Grocery Assistants 2 Brought forward 680 Confectionery Factory 2 Civil Service 20 Bakers 2 Butchers 9 Milkmen 2 Fish shops 1 Cooks 5 Waiters 11 Clerks 199 Domestics (valets, house.keepers, etc.) 18 Post Office 38 Salesmen 25 Medical Profession 1 Teachers 6 Independent 20 Students 12 Travellers 63 Gardeners 4 Opticians 2 Engineers 39 Electrical 18 Gunsmith 1 Surveyors 2 Chemists 3 Rubber planter 1 Photographers 3 Inventor 1 Farmers 2 Furriers 28 Tailors 55 Sailors 56 Soldiers 9 Carmen 41 Engaged in motor work 49 Porters 71 Labourers 331 Firemen 10 Policemen 25 Fitters 3 Printers 28 Railway workers 8 Machinists 5 Cellarmen 11 Miners 2 Tobacco 3 Electric work 8 Painters 15 Carpenters 34 Plumbers 2 Bricklayers 11 Watchmakers 2 Metal workers 12 Glass work 2 Picture work 1 Hat work 5 Pen work 1 Brush work 1 Aircraft work 1 Dockers 9 Brokers 6 Boots and matches 9 Straw roller 1 Drapers 1 Books 3 Dealers 11 Hawkers 7 Ironmongers 6 Iron founders 6 Timekeeper 1 Hairdressers 18 Laundry 2 Enameller 1 Tram and bus 3 Cricketer 1 Papers 5 Coal 2 Provision Assistants 3 Musicians 2 Music 2 School 4 Mason 1 Leatherwork 4 Barmen 11 Instruments 2 680 Total 1,469 29 Table showing Occupations followed by 442 Females known to be suffering from Venereal Diseases. Occupations. Number. Occupations. Number. Cooks 5 Brought forward 116 Domestic servants 11 Sweet shop 4 Waitresses 8 Nursery Attendant 1 Grocery assistant 1 Barmaids 2 Tobacco factory 6 Typists and clerks 26 Laundry 6 Housewives 262 Babies and school children (under 14 years) 47 French polishers 3 Shop assistant 1 Brush maker 1 Lamp makers 2 Caretaker 1 Pipe polisher 1 Tailoresses 8 Meat preparation packer 1 Rubber cutter 1 Printing factory 1 Box makers 4 Flower sellers 5 Labeller 1 Office cleaners 3 Manicurist 1 Teachers (school) 2 Tin work 1 Milliners 3 Paint factory 1 Factory 3 Machinist 4 Book folder 1 Photo mounts 1 Stage 1 Stationery 2 Drapery, &c. 3 Painting 2 Bottle washer 1 Kitchen work 4 Total 442 Carried forward 116 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 8.25 per cent. of these cases. Result. Specimen. Disease suspected. Positive. Negative. 195 Swabbings from throats Diphtheria 15 180 11 Sputum Tuberculosis 2 9 Of the 195 swabbings from throats, 172 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. Ten 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. E 30 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 1921. Month of the Year 1921. Place. 3 4 5 6 7 8 9 10 11 12 Metric tons of deposit per square kilometre during month. Rainfall in millimetres. Insoluble matter. Soluble matter. Total solids. Included in soluble matter. Tar. Carbonaceous other than tar. Ash. Loss on ignition. Ash. Sulphate as (SO3). Chlorine (Cl) Ammonia (NH3). January City of London 51 0.05 2.57 3.40 0.81 3.66 10.49 1.65 0.86 0.11 Lambeth 46 0.09 1.43 1.67 1.02 1.97 6.18 1.29 0.49 0.12 February City of London 6 0.05 2.26 2.94 0.59 2.18 8.02 0.87 0.36 0.06 Lambeth 5 0.03 0.19 0.48 0.79 1.63 3.12 3.93 0.22 0.02 March City of London 25 0.05 2.52 3 .75 1.12 2.13 9.57 0.86 0.81 0.09 Lambeth 26 0.11 3.48 4.49 1.25 2.13 11.46 1.26 0.59 0.10 April City of London 13 0.10 4.80 6.13 1.40 3.99 16.42 1.90 0.82 0.14 Lambeth 31 0.50 10.43 21.38 1.37 2.62 36.30 1.25 0.67 0.11 May City of London 27 0.04 3.19 3.51 1.85 3.15 11.74 1.12 1.14 0.12 Lambeth 23 0.03 0.80 0.85 1.40 1.92 5.00 0.90 0.71 0.10 June City of London 12 0.02 2.92 3.14 0.98 1.83 8.89 0.63 101 0.16 Lambeth 5 0.05 0.18 0.92 0.81 3.27 5.23 0.49 0.42 0.04 July City of London 4 0.01 2.05 2.55 1 .19 1.48 7.28 0.35 1.08 0.22 Lambeth 1 0.08 2.02 3.80 0.84 1.50 8.24 insutiicient quantities to estimate August City of London 23 0.05 5.96 4.41 1 . 72 2.18 14.32 0.94 1.10 0.23 Lambeth 20 0.04 1.36 2.12 3.36 1.74 8.62 0.89 0.58 0.14 September City of London 51 0. 05 3.06 2.36 1 .65 2.68 10.70 1.20 1.08 0.65 Lambeth 49 0.06 1.15 2.07 0.83 0.30 4.41 0.63 0.52 0.16 October City of London 19 0.08 2.44 3.43 1.37 1.83 9.15 0.91 0.52 013 Lambeth 17 0.11 3.18 4.20 1.10 2.41 1.10 1.21 0.33 0.08 November City of London 49 0.08 4.80 5.86 2.54 5.09 18.37 2.62 1 .41 0.37 Lambeth 47 0.19 3.27 3.41 1.70 3.76 12.33 1.96 0.55 0.26 December City of London 26 0.05 2.33 319 1.35 2.18 9.10 0.89 0.91 0.21 Lambeth 24 0.15 3.47 5.33 1.27 1.88 12.10 1.05 0.40 0.10 The foregoing table shows the rainfall for the months of January to December of the year 1921, 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. In examining the foregoing table it will be appreciated that in the month of November only, the amount of deposit registered as falling in the City amounted to 1837 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 27½ tons were soluble, and included the chemicals mentioned, and 19½ 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. 31 From the 1st January until the 31st December the amount of the impurity at noon has varied from half a milligramme to six milligrammes per cubic metre of air ; this latter figure includes times when there has been a fog. It is interesting to compare the results of similar observations made at other places, as for example, Malvern and Sheffield, where results are widely divergent. The value of the work being carried on in connection with the examination of the atmosphere in the City is evident, and the details recorded indicate the necessity of its continuation. VISIT OF CZECHO.SLOVAK MEDICAL COMMISSION. At the request of the Ministry of Health the Medical Commission of the Czechoslovak Government which visited the country in the early part of the year were shown some matters of administrative public health interest in the City. The following is a brief resume of the itinerary:—On the 14th February the Commission left the Guildhall in a motor omnibus for the Central Meat Market, Smithfield, where on arrival they were conducted over the Markets and their attention directed to certain of the stalls of special interest. The main object was to display the great variety of imported food products which London receives, and samples from most of the exporting countries were available for inspection. The Cold Air Stores were next visited and the methods of transportation explained. Subsequently the riverside wharves were seen where the visitors were most impressed by the enormous trade in imported foodstuffs which the great stores indicated. The methods adopted in the inspection of tinned and dried foodstuffs were also demonstrated. The Commission then returned to Guildhall for luncheon where they were received and entertained by Alderman Sir CharlesCheersWakefield. Afterluncheon a visit was paid to the new works of the Smithfield Animal Products Co., Ltd., at Stratford, the Contractors to the Corporation for the destruction of unsound meat. After tea at Guildhall the Commission retired apparently satisfied with the efforts which had been made on their behalf. BACILLUS OF TETANUS IN VASELINE. In April my attention was directed by Dr. MacFadden of the Ministry of Health to the reported death of an infant at Portsmouth from Tetanus Neonatorum, and it was suggested that infection had been received from Vaseline which had been used. Examinations had been made of the Vaseline, which in all cases were found to be sterile, but occasionally organisms had been found in caps covering the Vaseline and on the adjacent surfaces of the Vaseline. With a view to ascertaining the position so far as the City was concerned I caused six purchases of vaseline to be made and submitted to the City Bacteriologist., Sir Frederick Andrewes, for examination. His report thereon is as follows:— "Six pots, numbered 22—27, were received on April 26th, 1921. One was a collapsible "tube, and in the screw cap was a small cardboard disc. The other five were glass pots with "metal screw lids without any paper discs on them. I may say here, that in November, 1920, "I examined a number of pots for the C M Co., and found tetanus "spores and other anaerobes in 50 per cent. of the paper discs in the lids of the pots, but none "in vaseline itself. The Company removed all paper discs from the pots thenceforward sent "out, and the present samples prove this. "The technique employed was the same as I had previously used, viz., mass cultivation "in broth containing chopped meat. Of the six vaselines, four proved sterile, one specimen "grew a coccus and one an undetermined bacillus : no anaerobes were present in any. The "cardboard disc in the collapsible tube yielded a growth of B. Mesentericus ruber but no "anaerobes. As there were no paper discs in the lids of the other pots I swabbed the inner "surfaces of the lids and cultivated them. The wool which I used for swabbing was believed "to be sterile, but control cultures showed that it contained B. mesentericus. This organism "therefore grew in all the cultures from the swabs, but this would not have prevented the "growth of anaerobes—rather the reverse. In four out of the five lids no anaerobes grew. "The broths remained clear except on the surface and there was no offensive smell. In one e 2 32 "case, the lid of sample No. 26, there was some evidence of anaerobic growth and large Gram "positive bacilli were found in the depth. One cubic centimetre of this broth was therefore "injected into a mouse; it produced no harmful effect. "I therefore feel justified in asserting the absence of harmful organisms, including "anaerobes from these samples of vaseline and their receptacles." From the above report it will be seen that whatever criticisms were advanced previously, none exist in respect of these samples purchased in the City. It is further of interest to note that Sir Frederick Andrewes conducted the original investigation on behalf of the company manufacturing the vaseline. ANTHRAX INFECTED SHAVING BRUSHES. It has been necessary again during the present year to investigate the possibility of anthrax infection due to the use of shaving brushes. In no case, however, has the bacteriologist reported a positive result. Enquiries have been made with a view to ascertaining whether shaving brushes of Japanese origin were displayed for sale on stalls and barrows in the City of London, but after continual observation no brushes were found so exposed. It will interest your Worshipful Committee to know that the Ministry of Health has issued a Circular letter to Medical Officers of Health describing in brief what general action was taken in connection with the cases of anthrax in which shaving brushes were suggested as the medium of intection, and suggesting that all known dealers in shaving brushes should be warned of the serious results which might follow the sale of any Japanese shaving brushes which might still be in stock. The Circular further described the following method as partially disinfecting these brushes:— The brushes should be (a) Thoroughly washed with soap and warm water containing a little washing soda, then allowed to stand for half an hour in warm water containing a little soda ; (b) Placed in warm solution of formaldehyde (1 part of 40 per cent. formalin and 16 parts of water—2½ per cent. solution of formaldehyde) for half an hour. (c) Allowed to dry. It should, however, be clearly understood that complete sterilisation of the brushes is impracticable and that while the above method may be relied upon to free the exposed parts of the bristles from infection, it does not affect the spores embedded in the handle of the brush. In the City every assistance has been accorded to me by various City traders who have been affected, some of them seriously, by the discovery of anthrax in Japanese shaving brushes. They have readily complied with the suggestions I have made, and in many cases have voluntarily requested me to undertake the inspection of their stock rather than incur the risk that would attach to their sale. The following is a summary of the numbers of each pattern brush which up to the 31st December, 1921, have been destroyed under my supervision. In each case a certificate of infection has been given to the owners. Pattern No Total No. Destroyed. 5238 6741 1736 1044 5024 39 7065 2328 9011 717 9013 738 1223 907 and 1 box of bristles. 1224 456 1224a 72 5907 182 13224 and 1 box of bristles. 33 ENTERIC FEVER IN SHELL FISH. Contaminated shell fish have again been the suggested cause of a case of enteric fever occurring in a neighbouring Borongh. In this case the patient partook of Whelks purchased by a retailer from a wholesale merchant at Billingsgate Market. The onset of illness and the date of consumption of the whelks rendered enquiry into the circumstances necessary. It was found that the shell fish in question had been obtained from Brancaster. Samples of the whelks from that district were obtained by the Inspector of the Fishmongers Company and the following report by Professor Eyre thereon was forwarded to me by Sir John Wrench Towse, the Clerk to the Fishmongers Company:— "Sample of Cooked Whelks No. E. 286.—Sample of whelks taken 15th July, 1921, by "Inspector Hattersley from the premises of T. M. Wright, Billingsgate Market, which had "been consigned to him by W. Softley, Brancaster Staith, by King's Lvnn." 26th July, 1921. Re Sample of Cooked Whelks No. E. 286. "Six shell fish were examined from this particular batch. Of these, each was heavily "infected with B. coli associated with bacteria of the coli.typhoid group, Streptococcus "faecalis, bacillus enteritidis sporogenes, etc., indicating dangerous contamination with "sewage. This result further suggests that the cooking process to which the shell fish had "been subjected had been inefficiently carried out. "From plate cultures subsequently prepared, numerous lactose non.fermenting bacilli "were isolated; many of these proved to be merely coli varients, but one is still under "investigation on account of its close relationships with the ' Strong ' and ' Harris ' types of " B. dysenteriæ . "No typhoid or para.typhoid bacilli could be detected. (Signed) Jno. Eyre." Sir J. Wrench Towse sent a copy of this report to the Medical Officer of Health for Brancaster and asked him to warn all whelk merchants in his district that if, in future, whelks were not thoroughly cooked the sale would be prohibited in London. I expressed the hope that the Medical Officer of Health for the district would go further than this insistence on cooking, and deal with the contamination by prohibiting the sale of such whelks until the conditions were improved. Later, Sir J. Wrench Towse issued instructions to prohibit the sale of the shell fish upon the London Market until they were proved free from pollution. 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 Prince, 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. 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. Two of these were re.interred in the same graves, and five in other graves in the same cemetery. In accordance with the terms of the Licences issued by the Home Secretary in respect of these cases, the work of removal and re.interment was carried out in the early morning under the supervision of your Medical Officer of Health. 34 CREMATIONS IN THE UNITED KINGDOM. 37 Years—1885.1921. 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 1921 159 228 87 75 43 20 36 893 78 31 57 29 24 162 1,922 Totals 4,855 3,476 1,066 1,193 538 231 373 10394 829 367 639 336 244 877 25,418 * "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 there. "by to others."—Extract from speech made by th? late Sir Henry Thompson at the opening of Golder's Green Crematorium, 22nd Nov. "ember, 1902. Vide " Transactions of Cremation Society of England, 1903." p. 31. †Closed for reconstruction from August, 1913, to July, 1914. VISIT OF INSPECTOR W. C. KELLAND TO NEW ZEALAND. Inspector Kelland, one of the Meat Inspectors on my staff, was in 1919 granted leave of absence to enable him to take a journey to Australia for the benefit of his health. Inspector Kelland provided himself with a number of letters of introduction, and presentation of these on his arrival enabled him to make a fairly extensive study of the methods of slaughtering and inspection of meat in operation in the Commonwealth of New Zealand. The impressions gained by Inspector Kelland are contained in the following Report which he has prepared: — "I have the honour to submit herewith for your information some aspects of Meat Inspection and other allied matters in Australia and New Zealand, as they presented themselves to me on the occasion of my recent visit to these countries. I will deal with the subject in the order in which I visited these countries and will, therefore, open with seme remarks on conditions in New Zealand. 35 Upon arrival at Wellington, I presented letters of introduction to Dr. C. J. Reakes, the Director General of the Department of Agriculture, and desire here to place on record my appreciation of his personal kindness and the facilities arranged by him which enabled me to prosecute very full enquiries as to the conditions governing Meat Inspection in the Dominions. For the purpose of carrying out the various Acts relating to Meat Inspection and for closer supervision, New Zealand is divided into four distinct district organizations, with headquarters at Auckland, Wellington, Christchurch, and Dunedin, under the control of a District Superintendent, in each case a Veterinarian. During my visit I became personally acquainted with the Veterinary Superintendent of each centre, each of whom did everything possible, not only to make my visit profitable but enjoyable. Out of the forty.five Meat Export Slaughtering Establishments, I visited twenty, in addition to the Public Abattoirs in the four centres. I was much impressed by the approach to some of these Meat Works, which gave the impression that one was approaching a private residence—with its well. kept lawns, flower beds, and borders—rather than Meat Export Works. The slaughtering establishments are large spacious buildings, some of them with a killing capacity of from two thousand to eight thousand sheep and two hundred head of cattle per day, some being built on the two, others on the three.floor principle, the slaughtering being carried on on the upper floor. Most of the works that have been built in recent years are either of brick or reinforced concrete, while some of the old works are of wood; in the latter case the walls of the actual killing floors are lined with galvanized iron to the height of several feet, whereas the floors in each case are of some impervious material. Adjoining the killing floor is the cooling room, which is usually a large well ventilated apartment in which the carcases are allowed to hang for several hours prior to being put into the freezing chamber. The drainage on the whole was very good, in most cases the sewage was discharged into an adjacent river or the sea, but where that was not possible, after passing over collecting tanks the sewage was forced through pipes on to the land where it soaked into the soil. Generally speaking, the cleanliness of these Establishments was all that could be desired, a fact that surprised me greatly in view of the large quantities of sheep and cattle that are killed daily. By the side of each slaughterman on the mutton floor are two holes, one through which the skin is dropped, through the other the head, pluck and intestines, these being dealt with on the floor below. There is no accumulation of skins and offal, and with a plentiful supply of water the floors are kept comparatively clean even when work is going on. In most cases the butcher has by his side a tank with a constant supply of hot and cold water for washing and cleaning the carcases. On some of the beef floors a brush is used, to which is attached a hose, for washing down the vertebrae. Ample lavatory accommodation is provided for the employees and in some of the works which have been recently built, bathrooms, supplied with showers, and dressing rooms are provided. Facilities exist at all the meat export slaughterhouses for treating, to the best advantage, the offal and by.products on the premises. The various operations carried on under this heading, include the following:—meat canning, beef extract, tripe, tallow, pelts and slipe wool, hides and manures. In nearly all cases I visited the various departments which I found extraordinarily well kept, a feature that surprised me was how little effluvium existed, taking into consideration the nature of the work. This is accounted for by the fact that all offals are dealt with immediately after the animals are slaughtered. The freezing and chilling rooms are similar to those in this country. The methods of and preparation before slaughter are both for cattle and sheep the same (apart from the fact that in some cases the animals are rested, under cover) as in this country. I will not, therefore, go into unnecessary detail. DISPOSAL OF THE CARCASES AND OFFAL. The sides of beef, after they have been properly prepared, are sent by rail to the chilling room, where they are allowed to hang until properly cooled, usually from six to twenty.four hours depending on weather conditions, after which they are quartered, graded and labelled, they are then put into a freezing chamber say at fifteen degrees Farenheit until hard frozen, when they are clothed and put into stacks ready for export. The carcases of mutton and lamb immediately after dressing are weighed. En route to the cooling room they pass over a weighing machine which records the weight and automatically deducts 6 per cent, to allow for shrinkage between hot weight and weight on arrival in this country, they are then graded and labelled, each grade being sorted and placed on separate rails; in this way they are sent forward to the cooling rooms, where they remain from six to twelve hours, after which they are taken to a freezing chamber and kept at a temperature of about fifteen to twenty degrees Farenheit until hard frozen ; when frozen they are bagged and taken to store rooms where they are stacked to await shipment. OFFAL. Every possible care is taken when dealing with the offal and by.products " that nothing be wasted" and in justice to them, I am bound to admit their methods of utilizing everything to the best advantage was an education to me. We might with advantage adopt the New Zealand system in this country. DISPOSAL OF BYE.PRODUCTS. Blood.—All animals are bled in one place and the blood collected in one tank ; it is ultimately treated by a special process and dried for use as manure. Hides.—After the hides are prepared, scrubbed, washed and sprayed, they are classified, and put into stacks with dry salt between each hide ; here they are kept until sold. The hair from the tails is washed, dried and exported. Feet.—The feet are disposed of in various ways, the bones from them after being prepared are used for knife and toothbrush handles. The tendons and hoofs go for making glue and from the internal portions of the foot oil is extracted. 36 Horns.—These after preparation are used for fertilizer. Heads.—The flesh from the sides of the head, cheek meat, is either frozen for export or canned. The skull is split by a special machine, the brain carefully removed and the bones then sent to the digester and ground, after which they are used for fertilizer. Brains.—These are carefully frozen and either used locally or exported. Tongues.—These are washed, trimmed and either canned or frozen for export. Sweetbreads..—These are frozen for export, if not used locally. Lungs.—All lungs are put into the digester, the majority being affected with parasitic disease. Hearts.—These are either used for making Meat Extract, canned, or frozen for export. Livers.—Only a very small percentage are free from parasitic disease ; these are frozen for export. The diseased ones go to the digester. I found a great number of the lungs of both sheep and cattle affected with echinococcus veterin. orum, the cystic stage of the taenia echinococcus, and its presence in such proportions is due to the great number of dogs used in sheep and cattle droving. Pillars of Diaphragm..—These are either canned or frozen for export. Stomachs.—Portions of these are frozen for export, the remainder goes to the digester for fertilizer. Spleens.—These are put into the digester. Omentum and Mesentery..—The fat of the mesentry and the omentum is converted into oleo. Intestines.—These after examination and preparation are salted and packed for export; the portions unsuitable for export go to the digester. Kidneys..—If these are not left in the carcase they are carefully packed and frozen for export. Tails.—These are frozen for export if not consumed locally. Trimmings.—Trimmings from the carcases, generative organs, etc., are collected and sent to the digester. Sheep Offal.