AC 434 LON 49 REPORT OF THE MEDICAL OFFICER OF HEALTH OF THE CITY OF LONDON FOR THE YEAR 1923 LONDON. Printed by Drake, Driver & Leaver, Ltd., Rosebery Avenue EC 1 1924 REPORT OF THE MEDICAL OFFICER OF HEALTH OF THE CITY OF LONDON For the Year 1923. LONDON. Printed by Drake, Driver & Leaver, Ltd., Rosebery Avenue, E.C. 1. 1924. index. A. page. ANNUAL RATEABLE VALUE 7 ANTI-TOXIN—DIPHTHERIA 20 APPENDICES 87 AREA 7 ARSENIC IN COCOA 47 ARTIZANS' DWELLINGS, STONEY LANE 69 ATMOSPHERIC POLLUTION 33 B. BACTERIOLOGICAL EXAMINATIONS 20 ESTABLISHMENT OF CENTRAL LABORATORY 20 BIRTHS 8 INFANT WELFARE 10 NOTIFICATION 10 BORIC ACID IN CAKE AND EGG YOLK 54 BREAD—EXCHANGE OF UNUSED BREAD FOR FRESH 47 „ —HYGIENIC WRAPPING 47 BUTTER 36 „ —SALE OF BUTTER REGULATIONS, 1902 37 —BUTTER AND MARGARINE ACT, 1907 37 c. CAKE, BORIC ACID IN 54 CEMETERY—EXHUMATION AND REINTERMENT OF BODIES 35 CENTRAL LABORATORY FOR BACTERIOLOGICAL EXAMINATIONS 20 COCOA—ARSENIC 47 CONDENSED MILK REGULATIONS 36 COURTS, LIMEWASHING OF 74 „ SUMMER FLUSHING OF 74 „ CREMATIONS 35 D. DAIRIES, COWSHEDS AND MILKSHOPS ORDERS, 1885, 1880 & 1899 37 DENSITY 7 DIPHTHERIA ANTI-TOXIN 20 DISINFECTANTS, SUPPLY OF 71 DRAINAGE PLANS 74 DRUGS 36 E. EGG YOLK—PRESERVATIVES 54 ENTERIC FEVER AND MUSSELS 65 EXHUMATION AND REINTERMENT OF BODIES AT CITY OF LONDON CEMETERY 35 EXHUMATION OF HUMAN REMAINS—ST. BENET FINK 35 F. FACTORY AND WORKSHOPS ACT, 1901—ABOVEGROUND BAKEHOUSES 76 „ „ —FACTORIES, WORKSHOPS AND WORKPLACES 76 „ „ „—OUTWORKERS 78 „ „ „—SUMMARY OF WORK DONE 76 „ „ „—UNDERGROUND BAKEHOUSES 76 FISH—SUPPLIES AND SEIZURES 64 FLY NUISANCE 82 FOOD POISONING 65 FOOD AND DRUGS—OBSERVATIONS ON SUPERVISION OF 36 FOOD AT RIVERSIDE WHARVES—INSPECTION AND CONDEMNATION 66 G. GULLIES, STREET 7 H. HOLLAND—MILK FROM 45 „ —TINNED SPINACH 4 —MUSSELS AND ENTERIC FEVER 65 HOUSE, TRADE AND OTHER REFUSE REMOVAL 74 HUMAN REMAINS—CHURCH OF ST. BENET FINK 35 I. ICE CREAM 37 INDEX 3 INFANT WELFARE 10 INFANTILE MORTALITY 10 INFECTIOUS DISEASES 12 „ „ —BACTERIOLOGICAL AND PATHOLOGICAL EXAMINATIONS 20 „ „ —DIPHTHERIA ANTI-TOXIN 20 „ „ —ISOLATION ACCOMMODATION, 6, BRIDGEWATER SQUARE 15 „ „ —NURSING OF MEASLES—ENCEPHALITIS LETHARGICA, CEREBRO SPINAL FEVER AND INFLUENZA 15 „ „—SANITARY DEFECTS 74 „ „ —SMALLPOX 15 „ „ —TREATMENT OF PARTURIENT WOMEN SUFFERING FROM VENEREAL DISEASES 21 „ „ —TUBERCULOSIS 15 „ „—VENEREAL DISEASES 20 L. LEGAL PROCEEDINGS 74 LIMEWASHING OF COURTS 74 LODGING HOUSES, REGISTERED0 72 INDEX (continued). M. PAGE. MARGARINE 36 „ —BUTTER AND MARGARINE ACT, 1887 37 „ —MARGARINE ACT, 1887 37 „ —MARGARINE AND MARGARINE CHEESE—REGISTRATION 37 MEAT INSPECTION 55 „ „ —ALDGATE MARKET AND SLAUGHTERHOUSES 59 ,, ,, —ARGENTINE MEAT 57 ,, ,, —AUSTRALIAN „ 57 ,, ,, —DUTCH ,, 57 ,, ,, —IMPORTS OF FRESH MEAT AND BACON 55 ,, ,, —INFLATION OF VEAL 63 „ ,, —LEADEN HALL MARKET AND CITY SHOPS 59 ,, ,, —NEW ZEALAND MEAT 57 ,, ,, —PRESERVATION OF MEAT FROM S. AFRICA 64 „ „ —PROSECUTIONS 61 ,, ,, —SWEDISH MEAT 57 ,, ,, —TUBERCULOUS MEAT SEIZED AT CENTRAL MARKETS 62 ,, ,, —UNSOUND MEAT REMOVED FROM COLD STORES 58 MEDICAL EXAMINATIONS 86 MILK—BACTERIOLOGICAL AND CHEMICAL EXAMINATIONS FOR TUBERCULOSIS AND DIRT 44 „ —EXPERIMENTAL SAMPLING FROM COUNTERPANS 41 „ — „ ,, „ CHURNS ON PRAMS 42 „ — „ „ „ „ AFTER RAILWAY JOURNEY 42 — „ „ DURING PROCESS OF THAWING 43 „ —IMPORTED DUTCH 45 „ —MATTERS ASSOCIATED WITH SUPPLY OF 38 „ —MILK AND CREAM REGULATIONS 46 „ —MILK AND DAIRIES (AMENDMENT) ACT, 1922 38 ,, —REGISTRATION OF RETAIL PURVEYORS, MINIMUM STANDARD FOR 38 ,, —RETAIL PURVEYORS, REGISTRATION STATISTICS 45 MORTALITY 8 ,, —INFANTILE 10 ,, VIOLENCE 8 MORTUARY—DISINFECTION OF CLOTHING FOR EXPORT, INQUESTS, ETC 70 „ —PRESERVATION OF BODIES OF UNKNOWN DEAD 71 MUSSELS AND ENTERIC FEVER 65 N. NOTIFICATION OF BIRTHS ACT, 1907, AND INFANT WELFARE WORK 10 O. OVERCROWDING 74 P. PATHOLOGICAL EXAMINATIONS 20 ,, ,, ESTABLISH OF CENTRAL LABORATORY POPULATION 8 PRESERVATION OF BODIES 71 PRESERVATIVES—BORIC ACID IN CAKE 54 ,, -EGG YOLK 54 PROSECUTIONS—SALE OF FOOD AND DRUGS ACTS 45 ,,-MEAT PUBLIC HEALTH (CONDENSED MILK) REGULATIONS, 1923 36 ,, ,, -MILK AND CREAM) REGULATIONS, 1912 & 1917 46 R. RAILWAY STATIONS—SAMPLING OF MILK 42,44 RAT REPRESSION 82 RATEABLE VALUE 7 s. ST. BENET FINK CHURCH—HUMAN REMAINS 35 SALE OF FOOD AND DRUGS ACT 48 „ ,, ,, —ADMINISTRATIVE ACTION REGARDING SAMPLES REPORTED TO BE NOT GENUINE 48 ,, ,, ,, —PROSECUTIONS 45 „ ,, ,, —SUMMARY OF ARTICLES EXAMINED UNDER SALE OF FOOD AND DRUGS ACTS, AND PUBLIC HEALTH (MILK AND CREAM) REGULATIONS 50 SANITARY DEFECTS AND INFECTIOUS DISEASE 74 SANITARY INSPECTIONS 71 SANITARY STAFF 5 SEWER CONNECTIONS, DEFECTIVE 74 SHELLFISH—MUSSELS AND ENTERIC FEVER 65 SMOKE 33 SPINACH TINNED FROM HOLLAND • 47 SPIRITS 36 SUMMER FLUSHING OF COURTS 74 T TENEMENT HOUSES, REGISTERED 72 TINNED SPINACH FROM HOLLAND 47 TUBERCULOSIS 15 V. VACCINATION 12 VENEREAL DISEASES 20 VITAL STATISTICS 11 w. WATER CLOSET BYE-LAWS, NEGLECT TO COMPLY WITH 73 WHARVES, INSPECTION OF FOOD AT 66 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, Wm. J. Oct., 1915 Spalding, C. A. March, 1918 Naylor, Robert William Jan., 1922 Thredgold, Arthur W. Nov., 1923 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. July, 1909 SANITARY INSPECTORS. Hills, Arthur Reginald April, 1888 Gathercole, Wm. Henry Joseph May, 1891 Simmons, Edward John June, 1892 Robbins, Francis Joseph Sept., 1892 Ralph, William Holden June, 1898 Robinson, Ernest S. Feb., 1913 Fowler, George Henry Oct., 1920 McGrath, William Richard Mar., 1922 SANITARY INSPECTORS AND MEAT INSPECTORS. Sharp, J. Owen, Senior Inspector May, 1892 Kelland, William C. May, 1899 Mettam, Harry Dec., 1903 Davies, Thos. L. Dec., 1903 Bintcliffe, Charles E. March, 1907 Matson, William S. Dec., 1910 Mitchener, William E. Dec., 1910 Jones, John April, 1914 Slatter, Charles May, 1908 King, George G. April, 1910 Murray, Samuel B. Sept., 1911 Penman, Thomas -July, 1913 INSPECTOR OF SLAUGHTERHOUSES AND MEAT. Eglin, William (Retired Oct., 1923) July. 1896 ASSISTANT INSPECTORS OF SLAUGHTERHOUSES AND MEAT. Mellish, Cyril E. Jan., 1912 Pallett, Frank Nov., 1914 KEEPER OF THE MORTUARY. Oakley, J. E. Feb., 1909 DISINFECTORS Steggles, T. Dec., 1918 MESSENGERS. Pinkney, Robert W. Oct., 1921 Peacock, Percy L. (Resigned Dec., 1923) Oct., 1921 Perris, George A. Dec., 1923 LABOURERS. McDonnell, R. J. (General Duties at Mortuary) April, 1903 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 B annual report of the medical officer of health for the year 1923. To the Right Honourable the Lord Mayor, Aldermen and Commons of the Corporation of London. Public Health Department, Guildhall, E.C. 6th February, 1924. 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 1923. AREA. The City of London (excluding The Temple) comprises an area of 661 acres (excluding tidal water and foreshore), or 1.032 square miles, equal to a square of 1.016 miles to a side. The area of "Registration London" is 74,817 acres (excluding tidal water and foreshore), or 116.9 square miles, equal to a square of 10.81 miles to a side. DENSITY (1923). City of London, Registration District, at night 20.4 persons to an acre. „ „ „ „ during the day *578.5 „ „ Registration London, at night 61.1 ,, „ * 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 (including the City) was £49,252,050 on 6th April, 1923; whilst on the same date the corresponding rateable value of property in the City of London was £6,372,172 or about one-eighth of the whole County. The sum represented by a penny rate is £26,547. 8 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 (Not including the Temple) 661 2,784 2,398 19,657 13,527 These figures represent the population on the nights of the 3rd April, 1911, and the 19th June, 1921. 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 only one registration district in the City. The estimated population of the City for the year 1923 is 13,480. 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. BIRTHS. During the year 1923, 381 births were registered in the City, 305 of which however, did not belong thereto. To the remaining 76 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 111. The annual birth rate was 8.2 per 1,000 persons of all ages, compared with a quinquennial mean rate of 10 5 per 1,000. In the Metropolis the birth rate in 1923 was 20.2 per 1,000. MORTALITY. During the year under review, 714 deaths were registered in the District, including 641 persons dying in the City, but not belonging thereto. See Table, p. 9, for details. Deducting these latter, 73 deaths remain, to which must be added those of 82 persons who died in Institutions in outside districts, where they were registered; the total, therefore, on which the City death rate is calculated is 155. The death rate for 1923 was 11.5 per 1,000 per annum of the population (the previous year being 14.1), whilst that for the whole of the Metropolis was 11.2. DEATHS FROM VIOLENCE.—Of the City deaths, 5.8 per cent. were caused by injuries or violence, as compared with 5.7 in 1921 and 3.2 in 1922. This is 0.5 below the average for the previous five years. PERCENTAGE OF REGISTERED DEATHS FROM VIOLENCE. Year. City of London. Metropolis. Per cent. Per cent. 1918 4.2 5.6 1919 10.4 5.7 1920 7.8 4.7 1921 5.7 4.2 1922 3.2 3.3 Average previous five years 6.3 4.7 1923 5.8 4.5 9 CAUSES OF, AND AGES AT, DEATH DURING THE YEAR 1923. Causes of Death. Nett Deaths at the subjoined ages of "Residents" whether occurring within or without the District. Total Deaths whether of "Residents" or "NonResidents" in Institutions in the District. All ages Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 1-3 and under 25 years. 25 and under 45 years. -15 and under 05 years. 05 and upwards 1 2 3 4. 5. 6. 7. 8. 9. 10. 11. All causes Certified 155 9 - - 1 8 20 52 65 629 Uncertified l. Enteric Fever .... .... .... .... .... .... .... .... .... 2 2. Small-pox .... .... .... .... .... .... .... .... .... .... 3. Measles 1 1 .... .... .... .... .... .... .... .... 4. Scarlet Fever .... .... .... .... .... .... .... .... .... .... 5. Whooping Cough 1 1 .... .... .... .... .... .... .... 1 6. Diphtheria and Croup 1 1 .... .... .... .... .... .... .... 2 7. Influenza .... .... .... .... .... .... .... .... .... 4 8. Erysipelas .... .... .... .... .... .... .... .... .... 2 9. Phthisis (Pulmonary Tuberculosis) 15 .... .... .... .... 3 4 7 1 21 10. Tuberculous Meningitis 2 1 .... .... .... 1 .... .... .... 13 11. Other Tuberculous Diseases .... .... .... .... .... .... .... .... .... 4 12. Cancer, malignant disease 15 .... ... .... .... .... 2 5 67 13. Rheumatic Fever .... .... .... .... .... .... .... .... .... 6 14. Meningitis 1 1 .... .... .... .... .... .... .... 14 15. Organic Heart Disease 26 .... .... .... .... .... 2 5 14 47 16. Bronchitis 11 1 .... .... .... .... ..... 5 9 18 17. Pneumonia (all forms) 10 .... .... .... .... .... 1 6 3 47 18. Other diseases of respiratory organs 4 .... .... .... .... .... .... 1 3 6 19. Diarræha and Enteritis .... .... .... .... .... .... .... .... 1 8 20. Appendicitis and Typhlitis .... .... .... .... ... .... .... .... .... 13 21. Cirrhosis of Liver .... .... .... .... .... .... .... .... 1 3 21a Alcoholism .... .... .... .... .... .... .... .... .... .... 22. Nephritis and Bright's Disease . 6 .... .... .... .... .... 1 1 4 25 23. Puerperal Fever . .... .... .... .... .... .... .... .... .... 2 24. Other accidents and diseases of Pregnancy and Parturition 1 .... .... .... .... .... 1 .... .... 4 25. Congenital Debility and Malformation, including Premature Birth . 1 1 .... .... .... .... .... .... .... 24 26. Violent Deaths, excluding Suicide 7 .... .... .... .... 1 2 3 1 53 27. Suicide 2 .... .... .... .... .... 1 1 12 28. Other Defined Diseases 50 2 .... .... 1 3 6 15 23 228 29. Diseases ill-defined or unknown . .... .... .... .... .... .... .... .... .... 3 Totals 155 9 .... .... 1 8 20 52 65 629 10 DEATH RATES, PER 1,000 PER ANNUM. Year City of London. 105 Great Towns of England and Wales. Metropolis. 1918 20.9 18.2 18.9 1919 14.4 13.8 13.4 1920 15.6 12.5 12.6 1921 11.5 12.3 12.4 1922 14.1 13.0 13.4 Average previous five years 15.3 14.0 14.1 1923 11.5 11.6 11.2 The death rate from zymotic disease per 1,000 of the population was 0.22 compared with 1.51 in the Metropolis. The deaths from Phthisis correspond to a rate of 1.1 per 1,000 of the population, as compared with 0 92 in the Metropolis. infantle mortality The deaths of children under one year of age were at the rate of 81 per 1,000 births, as against 60 for the whole of London. NOTIFICATION OF BIRTHS ACT, 1907, AND INFANT WELFARE WORK. No new work has been undertaken in connection with Infant Welfare Work. Care has, of course, continued to be given to the City infants and the usual clinic has been held every Wednesday at St. Bartholomew's Hospital. Supplies of milk, in some cases at cost price and in others free, have been provided in accordance with the scheme outlined in my annual report for 1921. 439 notifications of births, made in accordance with the Notification of Births Act, were received. Of these only 98 belonged to the City, and the balance were transferred to the appropriate Authorities. Miss Wilkinson, who undertakes the work in connection with the Notification of Births Act and Infant Welfare, reports having made 278 visits in connection with birth notification and 89 special visits in connection with infant welfare. Seven visits have also been made in respect of cases coming within the scope of the Children Act, 1908 ; mainly in relation to nurse children. At the centre above referred to, a total of 511 attendances was made by mothers. 11 VITAL STATISTICS OF WHOLE DISTRICT DURING 1923 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. 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. Number. * Rate per 1,000 nett Births. Number. * Rate. I 2 3 4 5 6 7 8 9 10 11 12 13 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 1922 13,363 360 148 11.1 809 60.54 719 98 9 61 188 14.1 1923 13,480 381 111 8.2 714 52.96 641 82 9 81 155 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 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 (i, 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; (6) 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 in acres (land and inland water) 661 Number of inhabited houses 2,922 Average number of persons per house 4.6 12 VACCINATION. Of the 387 births notified to the Vaccination Officers during 1923, 102 had been successfully vaccinated by the end of the year, 17 had died before the age for vaccination, and in no case was a child reported as insusceptible. Vaccination was postponed by medical certificate in 4 cases, 215 had removed into other districts, or the vaccinations were pending at the end of the year. There were 49 instances of conscientious objection. The Public Vaccinators performed 349 re-vaccinations during the year, and in addition to the 102 successful vaccinations referred to above, 54 persons were vaccinated for the first time. 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 objec tions 1918 per cent. per cent. per cent. per cent. per cent. per cent. per cent. 312 22.7 Nil. Nil. 10.5 0.7 545 11.6 1919 460 23.7 ,, ,, 10.0 0.7 50.6 15.0 1920 471 31.4 „ ,, 4.6 1.2 42.2 20.3 1921 341 19.6 ,, ,, 9.4 0.6 49 9 20.5 1922 365 27.9 ,, ,, 5.3 0.3 48.7 17.8 Average previous 5 years. 390 25.1 ,, ,, 8.0 0.7 49.2 17.0 1923 387 26.4 ,, ,, 4.4 1.1 55.5 12.6 INFECTIOUS DISEASES. Few comments are necessary with reference, to the incidence of infectious disease during the year 1923. Diphtheria was prevalent to the extent of 17 cases as compared with 40 in 1922. The number of Scarlet Fever cases was 39 compared with 32 in 1922. Erysipelas showed an increase from four to five. Measles and Rubella are not notifiable diseases and only a few cases of illness of this type were brought to my notice through the medium of the school medical service. Five cases only of Chicken-pox were notified and one of Ophthalmia Neonatorum. The percentage of cases removed to hospital for treatment continues satisfactory, viz. : 95.3. 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 defect found by the District Inspector is given on page NOTIFICATION OF INFECTIOUS DISEASES.—In the following tables will be found particulars of certificates relating to cases of infectious disease, and information as to the removal of patients to hospitals, infirmaries, &c. 13 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 18 .... 17 .... .... .... l 17 Scarlet Fever 41 .... 37 2 .... 2 .... 39 Enteric Fever (including Para-typhoid) 3 .... 2 .... l .... .... 3 Puerperal Fever .... .... .... .... .... .... .... .... Erysipelas 5 3 1 .... l .... .... 5 Cerebro-spinal Meningitis .... .... .... .... .... .... ..... .... Acute Polio-myelitis .... .... ... .... .... .... .... .... Ophthalmia Neonatorum 1* .... .... .... l .... .... 1* Measles .... .... .... .... .... .... .... .... Rubella .... ... .... .... .... .... .... ... Malaria contracted abroad .... .... .... .... .... .... .... .... Acute Primary Pneumonia 6 .... .... .... 6 .... .... 6 Acute Influenzal Pneumonia .... .... .... .... .... .... .... ..... Totals 74 3 57 2 9 2 l 71 Chicken-pox 5 5 .... .... .... .... .... 5 Totals 79 8 57 2 9 2 l 76 * Patient recovered and suffered no impairment of vision. The following is a return of infectious diseases which have occurred in the City of London, exclusive of Tuberculosis, Measles, Rubella, Malaria, Pneumonia, Ophthalmia Neonatorum and Chicken-pox, with the percentages of such cases removed to hospitals for treatment or nursed at home during 1923 compared with the figures for the previous five years:— Number of cases reported Per cent, of cases reported. Year. Removed to Hospital Treated at home. 1918 42 88.1 11.9 1919 41 90.2 98 1920 74 91.9 8.1 1921 131 95 4.6 1922 77 94.8 5 2 Average for the five years 73 92.1 7.9 1923 64 95.3 4.7 14 CASES OF INFECTIOUS DISEASE AND TUBERCULOSIS NOTIFIED DURING THE YEAR 1923. NUMBER OF CASES NOTIFIED DISEASES. At Ages—years. No. of Cases Removed to Hospital. † At all ages. Under 1 year. 1 year and under 2 years. 2 years and under 3 years. 3 years and under 4 years. 4 years and under 5 years. 5 years and under 10 years. 10 years and under 15 years. 15 years and under 20 years. 20 years and under 35 years. 35 years and under 45 years. 45 years and under years. 65 years and over. Small-pox .... .... .... .... .... .... .... .... .... .... .... .... .... .... Cholera .... .... .... .... .... .... .... .... .... .... .... .... .... .... Plague .... .... .... .... .... .... .... .... .... .... .... .... .... .... Diphtheria 17 .... .... .... 2 2 4 5 1 2 l .... .... 17 Erysipelas 5 .... .... .... .... ..... 1 1 .... .... l 2 .... 2 Scarlet Fever 39 .... .... .... 1 1 24 6 1 5 1 .... .... 39 Typhus ,, .... .... .... .... .... ..... .... .... .... .... .... .... .... .... Enteric ,, (including Para-typhoid) 3 .... .... .... .... .... 1 1 .... 1 .... .... .... 3 Relapsing ,, .... .... .... .... .... .... .... .... .... .... .... .... .... .... Continued ,, .... .... .... .... .... .... .... .... .... .... .... .... .... .... Puerperal ,, .... .... .... ..... .... .... .... ..... .... .... .... .... .... .... Polio-myelitis .... .... .... .... .... .... .... .... .... .... .... .... .... .... Cerebro-spinal Meningitis .... .... .... .... .... .... .... .... .... .... .... .... .... .... Pulmonary Tuberculosis 24 .... .... .... .... .... 1 .... 3 11 3 6 .... 19 Other forms of Tuberculosis 2 .... ... .... .... .... .... 2 .... .... .... .... .... 2 Ophthalmia Neonatorum 1* l* .... .... .... .... .... .... .... .... .... .... .... 1* Measles .... .... ... .... .... .... .... .... .... .... ..... .... ..... .... Rubella .... .... .... .... .... .... .... .... .... .... ..... .... .... .... Malaria (contracted abroad) .... .... .... .... .... .... .... .... .... .... ..... .... .... .... Acute Primary Pneumonia 6 .... .... .... .... .... ..... .... .... .... 1 2 3 6 Acute Influenzal Pneumonia .... .... .... .... .... ..... .... .... .... .... .... .... .... .... Total 97 l .... .... 3 3 31 15 5 19 7 10 3 89 • Patient recovered and suffered no impairment of vision. †Metropolitan Asylums Board Hospitals, London Fever Hospital, City of London Infirmary, St. Bartholomew's Hospital, City Police Hospital, Sanatoria, &c. 15 SMALLPOX. Towards the end of the year the City was associated with a case of Smallpox which was the subject of considerable publicity at the time. The circumstances are as follows:- At mid-day on Saturday, the 8th September, information was received at my office from the Ministry of Health to the effect that a patient who had been staying at a West End Hotel and whose only known address was situate within the City, was believed to be suffering from Smallpox. Later I was informed that a case of smallpox had occurred in the person of a domestic servant working at the same hotel, and that it had been ascertained on enquiry that she had attended the patient referred to while she was lying ill at the hotel suffering from "spots." Considerable difficulty was experienced in tracing the City case, but on the following Monday morning the correct address was ascertained and the necessary information communicated to the Medical Officer of Health of the district concerned. He immediately visited, with the result that four people suspected to be suffering from smallpox were later removed from the house. The diagnosis was confirmed in respect of two and the other two were, after detention for some days, discharged as not suffering from smallpox. Throughout the year there have been no cases of smallpox amongst City residents. ISOLATION ACCOMMODATION —6, BRIDGEWATER SQUARE. Suitable accommodation for the isolation and observation of smallpox contacts is provided by the Corporation at 6, Bridgewater Square. Formal notice to vacate the premises has been received and they are now held on a monthly tenancy. It is hoped that it will be possible, shortly, to obtain more permanent provision. NURSING OF MEASLES, &c. The Corporation has approved of the expenditure of £25 per annum in respect of the nursing of complicated cases of Measles, Encephalitis Lethargica and Cerebrospinal Fever, and have also agreed to expend the sum of £30 on provision of medical assistance and nursing attendance in necessitous cases of Influenza. No action was necessary under this heading during 1923. TUBERCULOSIS. TUBERCULOSIS DISPENSARY.— The Tuberculosis Dispensary has been open throughout the year for the diagnosis and treatment of tuberculosis of various types on Tuesdays and Fridays from 12-30 to 3-30; on Mondays from 5-0 to 7-30 ; and on Thursdays from 6-0 to 7-30. In addition, owing to the great increase in the number of new cases during the past two years, a new session on Wednesdays, 11-30to 1-30, has more recently been started. In all 215 sessions have been held, and in addition the Tuberculosis Officer has visited cases at their homes when necessary. NEW PATIENTS.- The number of new patients examined was 378 as compared with 351* last year. A.— PATIENTS RESIDENT IN THE CITY, Number of Under observation it the Dispensary on Jan. 1st, pending diagnosis. Examined for the first time during the year. Total. Found to be Under observation at the Dispensary on Dec. 31st, pending diagnosis. Ceased attendance before completion of diagnosis. Suffering from Tuberculosis. Not suffering from Tuberculosis. Pulmonary. NonPulmonary. (a) All persons (including contacts) Adults | M .... 22 22 9 .... 12 l .... F l 20 21 4 .... 17 .... .... Children under 15 M .... 11 11 .... ....l 9 l ..... F l 8 9 .... .... 9 .... .... Total 2 61 63 13 l 47 2 .... (b) " Contacts" (included in (a)) Adults { M .... 9 9 .... .... 9 .... .... F .... 12 12 1 .... 11 ..... ..... Children under 15 M 1 5 6 .... .... 6 .... .... F 1 6 7 .... .... 7 .... .... (c) Insured persons (included in (a)) M .... 6 6 3 .... 2 1 ..... F .... 6 6 3 .... 3 ... .... ♦This figure included 114 patients attending on Jan. 1st, 1922, who had not been diagnosed or notified as Tuberculous. 16 B.— PATIENTS RESIDENT OUTSIDE THE CITY OF LONDON, Number of Under observation at the Dispensary on Jan. 1st. pending diagnosis. Examined for the first time during the year. Total. Found to be Under observation at the Dispensary on Dec. 31st, pending diagnosis. Ceased attendance before completion of diagnosis. Suffering from Tuberculosis. Not suffering from Tuberculosis. Pulmonary. NonPulmonary. (a) All persons (no contacts) Adults M 2 116 118 84 1 23 6 4 F 2 146 148 88 7 36 12 5 Children under 15 M 2 27 29 3 8 17 1 .... F 1 28 29 4 5 18 1 1 Total 7 317 324 179 21 94 20 10 (b) " Contacts" Adults M Contacts from the homes of non-resident patients are not examined at the City Dispensary. F Children under 15 M F (c) Insured persons (included in (a)) M 2 80 82 58 2 15 4 3 F 1 46 47 17 6 17 6 1 PATIENTS REFERRED TO THE HOSPITAL.— The following is the summary of patients referred to the various departments of St. Bartholomew' hospital for help in diagnosis or treatment:- Resident. Non-resident. Total. Referred to X -Ray Department 11 57 68 „ Surgical ,, 1 2 3 „ Dental „ 8. 8 ,, Throat „ 9 15 24 „ †pathological „ 1 3 4 „ Other „ 5 6 11 27 91 118 † This does not include examinations of sputum. PATIENTS ADMITTED TO THE HOSPITAL FOR DIAGNOSIS.— The wards of the Hospital are open for the reception of cases presenting difficulties of diagnosis which can only be overcome by observation as In-patients. Two resident and 10 non-resident patients were admitted for this purpose. EXAMINATIONS OF SPUTUM. —The following is a summarv :— City Residents. Non-Resident Total Positive 5 28 33 Negative 38 159 197 RESIDENTIAL TREATMENT.— The number of patients for whom residential treatment was arranged was 48. They are summarised as follows :— Admitted to L.C.C. Institutions Poor Law Institutions. Other Institutions. Total Patients resident in the City 12 2 3 17 Patients non-resident but working in the City 30 1 31 42 2 4 48 Persons neither resident nor working in the City are transferred immediately to their own Tuberculosis Officer and subsequent arrangements are made by him. This system has worked satisfactorily. PERSONS TREATED AND SUPERVISED AT THE DISPENSARY.— (A) Patients resident in the City. All persons suffering from tuberculosis who are resident in the City may be supervised and treated at the Dispensary. The total number of cases so treated was 73. The number of cases under supervision on December 31st, 1923, was 55, classified as follows:— Arrested 10 Quiescent 19 Active 22 Non-attendances 4 17 It is gratifying to note that only one of the cases classified last year as quiescent or arrested has become active. In addition a large number of contacts are kept under observation. (B) Patients non-resident in the City. (a) Who work in the City. On diagnosis these patients are informed that they can be treated and advised at the Dispensary or transferred to the Tuberculosis Officer of their own Borough. The majority decide to remain patients at the Dispensary. (b) Who do not work in the City. On diagnosis these patients are transferred to the Tuberculosis Officer of their own Borough, so none are treated here. TOTAL ATTENDANCES Insured. Non-Insured. Total Residents 193 456 649 Non-Residents 800 763 1,563 2,212 THE TUBERCULOSIS NURSE.— The work of the Tuberculosis Nurse has been continued on the same lines as former years. 90 homes have been visited and 647 visits made in connection with after care and following up. In addition to the above, patients, some of whom were in an advanced stage of the disease, have been nursed in their own homes. 12 of these cases terminated fatally. For nursing purposes 51 visits were paid. GENERAL.— 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. F. H. Young, O.B.E. ; one Tuberculosis Nurse is engaged in the work. Treatment in residential institutions is provided for insured and uninsured persons by the London County Council. (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. (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.) Considerable use is made of X-rays from the point of view of diagnosis and decision as to method of treatment to be recommended. The usual methods of treatment have been continued in the Dispensary. Tuberculin has been used in a few cases. In addition, three cases of pulmonary tuberculosis are attending for the continuation of their treatment by artificial pneumothorax. It is hoped to use this very promising method of treatment in suitable cases as they arise. (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 £20 has been expended. 18 (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 as members.* It receiver es 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 quiescent. 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. (xviii.) Difficulties also arise with regard to advanced cases. These are usually very infectious and do not care to go to the infirmary. It is hoped during the present year to make arrangements for their reception in an advanced care home. NOTIFICATION OF TUBERCULOSIS.— In August the Ministry of Health issued a circular letter to medical practitioners throughout the country, directing attention to the fact that the requirements of the Public Health (Tuberculosis) Regulations, 1912, so far as they relate to the notification of persons suffering from Tuberculosis, did not appear to be fully appreciated by certain practitioners. It was stated that in certain districts more than 40 per cent, of the persons dying from Tuberculosis had not been previously notified as suffering from that disease. Although no difficulty has been experienced in securing notification of City cases, the Sanitary Committee considered it desirable, in view of the above Circular, that a special communication should be addressed to the City practitioners by the Medical Officer of Health asking them to ensure prompt notification in order that it might be possible to deal with cases with the maximum of expedition. The following table sets out the number of cases, both of Pulmonary and Non-Pulmonary Tuberculosis, which were brought to my notice during the year 1923, and also the total number of deaths from Tuberculosis among City residents during the same period Age Periods. New Cases. Deaths. Pulmonary. Non-Pulmonary. Pulmonary. Non-Pulmonary. M. F. M. F. M. F. M. F. 0 .... .... .... ..... .... .... 1 .... 1 .... .... .... .... ..... .... .... .... 5 l .... .... 10 .... .... l 1 .... .... .... .... 15 3 .... .... .... 1 .... 20 2 1 .... .... l 1 .... .... 25 6 2 .... .... 2 .... .... .... 35 2 1 .... .... .... 1 .... .... 45 4 .... .... 5 .... .... 55 2 .... .... .... 1 .... .... 65 and upwards .... .... .... .... 1 1 .... .... Totals 20 4 1 1 10 3 2 .... Of the fifteen deaths recorded above, two or 13.3 per cent. referred to persons who had not been notified as suffering from Tuberculosis. These two cases were both Non-Pulmonary cases, one a baby of five months who had Tubercular Meningitis for seven days only before death, and the other a lad of eighteen years whose death was also certified to be due to Tubercular Meningitis. In both instances the disease was not determined until after death. * The present lady members of the Committee are Lady Cooper, O.B.E., and Miss Crosby. M.B.E. 19 TUBERCULOSIS. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary of Notifications during the period from the 1st January to the 31st December, 1923, in the City of London. AGE-PERIODS Notifications on Form A. Notifications on Form B t Number of Notifications on Form C- Number of Primary Notifications.* Total Notifications on Form A- Number of Primary Notifications.* Total Notifications on Form B. Poor Law Institutions Sanatoria. 