WES 15 ANNUAL REPORT on the STATISTICS and SANITARY CONDITION relating to THE CITY OF WESTMINSTER. FOR THE YEAR 1901. by FRANCIS J. ALLAN, M.D., C.M., D.P.H. Camd., F.R.S. Ed. medical officer of health. Printed by Order of the Public Health Committee. LONDON: harrison and sons, printers in ordinary to his majesty, st. martin's lane, w.c. iii CONTENTS. PART I. page Population 3 Houses 13 Births 24 Deaths 25 Tubercular Disease 17, 38 Infectious Diseases 46 Smallpox 49 Scarlet Fever 5 1 Diphtheria 52 Typhoid Fever 54, 104 Plague 58 Diarrhœal Diseases 59 Measles 60 Whooping Cough 65 Schools and Infectious Disease 65 Disinfection 66 Mortuaries 69 Cleansing of Persons 70 PART II. Staff 71 Inspection of Houses 73 Underground Dwellings 73 Houses let in Lodgings 73 Customs and Inland Revenue Act 74 Housing of the Working Classes— Adoption of Part III 21,74 Clare Market Scheme 74 Turner's Court 74 Tenement Dwellings 76 Healthiness of Block Dwellings 76 Common Lodging Houses 78 Workshops 78 Out-workers 82 Bakehouses 84 Dairies, Cowhouses 84 Slaughterhouses, Offensive Trades 85 Stables 85 Smoke Prevention 86 Water Supply 86,104 Water Companies' Regulations 87 Sale of Food and Drugs 87 Appendix I.—Report of Chief Sanitary Inspector 88 „ II.—Water Supply and Typhoid Fever 104 iv SUMMARY OF VITAL STATISTICS (Required by Local Government Board) FOR 1901. CITY OF WESTMINSTER, Area in Acres (exclusive of area covered by water) 2502.7 Population at Census 201,969 Number of Inhabited Houses 18,366 Average Number of Persons per house 8.9 Population estimated to middle of each year (corrected by addition of paupers) 185,648 Births 3,432 Rate per 1,000 estimated population 18.5 Total deaths registered in the City— Under 1 year of age 435 Rate per 1,000 births registered 126 At all ages 2,998 Rate per 1,000 estimated population 16.1 Total deaths in Public Institutions in the City 1,227 Deaths of non-residents in Public Institutions in the City 1,019 Deaths of Citizens in Public Institutions beyond the City 921 Nett deaths at all ages belonging to the City 2,900 Rate per 1,000 estimated population 15.6 Annual Report on the Health and Sanitary Condition of the City of Westminster. 1901. To the Mayor, Aldermen, and Councillors of the City of Westminster. My Lords and Gentlemen, I have the honour to submit to you my first Annual Report on the Health and Sanitary Condition of the City of Westminster during the year 1901. As the date of my taking office began at the end of the first three months, I am only required to report on what has transpired during the remaining nine months, but iu order that statistics may be comparable in future years, my predecessors (Professor Corfield, Dr. Edmunds, Dr. Skegg, and Dr. Norton) have supplied me with the Registrar's weekly returns for the parts of the City for which they were responsible, and I am therefore able to submit figures for the 52 weeks ending December 28th. This, together with the extra work entailed by smallpox, and waiting for the report of the census as afiecting the City, has delayed the issue of the Report. It is fortunate that the census was taken at an early date after the incorporation of the City, as the alteration of area in many parts of the City would have rendered comparison of birth and death rates impossible. I have considered somewhat fully the facts brought out by the census in relation to the various Wards, and have prepared tables summarising information given by the Registrar-General with reference to them, certain of these are included herewith. The meteorological conditions during 1901, as in the preceding year, proved favourable to health. 1901 was the seventh year hi succession in which the total rainfall has been below the average; the driest month of the year was November, and the wettest (8545; A 2 December; February was the coldest month of the year, but the three last months were somewhat colder than has been the case in recent years, with the result that fogs were more frequent. The temperature of the air of the third quarter of the year was 1.9 degrees above the average of each of the 30 years, 1872-1901, July being the hottest month of the year. Diarrhoea was, therefore, more prevalent, and raised the death-rate above the average for two weeks in August. The death-rate in London was above the average in only six weeks altogether, the other four being in November, due to cold and fog. The Report is arranged for convenience in two parts—the first dealing with the census and vital statistics; the second with sanitary work generally, and in connection with the latter I have included a report by Chief Inspector Strutt. Appended are returns required by the Local Government Board. The housing of the working classes has received much consideration during the past year, and information on this subject is included. Special attention has been devoted to consumption and tubercular diseases, and I submit certain recommendations which I trust will be found valuable. Much time has been taken up during the year organising the work of the department, in harmonising the various systems in vogue in the five original parts of the City, in the preparation of registers of workshops, bakehouses, records of work, &c., but a good deal still remains to be done. So far as the staff has been concerned, the first year has been in the nature of an experiment. I was of opinion that the number proposed in both the clerical and inspectorial divisions would be inadequate, and so it has proved. Their time has been fully occupied, and there is still a considerable amount of work which they have not been able to attempt. Under these circumstances, and with the additional duties cast upon the Council by the Factory and Workshop Act, I trust that the Council will, during 1902, take steps to strengthen the staff, so that this part of the Council's work may be carried out in a manner worthy of the position and importance of the City of Westminster. I have the honour to be, Your obedient servant, FRANCIS J. ALLAN, Medical Officer of Health.. May 20th, 1902. 3 PART I. Population. At the census taken in the spring of 1901 there were found to be 183,001 persons living in the City. I have already shown in my monthly reports that this represents a decrease of 18,958 (equal to 9.4 per cent.), as compared with the population as ascertained in 1891. The Registrar-General has now issued statistical tables for the County of London, and from these I have extracted the particulars relating to the City of Westminster. The population and number of inhabited houses in the old Civil Parishes and in the new Wards are given in Table I. The population and areas of the Wards, as now constituted, have been added by me for 1891. It has been somewhat difficult to ascertain the populations of certain Wards, as at previous census periods, but, so far as that is possible from the available records, that has been done, and I have made out a comparative statement, showing the alterations which have taken place in the population and number of houses in each Ward of the City. St. George's Group.—Dealing first with the Conduit, Grosvenor, Knightsbridge St. George, and Victoria Wards, which may be called the St. George's Group, I find that the population fluctuates up and down in such a way as to introduce a considerable element of doubt with regard to the accuracy of the figures. My predecessor, Professor Corfield, in his Annual Reports for 1892 and 1897, pointed out that a large number of the inhabitants are out of town on Sundays, and especially when the Sunday elected for taking the census is just immediately before or after Easter; thus in 1861 the Registrar-General noted that in the Parish of St. George, Hanover Square, "587 persons were temporarily in the district, and 3,206 were out of town at country houses, visiting, &c.," but since then this information is not given. The population of the group recorded at each census since 1801 to 1901 gradually increased from 38,440 to 90,028 in 1871, since which date there has been a steady decrease to 76,957, the number (8545) a 2 Table I.-—The City of Westminster, with Constituent Civil Parishes and Wards, Area, Houses, and Population. Name of Borough. Area in Statute Acres. Houses.—1901. Population. Inhabited. Uninhabited. Building. 1891. 1901. In Occupation. Not in Occupation. Persons. Persons. Males. Females. Westminster, City of 2502.7 18,366 2,427 1,036 157 201,969 183,011 84,963 98,048 Civil Parishes:— Close of the Collegiate Church of St. Peter (4-3) 9.6 30 - - - 235 231 111 120 Liberty of the Rolls (12-2) 9.3 43 24 — — 411 252 114 138 Precinct of the Savoy (12-2) 6.6 24 11 — - 201 166 80 86 St. Anne within the Liberty of Westminster (5-2) 53.4 835 185 39 20 12,317 11,493 6,01 L 5,482 St. Clement Danes (12-2) 56.6 514 118 88 4 8,869 6,090 3,120 2,970 St. George, Hanover Square (4 : 1, 2) 1111.2 8,931 571 522 24 78,920 76,957 32,761 44,196 St. James, Westminster (5-1) 163.1 2,139 817 136 42 24,995 21,588 10,674 10,914 St. Margaret and St. John (4:1,3) 766.2 4 533 252 196 45 56,215 51,068 24,479 26,589 St. Martin-in-the-Fields (12-1) 286.1 1046 326 40 18 16,115 12,980 6,486 6,494 St. Mary-le-Strand (12-2) 14.4 55 16 8 2 1,549 494 238 256 St. Paul, Covent Garden (12-2) 26.2 216 107 7 2 2,142 1,692 889 803 Wards:— Charing Cross 249 497 144 10 12 7,505 5,755 2,995 2,760 Conduit.. 63 670 186 41 8 7,931 5,876 2,384 3,492 Covent Garden 63.3 765 289 37 8 10,752 8,917 4,380 4,537 Great Marlborough 39.3 652 211 33 17 11,135 7,908 3,793 4,115 Grosvenor 506.2 1,841 172 177 11 15,802 15,266 6,142 9,124 Hamlet of Knightsbridge 343.1 898 18 74 7 7,320 7,601 2,959 4,642 Knightsbridge, St. George's 184 2,311 87 195 4 15,823 15,657 5,886 9,771 Pall Mall 49.1 454 167 25 4 3,683 4,122 2,248 1,874 Regent 74.7 1,033 439 78 21 10,178 9,558 4,633 4,925 St. Anne 53.4 835 185 39 20 12,317 11,493 6,011 5,482 St. John 210 2,658 92 90 24 34,106 29,914 15,093 14,821 St. Margaret 222.7 1,007 142 32 14 15,024 13,784 6,538 7,246 Strand 86.9 636 169 96 6 11,030 7,002 3,552 3,450 Victoria 358 4,109 126 109 1 39,364 40,158 18,349 21,809 5 at the recent census. The Conduit, Grosvenor, and Knightsbridge Wards appear to have decreased in population since 1861, but the Victoria Ward has shown an increase on some occasions and a decrease on others, and has now nearly the same population it had in 1881. The Westminster Group.—The population of the parish of St. Margaret, including what is now the hamlet of Knightsbridge and the Close of St. Peter, numbered 17,508 at the beginning of last century, it increased up to 1851, when it reached 31,314, and since that date it has decreased to 21,335 in 1901. The Ward of St. Margaret, as now constituted, contained 14,666 persons at the 1896 census, and 13,784 in 1901; while the hamlet, which was 7,076 in 1896, now numbers 7,601, the increase being chiefly due to the addition of 510 inhabitants, the difference in population of the areas interchanged with Kensington. St. John's Ward contained only 8,375 persons at the first census in 1801; in 1871 its population reached its maximum of 38,478, and since then it has declined to 29,914. The St. James's Group.—This group, which constituted St. James's Parish, had 34,462 inhabitants at the first census, 37,398 was reached in 1841, since when it has declined to 21,588. This decrease has been greatest in the Regent and Great Marlborough Wards, their population now being just half what it was in 1841. The figures for Pall Mall Ward show similar fluctuations to those noted in the St. George's Group, and apparently, although there is a decrease in 1901 as compared with 189(5, there is an increase on the figures for 1881 and 1891. The true population of that Ward may be taken to have been slowly decreasing. St. Anne's Ward, which forms with St. James's Parish the area of the Westminster Union, may be taken in connection with this group. Details relating to its population in the past have already been presented by me in a special report dealing with the late area of the Strand District Board of Works. It is, therefore, only necessary to point out that the population has decreased from 12,317 in 1'891, to 12,048 in 1896, and 11,493 in 1901, the larger part of the reduction in the last five years being in females, as noted on page 8. Strand Group.—The Strand, Covent Garden, and Charing Cross Wards have decreased in population very considerably during the last 10 years, due to improvement schemes connected more or less intimately with the new street from Holborn to the Strand; thus the Strand Ward, which had 11,030 inhabitants in 1891, had only 7,002 in 1901. 6 The population of the Parish of St. Martin-in-the-Fields, which was 28,252 in 1821, had decreased in 1901 to 11,527. Its Park and Embankment Wards have now become the Charing Cross Ward; their population in 1861 was 11,071, it is now about half—5,755, Its Long Acre Ward has been joined with the Parish of St. Paul and a piece of St. Giles to form Covent Garden Ward, and is, to some extent, also affected by street improvement schemes. It is customary to calculate birth and death rates on the population at the middle of each year, and as the census takes place about the end of the first quarter, it is necessary to estimate what increase or decrease is likely to take place. The Registrar-General usually takes it for granted that a similar condition of things will persist in the next 10 years as did in the past decade. According to this method, the population of the City, in the middle of 1901, was 182,502, as against 183,011, the number ascertained at the census in the spring. I have arrived at nearly the same figure by a different method. Instead of taking the population of the City in gross, I have taken it for each Ward, applying thereto information available as to property being built and occupied or about to be demolished; by this means I get 182,597. A further correction has, however, to be made for persons residing in Poor Law Institutions outside the City. When any person dies in such Institution the death is recorded against the locality in which he lived at the time of admission, even though that may have been many years previously. It is therefore only fair that, in estimating the death rate, the number of persons in such Institutions should be added to the population of the district. I find that there were 3,700 persons living in Poor Law Institutions connected with the City, and that 3,051 of these were in St. George's Workhouse and Infirmary and in the Strand Workhouse, both of which lie beyond the City boundary. I have, therefore, added these in making a total of 185,648. All the Poor Law population has been distributed among the various Wards, partly according to returns which the Masters of the Westminster and Strand Warehouses were good enough to supply, showing the part of these Unions from which the persons were admitted, and partly by distributing them in proportion to the deaths recorded in each Ward. The populations calculated to the middle of the year on which the rates have been calculated are:— 7 — Persons. Males. Females. Conduit Ward 5,830 2,369 3,461 Grosvenor Ward 15,335 6,186 9,149 Hamlet of Knightsbridge Ward 7,631 2,980 4,651 Kniglitsbridge St. George Ward 15,727 5,907 9,820 Victoria Ward 40,583 18,552 22,031 St. Margaret Ward 13,895 6,620 7,275 St. John Ward 31,325 16,080 15,245 St. Anne Ward 11,590 6,044 5,546 Great Marlborough Ward 7,570 3,633 3,937 Pall Mall Ward 4,134 2,265 1,869 Regent Ward 9,699 4,709 4,990 Charing Cross Ward 5,847 3,050 2,797 Covent Garden Ward 9,162 4,518 4,644 Strand Ward 7,320 3,718 3,602 The City of Westminster 185,648 86,631 99,017 (The figures relating to the number of persons per house, the number of persons occupying tenements of less than five rooms, &c., are dealt with on page 13.) Age and Sex.—Table XIV shows the proportion of persons at various ages in the City and its Registration or Poor Law areas in London (p. 28). The importance of knowing how many persons are living at various age periods is that persons at certain of these periods have a better health record than those at other periods. Consequently, a district may appear to have a good death-rate, whereas, on examination, it may turn out that its population is largely composed of persons living at an age period where the death-rate is naturally small, and allowance must therefore be made in comparing it with a district which has a standard distribution of its population. Sex, also, has a marked effect on the rate, and a preponderance of females in a population will lower the general death-rate considerably. In England and Wales the proportion of males to females in the population in 1901 was as 107 to 100, in London as 112 to 100. and in Westminster as 115 to 100. The proportion of males and females in the various Wards of the City, as compared with London, is shown on next page:— 8 — Males. Females. Proportion. Males. Females. County of London per cent. 47.2 per cent. 52.8 100 112 City of Westminster 46.4 53.6 100 115 Conduit Ward 40.6 59.4 100 140 Grosvenor Ward 40.3 59.7 100 148 Hamlet of Knightsbridge Ward 38.6 61.4 100 159 Knightsbridge St. George Ward 37.5 62.5 100 166 Victoria Ward 45.7 54.3 100 118 St. Margaret Ward 47.4 52.6 100 110 St. John Ward .. 50.5 49.5 100 98 St. Anne Ward 52.3 47.7 100 91 Great Marlborough Ward 48.0 52.0 100 108 Pall Mall Ward 54.6 45.4 100 83 Regent Ward 48 .6 51.4 100 105 Charing Cross Ward 52.1 47.9 100 92 Covent Garden Ward 49.1 50.9 100 103 Strand Ward 50.7 49.3 100 97 In St. George's Union the proportion was 44.8 males, 55.2 females; in Westminster Union, 50.5 males, 49.5 females; and in Strand Union, 50.4 males, 49.6 females. Although in the City, as a whole, the number of females per hundred males is not very different from that in the County of London, yet there is a very great divergence in the several Wards: thus, Pall Mall, Charing Cross, and St. Anne Wards have considerably less females than the average; while Conduit, Grosvenor, the Hamlet, and Knightsbridge St. George Wards are much above it. The latter group includes a large proportion of female domestic servants, while the former has probably a preponderance of men employed as waiters and servants in clubs, hotels, and restaurants. There does not appear to be much alteration in the intercensal period in the proportions between the sexes, except in St. Anne's Ward, where the females have been reduced to a much greater extent than the males during the last five years: in 1891 there were 6,245 males and 6,072 females; in 1896 the proportion was much the same (6,121 and 5,927); but in 1901 the figures were 6,011 males, 5,482 females, a reduction during the last five years of 110 males and 445 females. The proportion of females would be higher in Victoria, St. Margaret, St. John, the Hamlet, and Charing Cross Wards, were it not for the presence of military barracks and hospitals, which contain 3,356 males and 357 females. The Registrar has prepared a return 9 showing the number of families or separate occupiers, with the number of domestic indoor servants (excluding those employed in hotels, lodging- and eating-houses) in each Borough. Taking the Metropolis as a whole, the proportion of domestic servants of both sexes is rather less than one servant to four families. The proportion to 100 separate families varies in the Metropolitan Boroughs from ,V7 in Slioreditch and Bethmal Green to 65.8 in Westminster, 80.0 in Kensington, and 81.4 in Hampstead. Westminster heads the list with male indoor servants with 12.5 per cent., Chelsea coming next with 7.8 per cent. Female servants are in greatest proportion—in Westminster 53.3 per cent., Kensington 74.9 per cent., and Hampstead 79.8 per cent. Unfortunately, similar information is not available for Wards or Registration Districts. Occupation.—The statistics relating to the occupations of persons, over the age of 10, living in London and in the various Municipal districts are also given in the Census Report; but, as the RegistrarGeneral points out, they cannot be taken as showing the number of persons employed in London, which is, in fact, only the heart or working centre of a vastly larger area. At the census of 1891 the proportion of the population engaged in occupation in London was 82.8 per cent. in the case of males, and 38.4 in the case of females. At the recent census the percentages were 83.6 and 37.4 respectively. Among males there has been an increase of 116.4 per cent. (4,801 to 12,788) of persons engaged in the supply of electricity and electrical apparatus, and of 148.1 per cent. of males employed in connection with explosives (929 to 2,305). Actors have increased by 75 per cent., while civil servants, clerks, journalists, servants, railwaymen, builders, coachmen, and tailors have increased in smaller ratios, varying from 9.4 to 36 per cent. On the other hand, males engaged in silk manufacture have decreased 50.4 per cent. (1,104 to 548), persons engaged on rivers and canals 20.9 per cent. (17,941 to 14,185), boot and shoe makers 13 per cent. (31,462 to 27,377), shirtmakers 8.1 per cent. (3,196 to 2,936). Among females, commercial or business clerks have increased by 181.1 per cent. (6,793 to 19,097) in the 10 years, civil servants by 77.6 (1,568 to 2,785), actresses by 74.9 per cent. (1,664 to 2,911), printers by 73.6 per cent. (1,316 to 2,284), and other occupations to a smaller extent. Artificial flower makers have decreased by 41.7 per cent. (4,011 to 2,337), women employed in the boot and shoe trade by 9.9 per cent. (7,527 to 6,779), and sempstresses by 2 per cent. (107,848 to 105,678). The occupations of persons over 10 years of age in the City of 10 Westminster are shown in the Registrar-General's Report. There is 110 means of comparison with the figures for the former census, and no details are given for any of the sub-divisions of the City. Of the total males (84,963) 72,811 are above the age of 10 years, and of these 63,198 are engaged in occupations; of the total females (98,048) 85,858 are over the age of 10 years, and 46,388 are engaged in occupations. Of the total occupied males, 12,276 (19.4 per cent.) are engaged in domestic work, indoor and outdoor; 8,275 (13 per cent.) in the conveyance of men, goods, and messages; 7,556 (11.9 per cent.) in supplying food, tobacco, drink, and lodging; 4,605 (7.2 per cent.) in commercial occupations; 4,571 (7.2 per cent.) in the Army and Navy; 3,750 (5.9 per cent.) in professional occupations; 3,651 (5.7 per cent.) in building and allied trades; 3,247 (5.l per cent.) as general labourers, street sellers, &c.; 3,010 (4.7 per cent.) in general or local government; 1,948 (3.8 per cent.) are workers in metal; 1,731 (2'7 per cent.) are printers, bookbinders, &c.; 1,283 (2 per cent.) are watchmakers and jewellers; 1,155 (1.8 per cent.) are furniture makers. The remaining 15 per cent. are distributed in smaller proportions among other occupations. Of the total occupied females, 28,954 (62.4 per cent.) are engaged in domestic service, 7,689 (1(3.5 per cent.) as tailors, dressmakers, &c.; 2,.74 (6.1 per cent.) in the supply of food, tobacco, drink, and lodgings; 2,555 (5.5 per cent.) as nurses, teachers, &c.; the remaining 9 per cent. being distributed among other occupations. Combining males and females, it appears that of 158,669 persons over the age of 10, 41,230 living in the City are engaged in domestic service; 10,757 in dressmaking, and 10,430 in supplying food, tobacco, drink, and lodging. Nationality.—Of the 4,536,541 persons enumerated in the County of London, 3,016,580 were natives of London; 35,421 were born in Wales and Monmouth, being an increase of 4,129 since 1891; 56,605 in Scotland, an increase of 3,215; 60,211 in Ireland, a decrease of 6,254; and 33,350 in British Colonies or Dependencies. Persons of foreign birth numbered 161,222, and of these 20,224 were British subjects, 5,621 were naturalised British subjects, and 135,377 were foreigners; an increase in the case of the last named of 40,324 since 1891. From the accompanying II able II, it will be seen that Russians have increased considerably, and now head the list. Austrians, Italians, and natives of the Balkan States have also markedly increased, although their aggregate is comparatively small. Of the 135,377 foreigners, 79,804 are males and 55,573 females. Natives of Russia are now the most numerous, having increased 11 since the last census from 12,034 to 38,117; Germany stands second with 27,427, having, however, increased by no more than 507 persons since 1891; Russian Poland follows with 15,420, showing also only a trivial increase; France is fourth in importance with 11,264—no material increase; and Italy fifth with 10,889, or more than double the number returned in 1891. Foreigners are scattered throughout London, but no less than 54,310, or 40 per cent. of the whole, are in the Borough of Stepney (including Whitechapel, Mile End Old Town, and St. George in the East), of the population of which Borough they constitute 18.2 per cent. Table II.—Country of Birtli of Foreigners enumerated in the County of London, 1891 and 1901, and in the City of Westminster. Country of Birth. County of London. City of Westminster. 1891.* 1901. Persons. Males. Females. Persons. Males. Females. Persons. Males. Females. Total 95,053 55,084 39,969 135,377 79,804 55,573 11,831 7,509 4,322 Europe. Russia 12,034 6,875 5,159 38,117 20,519 17,598 903 509 394 Poland (Russian) 14,708 7,898 6,810 15,420 8,155 7,265 1,015 546 469 Sweden 1,482 1,031 401 1,675 1,180 495 185 117 68 Norway 1,011 872 139 1,067 857 210 28 14 14 Denmark 827 608 219 946 676 270 52 34 18 Holland 4,289 2,319 1.970 4,249 2,402 1,847 124 75 49 Belgium 2,044 1,023 1,021 2,102 1,108 994 323 149 174 France 10,366 4,879 5,487 11,264 5,462 5,802 2,249 1,143 1,106 Germany 26,920 16,440 10,480 27,427 17,215 10,212 2,031 1,319 712 A ustria 3,041 1,981 1,060 6,189 4,048 2,141 392 300 92 Hungary 471 321 150 750 533 217 91 61 30 Switzerland 3,295 2,025 1,270 4,419 2,920 1,499 958 667 291 Spain 650 405 245 666 502 164 102 78 24 Portugal 177 88 89 128 89 39 10 7 3 Italy 5,138 3,809 1,329 10,889 8,212 2,677 2,282 1,826 456 Greece 284 188 96 211 177 34 21 18 3 Servia, Roamania, and Bulgaria. 298 179 119 2,116 1,179 937 26 20 6 Turkey 458 310 148 660 496 164 35 32 3 Asia. China 302 176 126 120 97 23 1 - 1 Japan 377 224 153 151 123 28 25 17 8 Other countries 148 116 32 10 8 2 Africa. Egypt 104 58 46 61 43 18 3 3 - Other countries 221 122 99 107 78 29 22 19 3 America. United States 4,903 2,450 2,453 5,561 3,100 2,461 864 493 371 Mexico 57 34 23 58 35 23 8 5 3 Other States of Centraol America. 1,546 719 827 79 47 32 5 3 2 Argenti ne Republic 138 81 57 15 11 4 Brazil 142 75 67 8 5 3 Other States of South America. 266 137 129 18 11 7 Country not stated 100 50 50 251 142 109 25 19 6 * The figures for the year 1891 refer to the County of London as then constituted. 12 Westminster comes next with 11,831 foreigners, forming 8.75 of the total foreigners in London, and 6.46 per cent. of the population of Westminster. The nationality of foreigners in Westminster is shown in the above table; Italians, Germans, and French among males, and French among females, take the lead. The occupations of foreigners are given for London, but not for the separate Municipal areas. An idea of the occupations likely to be followed in Westminster may be obtained from the following statement:— Out of 20,519 males of Russian birth, 17,196 are returned as engaged in occupations. Of this number, (3,595 are tailors, 2,158 bootmakers, and 1,602 cabinet-makers. Of the 8,155 males of Russian-Polish birth, 6,968 are returned as engaged in occupations, and of this number 3,475 are tailors. Germany, with 15,902 males engaged in occupations, supplies 1,997 bread and biscuit makers and dealers, 1,577 servants (not domestic) in hotels and eating-houses, 1,305 tailors, 1,303 commercial clerks, and 1,115 hairdressers. France, with 4,522 males engaged in occupations, furnishes 684 cooks (not domestic) and 391 commercial clerks. Italy, with 7,494 males returned as engaged in occupations, comes next to Germany, with 1,150 servants (not domestic) in hotels, &c., and next to France with 488 cooks (not domestic). The occupations which Italians seem to have made specially their own are two in number—1,037 are costermongers and hawkers, out of a total of 1,753 foreigners pursuing that calling, and 325 are paviors, out of a total of 340. Sweden and Norway are remarkable as providing respectively 400 and 554 seamen. The leading occupations of female foreigners are—domestic indoor service, in which Germany stands first with 2,194, France second with 1,205, and Switzerland third with 651; tailoring, in which Russia leads with 1,814, Poland follows with 78!', and Germany comes third with 406; dressmaking, engaged in which there are 717 Frenchwomen, 355 Russians, and 207 Germans; and teaching, in which France supplies 399 schoolmistresses, &c., Germany 352, and Switzerland 136. Of minor occupations, Russia and Holland provide the great majority of foreigners of both sexes engaged in tobacco manufacture; the United States of America three-fifths of those returned as "actors"; and Germany predominates in the trade in watches and scientific instruments. 