—This is dealt with in a similar manner; everything possible that is fit for human consumption is taken every care of, the other portions going to the digester. The skins are sent to the fell.mongering department where they are dealt with, the wool being dried and baled and the pelts prepared for export. Every possible care is taken of the meat when it leaves the refrigerator for the ships. In the majority of cases the'meat export slaughterhouses are located alongside a shipping port, but in a few cases the premises are in live stock centres, inland, the meat being carried to the port of shipment in insulated railway vans. When shipped into over.seas steamers at open roadstead ports, insulated lighters are used for conveying the frozen meat and products from the freezing works to the steamers. This, however, is only necessary in the case of three or four of the works. MEAT INSPECTION AS CONDUCTED IN NEW ZEALAND. To carry out the very important work of meat inspection, the live stock division has twenty veterinarians, thirty.two abattoir inspectors and eighty.six inspectors at the various meat works. The following figures will show the extent and importance of the work. They indicate the number of carcases inspected during the year ended 3lst March, 1919. Meat export Abattoirs. Slaughterhouses. Cattle 88,945 218,871 Calves 14,547 4,325 Sheep 480,372 3,690,152 Lambs 83,479 2,845,413 Pigs 44,879 56,625 In addition 19,536 pigs slaughtered in bacon factories were inspected. DESCRIPTION OF SYSTEM OF MEAT INSPECTION. The meat inspection in each of the meat export slaughterhouses is under the control of a veterinary surgeon, who has under him a staff of lay inspectors (assistants) who do the actual work, the veterinary inspector supervises. All cattle and sheep are examined ante.mortem by the veterinary inspector. Cattle.—The method of examining the carcase and their organs are very similar to those employed in the City of London, and are as follows:— Every organ is carefully examined, palpated, and the glands incised, after which the carcase is gone thoroughly over, the serious membranes, the bones of the vertebrae examined and the superficial glands incised. If there is no evidence of disease in the carcase or organs it is passed on, but before being labelled .and clothed for export it is examined again, therefore there is little likelihood of any diseased carcase getting through. If any disease is found in a carcase of beef or its organs, it is sent to a detention room—a part of the cooling room is set aside for this purpose—there it is examined by the Veterinary Inspector and all the deep seated glands incised before judgment is passed. Any carcase, portions of a carcase, or organs condemned, are at once sent to the digester and dealt with under the supervision of the authorities. Sheep.—In addition to being examined in the killing room, an inspector examines each carcase as it passes the weighing scale, observing the serious membranes and palpating the parts containing the precrual, inguinal and prescapular lymphatic glands. If they are found free from disease and of good quality they are labelled for export, but if of poor quality they are sent to the canning department. Pigs.—A very careful examination is made of all pigs carcases and their organs and if the slightest trace of disease is found either in the carcase or its organs, the carcase is chopped into two sides, the serious membrane bones of the vertebrae and lymphatic glands all examined and if—in the case of tuberculosis—the disease is localized in the head it is removed, and the carcase passed as fit for human 37 food. If there is the slightest trace of disease beyond the head the whole carcase and organs are condemned. Under the Foreign Meat Regulations, only carcases free from disease are exported ; those affected in the region of the head are used for local consumption. Branding.—All carcases after examination are branded with an approved brand for particular district and those slaughtered for export are labelled, therefore there is no difficulty in ascertaining from which abattoir or meat export works a particular carcase may have come and by whom it was examined. COMPENSATION. Compensation is paid by the New Zealand Government for condemned carcases as follows:— Heifers and bullocks not exceeding 8 years One penny per pound dressed weight of the old and in every case of not less value than carcase, not including the head or any part of (three pounds) £3 per head, lambs and sheep the animal below the knee or hock. (other than rams) not exceeding five years of age, and in every case of not less than 10s. per head. Pigs of not more than 200 lbs. Two pence per lb. dressed weight not cluding the head. Pigs of more than 200 lbs. One penny per lb. dressed weight not cluding the head. Cows, not exceeding ten years of age, and not Three farthings per lb. dressed weight of of less value than £3 per head. meat condemned not including the head or any part of the carcase below the knee or hock. The amount expended under this head for the year ending 31st March, 1919, was £10,888 2s. lOd. In addition to the above 3,667 head of cattle were condemned and destroyed on account of disease either on the farms or at saleyards, for which £11,549 18s. 9d. was paid by the State in compensation. SLAUGHTERING FEES. Under the Slaughtering and Inspection Act a charge is made for the examination of all carcases killed in the meat export slaughterhouses and abattoirs as follows:— For every head of cattle Four pence. For every twelve (or fraction of twelve) calves, sheep or pigs Three pence. The amount received under this head during the year ending 31st March, 1919, was £14,962. All public abattoirs are registered and meat export slaughterhouses licensed, the license for a meat export slaughterhouse has to be renewed annually, no license is renewable without the consent of the Minister of Agriculture, and he may refuse his consent if he is of opinion that the business of any meat export slaughterhouse has been carried on, or is about to be carried on, in a manner prejudicial to the public interest. I would suggest such a procedure in connection with all cold stores within the City of London. I was very much impressed by the way the public abattoirs were conducted. In each case a veterinary inspector is in charge, assisted by lay meat inspectors. All carcases and their organs are most carefully examined and if free from disease are stamped on each quarter as having been passed. All towns with a population of two thousand must provide a public abattoir; this has to be erected by the Local Authority, and outside a district where an abattoir is established all slaughterhouses must be registered by the Local Authority, and licensed with the approval of the Minister for Agriculture. Inspection is then provided for, and all carcases slaughtered are subject to inspection, and are accordingly branded with a brand approved for the district. Therefore all meat, exposed or offered for sale throughout New Zealand, has been slaughtered under the supervision of the Government meat inspectors and passed as fit for human food. RECORDS. By Section 32 of the Slaughtering and Inspection Act, 1908, records are kept not only by the Government official, but the licensee of every slaughterhouse or meat export slaughterhouse must record in a book and make returns of all stock slaughtered each day, stating:— (a) The number, species, and sex of such stock. (b) The name, occupation, and address of the owner of such stock, or if the licensee is the owner then the person from whom, and the date on which he took delivery of same. In the case of a slaughterhouse the colour and earmark of such head of cattle and sheep must be recorded. No calf of a less dressed weight than sixty pounds including the skin is allowed to be sold and " blowing " is absolutely prohibited. TRAINING OF MEAT INSPECTORS. All meat inspectors are trained by the department. Suitable men, preferably with a knowledge of the meat trade, are taken on a period of probation after which time they have to pass a qualifying examination before a Government veterinarian; this is both written and practical and from what I could learn is a similar examination to that which is held by the Royal Sanitary Institute. Proper offices and accommodation are provided at all meat export slaughterhouses and abattoirs for the Government inspectors. I consider meat inspection as carried out in the Dominion to be excellent and we in this country can with perfect safety accept their certificate as a guarantee that not only is the carcase to which it is attached free from disease, but has been slaughtered under the best hygenic conditions. I would desire here to express my satisfaction with all I saw and to thank all those gentlemen with whom I came in contact for their personal kindness and for the information which was at all times freely given. It is needless to say that the experience gained during may visit to New Zealand will prove of great value to me as an official of the Corporation of the City of London." F 38 MEAT INSPECTION. The following records of work done in connection with meat inspection have been prepared by Mr. Dunlop Young. The net increase in importations (106,999 tons) is mostly accounted for by the increase in receipts of chilled beef (99,674 tons). It will be observed from the foregoing table that the total amount of beef, mutton and lamb deposited for sale in the Market was 364,612 tons, an increase of 39,194 tons or 12 per cent. over the preceding year. Home grown supplies amounted to 53,559 tons,being 14,634 tons less than in 1920 and only 14.7 per cent. in 1917 of the total supply of meat sold on the Market compared with 575 per cent. Although the quantity was small the quality was good and good prices were realised. The wholesale price of all classes of meat gradually decreased and the public should have benefited to greater extent than it has done. The result of the examinations made by the inspectors showed that there continues to exist a great lack of satisfactory meat inspection at the places of origin in this country, which it is hoped the recommendations made by the Departmental Committee on Meat Inspection may remedy, if they are carried out as they should be. IMPORTED MEAT FOR THE YEAR 1921.—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 three years, contrasted with 1913 and the values of the 1921 arrivals, were as follows, viz.:— From. 1913. 1919. 1920. 1921. Tons. Tons. Tons. Tons. Australia 150,666 69,044 154,743 104,732 New Zealand 122,234 121,209 197,305 263,665 Argentine 409,211 242,128 364,808 444,539 Uruguay 29,717 21,322 41,774 67,093 United States 74 42,809 11,233 8,903 Other Countries 8,355 31,842 40,552 28,482 Total 720,257 528,354 810,415 917,414 From. Increase or Decrease in 1921 compared with 1920. Total Import Value, 1921. Value per ton. Tons. £ £ Australia . 50,011 7,193,076 = 68 New Zealand + 66,360 20,937,998 = 79 Argentine + 79,731 33,277,407 =x 75 Uruguay + 25,319 4,921,938 = 73 United States 2,330 803,050 = 90 Other Countries — 12,070 2,570,175 = 90 Total + 106,999 69,703,644 = 76 The following table, compiled from statistics furnished by the Market Superintendent, shows the weights of the various descriptions of foodstuffs handled on Smithfield Market in 1920 and 1921:— Source of supply. Beef and Veal. Ratio of Beef, Veal, Mutton and Lamb. Mutton and Lamb to the total of these descriptions. Pork and Bacon. Poultry, Game and other Provisions. Totals. Tons. Tons. Tons. Tons. Tons. 1920 1921 1920 1921 1920 1921 1920 1921 1920 1921 1920 1921 United Kingdom Australasian and South African 51,465 33,203 16,728 20,356 21.0% 14.7% 5,531 9,908 15,110 16,684 88,834 80,151 15,860 24,810 103,320 101,359 36.6% 34.6% 76 106 5,499 4,312 124,755 130,587 North American 4,148 3,962 139 194 39.6% 1.2% 4,371 4,315 2,335 998 10,993 9,469 North American . 8,743 . 40 . 2.4% . . . . . 8,783 South American Continental 118,059 143,798 10,610 18,177 1.3% 44.4% 3,048 2,912 66 326 131,783 165,213 1,794 6,252 3,295 3,718 1.5% 2.7% 2,210 14,727 2,257 3,533 9,556 28,230 Totals 191,326 220,768 134,092 143,844 1000% 100 0% 15,236 31,968 25,267 25,853 365,921 422,433 39 Analysis of the total quantity of meat imported shows that the inspectors have to deal with meat arriving from many sources, viz.:— Mutton. Tons. Lamb. Tons. Beef, frozen. Tons. Beef, chilled. Tons. Offal, Tons Total. Tons. Australia 6,082 11,860 76,518 .... .... 95,510 New Zealand 104,038 62,906 45,290 .... .... 212,234 Canada .... .... ( .4,300 .) .... 4,300 Argentina 33,330 18,725 225,230 158,571 20,541 456,397 Uruguay 8,601 222 54,996 15,178 3,663 82,660 Brazil .... .... 61,000 .... .... 61,000 Patagonia 40,000 .... .... .... .... 40,000 U.S.A Sundries .... .... .... .... 12,500 GENERAL REMARKS. CHILLED BEEF.—The amount of chilled beef which arrived on the market during the year showed a considerable increase. The quality was good but evidently the meat was carried at a lower temperature than under the Linley system as at times it was difficult to state whether it was frozen or chilled. The cleanly condition and attractive appearance of the meat, more especially that displayed at Christmas, was an object lesson to all butchers. Consignments arrived from Canada, the quality was excellent and the refrigeration condition very satisfactory, the meat being carried at or slightly above 30 degrees F., but the dressing and general appearance as to cleanliness and finish was not up to the high standard attained by the Argentine shippers. If cost of transport and handling is not too high and greater attention given to the above.mentioned conditions, the Canadian chilled meat should be a serious competitor with Argentine supplies and even have some effect on home.grown meat prices. With the exception of a few quarters of beef which on being cut into joints showed lesions of tuberculosis in the deep seated glands, the chilled meat arrived satisfactory as to disease, but occasionally, consignments appeared as if they had originally been sent away as chilled and later reduced in temperature to the frozen condition. FROZEN BEEF.—Frozen beef also showed an increase but only to a small extent. This class of meat was satisfactory as to disease, but some consignments from Australia, New Zealand, South Africa and Brazil showed as regards quality, improvement as to breeding in the animals from which the meat was derived, grading, dressing and attractive appearance a standard considerably below what is considered necessary to effect a good demand and quick sale on the Central Markets in comparison with Argentine consignments. MUTTON AND LAMB.—Quantities of war stock mutton continued to be placed on the Market and required the attention of the meat inspectors as to condition. Many carcases were very poor in quality and unsaleable with the result that they hung in the stalls until they were unfit for food. A considerable quantity of boned out mutton carcases arrived from Patagonia. The quality of the meat was exceedingly poor and although generally. free from disease such meat has little nutritive value. An important feature was the great increase of good quality lamb carcases which arrived from Argentina. This country is becoming a serious competitor against New Zealand in this class of meat. EXAMINATION OF SOUTH AMERICAN TONGUES. Owners. No. of Tongues Examined. Percentage Examined. No. of Tongues Seized. Percentage. A 4,800 100% 170 3.5 " 6,036 5% 11 .18 B 99,772 5% 81 .08 C 1,824 100% 23 1.2 F 2 TONGUES EXAMINED AT DOCKS AND RELEASED. A 5,724 Tongues. C 69,996 }> D 3,470 >» 40 FOOD PRODUCTS CONDEMNED AT COLD STORES. Article. No. How Packed. Origin. Cause for Destruction. Tons Cwts. Qrs lbs. Bacon (Pieces) .... .... British Decomposed 0 14 2 15 Beef (Quarters) 49 .... New Zealand ” 3 4 1 12 ” ” 18 .... Argentine ” 1 7 2 17 ” ” 21 .... Brazil ” 0 19 2 0 ” ” 4 .... Australia ” 0 6 1 17 ,, (Pieces) .... .... British ” 0 14 1 3 ” ” .... .... New Zealand ” 15 14 1 19 ” ” .... .... Argentine ” 21 16 3 1 ” ” .... .... Australia ” 68 11 0 20 ” ” .... .... Brazil ” 0 5 0 22 Brains (Beef) .... .... Argentine ” 0 0 2 4 Calves (Carcases) 34 .... New Zealand ” 1 11 0 27 ” ” 50 .... Argentine ” 1 11 3 4 Cheeks (Sheep's) 217 Bags New Zealand ” 9 10 3 12 Chickens 1 Cases U.S.A ” 0 0 2 6 Feet (Ox) .... Bags Argentine ” 0 3 2 2 Fish (Various) .... Boxes British ” 10 1 1 13 ” ” .... ” Canada ” 6 12 3 9 Fruit (Tins) 163 Cases U.S.A ” 0 2 3 18 Geese 60 ” Holland ” 3 10 0 4 Hearts (Sheep's) .... Bags New Zealand ” 18 8 0 2 ” Ox) .... ” Argentine ” 5 16 3 3 „ (Calves) .... ” ,, ” 0 7 1 23 (Ox) 100 ” Australia ” 3 19 0 6 Lambs (Carcases) 154 ” New Zealand ” 2 1 3 7 ” ” 158 ” Chili ” 2 15 2 14 „ (Pieces) .... .... New Zealand ” 4 18 3 16 Livers (Sheep's) .... .... ,, ” 2 4 2 1 ,, ,, .... .... Argentine ” 0 10 1 5 Mutton (Carcases) 6026 .... New Zealand ” 141 2 1 23 ” ” 160 .... Chili ” 4 1 3 15 „ ,, 122 .... Argentine ” 2 8 3 5 ” ” 22 .... Australia ” 0 8 0 21 ” (Pieces) .... .... British ” 0 1 1 23 ” ” .... .... New Zealand ” 37 17 3 11 ” ” .... .... Chili ” 0 12 3 2 ” ” .... .... Argentine ” 2 16 2 4 ” ” .... .... Australia ” 2 0 1 16 „ (Carcases) 10 .... New Zealand Brine Stain 0 4 2 25 Offal (Various) .... .... Argentine Decomposed 15 15 1 9 ” ” .... .... British ” 0 2 3 23 „ (Sheep's) .... .... Australia ” 3 15 3 12 Pork (Carcases) 1 .... British ” 0 1 0 26 ” ” 93 .... Argentine ” 4 2 1 5 ” ” 2 ... South Africa ” 0 2 0 18 ” ” 2 .... U.S.A Diseased 0 1 2 1 „ (Pieces) .... .... Argentine Decomposed 4 10 3 7 Poultry (Various) .... Cases British ” 1 14 2 25 Rabbits 160 ” Australia ” 5 5 3 8 Tails (Ox) .... .... Argentine ” 0 1 0 0 ” ” .... .... New Zealand ” 1 1 3 26 Tongues „ 309 Bags Argentine Diseased 1 0 0 25 ,, (Sheep's) .... ” ” Decomposed 0 15 0 21 Turkeys .... Cases Hungary ” 0 18 2 27 Tins of Meat 10 Cases Argentine ” 0 6 0 12 Tins of Meat (Various) 70 ” .... ” 0 10 0 20 Veal (Pieces) .... .... British ” 0 3 2 22 Venison (Pieces) .... .... ” ” 0 1 3 12 420 9 0 18 Total condemned in the Year 1920 = 537 tons, 17 cwts., 2 qrs., 8 lbs. „ 1921 = 420 „ 9 „ 0 „ 18 „ Decrease 117 „ 8 „ 1 „ 18 „ 41 TUBERCULOUS MEAT SEIZED AT THE CENTRAL MARKETS DURING 1921. Carcases BEEF. Qrs. Pieces. Carcases. PORK. Qrs. Pieces. Carcases. VEAL. Qrs. Pieces. 1921 40 39 66 312 6 66 12 .... 3 1920 75 110 75 205 4 38 2 .... .... Increase .... .... .... 117 2 28 10 .... 3 Decrease 35 71 9 .... .... .... .... .... .... OFFAL. Heads. Tongues. Lungs. Hearts Livers Stomachs. Spleens. Mesenteries. Intestines. Kidneys. Oxen. 1921 45 40 16 13 13 2 .... .... .... .... 2,005 1 147 84 105 2 2 4 2 6 Pigs. 4 1 .... .... .... .... .... .... .... .... Calves 1920 164 162 80 35 86 6 22 7 .... 45 Oxen. 708 .... 154 77 88 .... 1 8 .... 4 Pigs. 1 .... 6 .... .... .... .... .... .... .... Calves. Total Weight for 1920 = 38 tons 14 cwts. 3 qrs. 11 lbs. „ 1921 = 33 „ 0 „ 1 „ 12 " Decrease = 5 " 14 „ 1 „ 27 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:— Bacon (Sides) 3 Offal (Baskets) 10 „ (Pieces) 20 „ (Heads—Ox) 1 Beef (Pieces) 14 „ (Heads—Pigs) 6 (Tins) 13,208 „ (Tongues—Ox) 4 Black Game 34 ,, (Livers—Ox) 2 Capercailzies 7 „ (Livers—Sheep) 72 Chickens 422 ,, (Stomach—Ox) 5 Ducks 1,608 „ (Feet—Ox) 28 Eggs (Fowls) 2,593 Partridges 2,295 „ (Plovers) 434 Pheasants ... 813 Fish (In tins) 3,094 Pigeons 1,194 Fowls 6,192 Plovers 139 Foxes 5 Pork (Pieces) 16 Fruit (In tins) 4,085 „ (Carcases) 6 Game (Cases) 3 Ptarmigan 44 ,, (Unclassified) 381 Quail 545 Geese 390 Rabbits 37,247 Goats (Carcases) 10 Snipe 236 Grouse 863 Stirk 1 Guinea Fowls 83 Teal 25 Hares 949 Turkeys 289 Hazel.hens 9 Venison (Carcases) 15 Kids 4 „ (Pieces) 16 Lambs (Carcases) 2 Widgeon 264 Milk (In tins) 29,398 Woodcock 26 Mutton (Pieces) 10 Total Weight for the year 1921 = 103 Tons, 17 Cwts., 3 Qrs., 25 lbs. „ „ „ 1920 = 81 „ 16 „ 0 „ 14 „ Increase 22 „ 1 „ 3 „ 11 „ ALDGATE MARKET AND SLAUGHTERHOUSES. The following table shows the number of animals slaughtered at Aldgate as compared with 1920:— 1921. 1920. Bulls 161 19 Calves 17,613 13,332 Cows 19 10 Goats 59 62 Heifers 216 7,232 Oxen 5,804 5,866 Sheep 15,844 6,233 / 39,716 32,754 42 NUMBER OF CARCASES AND QUARTERS SEIZED AND DESTROYED AT ALDGATE. Cause of Destruction. BEEF. MUTTON. VEAL. Carcases. Quarters. Carcases. Quarters. Carcases. Quarters. Anthrax l .... .... .... .... .... Decomposition .... .... 19 43 17 5 Tuberculosis 16 2 .... .... 8 .... Total for 1921 17 2 19 43 25 5 Total for 1920 9 .... 2 7 34 2 RECORD OF ORGANS SEIZED AT ALDGATE FOR THE YEAR 1921. Cause for Destruction. OXEN. SHEEP Heads. Tongues. Lungs. Hearts. Livers. Stomachs. Spleen. Mesenteries Intestines Kidneys. Heads. Tongues. Lungs. Hearts. Livers. Stomachs. Spleen. Mesenteries. Intestines. Kidneys Abscess 15 ... 37 ... 226 4 ... ... ... 4 ... ... ... ... 9 ... ... ... ... ... Actinomycosis 90 106 7 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Anthrax 1 1 1 1 1 1 1 1 1 2 ... ... ... ... ... ... ... ... ... ... Cirrhosis. ... ... ... ... 69 ... ... ... ... ... ... ... ... ... 4 ... ... ... ... ... Decomposition ... ... ... ... . 18 4 1 1 2 89 89 43 29 27 19 43 19 19 38 Jaundice and Melanosis ... ... ... ... . ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... Parasitic Disease ... ... 307 ... 1381 ... ... ... ... ... ... ... 1249 ... 16,91 ... ... ... ... ... Pleurisy and Pneumonia ... ... 2 ... ... ... ... ... ... ... ... ... 23 ... ... ... ... ... ... ... Pneumonia ... ... 328 ... ... ... ... ... ... ... ... ... 161 ... ... ... ... ... ... ... Pleurisy ... ... 502 ... ... ... ... ... ... ... ... ... 73 ... ... ... ... ... ... ... Tuberculosis 113 71 368 ... 91 23 ... 80 80 36 ... ... ... ... ... ... ... ... ... ... Unmarketable 1 1 ... 60 30 55 41 ... ... ... ... ... ... 137 67 8125 147 187 187 ... Totals for the year 1921 220 179 1552 61 1800 101 46 82 82 44 89 89 1550 167 1798 8144 190 206 206 38 Totals for the year 1920 130 108 1084 61 1356 99 35 1057 1057 37 4 3 460 26 507 1741 22 121 121 4 CALVES. GOATS. Abscess 6 ... 18 ... 72 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Actinomycosis 14 12 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Anthrax ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cirrhosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Decomposition 17 17 20 48 30 17 49 17 17 42 ... ... ... ... ... ... ... ... ... ... Jaundice and Melanosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Parasitic Disease ... ... 124 ... 117 ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... Pleurisy and Pneumonia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia ... ... 186 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pleurisy ... ... 1 6l ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculosis 25 14 106 ... 149 11 ... 10 10 18 ... ... ... ... ... ... ... ... ... ... Unmarketable ... ... ... 76 ... 70 37 25540 25540 ... ... ... ... ... ... 13 ... 10 10 ... Totals for the year 1921 62 43 615 124 368 98 86 25567 25567 60 ... ... 1 ... 1 13 ... 10 10 ... Totals for the year 1920 35 36 251 115 404 37 88 9042 9042 ... ... ... 6 1 3 1 ... 37 37 ... UNSOUND MEAT.*—The meat, &c., seized during the year by your Inspectors as unfit for food is classified as under:— 1921. Diseased. Unsound. Unwholesome. Tinned Meat. Tinned Milk. First Quarter tons. cwts. qrs. lbs. tons. cwts. qrs. lbs. tons. cwts. qrs. lbs. tons. cwts qrs. lbs. tons. cwts. qrs. lbs. 27 4 2 14 148 13 1 20 11 10 3 6 — Second „ 18 12 2 15 355 14 1 25 5 0 3 7 4 7 3 1 3 7 5 24 Third „ 12 17 2 17 411 4 3 25 19 5 0 2 6 11 2 1 Fourth 29 11 2 27 518 4 2 14 — 3 2 3 2 3 15 2 0 Total 88 6 2 17 1433 17 2 6 16 11 2 13 26 15 2 5 13 15 1 25 1921. Rabbits and Hares. Poultry and game. Offal fish total tons. cwts. qrs. lbs. tons. cwts. qrs. lbs tons. cwts. qrs. lbs tons. cwts. qrs. lbs. tons. cwts. qrs. lbs. First Quarter . 77 7 3 15 61 6 5 20 6 15 0 4 332 19 1 1 Second ,, . 54 0 0 1 77 15 0 20 14 3 26 519 14 1 7 Third . 28 4 3 16 145 8 3 9 3 14 2 22 627 7 2 2 Fourth „ 4 14 1 11 49 7 0 3 181 9 3 12 5 5 9 790 12 0 22 Total 4 14 1 11 208 19 3 7 466 1 0 27 11 11 0 5 2270 13 1 4 SUMMARY OF UNSOUND FOOD DESTROYED. Tons. Cwts. Qrs. lbs Central Markets, Smithfield 1,604 6 0 14 Cold Stores 420 9 0 18 Leadenhall Market and City Shops 103 17 3 25 Aldgate Market and Slaughterhouses 109 11 1 27 Total for the year 1921 2,238 4 3 0 Total for the year 1920 2,141 16 3 0 Increase 96 8 0 0 Seven officers of the Royal Army Service Corps, seven officers of the Royal Navy and three Veterinary Surgeons received training in meat inspection at the Central Markets, Smithfield, during the year. *Approximate weights. CENTRAL MARKETS, SMITHFIELD. *Table showing the average deliveries at the Central Meat Market, and other details for successive quinquennial periods during the past 48 years:— Quinquennium. Annual Average General Supply. Seizures by Inspectors. % of Unsound Meat. Tons. cwts. qrs. Tons. qrs. cwts. 