0 to 1 1 to 5 5 to 10 10 to IS 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 ... ... 1 ... 3 2 6 2 4 2 ... 20 28 ... ... ... Nil. Nil. l 10 „ Females ... ... ... ... ... 1 2 1 ... ... ... 4 5 ... ... ... „ „ ... 2 Non-pulmonary Males ... ... ... 1 ... ... ... ... ... ... ... 1 1 ... ... ... „ „ ... 1 „ „ Females ... ... ... 1 ... ... ... ... ... ... ... 1 1 ... ... ... „ „ ... 2 Col. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) Patients notified as suffering from both pulmonary and non-pulmonary disease have been included among the "pulmonary" returns only. All notifications on Form D have been disregarded in preparing this return. * Primary notifications relate to patients who have not previously been notified in this or former years, either on form A or on Form B, in the area to which the return relates. Any additional notification of a case which has been previously notified in the area is regarded as duplicate. (Note.—No primary notifications should be made on Form C. ) † A School Medical Inspector, or the Medical Officer of Health of a county, county borough, or other district, if acting as a School Medical Inspector, is required to notify on Form B all cases of tuberculosis discovered in the course of inspection of children attending public elementary schools whether or not these have previously been notified. Cols. 2-13. Only those cases which have been notified for the first time during the year on Form A in the area concerned, and which have never previously been notified in the area, either on Form A or on Form B, have been included in these columns. Col. 14. The object of this column is to show the extent to which duplicate notification of the same case occurs on Form A, and all notifications on Form A, whether duplicate or not, are included in this column. Cols. 15-18. Only those cases which have been notified for the first time during the year on Form B in the area concerned, and which have never previously been notified in the area, either on Form A or on Form B, have been included in these columns. Col. 19. All notifications which have been made during the year on Form B in the area concerned, whether the cases have previously been notified in the area, or not, either on Form A or on Form B, have been included in this column. 20 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 17.8 per cent. of these cases. Result. Specimen. Disease suspected. Positive. Negative. 36 Swabbings from throats Diphtheria 6 30 20 Sputum Tuberculosis 4 16 Of the 36 swabbings from throats, 12 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 Stepney, and pupils attend from many parts of the East and North-East of London, and also Boroughs and Urban districts in Essex and Middlesex. DISTRIBUTION OF DIPHTHERIA ANTI-TOXIN AND ANTI-INFLUENZA VACCINE. Provision has been made for the distribution of Diphtheria anti-toxin in accordance with the Diphtheria Anti-toxin (London) Order, 1910, and also for the distribution of anti-influenza vaccine in accordance with the suggestion contained in the letter from the Ministry of Health, dated 20th December, 1919. Under neither of these arrangements have applications for supplies been received during 1923. CENTRAL LABORATORY AND BACTERIOLOGICAL EXAMINATIONS. The Metropolitan Boroughs Standing Joint Committee during the early part of the year had before them a proposal for the provision of a Central Laboratory at which all bacteriological work of the Metropolitan Borough Councils could be carried out. In order that they might be in a position fully to consider the points involved, they communicated with, amongst others, the City Corporation and the subject was referred to me to report upon. It is possible that some advantage might accrue in the case of routine examinations, but the number of routine examinations carried out for City purposes is exceedingly small. On the contrary, much of the work done by Sir Frederick Andrewes for the Corporation is of a special character and the advantage of having a specialist of repute personally to conduct such examinations is obvious, especially when thousands of pounds are often involved in the issue. The Sanitary Committee after carefully considering the matter came to the conclusion that the establishment of a Central Laboratory would not, for their purposes, be such a satisfactory method as the arrangement already in force. VENEREAL DISEASES. The following is a brief summary of the work carried out at the Special Treatment Centre for Venereal Diseases during the year 1923:— At the beginning of the year 461 males and 141 females were registered on the books as receiving treatment, which compares with 452 males and 150 females at the beginning of the previous year. It will be observed that the total number of persons in each of the two years is the same. Of these patients, 256 males and 92 females were under treatment for syphilis and 205 males and 49 females for gonorrhœa. New patients admitted totalled 505 as compared with 583 in the previous year, and 758 in 1921 and 1,053 in 1920. 35 males and 16 females suffering from syphilis discharged themselves before completing the first course, and 40 males and 18 females after completing the first course, but before completion of treatment. 27 males and 9 females completed treatment, but failed to submit themselves to final test; 10 males and 2 females were transferred to other centres, whilst 13 males and 5 females were discharged after completion of treatment and observation. 21 In the case of gonorrhoea, 86 males and 38 females, out of the total of 226 and 54 of the respective sexes coming under treatment during the year for the first time, discharged themselves before completion of the first course of treatment. The total number of attendances of all persons at the clinic was 14,710, which total is made up as follows:— Syphilis. Soft Chancre. Gonorrhoea. Non-Venereal Conditions. Total Attendances. Male. Female. Male. Female. Male. Female. Male. Female. Male. Female. 5,106 1,908 - - 6,520 1,093 61 22 11,687 3,023 A few beds are provided at the Centre for in-patient treatment and the number of days of such treatment totalled: males, 23; and females, 26. In the laboratories associated with the Centre 6,832 specimens were examined, 47 for the detection of spirochetes, and 1,367 for gonococci. 5,269 examinations for the Wassermann reaction were undertaken and 149 other examinations. The following tabulation indicates the number of patients coming under treatment for the first time from the Counties stated and also the examinations which were made for the detection of Gonococci and for the Wassermann reaction in respect of these patients:— No. of patients treated. For Non-Venereal Conditions. Examinations. For Syphilis. For Gonorrhoea. For Gonococci. For Wassermann Reactions. London 172 249 31 1,210 5,115 Essex 5 10 1 39 36 Hertfordshire 3 4 Nil 15 28 Middlesex 5 12 Nil 70 34 Surrey 3 3 1 22 22 Kent 4 2 Nil 11 34 Totals 192 280 33 1,367 5,269 Included in the above total were 20 examinations for gonococci and 3,183 examinations for the Wassermann reaction at the request of general practitioners. TREATMENT OF PARTURIENT WOMEN SUFFERING FROM VENEREAL DISEASES. At the request of the Local Government Board, the Metropolitan Asylums Board in 1917 opened a Centre for the treatment of parturient women suffering from Venereal Disease. The accommodation is provided for the Board by the City of London Guardians at the Thavies Inn Infirmary, Robin Hood Court, and consists of beds for twenty mothers with infants. When first established the Centre was apparently fully appreciated, but for some little time past the attendances have been steadily declining. The Metropolitan Asylums Board felt that one of the reasons for this decline was that the existence of the Institution was not sufficiently well known to medical practitioners, and at their request a letter was forwarded to all medical men in the City, a copy of which is reproduced below:— TREATMENT OF PARTURIENT WOMEN SUFFERING FROM VENEREAL DISEASES. Dear Sir, In 1917, the Metropolitan Asylums Board, at the request of the Local Government Board, arranged for the provision of special accommodation for the treatment of parturient women suffering from Venereal Diseases. Pauper and non-pauper cases are admitted, the latter on the recommendation of the Medical Officer of Health. This accommodation, which is provided for the Board by the City of London Guardians in a portion of the Thavies Inn Infirmary, Robin Hood Court, High Holborn, E.C., consists of beds for twenty mothers with infants. There is also attached to the Infirmary an outdoor clinic for treatment after discharge. There are at the Institution a Matron and midwives with special experience and a medical and nursing staff. No definite regulations have been laid down as to the stage at which patients may be admitted, but it is customary to receive them not earlier than the seventh month of pregnancy. The cost of treatment is a charge on the rates. The Consulting Specialist (Mr. John Adams, F.R.C.S.), has reported that the continuation of the treatment after leaving the Centre is most important to effect a cure of both mother and baby. Perhaps you will consider whether advantage may not be taken of the facilities offered if patients suitable for treatment come under your notice. Applications for admission should be made on an order signed either by the Clerk to the Guardians or by me. A supply of application forms is kept at this office and may be obtained on request. Yours faithfully, 20th December, 1923. Medical Officer of Health. D 22 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, 1923. Syphilis. Soft Chancre. Gonorrhoea. Conditions other than Venereal. Total. Males Females Males Female Males Females Males Females Males Females 1. Number of persons who, on the 1st January, 1923, were under treatment or observation for:— 256 92 ... ... 205 49 ... ... 461 141 2. Number dealt with during the year for the first time and found to be suffering from:— Syphilis only 125 47 ... ... ... ... ... ... 125 47 Soft chancre only ... ... ... ... ... ... ... ... ... ... Gonorrhœa only ... ... ... ... 211 49 ... ... 211 49 Syphilis and soft chancre ... ... ... ... ... ... ... ... ... ... Syphilis and gonorrhœa 15 5 ... ... 15 5 ... ... 30 10 Gonorrhœa and soft chancre ... ... ... ... ... ... ... ... ... ... Syphilis, soft chancre and gonorrhœa ... ... ... ... ... ... ... ... ... ... Conditions other than venereal ... ... ... ... ... ... 31 2 31 2 Total—Item 2 140 52 ... ... 226 54 31 2 397 108 Total—Items 1 and 2 396 144 ... ... 431 103 31 2 858 249 3. Number of persons who ceased to attend (a) before completing the first course of treatment for 35 16 ... ... 86 38 ... ... 121 54 (b) after one or more courses but before completion of treatment for 40 18 ... ... ... ... ... ... 40 18 (c) after completion of treatment, but before final tests as to cure of 27 9 ... ... 84 19 ... ... 111 28 4. Number of persons transferred to other Treatment Centres after treatment for 10 2 ... ... 4 1 ... ... 14 3 5. Number of persons discharged after completion of treatment and observation for 13 5 ... ... 11 4 ... ... 24 9 6. Number of persons who, on the 1st January, 1924, were under treatment or observation for 271 94 ... ... 246 41 ... ... 517 135 Total—Items 3, 4, 5, & 6 396 144 ... ... 431 103 28 ... 827 247 7. Out-patient attendances:— (a) For individual attention by the Medical Officer 5,106 1,908 ... ... 2,871 969 61 22 8,038 2,899 (b) For intermediate treatment, e.g., irrigation, dressings, etc. ... ... ... ... 3,649 124 ... ... 3,649 124 Total attendances 5,106 1,908 ... ... 6,520 1,093 61 22 11687 3,023 8. Aggregate number of "In-patient days" of treatment given to persons who were suffering from:— 3 ... ... ... 20 9 ... 17 23 26 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 47 ... ... ... (b) Specimens from persons attending at the Treatment Centre which were sent for examination to an approved laboratory Films Cultures 1,116 231 C.F.T. 45 C.S.F. 24 1,064 Sigma 1,022 23 Statement showing the services rendered at the Treatment Centre during the year, classified according to the areas in which the patients resided. Name of County or County Borough (or Country in the case of persons residing elsewhere than in England and Wales) to be inserted in these headings. London. Essex. Herts. Middlesex. Surrey. Kent. Total. A. Number of persons from each area dealt with during the year for the first time and found to be suffering from:— Syphilis 172 5 3 5 3 4 ... ... ... ... ... 192 Soft chancre ... ... ... ... ... ... ... ... ... ... ... ... Gonorrhœa 249 10 4 12 3 2 ... ... ... ... ... 280 Conditions other than venereal 31 1 ... ... 1 ... ... ... ... ... ... 33 Total 452 16 7 17 7 6 ... ... ... ... ... 505 B. Total number of attendances of all patients residing in each area 14,571 39 28 37 15 20 ... ... ... ... ... 14,710 C. Aggregate number of "Inpatient days "of all patients residing in each area 34 6 ... ... ... 9 ... ... ... ... ... 49 D. Number of doses of Arsenobenzol compounds given in the:— 1. Out-patient Clinic 1,964 25 9 19 12 20 ... ... ... ... ... 2,049 2. In-patient Dept. to patients residing in each area. ... ... ... ... ... ... ... ... ... ... ... ... E. Give the names of Arsenobenzol compounds used in the treatment of syphilis and the usual initial and final doses. Neo.- Salvarsan. Novarsenobillon. Neo.-Kharsivan. Stabilarsan. Silver Salvarsan. Sulfarsenol. Initial dose→ o .6 to .9. o+ .6 to .75. 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. Usual course 8 to 10 inj. of Arsenical compound c 15 to 20 Mercury inj. 3 to 4 courses in the 1st yr., 2 to 3 in the 2nd yr., according to W.R. Hyd. Perchlor c Pot. Iod. between courses Quinine Iodo. Bismuthate, 15 inj. Trepol, Neotrepol, Muthanol, Luatol, Contraluesin, Cyarsol, Mercurosal, Collosal Iodine in conjunction with or without Arsenical compounds. G. State the nature of tests applied in deciding as to discharge of patients referred to in Item 5 on previous page. W.R. every 3 mths.; during 3rd yr., every 6 mths.; during 4th yr., without treatment. Gonorrhœa.—0→ Urethroscope, Alcohol. Films and cultures from urethra, threads, prostatic and vesicular secretions, taken 3 times at weekly intervals, after cessation of treatment, o+ Films and cultures, if necessary, from urethra and cervix and Bartholin's glands, if required, after successive menstrual periods, after cessation of treatment. Date 23 /1 /24. (Signed) KENNETH M. WALKER, Medical Officer of the Treatment Centre. d 2 24 HOUSING.—CENSUS RETURNS, WORKING POPULATION, Etc. It would appear desirable that some of the more important census figures relating to the City of London, which have been issued during the past year, should be brought to the notice of the Corporation. At the same time it will probably be interesting if certain previously recorded facts are repeated in order that the changing responsibilities of the City in public health concerns may be better appreciated. POPLTLATION.—The number of persons occupying houses and living within the boundaries of the City was recorded as 13,709 at the Census taken in 1921. This total represents by far the lowest yet reached in the decline of the City as a residential area and the following table clearly illustrates the progressive character of the decline. CITY OF LONDON. (Including Inner and Middle Temple). Table showing the number of Houses (Inhabited, Uninhabited and Building), and Population Totals (Males and Females), recorded at each Census, 1801 to 1921. Year. Houses. Population. Inhabited. Uninhabited. Building. Persons. Males. Females. 1801 17,738 600 - 129,528 63,711 65,817 1811 17,413 458 61 120,909 59,243 61,666 1821 17,170 1,015 105 125,434 61,947 63,487 1831 16,735 1,131 81 123,683 60,740 62,943 1841 16,080 1,567 103 125,008 61,776 63,232 1851 14,580 1,453 29 127,869 62,697 65,172 1861 13,298 2,058 97 112,063 53,991 58,072 1871 9,305 3,205 63 74,897 36,549 38,348 1881 6,507 4,755 98 50,652 25,174 25,478 1891 5,340 5,038 138 37,705 19,032 18,673 1901 3,865 6,199 166 26,923 13,825 13,098 1911 2,784 173* 24 19,657 10,080 9,577 1921 2,398 69* 92† 13,709 6,722 6,987 * Excluding shops, offices and warehouses. † Includes buildings and shops. It will be recognised that the City has now almost resigned its right to be regarded as a residential area of any importance and the tendency is towards further decline. A historical survey of the effects on residential accommodation of the development of the City as a commercial centre would prove an interesting study, but references in this report must be limited to a few outstanding features. Even at the beginning of the nineteenth century, the City was essentially a residential area. Many City Fathers and powerful City Magnates of those days lived within its borders, though commerce had begun to claim room for expansion; this was being gained at the expense of the dwellings. The City was evidently losing its attractiveness and, coincidentally with the demolition of houses on main thoroughfares, larger houses in other situations were being deserted by their original occupants and converted into two or more smaller dwellings. Washington Irving, writing during the early decades of that century, refers to one wellknown area as follows:— "In the centre of the great City of London lies a small neighbourhood consisting of a cluster of narrow streets and courts of very venerable and debilitated houses which goes by the name of Little Britain............ As London increased, rank and fashion rolled off to the west and trade, creeping in at their heels, took possession of their deserted abodes ....... But though thus fallen into decline, Little Britain still bears traces of former splendour. There are several houses ready to tumble down, the fronts of which are magnificently enriched with old oaken carvings of hideous faces, unknown birds, beasts, and fishes and fruits and flowers which it would perplex a naturalist to classify. There are also in Aldersgate Street, certain remains of what were once spacious and lordly family mansions but which have in latter days been sub-divided into several tenements ....... The lanes and courts also contain many smaller houses not on so grand a scale but, like your small ancient gentry, sturdily maintaining their claims to equal antiquity Little Britain may truly be called the heart's core of the City, the stronghold of John Bullism." 25 I he changes in the character of the City set out in the above extract continued during subsequent years but with increased intensity. The impelling force was the development of the commercial spirit which seized England and of which London was the centre. The above table shows that the number of inhabited houses was 17,738 in 1801, but in 1851 it had declined to 14,580. At the same time uninhabited houses, which include shops, offices and warehouses, had increased from 600 to 1,453, and I think it may be assumed th'at the increase was mainly due to the growth of commercial premises. In 1847,the first City Medical Officer of Health, Mr. (afterwards Sir John) Simon, was appointed. His reports, which are now classics in the domain of State Medicine, direct attention in picturesque and descriptive language to the evils which then existed. It seems strange to read of the effect on the general health of the people of the window tax in association with objectionable cesspools, dangerous overcrowding and extreme deficiency of internal and external ventilation. Closed courts were obviously the danger centres and, suggesting a visit, he graphically describes the effects:— "The stranger feels his breathing constrained as though he were in a diving bell and experiences afterwards a sensible and immediate relief as he emerges again into the comparatively open street." The efforts of Sir John Simon both in the City and later at the Privy Council doubtlessly contributed to the passing of the earlier Housing Acts and considerable advantage was taken by Dr. Sedgwick Saunders, a later City Medical Officer of Health, of the powers contained in the Artizans' and Labourers' Dwellings Improvement Act, 1875. On December 13th, 1878, the Finance and Improvement Committee reported to the Commissioners of Sewers respecting 21 areas which had been scheduled by Dr. Saunders in 1875. The houses affected numbered 582, containing 2,623 rooms, and inhabited by 5,546 persons. Very few of those houses remained standing at the date of the report referred to. The efforts of the Sanitary Authority combined with the inroads which demolitions for business purposes made on houses resulted in the 14,500 inhabited houses of 1851 being reduced to 6,507 in 1881, and conversely uninhabited houses, again including shops, offices and warehouses, increased from 1,453 to 4,755. At the same time the population declined to a total representing two-fifths of what it was in 1851. For many years no further demolition schemes were promoted. Private persons, singly or in combination, in answer to calls, purchased and demolished dwelling houses in large numbers. In this way courts and alleys disappeared rapidly, and the efforts of the Authority to rid the City of unsuitable premises were limited to action in respect of individual houses. Closures were obtained by invoking the aid of the City Sewers Acts, 1847—51. Concurrent with these demolitions, various institutions found it advisable to leave the City, the outstanding example being Christ's Hospital, and to meet increasing needs as a commercial centre, railway stations made additional calls on the remaining residential property. It may safely be stated that the decrease of inhabited houses from 6,507 in 1881 to 2,784 in 1911 was mainly due to commercial progress. The population in the same period declined from 50,652 to 19,657. During the demolition period a number of buildings designed to house members of the labouring classes were erected, the chief being the five blocks of Corporation Dwellings in Harrow Alley and Stoney Lane at present accommodating 880 persons, five small blocks erected by private enterprise in Dean Street, Fetter Lane, and a few in other places. POSITION IN RECENT YEARS.—The position at the beginning of the present century was that there was not a large number of courts or houses presenting those grossly insanitary conditions recorded in the fifties and even more recently. Some houses which had been found to be reasonably satisfactory in various courts had been left when the remainder were demolished, and some courts, which forty or fifty years ago were not absolutely closed in, and which received a reasonable amount of sunshine and were fairly well ventilated externally, were also regarded as fit for human habitation. It is these houses which to-day come under serious review. The spare land in the courts has been built upon and the whole court surrounded by 26 buildings the tendency of which has always been in the direction of greater height. The separate houses have now reached in most cases the age limit and are incapable of improvement. This state of affairs has necessitated during my tenure of office as medical officer of health the representation of three areas as insanitary, viz. : Cloth Fair, Hutchison Street and Vine Street. These are referred to later in this section of the Report. PRESENT POSITION OF HOUSING.—At the present time the City furnishes the following classes of residences - 1. Reasonably satisfactory houses occupied by members of one family. In these are chiefly to be found the clergy, a few doctors, fewer lawyers, and a number of the better class commercial workers. These residents like others are decreasing in numbers. The noise of the traffic on the main roads prevents that reasonable enjoyment of quiet which is necessary if home is to be comfortable. 2. In institutions there resides a considerable portion of the City population; for instance, at St. Bartholomew's Hospital there are over 1,000 persons, including patients, and there are residents at the Choir School, Poor Law Institutions, and the Police Hospital and dwellings. 3. It was a fairly regular custom in the past for business houses to board and lodge many of their employees. This practice is rapidly declining although a few of the firms still continue so to provide for a proportion of their staffs. 4. A number of residents are housed in blocks of buildings divided into tenements which were originally designed for the purpose, and these include Moor Lane Chambers. Bridgewater House. Albion Buildings. Six Blocks in Dean Street. St. Anne's Chambers. Blomfield House. Five Blocks of Corporation Dwellings, Harrow Alley and Stoney Lane. Barker's Buildings. 5. It was possible at one time to let off the top floors of business premises as residences but this practice has almost ceased, and so far as I can gather the difficulties in this connection have been two-fold, one relating to the water rate, the other to assessment. To appreciate the former point it must be remembered that until recent times it was customary to depend upon water from surface wells and pumps, and it was during Dr. Saunders' period of office that large numbers of these were closed. Many of these pumps were replaced by domestic hydrants in courts and alleys, but the supply of water to every house was not effected until many years after. At the time of the disuse of wells many owners of business premises were willing to let the upper portions of their premises for residences but only on the condition that the tenants paid the water rate. Water used on business premises was only trivial in amount, and it was regarded by the then owners rather as a luxury than a necessity. They were often able to obtain it off the premises, but when occupied as dwellings, a supply became essential on the premises. The water rate was charged upon the assessed value of the whole building. This was more than the residents could afford and it tended to reduce the occupation of such places. The second and perhaps more serious cause for discontinuing and avoiding the use of business premises in the City for living purposes was undoubtedly that which resulted from the charge for inhabited house duty. In former years this duty was not charged upon the portion of the building used only for a residence but the whole premises were assessed if anyone was in occupation of a portion. An example which came to my notice will make the point clear. A person of small means was paying £30 per annum as rent in the suburbs. He was prepared to pay £50 per annum for rooms over offices in the City which, although they lacked the suburban amenities, he was willing to rent because of their convenience to his business. On preparing to take up the tenancy he found that he would be required to pay £40 per annum for inhabited house duty, this being the amount of duty payable on the assessment of the whole building. Needless to say, this agreement fell through. Whatever may be the reason I think it may be accepted that there are very few City business premises, certainly if the premises are of any importance, which 27 are let off in part for residential purposes. It is, however, satisfactory to note that the difficulty connected with the payment of inhabited house duty is now removed and that in the future, assessment will only be made upon that portion of the building used as a residence, and payment of inhabited house duty on the whole premises of which the residential portion is only a part will not be enforced. 6. There are a few shops with residential accommodation. In these instances the tenants have found their living rooms encroached upon by the necessity for finding storage accommodation for business purposes. In other instances, the premises being of several storeys, the top rooms are not used and are often far from being satisfactorily clean. As a rule these premises are older houses which have been slightly remodelled to fit the requirements of the small businesses conducted. The circumstances under which the tenants reside are not always satisfactory. 7. There still exists in the City a number of caretakers' apartments in business houses. The provision for the caretakers is not always satisfactory and the value of rooms for office purposes is so great that there is a tendency to reduce these apartments to the minimum necessary, and to require unmarried persons to occupy them. The problem of the caretaker's dwelling is a different one to the one which is under review in this report and will receive separate attention on a future occasion. 8. The majority of the remaining houses require detailed attention and in respect of which a special report has been submitted to the Sanitary Committee. THE EFFECT OF COMMERCIAL DEVELOPMENTS.—With the decline of residential population there has been an increase in the day population. The removal of dwellings and the substitution on the cleared sites of commercial premises has resulted in an increased day population occupying the area. For the first time the Census returns give an analysis, so far as the area included in the home counties is concerned, of the places of residence of persons living outside, but working in the City, and in addition the returns indicate the place of work within the same boundaries of persons living within the City area. These show that the population of the City comprises 6,722 males and 6,987 females. Of these, 5,372 males and 3,650 females are above the age of 12 years and are engaged in some occupation or are students above the age of 18 years. Of these totals, 3,370 males and 2,960 females work within the City area and 613 males and 70 females have no fixed work place. To make the totals balance it should be noted that 97 males and 49 females did not state the place at which they were occupied. Of the occupied males, 1,292 and of the occupied females, 571 work outside the area and the districts in which they were so occupied are set out in the following summary. Place of occupation of Citv Residents who work outside the City area :— Essex 56 West Ham C.B. 21 Hertfordshire 11 Kent 15 London 1,477 (distributed as follows) Bermondsey 38 Bethnal Green 25 Finsbury 205 Hackney 47 Holborn 136 Islington 45 Lambeth 24 St. Marylebone 51 St. Pancras 43 Shoreditch 62 Southwark 63 Stepney 375 City of Westminster 251 Middlesex 34 Surrey 16 Other parts of England and Wales 133 Outside England and Wales 121 Total 1,863 28 The number of persons who live outside the City but who come into the City daily to follow some occupation, and using the same classification, namely occupied persons over 12 years of age and students over 18 years of age, was 288,626 males and 115,678 females. The residences of these persons were as set out in the following table :— Number of Persons working in the City but enumerated elsewhere in London or the Home Counties totalled 404,309. Essex 74,622. Berkhampstead R.D. 21 East Ham C.B. 10,779 Buntingford R.D. 25 Southend-on-Sea C.B. 6,937 Hadham R.D. 46 West Ham C.B. 12,819 Hatfield R.D. (Without) 98 Barking Town U.D. 1,498 Hemel Hempstead R.D. 57 Brentwood U.D. 207 Hertford R.D. 45 Buckhurst Hill U.D. 343 Hitchin R.D. 76 Burnham-on-Crouch U.D. 71 St. Albans R.D. 74 Chelmsford M.B. 121 Ware R.D. 147 Chingford U.D. 670 Watford R.D. (Within) 146 Clacton U.D. 751 Watford R.D. (Without) 161 Colchester M.B. 76 Welwyn R.D. 39 Epping U.D. 91 Kent 14,784. 