13 Houses. In London the Report states there were at the date of the census 1,019,546 families or separate occupiers, giving an average of rather more than 4.4 persons to a family. The number of inhabited houses* was 571,768, against 547,146 in 1891, an increase of 4.5 per cent.; of uninhabited houses 40,069, against 39,686 in 1891, an increase of 1.0 per cent.; and of houses building 4,624, against 4,194 for 1891, an increase of 10-3 per cent. Of the uninhabited houses 24,098 are '•'in occupation"—that is, utilised for business or other purposes, but without inmates on census night. The total number of separate tenements, which had been 937,606 in 1891, rose to 1.019,546, the increase being equal to 8.7 per cent. Of this total the tenements containing five or more rooms increased from 307,037 to 347,516, equal to 13.2 per cent.; while the increase of those with less than five rooms was from 630,569 to 672,030, and did not exceed 6.6 per cent. The rate of increase in the larger tenements was therefore exactly double that shown in the smaller tenements. Stated in another way, the tenements with five or more rooms were equal to 32.7 per cent. of the total tenements in 1891, and to 341 per cent. at the recent census; while the percentage of the tenements with less than five rooms declined from 67.3 to 65.9. The reduction in the number of the latter class of tenements was most strongly marked in the tenements of one room, which declined from 172,502 in 1891 to 149,524—that is, from 18.4 per cent. of the total tenements to 14.7 per cent. It may further be pointed out that the number of single-room tenements in which more than two persons were enumerated declined from 56,622 to 40,762; while the number of one-roomed tenements with six or more inmates on the census night declined from 4,097 to 1,802. The tenements of two rooms showed a slight, and those of three or four rooms a marked, increase upon the numbers returned in 1891. * The Registrar-General deems it necessary to draw prominent attention to the opinion he has been compelled to adopt, that the returns as to "Houses" are in many cases unsatisfactory, and to some extent misleading. The returns received have been carefully revised, and the result has been to disclose differences in certain districts, as compared with the returns for 1891, that are quile inccmpatible with any possible change in the amount of residential accommodation. For cens's purposes a block of model dwellings or residential mansions is counted as a single house, whatever may be the number of separate tonements; at the census of 1891, in some cases the local Registrars failed to observe this rule, and returned each tenement as a house; consequently the numbers of inhabited houses enumerated in 1891 and 1901 have, in many cases, little value for comparative purposes. The parishes of St. George Hanover Square, Bethnal Green, St. Botolph without Aldgate (Whtechapel), and Horsleydown may be cited as cxtreme instances in point. 14 In Westminster the total number of inhabited houses was 18,366, against 23,068 in 1891, a decrease of 20.3 per cent. Part of this decrease is real, as in Covent Garden and Strand Wards,* but in other Wards it is due, in part, to the erection of blocks of residential dwellings, each of which is reckoned as "one house," although containing many dwellings, and in part to the error (referred to by the Registrar-General in the footnote to p. 13) which made the number of houses in St. George's, Hanover Square, too great in 1891. There is no doubt, however, that there is a continuous conversion going on of dwelling-houses into places of business, as shown by the fact that there were, in 1901, 2,427 houses used solely as places of business, and not occupied by night, as compared with 2,230 in 1896, an increase of 8.3 per cent. The proportion of such houses varies very considerably in the City, for in the area of St. George's Union (including St. Margaret and St. John Wards) there are only six solely business premises to every 100 inhabited houses; in Westminster Union the proportion goes up to 33.6, while in the Strand Union it is 69. In addition, there are many other houses which have been converted in part into business premises, or have persons residing in them as caretakers only, and these are, therefore, not included in the list of business premises. The number of persons per inhabited house averaged 9.9 for the whole City, and varied from 6.7 to 13.8 (see Table VII). Separate Tenements.—There were 41,244 families or separate occupiers on the night of the census (as compared with 46,247 in 1891), giving an average of 4.44 persons to a family, the same as in all London. The number of tenements of less than five rooms was 26,668, being 64.6 per cent. of the total, as compared with 65.9 per cent. for the County of London. The proportion of tenements with less than five rooms showed marked variations in the Metropolitan Boroughs. The lowest percentages were 30 9 in Lewisham, 42.2 in Hampstead, and 42.3 in Wandsworth; while the highest percentages were 80.5 in Stepney, 82.9 in Southwark, 84.l in Bethnal Green, 81.9 in Shoreditch, and 85.1 in Finsbury. With the exception of the City of London, the proportion of 64.6 was exceeded by all the other Boroughs adjoining the City of Westminster. * In St. Clement Danes, St. Mary-le-Strand, and St. Paul Parishes there are 250 properties less on the rate books. 15 Table III.—Total Tenements, and Tenements of less than Five Booms, occupied by various Numbers of Persons, in the City of Westminster, 1901. The Number of Tenements in the Districts as existing in 1891 are also given. Total Tenements 41,244 Tenements of less than Five Rooms .. 26,668 Rooms in Tenement. Tenements of less than Five Rooms. Persons per Tenement. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12 or more. 1 1891. 10,84g 1901. 7,546 3,673 2,274 943 421 160 57 14 2 2 - - - 2 11,583 9,635 1,269 2,782 2,207 1,531 910 496 256 103 37 10 3 1 3 6,557 6,279 462 1,178 1,349 1,076 902 583 387 214 89 25 8 6 4 3,135 3,208 171 448 550 574 557 333 228 175 99 40 20 13 Note.—The table is to be read as follows:—Of the 41,241 tenements, 26,668 were tenements of less than five rooms, and of these 7,546 were tenements of one room, 9,635 of two rooms, &c., and of the 7,546 tenements of one room 3,673 were occupied byone person each, 2,274 by two persons each, &c. The distribution of the persons (83,304) occupying these tenements is shown in Table IV, which also contains figures compiled from the 1891 Census Returns for the component parts of the City as they then existed. Table IV.—Showing Number of Persons occupying 1, 2, 3, and 4.-roomed Tenements in the City of Westminster in 1901 and 1891. Rooms in Tenement. Average Occupants per room. Total. 1. 2. 3. 4. 5 6. 7. 8. 9. 10. 11. 12. Census, 1901. 1 1.8 14,008 3,673 4,548 2,829 1,684 800 342 98 16 18 2 1.5 30,048 1,269 5,564 6,621 6,124 4,700 2,976 1,792 824 333 100 33 12 3 1 .3 24,809 462 2,356 4,047 4,304 4,510 3,498 2,709 1,712 801 250 88 72 14 1.1 14,439 171 896 1,650 2,296 2,785 1,998 1,596 1,400 891 400 220 156 Census, 1891. | 1 2.9 21,078 4,231 5,084 4,605 3,400 2,165 1,146 308 120 9 10 — — 2 1.6 37,898 1,323 3,954 7,380 7,500 6,625 4,758 3,402 1,760 729 270 77 120 3 1.3 27,076 458 2,374 3,849 4,400 4,645 4,056 3,129 2,072 1,170 550 253 120 4 1.1 14,825 159 910 1,620 2,072 2,310 2,136 1,995 1,608 1,044 620 231 120 16 Percentage of families or separate occupiers occupying tenements of less than five rooms:— - Less than 5 Rooms. 1 Room. 2 Rooms. 3 Rooms. 4 Rooms. County of London 65.9 14.7 20 18 13 City of Westminster 64.6 18 23 15 8 The proportion of single-room tenements, which averaged 14.7 per cent. in all London, ranged from 3.5 per cent. in Lewisham to 26.3 in Marylebone, 26.4 in Finsbury, and 27.0 in Holborn; Westminster was 18, as compared Avith 23.4 in 1891. The proportion of tworoomed tenements varied from 6 per cent. in Lewisham to 28 per cent. in Holborn and Shoreditch, 29 in St. Pancras, and 33 in Finsbury. Westminster was 23 (as compared with 25 per cent. in 1891), and the County 20 per cent. Although above the London average in regard to one and two rooms, Westminster was below it when the three and four-room tenements are compared. The lowest proportion of three-roomed tenements was, in Kensington, 12 per cent.; the highest, Fulham, 25 per cent. The Westminster figure was 15 per cent. (as compared with 14 per cent. in 1891); that tor London 18 per cent. Four-roomed tenements were fewest in Holborn (7 per cent.), Westminster, Marylebone, and Hampstead (each 8 per cent.); while Poplar and Fulham (21 per cent.), Deptford and Greenwich (20 per cent.), Woolwich (19 per cent.), and Battersea (18 per cent.) had the greatest proportion of such dwellings. The proportion of one and two-roomed tenements to total tenements has decreased since 1891, while that of three and fourroomed tenements has slightly increased. Persons per Tenement.—In Table IV the number of persons occupying the various classes of tenement is given. In the Census Report for 1891, Dr. Ogle assumed, for the purpose of instituting a comparison between various districts, that overcrowding existed if there are more than two persons to each room of a given tenement. This is obviously not a very reliable test, because in central districts the old houses now utilised for tenements contain much larger rooms than the cottages of the more suburban boroughs, and even of blocks of workmen's dwellings. But employing the term " overcrowding" in this manner, it appears that in the City of Westminster there were 1.599 one-roomed, 1,846 two-roomed, 729 three-roomed, and 172 four-roomed tenements so circumstanced. The following table, 17 giving the percentage "overcrowded" in each class, shows how Westminster compares in this respect with the County of London:— 1 Room. 2 Rooms. 3 Rooms. 4 Rooms. County of London 27 25 13 7 City of Westminster 21 19 12 5 The position occupied by Westminster and other Metropolitan Boroughs may be seen at a glance in Table V, the particulars of which are taken from an article on "The Housing of London," in the British Medical Journal, March 8th, 1902. In it certain data are arranged, which will enable the relationship between proportion of tenements of fewer than five rooms, proportion of overcrowded tenements, and the death-rates from all causes and from consumption to be studied. Speaking generally, the writer concludes that the Metropolitan Boroughs with the highest proportion of tenements containing fewer than five rooms, and with the highest proportion of overcrowding in these tenements, have the highest general death-rate and the highest death-rate from phthisis. The death-rate from the latter disease may be taken as a fairly accurate gauge of the effects of overcrowding. At the other end of the scale the low phthisical and general deathrate of Lewisham, Hampstead, and Wandsworth show the important favourable influence of what may be described as the more diluted housing of the people in these districts. (8545) B 18 Table V.—The Metropolitan Boroughs. Arranged in order of the Proportion per cent. of Domestic Indoor Servants to Families or Separate Occupiers, beginning with the Boroughs having the Lowest Proportion. Arranged in order of the Number out of every 100 Total Families occupying Tenements of levs than Five Rooms. Arranged in order of Overcrowding, the Most Crowded being given First. Arranged in order of Death-rate per 1,000 of. Population during 1901 from— All Tenements Under Five Rooms. One Room. Two Rooms. Three Rooms. Four Rooms. All Causes. Phthisis. Shoreditch Finsbury Shoreditch Stepney Stepney Stepney Stepney Stepney Shoreditch (21.9) Holborn (2.81) Bethnal Green Finsbury Bethnal Green Finsbury Finsbury Bethnal Green Southwark (21.5) Southwark (2.50) Bermondsey Bethnal Green Bethnal Green Shoreditch Finsbury Bethnal Green Shoreditch Finsbury Finsbury (21.4) City of London (2.29) Southwark South wark Shoreditch Holborn Shoreditch Bethnal Green Shoreditch Stepney (20.9) Bermondsey (20.9) Shoreditch (2.22) Poplar Stepney Holborn St. Pancras Bermondsey Bermondsey Poplar St. Marylebone Finsbury (2.9) Deptford St. Pancras St. Marylebone St. Pancras Poplar Holborn Kensington Bethnal Green (20.3 Bethnal Green (2.15) Stepney Holborn Deptford Kensington Holborn St. Marylebone Holborn (20.1) Stepney (2.09) Battersea Bermondsey Kensington St. Pancras Southwark St. Marylebone St. Pancras Southwark City of London (20.1) St. Marylebone (1.92) Woolwich Poplar St. Marylebone Southwark Southwark Southwark Poplar (20.0) Westminster (1.80) Camberwell Bermondsey Islington Bermondsey Poplar St. Pancras Hammersmith Islington St. Pancras (18.3) St. Pancras (1.87) Deptford Islington Islington Kensington St. Marylebone Islington Lambeth (17.3) Poplar (1.79) Bermondsey (1.79) Islington Chelsea Popiar Paddington Chelsea Kensington Hammersmith (17.0) St. Pancras Fulham Chelsea Paddington Westminster Lambeth Battersea City of London Islington Battersea Westminster Chelsea Greenwich St. Marylebone (16.6) Chelsea (10.6) Woolwich (1.70) Hackney Paddington Poplar Chelsea (1.68) Lambeth Westminster Hackney Lambeth Hackney Holborn Camberwell (16.5) Deptford (16.5) Lambeth (1.65) Fulham Lambeth City of London Lambeth Camberwell Fulham Hammersmith Battersea Chelsea Hammersmith Camberwell Greenwich Hackney (1 .53) Hammersmith Battersea City of London Battersea Camberwell Deptford Fulham Battersea (16.4) Islington (1.51) Holborn Hammersmith Hammersmith Lambeth J Westminster (16.0) Islington (16.0) Camberwell (1.48) Greenwich Hackney Hammersmith Battersea Camberwell Hackney Paddington Westminster Cambenvell Westminster Battersea (1.43) Stoke Newington City of London Fulham Hackney Fulham (15.8) Hackney (15.8) Hammersmith (1.42) Wandsworth Deptford City of London Woolwich Hampstead Lambeth Paddington Westminster Woolwich Fulham (1.37) Lewisham Woolwich Deptford Hampstead Fulham Hackney Greenwich (15.3) Kensington (1.36) City of London Camberwell Bermondsey Chelsea Paddington Hampstead Kensington (15.2) Stoke Newington (1.35) Paddington Kensington Greenwich Fulham Deptford Woolwich (14.6) Deptford (1.19) St. Marylebone Greenwich Greenwich Stoke Newington Deptford Hampstead Wandsworth Paddington (14.3) Greenwich (1.16) Chelsea Stoke Newington Stoke Newington Woolwich Hampstead Stoke Newington Greenwich Woolwich Wandsworth Wandsworth (13.4) Wandsworth (1.14) Westminster Hampstead Woolwich Lewisham City of London Stoke Newington (13.2) Paddington (1.10) Kensington Wandsworth Wandsworth Wandsworth Lewisham Wandsworth Lewisham Stoke Newington Lewisham (13 0) Hampstead (0.91) Hampstead Lewisham Lewisham Lewisham Stoke Newington Hampstead (10.7) Lewisham (0.90) 19 Unfortunately no information is available for the various Wards or Registration Sub-divisions of the City, but that considerable difference exists is evident. I have compiled Table VI from the 1891 Census Report:— Table VI. Sanitary District. Percentage of all Tenements. 1 Room. 2 Rooms. 3 Rooms. 4 Rooms. St. George, Hanover Square 16.8 21.6 14.2 7.6 St. James, Westminster 22.3 29.0 14.5 5.5 St. Martin-in-the-Fields 25.6 24.1 13.7 5.7 St. Margaret and St. John, Westminster 29.1 27.8 13.2 7.2 Strand 33.2 26.8 15.1 9.3 For the combined districts, 1891 23.4 25.0 14.1 6.8 City of Westminster, 1901. 18 23 15 7 From Table IV it appears that there were 83,304 persons living in the City in tenements of less than five rooms. According to the Registrar-General's standard there is thus an excess of 2,589 persons living in single rooms for whom accommodation is requisite, of 3,386 in two-roomed tenements, 3,445 in threeroomed tenements, and 959 in four-roomed tenements, making a total of 10,379 persons. For various reasons, as stated, this number is considerably above the correct figure, but it must also be kept in mind that tenements of one to four rooms include many "flats" with a comparatively small population, so that, after deducting those, the tenements left have to accommodate a larger proportion of inmates than is shown by the official returns. There has been, however, a reduction of 3,300 one-room tenements, 1,948 two-room tenements, 276 three-room tenements, and an increase of 73 four-room tenements in the 10 years, which, on the Registrar-General's assumption, would mean 15,644 persons displaced, or calculated on the average number of persons in such tenements 12,539. As there has been a reduction in the population of the City of 18,958, it appears as if the greater part of it had fallen upon the occupiers of one and two rooms. The clearance effected in connection with the Holborn to Strand street, the Clare Market area, &c., are responsible for about a fourth of the above decrease, and most of the persons displaced were of the class occupying small tenements. Deducting these, there remain some 7,000 persons who (8545) B 2 20 have been displaced by other causes, and who have had to find accommodation in other localities. It is satisfactory to note that the average number of persons living in one-room tenements has fallen from 2.9 to 1.8, showing that overcrowding has been considerably abated during the 10 years. The figures generally show an improvement in this respect. Density of Population.—In studying Table VII it will be seen that a reduction of population, as in St. Margaret and St. Anne Wards, may lead to a greater number of persons per house, but, owing to the meaning given to the word "house" by the RegistrarGeneral, it is safer to take the number of persons per tenement. From this point of view, so far as comparison can be made with the 1891 figures, it appears that the demolition or conversion of houses has led to a greater average number of persons inhabiting each tenement, this being especially marked in the Wards comprising the Strand Union, and those forming the St. James's part of the Westminster Union. Table YII.—Densitii of Population in the Wards of the City of Westminster 1891 and 1901. Wards. Persons per Tenement. Persons per Inhabited House. Persons per Acre. 1891. 1901. 1891. 1901. 1891. 1901. Conduit 4.3 5.3 10.2 8.7 121.0 93.2 Grosvenor 8.0 8.3 31.0* 30.0* Knightsbridge St. George 4.2 6.7 6.7 86 0 85.0 Vietoria 9.6 9.7 109.9 114.0 Hamlet 4.9 5 0 8.5 (1896) 8.4 21.1* 21.9* St. Margaret 4.0 11.0 13.6 68.2* 62.6* St. John 12.8 11.2 162.4* 142.4* St. Anne 4.1 4.2 13.2 13.8 230.6 215.2 Great Marlborough 4.2 4.7 13.3 12.2 283.3 201.2 Pall Mall 7.4 9.0 75.0 84.0 Regent 9.0 9.2 136.2 127.9 Charing Crose 4.4 4.8 9.0 11.5 30.1 23.1 Covent Garden 11.6 11.5 169.8 140.0 Strand 11.4 11.0 126.9 80.5 The City - 4.4 8.7 9.9 80.7* 73.1* * Inclusive of parks. I have slated in previous reports that from inspection of the Strand and Covent Garden Wards this process was taking place, and that houses formerly occupied by one or two families, were being "made down" to accommodate a family on every floor, and even in every room. 21 The Housing Committee of the Council have considered the matter during the past year, and have had special reports from my predecessors and myself on the amount of accommodation available and being provided in the City for persons of the working classes, together with replies from employers of labour. In addition, houseto house enquiries have been made. In the report submitted by me (21st January, 1901), dealing with the Strand District, I said that, where circumstances will permit, persons working in central London should live in the suburbs, but there are certain kinds of work which render it necessary for those employed therein to live in the proximity to the places where that work is carried on. Thus there are those persons whose work is irregular, or which requires early or late attendance, such as waiters, policemen, commissionaires, kitchen and other porters, theatre attendants, charwomen, &c. Then there is a large class of persons making articles of dress, who work at home for West-end firms; from the fluctuating nature of the trade, it appears to be necessary for those employed in it to be in close proximity to their employers' place of business. From an aualysis of the 1891 Census Statistics, made by Mr. Charles Booth, it appears that at that date the tailors, bootmakers, dressmakers, milliners, shirtmakers, and allied trades, formed 13 per cent, of the population of the district represented by Soho, St. Giles, and Strand. This figure represents only the heads of families employed in these trades, but usually other members of a family take part in it also. In order to ascertain the class of persons for whom accommodation should be provided in this neighbourhood, and the rents which were at present being paid, a house-to-house enquiry was instituted in Chadwick Street, Great Peter Street, Laundry Yard, Monck Street, Monck Court, Blue Anchor Court, St. Matthew Street, St. Ann's Court, St. Ann's Lane, Medway Street, and Arneway Street. 655 tenements were visited with an admitted population of 2,934; 064 of whom were men, 781 women, and 789 children. Both men and women appear to be engaged in earning a livelihood, and all of them work in the City. 839 were costers and street hawkers, 121 news vendors, 172 labourers, 115 charwomen and laundresses, 11 tailoresses, 17 shop assistants, 19 bootmakers, 23 were in receipt of parish relief, and the remaining 94 were engaged in various occupations. A number of tenements in certain of the streets mentioned are single rooms, and are let furnished. Tables VIII and IX show the number of one, two, three, and fourroom tenements, and the rents paid, together with a note showing the relation between the weekly wage and rent. 22 Table VIII.—Housing Enquiry, St. John's Ward.—Tenements and Rents. Number of Rooms. Tenements and Rents. Totals. 2/6 3/- 3/6 4/- 4/6 5/. 5/6 6/- 6/6 7/- 7/6 8/- 8/6 9/- 9/6 10/- 10/6 11/- 11/6 12/- 12/6 13/- 14/- One 21 27 23 50 42 137 36 83 3 6 1 1 - - - - - - - - - - - 430 Two — 3 3 27 18 15 35 16 16 20 6 6 5 1 _ 1 - - - - 161 Three — — — — — 1 4 1 3 1 1 1 1 5 7 8 1 1 1 36 Three and over — — — - — — — - — — — — - 2 — 3 2 — 3 3 4 — 11 28 Total .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 655 Table IX.—Housing Enquiry, St. John's Ward.—Relation between Wages and, Bents. Wages eakned pee Week. Rent per Week. Total Number of Families whose earnings were ascertained. 2/6 3/- 3/6 4/- 4/6 5/- 5/6 6/- 6/6 7/- 7/6 8/- 8/6 9/- 9/6 10/- 10/6 11/- 11/6 12/- 12/6 13/- 12/-and under 15 21 8 17 10 17 4 3 - - - - - - - - - - - - - 95 13/- „ 14/- 1 — — 1 2 1 1 - - - - - - - - - - - - - - - 6 15/- „ 16/- 1 5 2 4 4 20 6 12 1 - - - - - - - - - - - - 17/- „ 18/- 1 — 2 2 3 7 3 7 - - - - - - - - - - - - - - 25 19/- „ 20/- 5 3 14 14 12 37 26 - - - - - - - - - - - - - - - 111 21/- „ 22/- — — 4 — 1 2 2 1 - - 1 - - - - - - - - - - - 11 23/- „ 24/- - 4 6 5 5 13 8 9 4 2 - - - - - - - - - - - - 56 28/- „ 29/- — 3 6 3 8 21 14 16 7 13 1 1 1 - - - - - - - - - 94 30/- „ 40/- - - - 2 2 14 4 10 4 6 4 2 3 9 — 5 4 - — 2 11 — 82 Total 23 36 42 48 47 132 68 5S 15 22 6 3 4 9 — 5 4 - — 2 11 — 535 (To face p. 23.) Table X—Housing Enquiry, Regent and Marlborough Wards.—Tenements and Rents. Number of Rooms in Tenements. 2/6 3/- 3/6 4/- 4/6 5/- 5/6 6/- 6/6 7/- 7/6 8/- 8/6 9/- 9/6 10/- 10/6 11/- 11/6 12/- 12/6 13/- 13/6 14/- 14/6 15/- 15/6 16/- 16/6 17/- 17/6 18/- 18/6 19/- 19,6 20/and over. Total. One room 7 24 42 54 50 52 33 48 37 41 15 17 13 9 1 2 2 - - - - - - - - - - - - - - - - - - - 447 Two rooms - - - - 6 7 18 14 25 50 30 47 38 26 42 24 25 16 36 19 30 3 19 5 9 - - — — — — — 1 — — 490 Three rooms — — — — — 1 — 1 5 1 3 4 3 22 6 25 3 19 6 11 9 11 5 11 9 15 5 17 2 9 2 18 4 1 1 17 246 Oyer three rooms — — - — — — — — - - — 1 — 1 — — 3 1 - 1 - 1 — - 3 4 1 2 2 4 — 4 6 3 2 29 68 Total 7 24 42 54 50 59 40 67 56 67 68 52 63 70 33 69 32 45 22 48 28 42 8 30 17 28 6 19 4 13 2 22 10 5 3 46 1,251 Table XI.—Housing Enquiry.—Relation between Weekly Wages and Rents. Wages eabned pek Week. 2/6 3/- 3/6 4/- 4/6 5/- 5/6 6/- 6/6 7/- 7/6 81- 8/6 3/- 9/6 10/- 10/6 11/ 11/6 12/- 12/6 13/- 13/6 14/- 14/6 15 15/6 16/- 16/6 17/- 17/6 18 18/6 19 19,6 20/and over. Number of families' earnings ascertained. 12/- and under 2 5 5 13 7 2 3 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - 38 13/- „14/- — — — — 1 5 — 2 1 — — — — — — — — — — — - — — — - - — - — - — — — — — — 9 15/- „16/- — 2 — 3 1 4 3 — 3 1 - - - - - - - - - - - - - - - - - - - - - - - - - - 17 17/- „18/- — — 1 1 — 1 — 1 — 2 2 1 - - - - - - - - - - - - - - - - - - - - - - - - 10 19/- „20/- 4 11 12 18 15 10 8 12 8 4 9 1 1 — 1 — — 1 — 2 — — - 1 — - — - — 1 — — - — - - 119 21/- „22/- — - — 1 1 — — - 1 4 1 1 2 - - - - - - - - - - - - - - - - - - - - - - - 12 23/- „24/- 1 1 8 12 7 8 3 8 8 14 5 6 4 2 - - - - - - - - - - - - - - - - - - - - - - 91 25/- „30/- — 1 8 6 14 13 12 19 15 15 19 11 20 17 10 16 7 10 5 10 3 9 2 7 3 7 1 7 - 4 — 5 1 — 1 4 282 35/- „40/- — 3 5 — 3 12 10 15 16 16 25 20 22 24 8 34 17 16 9 26 19 10 2 15 4 9 2 6 2 3 2 6 2 3 1 13 3S0 Over - — — — - — — 1 2 4 2 5 6 15 11 12 5 10 7 10 6 9 — 5 9 8 3 5 2 3 — 10 4 1 1 27 183 Total 7 23 39 54 49 55 39 59 54 60 63 45 55 58 31 64. 29 38 21 48 29 29 4 28 16 24 6 18 4 11 2 21 7 4 3 44 1,141* * Number visited, 1,251. (8545) 23 Taking into consideration the displacements which have already taken place, and those which are likely to occur within a very few years, and making allowance for such persons as do not require to live near their work, or who can afford to live in the suburbs, provision should be made for at least 500 persons at an early date. It is difficult to give an estimate as to the actual amount of accommodation which should be provided in addition thereto within the next five years, but sufficient for another 500 or 750 persons would doubtless not prove too many. The Committee considered that accommodation for these classes of persons was required in the City, and with the object of ascertaining if any sites were available for the purpose, examined a number of places in the City. Eventually, a piece of land—part of the Westminster Chapter Estate—was secured from the Ecclesiastical Commissioners. It is 64,000 square feet in area, and abuts on Regency Street, Page Street, and Vincent Street. It has been cleared of houses, and it is proposed to erect upon it dwellings similar to those recently erected by the Guinness Trust in Hammersmith, which have been visited by the Housing Committee. Several schemes for providing additional accommodation in the northern part of the City have been considered, but have not as yet assumed practical shape. In the near future schemes of street improvement in that district will render the demand for house room more urgent than it is now, as the persons living there are largely of the class who must live near their work. Thus of 1,992 persons, being the wage-earners in a population of 4,692 in 1,251 families, living in an area between Regent Street and Wardour Street, visited specially for this purpose, 945 were found to be tailors, 312 labourers, 83 waiters, 91 charwomen, 85 bootmakers, 34 hawkers, 35 shop assistants, and 17 police constables. Of these all but five persons were employed in the City. Probably a number of lodgers have not been accounted for in the above figures, as it is very difficult to get reliable information from persons in that neighbourhood. The number of persons per tenement has, however, increased to a greater extent (4.2 to 4.7) in the St. James's group of Wards than in the adjoining Ward of St. Anne (4T to 4.2). Rents of rooms vary according to size, position, and use. Of the 1,251 tenements, 447 were single rooms, 490 were two rooms, 246 three rooms, and 68 more than three-roomed tenements. Tables X and XI show the admitted earnings of the occupants, together with the rent paid, but it is evident that the earnings of the family must have been understated in a good many instances. It will be observed, however, that the larger proportion admitted to 24 earnings above 25s. a week, while about one-sixth only state they earn less than 20s. a week. While some accommodation is required for the poor class (charwomen and labourers) at the lowest possible rental, the majority want and are able to pay rent which may enable the Council to erect dwellings in this part of the City without entrenching on the rates. For those who can live in the suburbs there is need for the provision of very increased facilities for rapid transit. Parliamentary Committees dealing with railway and tramway Bills Lave intimated that they recognise the necessity for such facilities being provided, and that promoters need not now call evidence on this point. Births. 