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 i .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 1919.1921 361,116 0 0 2,133 5 1 .591 *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. American. American Killed.‡ Australian and New Zealand. Country Killed. Town Killed. †Foreign Killed. Home Killed. Per cent. Per cent. Per cent. Per cent. Per cent. Per cent. 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 1921 14.1 4.9 6.7 21 41.3 30.9 * 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:— 1917. 1918. 1919. 1920. 1921. Tons. Tons. Tons. Tons. Tons. Average daily delivery into the Markets 922 688 964 1,192 1,389 ‡Minimum delivery on any one day 135 61 107 101 101 Maximum delivery on any one day 2,397 1,668 2,101 3,103 3,537 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 169 tons of meat paying toll in the Central Markets, Smith field, was condemned last year, as compared with one ton in 174 in 1920. Table showing Weight of Meat delivered, and Meat delivered to Contractors as unsound, during each Month of the Years 1920 and 1921. Month. Meat delivered at the Market, 1920. Unsound Meat delivered to Contractors, 1920. Meat delivered at the Market, 1921. Unsound Meat delivered to Contractors, 1921. Tons cwts. qrs. Tons cwts. qrs. Tons cwts. qrs. Tons cwts. qrs. January 30,428 0 0 160 9 1 33,604 0 0 122 2 0 February 26,613 0 0 101 17 1 32,071 0 0 89 1 l March 31,315 0 0 224 19 1 34,037 0 0 139 7 0 April 28,439 0 0 158 7 1 34,002 0 0 111 17 l May 28,517 0 0 184 18 3 33,970 0 0 186 8 3 June 27,543 0 0 223 4 1 33,935 0 0 233 7 0 July 30,944 0 0 142 7 3 30,865 0 0 238 15 0 August 28,700 0 0 147 14 2 34,329 0 0 224 5 0 September 32,103 0 0 233 6 1 37,009 0 0 195 19 0 October 32,309 0 0 165 17 1 39,279 0 0 255 14 1 November 34,736 0 0 205 5 2 39,986 0 0 241 18 3 December 34,275 0 0 144 5 2 39,295 0 0 199 9 2 Totals 365,922 0 0 2,092 12 3 422,382 0 0 2,238 4 3 *I am indebted to the Clerk and Superintendent of the Central Markets for the figures relating to the market supplies, sources of origin, &c. 44 FISH SUPPLIES. 227,497 tons of fish, of which 198,839 were land.borne and 28,658 water.borne, were received at or near Billingsgate Market during the year. This was a decrease of 33,027 tons in the land deliveries, and an increase of 9,036 tons in the deliveries by water. MONTHLY FISH RETURNS. 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 1921. 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 17,522 1,606 19,128 80 13 2 1 ton in 237.108 tons or 0.421 February 18,231 1,926 20,157 155 0 2 1 „ 130.028 „ 0.769 March 17,978 1,663 19,641 63 16 1 1 „ 307.792 „ 0.324 April 16,588 1,873 18,461 180 6 1 1 „ 102.385 ,, 0.976 May 14,987 2,188 17,175 171 4 0 1 „ 100.321 ,, 0.996 June 14,490 2,060 16,550 202 15 0 1 „ 86.628 ,, 1.225 July 15,191 2,298 17,489 447 12 0 1 „ 39.074 „ 2.559 August 16,492 3,418 19,910 436 9 3 1 ,, 45.614 ,, 2.192 September 15,647 3,467 19,114 251 15 0 1 „ 75.926 ,, 1.317 October 17,087 2,984 20,071 285 2 3 1 ,, 70.392 ,, 1.420 November 18,643 3,150 21,793 176 12 3 1 „ 123.380 „ 0.010 December 15,983 2,025 18,008 129 9 2 1 „ 139.091 „ 0.718 Total 198,839 28,658 227.497 2,580 17 1 1 „ 88.089 „ 1.134 * Compiled from the Monthly Returns furnished to the Corporation by the Fishmongers' Company. Monthly Deliveries of Fish at London Central Markets, Smithfield, 1921. Tons. cwts. ###] January 109 19 0 February 121 0 0 March 101 16 0 April 109 15 0 May 94 16 0 June 92 14 0 July 79 2 0 August 85 1 0 September 96 1 0 October 111 6 0 November 116 9 0 December 93 6 0 Total 1,211 5 0 Of the above, 11 tons 11 cwts. 0 qrs. 5 lbs. were seized as unsound by your Officers and those of the Fishmongers' Company. This equals 0.95 per cent. of the whole, or 1 ton in 105 tons. Weight of Fish Delivered, Fish seized as Unsound, and percentage of Fish Condemned to that Delivered, at or near Billingsgate Market during 1921 and the five years 1916—1920. 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. 1916 114,268 4,529 118,797 1,183 5 0 1 ton in 100 tons, or .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 „ 1920 231,866 19,622 251,488 2,720 17 2 1 „ 92.425 „ 1.081 „ Average (5 years) 147,455 7,457 154,913 2,180 3 0 1 ton in 71.056 tons or 1.407% 1921 198,839 28,658 227,497 2,580 17 1 1 ton in 88.089 tons or 1 . 134% 45 THE DISPOSAL OF UNSOUND FOOD PRODUCTS. It has been the policy of the Corporation in the past, annually, to advertise the fact that the Corporation is prepared to enter into arrangements with a contractor to remove and dispose of unsound food products condemned, surrendered or seized, either at Smithfield market, the City markets, or at places within the jurisdiction of the Port Sanitary Authority. Somewhat similar arrangements have also been made at Islington, but there has existed at the Cattle Markets a special plant known as the "Podival" apparatus, by means of which certain products were converted into manure on the premises. The competition for the use of these products is of a limited character and no encouragement was made to firms to enlarge their plant in view of the fact that the tender was placed for one year only, and the unreliability of such arrangement did not encourage firms to establish up.to.date equipment. The disposal of unsound food products to a contractor is a somewhat serious responsibility, because however honourable a contractor may be, some confidence has to be placed in employees, and where such products have to be carted for a considerable distance, obvious sources of leakage are evident. Unsound food likewise in view of modern methods is capable of being transformed by means of appropriate processes into residual products of considerable value, and it is necessary that modern equipment should exist if the fullest value for this material is to be obtained, and the highest prices for the products can therefore be given by firms who are equipped to use the products to the best advantage. In view of these considerations three years ago I submitted to the Sanitary Committee the desirability of considering two alternatives, first whether the Corporation would establish its own plant for dealing with these condemned materials, or whether it would let the tender for a sufficiently long period to justify the contracting firm spending money on modern equipment. The Committee decided against the first, but in favour of the second of these alternatives. The first advertisement which was published during the war period did not meet with satisfactory response. At a later date, proposals were received from a body of men who were prepared to establish a new firm by the name of " The Smithfield Animals Products Company." I believe the chief shareholders, if not the whole, are firms engaged in the meat trade in the neighbourhood of Smithfield. It is these firms who supply in the main the substances which are ultimately destroyed. Unsound foods in the past have been dealt with by the Corporation, and the value received for the products, less per cent. in respect of cold stores' condemnation and 20 per cent. in respect of carcases surrendered at the Aldgate slaughterers, is returned to the owners. The deductions are the estimated costs of the administration of the work. It therefore came about that the owners of the products decided that they would attempt to deal with the materials themselves, accepting responsibility for the actual work of destruction and the sale of the residuals on an ordinary commercial basis. A contract was therefore entered into with the parties mentioned, which was subsequently transferred to the company formed, and a description of their methods and the works erected would seem to be desirable. The Company obtained land in Marshgate Lane, Stratford, and proceeded to obtain expert advice. It was formed for the express purpose of dealing with condemned foodstuffs obtained in the City, but not exclusively so. Apparently no expense has been spared in equipping the works in such a manner that it can deal efficiently with large quantities of material. A new factory of modern type has been erected and equipped with the most up.to.date plant on the land at Marshgate Lane. All the directors have a life.long experience in the melting trade. Their fundamental aim is, of course, to use the product to the best advantage, and for the purpose of avoiding nuisance, they have devised a system in which the minimum of handling is the outstanding feature. The raw material is loaded into trucks which are taken from the vans which convey the products from the various centres. G 46 These trucks are taken direct to the butchering department of the works where large pieces of meat are cut by band-saws into smaller pieces. From these they are conveyed to a crusher and thence by conveyor and elevator to the hoppers of the melting machines. These vessels are steam-jacketed, and in them the meat is subjected to a temperature of between 280 degrees and 300 degrees Fahrenheit. This ensures complete sterilisation. At the conclusion of the cooking process the free tallow which is obtained is run off into settling tanks, which after settlement is pumped to cleansing and storing tanks. Only one class of tallow is made and the whole of this is disposed of for candle and soap making. The residuals less this free tallow are raked from the vessels into a creeper.conveyor which carries the material into an elevator, whence it is discharged into a steam.heated revolving kettle. From this the residual is fed by means of a strickling box into hydraulic presses. These presses by means of accumulators, subject the resulting product, known as the wet "greave," to a pressure of 35 cwts. per square inch, the total pressure on each cake is therefore about 3,000 tons. This results in the bulk of tallow which is carried by the wet greaves being expelled and a solid cake of greaves is left behind. This can be handled with a very low percentage of breakages. These greaves are used in the manufacture of poultry food, dog biscuits and similar commodities. The works are capable of dealing with very large quantities of material, much larger than the average amount obtained from the various sources under the control of the City Corporation. In fact when the additions which are now being installed and near completion are finished the works will be capable of dealing with 500 to 600 tons weekly. The main supplies of materials handled consist of raw unsound meats, but the firm deals also with large quantities of tinned meat, fruit, jams, etc., and the supplies of these commodities are heavier since the armistice than in normal times owing to condemnations from Army dumps. It is interesting to know that it takes nearly 3,000 twelve.ounce tins to produce onetonof meat. Any profitable method, therefore, of dealing with this meat obviously requires a speedy method of emptying the tins. To overcome this difficulty the Company have built in their own workshops an electrically driven circular saw capable of opening 7,000 tins per hour. Fruit, jam, etc., having no fat contents, and being of no value for feeding purposes, is destroyed by acid and steam. With a view to ensuring economy and efficiency, all floors and other parts to which dirt impregnated with fat adheres are scraped down every day, and the fat content in the scrapings is subsequently extracted. Bags, cloths, etc., which have contained fatty materials are also washed and the grease extracted. The Company endeavour to avoid giving offence in any degree to the inhabitants or workers in the district surrounding the property, and for the purpose of minimising effluvium nuisance have installed a complete system of ducts through which the fumes thrown off during the cooking process are drawn by suction through a furnace. This practically ensures the destruction of the fumes. Various members of the Sanitary Committee have visited the works and have expressed their approval of them. Whenever I have visited I have found them to be conducted satisfactorily and adequate safeguards against leakage are adopted. I think the Corporation is to be congratulated on having made these arrangements, and I hope that the venture by the traders may prove profitable. The accompanying photographs illustrate the character of the work, which as stated above, is in every sense effective and efficient. Battery of Steam-Jacketed Melters. 47 OUTBREAK OF FOOD POISONING An outbreak of illness which occurred amongst the members of the staff of a large City trading concern and in which certain indications seemed to point to food poisoning was investigated in January and February last Suspicion attached to veal which had been served in the firm's dining room and of which each of the persons suffering had eaten The remaining portions of the veal were examined but no fault could be found with it The veal was purchased on the 20th January and on the 24th the shoulders and legs were served as roast veal with bacon gravy made from stock and stuffing comprised of herbs and breadcrumbs Vegetables were also served as were also fruit salad (made from tinned fruits) suet roll with golden syrup and plum and apple tart On the following day what was left of the cooked veal was served as braised veal No illness was reported among those who consumed the braised veal In all fortyfour persons complained of having suffered from diarrhoea and sickness Many of these persons were interviewed and requested to furnish particulars on a prescribed form drawn up with the object of eliciting essential information In the majority of cases it was found that the diarrhœal attack commenced in the early hours of the morning of the 25th In one instance only was vomiting a prominent symptom The illnesses were not of a serious character all the patients with one exception being back at work on the 26th January Samples of uncooked veal of veal cooked and used at the midday meal on the 24th of veal cooked and prepared on the 25th and of the bacon used on the 24th were submitted to bacteriological examination A rat and a mouse caught on the premises were also sent to the bacteriologist Unfortunately none of the stock from which the gravy was prepared on the 24th could be obtained Two of the patients attended at the Bacteriological Laboratory at St Bartholomew's Hospital and blood specimens were obtained One specimen of faeces was also obtained from the one patient in whom diarrhoea continued for more than one night The premises and the arrangements for the preparation of the food were found quite satisfactory and presented conditions above the average It was found however that on the 24th January a quantity of stock had been found to be tainted and although instructions were given for its destruction it was suggested by some of the staff that some of the material might have been used in the preparation of the gravy used Sir Frederick Andrewes' report on the specimens submitted for bacteriological examination was as follows:— "The material supplied to me for investigation was as follows:— "(1) Portions of roast veal believed to have been the cause of the outbreak " (2) Uncooked bacon which had been used "(3) Stewed veal which had been eaten without illeffect "(4) Four pieces of raw veal and one kidney from the carcases furnishing the veal ''In addition I examined the blood of two men and the stool of another—all these having "been sufferers in the outbreak a week previously—also a rat and a mouse caught on the "premises "Cultivations of the various meats were made on lactoselitmusagar plates—nine "plates in all Lactosenegative colonies were present in all plates in some very numerously "Fourteen such colonies representing all the types present were subcultured for further "study Many of them were motile Gram negative bacilli but none proved to be members "of the Salmonella group and none agglutinated with sera of the known foodpoisoning "bacilli (Gartner Aertrycke and Paratyphoid B sera) The four lots of meat were fed to "mice Two mice were fed for three days exclusively on each of the four samples of meat "The two mice fed on No (1) the cooked veal were found dead on the 4th day; the six mice fed on the other three samples remained unaffected This observation suggests the correct"ness of the opinion that it was the cooked veal which was at fault "Post mortem examination of the mice which died showed an acute diarrhœal condition "the intestines being full of watery fluid The spleens were scarcely enlarged One mouse "showed numerous haemorrhages in the lungs and elsewhere This mouse yielded an abun"dant growth of streptococci from the blood and organs Both mice yielded growth of Gram 48 "negative motile bacilli from the heart blood and liver and one growth of a similar organism "from the spleen Seven colonies from the organs and intestinal contents were subjected to "further study; those from the intestines and liver proved to be B coli fermenting lactose " Those from the bloods and spleen were lactosenegative but did not conform to the Salmonella "type and were not agglutinated by any of the following sera :—Typhoid Paratyphoid A "and B Siupestifer Aertrycke (Mutton) and Gartner Nor were they Morgan's bacillus for "they fermented mannite and formed no indol It may be concluded that the mice did not "die of infection with any of the foodpoisoning bacilli infecting man "The serum of the two patients who had suffered from diarrhoea a week previously "was tested against Gartner's bacillus the Mutton type of B Aertrycke and Paratyphoid B "One of them agglutinated the Aertrycke bacillus at 1 in 50 but not at 1 in 100 This was "the only reaction observed and is probably not significant The stool of a third case when "plated out yielded only lactose fermenting colonies The rat and mouse proved healthy "on dissection and their spleens were sterile on culture "CONCLUSIONS—In investigating an outbreak of this sort the bacteriologist is "always at a disadvantage when he cannot examine the acute cases of diarrhoea It gener "ally happens that as in this case he is called in late "The above observations suggest that the roast veal was at fault and they make it "reasonably certain that the outbreak was not one of infection with any of the usual food "poisoning bacilli but was more probably due to poisoning by some chemical substance in "the meat or gravy" 8th February 1921 (Signed) F W ANDREWES This outbreak is characteristic of the many minor outbreaks which are constantly occurring As a consequence of the general satisfactory condition of the premises etc the only precautionary measures necessary were special cleansing of utensils used and removal of all materials which might possibly have been contaminated INSPECTION OF FOOD IN CITY WHARVES The duty of supervision of food at the Wharves is undertaken by Mr T L Davies and the following is a summary of the chief matters coming under observation:— SUMMARY OF FOOD DISCHARGED AT CITY WHARVES Article Where from Description of Packages Total Number of Packages General Range of Weight of Packages Butter Holland Cases and Casks 100864 12 lbs—100 lbs Bacon Bales 66212 2 cwts—3 cwts Cheese Single Cheeses 312486 4 lbs—14 lbs Packages 173366 48 lbs—110 lbs Eggs Cases 28079 1 cwt—1 cwt 2 qrs Lard 4001 28 lbs—56 lbs Compound Lard 480 56 lbs Margarine 314996 24 lbs—56 lbs Cereals— Barley Bags 7131 100 lbs—1 cwt 2 qrs Beans 2879 1 cwt 3 qrs Peas 3220 1 cwt—2 cwts Groats 100 1 cwt Rice Holland and Italy 2000 1 cwt—2 cwts Farina Holland 4721 2 cwts Wheat Australia 15950 1 cwt 3 qrs —2 cwts Coffee North Africa 50185 1 cwt 2 qrs Cocoa & Chocolate Ceylon and Holland Bags and Cases 23154 28 lbs—2 cwts Fruit (Soft)— Apples Holland Packages 2870 40 lbs—1 cwt 2 qrs Peaches ,, 54 6 lbs Plums 34568 14 lbs—40 lbs Pears 33506 20 lbs—40 lbs Currants 4396 7 lbs—40 lbs Gooseberries 4819 14 lbs—1 cwt Strawberries 59472 7 lbs—28 lbs Bilberries 400 7 lbs Cherries 4343 12 lbs—28 lbs Cranberries 814 28 lbs Rhubarb 22281 1 cwt Fruit (Dried)— Currants Greece and Australia Cases and Bags 512009 40 lbs—2 cwts Sultanas Greece Smyrna Australia „ 428225 28 lbs—2 cwts 49 Article Where from Description of Packages Total Number of Packages General Range of Weight of Packages Raisins Australia S Africa and Spain Cases & Bags 91739 8 lbs—2 cwt Plums Australia & California Cases 72187 24 lbs—56 lbs Peaches 1197 24 lbs—56 lbs Apricots 10371 24 lbs—56 lbs Pears 2782 24 lbs—56 lbs Evaporated Apples California 11451 56 lbs Figs Greece Smyrna and Spain Cases & Bags 110652 14 lbs—3 cwt 2 qrs Dates Egypt and Persia Cases 4788 28 lbs—1 cwt Fruit (Green)— Oranges Italy and Spain Packages 384996 56 lbs—1 cwt 2 qrs Lemons 165887 56 lbs—1 cwt 1 qr Grapes Holland and Spain 25506 12 lbs—40 lbs Grape Fruit Jamaica 705 74 lbs Melons Spain 24140 56 lbs—1 cwt Pomegranates 7797 1 cwt Vegetables— Beans Holland Bags 5775 84 lbs Cauliflowers Packages 30810 40 lbs Cucumbers ,, 84053 15 lbs—40 lbs Cabbages Bags 30510 40 lbs—1 cwt Carrots Packages 30140 1 cwt—1 cwt 2 qrs Lettuce 36793 14 lbs—28 lbs Potatoes Bags 245784 100 lbs Radishes Baskets 1644 50 lbs Onions Holland and Spain Packegs 333332 100 lbs—1 cwt 1 qrs Spinach Holland ,, 20 40 lbs Tomatoes Holland and Italy 303786 12 lbs—40 lbs Beetroots Bags 1806 100 lbs Turnips Packages 40 56 lbs Parsnips Bags 7341 100 lbs Horseradish Baskets 20 56 lbs Sprouts Bags 9903 56 lbs Sugar Bags &Cases 65812 1 cwt—2 cwt Tinned Goods— Apricots Australia & California Cases 3001 48 lbs Fruit Pulp Holland and Spain Cases and Casks 16728 100 lbs—3 cwt 2 qrs Vegetables Holland and Italy Cases 4588 50 lbs—1 cwt 3 qrs Tomatoes Italy 29936 50 lbs—72 lbs Pears Australia & California 2855 48 lbs Peaches 2991 48 lbs Jam 700 60 lbs Condensed Milk Holland 855758 48 lbs Salmon Canada and Japan 15706 48 lbs Macaroni Italy 39918 28 lbs Nuts (Various) France Spain & Italy Bags & Cases 44019 28 lbs—2 cwt Milk Powder Holland 3486 50 lbs—1 cwt Milk Sugar Cases 1070 100 lbs Ginger (Preserved) China Cases & Casks 1865 30 lbs—3 cwt 2 qrs Vegetables(in Brine) Holland Casks 5719 3 cwt Miscellaneous— Carraway Seeds Holland Bags 3241 1 cwt 1 qr Liquorice Italy Cases 1189 1 cwt—3 cwt Confectionery Holland 1102 56 lbs—1 cwt Anchovies Spain Cases & Barrels 128 1 cwt—1 cwt 2 qrs Desiccated Cocoanut Ceylon Cases 1393 1 cwt 2 qrs—2 cwt Cocoa Butter Holland 180 1 cwt—1 cwt 2 qrs Dried Orange Peel Spain 20 90 lbs Pepper India Bags 4 1 cwt 2 qrs Cherries in Brine Italy Casks 565 3 cwt Citrons in Brine ,, 60 3 cwt 2 qrs Yeast Holland Bags & Baskets 1113 28 lbs 1 cwt Liquid Egg Yolk China Casks 1108 3 cwt 2 qrs—4 cwt 3 qrs Sugar Candy Holland Cases 385 28 lbs Mustard 102 1 cwt h As a result of the daily Inspect on of City Wharves 194 loads of unsound bod were removed from these places during the year by the Cleansing Department The material so disposed of comprised:— Tons cwts qrs Tinned Fruit Vegetables and Fish 70 7 0 Condensed Milk (removed at request of Owners) 1 7 0 Fruit Pulp 70 6 1 Fruit (Various) 39 6 2 Vegetables (Various) 26 0 2 Micellaneous 9 15 1 Total 217 2 2 A portion of the above was removed at the request of the owners IMPORTED EGG YOLK From time to time I have reported on the question of imported egg yolk and have directed attention to the fact that this was formerly imported in a frozen state free from preservative or in an unfrozen state either as whole egg containing albumin or as whole egg from which the albumin had been extracted and further that in the latter case preservative either salt or boric acid had been used Salt in large proportions was contained in egg yolk which was destined to be used for technical purposes such as leather dressing and boric acid in considerable proportions was present in egg yolk intended for human consumption Action has been taken to prohibit the sale of boracised egg yolk in small tins for domestic use but it is permitted to be sold to large manufacturers who use it for confectionery making only where in the finished product the amount of egg used in proportion to the bulk is so small that the amount of boric acid can be regarded as negligible in amount During the war yolk which possessed very considerable keeping qualities was submitted to me for examination but no preservative could be discovered More recently a firm of City traders have submitted to me an egg yolk possessed of similar keeping qualities which when submitted for examination was found to be free from formaldehyde sulphurous acid sulphides salicylic acid boric acid borates benzoic acid hydrofluoric acid and fluorides A portion of the sample was submitted to the Ministry of Health