22 Frinton-on-Sea U.D. 119 Grays Thurrock U.D. 136 Canterbury C.B. Harwich M.B. 38 Beckenham U.D. 3,002 Ilford U.D. 9,607 Bexley U.D. 456 Leyton U.D. 10.540 Broadstairs and St. Peter's U.D. 442 Loughton U.D. 299 Bromley M.B. 1,651 Maldon M.B. 35 Chatham M.B. 28 Romford U.D. 1,103 Chislehurst U.D. 297 Shoeburyness U.D. 61 Crayford U.D. 59 Waltham Holy Cross U.D. 79 Dartford U.D. 130 Walthamstow 10,685 Deal M.B. 140 Walton-on-the-Naze U.D. 138 Dover M.B. 68 Wanstead U.D. 1,570 Erith U.D. 205 Woodford U.D. 1,766 Folkestone M.B. 473 Billericay R.D. 696 Gillingham M.B. 88 Braintree R.D. 48 Gravesend M.B. 339 Chelmsford R.D. 192 Herne Bay U.D. 323 Dunmow R.D. 50 Hythe M.B. 57 Epping R.D. (Within) 101 Maidstone M.B. 33 Epping R.D. (Without) 245 Margate M.B. 1,645 Lexden and Winstree R.D. 63 New Romney M.B. 22 Maldon R.D. 88 Northfleet U.D. 58 Ongar R.D. 47 Penge U.D. 1,734 Orsett R.D. 238 Ramsgate M.B. 420 Rochford R.D. 606 Rochester M.B. 51 Romford R.D. (Within) 349 Sandgate U.D. 24 Romford R.D. (Without) 1,089 Sevenoaks U.D. 169 Saffron Walden R.D. 30 Sidcup U.D. 492 Stanstead R.D. 83 Southborough U.D. 27 Tendring R.D. 62 Tonbridge U.D. 106 Hertfordshire 5,104. Royal Tunbridge Wells M.B. 244 Whitstable U.D. 155 Barnet U.D. 407 Blean R.D. 59 Bishops Stortford U.D. 130 Bromley R.D. (Within) 503 Bsushey U.D. 237 Bromley R.D. (Without) 103 Cheshunt U.D. 207 Cranbrook R.D. 45 Chorleywood U.D. 92 Dartford R.D. 194 East Barnet Valley U.D. 753 Dover R.D. 34 Great Berkhampstead U.D. 90 East Ashford R.D. 38 Harpenden U.D. 152 Isle of Thanet R.D. 161 Hemel Hempstead M.B. 101 Maidstone R.D. 28 Hertford M.B. 95 Mailing R.D. 35 Hitchin U.D. 53 Romney Marsh R.D. 23 Hoddesdon U.D. 112 Sevenoaks R.D. 267 Letchworth U.D. 74 Strood R.D. 49 Rickmansworth U.D. 100 Tonbridge R.D. 82 St. Albans M.B. 505 Sawbridgeworth U.D. 29 London 222,863. Stevenage U.D. 46 Battersea M.B. 5,551 Ware U.D. 58 Bermondsey M.B. 6,305 Watford U.D. (Within) 75 Bethnal Green M.B. 7,043 Watford U.D. (Without) 699 Camberwell M.B. 18,350 Barnet R.D. 108 Chelsea M.B. 1,426 29 Deptford M.B. 5,298 Wembley U.D. 785 Finsbury M.B. 5,956 Willesden U.D. 4,971 Fulham M.B. 4,240 Wood Green U.D. 3,899 Greenwich M.B 2,327 Yiewsley U.D. 44 Hackney M.B. 16,009 Hendon R.D. 782 Hammersmith M.B. 3,511 South Mimms R.D. 82 Hampstead M.B. 4,759 Staines R.D. 420 Holborn M.B 2,484 Uxbridge R.D. 61 Islington M.B. 19,897 Kensington 4,960 Surrey 31,371. Lambeth M.B. 18,544 Lewisham M.B. 13,534 Croydon C.B. 10,093 Paddington M.B. 5,000 Barnes U.D. 1,548 Poplar M.B. 5,600 Beddlington and Wallington U.D. 1,304 St. Marylebone M.B. 2,721 Carshalton U.D. 684 St. Pancras M.B. 6,867 Caterham U.D. 230 Shoreditch M.B. 6,507 Chertsey U.D. 246 Southwark M.B. 13,846 Coulsdon and Purley U.D. 1,449 Stepney M.B. 13,253 Dorking U.D. 120 Stoke Newington M.B. 4,445 East and West Molesey U.D. 187 Wandsworth M.B. 17,745 Egham U.D. 149 Westminster, City of 3,956 Epsom U.D. 318 Woolwich M.B. 2,729 Esher and the Dittons U.D. (Within) 508 Middlesex 55,565. Esher and the Dittons U.D. (Without) 86 Farnham U.D. 25 Acton U.D. 1,588 Frimley U.D. 40 Brentford U.D 185 Godalming M.B. 31 Chiswick U.D. 1,437 Guildford M.B. 138 Ealing M.B. 2,816 Ham U.D. 20 Edmonton U.D. 3,269 Haslemere U.D. 22 Enfield U.D. 2,163 Kingston-on-Thames M.B. 1,006 Feltham U.D. 71 Leatherhead U.D. 103 Finchley U.D. 2,855 Merton and Morden U.D. 816 Friern Barnet U.D. 899 Mitcham U.D. 1,279 Greenford U.D. 29 Reigate M.B. 501 Hampton U.D. 288 Richmond M.B. 1,364 Hampton Wick U.D. 101 Surbiton U.D. 842 Hanwell U.D. 399 Sutton U.D. 957 Harrow-on-the-Hill U.D. 919 The Maidens and Coombe U.D. 802 Hayes U.D. 35 Walton-upon-Thames U.D. 390 Hendon U.D. 2,395 Weybridge U.D. 159 Heston and Isleworth U.D. 849 Wimbledon M.B. 3,017 Hornsey M.B. 8,709 Windlesham U.D. 76 Kingsbury U.D. 32 Woking U.D. 363 Ruislip Northwood U.D. 302 Chertsey R.D. 161 Southall Norwood U.D. 318 Dorking R.D. 110 Southgate U.D. 3,845 Epsom R.D. (Within) 779 Staines U.D. 159 Epsom R.D. (Without) 242 Sunbury-on-Thames U.D. 103 Farnham R.D. 67 Teddington U.D. 652 Godstone R.D. (Within) 118 Tottenham U.D. 8,289 Godstone R.D. (Without) 320 Twickenham U.D. 1,248 Guildford R.D. 151 Uxbridge U.D. 106 Hambledon R.D. 109 Wealdstone U.D. 460 Reigate R.D. 441 The above totals do not include visitors or other persons entering the City for business reasons; they refer to those actually engaged in work in the City. The information is of considerable value in many connections, but particularly as regards housing, transport, and public health matters. The figures being available for the whole county will assist in indicating to some extent the localities in which increased housing accommodation is necessary, or at any rate desirable, and the directions in which facilities for enabling persons to reach their work can be reviewed. Accurate knowledge with reference to the daily influx of population gives some indication of the public health problems in the City to-day compared with those when an essentially residential population was probably greater than the daily influx of workers. The conditions under which this population works, the methods of feeding, the removal of contaminations from the street and atmosphere generally, the ease and facilities of transportation all become emphasized with such considerable density during the daytime. The day population of the City represents 614 persons per acre, whereas e 30 the day population of Woolwich shows a density of about 18 and of Lewisham 20. The highest densities outside the City are recorded in Finsbury and Holborn, namely, about 240 in each place. These facts again increase the importance of the City density inasmuch as the next largest densities actually border on the City area and ultimately the City will be surrounded by these areas of high density with the consequences of added supervisory responsibilities. The nearest total day population recorded in the metropolis is the City of Westminster with 374,102, but the area available for the accommodation of this number is such that the average density only amounts to about 150 persons to the acre. HOUSES FOR THE WORKING CLASSES.—I recently submitted to the Sanitary Committee a report dealing with certain matters affecting the houses occupied by the working classes. This report, and the recommendations contained therein, is at the present moment receiving the consideration of that Committee, but attention is directed to the following facts :— (a) The Hutchison Street Area.—The Corporation will recollect that in May, 1919, the area known as the Hutchison Street Area was represented by the Medical Officer of Health as being insanitary. After Government enquiry this representation was approved and the area officially declared an insanitary area. I directed attention to the fact that within the area there were a certain number of houses which in themselves were unfit for human habitation. This is a different point from the assertion that the area owing to the closeness and narrowness of the streets, etc., and the interaction of one house upon another is insanitary as a whole. I pointed out that conditions in the area could be materially improved if the houses which in themselves were unfit for human habitation were removed together with other obstructive buildings. The houses coming within the former category include Nos. 1—20, Providence Place, 1—10, Garden Place and 3, 4 and 5, Hutchison Avenue. In the latter group I also include Nos. 20 to 26, Hutchison Avenue, of which No. 26 is now empty. This represents a total of 38 houses in occupation and one empty, in the former of which there were residing at the time of the representation 200 persons. The Sanitary Committee have already considered the advisability of erecting, on part of the area, a block of dwellings, comprising 28 four-room tenements and four three-room tenements. It should be noted that in the erection of these tenements certain property will require to be demolished to make room for the new tenements, and a large proportion of these new tenements will in consequence be occupied by the tenants displaced. It is important to note that the houses which will require to be first demolished to make room for these new tenements are by no means the worst, and that the demolitions will not affect the 38 inherently defective houses above referred to. (b) The Vine Street Area.—The Corporation will further recollect that in November, 1921, the Vine Street Area was also represented as being insanitary. This area consisted of seven houses in which were 72 persons. Each house in this area, in my opinion, was practically unfit for human habitation in the then condition. At the present time three of the houses are unoccupied, but some 60 persons continue in residence in those remaining. In spite of all endeavours it has been found impossible to discover alternative accommodation for the occupants. (c) Other Houses in the City.—At the present time from 30 to 40 other houses exist which can hardly be regarded as fit for human habitation, a similar number are arriving at a state of unfitness and many houses exist which when the restrictions are removed will probably be sold. Their ultimate fate will be demolition and on the site commercial premises will be erected. Nearly all the houses regarded as unfit, and many of the remainder, exist as single houses or as small groups of two or three forming part of a court, or in groups of eight or ten forming a complete court. A few are for the use of one family but generally they are sub-let in tenements, and the latter type of house being essentially converted houses do not possess satisfactory amenities for the residents on the upper floors. They represent mainly the remnants of court property which were left in the wholesale clearances of 30 or 40 years ago, and these have now reached that worn out state which hardly justifies expenditure on repair. Further, 31 they are more enclosed than was the case 40 years ago, inasmuch as the courts and alleys of which they formed a part have now been covered by buildings very much higher than the dwellings, and light and external ventilation are interfered with. These houses lack the necessary amenities and are occupied by persons probably who are unable to exercise discrimination in the choice of dwelling since they must reside near their work. The suggestion which I made for dealing with the present position was that endeavour be made to obtain a site as near the City boundaries as possible and thereon erect tenements which will house sufficient persons to allow of the preliminary demolitions to be proceeded with as well as enable proceedings to be taken to close the worst properties. By this means provision can be made for the occupants of the most unsatisfactory houses on the Hutchison Street Area and for the tenants of the Vine Street Area. If such additional houses were available the housing problem would be less acute in the City and progressive improvement would be possible. This suggestion, as already stated, is receiving the attention of the Sanitary Committee and both the City Engineer and the Medical Officer of Health have received instructions to furnish the Committee with additional information. SIZE OF CITY FAMILIES AND NUMBER OF ROOMS OCCUPIED. The following table shows in the first column the number of persons in different sized families and reading along horizontally it will indicate the number of families of that particular size occupying respectively one to ten rooms. Thus, reading the second line it will be observed that there are 76 families, consisting of two persons in the family, occupying a single room, 323 families of two persons occupying two rooms, 255 families of two persons occupying three rooms, and so on. The table shows one remarkable return, that of one family of 13 found to be living in one room. The circumstance is not within the knowledge of your staff, and it has not been found possible to discover this particular family. Using the basis of two persons to a room as the minimum standard of acceptable occupation it will be found that 109 families are living under conditions below that standard. These represent the families shown below the black line which runs through the table. CITY OF LONDON (County Corporate). Number of Persons in Family. Number of Private Families occupying the following number of Rooms. 1 - 3 4 5 6-7 8-9 10 and over. l 214 136 84 38 3 3 2 .... 2 76 323 255 129 40 22 8 l 3 17 186 231 148 40 32 5 7 4 6 94 148 144 44 35 5 6 5 .... 31 90 82 29 48 9 12 6 .... 8 44 41 24 27 15 4 7 .... 2 16 19 20 21 4 5 8 .... 3 6 18 5 16 8 7 9 .... 1 2 4 7 10 4 5 10 .... 1 2 3 5 8 4 1 11 .... .... .... 2 1 8 .... 1 12 .... .... .... .... .... .... 1 .... 13 1 .... .... .... 1 .... .... .... 14 .... .... .... .... .... .... 1 2 15 and over .... .... .... .... .... 2 .... 1 Total Private Families 314 785 878 628 219 232 66 52 Population in Private Families 454 1,976 2,791 2,337 985 1,249 382 335 Rooms Occupied 314 1,570 2,634 2,512 1,095 1,439 551 633 A. 9.9 24.7 27.7 19.8 6.9 7.3 2.1 1.6 B. 130 260 231 16.3 7.2 8.5 3.7 2.2 A. = Percentage of families living in various units of occupation in 1921. B. = Percentage of families living in various units of occupation in 1911. 32 It is very difficult to obtain accurate knowledge of the number of occupants of tenements. Truthful statements are not always forthcoming, and such information as is given can only be checked by regular night visits at hours when all the occupants are at home. Where overcrowding is discovered, of course, immediate steps are taken to remedy the complaint. In table 10 of the Census report, it appears that 214 dwellings were occupied by caretakers. In comparing the census year 1921 with 1911, it will be seen that the number of private families occupying one room has decreased from 13.0 to 9.9 and of those occupying two rooms the decrease is from 26.0 to 24.7. There is an increase in the number of families occupying tenements of three and four rooms. The actual percentages are shown in the last two lines of the table. OFFICIAL STATISTICS OF HOUSING.—The following particulars have been prepared in accordance with the requirements of the Ministry of Health. Action which will subsequently be taken in respect of the totals set out in paragraphs 1 (3) and 1 (4) is under consideration by the Sanitary Committee. HOUSING STATISTICS. Number of new houses erected during the year :— (a) Total Nil. (b) With State assistance under the Housing Acts, 1919 or 1923 :- (i.) By the Local Authority Nil. (ii.) By other bodies or persons Nil. 1. Unfit Dwelling Houses. Inspection—(1) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 935 (2) Number of dwelling houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 375 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 40 (4) Number of dwelling houses (exclusive of those referred to under the preceding subheading) found not to be in all respects reasonably fit for human habitation 40 2. 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 183 3. 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 :— (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 240 (2) Number of dwelling houses in which defects were remedied :— (a) by owners 214 (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. HYGIENE OF HAIRDRESSERS' AND BARBERS' SHOPS. A system of voluntary registration of hairdressers' establishments with the Department of the Medical Officer of Health was instituted in 1904. At one time there were 32 establishments registered in the books of this Department. This number has now, however, been reduced to six. This reduction has been gradual and doubtless results from the facilities offered by the Corporation, through the County Purposes Committee, for the proprietors of hairdressing establishments to obtain the statutory registration provided for by the London County Council (General Powers) Acts of 1915 and 1920. These Acts deal with the control and 33 registration of massage establishments, and as the businesses of hairdressing and massage treatment are frequently associated, the statutory registration has been regarded by the proprietors of those establishments where both trades are conducted as in substitution for voluntary registration. I understand that 120 of the hairdressers' establishments in the City have now been registered in accordance with these Acts. As, however, the regulations for voluntary registration were designed to ensure precautionary measures with regard to the prevention of contagious diseases, and as they still serve a purpose in this direction in respect of premises not otherwise registered, I am of opinion that it is desirable that the voluntary system be continued. The following is a list of establishments at present on the register:— Alfred Kingston, 8 & 10, Ludgate Arcade. Chas. Lehman, 8 & 9, Aldermanbury Postern. Martin Longman, 75, Mark Lane. Thos. W. Monk, 5, Angel Court. Ed. Hy. Prince, 36, Coleman Street. Harry C. Wicks, trading as Arthur & Co., 42a, Old Broad Street. 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 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. Much dirt and discomfort from smoke continues, although to a distinctly lesser degree than in former years, and for which the enormous number of the chimneys, domestic and otherwise, in and surrounding Greater London is largely responsible. Difficulties in the way of obtaining suitable coal and coke are still stated to be a source of trouble at times. 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, 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 shown in the attached table. The table also shows the rainfall for the months of January to December of the year 1923, 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 table it will be appreciated that in the month of October only, the amount of deposit registered as falling in the City amounted to 28.52 tons per square kilometre, which is equal (estimating the City as having an area of one square mile) to no less than about 73 tons avoirdupois. Of this mass of dirt, approximately 35½ tons were soluble, and included the chemicals mentioned, and 37½ 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. 34 From the 1st January until the 31st December the amount of the impurity at noon has varied from half a milligramme to three 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. For many years past it has been increasingly obvious that the use of electricity and gas for heating and cooking purposes is contributing to the diminution of the nuisance from smoke. The cost of electricity is still far too great for its general use, but I believe the substitution of gas for coal and coke in restaurants and business premises is practicable and might be more generally adopted if the gas companies encouraged its greater use, possibly to their own profit and certainly to the advantage of the populace, by arranging a special rate for the supply to premises of the class indicated. London, on the authority of Dr. Owens, in an interview granted to the Daily Express, receives now nearly 30 per cent. more sunshine than in 1881—were such special terms for gas as those suggested arranged, I am of opinion that the increased purity of our atmosphere, as would be observed by City workers, would be so marked than an agitation against the unnecessary use of common coal would result and public opinion might even extend to statutory prohibition being enforced. SUMMARY OF MONTHLY OBSERVATIONS AND REPORTS DURING THE YEAR 1923. Month of the Year 1923. Place. 3 4 5 6 7 8 9 10 11 12 Rainfall in millimetres. Metric tons of deposit per square kilometre during month. Insoluble matter Soluble matter. Included in soluble matter. Tar. Carbonaceous other than tar. Ash. Loss on ignition. Ash. Total solids. Sulphateas (SO3a). Chlorine (Cl) Ammoria (NH3). January City of London 28 0.05 2.07 3.11 1.23 2.47 8.93 0.96 0.56 0.07 Lambeth 30 0.08 1.06 1.49 1.33 2.41 6.37 1.44 0.17 0.09 February (Archbishop's Park) City of London 67 0.05 2.92 3.49 2.16 3.51 12.13 1.86 1.01 0.22 Lambeth 68 0.11 1.64 4.51 0.61 5.49 12.36 1.63 0.70 0.19 March City of London 55 0.08 3.57 5.04 2.22 3.33 14.25 1.98 0.83 0.20 Lambeth 49 0.10 2.40 2.60 1.97 3.90 10.97 1.73 0.52 0.02 April City of London 34 0.05 2.46 3.83 1.21 2.82 10.37 1.20 0.55 0.23 Lambeth 34 0.08 1.84 14.18 1.37 2.96 20.43 1.33 0.35 0.10 May City of London 32 0.09 6.00 7.90 2.56 4.35 20.91 2.68 0.77 0.32 Lambeth 52 0.09 1.89 2.20 1.50 4.01 9.69 1.63 0.49 0.15 June City of London 10 0.03 2.24 3.50 1.09 1.76 8.63 0.84 0.29 0.07 Lambeth 12 0.03 0.75 4.91 0.56 1.65 7.90 0.68 0.26 0.07 July City of London 66 0.03 2.06 4.28 2.65 4.23 13.88 1.78 0.94 0.37 Lambeth 74 0.09 2.39 4.10 0.95 3.92 11.45 1.16 0.54 0.13 August City of London 27 0.05 4.80 6.84 1.65 3.01 16.95 1.92 0.64 0.27 Lambeth 39 014 0.35 2.02 0.78 2.73 6.02 1.18 0.51 0.12 September City of London 20 0.02 1.91 3.04 1.00 2.03 9.20 1.36 0.04 0.13 Lambeth 25 0.04 1.17 1.80 0.49 2.00 5.50 0.87 0.28 0.07 October City of London 105 0.07 6.23 8.32 4.21 9.69 28.52 5.05 1.04 0.42 Lambeth 107 0.26 4.66 7.79 1.49 4.53 18. 73 1.87 0.58 0.19 November City of London 34 0.02 1.05 1.89 2.32 2.86 8.14 1.30 0.60 0.07 Lambeth 35 0.08 0.61 2.19 1.19 3.14 8.21 1.19 0.48 0.09 December City of London 51 0.04 2.53 3.50 1.01 3.65 10.73 1.67 0.76 0.18 Lambeth 50 0.14 2.44 2.85 1.41 3.44 10.28 1.92 0.63 0.15 35 CREMATIONS IN THE UNITED KINGDOM. 39 Years—1885-1923. YEAR. Woking.* Manchester. Glasgow. Liverpool. Hull. Darlington. Leicester Golder's Green Birmingham. Leeds. City of London. Sheffield. Bradford. W. Norwood. Hendon Park. No. of Cremations each year. 1885 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 1886 10 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10 1887 13 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 13 1888 28 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 28 1889 46 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 46 1890 54 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 54 1891 99 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 99 1892 104 3 ... ... ... ... ... ... ... ... ... ... ... ... ... 107 1893 101 30 ... ... ... ... ... ... ... ... ... ... ... ... ... 131 1894 125 47 ... ... ... ... ... ... ... ... ... ... ... ... ... 172 1895 150 58 l ... ... ... ... ... ... ... ... ... ... ... ... 209 1896 137 52 10 2 ... ... ... ... ... ... ... ... ... ... ... 201 1897 173 51 16 10 ... ... ... ... ... ... ... ... ... ... ... 250 1898 240 62 12 27 ... ... ... ... ... ... ... ... ... ... ... 341 1899 240 88 16 23 ... ... ... ... ... ... ... ... ... ... ... 367 1900 301 83 20 40 ... ... ... ... ... ... ... ... ... ... ... 444 1901 273 96 18 40 ... l ... ... ... ... ... ... ... ... ... 445 1902 275 81 20 54 ... 2 l 5 ... ... ... ... ... ... ... 451 1903 143 92 24 35 ... 1 5 158 l ... ... ... ... ... ... 477 1904 138 98 19 40 20 7 8 220 19 ... ... ... ... ... ... 569 1905 95 97 35 35 15 4 16 252 22 16 9 7 l ... ... 604 1906 140 90 44 46 17 13 12 298 25 15 23 6 14 ... ... 743 1907 108 98 30 34 29 8 12 290 33 16 18 18 13 ... ... 707 1908 119 116 28 32 37 6 14 364 18 24 19 12 6 ... ... 795 1909 105 106 30 46 15 9 19 421 30 19 24 18 13 ... ... 855 1910 106 114 28 37 21 9 16 415 38 12 22 8 14 ... ... 840 1911 114 124 39 50 25 12 13 542 44 17 20 10 13 ... ... 1,023 1912 125 149 44 52 27 15 14 591 40 24 32 12 9 ... ... 1,134 1913 128 172 49 66 23 11 11 602 59 16 21 15 15 ... ... 1,188 1914 124 184 57 48 16 11 7† 671 53 28 42 20 18 ... ... 1,279 1915 153 165 63 54 34 16 22 730 45 20 45 21 12 30 ... 1,410 1916 125 179 71 58 25 10 23 633 63 22 43 14 11 89 ... 1,366 1917 129 178 67 62 24 15 34 719 49 17 68 25 10 118 ... 1,515 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 1922 193 189 75 74 45 17 23 939 98 31 70 38 25 186 6 2,009 1923 170 227 90 62 45 21 36 920 75 27 69 37 23 178 6 1,986 Totals 5,218 3,892 1,231 1,329 628 269 432 12253 1,002 425 779 4l3 292 1,241 12 29,415 * "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 the 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. REMOVAL OF HUMAN REMAINS. CHURCH OF St. BENET FINK. In the course of excavations in connection with building operations on the site of St. Benet Fink Church, Threadneedle Street, a quantity of human remains were unearthed. These remains were stored as disinterred in a shed specially erected on the site for the purpose. Two cases, each containing a lead coffin, and one case containing a quantity of loose bones were ultimately removed to Ilford Cemetery for interment with others which have been in the past removed from this site. EXHUMATION AND REINTERMENT OF BODIES AT THE CITY OF LONDON CEMETERY. During the year the bodies of 8 persons buried at the City of London Cemetery at Ilford have been exhumed and subsequently re-interred in other graves in the same Cemetery. In accordance with the terms of the licenses 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. 36 SUPERVISION OF FOODS AND DRUGS. During the year 1923, 951 samples of food or drugs were submitted to the Public Analyst for examination. Of this number, 714 were taken as test samples without the formality of the Act being observed ; of these 21 were found to be adulterated, made up as follows:— 3 of Butter out of 72 samples taken. 3 of Milk out of 48 samples taken. 2 of Boracic Ointment out of 5 samples taken. 2 of Margarine out of 46 samples taken. 2 of Cream out of 12 samples taken. 2 of Sweet Spirits of Nitre out of 3 samples taken. 1 of Cocoa out of 25 samples taken. 1 of Mustard out of 18 samples taken. 1 of Zinc Ointment out of 8 samples taken. 1 of Sponge Cake out of 8 samples taken. 1 of Flaked Beef Suet out of 1 sample taken. 1 of Camphorated Oil out of 3 samples taken. 1 of Rice out of 12 samples taken. Of the formal samples, 27 out of 237 were found to be adulterated, made up as follows:— 16 of Milk out of 204 samples taken. 4 of Whiskey out of 6 samples taken. 2 of Cream out of 2 samples taken. 1 of Zinc Ointment out of 1 sample taken. 1 of Mustard out of 1 sample taken. 1 of Camphorated Oil out of 1 sample taken. 1 of Rum out of 1 sample taken. 1 of Condensed Full Cream Milk Sweetened out of 1 sample taken. Several of the above samples are additional samples purchased at the same shops as those from which samples purchased informally had proved to be adulterated. Only 48 samples of fresh milk were purchased informally, the practice during the last nine months of the year was to observe all formalities in milk sampling. GENERAL OBSERVATIONS.—The percentage rate of adulteration of all foods sampled in the City in 1923 is 5.0 as compared with 11.2 for 1922. The latter figure was due to the special method of sampling employed for the purpose of investigating the prevalence of the use of preservatives and for obtaining proof of the need for standards in certain classes of foodstuffs. In view of the appointment of a Departmental Committee to consider the question of preservatives in food, systematic sampling similar to that of last year was not carried out, it being deemed desirable to await the publication of the Report of the Committee. The Public Health (Condensed Milk) Regulations, 1923, became operative on 1st November, 1923, for the control of the sale of the commodity by retail. Sampling under the Regulations was commenced, but the examination of all the brands and varieties obtainable was not completed by the close of the year. The several instances of adulteration and failure to comply with statutory requirements are reported elsewhere under their respective headings. MARGARINE.—The three cases of adulteration of margarine were each due to an excess of water. The vendors were cautioned. BUTTER.—The two cases of adulteration of butter were both due to an excess of water. The vendors were cautioned. DRUGS.—A total of 8 samples of drugs were found to be adulterated inasmuch as they did not comply with the standards required by the British Pharmacopoeia. Six were informal samples and two formal. The latter resulted in two prosecutions. Cautions were given in the remaining instances. SPIRITS.—In two of the four instances of adulteration of whiskey, cautions were given because of the unsatisfactory manner in which the notices of dilution were displayed. In the remaining two cases no proceedings were taken as dilution notices were conspicuously exhibited at the time the purchases were made. The vendor of one sample of Rum slightly below the standard was cautioned. 37 It seems desirable that some statutory limit should be placed on the extent to which spirits for sale may be reduced, even in the event of a declaratory notice. The standard of 35 degrees under proof laid down in the Licensing Act of 1921 is rendered useless for administrative purposes if notice is given that the sale is of diluted spirits of which no alcoholic strength is guaranteed. Such notices usually take the form of printed cards placed in more or less conspicuous positions on the licensed premises, and the degree of dilution practised under the protection of the notices is sometimes considerable. A purchaser is often seriously prejudiced bv the sale of diluted spirits since there is now no control of the prices charged. MARGARINE ACT, 1887.—Three samples of margarine were supplied in unmarked or improperly marked wrappers. Cautions were issued in each instance. BUTTER & MARGARINE ACT, 1907.—Two samples of margarine were found to contain an excess of water. The vendors were cautioned. SALE OF BUTTER REGULATIONS, 1902.—Three samples of butter were found to contain an excess of water. The vendors were cautioned, and in one instance, in which it was ascertained that the butter had been imported, the facts were reported to the Ministry of Health. DAIRIES, COWSHEDS AND MILKSHOPS ORDERS, 1885, 1886 & 1899. No instances of contravention of these Orders were found during the year. The requirements as to Registration of Purveyors of Milk having been amended by the Milk and Dairies (Amendment) Act, 1922, details of registration effected are reported under that heading on page 38. REGISTRATION OF MANUFACTORIES AND PREMISES OF WHOLESALE DEALERS IN MARGARINE AND MARGARINE CHEESE. One application was received from a firm already registered as Wholesale Dealers in Margarine on account of removal to other premises. The application was granted. ICE CREAM. The conditions under which ice cream is manufactured and sold received attention during the year. The barrows of itinerant vendors were inspected at frequent intervals during the summer season, and in instances where the supplies had been prepared outside the City, enquiries were made as to whether the ice cream was being produced under satisfactory conditions. The practice of making ice cream on the premises where it is sold is decreasing and a considerable number of refreshment establishments now receive it from either a central depot or from wholesale manufacturers. This method of supply facilitates supervision of the materials used and the process of preparation, and tends to eliminate the danger of contamination which is liable to occur when small quantities of ice cream are made as a seasonal side line in connection with another business. Routine inspections were carried out of shops selling ice cream, and enquiries similar to those relating to itinerant vendors, were sent if the product was found to have been prepared in other districts. Six instances of unsatisfactory conditions of manufacture of ice cream were found in the City. In five of these the sale was discontinued as soon as the persons responsible were notified of the neglect to comply with the requirements. In the remaining instance steps were taken to effect certain alterations with a view to securing a general improvement in the methods of manufacture. f 38 MATTERS ASSOCIATED WITH THE SUPPLY OF MILK. THE MILK AND DAIRIES AMENDMENT ACT, 1922. REGISTRATION OF RETAIL PURVEYORS OF MILK.