3,241 births were registered in the City in the 52 weeks ending 28th December, 1901. On examination of the Registrar's returns 29 births were found to be referable to other districts. Through the courtesy of the Committees of Management of Endell Street, York Road, and the Queen Charlotte Lying-in Institutions, and of the Master of the Strand Workhouse at Edmonton, and the Steward of St. George's Workhouse, Fulham Road, I have ascertained that in these Institutions no less than 220 children were born, the home address of whose mothers was in Westminster. The net number of births was, therefore, 3,432; the birth-rate, uncorrected, was 17.4, corrected, 18.5 per thousand persons. The birth-rate for the County of London for 1901 was 29.0, and was lower than that in any of the 10 preceding years, during which the birth-rate averaged 30.7 per thousand. Consequent upon differences in sex and age distribution, and the proportion of married and unmarried persons in the various Wards of the City, the rates vary widely, from 7.0 in Charing Cross Ward to 27.7 in St. John's. A more exact method of estimating the birth-rate is by calculating it on the number of females living at child-bearing ages, distinguishing married and unmarried. That cannot be done this year on account of the information for the whole year not being complete with regard to the number of children born who were illegitimate. I have, however, calculated the birth-rate per thousand females at all ages for the City and Wards, and for the Registration Areas per thousand females between the ages of 15 and 45, and the resulting figures are shown on Table XII, compared with similar figures for all London. 25 Table XII.—Showing the Number of Births in the City of Westminster and its Wards, and in the County of London, with rates per 1,000 population, per 1,000 females, and for the Registration Areas of St. George, Westminster, and Strand per 1,000 females between 15 and 45 years of age. Also the Deaths per 1,000 Births of Infants under 1 year of age. Ward. Births. Birth-rate per 1,000 population. Birth-rate per 1,000 females. Birth-rate per 1,000 females between 15 and 45 years of age. Deaths under 1 year of age per 1,000 births. m. F. Total. m. F. Both sexes. Conduit 28 19 47 8.06 13.5 71 263 148 Grosvenor 78 75 153 9.9 16.7 115 186 150 Knightsbridge St. George 84 79 163 10.3 16.5 119 151 134 Victoria 464 372 836 20.5 37 .9 53.5 135 100 124 St. Margaret 103 94 197 14.2 27 .0 58 106 81 St. John 452 417 869 27.7 57 .0 146 146 146 Hamlet of Knightsbridge 36 32 68 8.9 14.6 27 218 117 St. Anne 145 144 289 24.9 52.0 82 76 79 Regent 103 110 213 21.9 42.6 74.3 116 154 136 Pall Mall 14 18 32 7.7 17.1 214 — 93 Great Marlborough 104 104 208 27.4 52.7 153 134 44 Charing Cross 23 18 41 7.0 14.6 130 55 97 Covent Garden 91 72 163 17.7 35.1 53.6 j 120 138 128 Strand 75 78 153 20.9 42.5 I 146 89 117 The City of Westminster 1,800 1,632 3,432 18 5 34 6 57.0 125 128 126 The County of London 66,975 64,303 131,278 29.0 54.9 105.7 — — 148 The total births reckoned on the number of married females (between the ages of 15 and 45) work out at 236 per thousand for London and 178 for the City of Westminster. In 1891 the rates were 259 and 210, and in 1881, 283 and 238 respectively, so that there has been actually a very considerable decrease in the number of children born per family. Deaths. 2,998 deaths were registered in the City in the 52 weeks ending 28th December, 1901. After deducting the deaths of 1,019 noncitizens in public institutions in the City, and adding those of 921 citizens who died in other districts, the corrected total is 2,900, and is equivalent to an annual rate of 15.6 per thousand persons. The London death-rate for the same period was 17.1. 26 Table XIII (Local Government Board Table A).—Vital Statistics of separate Localities in 1901 and previous Years. Names of Localities 1. The City of Westminster. 2. St. George's, comprising Wards Conduit, Grosvenor, Victoria, and Knightsbridge St. George. 3. Westminster, comprising Wards St. Margaret, St. John, and the Hamlet of Knightsbridge. 4. St. James, comprising Wards Regent, Marlborough, and Pall Mall. 5. St. Anne Ward. 6. Strand, comprising Wards Covent Garden, Strand, Charing Cross. Year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. 1891 202,136 4,507 4,024 740 79,967 1,610 1,312 216 55,651 1,449 1,148 256 24,839 508 493 84 12,422 334 293 65 29,257 606 778 119 1892 199,382 4,377 4,070 710 78,649 1,519 1,334 220 55,217 1,418 2,297 246 24,368 524 446 76 12,378 310 261 67 28,770 606 732 101 1893 198,249 4,255 3,970 699 78,883 1,496 1,217 204 54,783 1,350 1,290 255 23,873 520 470 71 12,334 330 278 58 28,376 559 715 111 1894 197,283 4,017 3,277 587 79,123 1,499 1,096 177 54,349 1,219 1,006 180 23,571 456 390 80 12,290 288 202 41 27,950 555 583 109 1895 296,254 4,155 3,559 683 79,368 1,470 1,185 204 53,915 1,278 1,154 246 23,149 528 407 74 12,246 324 203 48 27,576 555 610 111 1896 194,866 3,968 3,277 642 80,041 1,407 1,117 211 53,481 1,222 987 209 22,955 484 396 72 12,200 292 231 58 26.189 563 546 92 1897 194,120 3,846 3,177 587 80,376 1,365 1,067 183 53,047 1,238 1,005 200 22,576 446 388 75 12,150 314 185 39 25,971 483 532 90 1898 193,304 3,715 3,324 571 80,703 1,411 1,072 172 52,613 1,088 1,093 198 22,200 434 408 73 12,150 290 205 39 25,638 492 546 89 1899 192,452 3,610 3,442 600 81,033 1,348 1,156 177 52,179 1,114 1,174 229 21,827 435 387 69 12,100 296 210 40 25,313 417 515 85 1900 191,269 3,433 3,234 509 81,364 1,295 1,140 146 51,745 1,056 1,097 208 21,457 410 341 62 12,000 273 189 36 24,703 399 467 57 Averages of years 1891 to 1900 195,931 3,988 3,535 632.8 79,950 1,442 1,169 191 53,698 1,243 1,125 222 23,081 474 412 73 12,227 305 225 49 26,974 523 602 96 1901 185,648 3,432 2,900 435 77,475 1,199 1,007 156 52,851 1,124 971 151 21,403 453 350 62 11,590 289 148 21 22,329 357 425 43 The figures for the several districts previous to the formation of the City in November, 1900, relate to the areas as then existing, except as regards No. 6. in which case the figures relating to the added part were obtainable from the reports of the late Medical Officer of Health for St. Giles. The other figures are from the reports of the Medical Officer of Health of the separate districts and from those of the Registrar-General. 27 In comparing death-rates it is necessary to take into consideration both the age and the sex of the persons composing the populations whose rates are the subject of comparison, as the death-rate varies very considerably at different age-periods, and is generally higher in males than in females. In Table XIV the population of Westminster is shown to vary considerably from that of London : thus, in London 30 per cent. of the population is under 15 years of age, while in Westminster only 19½ per cent. At each age-period above 15 Westminster has a larger proportion of persons than in London. These figures are calculated from those given by the Registrar-General, and do not include persons in St. George's and the Strand Workhouses outside the City, for which detailed figures are not yet available, and thus the proportions are not quite correct, especially at the higher ages; but the addition of these 3,000 persons would increase the contrast between the proportions of persons living under and over the age of 15 years by slightly lowering the earlier figures and increasing the later ones, as most of the inmates of these institutions are elderly persons. I have also calculated the proportions for each of the three Registration Districts which correspond in area with the three Poor Law Unions. Here the omission of the outlying institutions affects practically only St. George's and the Strand, the former to a much less extent than the latter, where the original population is much smaller. The distribution of population in St. George's Union closely resembles that for the City; in Westminster Union the younger ages are slightly higher, from 15 to 45 years of age they are a good deal higher, while above 45 years the proportions are lower than in the City, and nearer those for London. In the Strand Union the number of persons living at all age-periods up to 35 years is less than in the City, while there is a corresponding excess in the higher periods of life when mortality is heaviest. When complete population statistics are available it will be possible to obtain factors by the use of which these variations of population as regards age and sex may be removed, and the rates be made directly comparable. Meanwhile, the effect of these variations may be estimated by comparing Table XIV with Table XV. Table XV shows the death-rate at certain age-periods, while Table XIV shows the proportion of persons liviug at these periods. Table XV also shows the effect of sex on the death-rates at the various periods. At all ages the male death-rate is 17.6, as compared with 13.8, the female death-rate. The preponderance, therefore, of females, as in St. George's Registration District, has 28 the effect of lowering the general rate, while the excess of males in the Strand has the opposite effect. In St. George, moreover, the excess of females is greatest between the ages of 16 and 30, when mortality is low, while in the Strand the excess of males is greatest from 35 to 65, when death-rates are much higher. These facts explain to some extent why the death-rate in one registration district differs from that in another, but it is evident, on looking at Table XIV, that in the Strand Registration District there are other conditions operating, as at every age-period among "persons" the Strand rate is higher than that for the City, and at most of the age-periods for " males " and " females " separately the same may be observed. It is within the knowledge of the Council Table XIV.—Number of persons per 1,000 living at different age-periods at the Census of 1901 in the City of Westminster, County of London. — Under 5. 5 10 15 20 25 35 45 55 65 and upwards. County of London 109.4 97.7 92.5 97.2 105.4 178.3 130.4 91.1 57.0 40.8 City of Westminster 69.9 63.0 61.9 97.5 138.2 216.5 150.6 101.4 61.9 38.4 Unions :— St. George 69.3 62.2 61 .3 96.6 137.8 213.9 150.4 104.4 62.4 40.6 Westminster 77.0 69.0 64.6 102.8 145.4 218.1 154.0 96.6 55.5 37.5 Strand 63.2 60.6 61.3 93.5 128.0 214.9 161.7 111.1 69.2 36.0 that for the last seven years a considerable portion of the area of the Strand Registration District has been the subject of improvement schemes, whereby the quality of the population has been gradually deteriorating (see Table XVI, showing where persons died). The greater crowding of families into the houses that are left, together with the withdrawal of persons in comparatively good circumstances of life, has an important effect in producing a high death-rate, which is the more obvious in the Strand Ward, which consists almost entirely of property on the line of the Holborn to Strand street. This high death-rate will persist for some years; in fact, so long as a considerable number of persons from this area remain in the workhouse.* * The long-continued effect of this is frequently noticed in the Register's returns, giving deaths of persons who have been inmates of one or other of the City workhouses for many years, and whose "home" address has long since been swept away in some improvement scheme. Thus, during the last year the death was chronicled of a person admitted from an alley now the site of the Law Courts; another had been an inmate since 1878. 29 Table XV.- Death-rate at Various Age- Periods per 1,000 Persons Liuing at these Age- Periods in the city of Westminster. Males. 0-* 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- 85- City of Westminster 125 25.1 2.77 1.79 2.94 4.51 6.41 15.1 24.7 42.8 92.4 15 327 Registration District or Union. St. George's, Hanover Square 126 26.0 3.25 1.81 2.62 4.63 6.44 14.5 23.2 42.3 88.5 166 355 Strand 132 33.0 2.99 2.99 3.92 4.90 6.36 16.2 31.1 45.6 120.8 200 285 Westminster 117 17.8 0.90 0.95 3.47 3.87 6.26 15.9 24.9 42.1 84.0 92 222 Females. City of Westminster 128 22.2 3.11 1.90 1.49 1.95 3.63 9.0 16.8 28.7 65.5 196 300 Registration District or Union. St. George's, Hanover Square 137 23.5 3.28 1.48 1.49 1.84 3.43 7.9 14.9 27.7 63.5 184 200 107 22.6 3.10 3.02 - 2.63 5.69 14.2 21.2 45.1 83.2 317 800 Westminster 111 20.1 2.56 2.76 2.53 2.00 3.09 10.5 24.2 20.2 62.5 177 692 Persons. City of Westminster 126 23.9 2.95 1.85 2.18 3.11 4.84 11.7 20.0 35.3 77.0 180 309 Registration District or Union. St. George's, Hanover Square 131 24.7 3.27 1.64 2.01 3.09 4.69 10.7 18.6 34.1 73.7 177 245 Strand 120 27.5 3.04 3.01 5.71 3.64 6.00 15.3 26.9 45.4 101.9 76 588 Westminster 114 19.0 1.75 1.87 2.94 2.91 4.70 13.3 24.5 31.5 73.0 134 500 * Deaths under 1 are calculated per 1,000 birth. Table XVI.—Deaths of Citizens during the Year ending 28th December, 190L, showing Locality at Time of Death and Inquests. Locality at Time op Death. Wards. At Home. Workhouses and Infirmaries. General and Special Hospitals. Fever Hospitals. lunatic Asylums. Elsewhere. Inquests on Residents. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Conduit 17 17 2 - 7 3 - - - 2 1 - 4 1 Gposvenor 50 56 7 12 9 8 1 1 3 7 4 10 7 Hamlet of Knightsbridge 23 30 6 2 5 3 1 — — — — 2 4 7 Knightsbridge St. George 50 76 12 5 12 13 2 — — 5 1 — 6 1 Victoria 184 218 56 51 53 29 4 5 4 10 8 2 30 16 St. Margaret 69 48 19 19 17 9 2 — 2 2 3 1 14 4 St. John 177 191 141 76 52 42 1 2 4 6 10 6 34 20 St. Anne 49 35 16 15 15 7 1 1 1 5 1 2 9 8 Great Marlborough 40 43 21 13 11 11 — 2 1 5 3 — 7 10 Pall Mall 19 10 — 1 7 1 — — — 6 — 5 1 Regent 36 46 20 17 17 7 2 3 2 3 2 1 11 2 Charing Cross 17 15 6 4 4 5 1 — 1 1 6 1 6 1 Covent Garden 43 42 23 24 10 13 5 4 2 1 3 — 13 4 Strand 31 30 51 34 18 7 6 2 5 7 2 — 12 11 Total 805 857 380 273 237 158 25 20 23 50 53 19 165 93 30 Table XVII.—Quarterly Annual Death-rates per 1,000 Inhabitants in the City of Westminster, in Various Wards, and in the County of London, and England and Wales, 1901. England and Wales. County of London. The City. Conduit. Grosvenor. Hamlet of Knightsbridge. Knightsbridge St. George. Victoria. St. Margaret. St. John. St. Anne. Great Marlborough. Pall Mall. Regent. Cliaring Cross. Covent Garden. Strand. 1st Quarter 18.3 18.2 18.0 10.9 13.8 11 .6 15.5 17.9 14.9 23.1 16.2 19.5 14.4 16.9 14.3 22.2 31.1 2nd Quarter 15.8 15.5 14.8 6.16 9.9 12.6 13.7 13.5 14.1 19.7 10.7 20.6 13.5 15.2 8.2 17.4 27.8 3rd Quarter 16.9 16.6 13.3 6.16 8.9 5.6 7.1 12.8 9.8 21.5 11.4 21.6 7.7 14.4 7.5 17.9 19.6 4th Quarter 16.6 17.9 16.4 10.3 9.4 7.3 8.4 17.3 16.1 25.9 12.8 17.4 6.7 17.7 11.7 16.5 26.7 The Yfar. Persons 16.9 17.1 15.6 8.4 10.3 9.4 11.2 15.4 13.7 22.6 12.7 19.8 10.6 16.0 10.3 18.5 26.3 Males .. .. — 19.0 17.6 11.4 11.9 13.4 13.0 16.6 16.9 23.9 13.5 21.0 15.6 16.7 11.4 19.0 30.3 Females.. — 16.0 13.8 6.3 9.2 6.9 10.1 14.3 10.8 21.1 11.9 18.7 4.8 15.4 9.3 18.1 22.2 31 In Table XVII the death-rates are given for each Ward during each quarter of 1901, together with the annual rate for each, distinguishing males and females. The Registrar-General does not publish the particulars of the numbers living at different ageperiods in each Ward, so that more detailed comparison cannot be made. Among males, the Wards of St. John, Great Marlborough, Covent Garden, and the Strand exceed the average rate for the whole City; the same Wards, together with Victoria and Regent, have also higher rates for females. In order to compare the deaths from various causes, I have calculated the deaths in each Ward per thousand estimated inhabitants, and these are set out in Table XVIII. The causes of excessive death-rate were:— Smallpox Strand; Covent Garden. Measles Strand; St. John. Scarlet fever Strand; Covent Garden. Influenza St. John. Diarrhoea Strand; St. John; Great Marlborough. Whooping-cough Great Marlborough. Phthisis Strand; Covent Garden; St. John; Great Marlborough. Nervous diseases Strand; Covent Garden ; St. John ; Great Marlborough. Heart disease Covent Garden. Diseases of lungs, &c. . Strand; Covent Garden; St. John; Great Marlborough. Kidney disease Strand; Covent Garden. Developmental diseases St. John; Great Marlborough. of childhood. In the Victoria and Regent Wards the excessive death-rates were due, in Victoria Ward, to diseases of the lungs, cancer, and alcoholism; in Regent Ward to diarrhoea, diseases of the heart and of the digestive organs. Deaths under One Year of A ge.—435 infants died under this age, that is to say, of every 1,000 children born an average of 126 died within 12 months; the rate is a little lower (125) for male children than for females (128). In Table XV the rates for the three registration (Union) areas in Table XII for each Ward are set out. From these it appears that in St. George's Union is the greatest loss of life, the rate being 131, the old St. George's group of Wards being equal to 130, the St. Margaret and St. John group to 134. On looking at the separate Wards, Grosvenor, Conduit, St. John, and 33 Knightsbridge St. George are seen to be the worst in this respect, although individually they do not vary much from the average (148) for all London. The causes of death in these infants in the City will be found in Local Government Board Table (p. 36). The year 1901 was a healthy one for children, and the death ratio was much below that usually prevailing, thus the London rate is 11 per 1,000 below the mean rate of the preceding 10 years. The rates in Metropolitan boroughs lower than that in this City were 104 in Hampstead, 107 in Marylebone, 115 in Stoke Newington ; the highest rates were 165 in Poplar, 168 in Hammersmith and in Southwark 169 in Bermondsey, 175 in the City of London, and 197 in Shoreditch. Deaths at other Age-periods are given in Table XV for each of the Registration or Union Districts, distinguishing males and females, by this means a more correct comparison can be made at ail except the higher age-periods. Causes of Death.—These are set out in detail in the Local Government Board Table (p. 36), and the relative rates for the principal causes for each Ward are shown in Table XVIII, with corresponding figures for the County of London. It is evident that deaths from diseases of the Respiratory Organs (bronchitis, inflammation of the lungs, &c.) form a very important group. The total deaths from these complaints give rates equal to:— Conduit 0.96 St. Anne 1.75 Grosvenor 1.88 Pall Mall 2.17 Knightsbridge St. George 2.96 Regent 3.27 Victoria 3.00 Great Marlborough 4.87 St. Margaret 3.00 Charing Cross 1.87 St. John 4.91 Covent Garden 4.35 Hamlet 1.30 Strand 5.98 The City of Westminster 3.55 per 1,000 persons. The County of London 3.26 „ „ In some of the Wards the variation is due to the greater proportion of persons living at an age when the mortality from these complaints is greatest. Thus in St. John's Ward there were 160 deaths from these causes, 41 of these were in children under five years of age, 12 between 35 and 45, 14 between 45 and 55, 27 between 55 and 65, and 60 in persons over 65. In the Strand there were 45 of such deaths, but only five were in young children, and more than half were in persons above 65. (8545) c Table XVIII.—Death-rates and Causes of Death during the 52 Weeks ending 28th December, 1901, for the County of London, the City of Westminster and Wards. Causes of Death. The County of London. The City of Westminster. Death-rates in Wakds (at all Age3). Conduit Grosvenor. Knightsbridge St. George. Victoria. St. Margaret. St. John. Hamlet of Knightsbridge. Pall Mall. Eegent. Great Marlborough. Charing Cross. Covent Garden. Strand. St. Anne. Smallpox 0 .05 0.091 - 0.06 0.06 0.03 0.20 0.17 0.43 0.95 - Measles 0.43 0.318 0.17 0.06 0.12 0.19 0.28 0.96 0.13 0.24 — 0.26 0.34 0.43 0.54 0.17 Scarlet fever 0.133 0.038 — — — 0.04 - 0.03 0.13 — — 0.13 — 0.21 0.27 — Typhus fever 0.00 — — — — — - — — — — — — — — — Epidemic influenza 0.146 0 156 — 0.19 0.31 0.12 0.07 0.38 0.26 0.24 -. - - - - - Whooping-cough 0.35 0.259 0.17 0.52 0.59 0.19 — 0.15 0.39 — 0.41 0.79 0.17 0.32 0.13 — Diphtheria, Membranous croup 0.29 0.113 — 0.06 — 0.14 0.14 0.15 — — — 0.26 — 0.21 0 13 0.17 Croup 0.008 0.005 — — — — — 0.06 — — — — — — — — Enteric fever 0.11 0.107 — — 0.12 0.17 0.07 0.06 — 0.24 0.20 0.26 0-17 — 0.27 — Diarrhoea, Epidemic enteritis 0.860 0.52 0.17 0.06 0.31 0.49 0.21 1.15 0.13 — 0.92 0.92 — 0.43 0.95 0.25 Dysentery 0.03 — — — 0.07 0.07 0.03 — — — — — — 0 13 — Enteritis 0.315 0.07 — — — 0.17 0.07 0.09 — — — 0.31 — — 0 13 — Other continued fevers 0.00 — — — — — — — — — — — — — — — Erysipelas 0.037 0.038 — — 0.12 0.02 0.07 0.06 — — o.10 — — — 0.13 0-08 Puerperal fever 0.045 0.021 — — 0.06 0.17 — 1.oo — — — — — — — — Other septic diseases 0.043 0.052 0.17 — 0.06 0.02 — 0.06 0.26 — 0.10 — — — 0.27 — Malarial disease — 0.013 — — — — — — — 0.48 o.10 — — — — — Rheumatic fever 0.080 0.096 0.17 — 0.19 0.04 0.28 0.06 0.13 — — — — 0.32 0 13 0.08 34 Tuberculosis of meninges 0.245 0 .166 0.17 0 13 0.06 0.12 0.14 0.12 — — 0.41 0.26 — 0.21 0.13 0.25 Tuberculosis of lungs 1 .66 1 .83 0.51 0.52 0.70 1 .67 1.36 3 .45 0.52 0.97 1 .64 2 .37 0.68 2.40 4.23 2.50 Tuberculosis of peritoneum 0.18 0.09 — — — 0.09 0 .07 0.28 — — — 0 13 — — 0.27 0.08 Other forms of tuberculosis 0.20 0.12 — 0.19 0 19 0 .09 0.07 0.15 0.26 0.48 0.20 — 0.17 — — Alcoholism — 0.188 — 0.39 0.25 0 .12 0.21 0.22 — 0.24 o.1o 0.26 0.17 0.21 0.54 0.08 Cancer and other malignant diseases 0.925 0.780 0.51 0.55 0.76 0.88 1.00 0 99 0.65 0.48 1.44 0.39 0.85 0.43 0.68 0.17 Premature birth 0.553 0.301 0.34 0 .32 0.19 0 .41 0 '07 0.54 — — 0.20 0.26 0.17 0.21 — 0.34 Developmental diseases — 0.473 — 0.26 0 .12 0.46 0.07 0.95 0.26 0.48 0.72 1 .05 0.17 0.32 0.95 0.17 Old age 0.617 0.537 0.17 0.26 0.82 0.46 0.21 0.89 0.65 — 0.30 0.79 — 0.65 1 09 0.34 Insanity, general paralysis 0.140 0.17 0.06 _ 0 .12 0.07 0.09 — — 0.20 0.26 0.17 0.54 0.54 — Nervous system (other diseases) 1.23 0.725 0.17 0.45 0 .70 0.74 0.57 0.95 0.39 0.72 1 .03 1.18 0.68 0.98 0.95 0.60 Valvular diseases of heart 0.490 0.68 0.32 0.19 0.32 0.35 0.47 0.26 — 0.72 0.66 0.68 1 .20 1 .63 0.43 Other diseases of heart and 2.12 blood vessels 1.61 1.02 1.37 0.95 1 .92 2.15 1.94 1 .04 1.45 1.34 1.58 2.05 1.31 1.63 1.81 Bronchitis 1.61 2.06 0.85 1.30 1.14 2.61 1.72 3.32 0.52 0.24 1.85 2.77 1.19 2.18 3 .55 1.04 Lobar (croupous) pneumonia 0.221 — 0.19 0 .12 0.07 0.07 0.19 0.13 0.48 0.20 0.66 — 0.65 0.40 0.60 Pneumonia (form not stated) 1.34 0.698 0.51 0.26 0.57 0 .81 0.86 0.89 0.52 1.21 0.92 0.66 0.34 0.76 0.81 0.51 Lobular (broncho) pneumonia 0.408 — 0.13 0.31 0.27 0.35 0.51 0.13 0.24 0.30 0.52 0.34 0.76 1.22 0.60 Other respiratory diseases 0.311 0.293 0.34 0.06 0.06 0.24 0.21 0.19 0.26 — — 0.26 - o.1o 0.13 0.08 Cirrhosis of liver 0.598 0.204 — 0.26 0.12 0.12 0.28 0.15 0.13 0.24 0.20 0.52 0.17 0.43 — 0.43 Other digestive diseases 10.521 0.51 0.45 0.38 0.64 0.35 0.63 0.39 0.48 0.50 0.26 0.17 0.54 0.54. 0.69 Nephritis and Bright's disease 0.513 0.521 0.17 0.39 0.44. 0.46 0.93 0.70 0.52 — 0.72 0.13 0.17 0.54 0.81 0.43 Other diseases of urinary system 10.140 0.51 — 0.31 0.04 0.21 0.19 — — — — — — 0.08 Accidents and diseases of parturition and generative organs 0.103 0.086 - - 0.06 0.07 0 .14 0.06 0.52 - - 0.13 0.17 0.21 - - Deaths by accident or negligence 0.624 0.467 0.51 0.45 0.31 0.37 0 .35 0.63 0 39 0.48 0.61 0.92 0.51 0 .43 0.54 0.25 Deaths by suicide 0.110 0.215 0.17 — 0.06 0.09 0 .35 0.35 0 13 0.48 o.10 0.66 0.34 0.21 0.40 0.25 All other causes 1.303 0.345 0.24 0.58 0.44 0.43 0.35 0.47 0.36 0.48 0.41 0.39 0 .34 0.32 0.98 0.86 All causes 17.087 15.620 8.4 10 .32 11 .2 15.3 13 .8 22.6 9.43 10.6 16.0 19.82 10.3 18.5 26.3 12.7 35 8445 c 2 Local Government Board Table B.—Causes of and Ages at, Death during the 52 weeks ending 28th December, 1901. Corrected Deaths in the City at subjoined Ages. Deaths in Wards (at all Ages). Causes of Death. All ages. Under 1. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. Conduit. Grosvenor. Knightsbridge St. George. Victoria. St. Margaret. St. John. Hamlet of Knightsbridge. Pall Mall. Regent. Great Marlborough. Charing Cross. Coyent Garden. Strand. St. Anne. Smallpox 17 1 2 - 3 11 - - 1 1 - 1 - _ 2 _ 1 4 7 - Measles 59 8 48 3 — - 1 1 2 8 4 27 1 1 — 2 2 4 4 2 Scarlet fever 9 2 4 1 2 — - — — — 2 — 1 1 - — 1 — 2 2 — Typhus fever — — — — — — - — — — — — — — - — — — — — — Epidemic influenza 29 — — 1 — 17 11 — 3 5 5 1 12 2 1 - - - - - - Whooping cough 48 17 29 2 — — 1 8 8 8 — 5 3 - 4 6 1 3 1 — Diphtheria, Memb. croup 21 — 16 2 1 2 - — 1 — 6 2 5 — - — 2 — 2 1 2 Croup 1 1 — — — — - — — — — — 1 — - — — — — — — Enteric fever 20 2 3 5 10 - — — 2 7 ] 2 1 2 2 1 — 2 — Asiatic cholera — — - — — Diarrhoea dysentery 79 59 7 2 — 6 5 1 1 4 15 3 30 — - 7 6 — 4 7 1 Epidemic enteritis 18 14 2 1 — 1 — — — 1 5 — 6 1 - 2 1 — — — 2 Enteritis 13 5 2 — 1 5 — — — — 7 1 3 — - — 1 — — 1 — Other continued fevers — — — — — — — — — — — — — — - — — — — — — Erysipelas 9 4 1 — 3 1 — — 2 1 1 2 — - 1 — — — 1 1 Puerperal fever 4 — — — 1 3 — — — 1 3 — — — - — — — — — Other septic diseases 10 1 2 6 1 1 — 1 1 — 2 2 - 1 — — — 2 — Intermittent fever and malarial cachexia 3 - - - - 3 - - - - - - - 2 1 - - - - - Tuberculosis of meninges 31 10 ]3 3 1 4 — 1 2 1 5 2 4 4 — 4 2 — 2 1 3 Tuberculosis of lungs 341 2 5 6 39 271 18 3 8 11 68 19 108 — 4 16 18 4 22 31 29 Other forms of tuberculosis 41 11 10 4 7 9 — — 3 3 8 2 14 2 2 2 1 1 — 2 1 Alcoholism 35 — — — — 33 2 — 6 4 5 3 5 — 1 1 2 1 2 4 1 36 Cancer 145 100 45 4 6 13 37 14 31 5 2 14 3 5 4 5 2 Premature birth 56 56 2 5 3 17 1 17 — — 2 2 1 2 — 4 Developmental diseases 88 81 7 — — — — — 4 2 19 1 30 2 2 7 8 1 3 7 2 Old age 100 1 4 13 19 3 28 5 — 3 6 — 6 8 4 Meningitis 28 16 7 1 — 4 — — 1 3 6 2 5 — — 2 4 — 3 — 2 Inflammation and softening of brain 13 - 8 5 - - 1 4 _ 5 1 _ 1 _ 1 Valvular diseases of heart 91 — — 2 3 54 32 4 5 3 13 5 15 2 — 7 5 4 11 12 5 Acute bronchitis 124 39 23 2 — 33 27 4 7 8 37 6 33 — 1 6 4 4 5 4 5 Chronic bronchitis 260 — — — 88 172 1 13 9 69 18 71 4 — 12 17 3 14 22 7 Lobar (croupous) pneumonia 41 7 - - 1 26 7 - 3 2 3 1 6 1 2 2 5 _ 6 3 7 Lobular (broncho-) pneumonia 76 23 22 - 1 18 12 - 2 5 11 5 16 4 1 3 4 2 7 9 7 Diseases of stomach 21 5 1 — — 11 4 — 2 1 3 1 10 2 — 1 — — — — 1 Obstruction of intestines 25 3 1 — 2 11 8 1 2 1 8 3 2 — — 3 — — 2 1 2 Cirrhosis of liver 38 — — 1 33 4 — 4 2 5 4 5 1 1 2 4 1 4 — 5 Nephritis and Bright's disease 97 1 - - 6 66 24 1 6 7 19 13 22 4 7 1 1 6 6 5 Tumours and other affections of genital organs 9 1 - - - 7 1 _ - 1 2 1 2 2 - - - - - - - Accidents and diseases of parturition 7 _ - - 2 5 - _ - _ 1 1 2 1 2 — — Deaths by accident or negligence 87 15 10 4 5 35 18 3 7 5 15 5 20 3 2 6 7 3 4 4 3 Deaths by suicide 40 — — 6 31 3 1 1 4 5 10 1 2 1 5 2 2 3 3 Deaths from ill - defined causes 5 3 — — 1 1 — — 2 — 1 1 1 - - - - - - - - All other causes 861 51 25 18 28 195 254 19 51 50 177 62 151 17 19 34 30 21 45 43 42 All causes 2,900 435 238 55 118 1,110 754 49 158 176 624 191 708 72 44 156 150 61 170 193 148 Deaths of citizens in General and Special Hospitals and Poor Law Institutions in the City have been distributed in the several Wards; as have also deaths of citizens in General and Special Hospitals, Asylums, Lying-in Institutions, St. George's Union Workhouse and Infirmary, Central Sick Asylum, Strand Workhouse, Fever Hospitals, and in streets outside the City. Deaths of non-residents have been excluded. 