for their investigation Apparently some new manufacturing process was being used of the details of which I am unable to obtain precise information IMPORTED COMPOUND LARD In the early part of the year two consignments of "Compound Lard " were landed at Custom House Quay Lower Thames Street One consignment which consisted of 250 boxes marked " Compound Lard" Dutch Produce arrived ex ss Batavier IV on the 19th February and the other consisting of 100 boxes similarly marked arrived by the same steamer on the 12th March Samples of each consignment were submitted to chemical analysis with the following results: No 1 per cent No 2 per cent Cottonseed Oil 90 80 Stearine 10 20 100 100 In directing the attention of the Sanitary Committee to these results I pointed out that the socalled compound lard was apparently not prepared from hog fat which of course is the material from which lard is made and stated that in my opinion the use of the word "Lard" even in conjunction with the qualifying adjective in connection with such a product as that examined is a pernicious proceeding and should be prohibited The position is similar to what happened in the days when margarine was first introduced when the word "Butter" in conjunction with some more or less appropriate adjective or such a misleading name 50 CONDEMNATION OF FOOD INSPECTED AT RIVERSIDE WHARVES 51 as "Butterine" was applied to products which were only substitutes for butter This practice was ultimately prohibited and the word "Margarine" substituted to denote all such products I advised the Sanitary Committee of the possibility of the sale of this Compound lard constituting an offence against the provisions of the Merchandise Mark Act but as this seemed to be a roundabout process the Ministry of Health and the Ministry of Agriculture were acquainted with the circumstances above referred to and a recommendation sent that it should be made illegal to use the word "Lard" in connection with preparations not consisting of lard or in which lard only constitutes a portion of the bulk if such preparations are intended as substitutes for lard and to be used for human consumption IMPORTED SKIMMED CONDENSED MILK In May last seven cases each containing 48 tins of Condensed Milk lying at Fresh Wharf Lower Thames Street and imported from Holland were examined by one of my officers Apparently the tins were in sound condition except that some were slightly rusty On being opened however many of the tins were found to contain thick and discoloured milk A stop was placed upon the consignment and specimen tins sent to the Public Analyst for examination who reported as follows " Both samples were condensed 'machine skimmed' (ie separated) milk and both samples were sweetened with cane sugar" As these tins were not labelled "machine skimmed" or "skimmed milk" as is required by Section 1 (c) of the Sale of Food and Drugs Acts 1899 information was forwarded to the Commissioner of Customs and to the Ministry of Agriculture It is of interest to note that action in respect of such unlabelled imported skimmed milk does not come within the scope of the duties of a Sanitary Authority but devolves upon the Commissioners of Customs I am not quite sure as to the reason for the difference in procedure in the case of imported skimmed condensed milk and imported margarine in which latter instance the Local Authority may take action and at my suggestion the Corporation communicated with the Ministry of Agriculture to the effect that it would be an advantage if the Local Authority could be given concurrent powers with the Commissioners of Customs in respect of offences of this nature CHEMICAL PRESERVATIVES IN IMPORTED FRUIT PULP The question of the presence of preservatives in imported food stuffs has again been the subject of report to the Sanitary Committee of the Corporation In consequence of a communication received from the Ministry of Health four samples of a consignment of fruit pulp were submitted to the City Analyst with a request that they should be examined for the presence of preservative The Analyst reported that each sample contained sulphur dioxide to the following extent:— Sample 18 Strawberry Pulp So2 014% „ 28 „ „ 0011% 38 „ „ „ 0011% „ 1R Raspberry Pulp 0018% The amount of preservative is certainly not large and would practically disappear in the process of the cooking to which as the pulp is used for jam making practically all of it is subjected I do not think however that chemical preservatives of any nature should be permitted in foodstuffs except under regulation So far as I am aware no other country permits the unrestricted importation of foodstuffs to which preservatives have been added and I certainly think if present scientific knowledge is inadequate for the purpose of enabling regulations to be framed or if doubt exists as to the harmfulness or otherwise to human beings of certain of the more commonly used preservatives it is time that some investigation work was carried out to enable a definite position to be taken up The circumstances were reported to the Ministry of Health the Corporation at the same time suggesting that some control should be exercised over the nature and amount of preservative used in imported foodstuffs H 2 52 53 SALE OF FOOD AND DRUGS ACTS AND THE PUBLIC HEALTH (MILK AND CREAM) REGULATIONS Articles examined during each Quarter of the year 1921 Articles submitted for Analysis No of Samples taken Quarter ending 31st March Quarter ending 30th June Quarter ending 30th September Quarter ending 31st December Total for 1921 No Genuine No Adulterated percentage of Adulteration No of Samples taken No Genuine No Adulterated Percentage of Adulteration No of Samples No Genuine No Adulters ted 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 4 3 l 250 l l 100 0 2 2 2 9 1000 9 5 4 444 Butter (on Bread) 5 5 1000 5 5 1000 Margarine 1 l 100 0 1 1 1000 Vinegar 2 2 2 2 Total Formal Samples 10 3 7 700 l l 1000 2 2 4 2 2 500 17 7 10 588 Informal— Milk 59 55 4 67 47 44 3 63 55 51 1 72 51 51 212 201 11 51 Butter 98 95 3 30 5 5 13 13 35 35 151 148 3 19 Malt Vinegar 10 10 3 3 4 4 17 17 Drugs 44 43 22 8 8 16 16 80 78 2 25 148 145 3 20 Cheese 2 2 13 13 9 9 24 24 Dripping 5 5 2 2 13 13 2 2 9 9 Mustard 3 3 1 1 5 5 11 11 Cocoa 6 6 7 7 2 2 15 15 28 28 Crushed Linseed 6 6 6 6 12 12 Ground Ginger 1 1 1 1 10 10 12 12 Almond Oil 13 13 11 11 24 24 Coffee 5 5 7 7 1 1 25 25 38 38 Baking Powder 1 1 2 2 1 1 2 2 5 5 Preserved Cream 2 2 5 5 7 7 Cream 5 4 1 200 5 4 1 200 Margarine 3 1000 7 7 10 7 3 300 Vinegar 3 3 11 9 2 181 14 12 2 142 Salmon & Shrimp Paste 1 1 11 9 1 1 Lard 3 3 4 4 7 7 14 14 Lime Juice Cordial 1 1 1 1 British Wines 4 4 4 4 Medicated Wines 6 6 6 6 Arrowroot 1 1 5 5 1 1 7 7 Custard Powder 2 2 1 1 1 1 4 4 Pepper 2 2 4 4 4 4 10 10 Ground Rice 2 2 2 2 Rice 2 2 2 2 2 2 6 6 Olive Oil 9 9 3 3 12 12 Self Raising Flour 1 1 4 4 12 12 Cake 16 16 Lemon Squash 16 16 4 4 Lemonade 4 4 4 4 Sugar 4 4 21 21 21 21 Sauces 12 12 12 12 Cayenne Pepper 9 9 9 9 Jam 14 13 1 14 13 71 Tapioca 4 4 1 71 4 4 Curry Powder 3 3 3 3 Flour 2 2 2 2 Eggpride 1 1 100 0 1 1 1000 Sponge Cake 22 15 7 318 22 15 7 318 Bread 6 6 6 6 Total Informal Samples 267 259 8 29 115 109 6 52 143 139 4 27 392 378 14 35 917 885 32 34 Totals 277 262 15 5 4 116 109 7 6 0 145 141 4 27 396 380 16 4 0 934 892 42 44 54 SALE OF FOOD AND DRUGS ACTS I regret to report that Inspector May who for 30 years performed the duties of Inspector of Food and Drugs died on the 13th October 1921 He had been ailing for a year or two and during the latter part of his illness his work was carried out by Mr Hills Mr May has been a loyal servant of the Corporation and of the Commissioners of Sewers previously and his death was keenly felt by his colleagues During 1921 934 samples were submitted to the Public Analyst for examination Of this number 917 were taken as test samples without the formality of the Act being observed; 32 of these were found to be adulterated made up as follows 11 of Milk out of 212 samples taken 3 of Butter out of 151 samples taken 2 of Vinegar out of 14 samples taken 3 of Margarine out of 10 samples taken 7 of Sponge Cake out of 22 samples taken 1 of Jam out of 14 samples taken 1 of Eggpride out of 1 sample taken 1 of Cream out of 5 samples taken 3 of Drugs out of 148 samples taken Of the formal samples 10 out of 17 were found to be adulterated made up as follows:— 4 of Milk out of 9 samples taken 5 of Butter out of 5 samples taken 1 of Margarine out of 1 sample taken The percentage of milk adulteration for both formal and informal samples together is 67 as compared with 43 for 1920 Of the 15 adulterated samples 11 were informal samples and four formal samples Two prosecutions resulted Two vendors of adulterated samples were cautioned BUTTER—The three cases of adulteration are again of butter sold on bread or rolls and not where butter was sold in bulk DRUGS—Three drugs were reported against two of Boric Acid Ointment and one of Gregory's Powder The ointments were deficient in boric acid The Gregory's Powder contained magnesium carbonate instead of light magnesia The vendors were cautioned in each instance SALE OF FOOD AND DRUGS ACTS 1875 TO 1907 RESULTS OF PROSECUTIONS 1921 First Quarter Sample Nature and Extent of A dulteration Result 11 Butter (on Roll) 100 per cent margarine £2 and 17 /6 costs 64 (on Bread) 90 per cent margarine £2 and 17 /6 costs Second Quarter 212 Butter (on Bread) 90 per cent margarine 5 / and 17 / costs 259 Margarine 100 Per cent. margarine sold in plan wrapper and bulk not labelled £5 and £1 costs ordered to pay £1 costs. Third quarter. nil. Forth Quarte. 858 Milk 9 per cent added water £2and£l 1s costs 859 „ 8 per cent added water £2 and £1 1s costs SUMMARY £ s d £ s d First Quarter : Fines 4 0 0 Costs 1 15 0 Second Quarter „ 5 5 0 „ 2 17 0 Third Quarter „ - - - „ - - - Fourth Quarter „ 4 0 0 „ 2 2 0 Total Fines £13 5 0 Total Costs £6 14 0 55 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 1921 „ Butter 10 100 Per cent. Margarine ... .... Vender cautioned. „ 11 100 „ „ Final £2 and 17s. 6d. Costs. 15 100 „ Resampled 16 100 „ 64 90 „ Fined £2 and 17s 6d Costs Same vendor as No 15 192 90 „ Cautioned 212 90 „ Fined 5s and 17s Costs 274 100 „ Cautioned Milk 37 7 per cent original fat abstracted Resampled Subsequent sample genuine 77 14 per cent „ Resampled „ 102 12 Resampled Subsequent sample genuine. 104 11 and 12 „ added water Resampled 111 4 „ Cautioned Boric Acid Ointment 206 62 „ Boric Acid cient. .... .... .... .... Referred to Borough of Holborn. Margarine 259 100 per cent Margarine Fined £5 and £2 Quarter ending 30th Juno 1921 Costs Margarine 284 100 „ Cautioned „ 285 100 „ „ „ 286 100 „ 2 per cent added water „ Subsequent Milk 302 4 per cent original fat abstracted Resampled sample genuine 6 per cent deficient in fat „ 319 8 per cent original fat abstracted Resampled „ 350 6 „ Cautioned „ 366 6 „ Resampled Subsequent sample Quarter ending 30th September 1921 genuine Milk 422 10 per cent original fat abstracted Sale of milk discontinued „ 441 6 „ Resampled Subsequent sample genuine „ 446 3 „ added water .... .... „ „ 458 6 „ „ .... .... „ Quarter ending 31st December 1921 Vinegar 617 12 per cent deficient in „ Subsequent „ 651 Acetic Acid 10 „ „ sample genuine 56 Name of Article Identification No given to the sample in the Quarterly Report Result of Analysis If any legal proceedings were instituted under the Sale of Food & Drugs Acts state result showing fines and costs separately If any legal proceedings were instituted under Acts other than the Sale of Food & Drugs Acts state result showing fines and costs separately If no legal proceedings were instituted state briefly the course adopted in regard to each sample Information if any as to previous convictions Remarks on any point of special interest Boric Acid Ointment 693 104 per cent deficient in Boric Acid Cautioned Sponge Cake 788 020 per cent of Boric Acid Reported to Ministry of Health „ 799 035 „ „ „ „ 801 042 „ „ „ „ 802 022 „ „ „ „ 804 031„ „ „ „ 807 029 „ „ „ Sponge Fingers 800 036 „ „ „ Black Currant Jam 809 581 per cent only of water soluble extract Cautioned Milk 858 9 per cent added water Fined £2 and £1 1s Costs „ 859 8 per cent added water Fined £2 and £1 1s Costs Gregory's Powder 878 66percent of Magnesium Carbonate in place of 66 per cent Magnesia Cautioned Eggpride 932 110 per cent Boric Acid Reported to Ministry of Health SALE OF FOOD ORDER 1921 The Sale of Food Order 1921 imposed upon Local Authorities certain responsibilities in respect of weight of bread and tea labelling of imported produce composition of jam marmalade and dripping margarine and other edible fats The enforcement of the provisions of the Order is entrusted as regards weight of bread and tea to Local Authorities for the purpose of the Weights and Measures Acts and as regards labelling of imported produce the composition of jam marmalade etc to Local Authorities authorised to appoint an Analyst for the purpose of the Sale of Food and Drugs Acts 1875 to 1905 and such of their officers as they may respectively designate or appoint for those duties Since the issue of this Order however an amending order has been received which removed lard from the list of imported products which are required to be labelled and revokes the Sections of the Order relating to the composition of jam marmalade and dripping margarine and other edible fats The only part of the Order now entrusted to the Sale of Food and Drugs Authorities is Part 3 which relates to the labelling of imported produce other than lard It is however possible that certain of the provisions of Part 5 which relate to fats even though they have been revoked may prove to be useful for the purposes of the Sale of Food and Drugs Acts as indicating the standard of composition generally recognised as the minimum of purity for the articles in question as the provisions were originally settled after consultation with the representatives of the trades concerned SALE OF MARGARINE Certain samples of Margarine purchased during the year were found to have infringed the provisions of the Margarine Act 1887 and the Sale of Food and Drugs Act 1899 57 Section 6 of the Margarine Act 1887 requires that every package containing margarine exposed for sale shall be clearly labelled in printed capital letters not less than oneandahalf inches square and Section 6 of the Sale of Food and Drugs Act 1899 requires that upon the paper wrapper in which margarine or margarine cheese is sold the word "margarine" or "margarine cheese" shall be printed in capital block letters not less than halfaninch long and distinctly legible and that no other printed matter shall appear on the wrapper The following are the details of the infringements above referred to:— Sample No 284—The margarine was delivered to the purchaser in a paper wrapper upon which was stamped in duplicate the word " margarine " in letters slightly less than a quarter of an inch long The bulk moreover from which the sample was taken was not labelled in any way Samples No 285 and 286—Both these samples were supplied in plain wrappers and no indication was given that margarine was being served A " margarine " stamp of the correct sized lettering was produced in each case and the reason given in each instance for not marking the paper wrapper was shortage of ink for the inking pad The separate bulks from which the samples were drawn were properly labelled After consideration of all the facts it was decided that the attention of the vendors be officially directed to the circumstances and that they be cautioned as to their future action THE PUBLIC HEALTH (MILK AND CREAM) REGULATIONS 1912 During the year 1921 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 the results:— Number of samples examined for the presence of a Preservative Number in which a Preservative was found to be present 1 Milk and Cream not sold as Preserved Cream :— Milk 212 0 Cream 5 l 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 7 ii Incorrect Statement 0 (b) Determination made of Milk Fat in Cream sold as Preserved Cream— i Above 35 per cent 7 ii Below 35 per cent 0 (c) Instances where (apart from analysis) the requirements as to labelling or declaration of Preserved Cream have not been observed— Nil (d) Particulars of each case in which the regulations have not been complied with and action taken— In one instance Cream not bearing any label of declaration of preservative was purchased and found on analysis to contain 027 per cent boric acid The vendor was cautioned DAIRIES COWSHEDS AND MILKSHOPS' ORDERS Seven applications for registration have been received during the year 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 EXAMINATION OF MILK AS REGARDS INFECTION WITH TUBERCLE During the year three series of milk samples were collected at the railway stations in the City of London receiving milk from the country and were submitted to Sir Frederick Andrewes for bacteriological examination and to the City Analyst for chemical examination i 58 The first series was submitted in May. and consisted of 30 samples. Seven. out of twenty-nine samples. or over 24 per cent. were reported to contain the tubercle bacillus. One of the samples submitted was not included in the report of the Bacteriologist as the inoculated animal died eight days after inoculation. a period too short to allow the milk sample to be pronounced negative. The percentage number of infected milk was higher in this series than ever previously recorded in the City. Although I gave consideration to the possibility of coincidence. having regard to the small number of samples submitted. I considered the circumstances sufficiently serious to justify the examination of a further series of samples. Before referring to this further series. I have to state that the samples were also examined for the presence of dirt. Of the thirty samples. 28 were clean and two distinctly not clean. The chemical examination showed that. with one exception. all samples were genuine milk and free from boric acid or formalin. In the second series. 24 samples were submitted to the Bacteriologist. but the pathological report refers only to 19. as four of the animals died within a few days of inoculation and one was lost. Of the 19 samples. five. or 263 per cent.. were found to be infected with the tubercle bacillus. Having regard to the fact that five of the samples are not included in these figures. it is quite possible that the true percentage is even more serious than the above. but even so. I think it is a matter of very serious concern that it is possible to purchase in the City of London 50 consecutive samples of milk and find that 1 in 4 of these milks is tuberculous. A third series of 24 samples was taken. and again a high percentage of tuberculous samples was reported. Of the 24 samples submitted. three were shown to contain tubercle bacilli. This represents a percentage of 125 and is considerably lower than the results obtained in the two previous series. though the proportion is still far too high. The infected milks were despatched to London from the following areas:— Sudbury. Lavenham. Chelmsford. Walton.on.Naze. Diss. Tivetshall. Spooner Row. Tolleshunt Darcy. Foulsham. Capel. Gunton. Thorpe-le.Soken and Yarmouth. The results of the bacteriological examination have of course been followed up by action at the farms at which the milk was produced. but I have before reported. and must here repeat. that in my opinion little permanent improvement can be expected until the responsibility of ensuring that milk is free from tubercle is made the direct obligation of the farmer. As the matter at present stands it has to be proved that the farmer is aware that "he sells or suffers to be sold or used for human consumption the milk of a cow which is suffering from tuberculosis of the udder." The difficulty of proving "knowledge" is obvious and I am satisfied that the obligation should rest on the farmer to ensure the milk he supplies to the public is free from infection and that it should not be necessary for any public body first to discover—an expensive undertaking—that infected milk is being sold and then to notify the farmer in order that suitable remedial measures may be adopted after the dangerous milk has been consumed by the public. Since 1904 continuous observation has been kept on the condition of milk arriving at the several railway termini in the City and the following summary sets out the percentage number of samples of milk which have been found to be infected with the tubercle bacillus during each year:— Since 1904 continuous observation has been kept on the condition of milk arriving at the several railway termini in the City and the following summary sets out the percentage number of samples of milk which have been found to be infected with the tubercle bacillus during each year:— 1904 7.7 per cent. 1913 10.4 per cent. 1905 9.1 „ 1914 10.2 „ 1906 8.0 „ 1915 8.5 „ 1907 8.3 „ 1917 4.2 „ 1st series 1909 12.5 „ 1919 14-8 „ 2nd „ . 4.7 „ 1921 24.2 „ 1st series. 