—The scheme of administration under this Act for the City of London, which was detailed in my Annual Report for 1922, subsequently received the approval of the Court of Common Council and was put into operation in January, 1923. It will be remembered that the former register of Dairymen, Cowkeepers and Purveyors of Milk, kept under the Dairies, Cowsheds and Milkshops Orders, was superseded, and the new Act required the Local Authority to keep two registers of Milk Sellers, one relating to Retail Purveyors only, and the other to all Milkdealers, other than Retail Purveyors. The first step taken was to classify the existing registrations, and to ascertain whether the conditions of business to which they related were, in all respects, such as would justify a recommendation for transfer to the new register. For this purpose a card of enquiry was completed for each business, giving detailed particulars of matters relating to the storage and sale of milk, and the methods employed in connection therewith. At each meeting of the Sanitary Committee reports respecting premises were presented, grouped under the following headings :— 1. Satisfactory. 2. Minor defects or omissions. 3. Defects of a more serious character. 4. Unsuitable for retention on the register. Those in group 1 were recommended for registration. Those in group 2 were similarly recommended, a letter having been sent previously to the proprietors calling attention to the defects or omissions. Letters were sent to the owners of businesses in group 3 notifying them of the defects found, and intimating that unless satisfactory improvements were effected the matters referred to would form the subject of a report to the Sanitary Committee, who would consider whether their names should be retained on the register. Registration was not recommended until the conditions were rendered satisfactory. Those in group 4 were speciallv inspected, and a more detailed report on each was presented to the Committee, who delegated the members of the Ward in which the premises were situate to visit them so as to become more intimately acquainted with the matters adversely reported upon. If they were deemed to be capable of sufficient improvement, either by structural alteration, re-organization or otherwise, the owners were afforded the opportunity of submitting schemes to overcome the conditions found to be unsatisfactory. In some instances this proved effective, and the proprietors were duly registered for a period of 12 months, at the expiration of which the registrations will again be* reviewed. Procedure similar to that detailed above was adopted in respect of new applications and the applicants notified of the defects found. In these cases, however, registration was not recommended under any circumstances until the premises and business methods were deemed to be quite satisfactory. In this way the various essential matters in connection with the formation of the new register were considered, and the Sanitary Committee enabled to decide whether it was desirable to permit a continuance of any registration in operation at the commencement of the Act, and also whether new applications could be granted. In addition, some degree of uniformity of compliance with requirements was assured for both old and new registrations. A schedule of defects, &c., found during the inspection of milk retailers' premises is as below:— SCHEDULE OF DEFECTS. The following table shows details of the various defects and unsatisfactory conditions found during the inspection of premises at which milk is retailed — Absence of, or defective cover to Milk Vessel 68 Milk Vessel kept in an unsuitable position 58 Want of cleanliness 36 Absence of, or unsuitable lavatory facilities 29 Inadequate facilities for cleansing Milk Vessels 17 Insufficient water closet accommodation 17 39 Exposure of Milk or Milk Utensils to dust contamination 16 Refuse Bin foul and/or without a proper cover 14 Want of ventilation 12 Defective water closet 11 Proximity of articles having a contaminating odour 10 Accumulation of Refuse 9 The use of Sawdust on floors, etc. 9 Sink waste-pipe not undertrapped 7 Absence of separate water closet accommodation for the sexes 6 Defective Sink 3 Choked Gulley 2 Defective Lavatory Basin 2 Leaking Waste-pipe 2 Defective Flooring 2 Broken Manhole Cover 1 Gas Stove emitting fumes 1 Total 332 The standard for registration purposes which I recommended was that which is laid down in the Corporation's existing regulations, further consideration being given to any special difficulties as they arose. The advisability of such a course has been proved by the information obtained during the routine inspections. The conditions under which milk is retailed in the City are in many respects peculiar to itself and, in consequence, several administrative problems have presented themselves which are not easy to solve. It is a comparatively simple matter to supply the needs of the permanent resident population, but a very different one to satisfy the demands of its nonresident day and night workers. This is exemplified by the increasing number of restaurants and refreshment rooms, and the utmost use which is made of small lock-up shops, basements, and even open air stalls, to provide refreshment for those that need them. Most of the new buildings which are being erected within the City's boundary are used for the executive control of large business concerns. Manufacturing and handicraft works are being removed gradually to surrounding districts because there is no longer room for them. The demand for refreshments, including milk, is not diminished by this change, though the class of premises at which they are sought is somewhat altered. There are no dairies or milk shops, as such, in this area. There are comparatively few premises where the sale of milk alone forms the principal, or even a substantial portion of the trade. Where such shops do exist, the over-counter business invariably is combined with the sale of light refreshments, and an out-door retail milk distribution of varying dimensions is carried on. In the remainder, the retailing of milk forms part of a restaurant, grocery, provision, confectionery, or dry goods business. In most of these, milk is not sold for the profit derived from it, but because it stimulates trade in other commodities. The sale of a few quarts of milk per day then becomes an important item of the total trade. It has been found that the premises, from an official point of view, are not ideal ; they were, perhaps, never intended for a milk business and may have been so crudely adapted for it as to provide little protection for the goods retailed. There may be an absence of most of the essential requirements for the sale of milk. The multiplicity of articles stored in some of these shops renders frequent and thorough cleansing, and freedom from dust accumulations on all interior surfaces, a practical impossibility. To prohibit the sale of milk, or almost any of the other commodities, would considerably reduce the daily turnover. In such cases the following principles were adopted:—In the case of existing registrations, such improvements as were practicable were made, and the proprietors registered for a period of 12 months. In certain cases in this category they were asked for an undertaking to sell milk only in beverages during that period. A distinction was thus made between milk in small quantity added as an ingredient to an article of drink (and in respect of which the purchaser can discriminate as to the quality of the beverage supplied), and milk sold in larger quantity for other purposes. Such an undertaking, if observed, eliminates the sale of milk as milk f2 40 from these premises, but registration having been effected they will come under periodical supervision to ensure that even the milk as used therein is not subjected to avoidable contamination. In course of time this class of premises will cease to require special consideration of this kind. Some will be demolished in the course of improvement and development schemes, and when changes of proprietorship occur, necessitating a new application for registration, it is unlikely that such applications will be granted. Another difficulty has been that of dealing with old-established milk businesses in buildings which, though sufficient to meet the needs of the past, have not been capable of the requisite reconstruction to satisfy the more exacting legislative and public requirements of the present day. Economic hindrances prevent the rehousing of such concerns in more suitable premises, however willing the proprietors may be to adopt this course. It is doubtful whether extensive renovation could be carried out satisfactorily and the business remain in continuous operation. It is not desirable at the present time to compel traders to expend considerable sums of money on old buildings. If the powers conferred by the new Act were strictly enforced in such cases, and the registration terminated, serious financial loss would ensue. The attitude of the Sanitary Committee has been to grant a generous period of time in which the proprietors concerned may make the most suitable arrangements to meet the requirements. Owing to the greatly enhanced value of ground space in the City, basements are extensively used as refreshment rooms, and in connection with the sale of milk. Reference was made in my Annual Report for 1921 to the detriments occasioned by the use of these rooms as workrooms. These are intensified in basement refreshment rooms, which become overcrowded and ill-ventilated during the busy hours of the day. However, the quantity of milk sold in each of these is relatively small and it would be difficult to say that the conditions are so unsatisfactory as to warrant a termination of registration. Some basements were found in which considerable quantities of milk were handled, or other incidental work, connected with out-door retail distribution, was carried on. This was a very objectionable feature. The rooms, originally constructed as cellars, had little natural light and were of necessity particularly liable to the access of gross impurities from the street, at which level the only ventilating openings were placed. They were entirely unsuited for use in connection with milk distribution, but by some alteration they might be made suitable to supplement the facilities required for a shop counter trade. For the reasons already specified it was found impossible to remove these businesses elsewhere; it therefore became necessary to decide whether the continued use of these basements could be permitted and, if so, what requirements must be complied with. I submitted a report to the Sanitary Committee on 27th Nov., 1923, and after an inspection by a sub-committee of the premises concerned, the following schedule of minimum requirements was approved for. all basements used as dairies or in connection with dairy work:— (1) The walls should be lined with some impervious material capable of being regularly washed, if not hosed. (2) Ceilings should be sound and regularly limewashed. (3) Floors should be of impervious material without cracks or crevices and capable of being regularly washed. (4) Drainage should be by means of a sealed gulley, and the necessity of regular attention to cleanliness must be impressed upon the occupiers. (5) Hot water should be available as well as cold. (6) A sink should be provided for ablution purposes. (7) All benches and counters should be movable so that they can be taken away from the walls and every part thoroughly cleansed. (8) The basement should be used for no other purpose than that of dairying. (9) Artificial light should be adequate. (10) Ventilation should be by means of a fan which draws in air from a chosen point, and it is desirable that such air should be filtered. When these conditions are satisfactorily complied with registration will be granted. 41 The foregoing remarks summarise the varying circumstances met with, and the general principles which have been adopted in the administration of that portion of the Act which deals with registration. The discretionary powers given to the Local Authority will enable a gradual improvement to be secured in milk retailing, particularly in respect of new applications. Where there is continued and gross neglect of essential principles in connection with either the quality, storage or distribution by registered purveyors, it can be checked by termination of registration. It will seldom be found necessary to exercise this power, but the fact of its existence will have a salutary effect upon careless milk retailers. EXPERIMENTAL SAMPLING OF MILKS. On numerous occasions retailers of milk from whom a sample has been purchased for analysis, and which has proved to be below the required standard, have stated with emphasis that the milk whilst in their control has not been tampered with. Enquiries showed that often the statement was probably correct and that in some instances careless methods in connection with the act of retailing could be held responsible. With a view to ascertaining to what extent this suggestion might be operative,experimental sampling was undertaken in the following circumstances:— Samples of milk were examined (a) From counter pans from which milk was being retailed during several hours; (b) From a churn which had been used to distribute milk throughout the City, the churn itself being carried on a four-wheeled " pram " ; (c) From churns of milk which had been in course of rail transit for several hours; and (d) From a churn of milk removed from a cold stores. Results in all these instances clearly indicate that, unless precautions are taken to ensure that milk is satisfactorily mixed, variations in the composition of the milk retailed must arise. 1—MILK RETAILED FROM COUNTER PANS.—Three counter pans were taken similar to those in use in the small restaurants. Into each were placed four gallons of milk. The milk was received in bulk at 9.50 a.m. A sample of this was examined and found to contain approximately 3 per cent. of fat. At short intervals half a pint of milk was taken from each pan, and before the removal of this quantity the milk in No. 1 pan was well stirred, that in No. 2 pan was stirred in the usual manner of the trader, and the milk in No. 3 pan was disturbed as little as possible. At 12.20 a sample of milk for analysis was taken from each pan, which at that time had been dipped into 24 times, and from each pan one and a half gallons had been removed. At this time analysis showed that the percentage amount of fat in Nos. 1 and 2 pans had not decreased, but that the fat content of the milk in No. 3 had been reduced by 32 per cent. below the standard of 3 per cent. At 3.40 p.m. a second series of samples for analysis was taken, and at this time each pan had been dipped into 48 times and there was remaining a gallon of milk in each pan. Analysis showed that the fat content in No. 1 was still as in the original sample, but that the fat in No. 2 was reduced by 20 per cent. and the fat in No. 3 by 45 per cent. below the standard. The following tables show the results of these analyses:— No. 1 Pan. Well stirred. No. 2 Pan. Stirred as by trader. No. 3 Pan. Disturbed as little as possible. Time. Fat. Solids not Fat. Water. % Fat abstracted. Fat. Solids not Fat. Water. Fat abstracted. Fat. Solids not Fat. Water. % Fat abstracted. 12.20 3.0 8.72 88.28 0 3.02 8.64 88.34 0 2.02 8.82 89. 16 32 3.40 2.96 8.92 88.12 0 2.40 8.88 88.72 20 1.64 8.66 89.70 45 The above results show (a) that with reasonable care milk can be served from a counter pan so that the fat content will remain constant for several hours, (b) that after two hours, and without any intention to deceive on the part of the retailer, the ordinary stirring which the retailer gives milk taken from the pan may 42 result in the remaining milk showing a deficiency amounting to 20 per cent. of fat, and (c) that milk served from a counter pan and not so stirred may show 32 per cent. deficiency of fat after two hours and as much as 45 per cent. after six hours. 2.—EXAMINATION OF MILK DISTRIBUTED BY CHURNS ON "PRAMS."—A pram churn is a receiver holding about 15 gallons which is supported on the framework attached to two, three or four wheels. The churn has a tap at the bottom through which milk is drawn from the churn. The pram is drawn through the City and milk is served as desired by customers. Sixteen gallons of milk were received, placed in the churn, well plunged and a sample taken from the upper level. This sample showed 3.10 per cent. of fat. The milk was received at 10.30 a.m. and the first round commenced at 10.45. At 12.15 the first round was completed, and a sample was taken from the tap and examined. The fat content of this sample was 3.08 per cent. Five gallons of milk, to represent the amount of milk which would have then been sold, were drawn off from the tap and the second round was commenced at 12.20. At 1.45 a third sample was drawn off which showed only 2.16 per cent. of fat. Five gallons of this milk were now drawn off and the remainder of the milk in the churn, that is five to six gallons, were well plunged. A sample of this well stirred milk was taken and was shown to contain 3.36 per cent. of fat. These analyses are set out in the following table:— Constituents. Original Milk. Sample of Milk drawn from tap after 1¼ hours' perambulation. Sample of Milk drawn from tap after 2½ hours' perambulation. Sample of the final five to six gallons left in the churn. Fat 3.10 3.08 2.16 3.36 Solids not fat 8.96 8.92 9.04 8.90 Water 87.94 88.00 88.80 87.74 100.00 100.00 100.00 100.00 These results clearly show that after a time the fat content of milk distributed from a churn on wheels tends markedly to rise to the top, and a sample of milk drawn from the tap at the bottom and taken half way through the distribution period will show much less fat than the milk remaining in the upper layers. It is only occasionally that a stirrer is available and the dealer in such circumstances exposes himself to the risk of a prosecution should an official sample be purchased. 3.—EXAMINATION OF MILK CONTAINED IN CHURNS AFTER A LONG RAILWAY JOURNEY.—It is frequently the practice of distributors to receive milk at the railway station after a long journey and to mix a portion from one churn with a portion from another. Unless the distribution is preceded by thorough stirring of the milk the constituent elements of the milk will show marked variations. For this purpose the milk in a churn, selected at random, was examined, the samples being drawn off by means of a syphon tube. The first sample was drawn from the churn at a level of two inches from the bottom, the second at a level of 12 inches from the bottom, and the third at a level of 5 inches from the top of the milk. A fourth sample was taken after the milk in the churn had been well plunged and mixed. The churn in question arrived from Darsham, which is 95½ miles from Liverpool Street, and contained 16 gallons of milk. In this experiment it was found that No. 1 sample was 46 per cent. deficient in fat, No. 2 was 10 per cent. deficient in fat and the third showed marked excess of fat. The mixed milk contained 3.22 per cent. of fat. The analyses are as follows:— Constituents. No. 1—taken 2" from the bottom of Churn. No. 2—taken 12" from the bottom of Churn. No. 3—taken 5" from the top of the Churn. Analysis of the Milk after being well plunged. Fat 1.60 2.68 9.00 3.22 Solids not fat 9.12 8.94 8.24 8.96 Water 89.28 88.38 82.76 87.82 100.00 100.00 100.00 100.00 It is interesting to compare these results with those obtained by Dr. Wilson and Mr. Charles MacAra, reported in the Medical Officer, of April 28th, 1923. Samples of pasteurised milk which had stood all night in churns and which had been 43 exposed to the joltings of a lorry, were taken from the top before being thoroughly mixed by plunging, and after mixing, and each submitted to analysis. The fat content in these cases was as follows:— After standing and before thorough stirring. After stirring No. 1 12.6 3.4 No. 2 10.2 3.3 No. 3 15.6 3.3 No. 4 9.6 3.1 No. 5 16.5 3.2 No. 6 12.9 3.3 The above experiments show clearly the necessity for thoroughly mixing milk if it has stood for any considerable time and particularly after it has been exposed to the unavoidable jolting of conveyance over a distance whether by train or road. 4.—EXAMINATION OF MILK DURING THE PROCESS OF THAWING. —It is sometimes a practice when surplus milk is available to keep it in cold store. Such milk should, before being mixed with other milk or being sold, be thoroughly and completely thawed and well plunged as is proved by the analyses set out below. For the purpose of the experiment a glass jar of about 5½ gallons capacity was filled with milk and put into cold store, where it ultimately froze solid. At a later date the milk was removed and slowly thawed, and each gallon as it thawed out was submitted to examination. In addition, a mixed sample consisting of the 1st, 2nd and 3rd gallons thawed was examined and another sample consisting of the 1st. 2nd. 3rd and 4th gallons thawed. The analvses are set out below:— Fat % Solids not fat % Water % Total. Mixed Milk 3.78 8.96 87.26 100.00 1st Gallon thawed 11.01 17.07 78.92 100.00 2nd „ „ 5.20 10.65 84.15 100.00 3rd „ ,, 6.01 5.88 88.11 100.00 4th „ „ 3.71 2.62 93.67 100.00 5th „ ,, 3.64 1.02 95.34 100.00 Mixture of 1st, 2nd and 3rd gallons thawed 4.45 12.93 82.62 100.00 Mixture of 1st, 2nd, 3rd and 4th gallons thawed 4.11 10.63 85.26 100.00 An analyst would at once recognise there was some abnormality in the milks under examination from the peculiar percentages and the results would be more suggestive of abnormality than the probability of adulteration. But, as Mr. Pinchin, the City Analyst, points out, if the 3rd, 4th and 5th gallons thawed out had been mixed with normal milk the result would be that the analysis would indicate added water. Take a definite case, if normal milk containing 3 per cent. of fat, 8.5 of solids not fat, and 88 per cent. of water were mixed with an equal bulk of the 5th gallon thawed out, the mixture would show 3.57 per cent. of fat, 4.76 per cent. of solids not fat, and 91.67 per cent. water. In this instance the ratio of fat and solids not fat points to something abnormal, but calculated on the usual basis would show 45 per cent. of added water. A smaller admixture of the 3rd, 4th and 5th gallon thawed would show added water without abnormality and would be treated as an adulteration in the ordinary way. The analyses in the above four series are of interest and indicate the necessity for using common sense both in the retail and wholesale distribution of milk, and particularly when such milk has been standing either still or subjected to jolting or if the milk has been subjected to a low degree of chilling. The details in connection with the above experiments were carried out by Mr. Fowler, Inspector of Foods and Drugs, and the analyses were all done by Mr. E. A. Pinchin, B.Sc., F.I.C., City Analyst. The following instances of unintentional adulteration of milk are perhaps of some interest:— (1) During the course of sampling in the hot weather at a milk shop, two churns containing milk for sale were found to have lumps of ice floating in them. A sample was taken from each churn and the public analyst reported the samples to contain 2 per cent. and 3 per cent. of added water respectively. The explanation given by the proprietor was that the ice had been put in to keep the milk cool, and the fact that the milk would be adulterated by the melting ice was presumably overlooked. 44 (2) A sample of hot milk was certified by the Public Analyst to contain 5 per cent. of added water. The vendor was cautioned and submitted the explanation that it was usual to serve hot milk from a special urn kept for the purpose, but when this was emptied it was the practice to pass live steam from a jet attached to the water boiling apparatus through a glass of cold milk until it had been sufficiently heated. Presumably it did not occur to the vendor that the steam which condensed in the milk would be equivalent to added water. EXAMINATION OF MILK.—CHEMICAL AND BACTERIOLOGICAL AND AS TO PRESENCE OF DIRT. (A) CHEMICAL.—The percentage of milk adulteration for both formal and informal samples together is 7.5 as compared with 5.4 for 1922. Of the 19 adulterated samples 3 were informal and 16 formal samples. There were seven prosecutions. The following summary is of interest as it shows the percentage of fat contained in each of the 252 milks examined. Eleven out of this number contained fat in amount below the point which presumes adulteration, i.e., 3 per cent. The highest proportion of fat was 6.2 per cent.:— TABLE SHOWING PERCENTAGE OF FAT IN ALL MILK SAMPLES. Percentage of Fat. No. of Samples. Percentage of Fat. No. of Samples. 2.4 l 4.4 2 2.5 l 4.5 5 2.6 2 4.6 1 2.7 2 4.7 1 2.8 2 4.8 2 2.9 3 4.9 - 3.0 5 5.0 - 3.1 15 5.1 - 3.2 17 5.2 1 3.3 19 5.3 - 3.4 30 5.4 1 3.5 35 5.5 2 3.6 31 5.6 - 3.7 23 5.7 1 3.8 17 5.8 - 3.9 8 5.9 - 4.0 7 6.0 - 4.1 8 6.1 - 4.2 8 6.2 1 4.3 1 Total 252 (B) BACTERIOLOGICAL AND AS TO PRESENCE OF DIRT.—During the month of October, 42 samples of milk were obtained and submitted to Sir Frederick Andrewes, F.R.S., City Bacteriologist, for bacteriological examination and investigation as to the presence of "dirt." These samples arrived from 42 different farms, viz.:—15 in Norfolk, 15 in Essex, 10 in Suffolk and 2 in Cambridgeshire. In three instances the investigation was not completed, which leaves 39 samples as the total on which statistics are based. Of these 39 samples only one proved to be tuberculous. The percentage was accordingly 26 as compared with 9.5 in 1922. All the samples were examined for the presence of dirt, and 28, or 66.6 per cent., were reported upon as clean, but it is satisfactory to note that of the remainder none were really dirty. 45 The percentage of samples infected with the tubercle bacillus is by far the lowest recorded since 1904, when these investigations were commenced in the City, particulars of which are detailed below:— Year. Percentage showing Tuberculous Infection. Year. Percentage showing Tuberculous Infection. 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 series 4.7 „ 1921 24. 2 „ 1st series. 1910 6.25 „ 26.3 „ 2nd „ 1912 6.6 „ 12.5 „ 3rd „ 1922 9.5 „ 1923 2.6 „ In the case of the infected sample the usual procedure was followed of notifying the Medical Officer of the London County Council. A subsequent communication was received to the effect that the animals at the farm from which the milk was received had been examined. These enquiries elicited the fact that one animal had been slaughtered a fortnight previous to the inspector's visit, on account of certain suspicious symptoms, but that the remaining 60 animals were found to be free from evident signs of disease. IMPORTED DUTCH MILK. Samples of new milk imported into this country from Holland were taken in April and submitted to the Public Analyst, who reported thereon as follows:— Fat 2.38 per cent. Solids not fat 8.68 ,, Water 88.94 ,, 100.00 "The sample was deficient in fat to the extent of 20 per cent. of the original. No preservatives could be detected. The absence of preservatives and the fact that less than half per cent. of cream rose to the surface on standing, point to the milk having been sterilized." From the above it will be seen that the milk was 20 per cent. deficient in fat, containing no trace of preservatives and was probably sterilized. This latter, doubtless, accounted for the importers' statement that the milk would keep for several days. It is not within the power of the Corporation to take action in connection with imported milk until after it has left the quay and been released for sale. The supervision is within the jurisdiction of the Commissioners of Customs. In these circumstances, therefore, the facts were forwarded to the Customs Authorities, and the Ministry of Health and Ministry of Agriculture were notified of the circumstances. REGISTRATION STATISTICS. Number of Retail Purveyors of Milk on the Register at the end of 1923:— Transferred from Old Register 284 New Applications 50 Total 334 Number of Milksellers (other than Retail Purveyors of Milk) on the Register at the end of 1923:— Transferred from Old Register Nil. New Applications Nil. Number of Inspections of Premises at which Milk is retailed 751 g 46 PUBLIC HEALTH (MILK AND CREAM) REGULATIONS, 1912 AND 1917. During 1923, 252 samples of milk were examined under these regulations, and all were found to be free from preservative. Fourteen samples of cream (not preserved) were taken, four of which were certified to contain boric acid, though not in excess of the amount permitted by the regulations. Of these four samples, two informal and two formal samples were purchased from the same two vendors respectively. The Sanitary Committee were unable to accept the explanations offered by the vendors for non-compliance with the requirements and proceedings were instituted resulting in a conviction in each case. Eleven samples of preserved cream were taken and found to comply with the regulations as to labelling and the amount of preservative allowed. In no instance did the fat content of preserved cream fall below 35 per cent. No contravention of the other requirements relating to preserved cream were found. All the samples of cream and preserved cream were found to be free from thickening substances. 1. MILK ; AND CREAM NOT SOLI) AS PRESERVED CREAM. (a) Number of samples examined for the presence of Preservative. (b) Number in which Preservative was reported to be present and percentage of Preservative found in each sample. Milk 252 None. Cream 14 4 0.34 per cent 0.21 „ 0.30 „ 10.35 „ Nature of preservative in each case in column (b) and action taken under the regulations in regard to it. (1) Boric Acid. Informal sample. Formal sample taken. (2) Boric Acid. Informal sample. Formal sample taken. (3) Boric Acid. Formal sample taken from the same vendor as No. (2). The vendor was afforded the opportunity of furnishing an explanation in writing. This explanation and the circumstances were considered by the Sanitary Committee and a prosecution was ordered. The penalty imposed was £15 15s. and £2 2s. Costs. (4) Boric Acid. Formal sample from the same vendor as No. (1). The vendor was afforded an opportunity of furnishing an explanation in writing. This explanation and the circumstances were considered by the Sanitary Committee and a prosecution was ordered. The penalty imposed was £15 15s. and £2 2s. Costs. 2. CREAM SOLD AS PRESERVED CREAM. (a) Instances in which samples have been submitted for analysis to ascertain if the statement on the labels as to preservatives were correct. (i.) Correct statements made 11 (ii.) Statements incorrect 0 Total 11 (iii.) Percentage of preservative found in each sample 0.16 Percentage stated on Statutory Label 0.4 0.25 0.4 0.32 0.4 0.16 0.4 0.19 0.4 0.33 0.4 0.32 0.4 0.26 0.4 0.38 0.4 0.23 0.4 0.39 0.4 (b) Determinations made of milk fat in cream sold as preserved cream. (i.) Above 35 per Gent. 11 (ii.) Below 35 per cent. 0 Total 11 47 (c) Instances where (apart from analysis) the requirements as to labelling or declaration of preserved cream in Article V. (1) and the proviso in Article V. (2) of the regulations have not been observed. Nil. (d) Particulars of each case in which the regulations have not been complied with, and action taken. Nil. THICKENING SUBSTANCES.