37 38 Two other factors have an important bearing upon the prevalence of respiratory diseases, these are insanitary conditions and the circumstances and occupation of the inhabitants. It is now recognised that overcrowding and defective ventilation, as well as dampness of houses, have an important effect in predisposing persons to diseases of the chest, both tubercular and otherwise. In future reports it may be possible to show the occupations of persons with the causes of their death. Influenza was present to some extent, and 110 doubt added to the number of deaths from respiratory organs; 29 deathswere attributed directly to this disease. Tubercular Diseases.—Deaths from this cause form also a large proportion of the total. In London, after excluding deaths of persons who had come up for treatment at its hospitals, there were 7,514 deaths from consumption of the lungs (phthisis pulmonalis), equal to a rate of 1.66 per 1,000. In the central district of London the mortality was 2.40, in the east district 2.06, in the north 1.59, in the south 1.55, and in the west (in which group is the City of Westminster) 1.47. In the City the death-rate from this form of the disease was 1.83. In some of the Metropolitan boroughs the rate was under 1 per 1,000 (as in Lewisham 0.90, and Hampstead 0.91), but in others it reached a higher figure, as in Southwark 2.51, and Holborn 2.81. Similar variations exist among the Wards of the City (Table XVIII), Conduit, Grosvenor, and the Hamlet being only 0.5 per 1,000, whereas in St. John the rate reached 3.45, and in the Strand 4.23. The phthisis deaths in the City were thus in the ratio of one in every 8.5 deaths in Westminster, compared with one in 10.3 deaths in all London. In order to realise the loss to the community which this disease causes, it must be recollected that for every death there are three or four other persons suffering, and as the disease is a chronic one, the long illness presses very severely on the resources of the patient's family, with the result that frequently relief has to be sought from hospitals and the Poor Law Guardians. During recent years considerable attention has been paid to this class of disease, and the public are beginning to recognise that it is of an infectious nature, and that it can be prevented and might be entirely eradicated in the same way as ague and typhus fever. Tubercular disease is due to a living organism which finds its way into the lungs and other parts of the body, where it grows and which it gradually destroys. Certain persons, from hereditary 39 tendencies, are less able to resist the inroads of this organism, but if such persons are placed in healthy surroundings, there is no reason why they should ever become tuberculous. Whereas not only they, but persons without any such predisposition may and do succumb to it when they live in rooms and workshops which are badly ventilated, overcrowded or otherwise insanitary; intemperance and deficient food are also potent factors in preparing the soil on which the organism may grow. The application of the Public Health and Factory Acts, together with the greater well-being of all classes of the community, has reduced the mortality from this cause, but little attention has been given to the destruction of the infective germ of the disease. A person suffering from consumption of the lungs coughs up enormous numbers of these germs, and if such expectoration is not carefully dealt with, but allowed to be spat on pavements, floors, &c., it becomes a source of infection to other persons, as the germ may remain alive and active for long periods, especially in houses which are dark, ill-ventilated, and dirty. Such houses may thus become so infected that new families moving into them fall victims to the disease. Numerous instances of this are on record, and I have mentioned some clear cases of such infection in former reports. Cases of consumption occurring in families are often due to infection by such infected dust, and it is extremely important that persons who are consumptive should be instructed in the precautions required to prevent the further accumulation of infection, and that rooms which have already been contaminated should be properly disinfected and cleansed. Means to be taken for the Prevention of Consumption.—The British Congress on Tuberculosis met in London in 1901, and the followingresolutions were adopted at the final meeting:— 1. "That tuberculous sputum is the main agent for the conveyance of the virus of tuberculosis from man to man, and that indiscriminate spitting should therefore be suppressed." 2. "That it is the opinion of this Congress that all public hospitals and dispensaries should present every patient suffering from phthisis with a leaflet containing instructions with regard to the prevention of consumption, and should supply and insist on the proper use of a pocket spittoon." 3. "That the voluntary notification of cases of phthisis attended with tuberculous expectoration, and the increased preventive action which it has rendered practicable, has been attended by a promising measure of success, and that the extension of notification should be 40 encouraged in all districts in which efficient sanitary administration renders it possible to adopt the consequential measures." 4. "That the provision of sanatoria is an indispensable part of the measures necessary for the diminution of tuberculosis." 5. "That, in the opinion of this Congress, and in the light of the work that has been presented at its sittings, medical officers of health should continus to use all the powers at their disposal, and relax no effort to prevent the spread of tuberculosis by milk and meat." 6. "That, in view of the doubts thrown on the identity of human and bovine tuberculosis, it is expedient that the Government be approached and requested to institute an immediate inquiry into this question, which is of vital importance to the public health, and of great consequence to the agricultural industry." 7. "That the educational work of the great national societies for the prevention of tuberculosis is deserving of every encouragement and support. It is through their agency that a rational public opinion may be formed, the duties of public health officers made easier of performance, and such local and State legislation as may be requisite called into existence." 8. "That this Congress is of opinion that a permanent international committee should be appointed: (a) to collect evidence and report on the measures that have been adopted for the prevention of tuberculosis in different countries; (b) to publish a popular statement of these measures; (c) to keep and publish periodically a record of scientific research in relation to tuberculosis; (d) to consider and recommend measures of prevention. This Congress is further of opinion that all international and great national societies whose object is the prevention of tuberculosis should be invited to co-operate." 9. "That, in the opinion of this Congress, overcrowding, defective ventilation, damp, and general insanitary conditions in the houses of the working classes diminish the chance of curing consumption, and aid in predisposing to and spreading the disease." 10. "That, while recognising the great importance of sanatoria in combating tuberculosis in all countries, the attention of Government should be directed to informing charitable and philanthropic individuals and societies of the necessity for anti-tubercular dispensaries as the best means of checking tubercular disease among the industrial and indigent classes." These resolutions indicate the lines on which sanitary authorities are acting, or on which they ought to act. The measures of sanitary improvement which are constantly being carried out in the City must in time bear fruit, but to remove the stigma of the high death- 41 rate now existing further measures are necessary. But before these can be put into operation it is necessary to know where the present cases are. On a very low estimate there are probably 1,200 to 1,500 adult persons in the City of Westminster who are suffering from phthisis, besides children. I have made an analysis of the occupations of those persons who died in 1901, and it is evident from the position in life which many of them occupied, that they must have been unable to carry out those precautions which are necessary to prevent them being sources of infection to their families and those with whom they worked. Occupations of Adult Persons who died from Tubercular Disease in 1901, and Place of Death. Occupation. Died at home. In Hospital. In Infirmary. Total. Males. Tailors 2 — 4 6 Collar cutter 1 — — 1 Upholsterers — 1 1 2 Hatter — — 1 1 Leather workers 5 — 3 8 Print colorer 1 — — 1 Bookbinder 1 1 Circular folder — 1 1 Bookseller 1 — — 1 Belief stamper 1 — — 1 Compositors, Printer 4 1 — 5 Machine ruler — 1 — 1 Newsvendors 1 1 1 3 Ticket writer 1 — — 1 House painters — 5 9 Paperhanger — — 1 1 Builders, masons 1 — 1 2 Chimney sweep 1 — — 1 Plumbers and gasfitters 1 1 — 2 Modeller 1 — — 1 Carpenters 1 — 1 2 Scene shifters, &c. 4 — 2 6 Coachmen 5 — 1 6 Carmen 2 1 1 4 Stablemen, grooms — 1 5 6 Cooks (male) — — 4 4 Male servants 3 — 1 4 Waiters — 4 3 7 Barmen, Potmen 2 — 3 5 Billiard marker 1 — — 1 Ice cream vendor — — 1 1 Butchers, greengrocers, fishmongers, and chemists 6 3 2 11 Hawkers 1 1 7 9 Labourers 7 — 8 15 Warehousemen and packers 5 1 2 8 Porters 4 3 15 22 42 Occupations of Adult Persons who died from Tubercular Disease in 1901, and Place of Death—(contd.). Occupation. Died at home. In Hospital. In Infirmary. Total. Males—contd. Hall and hotel porters, messengers 7 2 9 Police 1 1 — 2 Soldiers 1 8 — 9 Army pensioners — 1 1 2 Postmen, sorters 2 — 2 Silversmiths 2 — 1 3 Electrical engineer 1 — — 1 Stokers, engineer 1 — 1 2 Payiors, sweepers, &c 1 — 2 3 Journalist 1 — — 1 Clerks 7 — 3 10 Managers of common lodging houses 1 1 1 3 No occupation 7 — 1 8 Females. Dressmakers and sempstresses 3 3 1 7 Tailoresses 1 1 3 5 Laundresses — 1 4 5 Charwomen — — 6 6 Servants 9 4 6 19 Females (occcupation not stated) 57 6 7 70 Deducting deaths of children, 170 persons died in their homes, 47 in hospitals, and 113 in Poor Law Institutions. As a rule adults afflicted with consumption continue their work so long as their health and strength permits, especially when they have others dependent on them, and only seek shelter in infirmaries when they are no longer able to work, and their funds are exhausted. It must be kept in mind that had these persons been able to receive proper attention and treatment in the early stages of the disease, many of them might have been cured, and been able to continue their occupations and support their families, instead of which a number of them have become a burden on the rates. Sanatoria for the treatment of consumption have been formed all over the country, but except in a few instances the charges are beyond the means of the wage-earning class. The Borough Council of Chelsea have issued a memorandum prepared by Dr. L. C. Parkes, the Medical Officer of Heath for that Borough, suggesting that the Metropolitan Asylums Board is the proper body in London to provide sanatoria for the treatment of consumptive persons, and the City Council have signified their approval thereof. 43 It is obviously necessary that such treatment should not pauperise the subject of it. In the Chelsea memorandum this point is dealt with as follows:— "The principle involved in the isolation and treatment of consumptives in sanatoria is the same as that involved in the isolation and treatment of scarlet fever, diphtheria, and enteric fever. It is a measure necessary to safeguard the public health ; and it also holds out the prospect of a more hopeful mode of treatment for the poorer class of consumptives than is available for them at the present time. The general hospitals in London are averse to the reception of consumptive patients for any but short periods; nor are such patients, as a rule, very materially benefited by stay in wards of general hospitals. The special hospitals for consumption in London are too few to be able to deal with any but comparatively small numbers of such cases; and there is often a long period of delay after application before a case is admitted. Amongst the poor the wards of the Workhouse Infirmaries receive a very large number of cases; but they do not, as a rule, seek admission until they find they are unable to continue their occupations, and are generally in an incurably advanced stage of the disease. "I do not advocate any compulsion to secure the isolation of consumptives. The sufferers from this disease would quickly realise the benefits to be derived from early resort to sanatorium treatment, especially if, in the case of wage-earners of a family, a fund was available for the maintenance of their families during the somewhat prolonged period of six months, during which, on an average, treatment is desirable. "To sum up the benefits which would be derived from the provision of sanatoria by the Metropolitan Asylums Board for the treatment of consumptives:—(1) The public health would benefit by the withdrawal from amongst the general population of active foci of disease. A very considerable reduction in the prevalence of consumption would ensue when the system was thoroughly established; (2) the sanatorium treatment made available for sufferers in the early stages of the disease would restore to health and activity a considerable proportion, who, under present circumstances, succumb; (3) in the event of a recurrence of the disease in a person discharged from a sanatorium, the precautionary habits acquired by him. whilst under treatment, would largely tend to prevent, during his illness, the diffusion of infection which would otherwise occur in his own home and place of occupation." Voluntary Notification.—As I have already said before consumptives can be instructed as to the precautions to be taken, it is '1:4 necessary to know where they are, and to meet this a system of voluntary notification has been instituted in many provincial towns and already in several Metropolitan Boroughs—viz., Kensington, Finsbury, and Stoke Newington. In Manchester the Medical Officer of Health, referring to the work done in connection with phthisis, states in bis Annual Report for 1901 that "There is no department of public health Avork in which the value of administrative action is so apparent as in this. It may fairly be said that a considerable degree of success lias attended our efforts. It is true that only about one-third of all the cases are known to us and dealt with; but they are cases occurring in such houses as render them peculiarly dangerous, and our operations are, therefore, doing a maximum of good. Moreover, they must profoundly affect the precautions taken by those in better circumstances." I am strongly of opinion that the City Council should introduce a system of voluntary notification in the City. Notification must be voluntary, and can be given only with the consent of the patient or those in charge. It should only be of such cases of consumption as are attended with tuberculous expectoration. The same fee as is paid for compulsory notification certificates (of fever, &c.) under the Public Health (London) Act, 1891, would be payable, but only one certificate in respect of each case would be paid for, except in case of change of patien0ts' abode. Following on the notification of the disease in any person, the house in which he resides would be visited, and inspection of the premises made. Notes will be taken of any insanitary conditions, and these will be dealt with under the Public Health Acts. A printed card would be left at the house with advice on the best methods of cleansing the rooms and their contents, and instructions as to precautions to be taken to prevent the spread of disease through expectorated matter. The careful carrying out of these rules would greatly benefit the persons suffering, and minimise the risk of infection to the rest of the family. The disinfection and cleansing of the rooms occupied by the patient should, at stated intervals as may be necessary, be carried out by the Sanitary Authority, or under their supervision, with the consent of the owner, by methods which have been proved efficacious for the destruction of the tubercle bacilli. After the death of a patient, or when the family moves to another house, these measures should be repeated with the greatest care and thoroughness. When it is thought necessary the bedding and clothing should be disinfected by steam. 45 It should be clearly understood that no kind of publicity will be given to any information that may be obtained by the notification of the disease in any person; and no kind of interference will be attempted with the movements or work of the person suffering. Bacteriological Examination of Sputum.—The Council has entered into an arrangement with the Jenner Institute for the bacteriological examination of sputum in cases suspected to be tuberculous, it being of the utmost importance to the patient that the nature of his complaint be recognised at the earliest possible moment. Disinfection of rooms which have been occupied by consumptives lias been carried out in a number of cases during the year. These were chiefly as a result of a personal visit, but in a few cases on the request of the relatives. Neither the Inspectors nor I have had time to visit many of the houses where deaths have occurred from consumption, but it is a field in which much good work can be done. Tuberculous Milk.—During the year 100 samples of milk were taken with all necessary precautions to prevent contamination, and were submitted to the Jenner Institute for bacteriological examination. In each instance a note was made of the source of supply, the name and address of the farmer and number of churn being taken. The tubercle bacillus was found in 11 of the samples, and in two instances the supply was evidently the same—viz., from a farm in Wiltshire, through one of the large distributing companies. Many of the samples were found to contain pus cells, but in only one case were they reported to be numerous. On inquiry, Dr. Hewlett, of the Jenner Institute, informed me that a few pus cells seem to be present in all milk, but if in quantity they suggest that the cow has some suppuration or dermatitis of the udder. The Wards from which the tuberculous samples were taken were :—Great Marlborough, 2 ; Regent, 2 ; Victoria, 2 ; St. John, 2 ; Covent Garden, 1; Strand, 1; St. Margaret, 1. The milk from 22 shops was reported as containing ordinary bacteria in moderate or large amounts. In the remainder these were entirely absent, or present only in small numbers. I take it, therefore, that the presence of such bacteria in any quantity is evidence that the milk is not kept in as cleanly a manner as should be the case, or that it has been contaminated en route. None of the milk derived from cows kept in the City showed evidence of any contamination, and I am informed that the veterinary surgeon appointed by the London County Council to examine cows in London reports that none of the Westminster cows were found suffering from tubercle in 1901. 46 In each case the dairyman, the middleman, and the farmer were communicated with, and steps were taken by several of the wholesale firms to have the cows examined at the inculpated farms, with a view to preventing such milk being sent to them. I gather that it is contrary to the agreements made between the farmer and the companies to send milk so contaminated. There were 23 deaths of infants under one year registered as dying from various forms of tubercular disease ; in two the lungs were affected, in nine the abdomen, in 10 the meninges of the brain, and in two the system generally; of these, eight were less than three months old at the time of death, 10 were between three and six months. In several instances the mother was suffering from consumption at the time of birth. 28 deaths were of children between one and five years of age. Without systematic enquiry it is impossible to say in what way these children may have become infected ; it may have been through the agency of infected milk, but I believe the way in which most children become infected is by means of infected dust in carpets and floors of rooms which have been occupied by persons suffering from phthisis. So soon as they are able children are allowed to play and crawl about on the floor, and may easily convey infective materials from the hands to the mouth. Since Koch stated at the Tuberculosis Congress that there was some doubt that tubercle, as it grew in cows, could affect human beings, a Royal Commission has been appointed to investigate the point. Infectious Diseases. (1) Notifiable Diseases.—During the 52 weeks of 1901,1,057 cases of infectious disease were notified to my predecessors or to me. The details respecting them are set out in the Local Government Board's Return (Table C), which also shows the number treated in hospital as well as the number of deaths. The number of cases of each disease notified in London since 1890 are shown in Table XIX, together with cases notified during the same period in the different divisions which, with some modifications, now form the City. The total notifications in London in 1901 were equal to 88'9 per 10,000 population. As a total this is above that of 1900 (76*7), but is considerably below the average of the previous 10 years. The principal increase was in respect of scarlet fever; diphtheria was slightly higher, and smallpox was considerably above the figure recorded in recent years. The number of cases of all the other notifiable diseases were below both the average and that of 1900. 47 Table XIX.— Infectious Diseases Notified, 1890.1901, in London. Year. Smallpox. Scarlet Fever. Diphtheria and Croup. Enteric Fever. Typhus Fever. Other Continued Fevers. Puerperal Fever. Erysipelas. Cholera. Relapsing Fever. Totals. 1890 60 15,330 5,870 2,877 35 237 206 4,598 25 7 30,245 1891 114 11,398 6,412 3,372 27 152 221 4,764 23 39 26,552 1892 423 27,095 8,356 2.465 20 147 347 6,934 54 7 45,848 1893 2,813 36,901 13,694 3,666 22 205 397 9,700 86 4 67,485 1894 1,192 18 440 11,190 3,360 21 162 253 6,080 21 2 40,925 1895 979 19,757 11,223 3,506 14 105 236 5,660 29 3 41,612 1896 225 25,647 13,941 3,190 6 103 279 6,438 13 3 49,845 1897 104 22,848 13,199 3,103 4 65 264 5,800 38 1 45,361 1898 32 16,894 11,855 3,024 16 55 247 5,169 23 1 37,316 1899 29 18,113 13,704 4,463 14 69 330 5,615 15 1 42,353 1900 87 13,800 11,985 4,291 7 73 237 4,762 5 . 35,247 1901 1,700 18,381 12,157 3,194 20 48 253 4,604 3 — 40,360 In the City of Westminster. 1890 1 402 150 79 - 9 - 128 1 — 770 1891 2 379 174 100 — 7 9 144 1 — 817 1892 14 864 349 99 — 8 7 191 2 — 1,534 1893 165 1,366 353 148 — 5 11 230 4 — 2,284 1894 21 535 269 106 — 9 2 134 — — 1,134 1895 195 715 383 114 — 4 4 138 — — 1,297 1896 7 846 323 121 — 5 7 178 — — 1,487 1897 13 658 336 104 — 5 6 175 1 — 1,298 1898 2 409 338 112 - 2 5 131 — - 999 1899 - 534 283 143 - 1 3 176 — - 1,140 1900 2 453 287 118 - 4 5 129 - - 998 1901 102 475 253 104 — 2 6 117 — - 1,057 Table XX.— Case-rates per 10,000 Living in London. Year. Smallpox. Scarlet Fever. Diphtheria. Enteric. Typhus. Other Continued Fevers. Puerperal. Erysipelas. 1891 0.3 27.1 15.2 8.0 o.1 0.5 0.5 11.3 1892 1.0 63 .8 19.6 5.8 - 0.3 0.8 16.3 1893 6.5 86.1 32.0 8.5 o.1 0.5 0.9 22.6 1894 2.7 42.5 25.9 7.7 — 0.4 0.6 14.0 1895 2.2 45.2 25.7 8.0 — 0.2 0.5 12.9 1896 0.5 57.0 30.7 7.1 — 0.2 0.6 14.3 1897 0.2 51.2 29.6 7.0 — o.1 0.6 13.0 1898 o.1 37.6 26.3 6.7 — o.1 0.5 11.5 1899 1900 o.1 0.2 39 .9 30.1 30.1 26.1 9.8 9.3 — 0.2 0.2 0.7 0.6 12.3 10.3 Average of 10 years 1891.1900 1.4 48.4 26.5 7.9 0.03 0.03 0.6 14.0 1901 3.7 40.4 26.7 7.0 0.04 o.1o 0.5 10.1 In the City of Westminster. 1891 0.1 19.1 8.8 5.0 0.1 0.4 0.5 7.3 1892 0.7 43.9 17.8 5.0 . - 0.4 0.4 9.6 1893 8.4 69.7 18.1 7.5 — 0.3 0.6 11.7 1894 1.1 27.4 13.7 8.5 — 0.5 0.1 6.9 1895 1.0 36.9 15.6 5.9 — 0.2 0.2 7.1 1896 0.4 43.1 16.4 6.2 — 0.3 0.4 9.1 1897 0.7 34.3 17.5 5.4 — 0.3 0.3 9.1 1898 o.1 21.5 17.7 5.9 — o.1 0.3 6.9 1899 — 28.1 14.9 7.5 — 0.1 0.2 9.3 1900 o.1 24.0 15.2 6.2 — o.1 0.3 6.8 Average of 10 years 1891.1900 1.3 34.9 15.6 6.3 o.o1 0.3 0.3 8.4 1901 5.5 25.7 13.6 5.6 — o.1o 0.32 6.3 48 49 Smallpox.—This complaint did not put in an appearance in the City until the end of July. It had been prevalent in Glasgow in the early part of the year, but no cases seemed to have reached London. It was from Paris that London was infected. There had been an epidemic during the previous year, and it had continued into 1901. The first cases in London were persons who had been in Paris. (Smallpox was introduced into the United States from Honduras in the spring of 1897, and has been prevalent in North America since that date.) During August, September, and October only a few cases occurred in Westminster, but towards the end of the last-named month a woman of the lowest class suffering from the disease, in the neighbouring Borough of Holborn, was going about the neighbourhood of Clare Market, Drury Lane, visiting numerous public-houses both in Westminster and Holborn for four days. As a direct result a very large number of persons were infected, and in every publichouse into which she had been one or more of the inmates took smallpox. In a number of the remaining cases the source of infection was traceable to the same cause, more or less directly. There were 102 notifications, but 18 of these eventually proved not to be smallpox. There was in addition one fatal case, which was not notified until after death. The corrected total was therefore 85, and 17 of the persons affected died, equal to a mortality ot 20 per cent.; 13persons had never been vaccinated, and of these seven died; it is very doubtful if six of the 72 remaining cases had been vaccinated at any time, as there was no visible evidence, and four died. Sixty-seven persons who had been vaccinated in infancy, more or less successfully, developed the disease, and six died. The bulk of the cases were between the ages of 20 and 65, five only being below the age of 20, the youngest vaccinated person affected being 16 years of age, showing that the protective effect of infantile vaccination had worn off to a certain extent. The six deaths occurred at ages 28, 36, 42, and 47 respectively. If these 67 persons had not been vaccinated in infancy, 36 of them should have died instead of six, and it must be remembered that the bulk of these persons were tramps, or persons in casual employment, already in a debilitated state of health. Some of the cases were of the malignant hasmorrhagic form, asserted by some to be due to the presence of a putrefactive or septic organism in conjunction with the smallpox. In such cases the appearances are quite unlike ordinary smallpox, and death generally takes place, before the eruption appears, from hasmorrhage. (8545) D 50 Two cases occurred, neither of which was recognised at the time. One was removed as scarlet fever, and the other was suspected to be plague or typhus fever. The true nature of the former was recognised on admission to hospital, in the latter only after death. In view of the possibility of plague, an examination of the body was made, and Dr.Klein, the bacteriologist of the Local Government Board, found that the blood contained two organisms: (1) the capsulated diplococcus pneumonias in large numbers, and (2) in smaller numbers a pathogenic microbe of an undescribed kind, which he proposes calling bacterium myxoides, which in some respects (morphological and, in less degree, experimental) resembles bacillus pestis (the organism of plague), but in cultural respects it is altogether different from bacillus pestis. Such cases are invariably fatal, and are extremely infectious from the beginning. In the latter of these two cases all the inmates of the house who had not already been re-vaccinated were promptly done, and no further case occurred, but in the former case several would not avail themselves of it, and the wife and several others who had been in attendance on the patient took smallpox, the wife dying. In several instances vaccination or re-vaccination was performed after the person had already contracted the infection of smallpox, with the result that the attack was extremely mild, or aborted altogether. I have been frequently asked to what extent re-vaccination will protect a person. The best answer I can give is that only one person who had been re-vaccinated (12 years previously) had been notified as suffering from smallpox, and in this case the Metropolitan Asylums Board sent him home as not so suffering. The patient was one of the Council's disinfecting staff, who had been exposed to infection, and I believe it was smallpox which he had, but that it aborted at an early stage; the preliminary symptoms and temperature were typical, but when the time came for the eruption only a couple of spots appeared, and rapidly faded away without becoming pustular. Very great assistance in visiting suspected cases, and in keeping •' contacts " under observation night and day, was given by your Chief Inspector and the District Inspectors, and by Dr. P. J. Wilkinson, one of the Deputy Public Vaccinators of the Strand Union. Vaccination.