1910 6.25 „ 26.3 „ 2nd „ 1912 6.6 „ 12.5 „ 3rd „ 59 ICE CREAM Consideration was given during the year to the provisions which exist for dealing with ice cream vendors and the premises upon which ice cream is manufactured One of the Metropolitan Borough Councils approached the London County Council expressing the view that the present provisions are inadequate The letter from the Metropolitan Borough Council contained the following paragraph:— "The London County Council (General Powers) Act 1902 gives the Sanitary Authority "power to take action if and when premises are considered unfit for the purpose of manufac "ture of ice cream but it may often happen that such commodity is made for a considerable "time upon most unsuitable premises without discovery It is considered that as in the "case of milk vendors a system of compulsory registration of ice cream vendors should be "introduced and I am further directed to request your Council to consider the advisability "of including a clause in their next General Powers to give effect to this suggestion" The County Council were advised that the powers already possessed by the Local Sanitary Authorities in London are if duly exercised sufficient to protect the public from dangers arising from the consumption of ice cream Before giving further consideration to the question raised however the Council desired to ascertain the views of Local Sanitary Authorities thereon and approached the Corporation accordingly In my opinion there is something to be said in favour of compulsory registration for although the requirements with respect to the sanitation of premises on which ice cream is manufactured sold or stored and the precautions necessary in case of infection and notification of infection may be adequate there is some uncertainty in a district like the City in being sure that the commodity sold by itinerant vendors is prepared under satisfactory conditions and under adequate supervision There are in the City a considerable number of these itinerants and periodically the names and addresses of the persons from whom a vendor obtains the commodity or if the vendor is the actual manufacturer the name and address of the vendor is noted and a communication forwarded to the Medical Officer of Health of the district in which this address is situate This is necessary because the fact that ice cream is manufactured or stored at the address stated may not be known to the Medical Officer of Health of that area since possibly the vendor may sell only within the City area I think it would be a better procedure if all persons manufacturing selling or storing ice cream were required to be registered in the district in which the commodity is manufactured or stored and if all itinerant vendors were required to indicate the fact of registration on the barrow also the registered address If this were the case no communications would require to be forwarded to the Medical Officers of Health of outside districts the fact of registration would be sufficient guarantee that the premises on which the commodity was manufactured or stored were subjected to continuous supervision Without this intimation it is necessary to make periodical enquiries of the Medical Officers of Health as to whether the places of manufacture or storage are in all respects satisfactory For these reasons therefore I am of opinion that compulsory registration of ice cream vendors with the Local Authority in which the premises where the commodity is prepared are situate should be introduced and the County Council have been notified accordingly 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 775 persons compared with 805 in 1920 73 per cent are adults and 27 per cent children (under 14 years) i 2 60 The number of births was eight viz four males and four females The birth rate was 103 per 1000 which is 105 per 1000 below the average for the previous five years The death rate for 1921 was 155 per 1000 per annum The number of deaths of children under one year per 1000 births was 125 as against 93 for the City generally TABLE OF BIRTHS AND DEATHS OCCURRING AT THE ARTIZANS' DWELLINGS STONEY LANE HOUNSDITCH DURING THE YEAR 1921 Name of Block Births Mortality from all Causfs at subjoined ages Male Female At all ages Under 1 year 1 and under 5 5 and under 15 15 and under 25 25 and under 65 65 and upwards NORTH BLOCK 1 2 3 1 2 SOUTH 1 1 KING'S 1 2 1 1 QUEEN'S „ 1 1 3 1 1 1 PRINCE'S „ 2 3 1 2 Totals 4 4 12 1 4 7 The birth rate in these Dwellings reached a maximum of 469 per 1000 in 1896 and has since been falling as shown by the following figures :— BIRTH RATE ARTIZANS' DWELLINGS 1896 469 1909 296 1897 403 1910 329 1898 431 1911 295 1899 375 1912 334 1900 384 1913 297 1901 338 1914 363 1902 458 1915 288 1903 312 1916 226 1904 301 1917 293 1905 29 1 1918 138 1906 261 1919 187 1907 350 1920 198 1908 315 1921 103 The baths provided for the use of tenants of these Buildings which were opened in May 1904 continue to be extensively used the number of persons bathing during 1921 being 10791 of whom 3738 were males and 7053 were females The accompanying table is compiled from the monthly records of attendances at the baths :— RECORD OF ATTENDANCES AT THE BATHS ARTIZAN'S DWELLINGS Month Sex Total Males Females Children Adults Children Adults January 14 88 48 134 284 February 60 186 149 274 669 March 74 232 221 343 870 April 82 254 227 402 965 May 63 278 220 472 1033 June 89 294 258 463 1104 July 96 339 246 515 1196 August 75 226 208 416 925 September 89 274 280 450 1093 October 86 275 204 459 1024 November 52 184 143 316 695 December 89 239 196 409 933 Totals 869 2869 2400 4653 10791 61 CITY MORTUARY DISINFECTION—TRADE—In accordance with the requirements of the South African Authorities the disinfection of secondhand clothing prior to export to that country has been carried out as usual The following table gives the details of this work:— Number of Certificates issued Number of articles disinfected Fees received by the Corporation 479 561975 £1123 DISINFECTION—INFECTIOUS DISEASES Articles disinfected after cases of infectious disease 17329 BODIES RECEIVED POSTMORTEMS AND INQUESTS:- Bodies received at the Mortuary to await burial 153 Postmortem examinations made 71 Inquests held on bodies 140 Inquests held on fires 25 CLEANSING OF PERSONS ACT 1897:— Number of verminous persons bathed 22 NUMBER OF ARTICLES DISINFECTED BODIES RECEIVED AT THE MORTUARY AND INQUESTS HELD AT THE CORONER'S COURT IN THE CITY DURING 1921 COMPARED WITH THE PREVIOUS FIVE YEARS Year Articles disinfected Bodies received at the Mortuary Inquests held on bodies Inquests held on Fires 1916 438426 169 151 2 1917 295144 234 213 1 1918 179990 158 130 0 1919 207935 170 150 4 1920 549829 172 158 9 Average for previous 5 years 334265 181 160 3 1921 579304 153 140 25 DISINFECTION OF CLOTHING OF EMIGRANTS TO THE UNITED STATES OF AMERICA—The United States of America in order to prevent so far as was possible the introduction of infectious diseases into that country through the medium of emigrants have issued regulations requiring disinfection of the personal effects of all thirdclass passengers entering the United States ports A further requirement was the production of a certificate by a responsible authority vouching that such disinfection had been efficiently conducted As a result the Corporation were requested by the agents of two large shipping firms to effect the necessary work of disinfection The request was complied with and the usual charge for disinfection of £1 for each time the apparatus was used plus one half the overtime charges incurred resulted in the sum of £341 3s 3d being paid into the Chamber of London In all the personal effects of 3610 emigrants have been dealt with PRESERVATION OF BODIES OF UNKNOWN DEAD—The De Rechter apparatus for the preservation of the dead installed at the City Mortuary in March 1909 was fully described in the Annual Report for that year It has proved of considerable assistance in connection with the identification of persons found drowned in the river Thames FIRE INQUESTS—Dr F JWaldo JP Coroner for London and Southwark has kindly furnished me with the following list of places in the City which were the subject of Fire Inauests held bv him during 1921 :— INQUESTS HELD UNDER THE CITY OF LONDON FIRE INQUESTS ACT 1888 Date of Inquest Premises burnt 17th December 1920 and 4th January 1921 4 Jewin Crescent EC 6th 12th and 17th January 1921 11 12 and 13 Arthur Street EC 26th January 1921 6 and 7 Redcross Street EC 2nd and 10th February 1921 15 Aldersgate Street EC 2nd and 10th February 1921 15 Aldersgate Street EC 28th January 3rd 8th and 15th February1921 18 Old Swan Lane EC 3rd March 1921 2 Whitefriars Street EC 62 Date of Inquest 3rd March 1921 5th July 1921 19th July 1921 22nd August 1921 22nd and 30th August 1921 6th September 1921 6th and 13th October 1921 6th and 13th October 1921 6th and 13th October 1921 6th and 13th October 1921 6th and 13th October 1921 6th and 13th October 1921 20th October 1921 20th October 1921 7th November 1921 16th December 1921 16th December 1921 22nd December 1921 Premises burnt 68 Fleet Street EC 33 Whitecross Street EC 52 Aldersgate Street EC 41 Jewin Crescent EC 122 Minories EC 27 Camomile Street EC 39 Jewin Street EC 39 Jewin Street EC 39 Jewin Street EC 39 Jewin Street EC 39 Jewin Street EC 39 Jewin Street EC 7 Camomile Street EC 3 Lawrence Lane EC 2 Aldermanbury Avenue EC 13 Wine Office Court Fleet Street EC 13 Rose Street and Paternoster Square Newgate Street EC 142 Houndsditch EC In addition to the above the City Coroner personally inquired into 236 "nonfatal" City fires reported to him during the year 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 LIQUIDS SOLD AS DISINFECTANTS The Council of the Royal Sanitary Institute at their annual conference held in Birmingham in July 1920 passed the following Resolution and in the following November forwarded a copy to the Corporation with the request that it should be considered and if approved a similar Resolution passed and forwarded to the Ministry of Health (1) "That it is desirable in the public interest and on public health grounds that the "sale of any liquid as a ' Disinfectant' should be controlled by legislation (2) "That such legislation should demand that any liquid sold as ' Disinfectant' shall " have a carbolic acid coefficient (as tested by an approved method) of at least one (3) "That a penalty should be imposed (a) for any false or misleading statements as "to the germicidal value of a disinfectant and (b) for any misleading instructions with "reference to the effective use of a disinfectant" The efficient control of the sale of socalled "Disinfectants" is a matter which in my opinion should receive the attention of the Legislature and a Resolution in similar terms to that quoted above was passed by the Sanitary Committee and forwarded to the Ministry of Health SANITARY INSPECTIONS The following is a statement of the work of the Sanitary Inspectors in their several Districts durine each month of the vear:— WEST DISTRICT— Inspector F J Robbins Month Premises Inspected Orders issued Notices served Improvements effected January 142 2 3 10 February 200 4 2 20 March 227 7 8 28 April 321 6 71 36 May 266 18 10 22 June 282 7 20 52 July 200 1 3 25 August 218 1 5 30 September 200 2 5 30 October 225 7 12 27 November 232 3 16 23 December 342 8 8 30 Totals 2855 66 163 333 63 MIDDLE DISTRICT— Inspector E J Simmons Month Premises Inspected Orders issued Notices served Improvements effected January 106 4 4 20 February 266 5 11 41 March 242 4 10 24 April 302 6 11 24 May 288 6 7 28 June 259 7 10 36 July 216 1 2 31 August 204 1 2 33 September 200 2 6 33 October 217 6 10 34 November 228 3 9 26 December 346 6 11 46 Totals 2874 51 93 376 EAST DISTRICT— Inspector W H Ralph Month Premises inspected Orders issued Notices served Improvements effected January 127 12 19 10 February 236 17 27 14 March 265 43 64 34 April 349 16 55 64 May 273 8 24 49 June 265 4 18 37 July 235 5 11 20 August 119 3 3 11 September 273 4 9 18 October 232 4 18 28 November 239 6 13 32 December 297 10 20 35 Totals 2910 132 281 352 THE FOREGOING ARE SUMMARISED AS UNDER :— District Number of inspections made Orders issued Notices served Improvements effected West 2855 66 163 333 Middle 2874 51 93 376 East 2910 132 281 352 Totals 8639 249 537 1061 REGISTERED LODGING HOUSES Public Health (London) Act 1891 Sec 94 The Corporation as the Sanitary Authority in the City are required under the provisions of Sec 94 of the Public Health (London) Act 1891 to make and enforce Bye-laws applying to houses let in lodgings or occupied by members of more than one family for the following purposes:— For regulating the number of persons and separation of the sexes For the registration and inspection of such houses For enforcing drainage and promoting cleanliness and ventilation For the cleansing and limewashing of the premises at stated times For the taking of precautions in any case of infectious disease The Bye-laws now in force in the City for this class of property were made by the Court of Common Council on 24th November 1904 and confirmed by the Local Government Board on the 20th January 1905 Unfurnished lodgings when the rent is not less than 10s a week and furnished lodgings when the rent is not less than 12s 6d a week are exempt from the operations of the Bye-laws 64 Particulars relating to the registered Lodging-houses in the City now on the Register are given in the accompanying table:— REGISTERED LODGING-HOUSES District Number of Houses on Register Number of Lodgers Number of Tenements Average Number of Persons per Tenement Cleansing Notices Served West 72 424 189 23 74 Middle 4 25 17 15 4 East 64 357 157 23 73 Total 140 806 363 22 151 These houses are periodically inspected and in April of each year the landlords are called upon to carry out a thorough cleansing of them in accordance with the provisions of Bye-laws This necessitated the service of 151 Notices during 1921 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 Artisans' 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 14 3 .... .... .... 37 Dean Street Blocks, Fetter Lane— Block A 3 4 .... l .... 28 „ B 2 5 .... .... .... 29 „ C 6 3 .... .... .... 28 „ D 2 5 .... .... .... 24 „ E 2 5 .... .... .... 22 „ F .... 4 .... l .... 19 St. Ann's Chambers, Ludgate Hill 2 10 .... .... .... 19 Bloomfield House, Snow Hill .... 14 .... 3 .... 47 Total 31 72 .... 5 .... 291 MIDDLE DISTRICT. Bridgewater House, Fann Street .... 12 .... .... .... 12 City Buildings, Moor Lane .... 20 12 .... .... 90 Total .... 32 12 .... .... 102 EAST DISTRICT. Harrow Alley and Stoney Lane— North Block .... 48 8 .... .... 217 South „ 5 22 13 .... .... 178 1 Prince's „ 5 50 .... .... .... 167 Queen's „ 5 40 5 .... .... 160 King's „ 8 16 16 .... .... 158 Barker's Buildings, Catherine Wheel Alley, Bishopsgate 10 7 2 1 .... 41 Total Two "Blocks" 33 183 44 1 .... 921 These ten blocks contain 413 tenements and are inhabited by 1314 persons— an average of 3T8 persons to each tenement COMMON LODGING-HOUSE 116 MIDDLESEX STREET—The above premises which are 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 generally satisfactory condition 65 NEGLECT TO COMPLY WITH WATER-CLOSET BYE-LAWS—In accordance with the Bye-laws with respect to water-closets &c made under Section 54 of the City of London (Various Powers) Act 1900 every person who shall intend to construct a water-closet or to connect or disconnect any watercloset from any soil pipe or drain shall at least seven days before the work is to be commenced deliver or send to the Corporation at the Guildhall a plan showing the situation of such watercloset drawn to scale together with a section showing the proposed means of ventilation Under Section 17 every person who shall offend against these Byelaws 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 Byelaw 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 No instance of neglect in this respect has occurred during the year under review DRAINAGE PLANS—In the course of the year 156 plans were submitted with regard to proposed reconstruction of waterclosets or drains in the City Of these 133 were approved 10 revised and approved and 13 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 upto 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 Subsection 1 (e) of the Public Health (London) Act 1891 and during the year one case was reported by your officers On the service of the statutory notice of abatement the overcrowding was discontinued 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 151 cases so investigated in 1921 it was found necessary to reconstruct the sanitary system in five instances and to make amendments to soil and waste pipes waterclosets &c in 61 others HOUSE TRADE AND OTHER REFUSE REMOVAL—The City Engineer informs me that the refuse removed from the City in 1921 consisted of 17819 cartloads of street sweepings and slops and 46541 loads of house and trade refuse a total of 64360 loads The total for the year 1920 was 61236 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 537 notices have been served by the District Inspectors at the order of the Sanitary Committee and in three cases only was it found necessary in consequence of noncompliance therewith to refer the matters to the City Solicitor with a view to such steps being taken as he deemed necessary 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 33552709 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 K 66 Disinfectants are also freely applied where desirable The condition of the approaches to Billingsgate Market and the Customs House as heretofore required special attention There has always been a difficulty in keeping the thoroughfares in the immediate vicinity of these places free from the nuisance caused by the drippings from the fish carts especially during hot weather LIMEWASHING OF COURTS—There are 89 courts and narrow passages situated in various parts of the City the walls of which unless cleansed frequently become dirty and unsightly through the constant traffic of passengers or vehicles together with the action of the smokeladen atmosphere These are cleansed or limewashed twice a year under the direction of the City Engineer Of the places so dealt with during 1921 24 were situated in the East District 33 in the Middle District and 32 in the West District REMOVAL OF HUMAN REMAINS 184 FLEET STREET During the year only one instance of the disturbance of human remains in the City has been brought to my notice; the following is a brief summary of the facts relating thereto:— In the course of excavation in connection with the construction of new drains a small quantity of human remains were unearthed The bones were quite dry and not in an offensive condition They bore evidence of having been previously disturbed They were reinterred with due decency on the site FLY NUISANCE The prolonged drought experienced during the summer of this year together with the unusual heat resulted in the nuisance from flies being more pronounced than ever Every effort was made by your officers to impress on householders in the City the necessity for the observance of such precautions as cleanliness frequent removal of house and other refuse and the prevention of access of flies to foodstuffs especially milk Leaflets were also distributed throughout the City directing attention to the danger created by the fly and enlarging on the precautionary measures which should be taken in order to minimise the nuisance and danger so far as possible FACTORY AND WORKSHOP ACT 1901 &c FACTORIES WORKSHOPS AND WORKPLACES—The premises upon the Register number 3652 in which are included 7785 workrooms &c There were served 2139 notices during the year for various purposes under the Acts The number of Factories Workshops and Workplaces at present Registered is as follows:— Registered Places Workrooms &c in Registered Place FACTORIES 894 3,340 WORKSHOPS 1,808 2,800 WORKPLACES Kitchens of Restaurants Tea Rooms &c 789 1,274 Stables 25 56 Other places 136 315 3,652 7,785 The following is a Summary of Inspections of separate workrooms &c during the year:— Workshop Inspectors Women Inspectors Totals FACTORIES 1956 2 1958 WORKSHOPS 1958 - 1958 WORKPLACES 979 38 1017 67 The following is a Summary of Inspections of separate workrooms since 1914:- Workshop Inspectors Women Inspectors Totals FACTORIES 1914 3025 237 3262 1915 1438 319 1757 1916 1264 406 1670 1917 1501 234 1735 1918 904 3 907 1919 995 7 1002 1920 866 — 866 1921 1956 2 1958 WORKSHOPS 1914 2053 658 2711 1915 1411 751 2162 1916 1224 799 1960 1917 1308 347 1655 1918 783 11 794 1919 1069 18 1087 1920 731 — 731 1921 1958 — 1958 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 1921 979 38 1017 BAKEHOUSES—Bakehouses are scheduled as Workshops (Part 2 Sixth Schedule) and are required to be registered by the Local Authority (Section 132) The following is a list of Bakehouses registered in the City:— ABOVEGROUND BAKEHOUSES †*37 Middlesex Street * †*63 to 65 Middlesex Street 280 Bishopsgate †*122 Middlesex Street † 45 Fish Street Hill 3 Pancras Lane † Great Eastern Railway Hotel 21 Stoney Lane *61 Middlesex Street 68 St Mary Axe *85 Middlesex Street *75 St Paul's Churchyard 194 Upper Thames Street UNDERGROUND BAKEHOUSES 188 Aldersgate SUMMARY 262 Bishopsgate *4 Broadway Aboveground Bakehouses 5 8 Copthall Avenue Underground Bakehouses 16 15 Cornhill — f*67 Farringdon Street 21 *93 Fetter Lane 48 Knightrider Street * These have been established at least 35 years t Factory Bakehouses (power is used) K 2 68 SUMMARY OF WORK DONE UNDER THE FACTORY AND WORKSHOP ACT, 1901, AND THE PUBLIC HEALTH (LONDON) ACT, 1891, &c., FOR THE YEAR 1921. Men Inspectors. Women Inspectors. Special Inspector Gathercole. East District Inspector Rnhincnn West District Inspector Fowler. West District Miss East District Miss V ilkinson. Totals. INSPECTIONS. Factories, Initial Inspections (Tenancies) .... 86 112 .... .... 198 Do. Initial Inspections (Workrooms) .... 180 303 .... .... 483 Do. Periodical Inspections (Tenancies) .... 199 267 .... 2 468 Do. Periodical Inspections (Workrooms) .... 503 970 .... 2 1,475 Do. Re-inspections (Sanitary Works, &c., in hand) .... 298 308 .... .... 596 Workshops, Initial Inspections (Tenancies) .... 204 196 .... .... 400 Do. Initial Inspections (Workrooms) .... 296 310 .... .... 606 Do. Periodical Inspections (Tenancies) .... 555 412 .... .... 967 Do. Periodical Inspections (Workrooms) .... 654 659 .... ..., 1,313 Do. Re-inspections (Sanitary Works, &c., in hand) .... 438 432 .... .... 870 Workplaces, Initial Inspections (Tenancies) 39 .... .... .... 1 40 Do. Initial Inspections (Workrooms) 77 .... .... .... 1 78 Do. Periodical Inspections (Tenancies) 495 .... .... .... 33 528 Do. Periodical Inspections (Workrooms) 902 .... .... .... 37 939 Do. Re-inspections (Sanitary Works, &c., in hand) 725 .... .... .... 5 730 Bakehouses, Inspections 39 .... .... .... .... 39 Do. Re-inspections (Sanitary Works, &c., in hand) 10 .... .... .... .... 10 DEFECTS FOUND. Factories, Workshops and Workplaces, &c.— Want of Cleanliness 162 53 79 .... 5 299 Want of Ventilation 24 8 12 .... .... 44 Overcrowding .... 1 4 .... .... 5 Want of Drainage of Floors .... .... 1 .... .... 1 Other Nuisances, &c 56 183 210 .... 6 455 Kitchens Storage Cistern defective 4 .... .... .... .... 4 Accommodation for Refuse 3 .... .... .... .... 3 Accumulation of Refuse 9 .... .... .... .... 9 Insufficient (Tenancies) 3 1 8 .... .... 12 Sanitary Aecommodation Unsuitable (Do.) 1 19 50 70 Defective (Do.) 75 206 269 .... 6 556 Do. (No. of Conveniences)* 85 337 404 .... 8 834 Not separate for Sexes (Tenancies) 2 24 30 .... .... 56 Total Defects found 339 495 663 .... 17 1,514 DEFECTS REMEDIED. Factories, Workshops and Workplaces, &c.— Want of Cleanliness 161 52 65 .... .... 278 Want of Ventilation 33 8 10 .... .... 51 Overcrowding .... 1 4 .... .... 5 Want of Drainage of Floors .... .... .... .... .... .... Other Nuisances, &c. 56 207 167 .... .... 130 Kitchens Storage Cistern defective 2 .... .... .... .... 2 Accommodation for Refuse 6 .... .... .... .... 6 Accumulation of Refuse 4 .... .... .... .... 4 Insufficient (Tenancies) .... 1 7 .... .... 8 Sanitary Accommodation Unsuitable (Do.) .... 21 45 .... .... 66 Defective (Do.) 74 170 224 .... .... 68 Do. (No. of Conveniences)* 97 331 358 .... .... 86 Not separate for Sexes (Tenancies) 3 23 22 .... 48 Total defects remedied 339 483 544 .... .... 1,366 OUTWORKERS. Lists received from City Firms 411 .... .... .... .... 1,411 Names and Addresses, &c., received from other Authorities 279 .... .... .... .... 79 Names and Addresses transmitted to other Authorities 11,035 .... .... .... .... 11,035 Notices served on Employers 1,737 .... .... .... .... 1,737 Letters written, &c. 440 .... .... .... .... 40 Firms visited 124 .... .... .... .... 124 Workshops notified by H.M. Inspector .... 66 20 .... .... 86 General complaints received 11 5 .... .... 1 17 69  Men Inspectors. Women Inspectors Totals. Special Inspector Gathercole. East District Inspector Robinson. West District Inspector Fowler. West District Miss East District M iss Wilkinson. ACTION TAKEN. Matters referred to H.M. Inspector— Want of Cleanliness .... 3 2 5 Want of Ventilation .... 1 l .... .... 2 Overcrowding .... .... .... .... .... .... Want of Drainage of Floors .... .... .... .... .... .... Failure to affix Abstract .... 42 25 .... .... 67 Other Nuisances .... 1 2 .... .... 3 Action taken in matters referred by H.M. Inspector— Notified by H.M. Inspector l 25 20 .... .... 46 Reports sent to H.M. Inspector l 29 20 .... .... 50 Other matters .... .... .... .... .... .... Notices served— Factories—Intimation .... 13 25 .... 2 40 Statutory .... 4 13 .... .... 17 Workshops—Intimation .... 86 63 .... .... 149 Statutory .... 19 15 .... .... 34 Workplaces, &c.—Intimation 138 .... .... .... .... 138 Statutory 24 .... .... .... .... 24 Orders required from Sanitary Committee 75 41 39 .... .... 155 Certificates for Cleansing issued by Medical Officer of Health 46 8 5 .... .... 59 Matters referred to District Inspectors 17 4 3 .... .... 24 Matters referred to Women Inspectors .... 1 .... .... .... 1 Matters referred to Workshop Inspectors .... .... .... .... 1 1 Cases reported for Legal Proceedings .... .... .... .... .... .... Legal Proceedings taken .... .... .... .... .... .... SPECIAL INSPECTION WORK. Domestic Workshops—Inspection (Tenancies) .... .... .... .... 12 12 Do. Defects found .... .... .... .... .... .... Do. Defects remedied .... .... .... .... .... .... Outworkers' Premises, Inspections (Tenancies) .... .... .... .... .... .... Do. Defects found .... .... .... .... .... .... Do. Defects remedied .... .... .... .... .... .... SPECIAL INSPECTION WORK—(WOMEN INSPECTORS.) Offices, Inspections (Tenancies) .... .... .... .... 2 2 Do. Defects found .... .... .... .... .... .... Do. Defects remedied .... .... .... .... .... .... London County Council (General Powers) Act, 1904, Inspections of Premises after Cleansing of Children .... .... .... .... 13 13 Do. Do. Defects found .... .... .... .... 1 1 Do. Do. Defects remedied .... .... .... .... .... .... Children Act, 1908 (Nurse Children), Inspections of Premises .... .... .... .... 5 5 Do. Do. Defects found .... .... .... .... .... .... Do. Do. Defects remedied .... .... .... .... .... .... Underground Conveniences for Women, Inspections .... .... .... .... 16 16 Do. Do. Defects found .... .... .... .... 26 26 Do. Do. Defects remedied .... .... .... .... .... .... Railway Stations (Ladies' Rooms), Inspections .... .... .... 23 23 Do. Do. Do. Defects found .... .... .... .... 8 8 Do. Do. Do. Defects remedied .... .... .... .... .... .... Notification of Births Act, 1907, Visits .... .... .... .... 194 194 Number of Mothers attending " City Shelter " for advice .... .... .... .... .... 368 368 Special Visits .... .... .... .... 