—Any evidence of their addition to cream or preserved cream. Action taken where found. None. OTHER OBSERVATIONS, IF ANY. ARSENIC IN COCOA. In May last enquiries were made into the following circumstances. Information was received from the Medical Officer of Health of an outlying area to the effect that a sample of cocoa purchased in that area had been proved to contain arsenic to the extent of 1 /80 of a grain per lb. and that such cocoa was stated to have been obtained from a wholesale firm carrying on business in the City. It was learned that the wholesaler in question obtained his supplies from two manufacturers—one in Liverpool and one in Holland. A sample from each of these sources was examined and both were reported as free from arsenic. A portion of the sample returned by the retailer for purposes of identification was also examined and found to contain 0.009 grains of arsenic per lb. These facts were reported to the Medical Officer of Health who first acquainted me of the circumstances, and, I understand, he arranged for the destruction of the remainder of the affected parcel in his area. TINNED SPINACH. A consignment of greened spinach, packed in quart and half gallon tins, arrived in London in May from Holland. Samples were examined and found to contain copper and tin as follows:— Copper calculated as Crystallized Per Cent. Copper Sulphate. Grains per lb. Tin. Per Cent. Grains per lb. Quart Sample .069 4.85 .03 2.10 Half-gallon Sample .078 5.46 .044 3.08 The sale of the consignment for human consumption was prohibited and a request that it should be re-exported was refused. The consignment was ultimately destroyed. PROTECTION OF BREAD. A valuable suggestion was made during the year by one of the Metropolitan Borough Councils. In their area the practice of the exchange of unused bread for fresh bread had so developed as to give rise to some anxiety on the part of the Public Health Committee, as to the possibility of this practice contributing to the spread of infection. The following resolution was, therefore, passed and forwarded to the Ministry of Health and sanitary authorities throughout the country "That the Government be requested to introduce a Bill to make illegal the practice common among the vendors of bread of accepting from customers unused bread in exchange for fresh, this Council being of opinion that such practice provides a means of spreading contagion and infection and, in consequence, is prejudicial to the health of the community." The practice referred to is one which I am of opinion should be prevented so far as is possible, although I fear that any practical means of prevention are difficult to devise or, when devised, to enforce. The protection of bread also received attention in another Metropolitan Borough, the Council of which made representations to the Ministry of Health in favour of legislation or the making of regulations requiring that persons selling bread for human consumption should enclose the bread in a suitable hygienic wrapper or similar covering. With this view also I agree, although again recognising the difficulty of framing regulations which are likely to attain the end desired. g2 48 ADMINISTRATIVE ACTION REGARDING SAMPLES 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, stateresult, showing fines and costs separately.[/##] Quarter ending 31st March, 1923. Rice 4 Total mineral matter 1.45%, being about 1% in excess of the normal amount. .... .... Milk 50 13% of original fat abstracted .... .... „ 121 6% of added water .... .... 14% of original fat abstracted „ 133 20% of added water .... .... Boracic Ointment 167 18% deficient in Boric Acid .... .... „ 170 9.5% deficient in Boric Acid .... .... Milk 212 9% of added water Fined £2 £3 3s. Costs. .... „ 214 9% of added water Fined £2 Sponge Cake 234 0.20% of Boric Acid .... .... Quarter ending 30th June, 1923. Milk 312 16% of original fat abstracted Fined £2 and £1 1s. Costs. .... Cocoa 321 0.009 grains of Arsenic per lb. .... .... Milk 365 9% of added water Vendor ordered to pay £1 1s. Costs. .... „ 388 5% of added water .... .... „ 430 9% of original fat abstracted .... .... Quarter ending 30th September, 1923. Zinc Ointment 515 43% excess of Zinc Oxide .... .... Butter 534 1.9% excess of water .... .... Cream 542 0.34% of Boric Acid .... .... „ 546 0.21% of Boric Acid .... .... „ 580 0.30% of Boric Acid .... Fined £15 15s. & £2 2s. Costs. „ 581 0.35% of Boric Acid .... Fined £15 15s. & £2 2s. Costs. Zinc Ointment 583 33% excess of Zinc Oxide Fined £1 and £1 1s. Costs. .... Milk 600 2% of added water .... .... „ 601 3% of added water .... .... Margarine 618 0.7% excess of water .... .... Milk 635 8% of fat abstracted .... .... Whiskey 667 43.6 degrees under proof .... .... „ 668 37.5 degrees under proof .... .... ,, 670 38.6 degrees under proof .... .... „ 679 46.9 degrees under proof .... .... Mustard 693 31% of wheat flour coloured with a trace of Turmeric. .... .... Milk 694 8% of added water Fined £3 and £1 1s. Costs. .... Mustard 721 29% of wheat flour coloured with a trace of Turmeric. Fined £5 and £1 1s. Costs. .... Milk 738 8% of added water Fined £1 and 17 /6 Costs. .... „ 739 8% of original fat abstracted .... .... Quarter ending 31st December, 1923. Butter 758 0.3% excess of water .... .... „ 762 1.3% excess of water .... .... Margarine 765 0.3% excess of water .... .... Milk 781 7% of original fat abstracted .... .... „ 803 3% of added water .... .... „ 811 12% of original fat abstracted Fined £2 and £2 2s. Costs. .... Camphorated Oil 818 44% deficient in Camphor .... .... „ 858 48% deficient in Camphor Fined £5 and 19/6 Costs. .... Milk 900 5% of added water .... .... Sweet Spirit of Nitre 913 44% deficient in Ethyl Nitrite .... .... „ 914 34% deficient in Ethyl Nitrite .... .... Rum 923 37.1 degrees under proof .... .... Condensed Full Cream Milk Sweetened 951 9% deficient in fat .... .... 49 NOT REPORTED TO BE GENUINE. 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. Vendor cautioned. Resampled .... Subsequent sample genuine. Vendor cautioned .... Same vendor as No. 121. „ „ .... Samples from same vendor. Vendor cautioned. 1 Reported to Sanitary Committee. (See p. 47.) Vendor cautioned. .... Sample taken at vendor's request to assist in investigations relating to Sample No. 312. Resampled. Vendor cautioned. Resampled. Same Vendor as No. 546. .... .... „ „ 542. .... .... „ „ 515. Vendor cautioned .... Ice found in churns. „ „ .... Reported to Sanitary Committee. Vendor cautioned. .... Notice of dilution exhibited. Vendor cautioned. .... Notice of dilution faded and indistinct. Resampled. .... Same Vendor as No. 693. Vendor cautioned. .... Imported Butter. Circumstances reported to Ministry of Health. Resampled. .... Same Vendor as No. 818. Vendor cautioned. Reported to Sanitary Committee. Vendor cautioned. 50 51 SALE OF FOOD AND DRUGS ACTS, AND THE PUBLIC HEALTH (MILK AND CREAM) REGULATIONS. Articles examined during each Quarter of the year 1923. Articles submitted for Analysis. Quarter ending 31st March. Quarter ending 30th June. Quarter ending 30th SeDtember. Quarter ending 31st December. Total for 1923. No of Samples taken. No. Genuine. No. Adulterated. Percentage of Adulteration. No. of Samples taken. No. Genuine. No. Adulterated. Percentage of Adulteration. No. of Samples taken. No. Genuine. No. Adulterated. Percentage of Adulteration. No. of Samples taken. No. Genuine. No. Adulterated. Percentage of Adulteration. No. of Samples taken. No. Genuine. No. Adulterated. Percentage of Adulteration. Brandy .... .... .... .... .... .... .... .... 3 3 .... .... 3 3 .... .... 6 6 .... .... Butter .... .... .... .... .... .... .... .... 2 2 .... .... .... .... .... .... 2 2 .... .... Camphorated Oil .... .... .... .... .... .... .... .... .... .... .... .... 1 .... l 100.0 1 .... 1 100.0 Condensed Full Cream Milk. Unsweetened .... .... .... .... .... .... .... .... .... .... .... .... 1 1 .... .... 1 1 .... .... Condensed Full Cream Milk Sweetened .... .... .... .... .... .... .... .... .... .... .... .... 1 .... l 100.0 1 .... 1 100.0 Cream (not preserved) .... .... .... .... .... .... .... .... 2 .... 2 100.0 .... .... .... .... 2 .... 2 100.0 Gin .... .... .... .... .... .... .... .... 6 6 .... .... .... .... .... .... 6 6 .... .... Milk 32 29 3 9.3 33 29 4 12.1 88 82 6 6.8 51 48 3 5.8 204 188 16 7.8 Mustard .... .... .... .... .... .... .... .... 1 .... 1 100.0 .... .... .... .... 1 .... 1 100.0 Rum .... .... .... .... .... .... .... .... .... .... .... .... 6 5 1 16.6 6 5 1 16.6 Whiskey .... .... .... .... .... .... .... .... 6 2 4 66.6 .... .... .... .... 6 2 4 66.6 Zinc Ointment .... .... .... .... .... .... .... .... 1 .... 1 100.0 .... .... .... .... 1 .... 1 100.0 Total formal samples 32 29 3 9.3 33 29 4 12.1 109 95 14 12-8 63 57 6 9.5 237 210 27 11.3 Informal:— Allspice (Ground) 1 1 .... .... .... .... .... .... 2 2 .... .... .... .... .... .... 3 3 .... .... Almonds (Ground) 1 1 .... .... 1 1 .... .... 2 2 .... .... 2 2 .... .... 6 6 .... .... Almond Oil .... .... .... .... 3 3 .... .... .... .... .... .... 3 3 .... .... 6 6 .... .... Arrowroot 5 5 .... .... 4 4 .... .... 2 2 .... .... .... .... .... .... 11 11 .... .... Bacon .... .... .... .... .... .... .... .... .... .... .... .... 1 1 .... .... 1 1 .... .... Baking Powder 3 3 .... .... 3 3 .... .... 2 2 .... .... .... .... .... .... 8 8 .... .... Boracic Acid .... .... .... .... 4 4 .... .... .... .... .... .... 2 2 .... .... 6 6 .... .... Borax .... .... .... .... 4 4 .... .... .... .... .... .... .... .... .... .... 4 4 .... .... Bread 3 3 .... .... .... .... .... .... .... .... .... .... .... .... .... .... 3 3 .... .... Butter 16 16 .... .... 32 32 .... .... 4 3 1 20.0 20 18 2 10.0 72 69 3 4.1 Cake Flour 2 2 .... .... .... .... .... .... .... .... .... .... .... .... .... .... 2 2 .... .... Camphorated Oil .... .... .... .... .... .... .... .... .... .... .... .... 3 2 1 33.3 3 2 1 33.3 Castor Oil 6 6 .... .... .... .... .... .... .... .... .... .... .... .... .... .... 6 6 .... .... Cayenne Pepper 2 2 .... .... 2 2 .... .... .... .... .... .... 3 3 .... .... 7 7 .... .... Cheese 3 3 .... .... 7 7 .... .... 2 2 .... .... 3 3 .... .... 15 15 .... .... Chicory 4 4 .... .... .... .... .... .... .... .... .... .... 2 2 .... .... 6 6 .... .... Chocolate Powder 3 3 .... .... .... .... .... .... 1 1 .... .... 2 2 .... .... 6 6 .... .... Chutney 1 1 .... .... .... .... .... .... .... .... .... .... .... .... .... .... l 1 .... .... Cinnamon (Ground) 2 2 .... .... 1 1 .... .... 2 2 .... .... .... .... .... .... 5 5 .... .... Citric Acid 3 3 .... .... .... .... .... .... 3 3 .... .... .... .... .... .... 6 6 .... .... Cloves (Ground) 2 2 .... .... .... .... .... .... 2 2 .... .... .... .... .... .... 4 4 .... .... Cocoa 6 6 .... .... 9 8 1 11.1 7 7 .... .... 3 3 .... .... 25 24 1 4.0 Coffee 6 6 .... .... 7 7 .... .... 6 6 .... .... 2 2 .... .... 21 21 .... .... Cornflour 1 1 .... .... 1 1 .... .... 1 1 .... .... .... .... .... .... 3 3 .... .... Cream of Tartar 2 2 .... .... 3 3 .... .... 3 3 .... .... .... .... .... .... 8 8 .... .... Cream (Not Preserved) .... .... .... .... 3 3 .... .... 9 7 2 22.2 .... .... .... .... 12 10 2 16.6 Cream (Preserved) .... .... .... .... .... .... .... .... 11 11 .... .... .... .... .... .... 11 11 .... .... Curry rowder .... .... .... .... 4 4 .... .... .... .... .... .... .... .... .... .... 4 4 .... .... Custard Powder .... .... .... .... 4 4 .... .... 3 3 .... .... .... .... .... .... 7 7 .... .... Desiccated Cocoanut 2 2 .... .... .... .... .... .... 3 3 .... .... .... .... .... .... 5 5 .... .... Desiccated Soup .... .... .... .... 1 1 .... .... .... .... .... .... .... .... .... .... 1 1 .... .... Dripping 3 3 .... .... 5 5 .... .... .... .... .... .... .... .... .... .... 8 8 .... .... Egg Substitute Powder 3 3 .... .... 2 2 .... .... 1 1 .... .... .... .... .... .... 6 6 .... .... Epsom Salts .... .... .... .... 6 6 .... .... .... .... .... .... 6 6 .... .... 12 12 .... .... Flour, Self Raising .... .... .... .... .... .... .... .... 6 6 .... .... .... .... .... .... 6 6 .... .... Flowers of Sulphur .... .... .... .... .... .... .... .... .... .... .... .... 2 2 .... .... 2 2 .... .... Ginger (Ground) 2 2 .... .... .... .... .... .... 2 2 .... .... .... .... .... .... 4 4 .... .... Glycerine 6 6 .... .... .... .... .... .... .... .... .... .... .... .... .... .... 6 6 .... .... Glycerine of Borax .... .... .... .... .... .... .... .... 3 3 .... .... 3 3 .... .... 6 6 .... .... Golden Syrup .... .... .... .... .... .... .... .... 3 3 .... .... .... .... .... .... 3 3 .... .... Carried forward 88 88 - — 106 105 1 .94 80 77 3 3.7 57 54 3 5.3 331 324 7 2.1 52 53 SALE OF FOOD AND DRUGS ACTS, and the PUBLIC HEALTH (MILK AND CREAM) REGULATIONS.—Continued. Articles submitted for Analysis. Quarter ending 31st March, Quarter ending 30th June. Quarter ending 30th September Quarter ending 31st December. Total for 1923. No. of Samples taken. No. Genuine. No. Adulterated. Percentage of Adulteration. No. of Samples taken. No. Genuine. No. Adulterated. Percentage of Adulteration. No. of Samples taken. No. Genuine. No. Adulterated. Percentage of Adulteration. No. of Samples taken. No. Genuine. No. Adulterated. Percentage of Adulteration. No. of Samples taken. No. Genuine. No. Adulterated. Percentage of Adulteration. Brought forward 88 88 - - 106 105 l .94 80 77 3 3.7 57 54 3 5.3 331 324 7 2.1 Gregory Powder .... .... .... .... .... .... .... .... .... .... .... .... 2 2 .... .... 2 2 .... .... Honey .... .... .... .... .... .... .... .... 8 8 .... .... .... .... .... .... 8 8 .... .... Jam (Various) .... .... .... .... .... .... .... .... .... .... .... .... 3 3 .... .... 3 3 .... .... Lard 7 7 .... .... 6 6 .... .... 4 4 .... .... 3 3 .... .... 20 20 .... .... Lemonade Powder .... .... .... .... 6 6 .... .... 8 8 .... .... .... .... .... .... 14 14 .... .... Margarine 14 14 .... .... 17 17 .... .... 11 10 1 9.0 4 3 1 25.0 46 44 2 4.3 Marmalade .... .... .... .... .... .... .... .... .... .... .... .... 3 3 .... .... 3 3 .... .... Milk 37 35 2 5.4 2 2 .... .... .... .... .... .... 9 8 1 11.1 48 45 3 6.2 Milk Powder .... .... .... .... .... .... .... .... 1 1 .... .... .... .... .... .... 1 1 .... .... Milk Condensed Full Cream Sweetened ........ .... .... .... .... .... .... .... .... .... .... .... 6 6 .... .... 6 6 .... .... Milk Condensed Full Cream Unsweetened .... .... .... .... .... .... .... .... .... .... .... .... 3 3 .... .... 3 3 .... .... Milk Condensed Skimmed Sweetened .... .... .... .... .... .... .... .... .... .... .... .... 8 8 .... .... 8 8 .... .... Mincemeat .... .... .... .... .... .... .... .... .... .... .... .... 2 2 .... .... 2 2 .... .... Mustard 3 3 .... .... 5 5 .... .... 6 5 1 16.6 4 4 .... .... 18 17 1 5.5 Mustard Mixture .... .... .... .... .... .... .... .... .... .... .... .... 1 1 .... .... 1 1 .... .... Nutmeg (Ground) 2 2 .... .... .... .... .... .... 1 1 .... .... .... .... .... .... 3 3 .... .... Oatmeal 2 2 .... .... .... .... .... .... 2 2 .... .... .... .... .... .... 4 4 .... .... Ointment, Boracic 3 1 2 66.6 .... .... .... .... 2 2 .... .... .... .... .... .... 5 3 2 40.0 Ointment, Gall and Opium 3 3 .... .... .... .... .... .... .... .... .... .... .... .... .... .... 3 3 .... .... Ointment, Sulphur 2 2 .... .... .... .... .... .... 2 2 .... .... .... .... .... .... 4 4 .... .... Ointment, Zinc 3 3 .... .... 3 3 .... .... 2 1 1 50.0 .... .... .... .... 8 7 1 12.5 Olive Oil 5 5 .... .... 6 6 .... .... .... .... .... .... .... .... .... .... 11 11 .... .... Pearl Barley .... .... .... .... 4 4 .... .... .... .... .... .... .... .... .... .... 4 4 .... .... Pepper 4 4 .... .... 2 2 .... .... 3 3 .... .... .... .... .... .... 9 9 .... .... Pickles .... .... .... .... 10 10 .... .... .... .... .... .... .... .... .... .... 10 10 .... .... Potted Meat .... .... .... .... .... .... .... .... .... .... .... .... 4 4 .... .... 4 4 .... .... Rice 6 5 1 16.6 2 2 .... .... 2 2 .... .... 2 2 .... .... 12 11 1 8.3 Rice (Ground) 4 4 .... .... 2 2 .... .... 1 1 .... .... 2 2 .... .... 9 9 .... .... Sago 3 3 .... .... 2 2 .... .... .... .... .... .... .... .... .... .... 5 5 .... .... Salad-Oil .... .... .... .... 1 1 .... .... .... .... .... .... .... .... .... .... 1 1 .... .... Salt (Prepared) 1 1 .... .... .... .... .... .... 3 3 .... .... .... .... .... .... 4 4 .... .... Sauce (Various) 5 5 .... .... .... .... .... .... .... .... .... .... .... .... .... .... 5 5 .... .... Semolina .... .... .... .... 2 2 .... .... .... .... .... .... .... .... .... .... 2 2 .... .... Sherbet .... .... .... .... .... .... .... .... 6 6 .... .... .... .... .... .... 6 6 .... .... Sodium Bicarbonate 3 3 .... .... 4 4 .... .... .... .... .... .... 2 2 .... .... 9 9 .... .... Sponge Cake 3 2 1 33.3 .... .... .... .... .... .... .... .... 5 5 .... .... 8 7 1 12.5 Sponge Mixture .... .... .... .... .... .... .... .... .... .... .... .... 4 4 .... .... 4 4 .... .... Suet, Flaked Beef 1 .... 1 100.0 .... .... .... .... .... .... .... .... .... .... .... .... 1 .... 1 100.0 Sugar, Castor 2 2 .... .... .... .... .... .... .... .... .... .... .... .... .... .... 2 2 .... .... Sugar, Demerara .... .... .... .... 4 4 .... .... 3 3 .... .... 1 1 .... .... 8 8 .... .... Sulphur .... .... .... .... 3 3 .... .... .... .... .... .... .... .... .... .... 3 3 .... .... Sweet Spirit of Nitre .... .... .... .... .... .... .... .... .... .... .... .... 3 1 2 66.6 3 1 2 66.6 Tapioca 6 6 .... .... 2 2 .... .... .... .... .... .... 2 2 .... .... 10 10 .... .... Tartaric Acid 2 2 .... .... .... .... .... .... 2 2 .... .... .... .... .... .... 4 4 .... .... Tea 3 3 .... .... .... .... .... .... 3 3 .... .... .... .... .... .... 6 6 .... .... Treacle .... .... .... .... .... .... .... .... 1 1 .... .... .... .... .... .... 1 1 .... .... Vinegar, Malt .... .... .... .... .... .... .... .... 5 5 .... .... 3 3 .... .... 8 8 .... .... Vinegar 6 6 .... .... .... .... .... .... 12 12 .... .... 6 6 .... .... 24 24 .... .... Total informal samples 218 211 7 3.2 189 188 l 0.5 168 162 6 4.5 139 132 7 5.0 714 693 21 2.9 Totals 250 240 10 4.0 222 217 5 2.2 277 257 20 7.2 202 189 13 6.4 951 903 48 5.0 54 BORIC ACID IN CAKE. In view of the issue by the Ministry of Health in March last of a circular letter relative to the use of boric acid in connection with the manufacture of sponge cakes and biscuits, it may be of interest if I repeat here what has been done in connection with this subject in the City. It will be remembered that on numerous occasions during the past eight or nine years I have drawn attention to the excessive amount of boric acid contained in liquid eggs and in egg yolk, and that I have mentioned that egg yolk used as an ingredient in various articles was found to give rise to an excessive amount of boric acid in the finished product. I also on another occasion reported that there was a danger, if these yolks were sold in small quantities, of the public being heavily dosed with boric acid in the event of such yolks being used for the preparation of such articles as scrambled eggs. In order to minimise these risks, a meeting of my colleague from the Port, and of Medical Officers of Health from Metropolitan Areas in which the wharves where imported egg yolk was landed are situate, was called at my office, and it was agreed that bulk yolk should only be released on receipt of an undertaking— (1) That it did not contain any preservative other than boric acid or its sodium equivalent, and in an amount not exceeding 2 per cent. ; (2) That it would be sold only to firms engaged in the bakery, wholesale confectionery and allied trades, and that if used in products prepared for human consumption, the ultimate amount of boric acid contained in such product would be negligible in amount ; (3) That it would not be sold to the general public by retail over the counter ; and, (4) That it would not be put up in receptacles containing less than 7 lbs. For various reasons these arrangements were found not to be entirely satisfactory and a meeting was called of manufacturers at the Ministry of Health in the early part of 1922, when the following arrangements were arrived at:— "That sponge fingers, sponge biscuits and small sponge cakes should not "contain boric acid and that the trade as a whole should sign a bond that in "future when sending out liquid eggs:— "(1) Sale would only be made on the understanding that liquid whole egg "must not be used in the manufacture of sponge fingers, biscuits "and 1 d., 1 \d. and 2d. sponge cakes; "(2) That the invoice bears a statement to the buyer that liquid egg must "not be used in the manufacture of sponge fingers, biscuits and 2d. "sponge cakes; "and when sending out liquid yolks:— "(1) Sold only as an ingredient in the manufacture of liquid whole egg "and the liquid whole egg not to contain more than 50 per cent, of "the yolks." Even the above arrangements were found to be not quite satisfactory and a further agreement, which is referred to in the Ministry's letter, has now been entered into. This agreement is to the effect that:— (1) Liquid whole egg should not be manufactured or imported containing more than 1 per cent, of boric acid. (2) Liquid egg yolk would not be purchased after 22nd February, 1922, as new season's yolks for shipment containing more than 15 per cent, of boric acid. (3) The decision was not to interfere with stocks already on hand, manufactured or in course of manufacture, nor to apply to contracts already made and not completed. Later, in February, 1923, the Bakery Allied Traders' Association resolved that its members should sign a bond that in future the sale of liquid whole egg should be under the following conditions:— (1) Sale only to be made on the understanding that liquid whole egg must not be used in the manufacture of sponge fingers, sponge biscuits and 1^., 1 \d. and 2d. plain sponge cakes. (2) That all invoices bear a statement to the buyer that' liquid egg must not be used in the manufacture of sponge fingers, sponge biscuits and 1 d., 1 \d. and 2d. plain sponge cakes. It will be observed that the cakes and biscuits to which the above arrangement applies are those most likely to be consumed by infants and invalids. 55 SALE OF FOOD AND DRUGS ACTS, 1875 TO 1907. THE PUBLIC HEALTH (MILK AND CREAM) REGULATIONS, 1912 and 1917. RESULTS OF PROSECUTIONS, 1923. First Quarter. Sample. Nature and Extent of A dulteration. Result. 212 Milk 9 per cent. of added water £2 and £3 3s. Costs. 214 Milk 9 per cent. of added water £21 Second Quarter. 312 Milk 16 per cent. of original fat abstracted £2 and £1 1s. Costs. 365 Milk 9 per cent. of added water £1 1s. Costs. Third Quarter. 583 Zinc Ointment 33 per cent. excess of zinc oxide £1 and £1 1s. Costs. 580 Cream Contained preservative which was not declared £15 15s. and £2 2s. Costs. 581 Cream Contained preservative which was not declared £15 15s. and £2 2s. Costs. Fourth Quarter. 694 Milk 8 per cent. of added water £3 and £1 1s. Costs. 721 Mustard 29 per cent. of wheat flour and coloured with turmeric £5 and £1 1s. Costs. 738 Milk 8 per cent. of added water £1 and 17/6 Costs. 811 Milk 12 per cent. of original fat abstracted £2 and £2 2s. Costs. 858 Camphorated Oil 48 per cent. deficient in camphor £5 and 19/6 Costs. SUMMARY. £ S. d. £ s. d. First Quarter Fines 4 0 0 Costs 3 3 0 Second Quarter ,, 2 0 0 „ 2 2 0 Third Quarter ,, 32 10 0 „ 5 0 0 Fourth Quarter ,, 16 0 0 „ 6 1 0 Total Fines £54 10 0 Total Costs £16 11 0 MEAT INSPECTION. On pages 55-63 is a report by Mr. T. Dunlop Young, O.B.E., M.R.C.V.S., Veterinary Surgeon at the Meat Market. In that report are contained details respecting routine inspections, and the amount of meat which comes under observation and the amount which has been condemned. In order to show the quantity of imported food which passes through the Central Markets, Smithfield, the following table taken from the Board of Trade returns shows the total importations into this country in the year 1923:— IMPORTS OF FRESH MEAT AND BACON FOR TWELVE MONTHS, 1923. Beef. Cwts. Mutton. Cwts. Pork. Cwts. Bacon. Cwts. United States 78,949 - 291,539 2,828,662 Uruguay 1,138,979 208,959 — — Argentina 9,725,297 1,746,395 29,793 —- Australia 849,989 1,271,856 — — New Zealand 771,303 2,286,673 — — Denmark 54,893 — — 3,530,561 Canada — — — 834,284 Netherlands — 110,097 342,385 — China — — 9,709 — Other Countries 195,965 248,140 347,017 599,643 Total, 1923 12,815,375 5,872,120 1,020,443 7,793,150 Total, 1922 10,806,005 5,848,763 669,164 5,932,152 Total, 1913 9,203,310 5,338,380 495,864 4,857,890 It will be observed that the above statistics show an increase in the imports of beef of over 100,000 tons compared with the amount for 1922, and over 180,603 tons more than in 1913. The amount for 1923 is the largest in the history of the trade. Of the total, 60 per cent, was chilled, 39 per cent, frozen and I per cent. H2 56 fresh. Argentina supplied approximately 76 per cent. of the amount, Uruguay supplied 9 per cent., Australia 7 per cent. frozen, New Zealand 6 per cent. frozen, and the balance was supplied by the United States of America, Denmark and other countries. The amount of canned meats, extracts, tongues, etc., amounted to 50,000 tons. The imports of mutton and lamb were 1,167 tons more than in 1922 and 26,687 tons more than in 1913. Of the total, New Zealand supplied approximately 40 per cent., Argentina 30 per cent., Australia 22 per cent., the balance being supplied by "Other Countries." 3,462 tons of sheep's offals and 1,544 tons of canned mutton, tongues, etc., were also imported. The imports of pork show a record, there being an increase of 17,563 tons over the amount for 1922. There were considerable increases in the Danish and United States of America supplies. The imports of bacon also constitute a record, the amount being 389,657 tons— an increase of 93,049 tons over that of 1922 and 146,763 tons compared with the figures for 1913. The United States of America sunnlied 92 Der cent, of the trade in hams. The amount of food which passed through the Central Markets, Smithfield, during the year 1923, forms a record in the history of the Market, there being an increase of 7,326 tons over the amount for 1922. * Origin. 1923. Tons. 1822. Tons. Difference. Tons. Britain and Ireland 93,075 87,820 + 5,255 Australasia 105,151 128,008 — 22,857 North America 13,641 16,254 — 2,613 South America 213,429 186,189 + 27,240 Holland and other countries 45,105 44,804 + 301 Totals 470,401 463,075 + 7,326 Description:— BEEF. British 43,514 38,702 + 4,812 Imported 219,783 213,219 + 6,564 MUTTON. British 19,209 20,196 — 987 Imported 115,065 121,842 — 6,777 PORK. British 14,118 11,900 + 2,218 Imported 27,303 27,383 — 80 POULTRY, etc. British 16,234 17,022 — 788 Imported 15,175 12,811 + 2,364 Totals 470,401 463,075 + 7,326 *. Kindly supplied by the Market Superintendent. Of the total amount of imports into this country, 34.3 per cent. of the beef, 39.2 per cent. of the mutton and 53.5 per cent. of the pork passed through the Markets. The amount of meat gf all classes which is deposited in the City Cold Stores and from there sent direct to shops, the amounts sold in Leadenhall and Aldgate Markets, are not included in the above figures, if they are over the half of all the meats imported during 1923 passed under the supervision of the City Sanitary Authority. The quality of the British meat supplied was on the average good. Owing to the extensive outbreak of Foot and Mouth Disease a considerable quantity of meat from animals which had been compulsorily slaughtered appeared on the Market and was sold at low prices. The number of animals killed will tend to keep up the price of home-fed meat, especially as fewer Canadian cattle have arrived than was anticipated. The percentages of home-fed meat on the Market were beef 16.5, mutton 14.3 and pork 33.1. Holland continues to supply the bulk of our pork trade. Judging from the amount of diseased home killed meat surrendered or seized in the Markets, there appears to be no improvement in the inspection of meat in country districts. Some of the consignments were so obviously diseased that the consigners must have known that the meat was in a doubtful condition, but they did not trouble to have it inspected at the place of slaughter. A number of prosecutions were instituted against offenders. 57 From table No. 4, it will be observed that tuberculosis amongst pigs appears to be on the increase or less care is taken as to the freedom from tubercle bacilli in the food supplied to them. Advice to some pig feeders on this subject seems useless although it is given in their own interests. The eradication of tuberculosis from pigs will never be effected until the chief source of the tubercle bacilli, viz. the milk of diseased cows, is dealt with. . ARGENTINA.—The quality of the meat sent from this country during the year was excellent, though quarters of beef affected with tuberculosis continue to be occasionally found in some of the lymphatic glands, chiefly the precrural and ischiatic. Pathologically, it is interesting to find a well nourished hind quarter of beef showing no lesions of disease in the kidney or its associated gland, or in the lumbar and iliac glands, yet large lesions containing the tubercle bacilli in the precrural and ischiatic glands are found. The experience in this country is generally that those glands are only found affected when the disease is generalised. 59 quarters of beef (46 hinds and 13 fores) were found affected with tuberculosis. The examination of ox tongues was continued with results shown in Table 5. AUSTRALIA.—The quality of meat sent from this country showed an improvement. There was also a distinct improvement in the dressing, cleanliness and finish of the beef from some of the works. The new method of cutting the hind quarters has been done satisfactorily from a meat inspection point of view and has also given much satisfaction to the trade, both wholesale and retail. Two systems of defrosting were experimented with during the year, one on a fairly extensive scale, but it did not find any supporters either among the wholesale or retail traders. The other was only tried in a few quarters of beef and was not enough to form a definite opinion on. It was carried out by passing an electric current through the quarters. On the few tests made, it seemed the best system tried in the City, but there does not seem to be any desire on the part of the trade for any artificial system of defrosting meat. NEW ZEALAND.—The quality of mutton and lamb from this country was, as usual, good; only small quantities of beef arrived, some of which was good quality, but there is no improvement in the dressing and finish. An experiment is being made to bring a consignment of "Chilled" beef under the "Linley System," the ship with 1,000 hind quarters should arrive in the month of January. If success attends this effort it is proposed to try consignments of "Chilled" hind quarters of beef from Australia. Two hind quarters of beef were found affected with tuberculosis. HOLLAND.—Large quantities of meat, chiefly veal, pork, mutton and lamb, arrived from this country, which supplies the bulk of fresh pork of exceptionally uniform quality. The cleanliness, finish and method of handling has been very good. Only 12 pig carcases were found affected with tuberculosis. SWEDISH MEAT.—By special arrangement under the Foreign Food Regulations, Swedish meat is allowed to be delivered on the Markets without inspection at the port of landing, subject to the condition that it is not sold until examined. The following particulars show the quantity which arrived and the results of the examinations:— 168 Pigs' Kidneys. 2 Lambs. 1,424 Pigs. 8 Barrels Pigs' Plucks. 4 Cases ,, „ 393 Pigs' Plucks. RESULT OF EXAMINATION—Seizures. 58 Pigs'Livers Decomposition. 35 Pigs' Kidneys ,, 216 Pounds of Pork Injury. 8 Barrels Pigs' Plucks Decomposition. 