—The Vaccination Officers for the three Unions have kindly supplied me with information showing the amount of vaccination done during 1901:— 51 The total primary vaccinations under 14 years, done during 1901, amounted to 4,683 (2,467 in St. George's, 1,491 in Westminster, and 725 in Strand Union). This is a surplus of 1,734 over the number born in 1901, and represents a proportion of those who escaped vaccination in these or other Unions in past years. escaped vaccination in these or other Unions in past years. Of children born in the City in 1901, the following statement shows the number vaccinated up to the end of the year (by the time when the return has to be made to the Local Government Board this number will have been increased):— — Births. Successfully Vaccinated. Insusceptible. Died Unvaccinated. Vaccination Postponed. Not found, removed to address unknown. Removed, and Vaccination Officer informed. Conscientious Objectors. Remaining. St. George's Union 2,243 1,789 11 200 144 76 10 12 Westminster Union ... 672 509 1 46 10 78 18 5 5 Strand Union 322 229 1 29 15 40 4 2 2 The City 3,237 2,527 13 275 259 194 32 19 7 Deducting those who died, 86'8 per cent, were vaccinated (88, 80, and 78 per cent, respectively). Re-Vaccinations.—Information cannot be obtained of the entire number of persons who were re-vaccinated during 1901, but those done by the Public Vaccinators in their official capacity amounted to 2,201 in the Strand Union, 3,317 in Westminster Union, 4,039 in St. George's Union (697 in Belgrave District, 1,998 in Mayfair, and 1,344 in Westminster District of the Union), a total of 9,557 for the City. In a number of instances these persons were not residents in the City, but were employed therein, but as payment is made from a common fund, it is immaterial in which part of London a person is vaccinated. The Council during the year passed resolutions expressing the opinion that the control of vaccination should be with the Sanitary Authority, and not with the Poor Law Guardians. Scarlet Fever.—There were only 25-7 cases per 10,000 of population in Westminster as compared with 40-4 in all London. This does not necessarily imply that Westminster has been more free from this complaint than it ought to be, because on reference to the Local Government Board's Table C it will be seen that of the 475 cases, the bulk of them occurred in young persons under 20 years of age (chiefly betwjsen four and 12 years of age), at which ages (8545) D 2 52 the population of Westminster is much below that for London, consequently the proportionate number of cases should also be less. As has been reported in previous years young soldiers in barracks have contributed a considerable number of cases. The type of disease has continued to be extremely mild, only nine deaths have occurred, giving a case-mortality of 1*8 per cent., whereas the London rate was 3*1 per 100 cases; 421 or 88*8 per cent, of the cases were removed to hospital. During periods when scarlet fever is of this mild variety, there are many cases not recognised as such, there being often no rash, and only a little sore throat and feverishness. Such cases are, of course, a means of spreading the disease^ and counteract the good done by removal to hospital. The course of the disease during the year is shown week by week on the accompanying chart (p. 48). The curves are similar to those of previous years, except that after the usual fall in numbers during the school holiday period, the succeeding rise was small and did not continue. Proceedings were taken against a man for knowingly allowing his children to be exposed in the streets while suffering from scarlet fever, whereby several other children were affected, and a penalty was inflicted. Diphtheria.—253 cases of diphtheria and membranous croup were notified in 1901, equal to 13*6 per 10,000 inhabitants, as compared with 26*7 for all London, which was slightly below the average. Diphtheria, like scarlet fever, affects principally the younger members of the population, but it is not confined to them to such an extent as scarlet fever is. Generally about 60 per cent, of the cases occur between the ages of three and 13, the period of school attendance; and that was the proportion in Westminster during 1901. There were 21 deaths, equal to a mortality of 8*3 per 100 cases, as compared with 10*9 for London. Since the introduction of antitoxin in the treatment of this disease the case-mortality has fallen year by year from 23 per cent, to L0*9 per cent., which is the lowest yet reached. By the aid of bacteriology, cases may now be diagnosed at an earlier period than was formerly the case, and thus appropriate treatment may be employed sooner. Arrangements were in existence in certain of the districts on the formation of the City, to enable medical men to have an examination made of swabbings from persons' throats, concerning which they were in doubt. The Council during the year resolved to extend this benefit to the whole City, and accordingly arrangements were (To face p. 52.) Local Government Board Table C.— Cases of Infectious Diseases Notified during the 52 weeks from 29tin, December, 1901, to 28th December, 1902. Notifiable Diseases. Cases Notified in the City of Westminster. Total Cases Notified in each Ward. Number of Cases Removed to Hospital from each Ward. At Ages—Years. Conduit. Grosvenor. Knightsbridge St. George. Victoria. St. Margaret. St. John. Hamlet of Knightsbridge. Pall Mall. Regent. Great Marlborough. Charing Cross. Covent Garden. Strand. St. Anne. Conduit. Grosvenor. Knightsbridge St. George. Victoria. St. Margaret. St. John. Hamlet of Knightsbridge. Pall Mall. Regent. Great Marlborough. Charing Cross. Covent Garden. Strand. St. Anne. Total. At all Ages. 0 to 1 1 to 5 5 to 15 15 to 25 25 to 65 65 and upwards. Smallpox— Cases 102 1 7 6 28 60 — 2 2 i 5 — 6 — 1 9 4 2 20 43 7 2 2 i 5 - 6 - 1 9 4 1 20 43 6 100 Deaths 17 1 2 - 3 11 - - 1 1 - — 1 — - 2 — 1 4 7 — — — — — — — — — — — - - - - - Diphtheria— Cases 253 2 73 85 47 46 — 4 22 15 51 25 48 3 4 14 22 2 17 12 14 2 12 13 43 22 45 2 4 14 20 1 14 12 13 217 Deaths 21 — 16 2 1 2 — — 1 — 6 2 5 — — — 2 — 2 1 20 — - — - - - - - - - - - - - - Erysipelas— Cases 117 7 2 7 13 75 13 1 2 9 24 9 27 5 — 8 11 2 7 8 4 1 - 3 12 3 12 1 - 1 2 - 3 4 - 42 Deaths 9 4 1 - - 3 I - - 2 1 1 2 - — 1 — — — 1 1 — — — — — — — — - - — - - —- - FEVERS. Scarlet— Cases 475 8 110 230 93 34 — 8 12 17 109 41 78 39 4 30 18 8 38 16 57 7 11 12 100 36 71 35 3 26 17 7 31 14 51 421 Deaths 9 2 4 1 2 - - - - - 2 - 1 1 — — 1 — 2 2 — — — — — — — - - - - - - - - - Enteric— Cases 104 1 7 24 31 41 — 4 2 11 22 5 18 — 5 6 3 4 5 9 10 2 - 9 13 3 15 - 3 5 2 2 3 9 9 75 Deaths 20 - 1 4 5 9 - - - 2 7 1 2 - 1 2 2 1 — 2 — — — — — — — — - - - - - - - - Continued— Cases 2 — — 1 — 1 - - - - - — 2 - - - - - - - - - - - - - - - - - - - - - - - Deaths - - - - - - - - - - - - - - — — - - - - - - - - - - - - - - - - - - - - Puerperal— Cases 6 — — — 1 5 — — — 1 4 — 1 — — - - - - - - - - - 2 - 1 - - - - - - - - 3 Deaths 4 - - - 1 3 - — — 1 3 - - - - - - - - - - - - - - - - - - - - - - - - - Totals 1,059 19 199 353 213 262 13 19 40 54 215 80 180 47 14 67 58 18 87 88 92 14 25 38 175 64 150 38 11 55 45 11 71 82 79 858 18 canes notified as smallpox, 6 as scarlet fever, 5 as diphtheria, and 4 as enteric fever were eventually found not to be so suffering. In addition to the above, 1 fatal case of smallpox, 1 of diphtheria, and 1 of erysipelas were not notified. (8545) 53 made with the Jenner Institute to report 011 the samples sent to them as to the presence of the diphtheria organism. Fifty-two examinations were made in respect of samples sent from 44 patients, the difference representing second examinations to ascertain if the organism had disappeared from the throat :— In 16 instances the bacillus was found. In 34 instances the bacillus was not found. In 2 instances the pseudo-diphtheria bacillus was found.* Diphtheria is at present one of the most important diseases with which we have to deal. It affects a considerable number of persons, and has a considerable, though happily a declining, mortality. It is frequently difficult to detect, partly because other organisms may produce membrane in the throat, but more often because it is present in the throat without producing membrane, only causing slight sore throat from time to time. Then, again, in some cases it is extremely difficult to get rid of it, and a person who has recovered from an attack may still have the organism persisting in the noso and throat for weeks and even months, and be able to communicate it to others. It is due to this persistence that the prevalence of the disease is maintained. A child apparently well goes back to school, and soon other cases crop up. It ought to be clearly understood that diphtheria is a disease which is almost, if not entirely, spread by personal infection, and it would be well if we could insist that no child who had been suffering from diphtheria should be allowed to return to school without a certificate that the throat was free from the organism of the disease. Fortunately in a large proportion of the cases prompt treatment lias been able to get rid of the organism within a very few days, and it is to this fact I attribute the report sometimes sent by the Metropolitan Asylums Board Officers that the patient on admission to hospital has been found not to be suffering from diphtheria, although previous to notification a bacteriologic examination showed the bacillus to be present. During times ot epidemic prevalence, or when a case has occurred in a school, it would be well if all the children's throats were examined, as it has * The pseudo-diphtheria bacillus is an organism occurring in the throat in some cases of mild angina. It resembles the true diphtheria bacillus in some points, but differs from it in others, notably in being non-virulent to animals, e.g., the guinea-pig. Various views are held as to the relation of this organism to the true diphtheria bacillus; at the Jenner Institute it is provisionally regarded as a non-virulent form of the diphtheria bacillus. Cases in which the pseudo-diphtheria bacillus occur are usually mild, do not require anti-toxin, end in recovery, and are not followed by sequelae. It is desirable to isolate cases from susceptible individuals, though it would be preferable not to admit into a diphtheria ward. 54 been found that many get infected and have the organism in their throats without symptoms sufficiently serious to attract attention being set up, and yet they may convey infection to others. Two conditions operate in determining if the case is to be a mild or serious one—viz., the virulence of the organism, and the state of health of the patient. The bacillus often appears to gain in virulence as it passes from one throat to another, but there is no doubt that this quality is increased by insanitary conditions; air rendered impure in any way stimulates the bacillus, at the same time depresses the resistive power of the individual. Scarlet fever, measles, &c., and ordinary colds affecting the throat render it more susceptible, or prepare a soil on which the diphtheria bacillus can grow and produce the poison which, being absorbed, produces degeneration of the nerves, and often paralysis of the heart. Prompt use of a7iti-toxin in the early stages neutralises this poison. In many towns the municipality supplies anti-toxin free for use among those unable to pay for it, and to use as a protective injection for others Avho have been exposed to infection, as it appears to possess the power of protecting the person for three or four weeks at the least. In Westminster 75-8 per cent, of the cases were treated in hospital. The weekly notifications are shown on the accompanying chart (p. 48). Enteric or Typhoid Fever.—104 cases were notified during the 52 weeks of 1901 as enteric fever, and two as continued fever (both probably mild forms of enteric), but four of the patients were found to be suffering from some other complaint (miliary tuberculosis, leukoemia, appendicitis). The total notifications were only 5'62 per 10,000 inhabitants in Westminster, as compared with 7*03 for all London. But as a result of enquiries, it was found that 24 of the 102 actual cases came into the City suffering from the complaint which they had contracted, some in South Africa, some in France, and a number at other places in this country. Probably some of the other cases contracted the disease similarly, but no history could be obtained to that effect. Of the 78 actual cases among citizens, seven were due to direct infection from a previous case—three of these were in private families, two hospital nurses, and two soldiers in barracks; five persons were infected through eating shell-fish. The origin of infection in the remaining 66 was not discovered.* These 78 cases * See Appendix II for Report on Water Supply and Typhoid Fever. 55 were distribtued among the Wards as follows (the number of deaths being in brackets):— Conduit, 2 ; Grosvenor, 1 ; Knightsbridge St. George, 4 (2); Victoria, 19 (7). Total of the St. George's Group, 2(5 (9). St. Margaret, 4 (1); St. John, 17 (2); Hamlet, 0. Total of group, 21 (3). Pall Mall, 3 (1); Regent, 5 (2); Great Marlborough, 3 (2); St. Anne, 8. Total of group, 19 (5). Charing Cross, 2 (1); Covent Garden, 2; Strand, 8 (2). Total of Strand Group, 12 (3). There was a small group of six cases in the Strand and Covent Garden Wards in the early part of 1901; as five of the cases were treated in King's College, I made enquiry whether any common cause had been noted. The Medical Registrar kindly informed me that four of the patients had some slight gastric ailment before the proper symptoms appeared, which might probably suggest infection through food; three of these suffered from extremely toxic symptoms. A baby, whose mother was removed to another hospital, developed pneumonia a day or two later, whicli was probably of typhoidal origin. Another more definite case was of a girl, aged 12 years, living in a block of buidings in which there were no sanitary defects. She was very fond of cockles, and frequently bought some at a certain shop on Saturdays, on which day they arrived from Leigh-on-Sea. On 11th May she ate some; she felt ill the next day, and was seen by a medical man on the 15th, who treated her for congestion of the bowels. From this attack she recovered, but a week afterwards again became ill, and on the 26th May the doctor certified that she had typhoid fever. The fishmonger who sold the cockles gave all the information he had with reference to the source; in order to obtain the best quality he paid a little more than the market price for the cockles. The Public Health Committee deeming the matter one of peculiar importance, gave instructions that a bacteriological examination be made of some cockles as supplied by this fish merchant (which was done), and that a special report be made on the subject, which is incorporated herewith. The Jenner Institute subsequently reported that— " The cockles were examined by culture methods; the typical bacillus, coli communis, was isolated. A bacillus was isolated, which in all its characters resembled the typhoid bacillus. It was an actively motile, non-liquefying bacillus, producing no gas, and growing on culture media like the typhoid 56 bacillus. Its colonies in the Eisner medium were typical typhoid-like. It was agglutinated by typhoid blood, whereas normal blood did not produce agglutination." The Institute made some further experiments on animals, and were satisfied that it was the genuine typhoid bacillus which was present in the interior of the cockles. Although the typhoid bacillus has been found in oysters, and in the fluid contained in their shells, this is the first time its presence has been demonstrated in cockles. Leigh-on-Sea. Cockles are spread out on the banks of the creek until required for market. One patch of cockles is shown in the foreground, another on the opposite side of the creek. They are covered at high wa'er. The sheds where the cockles are prepared for market are on this side, a few yards further back. Particulars of the case were sent to the Medical Officer of Health for Leigh-on-Sea. I had the opportunity of discussing the matter with the Medical Officer of the Local Government Board and Dr. H. Timbrell Bulstrode, who reported on the Leigh cockle trade in 1896.* From that report I have made the following extract:— * Report on the cultivation and storage of oysters and certain other molluscs, in relation to the occurrence of the disease in man, p. 94. 57 " The village of Leigh has "within recent years assumed -considerable importance as a centre of cockle gathering, boiling, and exportation. The cockles are collected by the fishermen from off the Maplin Sands, brought by boat to Leigh, and laid down for a 'tide or two' on the banks of Leigh Creek. It is said that this temporary deposition of the cockles tends to clear them of the sands acquired by them on their native beds on the Maplins. After this cleansing process the cockles are scraped with a small hand-net by means of a short rake, and washed on the bed of the Leigh Creek; they are then taken into the boiling huts, of which there are some twenty or more along the foreshore immediately west of Leigh, and boiled in coppers. The boiled cockles are then riddled in a wire-meshed sieve, by which process the soft parts pass through, while the shells which remain behind are deposited in heaps near the sheds. The cockles—i.e., the 'fish'—are, after the boiling process, washed in sundry tubs of water, packed in wicker baskets, and despatched by rail. " That the cockles laid down to ' clean ' in the bed of Leigh Creek are liable to pollution must, I think, be admitted, since they are often placed near one or other of the Leigh sewage outfalls. Furthermore, the cockles here, prior to boiling, are rinsed in the bed of the stream, which is certainly liable to sewage pollution—in fact, one of the Leigh outfalls is near the cockle boiling sheds, while just below them are other sewage outfalls. On the foreshore, which is the reverse of clean here, I observed at the time of my visit evidence of sewage. " In regard to the risk of contamination incurred by the cockles of Leigh, the question seems to be whether, assuming the boiling process to destroy all germs present, the after-treatment of washing is open to suspicion. One of those engaged in boiling cockles, however, observed to me that no water would be taken from the stream during flood tide, as the sewage of Leigh floated up at that time. The water in which the cockles are washed after boiling is taken from tubs along the foreshore, and I was informed that these tubs are filled oidy at high water. But even if this rule is always observed in practice, it seems to me that the water stored in the tubs must still be liable to pollution." On inquiry I find that Dr. Bulstrode's description still applies, although some improvements have been made. Since his visit 58 water has been laid 011 from the town main to each boiling shed, so that there is no need to use the water of the creek to wash the cockles after cooking. The process to which the cockles are submitted can scarcely be called "boiling" them. It consists rather of dipping a cage containing the cockles into a copper of boiling water, the process taking only 1 or 1^ minutes, the object being to kill the "fish "and enable it to be separated from the shell. A more prolonged boiling would harden the cockle and render it unsaleable. Probably the dipping into boiling water is sufficient to wash off auy organism or sewage which may be within the shell or on the surface of the " fish," but it cannot be relied upon to kill the organism if it be inside, as in those examined by the Jenner Institute. Klein states that the typhoid bacillus never survives exposure of five minutes to a temperature of (30° C., and it is doubtful if dipping into boiling water is sufficient to raise the interior of the mollusc even to that temperature. There is 110 doubt as to the possibility of sewage obtaining access to the cockles as they lie on the side of the creek, and this appeal's to be the time when contamination occurs, for the sands from which the cockles are gathered are free from pollution. There should be no difficulty in arranging for some better method of keeping the cockles until they are wanted than laying them on the banks of this sewage-polluted creek, and thereby render free from danger a food which is largely used by certain classes of the community. Besides the typhoid bacillus the Jenner Institute found the coli bacillus, an organism intimately associated with sewage. These sewage organisms produce the gastric and intestinal symptoms which appear soon after eating polluted food, so that in typhoid cases, where there is a history of such disturbance followed by a temporary recovery, food is suggested as the vehicle by which the poison was conveyed into the body. Of course, if the typhoid bacillus is absent the digestive trouble passes off, and there is no subsequent attack of typhoid fever; but sometimes^ typhoid-like symptoms may result from the absorption into the system of poisons (toxins) produced by these sewage organisms. Bacteriological Diagnosis.—Examination was made of 10 samples of blood from suspected cases of typhoid fever: in five the Widal reaction was well marked, and in one it was feeble; in four the reaction was not obtained. Deaths.—20 deaths occurred, equal to a case mortality of 19-6 per cent., the London rate being 15'5 per cent. 59 Plague.—72 intimations were received from Port Sanitary Authorities that persons from ships On which cases of plague had occurred or which came from infected ports, were on their way to this City, but no cases resulted. Other Communicable Diseases. Besides the diseases which are legally notified, there are others which add materially to the death-rate, or which interfere seriously with educational work. Measles and whooping-cough belong to both divisions, diarrhoea to the former, chickenpox and mumps to the latter. Diarrhceal Diseases.—97 deaths were ascribed to diarrhoea or zymotic enteritis, in addition to which 13 deaths were ascribed to simple enteritis, five to colitis, and one to dysentery. The diarrhoea rate per 1,000 inhabitants was 0-52, compared with 0'86 for London. It varied from nil in Pall Mall and Charing Cross Wards to 1*15 in iSt. John (see Table XVIII). As the bulk of the deaths in this disease are among young children, a better guide to the incidence of the disease is to be obtained with comparing the deaths under, one year with the births. Thus per 1,000 births there were deaths from diarrhoea in the following ratio :— Conduit Ward .. 212 St. Anne Ward .. 6-9 Grosvenor 6-5 Regent .. .. 28-1 Knightsbridge St. George 30-G Pall Mall Victoria .. .. 20-3 (22-7) Great Marlborough .. 28 8 Hamlet .. 14-7 Charing Cross • v St. Margaret .. 10-2 (15-3) Covent Garden .. .. 18-4 St. .1 ohn .. .. 31-0 (33-3) Strand .. 26-1 The City of Westminster .. .. 21-8 (23*3). The figures in brackets represent deaths from diarrhoea with those from simple enteritis. Epidemic diarrhoea affects persons at all ages, but it produces fatal effects in the very young, the old, and in persons in feeble health. It is conveyed into the system chiefly through food which has become infected, and milk is a suitable medium in which it can grow. The presence of this disease is indicative of want of cleanliness in or about houses, such as badly cleansed streets, courts, and yards, accumulations of refuse, failure from carelessness or want of accommodation to keep food free from contamination, &c. A specific 60 organism, which is believed to be a common cause of epidemic disease, is found in quantity in horse dung, so that in streets not cleansed properly, or not sufficiently often, it may be readily blown into food with dust from the roads. The great value of thorough cleansing of streets and the daily removal of house dust is very clearly shown in St. Anne and the Strand Wards, where the introduction of these improvements at once produced a reduction in the death-rate from diarrhoea. In St. Anne's Ward it had been about 27 per 1,000 births, and in Strand Ward about 31 for the two preceding ten yearly periods—1860-1869 and 1870-1879. In 1880-1889 the practice of flushing out courts and alleys was begun (but both street-sweeping and dust removal were carried out by contract), the rate fell to 21-8 in St. Anne and to 27'6 in the Strand; since 1891, when contract work was given up and a daily collection of dust instituted, the rate fell again to 15*8 in St. Anne and 26'8 in the Strand in the ten years 1890-1899, while in London, as a whole, there has been no such improvement. It is evident there exists room for improvement in four Wards, especially St. John, Knightsbridge St. George, Great Marlborough, and Regent. The method in which milk is transmitted to London and delivered from house to house allows much contamination to take place, and the same applies to food exposed for sale on open stalls. In the latter the cooking to which it is subjected would in most instances prevent ill effects, but the protection of cooking milk is seldom taken. The supply of sterilised milk to the poor, particularly during warm weather, has been undertaken by several municipalities with beneficial results. Dysentery,—Six deaths are recorded under this heading. One case contracted the complaint abroad, but the five others were inmates of lunatic asylums. Ulcerative colitis, to which cause these deaths Avere attributed, is believed to be identical with dysentery, and to have been prevalent in certain asylums in which the conditions have not been all they ought. Measles.