15 15 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 70 No case of infectious disease was reported in connection with premises occupied by outworkers in the City Four contacts with Scarlet Fever were reported The necessary enquiries were made and suitable precautions taken The following figures show the number of Outworkers notified since 1902:— Year Number of Lists received Outworkers Employed in Citv Outworkers Employed outside City Total number of Outworkers 1902 17 3752 3769 (Note—First Notice issued to all employers at the 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 1921 1,411 717 11,035 11,752 NOTE ON THE USE OF PUBLIC CONVENIENCES WHERE THERE IS AN ABSENCE OF SUFFICIENT OR SEPARATE W C ACCOMMODATION IN BUSINESS PREMISES The problems of public health are so closely related to those of personal well being that the full strength of public opinion endorses the requirement of law which enforces the provision of separate and suitable sanitary conveniences for the sexes in premises where business is carried on In the City of London an enactment requiring the observance of this principle has been in operation since 1848 The result is that few commercial buildings are found to be without the conveniences necessitated by the employment of both sexes In plans of new buildings the proposed number of tenancies together with the probable numbers of each sex likely to be employed receive careful consideration and consequently difficulties of this nature seldom arise afterwards In older buildings and adapted dwelling houses extra sanitary accommodation to that originally provided has been frequently added during structural additions and alterations which have been executed from time to time The peculiar conditions imposed by the war and the resulting abnormal increase in the number of women workers have caused temporary difficulties but these are being gradually eliminated Other problems however have arisen to some extent which do not seem to be easy of solution The chief of these is due to the present economic necessity which has delayed the demolition and rebuilding of leaseexpired premises and which requires the fullest use being made of all available buildings whilst at the same time restricting expenditure to an absolute minimum Separate floors or rooms are let (perhaps temporarily) resulting in complications as to the use or apportionment of waterclosets These are accentuated if the new tenants employ persons of both sexes instead of one as under the former occupation or when the premises in question formed part of a larger tenancy The ideal arrangement is for every separate occupation to have conveniences exclusively for the use of the staffs employed therein This is however a counsel of perfection and unattainable under present conditions Where conveniences are situated on landings or staircases adjustments can be made between tenants But when some are located within one particular set of premises—separately occupied —difficulties of several kinds immediately present themselves though where possible one occupier in a building will generally give accommodation to another occupier by arrangement especially in the case of a small subtenancy There is however a great dislike to this practice both on the part of employers and their staffs It is not always desirable or convenient either to give or to accept free access to other premises at all times and moreover the hours of business may not always coincide 71 There are instances where fairly large staffs of either sex are employed together with only one or two of the other sex; or a small number of each sex This results in difficulty being experienced in providing separate W.C. accommodation on the premises for both or for the sex of smaller numbers particularly where several business tenements are found In old buildings where leases have expired or are approaching expiration owners are very reluctant to incur the cost of the erection of new conveniences which owing to the general demand for business accommodation and the unusual conditions of occupation which exist have become necessary The shortage of buildings in the City has been the cause of derelict structures becoming temporarily occupied as workshops until the more permanent occupation of suitable premises could be arranged A building or portion of premises occupied as a Factory or Workshop on which additional WC accommodation is found to be necessary may be so built as to render the construction of a new convenience or conveniences practically impossible so as to comply with the Byelaws in force Such cases are rare however The majority of lockup shops are without sanitary accommodation attached to them but it is an accepted principle that persons employed there have the use of conveniences in the building above or at the rear and of which the shops themselves form part Where the several conditions abovementioned are encountered the question arises from time to time as to the use of public conveniences (if they are situated within a reasonable distance) as an effort to meet the requirements of law and yet prevent any undue hardship No such arrangement is legally permissable Very comprehensive powers are given by the Factory and Workshop Act 1901 and the Public Health (London) Act 1891 relating to sanitary conveniences in Factories Workshops and Workplaces Section 38 of the Public Health (London) Act enacts:— "Every factory workshop and workplace whether erected before or after the passing "of this act shall be provided with sufficient and suitable accommodation in the way of "sanitary conveniences regard being had to the number of persons employed in or in attend "ance at such building and also where persons of both sexes are or are intended to be em "ployed or in attendance with proper separate accommodation for persons of each sex" Section 9 of the Factory and Workshop Act 1901 contains similar provisions (excluding workplaces) No standards are laid down but the Secretary of State is empowered to make an Order to determine what is sufficient and suitable accommodation within the meaning of this Section The Section does not apply to London and the Order made under it (Sanitary Accommodation Order 1903) therefore does not apply but the contents are extremely useful as a guide They are followed in the City of London the Sanitary Committee having adopted the contents of the Order as constituting their interpretation of the requirements of Section 38 of the Public Health (London) Act 1891 By Section 157 of the Factory and Workshop Act "mens" workshops are exempted from the provisions relating to sanitary conveniences so that by inference public or other accommodation outside the premises may be used In practice however this Section is ignored and all action taken under the Public Health (London) Act which contains no such limitation The responsibility both with regard to construction and the maintenance of efficient and cleanly conditions of sanitary conveniences in factories workshops and workplaces is placed primarily upon the Local Sanitary Authority HM Inspector of Factories acts in a supervisory capacity and is given power by the Factory and Workshop Act to take action only if a Local Authority makes default after receipt of information of some contravention from the Factory Inspector The requirements of the Act relating to sanitary conveniences are equitable All workers are given the right of access to suitable conveniences within the premises where they work at all times during employment ; facilities which physiological necessity demands It is found that the number of cases where the necessary accommodation is absent is not large It is noteworthy that while it is made necessary to provide separate conveniences for the sexes there exists no statutory power to prevent persons of both sexes using them promiscuously It appears therefore that once the necessary accommodation has been provided the jurisdiction of the Sanitary Authority as to its 72 use ends though the intention of the Acts undoubtedly is to secure'separate use as well as separate provision Presumably office rules are made to meet this circumstance If it should be considered desirable to recognise the use of a public convenience by one sex in special cases a somewhat difficult situation would be created It is in the first instance contrary to the letter and intention of law Further there is no guarantee that the public convenience would be used as permitted ; it is possible after such a concession had been granted that both sexes would use one and the same convenience in a building A distance within which a public convenience should be situated so as to be sufficiently nearwould have to be fixed This would be difficult It would also have to be decided in some cases which of the two sexes should be so accommodated Men's and Women's public conveniences are not always adjacent to one another It must not be overlooked that the use of a public convenience usually involves payment by the user This is an unfair—if slight—responsibility to place upon a person who is entitled to have proper accommodation provided without charge The principle involved is an important one Public conveniences were provided first of all for public use and not to act as reliefs to buildings which may have become occupied beyond their " convenience " capacity If it is intended to allow their use in every such case they would have to be multiplied to some considerable extent Consideration of this subject shows that the widest powers are provided to secure adequate accommodation in all premises and under almost any circumstances but without any discretionary latitude to meet special difficult cases Nevertheless it appears that in such circumstances particularly during the present period of industrial depression the use of a public convenience by employees of one sex if few in number is perhaps justifiable and for the time being preferable to costly alterations which may be necessitated if strict observance of the law as it stands were insisted upon But in view of the complications likely to arise from such a concession it is undoubtedly easier and safer to enforce the Statutory requirements LIGHTING AND MEANS OF VENTILATION OF BASEMENT WORKROOMS The demands of modern industry and commerce combined with economic problems produced by the extremely high value of land in the City of London control the development of sites and the use of buildings within its boundaries and necessitate the fullest use being made of all available space below as well as above ground Basement rooms are therefore a necessity in London and some persons are compelled under present conditions to pass the working dav below the ground level It has long been recognised that these rooms are undesirable from the depressing effect they produce and the difficulty of providing them with adequate natural light and ventilation which are essential to the maintenance of health Moreover it is unnatural for human beings to live or work regularly underground and therefore probably harmful Basement workrooms may be divided into two classes :— (1) Those in modern buildings and (2) Those in older buildings and former dwelling houses In the first group basements are provided generally with a certain amount of natural light and direct ventilation to the external air and supplemented with mechanical ventilation where necessary They generally have adequate provision for artificial lighting and though some are undesirable as workrooms still they present conditions which are the best obtainable under present circumstances The second class presents a more difficult problem In the older type of building and dwelling house the basements were constructed and intended usually for stores stock rooms or cellars only Under economic pressure many of these have become occupied and sometimes separately occupied as workrooms or offices Whereas little or no light and ventilation were needed originally these now become a necessity In some cases slight structural alterations have given good results but in others the necessary radical alterations would present extreme difficulty and be very costly Mechanical ventilation by means of fan and air ducts can be 73 installed in special cases but no such adaptation can be followed to introduce or increase natural light except to a very limited extent by borrowed light in the form of reflectors refracting glass and by the maintenance of cleanliness of walls ceilings and windows and the prevention of lightobstructing conditions generally In practice it is very rarely found that in the absence of natural light insufficient artificial light is provided in workrooms it being essential to efficient work Difficulties in providing natural light and ventilation will depend upon the degree to which the room is below the surface of the surrounding ground the proximity and height of other adjacent buildings and the area and position of available openings There is no definition in either the Factory and Workshop Act 1901 or the Public Health (London) Act 1891 of an underground workroom except an underground bakehouse which is considered to be such if the floor of the baking room is more than three feet below the surface of the adjoining street or ground adjoining or nearest the room The Public Health (London) Act contains a similar clause defining an underground room if occupied separately as a dwelling In each of the foregoing use of the rooms so specified is forbidden unless they comply with certain requirements which though embodying useful powers with regard to light and ventilation do not with one exception fix standards ; the exception being that of an underground room of a dwelling house the window (or windows) of which must be equal to onetenth the floor area half the window must be made to open at the top and an area be provided in front of it The Act of 1901 indirectly empowered Local Authorities to fix standards of lighting and ventilation in underground bakehouses by requiring the District Council to certify the premises to be suitable for use as a bakehouse In the City of London it was laid down that all such premises should be lighted naturally if possible failing this only electric light was to be used for illuminating purposes Through ventilation was insisted upon and inlets required to be at least 12 inches above any footway surface and then only if other higher positions were not practicable These standards are useful as a guide in dealing with basements generally and might usefully be applied in principle in any future action taken All basement workrooms may be considered to form part or come within the terms of a factory workshop or workplace The supervision of these premises varies within certain limits and may be broadly stated to be as follows :— In Factories all matters with the exception of watercloset accommodation are controlled directly by His Majesty's Inspector of Factories In Workshops and Workplaces the local Sanitary Authority is directly responsible for the general conditions including cleanliness ventilation and air space in workrooms as well as for enforcing special regulations in certain cases The Inspector of Factories however exercises a supervisory control and has power to act if a Local Authority makes default in relation to any matter to which the Inspector has called attention and which it is the duty of the Local Authority to deal with A basement workroom which forms part of a factory does not come within the jurisdiction of the Sanitary Authority but one forming part of a workshop or workplace does No definition of " workplace " is given in either the Factory or Public Health Acts though the term is quoted in both ; but it has been interpreted to mean any place not being a factory or workshop where persons are employed and regular work of some kind is carried on Offices warehouses and restaurants kitchens &c would therefore be classed as workplaces Statutory powers relating to workshops and workplaces are given to Local Authorities in London by the Factory and Workshop Act 1901 in conjunction with the Public Health (London) Act 1891 They contain no provision whatever for the lighting of workrooms either by natural or artificial means and it would appear that light of any particular description cannot be enforced under these Acts in general workrooms Moreover there is no power to secure even adequate lighting With regard to ventilation it is laid down in the Factory and Workshop Act 1901 that " every room in any factory or workshop sufficient ventilation shall be provided and sufficient ventilation shall be maintained" Workplaces are excluded from this requirement but it may be noted that the whole of any premises within L 74 a building, and in one occupation, is regarded by the Home Office to be a factory or workshop as the case may be; offices and other rooms in which work is carried on, except where certain specified exemptions have been allowed, could therefore be dealt with as being parts of a factory or workshop and subject to the same requirements. Presumably the intention of the provision quoted above is to require ventilation to the external air direct, but in some instances where these conditions are met with the ventilating openings are situated in, or so near to the ground level in the form of pavement ventilators, gratings in stall-boards and the risers of entrance steps, that quantities of dust and other impurities gain access to the rooms they serve which is extremely undesirable. On the other hand in workrooms where the means of ventilation are not in direct connection with the open air (and the intention of the Act, therefore, not complied with) sufficient air may be introduced and diffused to meet the requirements of the workers and be minus the gross impurities already mentioned. This would be preferable perhaps to an admittedly undesirable method of "direct" ventilation. In a basement, air usually enters the room just above head level, and in cold weather the workers find this objectionable, close the ventilating opening, and consequently ventilation is not maintained. Another aspect may be considered. Where mechanical means of ventilation by extraction fan have been installed in basements it is found that care has often been taken to select an outlet at some convenient point, but the incoming "fresh" air is drawn, frequently, not from special suitably selected points to ensure purity and freedom from dirt, but from any openings or spaces in aerial communication with the system, including other rooms, and not always direct from the external air. In such cases only a mechanical system which is principally indirect ventilation exists. These points render it difficult to say whether the provision of direct ventilation to the external air can be enforced and even if so, whether it is advisable to do it in every case. Factors which should not be ignored when considering means of ventilation are the close relationship it bears to means of heating, also that which the position of the ventilating openings bears to both. More adequate means of ventilation become necessary if the heating apparatus vitiates the air than would otherwise be required. The intense dislike sedentary workers have of a draught of cold air necessitates care in the use and position of windows and other openings if they are to be of any value for ventilating purposes, otherwise they will be kept permanently closed. It is noteworthy that offices, which are considered to be workplaces, are not legally, under the Factory and Workshop Act, required to be either adequately lighted or ventilated. The weakness of the Act is still further exemplified by Section 157 in which men's workshops are exempted from various requirements, among which is included "means of ventilation." The Public Health (London) Act, however, gives some power in this connection in workshops and workplaces, but only where "gases, vapours, dust or other impurities generated in the course of the work carried on therein that are a nuisance or injurious or dangerous to health " are found, and perhaps also under Section 2 (a) which refers to any premises in such a state as to be a nuisance or injurious or dangerous to health. An effort was made in 1913 to introduce legislation affecting underground workrooms in certain trades under which occupation of all such rooms was prohibited unless certified by the Local Authority as suitable for the purpose. Adequate lighting and ventilation were, amongst other requirements, specified as conditions to be complied with before the certificate was to be granted. The Secretary of State was to be empowered to make regulations for lighting and ventilation. The definition of underground room was to be held to mean any room any part of which is so situated that half or more than half of the whole height from floor to ceiling is below the surface of the footway of the adjoining street. The Bill did not become law. I referred to this fact in my Annual Report for 1913. Difficulty is sometimes experienced where a basement under a shop becomes used as a workroom connected with the business carried on above, the direct 75 means of ventilation of which is almost invariably obtained through the stall-board. If it has not been used previously as a workroom the ventilation arrangements are not always altered and increased to suit the new conditions. Cases have been found where even the openings which originally existed have been reduced or quite obliterated during the fixing of new shop fronts. Even the fresh air inlet to the drain has been enclosed. No notice to the Local Authority of such alteration is legally necessary but is very desirable. Modern shop-fronts have a tendency to become lower than formerly; as a consequence the stall-boards become reduced in depth with a corresponding reduction in the only available space for ventilating the basements direct to the external air, and sometimes to such an extent as to render them inadequate for the purpose, if the basements are to be used as workrooms. It is the duty of every occupier of a workshop to give notice to His Majesty's Inspector of Factories within a month of the commencement of occupation. The Factory Inspector in turn forwards the information to the Local Authority concerned. If this Regulation were observed without omission the supervision of basement workrooms could be more thoroughly carried out as it is most frequently in non-notified workrooms where faults of ventilation are found. However, even when this notification has been given, alterations affecting light and ventilation may be made by an occupier without hindrance and of which no notice is required. Any contravention so caused will remain to be discovered the next time the premises are visited. To summarise the powers of Local Authorities in relation to the question under consideration, it appears that in basement workrooms there is no specific power given in either the Factory and Workshop Act or the Public Health (London) Act in respect of lighting. The provisions as to ventilation are definite in relation to workrooms, where women, young persons, or children are employed, but no particular ventilating area can be insisted upon and the means must be "sufficient." A further power is given in general terms under Section 2 (a) of the Public Health (London) Act relating to "any premises in such a state as to be a nuisance or injurious or dangerous to health." Workplaces can only be required to be ventilated under the Nuisance Section of the Public Health London Act, by Section 2 (a) quoted above, or Section 2, Subsection (g) (ii.) relating to gases, vapours, dust, etc. In presenting these observations, due regard has been given to the peculiar difficulties which exist in the City of London and which render complex the problems reviewed. Much disorganisation of business would accrue if measures were taken to overhaul and improve the natural lighting and ventilating arrangements of basements on a large scale though some improvement is necessary. At present a Local Authority is given no power to act, apart from those herein quoted, except under the Nuisance Sections of the Public Health (London) Act, 1891. KITCHENS OF RESTAURANTS. The following is an epitome of the powers possessed by Local Authorities in dealing with kitchens of restaurants. In the memorandum dealing with the duties of Local Authorities issued by the Home Office in 1902, the following note appears:— "'Workplace' is not defined in the Act, but in a case under Sec. 38 of the Public Health "(London) Act, 1891, where the same phrase as in this Act occurs, viz.,' factory, workshop "and workplace' it was held that the word is not to be limited to places where something is "being manufactured or made, but includes 'any place where work is done permanently, "and where people assemble together, to do work permanently of some kind or other.' "It is therefore a word of wider signification than the word ' workshop.' In the case in "question a stable and stable yard where men were employed as cab-cleaners and "horsekeepers was held to be a workplace. Similarly the Secretary of State has been advised "that the kitchens of restaurants, &c., though they are not workshops, come within the meaning " of the term ' workplace.' " L 2 76 The London Count CounciL(General Powers) Act, 1908 (Section 8), contains sections intended to regulate premises used for the sale, etc., of food for human consumption, to the following effect:— 8.