1 Case Pigs' Plucks ,, 47 Pigs' Plucks ,, 58 UNSOUND MEAT REMOVED FROM COLD STORES. Article. No. How Packed Origin. Cause for Destruction. Tons Cwts. Qrs. lbs. Beef (Pieces) .... .... Argentine Decomposed 36 16 3 6 „ „ .... .... Australia „ 0 19 0 19 „ „ .... .... New Zealand „ 0 4 0 6 „ „ 4 Casks South Africa „ 0 10 3 26 „ (Quarters) 8 .... Argentine „ 0 16 1 0 Brains (Ox) 577 Cases „ „ 21 15 2 22 Caviarre 1 Barrel Russia „ 0 1 2 0 Chickens 4 Cases U.S.A. „ 0 0 3 16 Glands 103 „ Argentine „ 3 7 3 18 Kidneys (Ox) 403 „ „ „ 5 19 1 21 „ „ 284 „ U.S.A. „ 5 14 3 23 „ (Pigs) 293 „ „ „ 3 13 0 0 „ „ 222 „ Argentine „ 2 19 2 5 „ (Sheep) 3 „ New Zealand „ 0 1 2 12 „ „ 11 „ Australia „ 0 10 1 25 Lambs (Carcases) 273 .... New Zealand „ 3 17 1 7 „ „ 28 .... Patagonia „ 0 5 2 13 „ „ 89 .... Argentine „ 1 4 0 13 „ „ 123 .... Australia „ 2 0 3 7 „ (Pieces) .... .... „ „ 0 4 0 20 „ „ .... .... New Zealand „ 0 1 1 13 „ „ .... .... Argentine „ 0 2 1 12 Livers (Calves) 23 Cases „ „ 0 5 3 13 „ (Pigs) 162 „ „ „ 2 10 0 4 „ (Sheep) 33 „ Australia „ 0 8 3 10 „ „ 48 Bags Argentine „ 1 11 1 4 Mutton (Carcases) 120 .... „ „ 2 6 0 15 „ „ 82 .... New Zealand „ 1 7 0 27 „ „ 271 .... Australia „ 5 19 0 15 „ „ 40 .... Patagonia „ 0 15 0 14 „ (Pieces) .... .... „ „ 0 5 2 7 „ „ .... .... Australia „ 2 13 0 19 „ „ .... .... New Zealand „ 0 19 0 19 „ „ .... .... Argentine „ 0 19 3 25 Offal .... .... Uruguay „ 0 13 2 3 „ .... .... Argentine „ 18 4 0 20 „ 7 Cases Australia „ 0 6 2 18 „ .... .... New Zealand „ 1 13 3 4 „ .... .... Various „ 8 6 1 22 Plucks (Sheep) 21 Cases U.S.A. „ 0 19 0 18 Pork (Carcases) 5 .... Argentine „ 0 2 3 27 „ (Pieces) .... .... „ „ 0 4 3 12 „ „ .... .... British „ 0 0 3 17 Poultry (Various) .... .... „ „ 0 4 0 12 „ „ .... .... Various „ 0 15 2 6 „ „ .... .... Poland „ 6 18 0 9 Suet .... .... Argentine „ 0 4 0 10 Tails (Ox) 55 Bags „ „ 1 8 0 22 Tongues (Ox) 217 .... „ Diseased 0 11 3 9 „ (Calves) 32 Cases U.S.A. Decomposed 1 6 1 7 Veal (Sides) .... .... Argentine „ 13 17 1 14 „ „ .... .... Australia „ 1 13 2 12 „ „ .... .... British „ 0 1 1 10 „ „ 100 Cases U.S.A. „ 2 15 3 9 171 18 1 17 Total for the Year 1922=208 tons 7 cwts. 2 qrs. 14 lbs. „ „ 1923 = 171 „ 18 „ 1 „ 17 „ Decrease 36 „ 9 ,, 0 ,, 25 „ 59 LEADENHALL MARKET AND CITY SHOPS. The Leadenhall Market and City Shops have been systematically inspected during the year, and the following table shows the amount and variety of unsound food dealt with:— Bacon (Pieces) 1 Hazelhens 20 Beef (Pieces) 5 Kidneys 5 „ (Tins) 100 Marrow Fat (Tins) 2 Badgers 3 Milk (Tins) 11 Butter (Box) 1 Mutton (Legs) 2 Capercailzies 17 Offal (Heads—Pigs) 11 Chickens 1,220 ,, (Plucks—Pigs) 1 Cream (Tins) 455 Partridges 191 Curlew 8 Pheasants 1,457 Deer 19 Pigeons 921 Ducks 1,727 Plovers 560 Eggs 5,121 Pork (Carcases) 2 „ (Cases) 30 ,, (Pieces) 3 Fish (Tins) 3 Ptarmigan 216 Fowls 3,403 Quail 232 Fox. 1 Rabbits 22,344 Fruit (Tins) 128 Sardines (Tins) 1 Game (Black) 27 Snipe 598 ,, (Hamper) 1 Sweetbreads 1 Geese 143 Teal 30 Goats 3 Turkeys 271 Gooseberries (Gallons) 1 Vegetables (Cases) 2 Grouse 242 Venison (Pieces) 4 Guinea Fowl 1 Widgeon 23 Hares 289 Woodcock 5 Total Weight for the year 1923 = 32 tons 10 cwts. 0 qrs. 2 lbs. „ „ „ 1922 = 25 „ 17 „ 1 „ 15 „ Increase 6 „ 12 „ 2 „ 15 „ ALDGATE MARKET AND SLAUGHTERHOUSES. The extensive outbreak of Foot and Mouth Disease, which continued during the latter part of the year, made it very difficult for butchers to arrange supplies of home-fed animals. Nevertheless, the number of animals killed in the slaughterhouses, compared with that of 1922, show an increase of 12,900, as shown by the following table :— 1923. 1922. Bulls 83 145 Calves 33,219 23,826 Cows 165 51 Heifers 81 71 Oxen 5,269 6,250 Sheep 15,726 11,384 Goat 140 56 54,683 41,783 The extra hours of duty performed by the Inspectors under Bye-Law No. 19 were as follows Weekdays. Sundays. Before 6 a.m. After 9 p.m. Before 7 a.m. After 3 p.m. Hours. Hours. 1 128½ 3 30½ Number of animals killed during those hours were:— Bulls 8 Calves 1,997 Cows 75 Heifers 7 Oxen 284 Sheep 737 Goats 7 Total 3,115 60 Of the 38,817 bovine species (all classes), 131 or 0.34 per cent. showed lesions of tuberculosis. An analysis of the records shows that the percentage of animals with tuberculosis was:— Bulls 2.40 per cent. Calves 0.04 „ Cows 25.45 „ Heifers 11.11 „ Oxen 1.20 „ The carcases showing lesions of the disease were disposed of as follows:— Carcases Destroyed. Quarters Destroyed. Bulls — per cent. 25.00 per cent. Calves 38.00 „ - „ Cows „ 47.62 1.20 „ Heifers „ 55.55 5.55 „ Oxen „ 5.00 5.64 „ It is interesting to observe that six of the calves varying in age from two to nine months were affected with generalised tuberculosis, and nearly every organ of the bodies contained lesions. In addition, three of them had acute tubercular pleurisy and peritonitis, and another had acute pleurisy. Ten of the calves were affected with localised tuberculosis and again it is interesting to observe, from a point of view of infection, the positions of the lesions and the age of the animals which were as follows:— Number and ages of the Calves. 2 to 6 months. Parenchyma. Lungs. Situation of the lesions. Liver. Glands. Glands. Parenchyma. 6 - + + + 1 + + + + 3 - + - + Note. + = Affected. — = No lesions. No lesions were observed in either the intestines or the mesentric glands. All the diseased heifers were under two-and-a-half years of age. Five of them were affected with generalised tuberculosis; of these, one was affected in the lungs only; one showed lesions in the lymphatic glands of the head, tongue and lungs; and one had lesions in the lymphatic glands of the head, tongue, lungs and mesentery. Fifty per cent, of the cows affected with generalised tuberculosis and sixteen per cent, of all the cows affected with the disease had lesions of tuberculosis in the mammary glands, and three had, in addition, lesions in the uterus. All those cows had been producing milk. Certain Local Authorities and their officers have suggested that the Tuberculosis Order, 1914, should be re-introduced. The above figures support the proposal as tending to ensure a purer milk supply. The following tables show the numbers of carcases, portions of carcases and organs destroyed in the slaughterhouses and the cause for destruction :— TABLE I.—SHOWING NUMBER OF CARCASES AND QUARTERS SEIZED AND DESTROYED AT ALDGATE. Cause for Destruction, BEEF. MUTTON. VEAL. Carcases. Quarters Carcases. Quarters Carcases. Quarters Asphyxia (Partial) .... .... 6 .... 30 .... Decomposition .... l .... 2 1 2 Functional Derangement .... .... .... .... 4 .... Hydremia and Emaciation 1 .... 30 .... 1 .... Injury .... .... .... 2 2 1 Immaturity .... .... .... .... 1 .... Jaundice .... .... .... .... 1 .... Necrosis (Bacterial) .... .... .... .... 1 .... Peritonitis .... .... 2 .... .... .... Pleurisy .... .... 2 13 1 .... Pneumonia (Septic) l .... 7 .... 2 .... Pyaemia .... .... 1 .... 1 .... Tuberculosis 28 5 .... .... 6 .... Totals for the year 1923 30 6 48 17 51 3 Totals for the year 1922 24 9 40 .... 43 8 61 TABLE 2.—RECORD OF ORGANS SEIZED AT ALDGATE DURING THE YEAR 1923. Cause for Destruction. OXEN. CALVES. Heads. Tongues. Lungs. Hearts. Livers. Stomachs. Spleens. Mesenteries. Intestines. Kidneys. Heads. Tongues. Lungs. Hearts. Livers. Stomachs. Spleens. Mesenteries. Intestines. Kidneys. Abscess 66 17 6 ... 675 3 ... ... ... ... ... ... 7 ... 114 ... ... ... ... ... Actinomycosis 80 70 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Blood Aspiration ... ... 70 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Decomposition ... ... ... ... ... ... ... ... ... ... 1 1 1 19 32 1 39 8 8 2 Pleurisy ... ... 29 ... ... ... ... ... ... ... ... ... 5 ... ... ... ... ... ... ... Pneumonia ... ... 35 ... ... ... ... ... ... ... ... ... 252 ... ... ... ... ... ... ... Parasitic Disease ... ... 471 ... 531 ... ... ... ... ... ... ... 5 ... 7 ... ... ... ... ... Tuberculosis 64 50 101 ... 172 41 9 41 41 52 6 6 8 ... 6 6 6 6 6 10 Unwholesome 4 9 1010 39 1 4 32 4 4 14 44 49 40 89 63 46 125 30352 30352 84 Total for 1923 214 146 1722 39 1379 48 41 45 45 66 51 56 318 108 222 53 170 30366 30366 96 Total for 1922 187 167 871 43 1302 46 54 154 154 70 47 44 278 119 278 40 96 28691 28691 80 SHEEP. PIGS. GOATS. Abscess 1 ... 7 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Actinomycosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Blood Aspiration ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Decomposition ... 8 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pleurisy ... ... 56 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia ... ... 15 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Parasitic Disease ... ... 1491 ... 1151 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculosis ... ... ... ... ... ... ... ... ... ... 3 3 ... ... ... ... ... ... ... ... Unwholesome 84 63 41 157 107 11906 148 46 46 102 ... ... ... ... ... 6 ... 5 5 ... Total for 1923 85 71 1610 157 1258 11906 148 46 46 102 3 3 ... ... ... 6 ... 5 5 ... Total for 1922 28 28 1989 102 1426 10177 109 288 288 56 ... ... ... ... ... 19 ... 2 2 ... TABLE 3.—DISEASED MEAT PROSECUTIONS, 1923. Date of Hearing. Name. Business. Address. Where Heard. Before whom. Offence. Result. 27/3/23 Henry Bennett. Butcher. Ludwell, Donhead, St. Mary, Wilts. Guildhall. Ald. Sir C. Johnston. Depositing for sale a diseased carcase of beef. Fined £25 and £10 10s. costs. „ Frank Isgar. Farmer. Dengrove Farm, Donhead, St. Andrew. „ „ „ „ Discharged. 6/11/23 Frank Bolton. Farmer. Laverley Farm, West Pennard, Bridgwater Somerset. „ Ald. Sir J. Baddeley. Caused to be sent for sale, nine hind-quarters, four fore-quarters of diseased beef and quantity of offal. Fined £50 and 20 guineas costs. „ E. Pickard. Meat Salesman. 96, Central Market. „ „ Exposing abovementioned meat for sale. Dismissed on payment of 5 guineas costs. 23/11/23 E. Herring. Cattle Dealer. Garden Farm, Woodford Bridge, Essex. „ Ald. I. N. Jacobs. Depositing for sale four quarters of diseased beef & quantity of offal. Fined £20 and 3 guineas costs. 29/11/23 A. J. Butler. Farmer. Bromham House Farm, Chippenham Wilts. „ Ald. Sir W. Pryke. Being the person to whom belonged five hindquarters of diseased cow beef. Fined £20 and £3 3s. costs. „ W. H. Chapple. Farmer. Rickney Farm, Westham. „ „ Being the person to whom belonged four quarters of diseased cow beef. Fined £10 and £3 3s. costs. „ H. F. Watson. Butcher. High Street, Pevensey, Sussex. „ „ Sending the same beef for sale. Fined £20 and £3 3s. costs. 62 TABLE 4.—SHOWING AMOUNT OF TUBERCULOUS MEAT SEIZED AT THE CENTRAL MARKETS DURING 1923. BEEF. PORK. VEAL. Carcases. Qrs. Pieces. Carcases. Qrs. Pieces. Carcases Qrs. Pieces. 1923 34 88 43 271 3 188 5 .... .... 1922 29 71 52 325 .... 78 4 .... .... Increase 5 17 .... .... 3 110 1 .... .... Decrease .... .... 9 54 .... .... .... .... .... OFFAL. Heads. Tongues. Lungs. Hearts Livers. Stomachs. Spleens. Mesenteries. Intestines. Kidneys. 1923 80 87 76 24 13 .... 7 .... .... 5 Oxen. Pigs. Calves. 4,518 .... 22 66 76 44 .... 3 .... .... .... .... .... .... .... .... .... .... .... .... 1922 31 35 3 4 12 .... 1 .... .... 4 Oxen. Pigs. Calves 1,072 .... 9 3 81 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... Total Weight for 1923 = 47 tons 10 cwts. 2 qrs. 24 lbs. „ „ „ 1922 = 39 „ 6 „ 2 „ 2 „ Increase — 8 „ 4 „ 0 „ 22 „ TABLE 5.—EXAMINATION OF ARGENTINE OX TONGUES IN THE CITY Owners. No. of Tongues. Percentage Examined. No. of Tongues Seized. Percentage. A 72,420 5% 218 .30% B 68,952 5% 31 .04% C 44,056 5% 10 .02% The number of Argentine ox tongues transferred to the City from the Port and released after receipt of intimation that examination had proved satisfactory to the Port Officials was:—A, Nil; B, 58,876; and C, 35,396. TABLE 6.—SHOWING THE AMOUNT OF VARIOUS FOOD PRODUCTS SURRENDERED TO OR SEIZED BY THE MEAT INSPECTORS, AND THE COUNTRIES OF ORIGIN. DISEASED BEEF, MUTTON, PORK, VEAL AND ANIMAL OFFAL. Countries. Beef in lbs. Mutton in lbs. Pork in lbs. Veal in lbs. Offal in lbs. Total in lbs. Argentina 37,512 9,985 14,254 ... 1,928 63,679 Australia 358 6,461 ... ... ... 6,819 Belgium ... ... ... ... ... ... Britain 53,894 23,481 94,509 6,607 60,448 238,939 Canada ... ... ... ... ... ... Denmark ... ... 716 ... 22 738 France ... ... ... ... ... ... Germany ... ... 1,823 ... ... 1,823 Holland 302 4,359 16,157 2,376 891 24,085 New Zealand 276 189 388 ... ... 853 Patagonia ... ... ... ... ... ... Russia ... ... ... ... ... ... South Africa ... ... ... ... ... ... Sweden ... ... 77 ... ... 77 U.S.A. ... ... 1,654 ... ... 1,654 Totals 92,342 44,475 129,578 8,983 63,289 338,667 63 TABLE 7.—SHOWING THE AMOUNT OF VARIOUS FOOD PRODUCTS SURRENDERED TO OR SEIZED BY THE MEAT INSPECTORS, AND THE COUNTRIES OF ORIGIN. UNSOUND BEEF, MUTTON, PORK, VEAL AND ANIMAL OFFAL, Etc. Countries. Beef in lbs. Mutton in lbs. Pork in lbs. Veal in lbs. Offal in lbs. Venison in lbs. Bacon in lbs. Argentina 1,144,403 87,083 18,021 18,276 205,560 ... ... Australia 49,690 119,513 248 1,652 17,185 ... ... Belgium ... ... ... ... ... ... ... Britain 32,648 40,539 106,215 10,181 343,948 5,525 4,724 Canada ... ... ... ... 390 ... 1,383 Denmark ... ... 6,490 ... 72,656 ... 13,779 France ... ... ... ... ... ... ... Germany ... ... 188 ... ... ... ... Holland 1,428 14,785 29,985 13,831 43,002 ... 132 New Zealand 22,566 171,293 337 ... 10,354 ... ... Patagonia ... 3,015 ... ... ... ... ... Russia ... ... ... ... 168 ... ... South Africa 600 ... ... ... ... ... ... Sweden ... ... 798 ... 4,028 ... 1,945 U.S.A. 80 ... 704 3,000 8,087 ... 79 Totals 1,251,415 436,228 162,986 46,940 705,378 5,525 22,042 UNSOUND TINNED FOOD PRODUCTS, GAME, EGGS, CHEESE, Etc. Countries. Cheese in lbs. Furred Game. No. Feathered Game. No. Eggs. No. Meat in Tins. No. Milk in Tins. No. Fruit in Tins. No. Argentina ... ... ... ... 3,041 ... ... Australia ... 7,371 ... ... ... ... ... Belgium ... 132 ... ... ... ... ... Britain 616 36,015 29,257 3,641 ... 1,764 ... Canada ... ... ... ... ... 774 ... Denmark 146 ... ... ... ... 1,230 ... France ... ... 986 ... ... ... ... Germany ... ... ... ... ... ... ... Holland ... 752 264 ... ... 2,407 ... New Zealand ... ... ... ... 52 ... ... Patagonia ... ... ... ... ... ... ... Russia ... ... ... ... ... ... ... South Africa ... ... ... ... ... ... ... Sweden ... ... ... ... ... ... ... U.S.A. ... ... ... ... ... 3,537 794 Totals 762 44,270 30,507 3,641 3,093 9,712 794 TABLE 8.—SUMMARY OF UNSOUND FOOD DESTROYED. Tons. Cwts. Qrs. lbs. Central Markets, Smithfield 1,065 7 1 25 Cold Stores 171 18 1 17 Leadenhall Market and City Shops 32 10 0 2 Aldgate Market and Slaughter-houses 134 7 3 12 Total for the year 1923 1,404 3 3 0 Total for the year 1922 1,414 3 3 3 Total for the year 1923 1,404 3 3 0 Decrease 10 0 0 3 Seventeen Naval Officers received training in meat inspection at the Central Markets, Smithfield, during the year. CENTRAL MARKETS, SMITHFIELD. *Table showing the average deliveries at the Central Meat Market, and other details for successive quinquennial periods during the past 50 years:— Quinquennium. Annual Average General Supply. Seizures by Inspectors % of Unsound Meat. Tons. cwts. qrs. Tons. cwts. qrs. 1874-1878 178,373 10 0 192 18 2 .108 1879-1883 218,200 12 3 282 11 2 .129 1884-1888 249,580 19 2 248 1 2 .099 1889-1893 304,986 5 1 461 15 1 .151 1894-1898 372,440 12 2 749 3 3 .201 1899-1903 410,456 18 1 1,082 13 2 .263 1904-1908 414,906 11 1 1,584 19 3 .382 1909-1913 427,146 0 0 1,520 2 3 .356 1914-1918 324,715 0 0 1,370 11 2 .422 1919-1923 403,364 10 0 1,849 19 0 .459 I 2 64 *The sources of origin of the Central Markets Supplies during the past five years are here expressed in terms per cent. of the total annual deliveries. British. †Foreign Killed. American. Australian and New Zealand Country Killed. Town Killed. Home Killed. American Killed. Per cent. Per cent. Per cent. Per cent. Per cent. Per cent. 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 2.1 41.3 30.9 1922 14.7 4.3 9.7 1.7 42.0 27.6 1923 14.7 5.1 9.6 0.6 47.7 22.3 † Includes "General Foreign Meat and Produce." † Includes South American Imports. *Some idea of the amount of the work of your Inspectors of Slaughter-houses and Meat may be obtained from the following figures supplied by the Superintendent of the Market:— 1919. 1920. 1921. 1922. 1923. Tons. Tons. Tons. Tons. . Tons. Average daily delivery into the Markets 964 1,192 1,389 1,513 1,532 ‡ Minimum delivery on any one day 107 101 101 142 169 Maximum delivery on any one day 2,101 3,103 3,537 3,659 3,411 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 336 tons of meat paying toll in the Central Markets, Smithfield, was condemned last year, as compared with one ton in 320 in 1922. Table showing Weight of Meat delivered, and Meat delivered to Contractors as unsound, during each Month of the Years 1922 and 1923. Month. Meat delivered at the Market, 1922. Unsound Meat delivered to Contractors, 1922. Meat delivered at the Market, 1923. Unsound Meat delivered to Contractors, 1923. Tons cwts. qrs. Tons cwts. qrs. Tons cwts. qrs. Tons cwts. qrs. January 42,201 0 0 188 2 l 42,013 0 0 105 11 1 February 35,551 0 0 115 19 0 36,806 0 0 91 11 3 March 42,448 0 0 143 16 0 39,106 0 0 75 6 2 April 35,198 0 0 104 17 3 41,131 0 0 88 19 1 May 37,895 0 0 185 1 1 41,147 0 0 132 4 0 June 38,351 0 0 104 18 0 37,835 0 0 117 13 3 July 37,644 0 0 71 8 0 30,245 0 0 126 16 0 August 37,228 0 0 94 8 2 38,940 0 0 209 19 1 September 36,431 0 0 121 2 3 35,860 0 0 91 4 1 October 41,191 0 0 117 14 3 42,992 0 0 196 15 1 November 40,655 0 0 119 15 2 42,893 0 0 91 19 2 December 38,281 0 0 78 11 0 41,430 0 0 76 3 0 Totals 463,074 0 0 1,445 14 3 470,398 0 0 1,404 3 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. INFLATION OF VEAL. One of the Metropolitan Borough Councils during the year made representations to the London County Council that powers should be sought in the proposed County Council's (General Powers) Bill to prohibit inflation, whether by mechanical means or otherwise, of meat and fish intended for sale for human consumption. The Corporation are the owners of the largest slaughter-house in London, which is situate at Islington, and they are also responsible for the control of those situate at Aldgate, and the London County Council, presumably for this reason, asked the views of the Corporation on the subject. 65 Veal is generally blown after slaughter at each of the slaughter-houses abovementioned, but at Islington there exists a Bye-law to the following effect:— "No person shall in the slaughter-house inflate any carcase bv " blowing and breathing into it or use any mechanical apparatus " for inflating carcases unless such apparatus be clean." There is no restriction of this character at Aldgate but, as a matter of practice, no carcases are there blown by the mouth ; a mechanical apparatus is used for the purpose. Veal is blown to give the carcase a more pleasing appearance and I find that the practice is followed in Holland, for all Dutch carcases arriving at Smithfield are blown. It is an advantage to the butcher during the dressing of the carcase, since it is easier to remove the skin from a blown than from an unblown carcase. To inflate the subcutaneous tissues by the breath is obviously an objectionable process and should be unhesitatingly condemned. The objections to mechanical blowing are that poor quality veal is given a better appearance and that air forced into the subcutaneous tissues may contain objectionable organisms which may set up premature decomposition. As regards the latter objection, I have only to state that my experience of blown carcases does not support the suggestion that decomposition is rendered more rapid as a consequence. I have not noticed any difference between blown and unblown veal. To prohibit blowing by mechanical means would arouse considerable opposition from the trade, and I must admit that with the exception of giving a fictitious value from approved appearance, I cannot advance any strong argument against the practice. PRESERVATION OF MEAT IMPORTED FROM SOUTH AFRICA. Considerable interest amongst meat traders was created during the year by the arrival from South Africa of a trial shipment of beef which had not been subjected to refrigeration. The meat had been treated by some secret process of preservation which it was claimed would keep it sound for a considerable period after slaughter. The first consignment of this meat arrived in London on the 17 th February and was exposed in Smithfield Market for two or three days. The consignment consisted of two hind quarters only. The animals were stated to have been slaughtered on the 13th January. Examination of the quarters on the 22nd February showed on section that the interior muscular tissue was apparently in a perfectly fresh and normal condition. The outer layers of the carcase showed moulds and the commencement of decomposition. The method of treatment had obviously consisted of injection into the arterial system of a preservative fluid. With the object of determining what fluid had been used a portion of the meat was sent to Sir Frederick Andrewes. It was subsequently ascertained that a weak solution of vinegar had been injected into the carcase. The process appears to result in some degree of sterility of the interior of the meat, but I do not anticipate that it is one which will be used on a large scale in connection with imported meat. This view is supported by the fact that since the above consignment arrived only one or two others have been received and these were not viewed favourably by the trade. The process may have advantages in warmer climates, and perhaps enables meat to be preserved in such climates during a journey of limited extent when the alternative of transporting in a refrigerator is either impracticable or exceedingly costly. FISH SUPPLIES. 239,215 tons of fish, of which 211,736 were land-borne and 27,479 water-borne, were received at or near Billingsgate Market during the year. This was a increase of 822 tons in the land deliveries, and a decrease of 3,992 tons in the deliveries by water. 66 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 1923. Month. Weight of Fish Delivered. Total. Weight of Fish Condemned. Ratio of Fish Condemned to that Delivered. By Land. By Water. Tons. cwts. Tons. cwts. Tons. cwts. Tons. cwts. qrs. Per Cent. January 18,888 8 2,258 19 21,147 7 62 6 0 1 ton in 339.443 tons or 0.294 February 16,605 10 1,891 10 18,497 0 102 17 3 1 „ 179.778 „ 0.556 March 19,483 10 3,040 14 22,524 4 269 5 3 1 „ 83.643 „ 1.195 April 15,688 11 2,506 0 18,194 11 116 15 0 1 „ 155.841 „ 0.641 May 18,329 10 2,204 0 20,533 10 152 13 1 1 „ 134.502 „ 0.743 June 19,182 7 2,010 14 21,193 1 227 5 3 1 „ 93.243 „ 1.072 July 17,208 2 2,119 0 19,327 2 349 16 3 1 „ 55.245 ,, 1.81 August 18,202 5 2,527 0 20,729 5 226 2 0 1 „ 91.681 ,, 1.09 September 15,921 13 2,706 0 18,627 13 132 13 3 1 „ 140.387 ,, 0.712 October 18,263 0 2,537 0 20,800 0 209 9 2 1 ,, 92.295 „ 1.007 November 18,330 10 2,197 0 20,527 10 62 13 2 1 „ 327.522 „ 0.305 December 15,633 0 1,480 15 17,113 15 95 4 3 1 „ 179.695 „ 0.556 Total 211,736 0 27,478 12 239,214 18 2,007 3 3 1 „ 119.178 „ 0.839 * Compiled from the Monthly Returns furnished to the Corporation by the Fishmongers' Company. Weight of Fish Delivered, Fish seized as Unsound, and percentage of Fish Condemned to that Delivered, at or near Billingsgate Market during 1923 and the five years 1918—1922. 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. 1918 121,270 154 121,424 2,166 9 1 1 ton in 56.047 tons, or 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 ,, 1921 198,839 28,658 227,497 2,580 17 1 1 „ 88.089 „ 1.134 ,, 1922 210,914 31,471 242,385 2,259 10 0 1 „ 107.273 „ 0.932 „ Average (5 years) 184,243 17,853 202,096 2,561 10 0 1 ton in 78.897 tons or 1.267% 1923 211,736 27,479 239,215 2,007 3 3 1 ton in 119.178 tons or 0.839% ENTERIC FEVER AND MUSSELS. Enquiries, instituted as a result of two cases of enteric fever occurring in a neighbouring Borough, appeared to indicate that the probable source of infection was mussels. In both cases the children who were taken ill had eaten a considerable quantity of these shellfish. It was ascertained that the mussels came to Billingsgate Market from North Holland and were accompanied by a Government certificate testifying to their freedom from pollution. Shortly before the outbreak of the illness, mussels from the same source in Holland had been bacteriologically examined by officers of the Fishmongers' Company and had been certified to be satisfactorily clean. As so frequently happens in these cases there was no proof which would enable contamination of the mussels to be associated with the illness of the two children referred to. FOOD POISONING. Two separate instances only of food poisoning have been reported to me this year and the circumstances are as follows:— On the 9th February I received information that some twenty or thirty* members of the staff of one of the City Banking houses were suffering from diarrhoea and that suspicion centred on food supplied on the Bank premises. Enquiries were made and it was ascertained that the kitchen in which the meal was prepared, together with the fittings and general arrangements for both preparation and cooking, were in every way satisfactory. The meal consumed had consisted of haricot ox-tail, venison and a sweet made of a proprietary cake mixture 67 and mincemeat. Only those who were served with the haricot ox-tail suffered from diarrhoea and in each case illness commenced some four or five hours after the meal. None of the cases were serious. A sample of the ox-tail was submitted to Sir Frederick Andrewes, who reported thereon as follows:— "No ordinary food poisoning bacilli could be found in the material either by direct culture or by brilliant green enrichment. The only organisms growing on direct culture are streptococci (fermenting lactose and saccharose but not raffinose or mannite). It seems to be doubtful whether these played any part. Two mice fed for three days exclusively on the ox-tail have remained perfectly well." From the above it will be seen that the bacteriological examination does not provide any support to the theory that the illness referred to was due to poisoning by haricot ox-tail, although the circumstances and the facts ascertained would appear to suggest that such was the case. The other instance occurred in June at a City Luncheon, where two persons were reported to have been ill the morning following the luncheon. In this instance it was impossible to make any investigations into the condition of the food as none which had been left over was available for examination. Instances of this kind must, of course, continue to occur from time to time. It is only, however, on rare occasions that these small outbreaks permit of complete investigation and therefore of definite decision. 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. General Farm Produce— Butter Holland Boxes and Casks 125,823 6 lbs.—1 cwt. Bacon „ Bales 8,813 2 cwts.—3 cwts. Cheese Holland and Italy Single Cheeses 172,487 4 lbs.—14 lbs. „ Holland, Denmark and Italy Packages 324,157 24 lbs.—1 cwt. Eggs Holland and Egypt Cases 55,027 1 cwt.—1 cwt. 2 qrs. Lard Holland „ 32,113 28 lbs.—56 lbs. Compound „ 13,132 28 lbs. Margarine „ „ 462,520 12 lbs.—56 lbs. Cereals— Barley „ Bags 7,891 100 lbs.—1 cwt. 2 qrs. Beans „ „ 1,598 1 cwt.—1 cwt. 3 qrs. Peas „ „ 9,127 1 cwt.—1 cwt. 2 qrs. Farina „ „ 290 2 cwts. Beverage Products— Coffee Africa and Costa Rica „ 60,516 1 cwt. 2 qrs. Cocoa & Chocolate Ceylon, Africa and Holland Bags and Cases 19,871 28 lbs.—2 cwts. Fruit (Soft)— Apples Holland Packages 6,429 40 lbs.—2 cwts. Peaches „ „ 119 6 lbs. Bananas Canary Islands „ 1,015 56 lbs.—1 cwt. Plums Holland „ 51,775 12 lbs.—40 lbs. Pears „ „ 27,889 14 lbs.—40 lbs. Currants „ „ 4,045 7 lbs.—40 lbs. Gooseberries „ „ 27,949 14 lbs.—100 lbs. Strawberries „ „ 4,520 7 lbs.—28 lbs. Cherries „ „ 12,346 12 lbs.—40 lbs. Cranberries „ „ 217 28 lbs. Rhubarb „ Bundles 15,996 28 lbs.—1 cwt. Fruit (Dried) — Currants Australia, S. Africa Greece Packages 895,042 40 lbs.—56 lbs, Raisins Australia, S. Africa Greece, Spain and California „ 168,466 8 lbs.—56 lbs. Sultanas Australia, S. Africa Greece, Afghanistan, Smyrna, and California „ 345,580 28 lbs.—56 lbs. 68 Article. Where from. Description of Packages. Total Number of Packages. General Range of Weight of Packages. Fruit (Dried)—contd. Plums California Packages 132,295 24 lbs.—56 lbs. Apricots Australia & California „ 10,956 24 lbs.—56 lbs. Evaporated Apples California „ 2,931 56 lbs. Pears Australia & California „ 2,552 24 lbs.—56 lbs. Peaches „ „ „ 10,873 24 lbs.—56 lbs. Dates Egypt „ 8,300 28 lbs. Figs Greece, Smyrna and Spain „ 137,484 28 lbs.—3 cwts. Fruit (Green)— Oranges Italy and Spain „ 334,673 56 lbs.—1 cwt. 2 qrs. Lemons „ „ „ 202,127 56 lbs.—1 cwt. 1 qr. Grapes Holland and Spain „ 29,894 12 lbs.—40 lbs. Melons „ „ „ 6,286 56 lbs.—1 cwt. Pomegranates Spain „ 1,420 1 cwt. Vegetables— Cauliflowers Holland „ 25,889 24 lbs.—40 lbs. Beans „ „ 591 1 cwt. Cucumbers „ „ 18,178 12 lbs.—40 lbs. Carrots „ „ 24,104 56 lbs.—1 cwt. Cabbages „ „ 18,178 1 cwt. Lettuce „ „ 60,653 14 lbs.—28 lbs. Sprouts „ „ 1,065 1 cwt.—1 cwt. 2 qrs. Potatoes Belgium & Holland Bags 65,413 100 lbs.—1 cwt. Parsnips Holland „ 3,145 100 lbs.—1 cwt. Onions Holland, Italy and Spain Bags and Cases 258,776 56 lbs.—1 cwt. 2 qrs. Radishes Holland Packages 2,338 50 lbs.—1 cwt. Tomatoes Italy and Holland „ 184,531 12 lbs.—40 lbs. Beetroots Holland Bags 844 1 cwt. Turnips „ Packages 167 40 lbs. Horseradish „ „ 41 56 lbs. Garlic Italy „ 428 56 lbs. Sugar Holland Bags and Cases 159,009 1 cwt.—2 cwts. Tinned Goods— Apricots Australia & California Cases 4,985 48 lbs. Cherries Italy „ 9,140 50 lbs. Fruit Pulp Australia and Spain „ 7,900 60 lbs.—100 lbs. Anchovies Spain „ 508 56 lbs.—1 cwt. 2 qrs. Vegetables Holland and Italy „ 5,588 50 lbs.—1 cwt. 2 qrs. Tomatoes Italy and Spain „ 35,462 50 lbs.—100 lbs. Pears California „ 935 48 lbs. Peaches „ „ 800 48 lbs. Condensed Milk Holland and Italy „ 812,378 48 lbs. Sardines Portugal „ 7,332 50 lbs.—1 cwt. Salmon Alaska and Canada „ 26,600 48 lbs.—56 lbs. Crayfish S. Africa „ 300 48 lbs. General Products— Macaroni Italy „ 141,861 28 lbs. Nuts (Various) Italy, Spain, Turkey and Persia Bags & Cases 58,763 28 lbs.—2 cwts. Milk Powder Holland Cases 4,252 50 lbs.—1 cwt. Milk Sugar „ „ 453 100 lbs. Ginger (Preserved) China Casks & Cases 11,300 30 lbs.—3 cwts. Vegetables (in Brine) Holland Casks 7,823 3 cwts.—4 cwts. Miscellaneous— Carraway Seeds Holland Bags 1,635 1 cwt. 1 qr. Confectionery Holland and Turkey Packages 4,717 56 lbs.—1 cwt. Liquorice Italy „ 873 1 cwt.—3 cwts. Liquid Egg Yolk China Casks 725 3 cwts.—4 cwts. Sugar Candy Holland Cases 2,279 28 lbs. Cocoa Butter „ Packages 3,898 1 cwt.—1 cwt. 2 qrs. Citrons (in Brine) Italy Casks 15 2 cwts.—2 cwts. 3 qrs. Peel (in Brine) „ „ 135 2 cwts.—2 cwts. 3 qrs. Orange and Lemon Peel (in Brine) Spain „ 226 2 cwts.—2 cwts. 3 qrs. Cherries (in Brine) Italy „ 400 3 cwts.—3 cwts. 2 qrs. Desiccated Cocoanut Ceylon Cases 800 1 cwt. 2 qrs.—2 cwts. Olives (in Brine) Italy Kegs 36 56 lbs. Anchovies Spain Barrels 298 1 cwt.—1 cwt. 2 qrs. Chillies E. Africa Bags 637 1 cwt.—1 cwt. 1 qr. 69 CONDEMNATION OF FOOD INSPECTED AT RIVERSIDE WHARVES. As a result of the daily Inspection of City Wharves 142 loads of unsound food 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 60 18 3 Condensed Milk (removed at request of owners) 16 0 Fruit Pulp 41 9 1 Fruit (Various) 23 7 1 Vegetables (Various) 23 3 3 Miscellaneous 7 17 1 Total 157 12 1 A portion of the above was removed at the request of the owners. 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 786 persons, compared with 785 in 1922. 