—This complaint is popularly regarded as a simple and harmless one, yet during 1901 no less than 1,952 deaths occurred from it in London, nearly four times as many as from scarlet fever, 600 more than from diphtheria, and probably this does not represent the total, as deaths due to measles are not infrequently assigned to bronchitis. The deaths in London were equal to 0'43 per 1,000 persons, and was most fatal in Shoreditch, Bethnal Green, Stepney, Southwark, Bermondsey, and Battersea. in Westminster 59 children 61 died, giving a rate of 032 per 1,000, this rate was exceeded in Charing Cross (0-34), Covent Garden (0'43), Strand (0'54), and St. John ((>96) Wards; eight of the deaths were in children under one year of age, 48 between one and five years of age, and three over five years. Children are most susceptible to measles, but the younger the child is the greater the danger. If children could be protected from this disease until they were over five years of age there would be a considerable saving of life. The danger is chiefly from bronchitis and inflammation of the bowels, due to the too early exposure of the child, under the mistaken notion that so soon as the rash has disappeared the child has got over the complaint. There is much need for giving the poorer classes information and advice on the proper rearing of their children. Reckoned according to the number of children living uuder five years of age, the death-rate was 3-9 for London, 4*6 for the City, 1-9 for Westminster Union, 4-9 for St. George's Union, and 7-3 for the Strand Union. From returns made by school teachers it appears that measles was prevalent in May, June, and July in the north-eastern part of the City, 230 cases-being notified, and in addition 69 children were excluded on account of measles in their families; after that date there were notified only 17 cases and 13 exclusions. It was probably also prevalent in the south-western district, but the system of notification had not been adopted fully at that time, but 45 cases were notified in connection with two schools in April, May, and July, and 16 other children were excluded. In November and December 237 cases were notified and 161 children excluded in the south-west part of the City. One school was closed on July 3rd until the end of the month, when the holidays began; one infant school in October for 14 days, two in November for three weeks, and one mixed school for 14 days from 22nd November (the infant department of the same school having been closed a week earlier). The closure, especially just before the usual holiday period, was accompanied in most instances by a cessation of the outbreak. The total number of cases notified was 529, and 259 other children were excluded on account of measles being in the house. A great many other cases no doubt occurred. Inclusion of Measles in the term "Dangerous and Infectious Diseased —The County Council addressed the following communication to the City Council in December, 1900, and it was considered early in the year 1901:— 62 London County Council, Spring Gardens, S.W., ls£ December, 1900. Measles. Sir, I am directed to inform you that the Public Health Committee of the Council have under consideration the question whether it is advisable that the Council should include " measles " in the term "dangerous and infectious disease," for the purposes set out in the following sections of the Public Health (London) Act, 1891 :— Section 68, which prohibits, under a penalty, the exposure of infected persons and things. Section 60, Avhich gives power to sanitary authorities to require the cleansing and disinfection of infected premises, and the disinfection or destruction of infected articles, and contains other provisions as to compensation and shelter during disinfection. Section 61, under which sanitary authorities can require bedding, clothing, &c., to be delivered up to them for disinfection, and must pay compensation for any unnecessary damage. Section 62, which prohibits, under a penalty, the casting of infectious rubbish into ash-pits without previous disinfection. Section 63, which prohibits, under a penalty, persons from knowingly letting houses in which infected persons have been lodging, until such premises have been disinfected. Section 64, which provides for a penalty on persons letting houses who make false statements as to infectious disease. Section 65, which provides for a penalty on persons ceasing to occupy houses without disinfection or notice to owner, or making false answer. Section 66, which provides for the removal to hospital of infected persons without proper lodging. Section 69, which prohibits infected persons from carrying on any occupation in such a manner as to be likely to spread disease.. Section 70, which prohibits the conveyance of infected persons in public conveyances. Section 72, which prohibits, in certain cases, the retention of the body of a person who has died of any dangerous infectious disease. Section 73, as to the body of a person who has died in hospital of any dangerous infectious disease being removed only for burial. Section 74, as to the disinfection of a public conveyance if used for carrying the body of a person who has died of any infectious disease. 63 In 1898 a letter was received from the School Board for London on the subject, and in accordance with a resolution of the Committee I addressed a circular letter to the various vestries and district boards asking for their views on the question. The replies received showed a considerable divergence of opinion, and in these circumstances the Committee think it desirable to consult the Councils of the Metropolitan Boroughs with reference to the proposal. I am accordingly to ask that your Council will be so good as to state whether they are in favour of the extension to measles of the provisions contained in any or all of the sections above mentioned. You will observe that these sections do not relate to the question of " notification," which is dealt with in sections 55 and 56. I shall be glad to be favoured with a reply by the end of January, 1901. I am, Sir, Your obedient Servant, The Town Clerk, g. L. gomme, Clerk of the Council. City of Westminster. This letter was referred to the Public Health Committee for consideration, when they requested the Medical Officers of Health of the Council to consider and report upon the subject. In accordance with the above decision of the Committee, the Medical Officers of Health presented the following joint Report:— Measles. To the Health Committee. Mr. Chairman, Lords, and Gentlemen, We, the Medical Officers of Health of the City, beg to report that the following are the grounds upon which we recently reported in favour of the inclusion of " measles " in the term " dangerous and infectious disease," for the purposes set out in the letter of the Clerk of the London County Council, of the 1st December, 1900. At the same time we desire to point out that we do not report in favour of measles being added to the list of legally notifiable diseases, and that the adoption of these sections of the Act by the County Council would not make it a notifiable disease. The sections of the Public Health Act quoted in the letter give power to local authorities to require disinfection after cases of measles, and to prevent children suffering from measles attending school, or being exposed in public. We find that disinfection is now carried oat after measles in most London boroughs where possible, and it is obviously desirable that local authorities should have power to deal with any cases 64 that may be reported, or with any cases of exposure of infected persons or things. Many persons look upon measles as a trivial disease, and therefore take no precautions, whereas at the present time it causes a greater mortality than any other infectious disease. Thus, in London, in 1899, there were, according to the Report of the Registrar-General, 398 deaths from scarlet fever, 1,946 from diphtheria, 1,728 from whooping cough, 759 from enteric fever, and 2,141 from measles. Moreover, nearly all the deaths from measles are in young children, who if they could be protected from it until after the age of six years, would be much less likely to succumb to the complaint. We are of opinion that the placing of measles among " dangerous infectious diseases," with the consequent warnings which would be issued to parents during times of epidemic, would lead the public to look more seriously upon this disease, and to take steps to avoid the fatal complications which ensue from improper exposure and want of care. We would point out that Board School teachers are bound to inform Medical Officers of Health of any case of measles or other infectious disease among the children, and that many Church and private schools do so voluntarily, thereby obtaining the Government grant for such children as have to be excluded in consequence. We find that the Vestries of the Parishes of St. George, Hanover Square, and St. Martin-in-the-Fields, and the Board of Works for the Strand District, passed resolutions in 1898 approving of the course being taken which we recommend. We beg to append copies from our past Reports, in so far as they relate to measles. We have the honour to be, Mr. Chairman, Lords, and Gentlemen, Your obedient Servants, Whooping-cough.—Whooping-cough was responsible for 1,604 deaths in London (0-35 per 1,000) and 47 in the City (0-26). Its distribution was not quite identical with that of measles, and the rate was above the City average in Grosvenor (0*52), Knightsbridge W. H. Corfield, M.A., M.D., F.R.C.P. James Edmunds, M.D., M.R.C.P. J. J. Skegg, M.R.C.S., L.R.C.P.E. ) John Norton, M.D., D.P.H. I F. J. Allan, M.D., D.P.H., F R.S.E. j | Medical Officers y of Health for the City. 65 St. George (0-59), Hamlet (0-39), Regent (04! ), Great Marlborough (0-79), and Covent Garden (032) Wards. Seventeen deaths of infants under one year, 29 children between one and five, and one over five years. Compared with the population living under five years of age, the rates are London, 3-23 ; Westminster, 3*67 ; St. George's Union, 3-48; Strand Union, 3*64; and Westminster Union, 3-93. Information reached me from schools of only eight cases. Schools and Infectious Disease.—The teachers of Board Schools are required to notify me when they exclude children on account of infectious disease, but teachers in Voluntary Schools are not compelled to do so. It is to the interest of such schools that they should notify, as thereby the grant may not be lost by the absence of such children. Several schools had adopted the practice, and the Public Health Committee considered it was desirable to extend it to all the schools in the City, and that the teachers should be supplied with the books of forms on which to notify. There are five Board Schools in the City, with 3,550 children on the roll.* There are 36 Elementary (three being private) Schools. With four exceptions all the Elementary Schools acceded to the request, and the teachers of some of them have very promptly informed me of cases of infectious sickness, and were thus enabled to secure a substantial addition to the school grant at the end of the year. There are 13 Higher Grade Schools in the City which do not receive Government grants, but four of them agreed to notify if it would be of assistance in ascertaining the existence of infectious disease. Notifications were received from schools and elsewhere as follows :— Measles. Whooping-cough. Cases. Deaths. Cases. Deaths. 3 February .. .. .. ., — 2 10 March — 2 3 April .. .. .. .. 2G 2 6 10 22 — — 13 June .. .. .. .i 138 5 — 5 July 89 6 — — August 4 4 — 3 September.. 10 1 — 1 October .. .. .. .. G6 4 2 — N ovember 72 5 — — December 96 21 — 1 * A sixth Board School has since been opened at Millbank. (8545) E fi6 Thirty-nine notifications of mumps (28 being in November at one school), 49 of chicken-pox, 101 German measles, 10 of ringworm, and four of ophthalmia were received during the year. Copies of 570 certificates relating to the various notifiable diseases were sent to school teachers during 1901. Disinfection. When the City was incorporated there were four disinfecting stations and four temporary shelters. Considerable inconvenience has been experienced in carrying on the work of disinfection under such circumstances. Two of the shelters were discontinued, and a Sub-Committee of the Public Health Committee have had under consideration the erection of a central station, and with this view have visited three disinfecting stations recently erected in Hackney, Battersea, and Fulham. The following extract from a special Report made by me to this Sub-Committee explains the present position :— Disinfecting Stations.—All the work of the City in connection with the disinfection of bedding, articles of clothing, &c., could be carried out at one sufficiently equipped station. About 40,000 articles have been disinfected annually at the various stations, and during epidemic years that number has been exceeded. The bulk of these articles have been dealt with at Horseferry Road and Commercial Road stations—viz., 18,000 at the former, 8,500 at the latter. The former, however, includes a large number of articles (8,240 in the year 1900) from the Guards' hospitals and quarters. It is evident, therefore, that a site for a central disinfecting station should be selected in the southern part of the City. In view of the amalgamation of some of the districts now composing the City, the late Strand Board, at my suggestion, asked and were successful in securing the insertion of a clause in the Improvements Bill of 1899, promoted by the London County Council, which eventually became law, dealing with the depot, mortuary, and disinfecting station in Denzell Street, the site of which is required in connection with the new street. The section is as follows:— " 52. The following provisions shall have effect in respect of the mortuary, disinfecting chamber, dwelling-house, and premises situate in Denzell Street and Clare Street belonging to the Board of Works for the Strand District (hereinafter called ' the Strand Board'):— " (1) The Council shall, if required by the Strand Board, before in any manner interfering under the powers of this Act with the existing mortuary, disinfecting chamber, dwellinghouse, and premises (hereinafter called 'the existing premises') of the Strand Board, numbered 97 on the deposited plans for the parish of Saint Clement Danes, provide and convey to the Strand Board, free of charge to the Strand Board, a suitable site within their district, or within the district in which the Coroner for the Strand district exercises jurisdiction, as may be reasonably appi-oved by the Strand Board on which a new mortuary, disinfecting chamber, dwelling-house, and premises can be erected, occupied, and used for all such purposes as the same are now used and occupied (hereinafter called ' the reinstated premises '). Such site shall have a superficial area not less than the existing premises, and shall be capable of affording access from two streets if reasonably possible, or a double access from one street: " (2) The Council shall at their own expense clear the site for possession by the Strand Board, and shall pay or recoup the Strand Board all the expenses incurred by the Strand Board— " (A) In erecting and reinstating the reinstated premises so as to contain the like accommodation, and to be of like character and equally convenient to the existing premises; " (b) In removing from the existing to the reinstated premises such appliances, apparatus, and conveniences as are capable of being removed, and of providing and fitting up on the reinstated premises such new appliances, apparatus, and conveniences as are necessary to enable the Strand Board to use the reinstated premises in the same way as the existing premises : " Such expenses shall be paid by the Council in such instalments and at such times as may reasonably be required by the Strand Board, who shall be entitled to require payments in advance as may be reasonably required by the Strand Board: " (3) The Council shall not take or in any way interfere with the existing premises, or make the same or any part thereof less fit for the purposes for which they are used till the reinstated premises are in all respects completed and ready for use to the satisfaction of the Strand Board, but such (8545) E 2 68 reinstated premises shall be completed by the Strand Board and ready for use as aforesaid with all reasonable despatch after possession of the new site is given by the Council to the Strand Board, and the Council have paid to the Strand Board, or secured to the satisfaction of the Strand Board the sums which the Strand Board require to have paid before they commence the buildings: " (4) If any question shall arise under this section as to the site, or as to the sums to be paid, or as to the sufficiency of the reinstatement, the same shall in default of agreement be determined by arbitration in manner provided by the Lands Clauses Acts." By this action of the Strand Board, the City Corporation may be able to obtain such a properly equipped disinfecting station as is required. I have been in communication with the officers of the London County Council with reference to the provision of a centrallysituated site on which to erect a disinfecting station, and the matter is engaging their attention. During 1901, 1,287 rooms, in 834 houses, were disinfected by the staff of the Department, and 32,218 articles were subjected to steam disinfection in the City disinfecting stations. In addition, a number of rooms and their contents were disinfected to the satisfaction of a medical man by private firms. Fifty-eight articles were destroyed by fire (in most instances this was done at the request of the owner), in the remainder the articles were replaced, or compensation was given, at a cost of £3 7s. Forty-five books were disinfected and returned to public libraries, and a number of books, which were in smallpox houses, were destroyed at the request of the Libraries Committee. Disinfection was carried out after all cases of the notifiable diseases, except as regards erysipelas (in which disinfection was only performed where the circumstances of the case required it), and also after 2 cases of chickenpox, 2 whooping-cough, 5 cancer, 11 measles, 2 German measles, and 29 phthisis. The method of disinfecting rooms has now been made uniform throughout the City, and consists ordinarily of spraying walls and floors and furniture with a 2 per cent. solution of formic aldehyde, all textile articles having been first removed in special vans to undergo disinfection by steam. This method of disinfecting has given very satisfactory results, for besides being effective, it is 69 more economical than the old way of burning sulphur. There is a great reduction in the time occupied: a couple of rooms in a tenement house can now be treated in one hour, whereas with sulphur they would have had to be closed for eight or twelve hours, and the inmates to seek shelter with friends or in the rooms provided for that purpose. Burning sulphur or generating formic aldehyde gas is still resorted to in certain cases. Shelters.— The need for shelters has been reduced by the adoption of the method of disinfection just mentioned, and two of the shelters (those in Commercial Road and Little Chapel Street) have been closed, leaving one in Horseferry Road and one in Dufours Place. Thirteen persons were admitted to these shelters in 1901, three in March, one in April, one in July, three in November, and five in December. Mortuaries. The number of bodies removed to public mortuaries in the City during 1901 was 438. 391 were taken to Horseferry Road, where the Coroner's Court is situated, 34 (two of these being persons dead of an infectious disease) to Denzell Street, six to Dufours Place, five to St. Martin's, one to Ebury Bridge, and one to Dean Street Mortuary. There were 369 inquests held, all but one being at Horseferry Road. There were seven mortuaries in the City, the seventh one, in addition to those already mentioned, being at the back of the Vestry Hall, Mount Street, but it has been but little used. The Mortuaries Sub-Committee viewed each of them, and resolved on the closure of those at Dean Street, Ebury Bridge, and St. Martin's Church. In consequence of the increased use to which the Horseferry Road Mortuary is being put, some re-arrangement is necessary, and can be effected when the central disinfecting station is provided, as the shed now used for this purpose can be utilised as a store for trestles, shells, &c. The Cleansing of Persons Act. Since this Act came into force the Strand Guardians have been providing free baths to all whom applied, and have stoved their clothing in order to destroy vermin therein. During 1901 they addressed a letter to the Council, suggesting that this was the duty of the Council rather than of the Guardians, and asked to be paid for the cleansing of such persons as were not inmates of the casual ward. The Council agreed to do this for a period of three months, at the rate of 2s. 6(/. per person, but at the end of that period, as 70 the Guardians declined to reduce their charge, the arrangement came to an end. During these three months (July, August, and September) 473 persons were cleansed, at a cost of £59 2s. 6d. It appears that during the 12 months about 1,700 persons availed themselves of the Guardians' offer, about half of them giving addresses in the City, generally common lodging-houses. It is, therefore, a boon which is largely appreciated, and it is suggested that at the new central disinfecting station proper accommodation be provided for this purpose; meanwhile, instructions have been given to utilise the bath and disinfecting apparatus at Denzell Street, and 60 sets of verminous clothing and bedding have been treated, in addition to which 10 rooms have been fumigated. 71 PART II. Staff. From January to June, 1901, the Sanitary Inspectors continued their work in the districts to which they had been appointed before the incorporation of the City. Some re-arrangement was necessary, and eight districts were formed, and an Inspector assigned to each, to be responsible for the execution therein of all the duties of a Sanitary Inspector, except such as were allotted to two special Inspectors. To these were given the carrying out of the provisions of the Sale of Food and Drugs Act, the inspection of meat, &c., and of street markets, and the execution of the sections of the Public Health (London) Act dealing with smoke prevention. For these purposes the City was divided into two parts, and Inspectors Dee and Mc Nair were appointed. Both of these Inspectors have had special training in dealing with food-stuffs, and hold the special certificate granted by the Sanitary Institute for proficiency as Food Inspectors. The District Inspectors are :— Conduit and Grosvenor Wards Inspector Taylor. Knightsbridge St. George and Hamlet „ Whipp. Victoria Ward (south part) - „ Aris. St. Margaret's, and north part of Victoria Ward „ Kirk. St. John Ward Martinson. Charing Cross, Regent, and Pall Mall Wards „ Folland. St. Anne and Great Marlborough Wards „ Calverley. Strand and Covent Garden Wards „ Sanderson. There is also a temporary Assistant Inspector (Chamberlain) for the inspection of houses let in lodgings, and generally to assist. The districts are shown on the map of the City appended to this Report. To supervise the work of the sanitary inspectors, disinfectors, &c., under the Medical Officer of Health, the Council, on April 25th, from 72 among those already in their service, appointed Mr. T. F. Strutt to be Chief Sanitary Inspector, and I am glad to have the opportunity of saying that the work has proceeded very smoothly and satisfactorily under him. I desire also to express my appreciation of the manner in which the whole staff of the Health Department have freely given their services during the outbreak of smallpox. Many of them have been on duty to midnight or longer for several weeks, and gave up Saturdays and Sundays, in order that patients might be promptly removed and precautions taken to prevent infection spreading to others. The division of the City as described was a tentative one, and so far worked fairly well, but the present outdoor staff has not been able to cope with several branches of work. Partly, this has been due to the smallpox outbreak, but the extra duties imposed by the Factory and Workshop Act will render it inadequate to carry out the duties in the efficient manner which is the aim of the Department. It will be the duty of the Council to consider how best this may be met during the present year. Most Metropolitan Boroughs are appointing women to act as Health Visitors, to look after places where women are employed, to visit among the poorer classes, and give advice with reference to domestic hygiene, to call at houses let out in tenements, &c. The work of such Health Visitors is reported to be of much value wherever they have been appointed, and they do not interfere with, but rather relieve, the Sanitary Inspector of a good deal of work with which a man is not so well qualified to deal. The question of appointing an Assistant Medical Officer was discussed by the Council at the time when the staff was being arranged. I am able to say now that there is ample work for such an officer, who might be obtained without much extra cost, as he would be able to undertake the examination of candidates selected for positions under the Council, of employes who were ill or incapacitated, as well as the bacteriological and other work, for which the Council now employs outside help. The clerical staff has been reinforced by the temporary appointment of a boy clerk and of an officer to collect statistics relating to the question of the housing of the labouring classes. There were five mortuary keepers, but these have been reduced to three, and two of these assist in other work, disinfecting, &c. The disinfecting staff consists of eight men (two being drivers, and one engineer), assisted by those mentioned above, and temporary men when required. 73 Inspection of Houses. The Chief Sanitary Inspector has prepared a summary of the sanitary work completed during the year 1901, which will be found appended hereto. 5,085 dwelling-houses in the City have been inspected during the year, and in 2,101 instances preliminary notices have been sent calling attention to defects requiring attention. In addition thereto, numerous improvements have been effected on the Inspector calling attention to the matter. It says a good deal for the reasonableness of the requests of the Inspectors, that in only 10 per cent. of the complaints was it necessary to apply for statutory notices, and that legal proceedings had to be taken to enforce these orders in only eight instances, and in each case successfully. Closing orders were obtained in respect of three houses (all of them being in the area required for the new Holborn to Strand street). Proceedings were taken against builders and others for neglect to give notice, or for improperly erecting or altering waterclosets, drains, &c.; in eight instances, a penalty was inflicted in each case; a number of others were cautioned by the Public Health Committee. Underground Dwellings. It was found that, whereas in all the other parts of the City, the use of underground dwellings had not been permitted, in St. James's Parish a number existed. In view of the difficulty experienced by the poorer classes in obtaining other more suitable living accommodation in the district, the Council resolved (p. 393 Minutes) not to turn out the occupants of these dwellings all at once, but ordered a list to be prepared, and an examination made, with a view to prevent the use of such dwellings as, in my opinion, should be closed at once, and, with regard to the remainder, notices were to be served on the owner that, in the event of them being vacant, they were, on no account, to be re-let separately for living purposes. As a result, 25 underground rooms were vacated during the year, leaving 21 to be dealt with as circumstances arise. Houses Let in Lodgings. Forty houses were placed upon the register during 1901, making a total of 1,678 so registered. Some of these require visiting only once a year, while others need to be visited every week, or oftener, on account of the dirty habits of the tenants. These visits are productive of much good, and an improved standard of cleanliness is being attained. Proceedings were taken under these bye-laws in 74 nine instances for failure to cleanse rooms and passages, in one for overcrowding, in six for failure to maintain drainage in good order. The bye-laws for one part of the City differ from those governing the remainder; it is therefore necessary to adopt fresh bye-laws, which has been done, but the Local Government Board has not yet given consent thereto. Customs and Inland Revenue Act. Where an owner is able to obtain the certificate of the Medical Officer of Health under this Act, he may obtain exemption from or abatement of the Inhabited House Duty; the intention being to assist owners who construct houses for the labouring classes, so as to afford suitable accommodation with one provision for their sanitary requirements, and in every respect fit for habitation. 385 tenements were examined by me, and the certificate asked for was granted for 295, and refused for 90. Housing of the Working Classes Acts. A doption of Part III.—(1) Part III of the Housing Act, 1890, was adopted by the Council, and in pursuance of the power contained therein, steps have been taken to ascertain the number of persons who, from the nature of their occupation, require to live in the City, with the view ot erecting suitable dwellings for them. Reference has already been made to this enquiry in an earlier part of this Report (see p. 21). Clare Market Scheme.