—(1)—From and after the passing of this Act the following provisions shall apply to any room, shop or other part of a building within the County in which any article whether solid or liquid intended or adapted for the food of man is sold or exposed for sale or deposited for the purpose of sale or of preparation for sale or with a view to future sale: (a) no urinal water closet, earth closet, privy, ashpit or other like sanitary convenience shall be within such room, shop or other part of a building or shall communicate therewith except through the open air or through an intervening ventilated space; (b) no cistern for supplying water to such room, shop or other part of a building shall be in direct communication with or directly discharge into any such sanitary convenience; (c) no drain or pipe for carrying off faecal or sewage matter shall have any inlet or opening within such room, shop or other part of a building; (d) no such room, shop or other part of a building shall be used as a sleeping place and so far as may be reasonably necessary to prevent risk of infection or contamination of any such article as aforesaid no sleeping place shall adjoin such room, shop or other part of a building and communicate therewith except through the open air or through an intervening ventilated space; (f) refuse or filth whether solid or liquid shall not be deposited or allowed to accumulate in any such room, shop or other part of a building except so far as may be reasonably necessary for the proper carrying on of trade or business; (/) Due cleanliness shall be observed in regard to such room, shop or other part of a building and all articles apparatus and utensils therein and shall be observed by persons engaged in such room, shop or other part of a building; (2) If any person occupies or lets or knowingly suffers to be occupied any such room, shop, or other part of a building wherein any of the conditions prohibited by this section exist or does or knowingly permits any act or thing therein in contravention of this section he shall be liable on summary conviction to a fine not exceeding for a first offence twenty shillings and for every subsequent offence five pounds and in either case to a daily penalty not exceeding twenty shillings. The business of a vendor of fried fish is separately legislated for and bye-laws controlling this trade are operative in the City. The Public Health (London) Act, 1891, Section 2, specifies defects, e.g., want of cleanliness, ventilation and overcrowding, occurring in workplaces which may be dealt with as Nuisances, and Section 25 gives power to the Medical Officer of Health and the Sanitary Inspector to certify where cleansing or limewashing is necessary. Section 38 requires separate, suitable, and sufficient water closet accommodation to be provided. The Sections of the Acts, &c., quoted appear to represent the powers available in respect of workplaces and, therefore, of restaurant kitchens. The greatest difficulty experienced in the City, in connection with statutory requirements, is in respect of Section 8 (c) of the 1908 Act. Presumably a gully, although it is effectively trapped, must be regarded as a drain opening. This deficiency exists in many of the places which existed prior to the passing of the Act, and if it is to be regarded as preventing the use of a room as a kitchen, very many of these places would cease to exist. A drain inlet cannot be removed from a basement kitchen unless an open area exists in which the gulley can be placed. Such an open area is a rare circumstance in the City and the alternative is to require an upper floor to be used for the purpose and to take the discharge pipe into the basement where a sealed gully can be provided. This is an altogether impracticable requirement in the majority of cases, though the necessity can be pointed out to those who propose opening a new restaurant with a basement kitchen attached. As a consequence of these difficulties it has been the practice in the past not to close kitchens presenting circumstances such as those outlined above, but to require the provision of the best known appliance for use as a trap, and to endeavour to ensure that the defect is minimised by frequent visitation. 77 The principal defects ascertained on inspection may be assumed to be the following:— (a) The situation of the kitchen. This may be underground and, as a consequence, lighting and ventilation are defective. In addition, some of the kitchens, both underground and otherwise, are located in old, dirty premises, which apparently are waiting for improvement schemes to mature, when they will be demolished. Ventilation of the basement kitchen generally means facilities for the entrance of dust from the street level and various devices have to be adopted to minimise this evil. (b) The conditions of the floors, walls and ceilings is not always what could be desired. Impervious floors are by no means the rule. Walls faced with glazed bricks are the exception. Ceilings are sometimes not satisfactory. In new places these essentials invariably receive adequate attention. (c) Old buildings are ill-provided with facilities for storing food. All gradations, between practically no provision to kitchens to which small stores are attached, exist. Improvements in this respect are taking place. The occupiers of small kitchens endeavour so to arrange the work that the food purchased each day is consumed that day and none is ever required to be stored. This attempt is, of course, practically never completely successful. (d) The water closet accommodation has often been a serious difficulty, particularly where a small number of workers is employed and these consist of two sexes. The requirement of separate, suitable conveniences with an intervening ventilating lobby, should such conveniences be in close relationship to the kitchen, is always insisted upon, but it should be an additional requirement that in the lobby, or attached to the conveniences, there should be installed satisfactory provision for personal ablution. (e) A changing room for the staff is rarely provided, but cupboards in a small place, ranging to a separate room in a large place, should be an essential. (f) The number of sinks for washing-up purposes should bear a relationship to the business done. Often this provision is inadequate. The sanitary condition of these appliances requires careful attention. (g) Water storage cisterns are a necessity where boilers are used for generating steam. They are, however, frequently placed in positions where they cannot be kept free from dust or dirt. In some instances occupiers have been ignorant of the existence of these cisterns and their condition when examined will be imagined. (h) The condition of cooking utensils is a matter of general administrative supervision by the occupier whose attention requires sometimes to be called to unsatisfactory conditions. (i) Adequate provision for the storage of refuse is most important. Neglect of simple precautionary measures results in the rat nuisance becoming a serious problem in some places, and in customers being exposed to unnecessary risks from food poisoning. In old premises rats frequently gain access to the kitchen, and much educational work has recently been carried out, and improvements effected, in connection with rat repression. (j) The condition of food used and stored upon the premises is a matter of considerable importance and although examination of food is often made, the main responsibility rests upon the manager. A difficulty of a subsidiary character is the objection which neighbouring tenants frequently make to the smells of cooking which occasionally arise. When 78 the nuisance is caused by the burning of refuse of an offensive nature, perhaps this can be dealt with under the Public Health Acts, but where this is simply a cooking smell and affects personal comfort, perhaps the only remedy is an action at common law by the party affected. In previous reports attention has been directed to the fact that restaurant kitchens, being workplaces, may be established without notice of any kind being given, in which respect they differ from factories and workshops. It is not necessary either that such places should be registered, although an attempt is made to keep as complete a register as possible of all kitchens known to exist in the City. It would prove a great advantage to public sanitation if all restaurant kitchens were required to be registered under different conditions of occupation. These conditions should specify the minimum requirements in respect of the matters set out above. SUGGESTION.—I would suggest that when another Bill is promoted by the Corporation for general purposes that an endeavour be made to obtain additional powers in respect of regulations of kitchens in which food is prepared for consumption by the general public, whether such kitchens are attached to restaurants or to hotels. FACTORIES, WORKSHOPS, WORKPLACES AND HOMEWORK. 1921. 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) 666 57 - Workshops (including Workshop Laundries) 1,406 183 - Workplaces (other than Outworkers' premises included in Part 3 of this Report) 568 162 - Total 2,640 402 - 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. Inspectors. (4) Nuisances under the Public Health Acts :—† Want of cleanliness .... 299 278 5 - Want of ventilation 44 51 2 - Overcrowding 5 5 — - Want of drainage of floors 1 -— - - Other nuisances .... 471 142 3 - Sanitary accommodation ( insufficient 12 8 - - unsuitable or defective 626 504 - - [ not separate for sexes 56 48 - - Offences under the Factory and Workshop Act:— - - - - Illegal occupation of underground bakehouse (S. 101) — — - - Breach of special sanitary requirements for bakehouses (SS. 97 to 100) - - - - Other offences (excluding offences relating to outwork which are included in Part 3 of this Report) - - - - Total 1,514 1,366 10 - † Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 79 80 81 3.-HOME WORK. NATURE OF WORK.* OUTWORK IN UNWHOLESOME PREMISES, SECTION 108. OUTWORK' IN INFECTED PREMISES, SECTIONS 109, 110. Lists received from Employers. Notices served on occupiers as to keeping or sending Lists. Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made (S: 110). Prosecutions (Sections 109, 110). Sending twice in the year. Sending once in the yean Failing to keep or permit inspection of lists. Failing to send lists. Lists.† Outworkers,† Lists. Outworkers. (1) (2) Contractors. (3) Workmen. (4) (5) Contractors. (6) Workmen. (7) Wearing Apparel— (8) (9) (10) (11) (12) (13) (14) (15) (16) making, &c. 1,178 2,971 7,175 39 84 96 1,737 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) 94 151 298 4 5 2 Cables and Chains Anchors and Grapnels Cart Gear Locks, Latches and Keys Umbrellas, &c. 52 33 275 Artificial Flowers 34 326 Nets, other than Wire Nets Tents Sacks Racquet and Tennis Balls Paper, &c., Boxes, Paper Bags 10 4 53 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 1,368 3,159 8,127 43 89 98 1,737 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 number of workers in each class 4 (or 4 and 7) into their respective classes. A footnote should be added to show that this has been done. . † 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 statutory duty of sending two lists of work, the list should be included among those in column 2 (or 5 as the case may be) against the principal class only, but the outworkers should be assigned in columns 3 and some previous returns odd numbers have been inserted. The figures in columns 3 and 4 will usually be (approximately) double of the number of individual outworkers whose each year and of the entries of names of outworkers in those lists. The entries in column 2 must necessarily be even numbers, as there will be two lists for each employer—in names are given, since in the February and August lists of the same employer the same outworker's name will often be repeated. 4—REGISTERED WORKSHOPS. Workshops on the Register (S. 131) at the end of the year. (1) Number. (2) Important classes of work- shops, such as workshop bakehouses, may be enumerated here. General Workshops 1,787 Bakehouses (including Factory Bakehouses) 21 Total number of Workshops on Register *1,808 * These were found to be 2,800 Workrooms &c. in places Registered. Note.—The Factory and Workshop Act, 1901 (S. 132), requires the Medical Officer of Health in his Annual Report to the District Council to report specifically on the Office). If the Annual Report is presented otherwise than in print, it is unnecessary to include in the copy sent to the Home Office, the portions which do not relate to Memorandum of March, 1912. 5.—OTHER MATTERS. Class. (1) Number. (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (S. 133, 1901) 67 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (S. 5, 1901). ( Notified by H.M. Inspector 46 \ Reports (of action taken) sent to V H.M. Inspector 50 Other 3 Underground Bakehouses (S. 101):— Certificates granted during the year Nil. In use at the end of the year 16 Date, 31st December, 1921. (Signature) W. J. HOWARTH, Medical Officer of Health. administration of that Act in workshops and workplaces, and to send a copy of his Annual Report, or so much of it as deals with this subject, to the Secretary of State (Home factories, workshops, workplaces, or homework. The duties of Local Authorities, and the Medical Officer of Health under the Act of 1901 are detailed in the Home Office 82 RAT REPRESSION. The Rats and Mice (Destruction) Act, 1919, which became operative on January 1st, 1920, involved the Corporation, the citizens and occupiers of premises within the City in additional responsibilities in connection with the suppression of rats. The first section of the Act reads as follows:— "(1) Any person who shall fail to take such steps as may from time to time be neces"sary and reasonably practicable for the destruction of rats and mice on or in land of which "he is the occupier, or for preventing such land from becoming infested with rats and mice "shall be liable to penalties." Section 3 of the Act makes the Ministry of Agriculture and Fisheries the Supervising Central Authority, and also vests this Ministry with executive powers in case of default by the Local Authority. By Section 8, the expression "land" includes any building or any other erection on land, and any cellar, sewer, drain or culvert in or on the land. Section 5 empowers the Local Authority to do the necessary work and recover expenses where the occupier on whom a notice has been served under Section 1 fails to take the necessary steps for the purpose of destroying rats and mice or of preventing the land from becoming infested with these vermin. Apparently the owner of the property is involved in no responsibility unless the land is not occupied by any tenant, in which case the owner is regarded as the occupier. The subject had been interesting the Sanitary Committee for some considerable time prior to the passing of this Act and numerous reports had been submitted for their consideration. Up to the present the work carried out has been more or less of a tentative or experimental character, and the time has now arrived when a definite decision as to future procedure should be arrived at. In deciding on a course of action it may perhaps be advisable to refer briefly to previous reports. The subject of viruses first received attention and the virus used at the Central Meat Market was investigated in 1913 by the City Bacteriologist, who reported that this particular virus was inert though it was stated to contain a modified Loeffier's bacillus, possibly the bacillus typhi murium of Loeffler. The virus question was again enquired into in 1920, when three samples were obtained. One proved to be identical with Gaertner's B. enteritidis, the second resembled Gaertner's bacillus and the third was similar to the first. The conclusion arrived at, after considering the subject at some length, was that Gaertner's bacillus was not a natural inhabitant of the intestine of either rats or mice, but tljat both these animals might be infected by these organisms and the result might be death or recovery, or the animals might survive as carriers. It was further suggested that there was a possibility of a carrier animal gaining access to food and thus contaminating it. The question therefore arose whether the use of virus should not be prohibited. In November, 1918, a report was presented advising the appointment of an inspector whose sole duties should be concerned with the problem of control of vermin. This report was acted upon and Inspector Mayne was accordingly appointed as a temporary inspector for this purpose. In this report I also drew attention to the information which I had obtained, though I was unable to vouch for its accuracy, that rats in the City had increased considerably since the prohibition of the sale of live rats for rat baiting. I was informed that in former days sewer men carried sacks about with them in which to put rats they caught and subsequently sold, but to-day there is no market for live rats and no attempts are now made to catch them as each rat becomes an incubus to the catcher from the point of view of disposal. In March, 1919, I submitted a report prepared by Major Fullerton on the "Protozoal Parasites of the Rat with special reference to the occurrence of Spirochetal Jaundice in man and to the London rat as a natural reservoir of Spirochceta icterohæmorrhagiæ." This report was a most useful contribution to the subject and added to the known iniquities of the rat. In April, 1920, a lengthy report on rat repression was submitted in printed form. This dealt in a fairly comprehensive manner with the natural history of the animal, the circumstances which contribute to the prevalence of rats in the City, and the available methods for attacking the problem. 83 In October, 1920, two temporary inspectors in addition to Mr. Mayne were appointed to carry out work in connection with rat repression. These inspectors, in addition to investigating complaints, proceeded to make house to house enquiry throughout the City and summaries of the main details of the work performed by them have been submitted in monthly reports. By means of this systematic survey a considerable amount of accurate knowledge of local circumstances has been gained. One of these inspectors resigned in April, 1921, and the vacancy has not been filled, but the Court of Common Council sanctioned the employment of the remaining two officers until June, 1922. This decision was passed on a report dated May 24th, 1921. Other minor reports have been submitted at different times, but those referred to are the most important. The chief conclusions arrived at are as follows:— (1) Rat infestation if uncontrolled will depend upon the amount of food which is available. Rats increase to the limits of the means of subsistence. Available food is therefore an important factor in the work of rat repression. (2) The increase to this maximum can also be to some extent prevented by(a) Rendering premises rat proof and thereby preventing casual infestation. Such means include satisfactory drainage and construction of drains and adequately guarded openings of basements and even of doors. Also by effecting internal improvements in premises with the object of doing away with conditions which provide the rat with shelter and suitable nesting places. (b) Efforts to catch or kill rats which have infested premises by means of traps, poisons, varnish, by rat catchers, or by the use of suitable animals. (3) In view of the fact that black rats are increasing in the City and that this particular species is capable of climbing, preventive measures against ingress are not to be limited to the ground floor but to extend to the highest floor of a building. These rats will enter buildings by travelling along even telephone cables. If the above requirements are diligently pursued rats can be reduced in numbers, but the experience of Copenhagen tends to show that even if, with such measures, there is combined rewards for rats killed, which apparently would encourage a large number of persons to be rat catchers, the reduction can only reach a certain limit, and that if at any time these energies are relaxed for any reason, the prolificacy of the rat is so great that the previous maximum dependent upon the means of subsistence will again rapidly be reached. This fact whilst not furnishing a reason against energetic action certainly suggests that present methods cannot be regarded as final or even as adequate. It is, however, difficult to suggest alternatives in present knowledge which fact emphasises the necessity for research work by competent persons. The complete control of refuse food would undoubtedly result in material improvement, and in this connection, I venture to suggest that the collection of refuse in the City, if it could be carried out immediately after the work is completed in the evening, would remove much food which at the present time is left available all night for rat consumption. The majority of the receptacles provided to hold refuse are of metal with metal lids. When purchased they meet requirements. It does not, however, take long for these receptacles to become mis-shapen and the lids ill-fitting, in fact the lids are frequently lost. I am not sure, however, whether arrangements for evening collection is a practical suggestion for fairly obvious reasons, such as those relating to the locking up of buildings after the staff have left. It will be noted that the Ministry of Agriculture and Fisheries is the supervising body under the Rats and Mice (Destruction) Act, 1919, and in this connection I desire to mention that the problem of rat repression in a built-on area like that of the City is totally different from the problem in an agricultural district. The work is closely associated with that of nuisance control and for this the first M 2 84 essential knowledge is an intimate acquaintance with the elements of sanitary science, drainage, sanitary fittings and traps, and also food hygiene, all of which are matters of prime importance in rat repression, and without a knowledge of these fundamentals a man, even if possessed of considerable acquaintance with the natural history of rats and their habits, will be unable efficiently and effectually to apply his knowledge to the difficult subject of rat repression in the City. In these circumstances it is my strong opinion that rat repression should be undertaken by the district and factory and workshop inspectors. That is to say, that such inspectors investigating premises should always have this subject in mind and that just as to-day it is the duty of these inspectors always to enquire as to whether there is, say for instance, the possibility of escape of sewer gas from defective fittings, so ought he at the same time invariably to enquire "Is this place rat infested or are the conditions such as favour rat infestation?" I would suggest that the actual work of inspection and examination is undertaken in the future by the district and factory and workshop inspectors,* but as they could hardly supervise the subsequent remedial measures, owing to the excessive calls 'which repeated visits would make on their time, I suggest that there should be attached to my staff another officer whose duty it will be to investigate these complaints and supervise the efficient carrying out of repressive measures where such measures are solely of the nature intended to deal with the rat problem. If the work is arranged in this manner, one instead of two inspectors, as now engaged, would meet requirements. Another point to consider is whether the law as at present enacted is quite satisfactory. It would appear that the onus of ridding a premises of rats devolves entirely upon the occupier. In many instances the premises themselves are such as favour the harbouring and propagation of the vermin and structural alterations are necessary to effect improvements. In some instances these alterations may be of such a character that only the owner is competent to give instructions for such work to be carried out. In any event the premises should be such that the occupier should be able to ensure that he can control casual rat infestation, and that should be his distinct responsibility. The condition of the structure should be the landlord's responsibility. This is somewhat similar to the remedial measures in the case of nuisances where responsibility for structural repairs devolve upon the owner and the responsibility for non-structural repairs upon the occupier. Another suggestion which I have previously made is that rat catchers should be registered with the Local Authority. If in complying with the law an occupier finds it necessary to employ rat catchers, such men should in some way be under official control. Various suggestions are made of doubtful action on the part of rat catchers, but I cannot confirm these. I consider it desirable that rat catchers should work in conjunction with the local officers and that the latter should know the premises which require the services of a rat catcher. They should know what success has met his efforts, and should be made acquainted with the means of disposal of the captured rodents. Registration seems to be the best way of proceeding, and a conference between your officers and those rat catchers who are known to be engaged in this work in the City might well be held with a view to establishing some form of voluntary regulations and for setting out the rules which a person should be required to comply with to entitle him to registration. A development of the scheme would be the suggestion that occupiers of premises in the City should be notified of the fact and requested to engage only rat catchers who are on the registered list. Possibly it might also be advisable to arrange that registered rat catchers should bring their live rats to some central station arranged by the Corporation for destruction under supervision. SUGGESTIONS. 