72 per cent. are adults and 28 per cent. children (under 14 years). The number of births was thirteen, viz., eight males and five females. The birth rate was 16.5 per 1,000, which is 0.7 per 1,000 below the average for the previous five years. The death rate for 1923 was 13.9 per 1,000 per annum. The number of deaths of children under one year, per 1,000 births, was nil, as against 9 for the City generally. TABLE OF BIRTHS AND DEATHS OCCURRING AT THE ARTIZANS' DWELLINGS, STONEY LANE, HOUNDSDITCH, DURING THE YEAR 1923. Name of Block. Births. Mortality from all Causes at subjoined ages. Male. Female. At all ages. Under I year. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. NORTH BLOCK 2 2 1 .... .... .... .... 1 .... SOUTH „ .... 1 2 .... .... .... .... l l KING'S „ .... .... 2 .... .... .... .... .... 2 QUEEN'S „ 3 1 3 .... .... .... l .... 2 PRINCE'S „ 3 1 3 .... .... .... .... 3 .... Totals 8 5 11 .... .... .... l 5 5 k 70 The birth rate in these Dwellings reached a maximum of 46 9 per 1,000 in 1896, and has since been falling, as shown by the following figures:— BIRTH RATE, ARTIZANS' DWELLINGS. 1896 46.9 1897 40.3 1898 43.1 1899 37.5 1900 38.4 1901 33.8 1902 45.8 1903 31.2 1904 30.1 1905 29.1 1906 26.1 1907 35.0 1908 31.5 1909 29.6 1910 32.9 1911 29.5 1912 33.4 1913 29.7 1914 36.3 1915 28.8 1916 22.6 1917 29.3 1918 13.8 1919 18.7 1920 19.8 1921 10.3 1922 16.5 1923 16.5 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 1923 being 11,776, of whom 4,357 were males and 7,419 were females. The accompanying table is compiled from the monthly records of attendances at the baths:— RECORD OF ATTENDANCES AT THE BATHS, ARTIZANS' DWELLINGS. Month. Sex. Total. Males. Females. Children. Adults. Children. Adults. January 98 229 175 371 873 February 84 231 189 398 902 March 85 297 244 397 1,023 April 111 209 196 438 954 May 198 461 85 248 992 June 118 243 262 470 1,093 July 95 294 215 547 1,151 August 97 200 220 497 1,014 September 84 264 213 472 1,033 October 96 232 183 425 936 November 79 230 198 430 937 December 78 244 149 397 868 Totals 1,223 3,134 2,329 5,090 11,776 CITY MORTUARY. DISINFECTION—TRADE.—In accordance with the requirements of the South African Government, the disinfection of second-hand clothing prior to export to that country has been carried on as usual. The following table gives the details of the work of disinfection carried out at the Disinfection Station during the year in connection with the export trade:— Number of Certificates issued. Number of articles disinfected. Fees received by the Corporation. 1,029 351,004 £1,376 DISINFECTION—INFECTIOUS DISEASES Articles disinfected after cases of infectious disease 4,653 Public Vehicles Nil. BODIES RECEIVED POST-MORTEMS AND INQUESTS:- Bodies received at the Mortuary to await burial 149 Post-mortem examinations made 47 Inquests held on bodies 128 Inquests held on fires 1 CLEANSING OF PERSONS ACT, 1897:- Number of verminous persons bathed 19 CLEANSING OF SCHOOL CHILDREN:— Total number of children cleansed 866 71 NUMBER OF ARTICLES DISINFECTED, BODIES RECEIVED AT THE MORTUARY, AND INQUESTS HELD AT THE CORONER'S COURT IN THE CITY DURING 1923 COMPARED WITH THE PREVIOUS FIVE YEARS. Year. Articles disinfected. Bodies received at the Mortuary. Inquests held on bodies. Inquests held on Fires. 1918 179,990 158 130 0 1919 207,935 170 150 4 1920 549,829 172 158 9 1921 579,304 153 140 25 1922 760,860 135 114 15 Average for previous 5 years 455,584 158 138 11 1923 355,657 149 128 1 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 of 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. J. Waldo, J.P., Coroner for City of London and Southwark, has kindly furnished me with the following list of places in the City which were the subject of Fire Inquests held by him during 1923 :— INQUESTS HELD UNDER THE CITY OF LONDON FIRE INQUESTS ACT, 1888. Date of Inquest. Premises burnt. 20th July, 1923 8, Red Cross Street. In addition to the above, the City Coroner personally inquired into 173 " non-fatalj" 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 :—Deodorising and " denaturising " condemned meat, disinfecting public conveniences, disinfecting roadways, street gullies, disinfecting premises, &c., after infectious disease, drain testing and sundries. SANITARY INSPECTIONS. The following is a statement of the work of the Sanitary Inspectors in their several Districts during each month of the year :— WEST DISTRICT— Inspector F. T. Robbins. Month Premises Inspected, Orders issued. Notices served. Improvements effected. January 202 3 9 10 February 250 — 10 6 March 250 28 23 12 April 145 10 73 29 May 360 16 20 62 June 233 22 42 31 July 172 8 14 28 August 275 — 4 19 September 300 5 7 100 October 306 — 7 18 November 120 5 7 20 December 321 5 9 27 Totals 2,934 102 225 362 MIDDLE DISTRICT— Inspector E. I. Simmons. Month. Premises Inspected. Orders issued. Notices served. Improvements effected. January 207 12 22 10 February 84 11 20 9 March 200 25 42 35 April 365 8 33 42 May 328 6 16 42 June 218 8 8 23 July 182 3 9 26 August 260 6 11 54 September 282 14 3 42 October 223 10 13 20 November 212 11 12 21 December 349 6 24 66 Totals 2,910 120 213 390 k2 72 EAST DISTRICT— Inspector W. H. Ralph. Month. Premises inspected. Orders issued. Notices served. Improvements effected. January 193 4 16 27 February 190 4 10 19 March 97 2 3 10 April 354 3 78 20 May 337 19 15 25 June 225 6 12 89 July 169 9 15 20 August 249 3 7 17 September 274 5 18 23 October 219 7 2 21 November 240 4 10 10 December 416 5 17 35 Totals 2,963 71 203 316 THE FOREGOING ARE SUMMARISED AS UNDER District. Number of inspections made. Orders issued. Notices served. Improvements effected. West 2,934 102 225 362 Middle 2,910 120 213 390 East 2,963 71 203 316 Totals 8,807 293 641 1,068 REGISTERED LODGING HOUSES. Public Health (London) Act, 1891, Sec. 94. The Corporation, as the Sanitary Authority in the City, are required, under the provisions of Sec. 94 of the Public Health (London) Act, 1891, to make and enforce Bye-laws applying to houses let in lodgings or occupied by members of more than one family for the following purposes:— For regulating the number of persons and separation of the sexes. For the registration and inspection of such houses. For enforcing drainage and promoting cleanliness and ventilation. For the cleansing and limewashing of the premises at stated times. For the taking of precautions in any case of infectious disease. The Bye-laws now in force in the City for this class of property were made by the Court of Common Council on 24th November, 1904, and confirmed by the Local Government Board on the 20th January, 1905. Unfurnished lodgings, when the rent is not less than 10s. a week, and furnished lodgings when the rent is not less than 12s. 6d. a week, are exempt from the operations of the Bye-laws. Particulars relating to the registered Lodging-houses in the City now on the Register are given in the accompanying table:— 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 74 525 211 2.4 78 Middle 3 25 16 1.5 3 East 55 285 143 2.0 72 Total 132 835 370 2.2 153 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 153 Notices during 1923. 73 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 .... 10 .... .... .... 21 Albion Buildings, No. 22, Bartholomew Close .... 10 .... .... .... 22 Bartholomew House, Bartholomew Close 14 3 .... .... .... 27 Dean Street Blocks, Fetter Lane— Block A .... 8 .... .... .... 16 „ B 4 2 .... l .... 14 „ C 4 3 .... l .... 14 „ D 6 3 .... .... .... 17 „ E 8 2 .... .... .... 19 „ F 4 4 .... .... .... 13 St. Ann's Chambers, Ludgate Hill 6 12 .... l .... 30 Bloomfield House, Snow Hill .... 14 .... 3 .... 42 Total (Six "Blocks ") 46 71 .... 6 .... 235 MIDDLE DISTRICT. Bridgewater House, Fann Street .... 12 .... .... .... 15 City Buildings, Moor Lane .... 20 12 .... .... 80 Total (Two "Blocks") .... 32 12 .... .... 95 EAST DISTRICT. Harrow Alley and Stoney Lane— North Block .... 48 8 .... .... 217 South „ 5 22 13 .... .... 178 Prince's „ 5 50 .... .... .... 167 Queen's „ 5 40 5 .... .... 160 King's „ 8 16 16 .... .... 158 Barker's Buildings, Catherine Wheel Alley, Bishopsgate 11 5 2 2 .... 42 Total (Two "Blocks") 34 181 44 2 .... 922 These ten blocks contain 428 tenements, and are inhabited by 1,252 persons— an average of 2 92 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. NEGLECT TO COMPLY WITH WATER-CLOSET BYE-LAWS.—In accordance with the Bye-laws with respect to water-closets, &c., made under Section 54 of the City of London (Various Powers) Act, 1900, every person who shall intend to construct a water-closet, or to connect or disconnect any water-closet from any soil pipe or drain, shall, at least seven days before the work 'is to be commenced, deliver or send to the Corporation at the Guildhall, a plan showing the situation of such water-closet, drawn to scale, together with a section showing the proposed means of ventilation. Under Section 17, every person who shall offend against these Bye-laws renders himself liable to a penalty of £5 for every such offence, and in the case of a continuing offence, to a further penalty of 40s. for each day after written notice of this offence from the Corporation. Any infringement of such Bye-law is a serious matter, and may lead to considerable trouble and expense to the owner of the property, inasmuch as it may necessitate the condemnation of a system installed in contravention of the Corporation requirements. No instance of neglect in this respect has occurred during the year under review. 74 DRAINAGE PLANS.—In the course of the year 202 plans were submitted with regard to proposed reconstruction of water-closets or drains in the City. Of these, 189 were approved; 4 revised and approved; and 9 not approved. STREET GULLIES.—The gradual substitution of properly trapped gullies for those formerly existing has greatly reduced the number of complaints received of offensive smells arising from those appliances, especially in warm weather. In some cases this nuisance was doubtless due to want of flushing, but in the majority faulty construction was the cause of the trouble. The City Engineer has given special attention to this matter for several years past, and his action in replacing the old pattern gullies with those of a more up-todate design will, I hope, eventually lead to a complete abatement of the evil. OVERCROWDING.—Overcrowding is a nuisance to be dealt with summarily under Section 2, Sub-section 1 (e) of the Public Health (London) Act, 1891, and during the year 2 cases were 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 105 cases so investigated in 1923, it was found necessary to reconstruct the sanitary system in two instances, and to make amendments to soil and waste pipes, water-closets, &c., in 63 others. HOUSE, TRADE AND OTHER REFUSE REMOVAL.—The City Engineer informs me that the refuse removed from the City in 1923 consisted of 21,055 cartloads of street sweepings and slops, and 43,153 loads of house and trade refuse, a total of 64,208 loads. The total for the year 1922 was 63,330. 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 641 notices have been served by the District Inspectors at the order of the Sanitary Committee, and in five cases only was it found necessary, in consequence of non-compliance therewith, to refer the matters to the City Solicitor with a view to such steps being taken as he deemed necessary. 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 5,612,742 gallons of water were used. Of these courts and alleys; 20 were flushed six times a week, 10 five times a week, 2 four times a week, 27 three times a week, 126 twice a week, and 94 once a week. Disinfectants are also freely applied where desirable. The condition of the approaches to Billingsgate Market and the Customs House, as heretofore, required special attention. There has always been a difficulty in keeping the thoroughfares in the immediate vicinity of these places free from the nuisance caused by the drippings from the fish carts, especially during hot weather. LIMEWASHING OF COURTS.—There are 89 courts and narrow passages situated in various parts of the City, the walls of which, unless cleansed frequently, become dirty and unsightly through the constant traffic of passengers or vehicles, together with the action of the smoke-laden atmosphere. These are cleansed or limewashed twice a year under the direction of the City Engineer. Of the places so dealt with during 1923, 24 were situated in the East District, 33 in the Middle District, and 32 in the West District. DEFECTIVE CONNECTIONS TO SEWER. During the year, 115 reports were received from the City Engineer respecting the condition of connections between the drains of certain City houses and the public sewer. 75 Investigations showed that it was necessary to reconstruct 109 of the connections referred to. Of these, 84 have been completed and the remainder are, at the time of writing this report, in process of reconstruction. As a result of the inspection of the internal drainage system of these premises, reconstruction or alteration was found necessary in 47 instances. In the majority of cases these external drains were brick-barrel drains, in which rats had their breeding places, and were, undoubtedly, a source of much annoyance to the occupiers of the houses to which they were connected. FACTORY AND WORKSHOP ACT, 1901, &c. FACTORIES, WORKSHOPS AND WORKPLACES.—The premises upon the Register number 3,660, in which are included 7,802 workrooms, &c. There were served 2,180 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 Places. FACTORIES 1,056 3,644 WORKSHOPS 1,728 2,647 WORKPLACES Kitchens of Restaurants, Tea Rooms, &c. 749 1,221 Stables 21 21 Other places 106 269 3,660 7,802 The following is a Summary of Inspections of separate workrooms, &c., during the year:— Workshop Inspectors. Woman Inspector. Totals. FACTORIES 1,517 — 1,517 WORKSHOPS 1,387 — 1,387 WORKPLACES 675 33 708 The following is a Summary of Inspections of separate workrooms since 1914 FACTORIES. Workshop Inspectors. Woman Inspector. Totals. 1914 3,025 237 3,262 1915 1,438 319 1,757 1916 1,264 406 1,670 1917 1,501 234 1,735 1918 904 3 907 1919 995 7 1,002 1920 866 — 866 1921 1,956 2 1,958 1922 1,763 — 1,763 1923 1,517 — 1,517 WORKSHOPS. 1914 2,053 658 2,711 1915 1,411 751 2,162 1916 1,224 799 1,960 1917 1,308 347 1,655 1918 783 11 794 1919 1,069 18 1,087 1920 731 — 731 1921 1,958 — 1,958 1922 1,598 — 1,598 1923 1387 — 1,387 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 1,017 1922 957 1 958 1923 675 33 708 76 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. † 280, Bishopsgate. † 45, Fish Street Hill. † Great Eastern Railway Hotel. *61, Middlesex Street. *85, Middlesex Street. †*37, Middlesex Street. *63 to 65, Middlesex Street. †*122, Middlesex Street. 3, Pancras Lane, † 21, Stoney Lane. 68, St. Mary Axe. *75, St. Paul's Churchyard. 194, Upper Thames Street. UNDERGROUND BAKEHOUSES. † 188, Aldersgate. 262, Bishopsgate. *4, Broadway. 8, Copthall Avenue. †*67, Farringdon Street. *93, Fetter Lane. 48, Knightrider Street. * These have been established at least 37 years. SUMMARY. Aboveground Bakehouses 5 Underground Bakehouses 15 20 † Factory Bakehouses (power is used). Note.—No. 15, Cornhill has ceased to be used as a Bakehouse. SUMMARY OF WORK DONE UNDER THE FACTORY AND WORKSHOP ACT, 1901, AND THE PUBLIC HEALTH (LONDON) ACT, 1891, &c„ FOR THE YEAR 1923. Men Inspectors. Women Inspectors. Special. Inspector Sathercole. East District. Inspector Robinson. West District. Inspector McGrath. West District. Miss East District Miss v\ ilkinson. Totals. INSPECTIONS. Factories, Initial Inspections (Tenancies) 77 17 94 Do. Initial Inspections (Workrooms) 152 48 200 Do. Periodical Inspections (Tenancies) 201 201 402 Do. Periodical Inspections (Workrooms) 528 782 1,310 Do. Re-inspections (Sanitary Works, &c., in hand) 119 108 227 Workshops, Initial Inspections (Tenancies) 137 42 179 Do. Initial Inspections (Workrooms) 193 71 264 Do. Periodical Inspections (Tenancies) 440 282 722 Do. Periodical Inspections (Workrooms) 595 515 1,110 Do. Re-inspections (Sanitary Works, &c., in hand) 510 233 743 Workplaces, Initial Inspections (Tenancies) 77 3 23 103 Do. Initial Inspections (Workrooms) 96 4 46 146 Do. Periodical Inspections (Tenancies) 160 82 89 31 331 Do. Periodical Inspections (Workrooms) 269 130 160 33 562 Do. Re-inspections (Sanitary Works, &c., in hand) 267 130 142 9 548 Bakehouses, Inspections 17 13 8 38 Do. Re-inspections (Sanitary Works, &c., in hand) 4 7 3 14 DEFECTS FOUND. Factories, Workshops and Workplaces, &c.— Want of Cleanliness 75 51 59 6 191 Want of Ventilation 27 4 2 33 Overcrowding 8 2 10 Want of Drainage of Floors Other Nuisances, &c. 46 222 57 4 329 Storage Cistern defective 1 5 6 Kitchens Accommodation for Refuse 10 10 Accumulation of Refuse 2 2 Insufficient (Tenancies) 2 5 7 Sanitary Unsuitable (Do.) 5 19 24 Accom Defective (Do.) 43 154 143 7 347 modation Do. (No. of Conveniences)* 44 276 259 8 579 Not separate for Sexes (Tenancies) 5 10 11 26 Total Defects found 209 461 298 17 985 * Figures not included in total defects found or remedied. 77 Men Inspectors. Women Inspectors. Special. Inspector Gathercole. East District. Inspector Robinson. West District. Inspector McGrath. West District. Miss East District. Miss Wilkinson. Totals DEFECTS REMEDIED. Factories, Workshops and Workplaces &c.— Want of Cleanliness 37 39 48 1 125 Want of Ventilation 8 5 5 18 Overcrowding 7 2 9 Want of Drainage of Floors Other Nuisances, &c. 17 174 79 1 271 Storage Cistern defective 5 5 Kitchens Accommodation for Refuse 7 7 Accumulation of Refuse Insufficient (Tenancies) 1 1 Sanitary Unsuitable (Do.) 3 15 18 Accom- Defective (Do.) 21 113 149 3 286 modation , Do. (No. of Conveniences)* 23 232 256 3 514 Not separate for Sexes (Tenancies) 8 9 17 Total Defects remedied 90 355 307 5 757 OUTWORKERS. Lists received from City Firms 1,406 1,406 Names and Addresses, &c., received from other Authorities 218 218 Names and Addresses transmitted to other Authorities 11,375 739 12,114 Notices served on Employers 1,926 1,926 Letters written, &c. 84 3 87 Firms visited 119 119 Lists not kept by Employers 62 5 67 „ „ forwarded „ 58 5 63 Workshops notified by H.M. Inspector 59 21 80 General complaints received 3 15 11 29 Miscellaneous Visits 204 187 391 ACTION TAKEN. Matters referred to H.M. Inspector— Want of Cleanliness 1 5 6 Want of Ventilation Overcrowding Want of Drainage of Floors Failure to affix Abstract 47 21 68 Other Nuisances Action taken in matters referred by H.M. Inspector— Notified by H.M. Inspector 28 7 35 Reports sent to H.M. Inspector 28 7 35 Other matters Notices served— Factories—Intimation 16 7 23 Statutory 1 1 2 Workshops—Intimation 1 50 35 86 Statutory 37 19 56 Workplaces, &c.—Intimation 55 2 4 61 Statutory 24 2 26 Orders required from Sanitary Committee 34 32 20 86 Certificates for Cleansing issued by Medical Officer of Health 18 7 6 31 Matters referred to District Inspectors 4 8 4 16 Matters referred to Women Inspectors Matters referred to Workshop Inspectors Cases reported for Legal Proceedings 2 2 Legal Proceedings taken INSPECTION OF OUTWORKERS' PREMISES AND DOMESTIC WORKSHOPS. Registered Workshops at which Outwork is received— Inspections115 12 127 Defects found 46 5 51 Defects remedied 21 5 26 Outworkers' Premises—(Tenancies not registered as Workshops) Inspections 9 9 Defects found Defects remedied L 78 Men Inspectors. Women Inspectors. INSPECTION OF OUTWORKERS' PREMISES AND DOMESTIC WORKSHOPS—contd. Special. Inspector Gathercole. East District. Inspector Robinson. West District. Inspector McGrath. West District. Miss East District. Miss Wilkinson. Totals. Domestic Workshops at which Outwork is received- Inspections 2 2 Defects found Defects remedied Domestic Workshops which do not receive Outwork— Inspections Defects found Defects remedied Places from which " work is given out," but which are not registered as factories or workshops— Inspections6 2 8 Defects found Defects remedied WOMAN INSPECTOR. Offices, Inspections (Tenancies) Do. Defects found Do. Defects remedied London County Council (General Powers) Act, 1904, Inspections of Premises after Cleansing of Children Do. Do. Defects found Do. Do. Defects remedied Children Act, 1908 (Nurse Children), Inspections of Premises 7 7 Do. Do. Defects found Do. Do. Defects remedied Underground Conveniences for Women, Inspections42 42 Do. Do. Defects found 32 32 Do. Do. Defects remedied 5 5 Railway Stations (Ladies' Rooms), Inspections 32 32 Do. Do. Do. Defects found 14 14 Do. Do. Do. Defects remedied 3 3 Notification of Births Act, 1907, Visits 278 278 Number of Mothers attending Welfare Centre for advice 511 511 Special Visits 89 89 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 64 cases employers neglected to keep lists at their premises and to send copies of the same to the Corporation as required by the Act. Notice in each case was served upon the offender and in all cases complied with. No case of infectious disease was reported in connection with premises occupied by outworkers in the City. Three 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 City. Outworkers Employed outside City. Total number of Outworkers. 1902 17 3,752 3,769 (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 1922 1,493 783 11,956 12,739 1923 1,406 701 12,114 12,815 79 FACTORIES, WORKSHOPS, WORKPLACES AND HOMEWORK. 1923. 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) 496 25 - Workshops (including Workshop Laundries) 901 142 - Workplaces (other than Outworkers' premises included in Part 3 of this Report) 434 87 — Total 1,831 254 — 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 191 125 6 — Want of ventilation 33 18 — — Overcrowding 10 9 — — Want of drainage of floors — — — — Other nuisances 347 283 — — Sanitary accommodation insufficient 7 1 — — unsuitable or defective 371 304 — - not separate for sexes 26 17 — - 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 985 757 6 - † Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. L2 80 81 3.—HOME WORK. NATURE OF WORK.* OUTWORKERS' LISTS, SECTION 107. 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. Lists. Sending once in the year. Failing to keep or permit inspection of lists. Failing to send lists. Lists.† Outworkers.† Outworkers. (1) (2) Contractors. Workmen. Contractors. Workmen. (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Wearing Apparel— 1,926 making, &c. 1,173 3,836 7,138 40 99 255 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) 108 250 395 3 2 3 Cables and Chains Anchors and Grapnels Cart Gear Locks, Latches and Keys Umbrellas, &c. 46 30 248 — — - Artificial Flowers 31 — 317 1 — 1 Nets, other than Wire Nets Tents Sacks Racquet and Tennis Balls Paper, &c., Boxes, Paper Bags 8 8 15 — — - 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 1,366 4,124 8,113 44 101 259 1,926 Nil. Nil. Nil. Nil. Nil. Nil. Nil. Nil. *It 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 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 4 (or 6 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 each year and of the entries of names of outworkers in those lists. The entries in column 2 must necessarilv be even numbers, as there will be two lists for each employer—in 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 name 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. Number. (1) (2) Important classes of workshops, such as workshop bakehouses, may be enumerated here. General Workshops 1,708 Bakehouses (including Factory Bakehouses) 20 Total number of Workshops on Register *1,728 *These were found to be 2,647 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. Number. (1) (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (S. 133, 1901) 68 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 35 Reports (of action taken) sent to H.M. Inspector 35 Other — Underground Bakehouses (S. 101):— Certificates granted during the year Nil. In use at the end of the year 15 Date, 31st December, 1923. (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 FLY NUISANCE. As in past years, attention was given to the possibility of the spread of infection by flies, in the summer months. Leaflets were distributed throughout the City calling attention to the danger created by the fly and making special reference to the precautionary measures which should be taken to minimise the danger. In addition to this, your officers, wherever opportunity occurred, made a special point of directing the attention of householders to the necessity for the observance of cleanliness, frequent removal of house and other refuse, and the prevention of access of flies to foodstuffs, especially milk. RAT REPRESSION. The table set out on page 85, indicates the number of investigations and inspections made and details of work carried out under the Rats and Mice (Destruction) Act, 1919, during the year ended December 31st, 1923. From this summary it will be seen that 1,161 buildings were inspected and that those buildings were occupied by 2,463 firms. Of these premises no fewer than 467 were rat infested. One or other of the rat-catchers working in the City were engaged by business firms in 108 instances; poisons were laid down by 382 firms, and traps of the breakback character were used in 321 premises and wire traps in 89. Varnish traps which were used in special circumstances were relied upon in 236 premises. Cats and dogs were found to be kept by 132 firms. Complaints have been received at the office, or applications for advice, in 139 instances. The work done in addition to poisons and traps and the keeping of animals, included rat-proofing in 348 instances and drainage defects repaired in 119 instances. In this relation it should be stated that rat-proofing cannot be relied upon absolutely to exclude rodents from buildings, for reasons I have pointed out from time to time, e.g., the importation of rats into buildings in cases and crates from the Docks, and ingress through open doors and windows, especially through roof doors provided for exit in case of fire. But for the following reasons the value of properly carried out rat-proofing should not be under-estimated—food is protected; the domestic water supply is guarded; fire risk is lessened; insanitary defects are remedied, which might otherwise remain undiscovered; rats are more easily caught as hiding places are eliminated, and absence of hiding places results in a decrease in the rat population. I have pointed out in previous reports that the construction of many City buildings is such as to render rat-proofing practically impossible and, further, that the only persons competent to deal with these buildings (the owners) are not responsible under the Act. Where the owner is also the occupier and is anxious for advice and willing to make the necessary outlay, rat-proofing can be carried out with good results. Several instances of this have occurred in the City. The mode of procedure which the Rat Officer adopts is first to discover which kind of rat is infesting the building. Occasionally both kind are found in one building. If the black rat is the intruder, the examination of the building begins at the roof. If it should be the brown rat, then the inspection begins in the basement and it is frequently found necessary to test the drainage system. It may be of interest to cite an instance of a City bank badly infested with black rats from the roof. Rats were found to be breeding in the space between the wood casings surrounding the cisterns from which water was obtained. From the roof they gained entrance to the kitchen—where they fed from the refuse bins, etc.— by way of the ventilating fan opening. They also gained entrance through the skylight and the fire exit door when open. The rats then proceeded to establish themselves under the floors in various parts of the building. 83 A considerable amount of rat-proofing work was done, due regard being paid to the fact that the buildings are to be entirely reconstructed in the near future. The actual list of suggestions detailed by the Rat Officer was as follows:— (1) Roofs and Kitchen. Cut away part of wood casing surrounding c `istern on roof, clear away refuse under cistern, make good the woodwork throughout, repair the cover and fix a zinc rim around the edge. Fill in the apertures between wall and at bottom with wood covered with zinc. Fix a wire guard of small mesh (½-in. or less) in front of ventilating fan. Make and fix wire guards to ends of all overflow pipes from cisterns in loft discharging on to roof. Cut out and reinstate the broken glass in skylight. Ease, overhaul, oil and adjust all opening gear to ventilating lights, ease lights to admit of same being tightly closed. Refix and renew the broken ones. Clean out the loft by the side of the tanks on the top floor and lay poison as directed. Remove the large cupboard in vegetable store, clean away the rubbish deposited at back by rats, make good all holes in floor and cupboard and replace in position. Examine the well-hole of service lift in scullery and stop the runs in woodwork and walls. Lay traps as advised in all places where traces of rats can be determined. (2) Lift and Basement. Examine the well-hole of the passenger lift and fill in the holes around electric cables and pipes with cement and broken glass. Fill in the spaces between the sashes and pavement lights in the street with small mesh wire or expanded metal. Make and fix a metal grid to front of open air shaft and fix wire guards to other openings in area. Protect the bottom of door leading to area where gnawed by rats with a zinc shoe at bottom and sides. Search for and fill in all holes in basement walls and ceiling with cement and broken glass. Cut up a part of the flooring close to skirting showing a rat run, seal off the run and make good. Cut off the batten from potboard of racks and remove the packages on the bottom tier, repair if necessary and replace the packages. Note.—The cook was instructed that all food should be securely placed beyond the reach of rats. Also, that the refuse bins should not be overfilled which prevents the lids fitting properly. This is important, as also is the tight closing each night of all ventilators and windows leading on to the roof, otherwise the other suggestions to exclude rats would be useless. The whole of the above work has been carried out with the result that the premises have been freed from rats. Mr. Engineer informs me that during the year the following sewerage and drainage works, all of which tended to reduce the number of breeding places for rats, were carried out by his Department:— Pipe sewers reconstructed 6 Pipe sewers in course of construction 1 Pipe sewers substituted for old brick sewers 1 Brick sewers re-inverted 4 Brick sewers in course of being re-inverted 1 Brick sewers reconstructed 1 Brick sewers in course of being reconstructed 1 Disused sewers filled in 3 New drains constructed in connection with new buildings 44 Drains of existing buildings reconstructed 137 New gully drains constructed 3 Gully drains reconstructed 49 Disused drains bricked up 393 It was not found necessary in any case either to serve statutory notices or to take legal proceedings. I am indebted to Messrs. Dalton & Sons, professional rat-catchers, for the information that they have, during the year, caught 18,430 rats in the City area. In May, 1922, in accordance with the instructions of the Court of Common Council, I presented a report on this subject, which appeared in printed report No. 249 of the Medical Officer of Health. I then made the following suggestions:- "l —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 workshops 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. 