—(2) The clearing of this area proceeds slowly, and is dependent on the progress which is made with the Holborn to Strand street. The number of persons displaced is shown in the census statistics of the parishes and wards most affected. Turner s Court.—(3) This is a narrow court containing 11 houses, which extends between St. Martin's Lane and Bedfordbury, and for several years its condition occupied the serious attention of the St. Martin's Vestry. In 1900 Dr. Skegg, then Medical Officer of Health for that parish, Avas requested to report to the Vestry on the sanitary condition of the Court, in order that action might be taken under the Housing Acts, which he did, showing that there were about 155 persons living in the Court, that the average death-rate for five years was 47.8 per 1,000 as compared with 15.3 for the whole parish, and 13.4 for the block of Peabody Buildings close by in Bedfordbury. A copy of this report was sent to the London County Council, with a proposition that they should deal with the Court 75 under Part I of the Act, as the Vestry felt that there were difficulties in the way of taking action under Part II of the Act. The London County Council replied that they were of opinion that the area being so confined, it should be dealt with by the Vestry. However, the dissolution of the Vestry being so near at hand, the further consideration of the matter dropped. I brought the matter before the Housing Committee before the autumn recess, and it was allowed to stand over until the end of that period, as the owner promised to bring forward a scheme dealing with a larger area. This he did, but up to the end of the year he had not been able to formulate a scheme which met with the approval of the Council and its Improvements Committee. Orders were, therefore, issued under the Housing Act, Part II, Section 32 (b), with express object of securing the closure of the houses, but proceedings to effect this were not completed at the end of the year.* Turner's Court is approached on each side by narrow covered passages. The buildings in the Court are in height quite out of proportion to the space in their front and rear. Some of them are four storeys high, while the back yards are only 4 feet 3 inches wide, and the space in front of those in the longer arm of the court (the court has two right angled turns in it) has an average width of 3 feet 8 inches. Nos. 1 to 4, which are in this narrow part, have a wall 14 feet high in front, and above the wall the distance to the opposite buildings is only about 15 feet. At the back, the obstruction to light and air varies, being most marked in the case of No. 4, where the building in the rear renders the whole house dark. The other seven houses are slightly better as regards some of the rooms, but the houses are older and structurally worse than the others. Besides the obstruction to light and air, which were the points on which reliance was placed in making the orders, the houses generally were in bad condition as regards drainage, cleanliness, and repair. There was also overcroAvding to an extent of 20 or 30 persons. Calculated on an average population of 155 persons, the death-rate averages 61.8 for the period of 12 years, 1890 to the end of 1901. If calculated on the existing population (168) it would equal 57, but if allowance be made for seven empty rooms it would be reduced to 47 per 1,000—a rate still much in excess of that for London, and which, moreover, means considerable overcrowding. Diseases of the respiratory organs were the most fatal, being at the rate of 20 per 1,000 compared with 3.5 for Westminster. The tubercular death-rate averaged 9.7, that for Westminster being 2.5 per 1,000. * Closing orders were eventually obtained. 76 Table XXI.— Death-rates -in London, St. Martin's Parish, Peabody Buildings, Bedfordbury, and Turner's Court, from, 1890-1901. Year. Loudon. St. Martin's Parish. Peabody Buildings. Turner's Court. 1890 21.4 24.3 11.0 64.6 1891 21.5 23.2 8.0 90.4 1892 20.3 22.9 8.0 83.9 1893 21.0 21.3 11.4 45.2 1894 17.4 19.4 21.0 90.4 1895 19.5 18.4 12.3 38.8 1896 18.2 16.2 12.3 51.7 1897 17.7 16.3 17.6 83.9 1898 18.3 15.5 8.8 19.4 1899 19.3 15.6 15.8 32.3 1900 18.3 17.7 23.7 51.7 1901 17.1 15.0 12.3 90.4 Average for 12 years. 19.1 18.9 11.8 61.8 Tenement Houses.— Many houses at one time occupied by one family are let out in tenements, without any attempt being made to provide for the altered requirements of the tenants. It is most desirable that owners should be prohibited from so letting their houses, until the local authority has been satisfied that adequate provision has been made from a sanitary point of view. Healthiness of Block Dwellings. In order to ascertain the relative healthiness of dwellings erected in blocks, I have extracted from the Registrar's Weekly Returns deaths of persons residing therein, and have compared the figures with the officials of nearly all the companies owning such buildings in the City, to whom I am indebted for the trouble they have taken. It has not been possible to ascertain the rates for all of them, as some owners do not know the population of their houses, or have not communicated it to me, and at present it is not possible to obtain the information from the Census Office. The Peabody Fund has the most complete information as to population, as a census is taken by its officers quarterly. The Trust provides accommodation for 6,902 persons in the City. Divided into five groups of ages, it is evident that the Peabody population has a much larger percentage at the younger periods than either London or Westminster. 77 Peabody Buildings. - 0—5, 5—20. 20—40. 40-60. Over 60. Population at five age-periods 946 2,310 2,013 1,280 353 Percentage— Peabody Buildings 13.7 33.5 29.2 18.5 5.1 London 10.9 28.6 35.0 18.1 6.6 Westminster 7.0 22.2 43.2 23.0 4.6 Deaths in Peabody Buildings. 40 6 112 24 19 All ages total 101 Birth and Death Bates at Age Groups per 1,000 Population. - Birth Bate. Death Rate. All Ages. Under 1 year. 0—5. 5—20. 20—40. 40—60. Over 60. Peabody Buildings 28.6 116 42.1 2.6 5.9 18.7 53.8 14.6 London 29.0 148 58.7 3.2 5.5 18.4 66.0 17.1 Westminster 18.5 126 52.5 2.3 5.5 20.0 67.9 15.6 Twenty-five deaths were registered from diseases of the respiratory organs (3.6 per 1,000), four from measles (0.5 per 1,000), 13 from tubercular disease (1.8 per 1,000), three from whooping-cough (0.4 per 1,000), four from diarrhoea (0.5 per 1,000). These rates may be compared with those on Table XVIII. The Improved Industrial Dwellings Company, Limited, provide accommodation for 6,878 persons. The births were 112, the deaths 68, yielding a birth-rate of 16.28 and a death-rate of 9.88. Respiratory diseases caused 18 deaths (2.6 per 1,000), measles one (0.14), tubercular disease five (0.72), whooping-cough one (0.14), diarrhœa one (0.14), erysipelas three (0.43), diphtheria one (0.14). Deaths of children under one year numbered 17, equal to 151 per 1,000 births. The Metropolitan Association for Improving the Dwellings of the Poor house 732 persons. The births were 24, the deaths 13, equal to a birth-rate of 32.7, and a death-rate of 1.77. Measles, enteric fever, and tubercular disease caused one death each (1.3 per 1,000 each). No respiratory deaths. The infantile death-rate was equal to 166 per 1,000 births. Soho, Clerkenwell, and General Industrial Dwellings Company have a population of 1,149. There were 35 births and 15 deaths (30.46 78 and 13.05 respectively). Respiratory deaths were four (3.48), tubercular three (2.6), measles one (0.87), and infantile deaths two (57 per 1,000 births). London County Council Buildings, Millbank.— Four of this group of dwellings were open during the whole of the year 1901, with a population of 836 ; there were seven deaths (8.3 per 1,000) in all, one each from respiratory and tubercular disease (1.2 per 1,000), and two from diarrhoea (2.38 per 1,000). The number of births during the year is not available. Common Lodging-Houses. There are 16 common lodging-houses in the City, accommodating 1,825 men : three for women, with accommodation for 133 ; and one for women and married couples, accommodating 86 persons. Nine of these are in St. John's Ward, and six in the Strand, and their influence adds to the highness of the death-rates of these Wards; the others are distributed among Covent Garden, 2 ; St. Anne, 1; St. Margaret, 1; and Regent. 1. There were 37 deaths of men and four of women of consumption; assuming that the lodgers were regular users of these houses, the rate would be three times that for males, and twice that for females. A considerable portion of the lodgers in some houses have lived in them continually for many years. There is room for much impiovement in most of the houses devoted to this purpose. The improvement in progress in the Strand Ward will remove all the six lodging-houses (accommodating 362 men and 115 women) now situated in it, but the London County Council have plans ready for a new one, to be erected at the corner of Kemble Street and Drury Lane, for 673 men. Workshops. During 1901, Parliament was engaged in amending and codifying the numerous Acts dealing with factories and workshops. The Public Health Committee made certain suggestions (Council Minutes, pp. 538 and 539), and eventually clauses embodying these requirements were added to the Bill. These were that a higher amount of cubic space per head should be required in the case of a room which is used both as a workroom and as a living or sleeping room, where the workers are not members of the same family (Section 3 (3) of the Act), and that London sanitary authorities should have the same right of entry as is possessed by factory inspectors (Sections 125 and 119). The Act was passed on the 17th August, and came into force on 1st January, 1902, with the exception of Section 101 (1), relating to 79 underground bakehouses not in use at the passing of the Act, whereby if such bakehouse is not then in use it shall not be again used as a bakehouse, and no new underground bakehouse may be opened after that date. At the end of 1901 a copy of the register of workshops kept by the Home Office was made, and it was found that with those already on our list there were 2,065 workshops in Westminster registered, but many more have been added. Anticipating the requirements of the Factory and Workshop Act, 1901, a register showing particulars of the various workshops has been prepared. A copy of the headings is given on p. 80. The workshops registered are— Tailors 643 Bootmakers 32 Dressmakers 522 Printers and bookbinders 60 Milliners 251 Carriage builders 15 Corset-makers 6 Laundries 112 Featlier curlers 2 Jewellers 26 Metalworkers 66 Hat and cap makers 24 Silversmiths 24 Stick and umbrella makers 14 Engineers 7 Leather dressers 15 Gold and silver embroiderers 7 Opticians 3 Shirtmakers 43 Gunmakers 5 Hosiers 18 Electro-platers 4 Cabinet-makers 13 Cutlers 2 Paper-stainers 5 Paper pattern makers 8 Wigmakers 9 Furriers 5 Surgical Instrument makers 2 Various 125 In the report of the Chief Inspector of Factories and Workshops it appears there are also the following factories :—Laundries, 3; cap and helmet making, 3; gold and silver embroidery, 5; shirt, &c., making, 2 ; paper pattern making, 3; tobacco factories, 10 ; confectionery, 429 ; fruit and pickle trades, 5 ; printing, bookbinding, and allied trades, 49. Particular attention has been given to workplaces generally, especially those engaged in making wearing apparel, and frequent conferences have taken place with the Home Office Inspectors, so that there should be a general agreement of the lines on which the Home Office and the City Council should work. The relative duties under the Factory and Workshop Act are curiously allocated, thus, while the methods of ventilation have to be supervised by the Sanitary Authority, the Home Office has to see that the temperature of workrooms is suitable. The new Act requires that the measures 80 No. Premises, Name of Occupier. Nature of Business. No. of Workrooms. Number of Hands Employed. Dimensions of Workrooms. Cubical Contents. No. of Workers Allowed. General Condition of Room. Ventilation : How Maintained. Means of Warming. Gas Fixed: How Placed and Ventilated. Dates when Visited, and Remarks. — — — ■ 81 taken to obtain a reasonable temperature must not interfere with the purity of the air of any room in which any person is employed. This proviso is intended to prevent occupiers of such places trusting to the warmth from the bodies of the workers or to gas jots for heating rooms. In many of the tailors' and dressmakers' workrooms gas stoves for heating irons are used, and the fumes of the burnt or partially burnt gas pass into the room to the detriment of the health of the workers. To obviate this, instructions have been given to the Sanitary Inspectors to secure efficient means of ventilation for such stoves. From the number of workplaces in Westminster, and especially those employing female labour, it would have taken the staff a considerable time to inspect them; it is, therefore, fortunate that the Home Office, during 1901, entered into an inquiry as to the nature and the extent of, and condition of, women's employment in West London, and one Lady Inspector has visited a large number of workshops in Westminster, 344 visits having been paid to dressmakers and milliners alone. The reports on the conditions under which work is carried on in West End dressmakers' establishments reveal a by no means satisfactory state of affairs ; such conditions of overcrowding, defective ventilation and heating, dirtiness of workshops, were amended after the visit, but it is evident that regular supervision is required. Special mention is made of gold and silver embroidery (lace and braid), and to theatrical costumiers. Both are peculiar to Westminster: in the former, questions of light and ventilation have arisen; in the latter, from the pressure put upon the costumiers at certain seasons overcroAvding, excessive hours, &c., result. This trade is one which calls for special and very constant inspection. In consequence of the special inspection, 206 instances of defects were sent by the Lady Inspectors to the City Council in 1901 (106 notices relating to laundries, dressmakers and milliners' workshops). The nature of the complaints were:— No separate sanitary accommodation for women— In factories 2 In workshops 38 Insufficient, insanitary, or unsuitable accommodation— In factories 1 In workshops 19 Overcrowding in workshops 39 Want of cleanliness in workshops 63 Want of ventilation in workshops 37 Other defects in factories and workshops 7 (8545) F 82 With reference to separate accommodation for women, the notices chiefly referred to tenement houses wherein each floor, or perhaps one or two rooms of each floor, is rented by a different occupier, each of whom employs men and women in tailoring and other industries, and where the only accommodation is placed either on the ground floor only, or between two of the upper floors. This is due very often to the fact that the houses were built as dwelling-houses and not as workplaces, to which they have now become converted in whole or part, and for which they are by no means suitable. Very often the detect was easily overcome by a little re-arrangement, but in other cases there was no means of providing the additional accommodation required, with the result that some of the persons had to vacate the premises. In respect of the Home Office complaints, I find that 186 were received from the Lady Inspectors in the last nine months of the year, and that in 147 it was found necessary to take action; 30 complaints were received in the same time from the other Home Office Inspectors, and action was taken with regard to 25 of them. I find from the summary of the Chief Sanitary Inspector that 1,115 workshops have been inspected, and sanitary defects where found remedied: thus light and ventilation have been improved in 47 cases, overcrowding abated in 57, extra water-closet accommodation provided in a number, and 279 workrooms have been cleansed; 199 workrooms were measured, and cards issued stating the amount of cubic space and number of persons allowable. Outworkers. At the end of 1901 there were 1,183 outworkers on the register. These were engaged in making various kinds of wearing apparel. It has not been possible for the staff since it was reconstructed to make any systematic inspection of the houses occupied by these outworkers, but in 1902 the new Act requires this to be done, so that the local authority may determine if they are suitable places for carrying on work. Home Work Order.—In pursuance of the powers conferred on him by the Factory and Workshop Act, 1901, the Home Secretary has made the following Order, which may be cited as the Home Work Order, 1901, and which comes into force on 1st January next:— I. Section 107 of the Act (relating to lists of outworkers) and Section 108 (relating to employment in unwholesome premises) shall apply to the following classes of work :—The making, cleaning, washing, altering, ornamenting, finishing and repairing of wearing apparel and any work incidental 83 thereto; the making, ornamenting, and finishing of lace and of lace curtains and nets; cabinet and furniture making and upholstery work ; the making of electro-plate; the making of files ; and fur-pulling. II. Section 110 (relating to the prohibition of home work in places where there is infectious disease) shall apply to the following classes of work :—The making, cleaning, washing, altering, ornamenting, finishing, and repairing of wearing apparel, and any work incidental thereto (as in the said section specified); the making, ornamenting, and finishing of lace and of lace curtains and nets; upholstery work; and fur-pulling. From the Census Report it appears that there are 4,068 males and 7,789 females engaged in occupations connected with dress, 955 males and 159 females as cabinet-makers, &c., besides about 200 males engaged in electro-plating, who live in the City ; but there are a great number who come to work from other boroughs, and many of those resident in the City, especially in the West-End establishments alluded to, are young persons who have come up from the country to learn the business. Thus if ill-health results from the conditions under which they work they return home, and the West-End District is not debited with their deaths should the complaint prove fatal. Separate list of outworkers who reside outside, but receive work from employers within the City, have been prepared and forwarded to the Medical Officer of Health for the borough in which the outworker resided or is employed. The following is a list showing the number of outworkers which have been sent to other authorities, with their addresses and name of employers :— St. Marylebone 150 Kensington 4 St. Pancras 30 Finsbury 4 Paddington 16 Hackney 3 Battersea 13 West Ham 3 Lambeth 11 Deptford 2 Wandsworth 11 Poplar 1 Islington 8 Croydon 1 Fulham 8 Leyton 1 Camberwell 8 Hendon 1 Holborn 8 Wood Green 1 Chelsea 7 Tottenham 1 Southwark 7 312 Stepney 7 Hammersmith 6 (8545) F 2 84 Bakehouses. In addition to the workshops above enumerated, there were during the year 129 bakehouses in the City. These have been inspected during the year, cleansed at the proper periods, and in a number of instances improvements have been carried out in them. At the end of the year the number on the register had been reduced to 120 by two causes:— (1) Five have been closed in consequence of street ments. (2) The Factory and Workshop Act lays down that on the date of its passing, 17th August, no underground bakehouse not then in use could afterwards be so used. At that date there were four such. The probability is that with the increase in the stringency of the requirements, underground bakehouses will gradually disappear, the tendency being to build bakehouses which will serve several shops, and to provide mechanical power in place of hand labour. Dairies, Slaughter-Houses, &c. In November, 1900, the following powers, hitherto exercised by the London County Coimcil, were transferred to the Metropolitan Borough Councils:— (1) Power under Section 28 of the Public Health (London) Act, 1891, of registering dairymen. (2) Power of enforcing the bye-laws and regulations for the time being in force with respect to dairies and milk, and with respect to slaughter-houses, knackers' yards, and offensive businesses. The power to make bye-laws is still retained by the County Council, but the right of entry, which the County Council had, has been taken awav from that body-. Your Medical Officers of Health obtained from the County Council a list of the above-mentioned businesses registered in the City of Westminster, which were thus distributed:— 85 — St. George. St. Margaret and St. John. St. James. St. Martin. Strand. Total. Slaughter-ho uses 1 2 — — — 3 Cowkeepers — 3 — — — 3 Offensive trades— Tripe boilers — 1 — — 1 2 Tallow melter — — 1 — — 1 Dairies and milkshops 80 94 52 25 59 310 There were, in addition, several milkshops noted by the County Council " for registration," and it was found that in some instances the sale of milk had been discontinued at registered shops. The County Council did not register companies owning refreshment premises, although the City of London did so. It was resolved to register them in this City also. It is an absurd arrangement that the Council must register any person as a purveyor of milk who applies to be registered, although they may consider the place in which he keeps milk an improper one for the purpose. At the end of 1901, 321 dairies and milkshops had been registered, and 425 visits had been paid to them; 15 visits had been paid to the three cowsheds during the year. Slaughter-houses have been reduced to two, and these are not used to any extent. They have been visited 10 times by the Inspectors. Offensive Trades.— These consist of two tripe-boiling establishments and one tallow melter. One of the former is not altogether a suitable place, but as it will be pulled down shortly, and is only occasionally used, it has been permitted to remain, subject, however, to certain alterations having been effected. I have visited each of the bakehouses, cowsheds, slaughter-houses, and offensive trades' premises during the year. Stables.—The number of mews is considerable in Westminster, and they require a good deal of attention to show that they are properly kept. 155 notices had to be served requiring the removal of accumulations of manure; 64 for the provision of proper dung receptacles, and no less than 49 for the removal of dung-pits, the use of which was made illegal seven years ago; 104 stables were re-drained, 97 paved, and 58 cleansed. 86 Smoke Prevention. The Council decided to take energetic measures to deal with this nuisance, and 1,370 observations have been made by the two Inspectors appointed for this purpose. Eight prosecutions resulted, and penalties were inflicted to the amount of £63 on offenders, with £9 costs. In one case an appeal was taken to the High Court, and was heard by the Lord Chief Justice, Mr. Justice Darling, and Mr. Justice Channell, sitting as a Divisional Court (November 11th, 1901):— Queen Anne Residential Mansions and Hotel Company v. Mayor, &C., of Westminster. " There were three summonses for separate alleged violations of the Act. The building consists of 300 sets of residential chambers or flats, none of which is provided with a chimney, there being a general kitchen in which all the cooking is done for the residents. There is a general dining-room in which the residents may have their meals instead of in their own rooms. In the basement there are five boilers, used for generating steam, for cooking in the kitchen, for warming the building, for generating electricity for lighting, and also for the laundry. The boilers are connected with a chimney, 168 feet high. On behalf of the appellants, it was contended that no offence had been committed under Section 24 of the Act, the chimney being the chimney of a private dwelling-house. Every reasonable precaution had been taken to prevent any black smoke being emitted, but this, the respondent said, formed no defence to their action. The Magistrate held, as a mixed question of law and fact, that the chimney was not a chimney of a private dwelling, and he ordered the appellants to pay a fine of £5 and £5 5s. costs on the first summons, and a fine of 10s. on each of the other two summonses, and the question for the Court was whether this decision was correct in law. " The Court dismissed the appeal with costs, looking at the fact that there were 300 flats with five boilers in the basement for electric lighting, cooking, warming, and other purposes for the benefit of the residents in these flats, and that, in truth, a large trade establishment was carried on, the decision of the Magistrate was right." Water Supply. Applications were received for certificates that the water supply of new buildings was sufficient, and were granted in each instance : 340 notices of the withdrawal of water supply were received from the water companies, and in 116 instances it was reinstated; in the 87 others the houses have been pulled down or are empty. In 486 instances cisterns were required to be cleansed, but it is evident that this is not done so systematically as the bye-laws require— viz., " once at least in every six months." Water Companies' Regulations. Early in 1901 the Metropolitan Water Companies brought out a series of new regulations, which they sought to have sanctioned by the Local Government Board. They were opposed by the local authorities generally, and finally were withdrawn. The proposed regulations were considered by your then existing Medical Officers and Engineers, and a report drawn up conjointly by these 10 officers was submitted to the Council, and formed the groundwork for opposing the regulations and for preparing amendments. Sale of Food and Drugs Acts. 1,230 samples have been purchased during the year and submitted to your analysts :— Articles. No. of Samples. Prosecuted. Convicted. Fines. Costs. £ s. d. £ s. d. Milk 402 36 35 63 10 0 20 16 0 Butter 218 18 12 35 0 0 8 2 0 Cheese 135 3 3 6 0 0 1 19 6 Cocoa 20 1 1 2 0 0 0 14 6 Rum 30 1 1 2 0 0 0 12 6 Precipitated sulphur 10 1 1 2 0 0 0 14 6 Margarine not labelled as such. — 1 1 2 0 0 0 12 6 Selling milk from vehicle without vendor's name or address being inscribed thereon. 1 1 0 8 0 0 2 0 Samples were also taken of the following articles, to the number appended:—Drugs, 50; honey, 35 ; raspberry jam, 35; pepper, 20 ; olive oil, 20 ; vinegar, 5 ; lard, 30 ; treacle, 20 ; golden syrup, 15 ; Demerara sugar, 30 ; beer, 40 ; sweets, 30 ; condensed milk, 10; whiskey, 10 ; coffee, 10; arrowroot, 5 ; icecream, 10 ; tinned fruit, 5. No proceedings have been instituted against the sellers of any of these samples, generally because they were found genuine, but in some instances—as in the case of Demerara sugar—because the report of the analyses had not been received at the end of the year. 88 APPENDIX I. Report of Chief Sanitary Inspector. To the Chairman and Members of the Public Health Committee. Gentlemen,— I have the honour to submit my Report on the work carried out by your Sanitary Staff during the year ended 31st December, 1901. Summary of Sanitary Work completed during the Year 1901. Complaints received and dealt with 1,028 Houses and premises inspected 5,085 „ „ „ re-inspected .. 