1. That rat investigation and repression should be regarded as coming under the heading of general sanitary work, and be referred to the district and factory and workshop inspectors* who will report on rat infested premises. There should be attached to the department an inspector competent to supervise the execution of the remedial measures necessary. 2. Remedial measures should be the responsibility not of the occupier alone but of both the occupier and the owner. Of the owner when structural defects exist such as favour the harbouring of rats and prevent the occupier dealing effectually with infestation. The occupier should be responsible for ridding his premises of casual infestation when structural conditions are such as enable him with reasonable care to rid the premises of casual rats. * Since writing this report I observe that the recently issued Sanitary Officers' Order, 1922, provides that a Sanitary Inspector shall "if so directed by the Local Authority, act as officer of the Local Authority under the Rats and Mice (Destruction) Act, 1919, and under any orders or regulations made thereunder." 85 3. Rat catchers, for reasons stated, should be registered with the Local Authority, and controlling regulations should be framed. 4. In view of the difficulties of the problem and the practical impossibilities of exterminating rats by present known methods, research work should not only be encouraged, but should be a function of the central department. As regards work done during the year, I have to report that the number of buildings systematically inspected was i,523, and those inspected as a consequence of complaints was 288. The number of premises found to be rat infested was 968, at all of which premises some action bad been taken prior to the first inspection. As a consequence of inspection, rat proofing has been carried out at 147 buildings and for the same reason drainage repairs have been effected at eleven others. 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, 55 persons were examined by the Medical Officer of Health during 1921, one of these persons was reported as physically unfit for office. Nine officers were also medically examined with a view to their retirement, six 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 cf Mortality 88 „ B— „ „ Infectious Diseases 91 „ C—Register of Houses let in lodgings or occupied by members of more than one family 93 88 APPENDIX A.-STREET LISTS OF MORTALITY. STREET OR PLACE. No. of House Sex. Age. Date of Death. Cause of Death. Remarks Albion Buildings 22 M 70 29 June Enlarged Prostate Aldersgate Street 27 F 56 2 April Albuminuria Aldgate 36 F 24 30 March Difficult Delivery—Influenza ,, 3 M 86 16 April Enlarged Prostate „ Avenue 26 F 70 10 April General Hæmorrhage—Fall from Window Died at Vallence Rd., E. Inquest. „ High Street 34 M 21 19 Sept. Endocarditis „ „ „ 32 M 60 12 Nov. Syncope due to Chronic Disease of Heart P.M., Inquest. Aldgate High Street, Three Nuns Hotel - M 26 2 July Coal Gas Poisoning Inquest, Felo de Se. „ „ „ - M 68 18 August Chronic Interstitial Nephritis Amen Court 3 F 73 8 March Bronchitis—6 days Resided at Upton Park. Bank Tube Station - M 61 29 Jan. Threw himself in front of train Barkers Buildings 21 M 37 28 Oct. Pulmonary Tuberculosis Died at Colindale Hospital. Bartholomew's House, Cloth Fair. 13 M 78 17 March Cancer of Stomach Died in City of London Infirmary, Bow Road. Basinghall Street 31 M 74 22 Jan. Myocardites Resided at Brixton. „ „ 19 F 86 29 June Chronic Bronchitis Died at City of London Infirmary, Bow Road. „ „ 162 F 60 18 Aug. Asthma and Bronchitis Bishopsgate 86 F 48 21 Nov. Valvular Disease of Heart „ 192 M 14 23 Dec. Acute Arteo Myelitis Blackfriars Station, District Railway. - M 47 26 July Fracture of Skull—Threw himself in front of train Inquest, Felo de Se. Bride Lane 20 M 3 days 20 Nov. Prematurity Bridgewater Square 7 F 69 9 Jan. Carcinoma of Stomach Died in Hackney Infirmary. Broadway, Ludgate Hill 5 F 70 11 Oct. Myocardial Degeneration. Arterio Sclerosis Died at City of London Infirmary, Bow Road. Brushfield Street 14 F 70 28 Sept. Carcinoma of Arteries „ „ - F 81 16 Oct. Bronchitis, 12 days Bush Lane 29 F 10 27 June Mikuliez Disease—Asthenia Died in Guy's Hospital. Cannon St., Fire Station - M 25 21 Oct. Syncope—Stenosis of the Aorta Inquest, P.M. Carter Lane 22 M 40 12 Feb. Carcinoma of Breast Died in St. Bart's. Hosp'l. „ „ 8 M 70 17 June Morbis Cordis Circus, Minories 5 M 48 23 Nov. Pulmonary Tuberculosis Died at City of London Infirmary, Bow Road. Crosby Square 7 M 51 23 Feb. Diabetes and Tuberculosis of Right Lung Cross Lane, St. Dunstan's House. - F 45 16 June Malignant Endocarditis Crown Court 1 M 20 30 June Pulmonary Tuberculosis Died in N.W. Hospital. Crown Place, Aldgate 3 M 79 1 May Fractured ribs, crushed between van and wall. Died at Vallence Road, Inquest. Crutched Friars 1 F 72 2 Jan. Senile Decay Died at Hackney Infirmary. Dean's Court, St. Paul's School. - M 12 16 Sept. Hæmorrhagic Diphtheria Died at London Fever Hospital. Dean Street 5B F 72 11 Jan. Bronchitis „ „ 8A F 55 13 Feb. Carcinoma of Cervix Uteri Died at University College Hospital. „ „ Fetter Lane 6A M 75 9 July Valvular Disease of Heart Duke Street 5 F 61 6 March Carcinoma of Recti Eastcheap 38 M 73 22 Dec. Chronic Bronchitis Died in French Hospital. Elm Court, Middle Temple - M 72 21 April Aortic Disease Farringdon Street, Farringdon Hotel. - M 24 24 Nov. Epistaxis Fleet Street 21 F 41 24 March Suppurating Fibro Cystic Tumour of Uterus. Died in Grosvenor Hospital. ,, ,, Anderton's Hotel. - F 62 23 June Acute Gastritis „ „ Daily Tele- Telegraph. 141 F 60 17 July Cancer Uterus „ „ 92 M 57 12 Nov. Aortic Stenosis „ „ 69 M 62 18 Nov. Valvular Disease of Hesrt Fleet Lane 29 M 66 11 Nov. Cerebral Hæmorrhage—Arterio Sclerosis Died at City of London Infirmary, Bow Road. Goodman's Yd., Minories 3 F 47 5 Dec. Ascitis of uncertain origin „ „ „ 21 M 42 20 Dec. Malignant Disease of Mesentery—Emanciation and Exhaustion Great Eastern Hotel - F 57 13 April Diabetes Mellitus Great New Street 20 M 72 1 May Mitral Valve Disease of Heart Died in City of London Infirmary, Bow Road. „ „ „ 3 F 62 16 June Syncope—Flabby and Fatty Heart „ „ „ 20 M 56 15 Nov. Phthisis Died at King's College Hospital. Great St. Helens 35 F 51 18 May Carcinoma Died at Elizabeth Garratt Anderson Hospital. Greenwich Street 2 M 65 5 May Valvular Disease of Heart Gresham Street 64 F 78 20 March Syncope—Chronic Bronchitis accelerated by Catarrh. Inquest, P.M. „ „ 23 F 62 22 Sept. Broncho-pneumonia Greystoke Place 8 M 10 Mths. 8 August Diarrhoea—5 days Died at City of I.ondon Infirmary, Thavies Inn. Harcourt Buildings 3 F 54 20 Feb. Carcinoma of Ventrical—7 months Heneage Lane 6 M 77 6 June Lobar-pneumonia Holborn Buildings 7 F 78 22 Feb. Morbus Cordis Died at City of London Infirmary, Bow Road. 89 STREET LISTS OF MORTALITY—continued. STREET OR PLACE. No. of House Sex. Age. Date of Death. Cause of Death. Remarks. Holborn Buildings 7 F 73 16 Sept. Bronchitis Died in Archway House. Huggin Court 2 F 42 8 Jan. Pulmonary Tuberculosis Died in St. Columbus Hospital. „ Lane 9 M 44 10 May Carcinoma of Tongue Hutchison Avenue 10 F 26 4 Oct. Pulmonary Laryngeal Tuberculosis „ „ 4 F 70 27 Nov. Broncho-pneumonia Died at City of London Infirmary, Bow Road. „ Street 8 F 68 28 Jan. Chronic Interstitial Nephritis Died in Stone Asylum. „ „ 14 M 6 weeks 22 April Found Dead—Suffocation while in bed with Mother. „ „ 19 F 3 hours 24 Oct. Premature Birth Died at 24, Underwood Street, E. „ „ 19 F 8 hours 23 Oct. „ „ „ „ 9 M 18 days 7 Feb. Ophthalmia Neonatorium Died in St. Margaret's Hospital. John Street (Minories) 15a M 69 2 Aug. Syncope—Valvular Disease of Heart „ „ „ 13 M 60 28 Aug. Broncho-pneumonia Died at City of London Infirmary, Bow Road. King's Bench Walk 6 M 64 9 Nov. Carcinoma of Œsophagus Died in St. Bartholomew's Hospital. King's Block, Stoney Lane 26 F 30 5 Jan. Heart Failure, probably Old Rheumatic Fever. „ „ „ 6 M 73 5 Feb. Stenosis of both Coronary Arteries. Inquest. King Street, Snow Hill 16, Bloomfield House — M 60 13 June Lobar Pneumonia Lawrence Poultney Lane 17 M 66 12 May Carcinoma of Œsophagus Died in St. Bartholomew's Hospital. Liverpool Street Station — M 29 12 April Injuries—Run over by Train Resided at Newbury— Inquest. „ „ „ — F 43 10 June Injuries—Fall from Window Resided in Norfolk— Accidental. Long Lane In Str't M 49 28 Nov. Diabetes Mellitus Resided at Palmer's Green „ „ 80 F 42 8 Dec. Obstructed Labour Died at City of London Maternity Hospital. Ludgate Hill 62 M 71 12 May Cerebral Hæmorrhage Resided at Brixton. „ „ 56 M 44 16 June Rupture of Artery—Accelerated by Valvular Disease of Heart. P.M., Natural. Mansell Street 8 M 71 5 May Chronic Bronchitis Died at City of London Infirmary, Bow Road. Mark Lane 75 F 56 7 Mav Fall on Staircase Accidental—Inquest, P.M. Middle Street 5 F 83 8 Sept. Cerebral Thrombosis—Myocardial Degeneration. Died at City of London Infirmary, Bow Road. Middlesex Passage 1 F 82 21 Feb. Senile Decay Died at Stone Asylum. ,, Street— Salvation Army Shelter — M 48 26 Jan. Morbus Cordis Died in Hackney Infirmary. „ „ „ — M 57 22 Dec. Chronic Bronchitis Died at City of London Infirmary, Bow Road. Middlesex Street 123 F 64 11 Feb. Gastric Carcinoma Salvation Army Shelter — M 69 7 March Bronchitis Died at City of London Infirmary, Bow Road. Middlesex Street 116 M 63 13 April Lobar Pneumonia „ „ „ „ „ — M 59 24 May Epilepsy „ „ „ Salvation Army Shelter M 65 11 June Carcinoma of Rectum „ „ — M 65 18 July Morbus Cordis Middlesex Street 97 F 81 27 Oct. Chronic Bronchitis „ „ M 71 26 Nov. Lobar Pneumonia—Arterio Sclerosis Died at City of London Salvation Army Shelter Infirmary, Bow Road. Middlesex Street 41 M 18 25 Nov. Broncho-pneumonia Minories 47 M 16 23 May Endocarditis „ 81 F 39 12 July Valvular Disease of Heart „ 83 F 22 10 Sept. Tuberculosis of Lungs Montague Court 5 F 58 18 Feb. Carcinoma of Auditory Meatus Died in St. Bartholomew's Hospital. „ „ 3 F 71 26 Aug. Arterio Sclerosis Died at Stone Asylum. „ „ 3 F 49 22 Dec. Cerebral Hæmorrhage Died at City of London Infirmary, Bow Road. Monument Street 19 M 65 17 Oct. Diabetes Mellitus—Arterio Sclerosis Died at City of London Infirmary, Bow Road. Moor Lane Chambers 4 F 87 26 Oct. Senility—Bronchitis Nevill's Court, Fetter Lane 11 F 3 mths. 27 Aug. Hydrocephalus—Meningocele „ „ „ 2 F 87 13 Nov. Valvular Disease of Heart—Arterio Sclerosis. New Bridge Street 26 M 66 23 May Asphyxia—Drowning Found in River Thames off Temple Steps. New Street, Bishopsgate 30 M 64 10 Feb. Chronic Bronchitis Died at City of London Infirmary, Bow Road. „ „ „ 36 F 67 13 Dec. Acute Bronchitis—Asthenia „ „ „ 30 F 5 days 16 Dec. Spina Bifida Died in City of London Maternity Hospital. North Block, Stoney Lane 10 M 72 21 Feb. Emphysenia of Rectum „ „ „ 44 M 74 23 Aug. Spontaneous Fracture of Femur „ „ „ 12 F 60 27 Nov. Myocarditis Died at Charing Cross Hospital. Norwich Street 2 F 52 4 July Carcinoma of Breast N 90 STREET LISTS OF MORTALITY—continued. STREET OR PLACE. No. of House Sex. Age. Date of Death. Cause of Death. Remarks. Old Bailey 60 M 69 27 Feb. Acute Bronchitis Old Broad Street 42 F 19 6 April Lobar Pneumonia ,, ,, Gresham House — M 51 30 March Shock—Collapse of Floor Resided at Edmonton. „ „ „ — M 46 30 March Suffocation when buried under debris— Collapse of Floor. „ „ 11 M 43 13 Dec. Valvular Disease of Heart—Heart Failure Prince's Block,Stoney Lne. — M 38 18 April Pulmonary Tuberculosis „ „ „ 9 F 78 26 June Syncope—Fatty Degeneration of Heart „ „ „ 13 F 87 18 Nov. Senility—Bronchitis Providence Place 3 F 84 24 March Cardiac Valvular Disease Queen's Block,Stoney Lne. 11 M 5 days 9 Sept. Gastro Enteritis Died in London Hospital. 58 F 58 12 May Morbus Cordis—Fatty Degeneration „ „ „ 47 F 3 mths. 22 May Broncho-pneumonia „ „ „ 34 F 85 18 July Myocardial Degeneration Died at City of London Infirmary, Bow Road. Queen Victoria Street 5 F 70 11 Sept. Broncho Pneumonia—Arterio Sclerosis Died at City of London Infirmary, Bow Road. Red Cross StreetFire Station. - M 3 days 4 March Prematurity Died in City of London Maternity Hospital. River Thames, Near Blackfriars - M 48 12 Oct. Asphyxia—Drowning. No evidence to show how he entered the water. Resided at Peckham. „ „ - M about 3 weeks 29 June Inanition.—Not sufficient evidence to show to what cause due. P.M., Inquest. Rood Lane 24 F 76 13 Nov. Severe Varicose Ulceration of both legs St. Anne's Chambers, The Broadway 33 F 22 10 May Diabetes Mellitis St. Bride Street 10 F 23 5 Aug. Pulmonary Tuberculosis, 8 months St. Paul's Churchyard 22 M 45 2 Feb. Fall Downstairs P.M.—Died in St. Bart's. St. Swithin's Lane 24 M 63 22 April Aortic Regurgitation Hospital. Sergeant's Inn,Fleet Street 6 M 69 8 Feb. Arterio Sclerosis Died in Asylum at Stone. South Block,Stoney Lane 4 F 85 29 March Mitral Disease of Heart Stoney Lane 23 M 59 10 March Hodgkins Disease Died in London Hospital. Temple Avenue, Temple Chambers 217 M 70 10 Jan. Laceration of Brain—knocked down by Tram Car. P.M., Accidental. „ „ „ 242 M 6 15 Feb. Urœmia Peritonitis Died at St. Bartholomew's Hospital. Temple, Middle (Western Gate) - M newly born 28 Feb. Found Dead—Want of attention at Birth. Inquest, P.M. Thavies Inn 18 M 73 21 Jan. Senile Decay Died at City of London Asylum, Stone. „ „ 18 M 48 19 April Pulmonary Tuberculosis Died at City of London Infirmary, Bow Road. „ „ 18 F 71 17 July Tuberculosis of Lymphatic Glands Died at Long Grove Mental Hospital. „ „ 18 M 56 9 Oct. Aneurysm of Thoracic Aorta. Died at City of London Infirmary, Bow Road. „ „ 18 F 79 18 Nov. Myocardia Degeneration Upper Thames Street 24 F 55 10 Feb. Cancer of Breast Died in Cancer Hospital, Chelsea. „ „ „ 21 M 43 22 April Found Dead—Rupture of Aneurysm o1 Aorta. Inquest. Warwick Square 7a F 70 6 Dec. Chronic Bronchitis Died at City of London Asylum, Stone. Wood Street 119 F 70 10 Sept. Gall Stones Wormwood Street 8 F 72 6 Feb. Morbus Cordis Died at City of London Infirmary, Bow Road. 91 APPENDIX B.—LIST OF CASES OF INFECTIOUS DISEASE OTHER THAN TUBERCULOSIS, 1921. STREET LISTS.—Compiled from Notifications received. Street or Place. No. of House. Sex. Age. Disease. Date of Notification. Aldermanbury Buildings 2 M 16 Scarlet Fever 1921. 29th November. Aldersgate Street 153 F 11 Ditto 10th March. Ditto 46 M 8 Ditto 20th July. Austin Friars 13 M 1 Diphtheria 15th September. Basinghall Street 73 M 7 Scarlatina 4th October. Bank of England — M 8 Ditto 4th October. Bartholomew House 20 M 30 Malaria 18th August. Beer Lane 13 F 12 Scarlet Fever 16th January. Ditto 13 F 13 Ditto 18th January. Ditto 13 M 15 Ditto 28th May. Cannon Street 120 M 61 Erysipelas 21st November. Carmelite Street, Fire Station 13 F 9 Scarlet Fever 4th February. Ditto ditto 24 F 9 Ditto 20th February. Carter Lane 36 M 8 Diphtheria 30th June. Ditto 36 M 12 Ditto 11th September. Ditto 36 M 9 Ditto 12th September. Ditto 36 M 8 Ditto 18th September. Ditto 36 M 11 Ditto 23rd September. Ditto 36 M 9 Ditto 2nd November. The Circus, Minories 1 M 9 Scarlatina 11th September. City of London Union, Bow Road - M 29 Pneumonia 5th October. Ditto ditto - M 70 Ditto 22nd November. Ditto ditto - M 20 Ditto 13th December. Ditto ditto - M 48 Ditto 16th December. Ditto ditto - M 24 Ditto 29th December. City Police Hospital - M 24 Ditto 27th July. Ditto ditto - M 29 Ditto 11th October. Coleman Street 68 F 10 Scarlet Fever 4th July. Cooper's Row 11 M 6 Scarlatina 7 th December. Cornhill 30 M 13 Scarlet Fever 15th July. Ditto - M 6 Ditto 18th July. Crosby Square 4 M 9 Ditto 31st October. Crown Court 1 M 20 Diphtheria 9th June. Crown Place 6 F 10 Scarlet Fever 31st October. Ditto 6 F 5 Ditto 7 th November. Dean Street lA F 11 Ditto 20th September. Devonshire Square 15 M 14 Scarlatina 6th September. Ditto 16 F 16 Diphtheria 26th March. Duke Street 18 F 10 Scarlatina 2nd June. Fenchurch Street 1 F 12 Ditto 30th May. Fetter Lane 108 F 9 Scarlet Fever 14th November. Fish Street Hill 21 F 14 Diphtheria 12th February. Great Ormond Street Hospital - M 5 Scarlet Fever 29th April. Great St. Helen's 12 M 9 Scarlatina 10th September. Great Tower Street 34 F 34 Scarlet Fever 29th October. Harrow Alley 39 F 13 Ditto 24th January. Ditto 39 F 11 Ditto 27th August. Ditto 39 F 12 Ditto 28th August. High Street, Aldgate 53 F 4 Ditto 12th April. Hutchison Avenue 20 M 41 Malaria 11th August. Hutchison Street 9 M 7/365 Ophthalmia Neonatorium 28th January. Ditto 20 F 8 Scarlatina 14th June. Ditto 16 M 12 Scarlet Fever 23rd July. Kinghorn Street 13 M 1 Ditto 13th November. King's Block 13 F 8 Diphtheria 27th June. Ditto 26 F 6 Scarlet Fever 23rd June. Lime Street 39 F 9 Ditto 12th July. Ditto 39 M 5 Ditto 23rd May. London Hospital - F 2 Ditto 25th January. Lothbury 7 M 8 Ditto 17th October. Mark Lane 20 F 62 Pneumonia 2nd November. Middlesex Street 39 F 7 Scarlet Fever 7th June. Ditto 43 F 2/365 Ophthalmia Neonatorium 26th June. N 2 92 STREET LISTS.—Compiled from Notifications received.—continued. Street or Place. No. of House. Sex. Age. Disease. Date of Notification. Mincing Lane 27 M 8 Scarlatina 3rd October. Minories 60 F 14 Scarlet Fever 11th October. Ditto 98 F 7 Ditto 29th August. Ditto 82 M 16 Enteric Fever 12th September. Ditto 122 F 13 Scarlet Fever 15 th November. Montague Court, Little Britain 2 M 4 Ditto 17 th November. Moorgate Street 15 M 13 Diphtheria 1st March. Newbury Street 14 M 1 Scarlet Fever 8th October. New Street 12a F 19 Ditto 28th January. New Street, Houndsditch 24 F 1 Ditto 12th September. North Block 16 M 8 Ditto 14th May. Ditto 17 F 3 Ditto 10th February. Ditto 29 F 4 Ditto 8th August. Ditto 33 F 3 Ditto 30th May. Ditto 33 F 2 Ditto 30th May. Ditto 34 F 6 Ditto 21st August. Ditto 35 F 10 Scarlatina 29th May. Ditto 39 F 10 Ditto 30th May. Ditto 39 F 5 Ditto 30th May. Ditto 47 M 5 Scarlet Fever 15th August. Ditto 48 M 6 Ditto 15th August. Ditto 56 F 5 Ditto 4th September. North Western Hospital — M 15 Diphtheria 13th June. Old Broad Street 11 F 43 Erysipelas 27th July. Prince's Block 12 F 4 Scarlet Fever 31st July. Ditto 16 F 5 Ditto 30th April. Ditto 37 M 15 Ditto 7th October. Ditto 46 M 3 Ditto 22nd July. Ditto 46 F 28 Diphtheria 30th July. Ditto 52 F 7/12 Ditto 30th January. Ditto 53 M 6 Scarlet Fever 27th June. Providence Place 10 M 4 Diphtheria 13th June. Queen's Block 19 M 8 Scarlatina 4th August. Rose Alley 26 F 3 Diphtheria 28th January. Ditto 2 F 10 Scarlet Fever 24th June. Ditto 7 F 3 Ditto 2nd July. Ditto 9 M 11 Ditto 12th October. Ditto 21 F 6 Scarlatina 17th December. Saint Bartholomew's Hospital Diphtheria, 11 cases; Scarlet Fever, 10 cases; Erysipelas, 2 cases. St. Helen's Place 21 F 11 Scarlet Fever 11th September. St. Mary-at-Hill 27 M 7 Ditto 3rd November. Sergeant's Inn 10 M 10 Ditto 27th June. Salisbury Square 10 M 17 Ditto 5th February. Snow Hill 4 F 24 Ditto 25th July South Block 17 M 7 Ditto 28th May. South Eastern Hospital — F 4 Diphtheria 4th July. Ditto ditto — F 14 Scarlet Fever 29th November. Stoney Lane 15 M 8 Ditto 6th September. Thavies Inn, City of London Union — F 17 Ditto 6th May. Ditto ditto — F 79 Erysipelas 29th August. Tudor Street 6 M 13 Scarlet Fever 26th April. Upper Thames Street 104 F 1 Ditto 13th April. Whistler's Court — M 9 Diphtheria 2nd July. Widegate Street 25 F 9 Ditto 6th March. Ditto 25 F 10 Ditto 18th October. Wood Street 46 F 58 Erysipelas 23rd April. 93 APPENDIX C.—REGISTER OF HOUSES LET IN LODGINGS OR OCCUPIED BY MEMBERS OF MORE THAN ONE FAMILY. WEST DISTRICT. Situation of Premises. Name and Address of Landlord. Tenements. Lodgers 6, Bartholomew Place Veil, 6, Bartholomew Place One family. 20, Bride Lane A. Green, 24, Leysfield Rd., Shepherd's Bush 1 3 5, Britton's Court Mrs. Hurrel, 5, Britton's Court 1 6 1, Chapel Place Moravian Mission, 32, Fetter Lane 2 8 2, do. Do. do. 2 7 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 2 7 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. 2 4 4, Dorset Street E. King, 23, Whitefriars Street 3 5 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 Morris & Co., 28, East Road, City Road 2 4 1, Fenton's Buildings Evans. Fisher, Webb, 60, Bartholomew Close 2 4 2, do. Do. do. do. 2 5 3, do. Do. do. do. 3 6 42, Fetter Lane W. Read, 102, Fetter Lane 3 5 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 8 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. Quilty, 21, Great New Street 3 7 5, Green Dragon Court Smith, Oakley & Gerrard, 4 & 5, Charles Street, W. 1 6 6, do. C. Fleming, 6, Green Dragon Court 1 4 7, do. Smith, Oakley & Gerrard, 4 & 5, Charles Street,W. 1 4 6, Grevstoke Place W. G. Cuss, 6, Greystoke Place 1 4 7, do. Solicitors' Law Stationery Society, 104 Fetter Lane 6 7 8, do. Do. do. do. 4 8 9, do. Do. do. do. 4 13 2, Gunpowder Alley T. Richardson, 2, Gunpowder Alley 1 6 7½, do. T. Townsend, 259, Essex Road, N. 2 6 8, do. Do. do. 3 6 25, Kinghorn Street W. B. Hallett, 11, Queen Victoria Street Empty. 25a, do. Do. do. 1 4 54, Little Britain J. Boni, 54, Little Britain 1 2 79, Long Lane Robert Dyas & Sons, 63, Fore Street 1 5 2, Middle Street F. B. Westacott, 74, Camden Road, N.W. 1 4 3, do. Do. do. 1 5 4 & 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 3, do. Mr. Long, 3, do. 4 4 4, do. Do. do. 3 4 5, do. Mrs. Hutchins, 5, do. 2 7 6, do. Mr. F. J. Swain, 6, do. 1 4 7, Nevill's Court Moravian Mission, 32, Fetter Lane 1 6 8, do. Do. do. 4 7 9, do. Do. do. 3 8 10, do. Do. do. 6 14 Carried forward 173 387 94 WEST DISTRICT—continued. Situation of Premises. Name and Address of Landlord. Tenements. Lodgers. Brought forward 173 387 11, Nevill's Court Goldsmiths' Company, Goldsmiths' Hall 4 8 12, do. Do. do. 5 9 57, West Smithfield T. A. Allen, 57, West Smithfield 1 4 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 189 424 Average number of lodgers to each occupied tenement: 2.3. Houses demolished:— Tenement houses on Register 72 Cleansing Notices served 74 MIDDLE DISTRICT. 1 and 2, Huggin Court City Parochial Charities Trustees, 3, Temple Gardens 6 12 9, Huggin Lane H. Belcher, 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 2 Total 17 25 Average number of lodgers to each occupied tenement: 1.5 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 3 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 5 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. Balch & Balch, 17, Argyle Square 4 7 3, Crown Place, Aldgate W. Harper, 31, 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 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, Hutchison Avenue 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 Carried forward 92 193 95 EAST DISTRICT—continued. Situation of Premises. Name and Address of Landlord. Tenements. Lodgers. Brought forward 92 193 Janes Buildings, 2, Hutchison Street. Messrs. Moore & Moore, 7, Leadenhall Street 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 Balch & Balch, 17, Argyle Sq. 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 Balch & Balch, 19 ,Argyle Square 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 157 357 Average number of persons to each occupied tenement: 2.3 Houses demolished or closed in 1921 Nil. Tenement houses on Register 64 Cleansing Notices served 73