84 "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 the first of these suggestions, I am satisfied increasing experience will justify the recommendation. It is somewhat unfortunate, in my opinion, that the Act under which rat repression is carried out does not recognise that there is a difference in the nature of the work to be performed in rural and urban districts. The problems, whilst being similar in minor respects, are totally dissimilar in major respects. Rat repression in urban districts in so far as the vermin infest separate buildings, resolves itself into a consideration of whether the sanitary conditions of that building, particularly as regards drains, are satisfactory; whether refuse is properly stored and whether the construction of the building is such that renders difficult the ingress of the vermin to the premises, and the vermin having gained entry, whether life is rendered difficult by the absence of suitable nesting places and by the reduction of available food supplies to a minimum. Similar principles apply in a rural district, particularly as regards what might be termed common harbourage, but the application of preventive measures is a different problem to what is presented in urban areas. In view of a discussion which recently took place in the Court of Common Council, I venture to repeat the following observations from last year's report:— "It is also perhaps of interest briefly to mention the standpoints from which rat repression is viewed by the owner and the occupier of a building since the Act came into operation. "Before January, 1920, the date of the Act coming into force, if rats became a nuisance the occupier usually complained to the owner who took the necessary steps to abate the nuisance, either by calling in professional rat-catchers or by instructing his builder to see to the drains if necessary and to stop all holes and places of ingress. Poisons also were used, chiefly by the rat-catcher and the building was dealt with as a whole. The chief poison in those days was generally phosphorous and from it reasonably good results were obtained. Viruses of more or less efficiency have also been in use for some years. The dangers to be apprehended from the use of bacterial preparations and their limited application were fully discussed in my report to the Corporation dated February 24th, 1920. When the Act came into force, however, the occupier of a building or part of a building, became solely responsible for rat riddance, the owner being under no obligation whatever to carry out any structural works which might be shown to be necessary to repress rats. "This is the weak part of the Act for it becomes exceedingly difficult in a large building occupied by a large number of tenants to get joint action, owing to circumstances connected with the business; infestation say of a five-storey building may only be noted on three or four of the stories. The fourth and fifth occupiers who are not affected are extremely reluctant to spend money in bringing about improvement which is of no benefit to themselves. "Even though premises may be only partially infested the necessary alterations are such in some cases that they can only be regarded as a charge which should be equally distributed over the whole of the occupiers. This brief illustration indicates clearly the necessity for the landlord or owner having responsibility where premises present difficulties which only structural alterations can remedy. If, however, the premises structurally are sound and separate tenancies are either accidentally infested or the nature of the business is such as to encourage infestation or render de-infestation difficult, then the occupier should shoulder the responsibility." Owing to organised activities, the work of rat repression would appear to be having an effect on the rat population. Considerable assistance is given by those concerned and interested in the subject, such as the owners of multiple teashops and restaurants, food places, railway stations, goods depots and the like. The Manager of one of the larger Railway Companies has expressed a definite opinion that rats appear to be less numerous than in former years, and in the above report it will be noted that Messrs. Dalton and Sons, who are actively engaged in rat catching in the City, were successful in taking nearly 2,000 less rats than in 1922, despite the fact that the number of their contracts with City firms has increased by 25 per cent. Mr. Mayne, who is in charge of the work of rat repression, also reports that of 1,161 buildings which he inspected during the year, 467 were found to be rat infested. This compares favourably with 855 rat infested buildings occurring in 1,076 buildings inspected in 1922. The reduction is probably not striking, but if it can be made progressive it will be a source of satisfaction. 85 RATS AND MICE (DESTRUCTION) ACT, 1919. Summary Showing Investigations and Inspections Made and Details of Work Carried Out under the Above Act, for the Year ended December 31st, 1923. Months. No. of Buildings Inspected. Average No. of Firms in building. No. of premises Rat Infested. Total No. of Firms interested. Steps taken to destroy Rats*. Rat Proofing done, Rat-holes stopped, &c. Drainage and Sewage Work carried out during the year. Special Observations. Rat-Catcher Employed. Poison Used. Wire Traps. Breakbacks. Varnish Traps Other Traps. Cats or Dogs kept. By City Engineer's Department. By M.O.H. Department. Complaints or Applications for Advice. January 129 2.3 46 298 3 35 6 22 16 4 9 31 542 119 23 February 115 2.0 27 238 7 24 5 22 10 - 10 24 3 March 129 0.2 47 257 5 33 4 28 20 - 26 28 9 April 122 2.7 51 332 18 31 12 31 29 1 12 45 11 May 126 2.0 33 259 10 24 10 22 16 3 7 27 11 June 90 2.9 32 267 5 47 5 25 18 2 6 34 7 July 138 2.0 56 278 22 61 12 41 38 3 14 42 24 August September 158 1.4 92 234 20 65 13 58 35 — 13 61 35 October November 154 1.9 83 300 18 62 22 72 54 2 35 56 16 December Totals * 1,161 2.1 467 2,463 108 382 89 321 236 14 132 348 542 119 139 *Buildings systematically inspected 1,022 „ inspected as a consequence of complaints 139 Totals 1,161 M 86 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, 51 persons were examined by the Medical Officer of Health during 1923, four of these persons were reported as physically unfit for office. Sixteen officers were also medically examined with a view to their retirement, thirteen of whom were reported to be unfit for duty. I have the honour to be, Gentlemen, Your obedient Servant, Aowarth. Medical Officer of Health for the City of London. Public Health Department, Guildhall, E.C. APPENDICES. page Appendix A—Street Lists of Mortality 88 „ B— „ „ Infectious Diseases 92 „ C—Register of Houses let in lodgings or occupied by members of more than one family 94 „ D—List of Adoptive Acts, Orders, Bye-laws and Regulations in operation in the City 97 88 APPENDIX A.—STREET LISTS OF MORTALITY. STREET OR PLACE. No. of House Sex. Age. Date of Death. Cause of Death. Remarks. Albion Buildings, Room 5 21 M 62 5th Oct. Pulmonary Tuberculosis Aldermanbury 19 M 73 19th Feb. Cardiac Disease—Cardiac Degeneration Resided at Camberwell. Aldersgate Street - F 69 6th Dec. Cirrhosis of Liver—Toxic 9 months Aldgate High Street (In Street). 180 M 66 19th Mar. Thrombosis, Coronary Artery of Heart Inquest—P.M.—Natural. Resided at S. Acton. Aldgate High Street (Three Nuns Hotel) — M 82 2nd Feb. Senile Debility—Bronchitis 21 days Aldgate High Street 24 F 80 30th Nov. Cerebral Hæmorrhage—Heart Failure Artillery Lane 5 F 64 18th April Br. Pneumonia—Chr. Endocarditis Died in City of London Infirmary, Bow Road. „ „ 7 M 50 18th April Drowning in River Thames Inquest—Open verdict. „ „ 9 M 56 15th Jan. Swallowed tooth of comb—Abdominal Abscess (Op.) Empyema P.M.—Inquest—Accidental. Died in London Hospital. „ „ 10 F 3 mths. 10th Oct. Measles—Bronchitis „ „ 21 F 58 22nd April Mediastinal Growth—Pleurisy and Asthenia Bartholomew Close Bartholomew House. — F 85 16th April Senile Decay—Bronchitis Cloth Fair Bartholomew House. 4 F 36 12th Jan. Pulmonary Tuberculosis, 1 year, 6 mos. Died in St. George's Home, Westminster. Bartlett's Buildings Holborn. 16 F 87 7th April Myocardial Degeneration „ „ „ 19 M 50 30th April Coal Gas Poisoning Inquest - P.M. — Suicide unsound mind. Resided at Tunbridge Wells. Basinghall Street 17 M 53 16th Mar. Broncho-pneumonia „ „ 72 M 65 26th Nov. Acute Bronchitis—Heart Failure Beech Street 25 M 49 22nd May Cerebral Apoplexy P.M.— Inquest—Natural. Bishopsgate 86 F 86 13th April Senectus—Valvular Disease of Heart „ 99 M 70 1st Aug. Carcinoma of Œsophagus Blomfield House, Snow Hill. 20 M 47 15th Aug. Pulmonary Tuberculosis—Laryngeal Tuberculosis „ „ „ 21 M 67 2nd May Chr. Bronchitis—Chr. Myocarditis Died in City of London Infirmary, Bow Road. Bloomfield Street, Finsbury House. - M 48 9th Aug. Perforated Duodenal Ulcer Died in Charing Cross Hospital. Botolph Alley "Green Dragon." - M 54 29th July Cerebral Hæmorrhage Died in Victoria Hospital. Bridgewater House 8 F 79 5th Oct. Chronic Nephritis—Myocarditis Died in City of London Infirmary, Bow Road. Bridgewater Street 2 M 70 12th Jan. Enlarged Prostate Died in Freemasons' Hospital. Brushfield Street 12 F 73 26th Feb. Myocardial Degeneration—Œdema of Lungs Died in City of London Infirmary, Bow Road. Camomile Street 23 F 68 2nd Dec. Bronchitis—Broncho-pneumonia Cannon Street 45 M 20 6th Oct. Pulmonary Tuberculosis „ „ 90 M 24 28th May Actinomycosis—Empyemia—Unresolved Pneumonia Carter Lane 22 M 61 16th Jan. Cerebral Hæmorrhage, 1 year, 4 mos.— Calcareous Arteries Died in City of London Infirmary, Bow Road. Charterhouse Street 6 M 53 9th June General Paralysis of Insane Died in City of London Asylum, Stone. Charterhouse Street "Triangle Hotel" — M 79 14th July Chr. Myocarditis—Arterio Sclerosis Died in City of London Infirmary. Cheapside "Saddlers Hall." 141 F 21 6th Mar. Pulmonary Tuberculosis Died in St. Bartholomew's Hospital. Circus, Minories 3 M 72 9th Aug. Fracture of Skull—Laceration of Brain —Knocked down by motor omnibus Inquest—P.M.—Accidental. „ „ 7 M 80 11th Feb. Cerebral Thrombosis—Arterio Sclerosis Died in City of London Infirmary, Bow Road. Clifford's Inn 17 F 54 26th Nov. Syncope, due to Chronic Disease of Heart and Coronary Arteries Inquest—P.M.—Natural. Cloth Fair 21 F 75 26th May Hemiplegia Died in City of London Asylum, Stone. College Hill 4 M 76 10th Mar. Bronchitis—Myocarditis Died in City of London Infirmary, Bow Road. College Street 24 F 73 16th Sept. Arterio Sclerosis Died in City of London Asylum, Stone. Crown Place, Aldgate 5 M 49 8th May Pulmonary Tuberculosis—Heart Failure Dorset Street 7 M 18 1st June Tuberculous Meningitis Eastcheap 47 F 50 14th June Carcinoma of Breast Died in City of London Infirmary, Bow Road. Eldon Street, St. Mary's, Moorfields. - M 22 18th Sept. Suffocation by Drowning Died at Rotherhithe. Ellison Street 11 M 69 20th April Intestinal Obstruction—General Peritonitis Died in London Hospital. Fenchurch Street 18 19 F 33 20th Sept. Coma consequent upon Cerebral Hæmorrhage due to Chronic Nephritis Inquest—Natural. „ „ 92 M 39 4th April Acute Tubercular Disease—Bronchopneumonia Resided in Camberwell. Fenton's Buildings 3 F 80 7th April Chr. Endocarditis—Arterio Sclerosis Died in City of London Infirmary, Bow Road. Fetter Lane 57 F 85 28th June Cardiac Degeneration „ „ 93 F 60 29th Dec. Carcinoma of Stomach 89 STREET LISTS OF MORTALITY—continued. STREET OR PLACE. No. of House Sex. Age. Date of Death. Cause of Death. Remarks. Fish Street Hill 45 F 73 22nd Aug. Fibrosis of Lungs Died in City of London Asylum, Stone. Fleet Street "Anderton's Hotel." - M 39 6th April Potassium Cyanide Poisoning Inquest—Self destruction —Unsound mind. Fore Street 64 F 97 18th April Senile Decay Garden Place 4 F 85 14th Dec. Carcinoma of Stomach—Asthenia Goodman's Yd., Minories 2 F 74 2nd June Hæmorrhage from Ruptured Thoracic Aneurysm Inquest. Gracechurch Street 80 F 44 6th March Syncope due to Hypertrophy and Dilation of Heart Gravel Lane 7 F 63 14th April Epilepsy—Cerebral Thrombosis Died in City of London Infirmary, Bow Road. Great New Street 3 M 2 mths. 20th June Pulmonary Atelectasis Died in Charing Cross Hospital. „ „ 20 F 64 31st May Carcinoma of Colon—Malignant Cachexia Great Tower Street 26 M 61 25th Feb. Valvular Disease of Heart—Myocarditis Greystoke Place 3 M 63 19th Mar. Chr. Myocarditis—Chr. Bronchitis Died in City of London Infirmary, Bow Road. Gunpowder Alley 8 F 6 wks. 12th Nov. Syncope due to Acute Bronchitis Inquest—P.M.—Natural. Died in Ambulance. Gutter Lane 21 M 68 10th May Carcinoma of Rectum „ „ 37 M 28 8th Jan. Pulmonary Tuberculosis, 4 years— Heart Failure Houndsditch 56 F 69 23rd Dec. Pulmonary Congestion—Cardiac Failure Carcinoma of Breast „ 154 M 86 26th July Chronic Gastric Catarrh—Intestinal Obstruction Huggin Court 2 F 50 4th May Bronchitis—Acute Bronchitis Hutchison Avenue 4 M 48 12th Aug. Phthisis Died in St. Peter's Hospital, Whitechapel. „ „ 11 F 59 6th June Cholelithiasis—Peritonitis Died in London Hospital. „ „ 22 F 35 12th Feb. Suffocation by Drowning Found in River Thames. P.M.—Inquest—Open verdict. „ „ 22 F 62 5th Mar. Cerebral Hæmorrhage, accelerated by fall down stairs P.M.—Inquest—Accidental. Died in London Hospital. „ „ 23 F 68 22nd Oct. Diabetes Mellitis— Chronic Endocarditis Died in City of London Infirmary, Bow Road. „ „ 24 M 48 22nd July Pulmonary Tuberculosis Hutchison Street 16 F 55 7th Oct. Carcinoma of Uterus „ „ Jewry Street 36 F 30 13th April Miscarriage—Retained Placenta— Septicœmia Died in Paddington. John St., Minories 15a F 52 11th July Sarcoma of Uterus— Exhaustion King's Block, Stoney Lane. 20 F 66 22nd Mar. Pulmonary Tuberculosis—Exhaustion „ „ „ 20 M 72 26th May Br. Pneumonia—Chr. Myocarditis Died in City of London Infirmary, Bow Road. King St., Snow Hill 5 M 74 12th April Sarcoma, lower jaw (R) „ „ King William Street 4751 M 48 22nd June Cerebral Hæmorrhage Died in Cottage Hospital, Margate. Leadenhall Street 11 M 50 2nd June Carcinoma of Mediastinum „ „ 36 M 60 13th July Syncope due to Chronic Fatty Degeneration of Heart accelerated by heat Inquest—P.M.—Natural. Liverpool St., G.E.Hotel "Abercorn Rooms." - M 69 1st Nov. Aterio Sclerosis—Aortic Regurgitation Resided at Lee, S.E. „ „ „ — F 49 7th Nov. Liver Abscess—Cardiac Failure London Wall Buildings 3 M 2 mths. 13th Feb. Infantile Convulsions—Collapse of Lungs Inquest—Died at Woolwich. Long Lane 64 M 70 9th Jan. Acute Nephritis, 12 days—Uræmia, 8 days Ludgate Hill 56 M 57 29th Aug. Pernicious Anæmia Middlesex Street 23 M 6 mths. 13th Jan. Whooping Cough—Pneumonia Middlesex St., Salvation Army Shelter 116 M 84 20th Jan. Chr. Myocarditis—Œdema of Lungs Died in City of London Infirmary, Bow Road. „ „ „ 116 M 66 7th Mar. Lobar Pneumonia—Chr. Endocarditis „ „ „ „ „ 116 M 77 25th Mar. Myocardial Degeneration—Asthma „ „ „ „ „ 116 M 72 15th May Chr. Myocarditis—Arterio Sclerosis „ „ „ „ „ 116 M 60 29th June Chr. Nephritis—Chr. Endocarditis „ „ „ „ „ 116 M 63 17th July Self-inflicted wound left ventricle Inquest—P.M.—Suicide, unsound mind. „ „ „ 116 M 78 13th Aug. Gangrene of left foot—Arterio Sclerosis Died in City of London Infirmary, Bow Road. „ „ „ 116 M 50 8th Sept. Lobar Pneumonia Died in Royal Northern Hospital. „ „ „ 116 M 54 27th Nov. Acute Bronchitis—Emphysema Died in St. Peter's Hospital. „ „ „ 116 M 72 1st Dec. Senile Decay Died in City of London Asylum, Stone. Middle Street 2 M 8 dys. 26th Feb. Prematurity Minories 76 M 57 9th Oct. Lobar Pneumonia Died in London Hospital. „ 143 M 82 6th April Chr. Bronchitis—Senile Decay—Cardiac Failure Died at Clacton. „ 147 M 75 18th Oct. Syncope due to Chronic Valvular Disease accelerated by serious effusions of the Pleura 90 STREET LISTS OF MORTALITY—continued. STREET OR PLACE. No. of House Sex. Age. Date of Death. Cause of Death. Remarks. Montague Court 2 F 66 13th Nov. Lobar Pneumonia—Chr. Myocarditis Died in City of London Infirmary, Bow Road. Monument Street 24 M 45 26th May Heart Disease—Mitral Stenosis Moor Lane Chambers 30 F 74 30th Nov. Broncho-pneumonia—Heart Failure Newbury Street 15 M 68 25th July Carcinoma of Ascending Colon Died in City of London Infirmary, Bow Road. New Street Hill 14 F 89 1st March Myocarditis—Bronchitis „ „ New Street Hill, Houndsditch. 24 F 36 27th June Lobar Pneumonia—Chr. Nephritis „ „ „ „ „ 26 F 75 7th Oct. Pernicious Anæmia—Uræmia „ „ „. 30 F 5 dys. 4th Feb. Cerebral Meningitis, probably Pneumococeal Died in City of London Maternity Hospital. „ „ „ 33 M 45 22nd May General Paralysis of Insane Died in City of London Asylum, Stone. „ „ „ 80 F 80 3rd March Myocardial Degeneration—Arterio Sclerosis Died in City of London Infirmary, Bow Road. New Street Square 10 M 75 16th July „ „ „ „ „ North Block, Stoney Lane. 29 M 52 11th June Pulmonary Tuberculosis—Diabetes Mellitus „ „ Old Broad Street 22 M 24 9th April Encephalitis Lethargica, prior to admission Died in City of London Asylum, Stone. Old Jewry Chambers 13 M 66 13th Mar. Influenza—Heart Disease Resided at Goring on Thames. Paternoster Square 19 M 42 19th Oct. Acute Mastorditis—Lateral Sinus Thrombosis P.M. Poppin's Court, Fleet St. 31 F 50 8th Sept. Epilepsy—Cerebral Softening Prince's Block, Stoney Lane 15 F 36 9th June Suppurating Ovarian Cyst „ „ „ 32 M 53 14th Nov. Carcinoma of Pancreas Died in London Jewish Hospital. „ „ „ 52 F 63 28th Mar. Mitral Stenosis—Arterio Sclerosis Died in City of London Infirmary, Bow Road. Queen's Block, Stoney Lane. 28 F 87 4th May Pulmonary Congestion—Chr. Myocarditis and Senility „ „ „ 31 M 21 3rd June Epilepsy Died in Metropolitan Hospital. „ „ „ 42 M 78 9th April Infective Enteritis—Diarrhœa Queen Street 29 F 85 12th July Syncope due to Chronic Disease of Heart Inquest—P.M.—Natural. „ „ 34 M 50 6th July General Paralysis of Insane Died in City of London Asylum, Stone. Queen Victoria Street 35 M 71 13th Jan. Chronic Nephritis—Cerebral Embolism Redcross Street 35- F 64 12th Sept. Acute Bronchitis—Chr. Bronchitis and Heart Failure 38 River Thames - M 62 22nd Feb. Drowning Inquest—No evidence to show how he came into water. River Thames, off Old Swan Pier. - M 68 5th April Suffocation by Drowning Resided at Battersea. Inquest — P.M. — Suicide unsound mind. Resided at Islington. River Thames - M 65 1st May „ „ „ Inquest—Suicide, unsound mind. Resided at Islington. River Thames, off London Bridge. - M 54 28th Oct. Coma due to Cerebral Hæmorrhage from fractured skull and laceration of brain P.M.— Inquest—Insufficient evidence to show cause of injuries. Resided at Pimlico. Robinhood Court 5.6 M 10 mths. 25th Jan. Diphtheria Died at Southwark Hospital, 72a, E. Dulwich Grove. Royal Exchange — M 38 7 th May Syncope due to Disease of Coronary Arteries P.M.—Inquest. Resided at Earl's Court. St. Paul's Churchyard, The Deanery. — F 11 29th Mar. Diabetes Mellitis—Diabetic Coma St. Swithin's Lane 23 F 66 11th July Morbus Cordis—Asthenia Shoe Lane 35 F 68 4th Dec. Bronchitis—Heart Failure „ „ 91 F 72 20th July Arterio Sclerosis P.M.—Died in Banstead Mental Hospital. South Block, Stoney Lane. 12 F 60 22nd Dec. Diabetes—Ischio Rectal Abscess „ „ „ 28 F 79 25th Feb. Morbus Cordis—Uræmic Coma Star Alley, Fenchurch Street Lodge. - M 32 22nd Dec. Pulmonary Tuberculosis Died in Collindale Hospital. Temple Chambers, Temple Avenue. 39 M 62 3rd Aug. Lympho Sarcoma of Spleen and Glands Died in St. Marylebone. Tenter Street 23 F 89 15th May Chronic Bronchitis and Emphysema Died in Hospital for Jewish Incurables. Thavies Inn 18 F 75 22nd Mar. Myocardial Degeneration-Chronic Bronchitis Died in City of London Infirmary, Bow Road. „ „ 21 F 55 6th June Acute Intestinal Obstruction due to a band. (Meckel's Diverticulum) 91 STREET LISTS OF MORTALITY—continued. STREET OR PLACE. No. of House Sex. Age. Date of Death. Cause of Death. Remarks. Upper Thames Street 98 M 66 4th April Progressive Muscular Atrophy— Bronchitis Died in City of London Infirmary, Bow Road. Vine Street, Minories 4 M 65 8th June Pulmonary Tuberculosis Died in Upton-on-Severn County and City Asylum. „ „ 5 M 46 15th Nov. Intestinal Obstruction Water Lane, Gt. Tower Street. 9 F 59 16th Mar. Carcinoma of Breast Watling Street 64 F 70 24th Nov. Chronic Nephritis—Cardiac Failure „ „ 66 M 5 mths. 13th Mar. Tubercular Meningitis Whitecross Street 12 F 84 7th Mar. Chr. Endocarditis—Œdema of Lungs Died in City of London Infirmary, Bow Road. 92 APPENDIX B.- LIST OF CASES OF INFECTIOUS DISEASE OTHER THAN TUBERCULOSIS, 1923. STREET LISTS.—Compiled from Notifications received. Street or Place. No. of House. Sex. Age. Disease. Date of Notification. Aldgate Avenue 21 F 5 Scarlet Fever 22nd September. Ditto 21 F 9 Ditto Ditto. Bartlett's Buildings 16 F 23 Chicken-pox 29th March. Billiter Street 21 F 7 Scarlatina 28th December. Ditto 21 F 10 Ditto 14th December. Bishopsgate, City Police Hospital - M 42 Scarlet Fever 11th December. Brick Hill Lane 5 F 5 Diphtheria 26th September. City of London Infirmary — M 65 Ac. Primary Pneumonia 5th March. Ditto - M 72 Ditto 28th May. Ditto - M 66 Ditto 12th November. Ditto - F 23 Ditto 18th April. Ditto — F 36 Ditto 26th June. Copthall Avenue 10/12 M 38 Diphtheria 23rd March. Cross Lane 3 M 8 Scarlet Fever 22nd November. Crown Court - M 21 Ditto 12th November. Crutched Friars 39 F 7 Ditto 21st October. Devonshire Square 16 F 7 Ditto 6th December. Duke Street 3 F 7 Ditto 9th October. Ditto 3 F 9 Ditto Ditto. Eastcheap 10 F 8 Ditto 16th November. Ditto 10 F 13 Ditto 21st November. Ditto 10 F 15 Ditto 27th November. Fenchurch Street 3 M 11 Chicken-pox 7th June. Fetter Lane 58/61 F 9 Scarlet Fever 6th June. Ditto 93 M 8 Ditto 11th June. Fleet Lane 29 F 8 Diphtheria 20th September. Ditto 29 F 3 Ditto 18th September. Fleur-de-Lys Court 6 F 4 Ditto 10th February. Garden Place 6 F 5 days Ophthalmia Neonatorum 11th June. Ditto 6 M 14 Diphtheria 1st October. Gravel Lane L'dge. M 5 Scarlet Fever 4th September. Hutchison Avenue 26 M 8 Enteric Fever 26th January. Ditto 26 M 14 Ditto 22nd March. Hutchison Street 18 M 21 Ditto 7th May. Ditto 2A M 14 Erysipelas 1st November. Jewry Street 13 M 10 Scarlatina 19th November. King's Block 27 M 11 Scarlet Fever 15th August. Ditto 35 M 49 Erysipelas 22nd October. Ditto 38 F 5 Scarlet Fever 31st August. King Street, Snow Hill 5 F 22 Diphtheria 19th June. Leadenhall Street 96 F 6 Chicken-pox 8th July. Liverpool Street 21 M 7 Scarlet Fever 10th October. Middlesex Street 37 M 6 Ditto 15th October. Ditto 37 M 7 Ditto Ditto. Ditto 37 M 7 Diphtheria 31st October. Minories 54 M 8 Chicken-pox 14th December. Ditto 76 M 60 Ac. Primary Pneumonia 8th October. Ditto 122 F 7 Scarlet Fever 24th September. Ditto 136 M 10 Ditto 24th December. Ditto 139 M 6 Ditto 7th November. Montague Court 1 M 3 Diphtheria 20th November. Ditto 1 M 4 Ditto Ditto. Monument Street 25 F 7 Scarlet Fever 30th November. New Street, Bishopsgate 12A M 10 Diphtheria 16th June. New Broad Street 15 F 13 Ditto 11th December. Old Bailey 21/22 F 10 Scarlet Fever 8th June. 93 STREET LISTS.—Compiled from Notifications received.—continued. Street or Place. No. of House. Sex. Age. Disease. Date of Notification. Old Bailey 59/60 F 16 Diphtheria 2nd February. Old Broad Street 20 F 30 Scarlet Fever 29th January. Prince's Block 22 F 3 Ditto 29th May. Queen's Court 2 F 5 Ditto 2nd August. Queen Victoria Street 71A M 10 Diphtheria 3rd February. Ditto 71A F 6 Ditto 6th February. Ditto 71A F 13 Ditto 17th February. Rood Lane 13 F 5 Scarlet Fever 27th September. Rose Alley 41 M 8 Ditto 23rd October. St. Bartholomew's Hospital — F 26 Ditto 7th May. Ditto — F 28 Ditto 6th June. Ditto — F 25 Ditto 1st July. Ditto — F 24 Ditto 24th September. Ditto — F 27 Diphtheria 4th November. Ditto — M 37 Erysipelas 7th February. Salisbury Court 136 F 8 Ditto 16th January. Salisbury Square 16 F 59 Ditto 9th November. Tudor Street 12 M 25 Chicken-pox 12th January. Upper Thames Street 98 M 5 Scarlet Fever 8th September. Ditto 98 F 6 Ditto 2nd December. 94 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. 20, Bride Lane A. G. Bodenham, 46 Carter Lane 2 5 5, Britton's Court Mrs. Hurrel, 5, Britton's Court 1 6 9, Broadways, Ludgate Hill F. J. Wells, 9, Broadways 2 4 1, Chapel Place Moravian Mission, 32, Fetter Lane 1 2 2, do. Do. do. 3 9 43, Cloth FairMr. C. Taylor, 6, Finsbury Square, E.C. 2 2 5 44, do. Do. do. 1 2 45, do. W. F. Masters, 45, Cloth Fair 3 12 5, Currier's Row T. Simmons, 5, Currier's Row 2 5 6, do. A. Bedford, 6, do. 2 3 7, do. W. Bampton, 7, do. 1 6 12, do. R. Edwards, 12, do. 2 3 13, do. J. Pringle, 13, do. 1 6 4, Dorset Street E. King, 23, Whitefriars Street 1 1 7, do. E. King, 23, Whitefriars Street 1 6 10, East Harding Street Eyre and Spottiswoode 2 10 11, do. Do. 2 7 12, do. Do. 4 9 2, Evangelist Court Morris & Co., 37, East Road, City Road 2 5 1, Fenton's Buildings Evans, Lescher, Webb, 60, Bartholomew Close 1 5 2, do. Do. do. do. 3 3 41, Fetter Lane Mrs. Vaughan, Railway Hotel, Bishop's Stortford 1 4 42, „ W. Read, 102, Fetter Lane 3 6 93, do. LB. Hayward, 93, Fetter Lane 3 10 29, Fleet Lane Messrs. Watney, Combe & Reid, Stag Brewery, Pimlico 4 14 30, do. Do. do. do. 3 9 31, do. Do. do. do. 4 10 1, Great New Street Mrs. J. Barnsley, 1, Great New Street 4 8 2, do. Do. do. 8 13 3, do. Do. do. 7 10 4, do. Goldsmith Company 3 8 13, do. Mr. Lee, 13, Great New Street 2 6 14, do. Mr. A. E. Walker, 14, Great New Street 2 9 15, do. Mrs. A. E. Jackson, 15, Great New Street 4 9 16, do. J. Day, 16, Great New Street 3 5 20, do. F. Wilson, 51, Frankfort Road, Heme Hill 11 22 21, do. M. Quilty, 21, Great New Street 2 7 5, Green Dragon Court T. Pringle, 58, Chancery Lane 1 6 6, do. Do. do. 2 9 7, do. Do. do. 3 9 6, Greystoke Place W. G. Cuss, 6, Greystoke Place 1 8 7, do. Solicitors' Law Stationery Society, 104 Fetter Lane 4 4 8, do. Do. do. do. 3 7 9, do. Do. do. do. 4 13 2, Gunpowder Alley T. Richardson, 2, Gunpowder Alley 1 6 7\, do. T. Townsend, 259, Essex Road, N. 2 6 8, do. Do. do. 4 8 54, Little Britain J. Boni, 54, Little Britain 1 6 25, do. Mrs. Davis, 25, Little Britain 3 4 79, Long Lane Robert Dyas & Sons, 63, Fore Street 2 6 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 5 10 6, do. r. Crook, 6, Middle Street 2 2 20, do. T. Green, 20, Middle Street 1 2 1, Montague Court H. Tenant, 1, Montague Court 3 9 2, do. Mr. G. Hanlan, 2, do. 2 5 3, do. Mrs. Vincent, 3, do. 3 7 4, do. Mrs. F. Smith, 4, do. 3 4 5, do. Miss Saunders, 5, do. 2 8 6, do. Mr. F. J. Swain, 6, do. 3 6 7, Nevill's Court Moravian Mission, 32, Fetter Lane 1 5 8, do. Do. do. 4 6 9, do. Do. do. 3 9 10, do. Do. do. 7 12 Carried forward 175 450 95 WEST DISTRICT—continued. Situation of Premises. Name and Address of Landlord. Tenemsiits. Lodgers. Brought forward 175 450 11, Nevill's Court Goldsmiths' Company, Goldsmiths' Hall 8 12 12, do. Do. do. 7 17 9, New Street Square L. G. Taylor, 9, New Street Square 4 6 14, Newbury Street J. W. Neighbour, 2, Ironmonger Row 4 15 57, West Smithfield T. A. Allen, 57, West Smithfield 6 12 13, Wine Office Court .... Messrs. Reynolds & Eason, 192, Bishopsgate 1 1 14, do. Do. do. 2 5 16, do. Do. do. 2 5 17, do. Do. do. *2 2 Total 211 525 Average number of lodgers to each occupied tenement: 2.4. Houses demolished or closed as dwelling-houses 3 Tenement houses on Register 74 Cleansing Notices served 78 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 8 Total 16 25 Average number of lodgers to each occupied tenement: 1.5 Houses demolished or closed as dwelling-houses 1 Tenement houses on Register 3 Cleansing Notices served 3 EAST DISTRICT. 7, Artillery Lane Clerk to Bishopsgate Institute, Bishopsgate 3 10 9, do. Claude M. Leigh, 268, Bishopsgate 3 6 21, do. Clerk to Bishopsgate Institute 3 7 10, Brushfield Street Reynolds & Eason, 192 Bishopsgate 6 7 12, do. Luke Cohen, 12, Brushfield Street 2 7 14, do. Clerk to Bishopsgate Institute 7 9 1, Circus, Minories S. Moses, 65, Mansell Street 6 24 2, do. T. Shaw, 2„ Circus, Minories 1 4 3, do. W. Lewis, 3, do. 3 7 4, do. W. Wisdom, 4, do. 4 8 5, do. T. Grover, 5, do. 7 10 7, do. City Corporation 8 12 3, Crown Place, Aldgate W. Harper, 3, Crown Place 1 2 5, Duke Street Imbert Terry & Co., 28a, Basinghall Street 1 1 6, India Street, Minories B. Marks, 6, India Street 1 3 1, Hutchison Avenue A. J. Hollington, 8, Middlesex Street 2 2 3, do. E. Pooler, 3, Hutchison Avenue 1 2 4, do. Morris Cohen, 4, Hutchison Avenue 2 4 6, do. S. Owen, 6, Hutchison Avenue ] 4 7, do. A. Miller, 7, do. 1 2 9, do. Barnet Barnet, 9, do. 1 1 10, do. C. Zeffie, 10, do. 3 3 12, do. A. Cohen, 11, do. 3 3 13, do. B. Levy, 13, do. 3 8 14, do. P. Sugarman, 14, do. 1 1 21, do. A. Fuglar, 21, do. 2 3 22, do. B. Dubowski, 22, do. 2 2 23, do. J. Cronie, 23, do. 2 6 24, do. S. Ereira, 24, do. 1 1 5, Hutchison Street J. Silver, 5, Hutchison Street 1 2 6, do. J. Soloman, 6, do. 3 5 10, do. I. Levy, 10, do. 1 1 12, do. A. Poski, 12, do. 1 1 17, do. A. Cohen, 17, do. 1 1 18, do. E. Joseph, 18, do. 1 2 Janes Buildings, 2, Hutchison Messrs. Moore & Moore, 7, Leadenhall Street 3 14 Street. Carried forward 92 185 96 EAST DISTRICT—continued. Situation of Premises. Name and Address of Landlord. Tenements. Lodgers Brought forward 92 185 14, New St., Gravel Lane J. Panyer, 14, New Street, Gravel Lane 2 3 15, do. H. Norden, 15, do. 2 2 16, do. H. Glyn, 16, do. 1 1 22, do. B. Levy, 22, do. 1 1 23, do. J. Elsley, 23, do. 2 3 27, do. E. Marks, 27, do. 1 2 30, do. E. Hassan, 30, do. 3 4 40, do. M. Roche, 40, do. 1 1 2, Queen's Court, Vine Street Mrs. Cox, 2, Queen's Court, Vine Street 1 4 3, Three Crown Court, Mr. Martin, 14, Seething Lane 3 5 Jewry Place 3, Vine Street, Minories City Corporation 4 14 5, do. Do. 3 19 18, Widegate Street S. Franks, 18, Widegate Street 2 5 21, do. A. Field, 182, Hanbury Street, E. 6 6 24, do. W. I. Crane, 25, Widegate Street 4 6 25, do. Do. do. 3 6 2, Goodman's Yard Charrington, Brewers, Mile End Road 3 3 5, Artillery Lane Clerk to Bishopsgate Institute, Bishopsgate 6 9 21, do. do. do. 3 6 Total 143 285 Average number of persons to each occupied tenement: 2.0 Houses demolished or closed as dwelling-houses 1 Tenement houses on Register 55 Cleansing Notices served 72 97 APPENDIX D.—LIST OF ADOPTIVE ACTS, BYE-LAWS AND LOCAL REGULATIONS RELATING TO PUBLIC HEALTH IN FORCE IN THE CITY OF LONDON. ADOPTIVE ACTS.—Nil. ADOPTIVE ORDERS. Subject. Act. Date adopted. Sanitary Accommodation Sanitary Accommodation Order, 1903 Sept., 1904. BYE-LAWS. Vendors of Fried Fish London County Council (General Powers) Act, 1908, Sec. 9 Jan., 1914. Fish Curers ditto ditto ditto. Slaughter of Cattle Public Health (London) Act, 1891, Sec. 19 May, 1911. Prevention of Nuisances arising from Snow, Ice, Salt, Dust, Ashes, Rubbish, Offal, Carrion, Fish or Filth, or other matter or thing in any street Public Health (London) Act, 1891, Sec. 16 Feb., 1894. Prevention of nuisance arising from offensive matters running out of any manufactories, breweries, slaughterhouses, knackers' yard, butchers, or fishmongers' shop, or dunghill ditto ditto ditto. Prevention of keeping of animals on any premises in such a manner as to be a nuisance ditto. ditto. ditto. As to the paving of yards or open spaces in connection with ing houses ditto ditto ditto. Keeping W.C.'s supplied with a sufficient supply of water Public Health (London) Act, 1891, Sec. 37 Feb., 1894. Cleansing of Cisterns ditto ditto Sec. 50 ditto. Water Closet, Earth Closet, &c. City of London (Various Powers) Act, 1900 Sept., 1909. Houses Let in Lodgings Public Health (London) Act, 1891, Sec. 94 Jan., 1905. Demolition of Buildings City of London (Public Health) Act, 1902, Sec. 5 July, 1904. Ice Cream London County Council (General Powers) Act, 1902 Sept., 1902. REGULATIONS. Soda Water 1908. Hairdressers Nov., 1904. Kitchens of Restaurants and above-ground Bakehouses Jan., 1904. Milk Stores and Milk Shops July, 1903. Ice Cream Nov., 1902. Common Lodging Houses Oct., 1902. House Drainage Sept., 1898.