17,165 ,, (registered) visited 487 Workshops inspected 1,115 „ visited 1,569 Milkshops visited 425 Notices issued (preliminary) 2,104 ,, (statutory) 212 Sanitary work completed:— Houses— Closed under Public Health (London) Act 3 Cleansed throughout 338 „ partially 626 Overcrowding abated 87 Light or ventilation improved 49 Roofs repaired 196 Floors and staircases repaired 144 Underground rooms vacated 25 Yards, areas, paved or repaired 348 Offensive refuse removed 242 Keeping of animals discontinued 30 Workshops— Newly registered 46 Measured 199 Workrooms — Light or ventilation improved 47 Cleansed 279 Protected persons reported to Home Office _ 10 Outworkers registered 1,183 Overcrowding abated 57 Drains :— Constructed 712 Amended and repaired 231 Disconnecting traps fixed 630 Ventilated 529 Tested 1,643 Unstopped or cleansed 183 Gully traps fixed 2,036 Inspection chambers built 1,344 „ ,, repaired or cleansed 198 Drains :— Inspection chambers, cover fixed or sealed 1,093 Soil pipes fixed or repaired 641 Yentilating pipes fixed or repaired 398 Water closets:— Constructed 867 Repaired 237 Ventilated 285 Cleansed or limewashed 464 New pans fixed 881 Pans and traps cleansed 288 Obstruction removed 76 Traps ventilated 594 Water supply provided 267 Flushing apparatus fixed 982 „ „ repaired 326 Waste pipes :— To sinks, baths, lavatory basins, &c. 36 Fixed 1,006 Repaired or unstopped 130 Disconnected from drain 359 Trapped 962 y entilated 381 Water supply:— Provided 115 Reinstated 87 Cisterns fixed 194 „ cleansed 486 „ covered 9 „ improper, abolished 88 Disconnected irom w.c. supply 146 Dust bins:— Provided 322 Repaired 77 Old, abolished 139 Stables :— Drained 104 Paved 97 Cleansed 58 Dung receptacles provided 64 ,, ,, repaired 7 „ pits abolished 49 „ accumulations removed 155 89 A reference to the above table will show the important nature of the work carried out by your Inspectors, and on comparing this with the collective reports of the old authorities, bears favourable comparison with the work done last year in the parishes which now comprise the City of Westminster. Of the 6,200 houses (including workshops) inspected during the year, sanitary defects were found to exist in no less than 2,104 ; in each case a preliminary notice was served, calling attention to these defects, but in 212 of that number it was found necessary to serve statutory notices, and in nine cases legal proceedings had to be taken to enforce the order of your Committee. The results of such proceedings are shown below :— Ward. Premises. Court and Magistrate. Offence. Result. Strand 14 and 15, White Hart Street. Bow Street Premises unfit for habitation. Closing order in each case and costs. Pall Mall 29, Whitcombe Street. Great Marlborough Street. Improperly altering a drain. Fined £3 and costs. Charing Cross Tivoli Restaurant Bow Street (Sir A. de Rutzen.) Improperly altering a soil pipe. Fined £2 and costs. Regent 6, Rupert Street .. Great Marlborough Street. Keeping animals so as to be a nuisance. Fined £2 and costs. St. Anne 230, Sandringham Buildings. Great Marlborough Street. (Mr. Fenwick.) Do. do Fined £5 and costs, and ordered to cleanse premises forthwith. Charing Cross Drury Lane House, Drury Lane. Bow Street (Sir A. de Rutzen.) Improperly altering a drain. Fined 10/- and costs. Strand 7, Windsor Court. Bow Street (Sir F. Lushington.) Premises unfit for habitation. Closing order and costs. Strand 36, Chancery Lane Bow Street (Mr. Marsham.) Defective drain Order to do the work and pay costs. Bye-laws. During the year the bye-laws regulating the construction of drains, made by the London County Council under the Metropolis Management Act, 1855, Section 202, were approved by the Local Government Board, and since the date of their approval, viz., 14th June, have been strictly enforced. The want of such bye-laws had long been felt in London ; they have already proved beneficial, and of great assistance to the Inspectors in the discharge of their duties. The Bye-laws under Sections 16 and 39 of the Public Health (London) Act have been amended and approved by the Local Government Board, and the sections relating to soil pipes, &c., are now incorporated in the Drainage Bye-laws. As regards these Bye-laws, Section 37 of the Public Health Act, Sub-section 3, enacts :— " It shall be the duty of every Sanitary Authority to observe and enforce the Bye-laws made under this section, and any directions 90 given by the Sanitary Authority under this Act shall be in accordance with the said Bye-laws, and so far as they are not so in accordance, shall be void." All Bye-laws have been enforced by your Inspectors throughout the City, under the direction of your Committee; 41 cases of infringement were reported—via., 19 in respect to water-closets, nine for removing offensive refuse during prohibited hours, and 13 under Yestry Bye-laws. Of the 41 cases reported, no action was taken in 18 instances, the required alterations being made upon notice, five were cautioned, and 14 were the subject of legal proceedings, with the result that in all cases fines were inflicted, and in four cases the summonses were withdrawn, the work having been completed after service and previous to the hearing of the summons:— Results of Prosecutions under Bye-Laws. Ward. Offence. Court and Magistrate. Result of Hearing. Strand Removing offensive refuse during prohibited hours. Bow Street Fined 40s. and costs. Strand Do. do. Do Fined £4 and costs. Conduit Do. do. Great Marlborough Street (Mr. Denman.) Fined 40s. and costs. Grosvenor Do. do. Great Marlborough Street (Mr. Fenwick.) Fined 40s. and costs. St. John Failinpr to cleanse rooms. Vestry bye laws. Westminster (Mr. Shiel.) Fined £3 and costs. Strand Failing to give notice of alteration to w.c. at 61, Carey Street. Bow Street (Mr. Marsham.) Fined 20s. and costs. Strand Failing to give notice of alteration to w.c. at 12, Burleigh Street. Do. do. Fined 40s. and costs. St. John Defective w.c.—Yestry byelaws. Westminster Fined 10s. and costs. St. Anne Filthy condition of w.c.'s at 2, 6, 12, and 14, Meard's Street. Strand bye-laws. Great Marlborough Street (Mr. Dsnman.) Fined 10s. and costs. Pall Mall Defective sink. Vestry bye-laws. Do. do. Fined £3 and co3ts. Victoria Depositing refuse in Warwick Street. Westminster Fined £2 and costs. Knightsbridge St. George Failing to give notice of alteration to w.c. at 2, Wilton Crescent. Westminster (Mr. Horace Smith.) Fined 20s. and costs. Strand Failing to give notice of alteration to w.c. at 40, Strand. Bow Street (Sir A. De Rutzen.) Adjourned 14 days. Fined 3s. and 2s. costs. Strand Fixing w.c. not in accordance with bye-laws. Do. do. Adjourned 14 days for alteration to be made. Fined 2s. and 2s. costs. Factory and Workshops Act. Some of the difficulties with which the Sanitary Inspectors have to contend may be gathered from reference to this and to the tables of sanitary work completed; for, apart from the number of premises to be kept under observation, are the ever-increasing number of points to be observed in the examination of workplaces. 91 Among the difficulties connected with these, and especially those situate underground, is the important question of ventilation. This, in its proper sense, means a supply of fresh air, as distinguished from the mere air space of the workshops; not only has means of ventilation to be provided, but it must be maintained. The requirements of former Acts were satisfied if the means of ventilation had been provided, but Section 7 of the 1901 Act goes further, and enacts that sufficient ventilation shall be maintained By the same section, the Secretary of State, by special order, may prescribe a standard of sufficient ventilation, and when this has been fixed, Inspectors will be better able to adopt a uniform mode of procedure, in requiring the necessary supply of pure air for those working in the rooms. Measures have also to be taken for securing and maintaining a reasonable temperature in each workroom, and the means to attain this must not be such as to interfere with the purity of the air in such room. Underground workrooms are steadily increasing, and rooms fit only for storage are daily being utilised as workrooms or offices; in the majority of cases the ceilings are on a level with the street paving, and the area, which ought to be open, is usually covered with thick glass. Some legislation is necessary for regulating these places, and the section of the Public Health Act relating to underground dwellings might, with advantage, be extended to workrooms. In many parts of the City the ground-floor and basement are let together as a separate tenancy, quite shut off from the upper floors, and in modern buildings, where the whole of the site is built over (this is allowed by the London Building Act), it is quite impossible to provide proper and sufficient sanitary accommodation for the workers, especially where both males and females are employed. These are difficulties which the Department has to meet day by day. The question of what shall be deemed sufficient and suitable accommodation by way of sanitary conveniences is now likely to be settled, for by Section 9 of the Factory and Workshops Act, 1901, the Secretary of State is required to determine, by order, what is sufficient and suitable accommodation within the meaning of the Act. Notices of sanitary defects in workshops have been received from His Majesty's Inspectors of Factories under Section 4, Factory and Workshops Act, 1878; Section 2, 1891 Act; and Section 3, 1895 Act:— 92 "Where it appears to the Inspector of Factories that there is any neglect or default in relation to any drain, water-closet, water supply, nuisance, or other matter in connection with workshops, remediable under the Public Health Acts, it is his duty to give notice of such nuisance to the Sanitary Authority, and it is the duty of the Sanitary Authority to inform the Inspector of the proceedings taken in consequence, and if no proceedings are taken within one month, His Majesty's Inspector may take proceedings as if he were the Sanitary Authority, and is entitled to recover the expenses he incurs in and about the proceedings from the Sanitary Authority." In each of the cases reported an inspection has been made, the defects where found were remedied, and the results reported to the Inspector of Factories. Outworkers.—A separate register of outworkers is required to be kept, and all those resident in the City whose names have been received have been entered; the number on the register at the end of the year was 1,183. I anticipate the above figures represent but a very small proportion of the actual number of outworkers receiving work from employers within the City, and that during 1902 the lists will be more complete. Section 107 of the Factory and Workshop Act, 1901 requires every occupier of every factory and workshop, and every contractor employed by any such occupier, to send on or before the 1st day of February and the 1st day of August in each year copies of lists, showing the names and addresses of all persons directly employed by him, and the places where they are employed, to the District Council of the district where such workshop is situate, and every District Council shall cause the lists received in pursuance of this section to be examined, and shall furnish the name and place of employment of every outworker included in any such list, whose place of employment is outside its district to the Council of the District in which his place of employment is. With the great increase in the number of workshops and workplaces within the City the present staff has been unable to cope, indeed it has been found totally inadequate to deal with the additional duties imposed upon the Sanitary Authority by the Factory and Workshops Act, and the transference from the London County Council of the duties connected with the orders regulating dairies, cowsheds, milkshops, slaughter-houses, and offensive trades. To carry out these duties thoroughly efficiently, and to maintain the standard of excellence which has been the aim of the department, it will be necessary to provide some temporary help to assist in the inspection and registration of workplaces, and to catch up with 93 the additional duties imposed upon the authority as mentioned above. Smoke Clauses of Public Health London Act; Sale of Food and Drugs Acts; Inpection of Food, &c. During the first half-year there was no special inspectors for this work, but, as previously stated, each officer was acting in the parish for which he was appointed by the old authority. The following are the statistics for this period:— Parish or District. St. George. St. James. St. Margaret and St. John. St. Martin-inthe-Fields. Strand. Total. Smoke observations taken 12 90 70 22 159 353 Samples purchased for analysis. 20 30 25 60 87 222 The division of the City for the above-mentioned purposes are as follows: — North District Wards, 1 to 9,1st June to 31st December, Mr. Dee. South „ 10 to 13, ,, ,, Mr. McNair. The following are the particulars of their work:— 94 Particulars of Matters With. Conduit. Grosvenor. Hamlet of Knightsbridge. Knightsbridge St. George. Victoria. St. Margaret. St. John. St. Anne. Great Marlborough. Pall Mall. Regent. Charing Cross. Covent Garden. Strand. Totals. 8 9 12a 10 11 12 13 2 7 6 5 4 3 1 Smoke—Complaints received and dealt with 1 3 1 - 2 1 8 2 1 4 1 - - 2 26 „ Observations taken 18 28 41 48 284 167 316 45 18 41 148 93 28 95 1,370 „ Nuisances reported 5 7 - 1 9 11 23 8 5 14 45 41 7 26 202 Cowsheds inspected — — 5 — — — 10 — — - — - — — 15 Slaughter-houses inspected — — — 4 1 — 5 - - - - - - - 10 Offensive trades inspected — - - — — 5 — — — — 2 - — 3 10 Food and drugs, samples taken 43 45 25 42 144 45 115 101 39 27 146 51 52 55 930 Smoke—Preliminary notices served 5 7 1 2 9 8 9 4 1 9 16 4 1 8 84 „ Statutory notices served — — — 1 3 3 7 — — — 3 2 — 3 22 95 Smoke.—The prevention of smoke has engaged the earnest attention of your Committee, and the sections of the Public Health London Act, dealing with this question, have been rigidly enforced. No less than 1,370 observations have been kept on chimneys of factories, restaurants, and other business premises, resulting in 202 nuisances being reported, of these 118 were ordered to be kept under further observation, and 84 preliminary and 22 statutory notices have been served; of the 22 statutory notices, eight resulted in prosecutions being taken, with results as follows:— Ward. Name. Premises. Police Court. Result of Hearing. Strand Slater's Limited 399, Strand Bow Street £5; 2a. costs. St. Anne Grumell, Limited 12, Nassau Street Great Marlborough Street. £2; £1 3s. costs. St. Margaret Queen Anne Mansions, Limited. Queen Anne's Gate Westminster £6; £5 5s. costs. St. Margaret Army and Navy Auxiliary Supply Stores. Francis Street Do. £10; £2 2s. costs. St. John Westminster Electric Supply Corporation. Millbank Street Do. £10; 2s. costs. St. John John Mowlem and Co. Grosvenor Wharf Do. £10; 2s. costs. Strand Francis Kissel Tivoli Restaurant, Strand Bow Street £10; 2s. costs. St. Margaret W. H. Hill 60, Buckingham Gate Westminster £10; 2s. costs. This important work was for many years entrusted to the police, but it was not until the passing of the Public Health (London) Act, 1891, and the duties transferred to the Sanitary Authorities, that the work was taken seriously in hand. The chief cause of the pollution of the atmosphere of London is smoke, and in this respect the principal offenders are the chimneys of private dwelling-houses, which are exempt under the Act, and until something is done towards better heating of our homes, improved stoves and careful stoking, the nuisance will continue. In my opinion the latter will reduce the smoke to a minimum, besides being the more economical. Sale of Food and Drugs Act, 1875-1899.—The Acts relating to the sale of food and drugs have been strictly enforced throughout the City by your Committee: 1,230 samples have been purchased and submitted to your analysts, who have submitted reports thereon. Of those found to be adulterated, 62 were ordered to be prosecuted. Since my appointment the prosecutions under this Act have been conducted by me, and I am glad to report that not one case has been lost through want of form. Your Inspectors have been most careful, and the prosecutions in every case except three successful; the three unsuccessful cases were the butters containing an excessive quantity of water. One summons was dismissed by the Magistrate, because the standard of water in butter had not been officially fixed; the other two were withdrawn (see note on p. 99). 96 List of Prosecutions. Ward and Inspector. Date of Hearing. Court and Magistrate. Name and Address of Defendant. Offence. Result of Hearing. Strand Jan. 3 Great Marlborough Street (Mr. Fenwick.) W. Glover, 21, Bateman Street. Milk adulteration Fined £5 and 12s. 6d. coscs. St. Anne Jan.3 Do. do. David Pearce, Lexington Street. Do. do. Fined £5 and 12s. 6d. costs. St. Martin's — — — Do. do. Fined £2 and 12s. 6d. costs. St. George's, Hanover Square. Jan. 10 Westminster (Mr. Shiel.) John Reynolds Do. do. Fined £5 and 12s. 6d. costs. Strand - Bow Street (Mr. Marsham.) Richard Mason, Hosier Lane, E.C. Do. do. Fined £1 and costs. Strand — — — Do. do. Fined £2 and costs. St. Martin's - — — Do. do. Fined £2 and 12s. 6d. costs. St. George's, Hanover Square. Mar. 14., Westminster (Mr. Fenwick.) Hermann Smidth Do. do. Fined £3 and 12s. 6d. costs. St. George's, Hanover Square. Mar. 15 Westminster (Mr. Hopkins.) Henry Fountain, Vauxhall Bridge Road. Do. do. Fined £2 and 12s. 6d. costs. St. George's, Hanover Square. Mar. 15 Do. do. George Wilson Do. do. Fined £1 and 12s. 6d. cost. St. Anne June 18 Great Marlborough Street (Mr. Denman.) Isaac Woolcott, 30, Little Newport Street, W. Selling margarine as butter Fined £3 and 12s. 6d. costs. St. Anne June 18 Do. do. S. Taylor, 16, Dorset Street, Portman Square, W. Selling milk in Gerrard Street, Soho, adulterated with 6 per cent. of "added water." Fined £2 and 12s. 6d. costs. Victoria June 19 Westminster (Mr. Horace Smith.) John Lillywhite, 73, Hanover Street. Selling milk from vehicle in Sussex Street, vendor's name and address not being inscribed thereon. Fined 8s. and 2s. costs. 97 Victoria June 19 Do. do. Maurice Smith, 27, Gillingham Street. Selling rum containing 28.85 per cent. of water, being 3.85 below the legal limit. Fined 40s. and 12s. 6d. costs. Strand June 21 Bow Street (Mr. De Rutzen.) Howard Kowin, 35, Wych Street. Selling margarine as butter Fined £5 and 12s. 6d. costs. Strand June 21 Do. do. Henry Meakin, 20, Houghton Street. Selling margarine not labelled as such. Fined £2 and 12s. 6d. costs. St. John July 3 Westminster (Mr. Francis.) R. H. Rees, 8 Strutton Ground. Selling cheese containing 35 per cent. of fat, of which not more than 3 per cent. was butter fat. Fined £3 and 12s. 6d. costs. Victoria July 16 Westminster (Mr. Shiel.) Ruben Spurr, 2, Effingham Street, S.W. Selling butter adulterated with 92 per cent. of margarine. Fined £5 and 12s. 6d. costs. Victoria July 16 Do. do. John W. Wiltshire, 5, Westmoreland Street. Selling butter adulterated with 90 per cent. of margarine. Fined £5 and 12s. 6d. costs. Strand July 19 Bow Street (Mr. De Rutzen.) J. Morgan, 13, Drury Court. Selling butter adulterated with 20 per cent, of margarine. Fined £5 and 12s. 6d. costs. St. Anne Aug. 12 Great Marlborough Street (Mr. Denman.) J. E. Price, 91, Cleveland Street, St. Pancras. Selling milk adulterated with 7 per cent. of added water. Defendant relied on warranty. Notice not given in time. Costs asked for and allowed, 12s. 6d. St. Anne Aug. 12 Do. do. ♦ Philip Townsend, 26, Frith Street. Selling milk adulterated with 12 per cent. of added water. Defendant produced certificate by his own analyst, stating sample to be pure: third portion sent to Somerset House. Mr. Cribb's (the Council's analyst) analysis confirmed, and defendant fined 40s. and 12s. 6d. costs. St. Anne Aug. 12 Do. do. Hannah Foakes, 8, Great Chapel Street. Selling milk from which 15 per cent. of fat had been abstracted. Fined 20s. and 12s. 6d. costs. St. Anne Aug. 12 Do. do. D. Jones, 2, Upper Rathbone Place, St. Paneras. Selling milk adulterated with 12 per cent. of added water. Fined 20s. and 12s. 6d. costs. (8545) (j 98 List of Prosecutions—(continued). Ward and Inspector. Date of Hearing. Court and Magistrate. Name and Address of Defendant. Offence. t of Hearing. Regent Aug. 12 Great Marlborough Street (Mr. Denman.) Pearkes, Gunston, and Tee (Limited), 8, Walker's Court. Selling butter containing 10 per cent. of water in excess. Withdrawn. Summons served at Walker's Court instead of registered offices of Company. Covent Garden Aug. 13 Bow Street (Mr. De Rutzen.) J. Driscol, 6, Garrick Street. Selling butter adulterated with 40 per cent. of margarine. Fined £5 and 12s. 6d. costs. Regent Sept. 18 Great Marlborough Street (Mr. Fenwick.) Pearkes, Gunston, and Tee (Limited), 8, Walker's Court. Selling butter containing 4.96 per cent. of water in excess. Bath summonses adjourned, pending result of appeal to higher Court against Magistrate's decision in a similar ease in the South Western Police Court. Regent Sept. 18 Do. do. Do. do. Selling butter containing 4.22 per cent. of water in excess. Charing Cross Oct. 9 Bow Street (Mr. Mavsham.) C. and L. Corraza, 20, Villiers Street. Selling milk from which 36 per cent. of fat had been abstracted. Fined £3 and 12s. 6d. costs. Strand Oct. 9 Do. do. H. Appenrodt, 356, Strand. Selling milk with 10 per cent. added water. Fined 20s. and 12s. 6d. costs. Great Marlborough Oct. 10 Great Marlborough Street (Mr. Plowden.) Henry Davis, 28, Portland Street. Selling milk with 10 per cent. added water. Fined 20s. and 12s. 6d. costs. Great Marlborough Oct. 10 Do. do. Henry Bannister, 33, Great Marlboro' Street. Selling milk with 15 per cent. of fat abstracted. Fined 40s. and 12s. 6d. costs. Regent Oct. 10 Do. do. Henry Fisher, 12, Ingestre Place. Selling milk with 9 per cent. added water. Fined 10s. and 12s. 6d. costs. Regent Oct. 10 Do. do. R. W. Evans, 8, Green's Court. Selling milk with 12 per cent. added water. Fined 40s. and 12s. 6d. costs. St. John Oct. 11 Westminster (Mr. Shiel.) James Pearson, 37, Page Street. Selling milk with 10 per cent. added water. Fined 20s. and 14s. 6d. costs. St. John Oct. 11 Do. do. Stephen Ketskemety, 154, Horseferry Road. Selling milk with 10 per cent. adderl water. Fined 20s. and 14s. 6d. costs. St. John Oct. 11 Do. do. Annie Jones, 61, Great Peter Street. Selling butter with 99.5 per cent. margarine. Fined 20s. and 14s. 6d. costs. 99 St. John Oct. 11 Westminster (Mr. Shiel.) Annie Jones, 61, Great Peter Street. Selling cheese with 24 per cent. foreign fat. Fined 20s. and 12s. 6d. costs. St. John Oct. 11 Do. do. William Millen, 21, Great Peter Street, Selling cheese with 18 per cent. foreign fat. Fined 40s. and 14s. 6d. costs. St. John Oct. 11 Do. do. Sarah Brooks, 41, Wood Street. Selling butter with 99.5 per cent. margarine. Fined 40s. and 14s. 6d. costs. Knightsbridge St. George. Oct. 11 Do. do. William Chandler, 68, Pimlico Road. Selling butter with 99'5 per cent. margarine. Fined 40s. and 14s. 6d. costs. Knightsbridge Hamlet Oct. 11 Do. do. Mary Evans, 9a, Lancelot Place. Selling butter with 94 per cent. margarine. Fined 20s. and 14s. 6d. costs. Strand Oct. 22 Bow Street (Mr. Marsham.) British Tea Table Company (Limited), 163 a, Strand. Selling milk with 10 per cent. of fat abstracted. Fined 20s. and 12s. 6d. costs. St. John Oct. 23 Westminster (Mr. Shiel.) Walter Taylor, 23, Horseferry Road. Selling milk with 8 per cent. added water. Fined 20s. and 14s. 6d. costs. St. John Oct, 23 Do. do. Joseph Corbyn, 69, York Street. Selling milk with 16 per cent. of fat abstracted. Fined 40s. and 14s. 6d. costs. St. John Oct. 23 Do. do. Thomas Evans, 76, Tufton Street. Selling milk with 10 per cent. of fat abstracted. Fined 20s. and 14s. 6d. costs. St . John Oct. 23 Do. do. John Regan, 14, Horseferry Road. Selling milk with 20 per cent. of fat abstracted. Fined 20s. and 14s. 6d. costs. St. John Oct. 23 Do. do. Thomas Richards, 146, Horseferry Road. Selling milk wilk with 16 per cent. added water. Fined 40s. and 14s. 6d. costs. Victoria Oct. 23 Do. do. Emily Gledhill, 17, Commercial Road. Selling milk with 26 per cent added water. Fined 40s. and 14s. 6d. costs. Covent Garden Oct. 30 Bow Street (Mr. Marsham.) Mary Ann Forster, 7, Chandos Street. Selling milk from which 18 per cent. of fat had been abstracted. Fined 20s. and 12s. 6d. costs. St. Anne Oct. 31 Great Marlborough Street (Mr. Fen wick.) Mary Robson, 71, Charing Cross Road. Selling milk adulterated with 40 per cent. added water. Fined £7 and 12s. 6d. costs. St. Anne Nov. 6 Great Marlborough Street (Mr. Denman.) J. Tildersley, 2, Lisle Street. Selling butter containing 18.8 per cent. of water. Dismissed.* *Mr. Denman, in giving his decision, said it was probably recognised that there were some things which could not be arrived at accurately by evidence, and therefore it was desirable to have an official standard fixed, so that a Magistrate might say there had been an addition of water when that standard was exceeded. With regard to milk, that had been done, but it had not been done with respect to butter. It seemed to him it had not been done because at present it had not been sufficiently ascertained what was the amount which ought to form the standard. It would not be safe to convict in such circumstances, and the summons would therefore be dismissed. 100 List of Prosecutions—(continued). Ward and Inspector. Date of Hearing. Court and Magistrate. Name and Address of Defendant. Offence. Result of Hearing. St. Anne Nov. 6 Great Marlborough Street (Mr. Denman.) A. Harris, 18, Meard's Street. Selling butter containing 27.28 per cent. of water. Withdrawn. Great Marlborough Nov. 6 Do. do. Peter Blumenthai Selling butter containing 25.70 per cent. of water. Withdrawn. Victoria Dec. 11 Westminster (Mr. Shiel.) Eli Fry, 11, Ebury Street Selling butter adulterated with 80.5 per cent. foreign fat. Fined 10s. and 14s. 6d. costs. Knightsbridge St. George. Dec. 11 Do. do. Thomas Griffiths, 63, Kinnerton Street. Selling butter adulterated with 82.2 per cent. foreign fat. Fined 10s. and 14s. 6d. costs Great Marlborough Dec. 12 Great Marlborough Street. (Mr. Kennedy.) Ridgways (Limited), 443, Oxford Street. Cocoa—30 per cent. sugar, 32 per cent. starch. Fined £2 and 14s. 6d. costs. Victoria Dec. 13 Westminster (Mr. Shiel.) Grosvenor Dairies Company, 2, Claverton Street. Selling milk 6 per cent. water adulteration. Fined £2 and 14s. 6d. costs. Victoria Dec. 13 Do. do. A.B.c., 344, Wilson Road. Selling milk 12 per cent. fat abstracted. Warranty proved. Summons withdrawn. Victoria Dec. 13 Do. do. Charles Topham, 2, Vincent Street. Selling milk 8 per cent. added water. Fined £3 and 14s. 6d. costs. Victoria Dec. 13 Do. do. William Buddell, 46, Churton Street. Selling precipitated sulphur containing 4313 per cent. sulphate of lime. Fined £2 and 14s. 6d. costs. Covent Garden Dec. 20 Bow Street (Mr. De Rutzen.) J. L. Davis, 62, Castle Street. Selling milk 10 per cent. fat abstracted. Fined £1 and 14s. 6d. costs. 101 Food and Market Inspection. The inspection of market-places and the foodstuffs sold in the City has received the careful attention of your Inspectors. The following list shows the quantity condemned and destroyed as unfit for food during the year:— Anchovies 114 bottles. Chicory 20 baskets. „ 1 cask. Damsons 40 bushels. Beef 130 stone. Gooseberries 29 „ Caviare.. 800 lbs. Grapes 9 boxes. „ 13 tins. Lychees 25 baskets. Fish 3 boxes. Mangoes 40 boxes. ,, (soles and plaice) 200. Onions 10 bags. Pork 1 piece. Oranges.. 83 boxes. Rabbits 10. Pineapples 29 cases. „ 30 loose. Apples 33 barrels. Plums „ 45 bushels. Bananas 1,266 crates. Pomegranate 32 cases. „ 2 parcels. Potatoes 44 sacks. Blackberries 6 bushels. Spinach.. 27 crates. Brussels Sprouts 8 „ Strawberries 20 pecks. Cherries 24 baskets. Tomatoes 707 boxes. 23½ bushels. Turnip-tops 28 bags. Legal proceedings were taken in two instances:— (1) Ten rabbits, exposed for sale on a barrow in Berwick Street, were seized by Inspector Dee and ordered to be destroyed, and the owner was subsequently convicted, but was only ordered to pay the cost of the prosecution, the Magistrate, Mr. Denman, giving him the benefit of the doubt as to their being intended for human food, but held that the seizure and destruction was necessary. (2) Caviare.—On the 2nd November I received information that some caviare and other foodstuffs in bad condition had been deposited at the premises of Mr. George White, a merchant in Russian produce, at 10, James Street, I Haymarket, and that it was intended to be packed and sold for food. I immediately visited the premises with the Medical Officer of Health, and found in the basement one cask and seven tins of caviare and 116 bottles of anchovies; the whole were in a putrid condition, and were seized and taken before Mr. Fenwick, at Great Marlborough Street Police Court, who, after seeing them, made an order for their destruction. From inquiries it was discovered that in July Mr. White received an order from a well-known firm to supply 10 casks of caviare; after delivery, two casks were found to be unfit for use, and were returned to Mr. White (the value of the two casks, if good, would be about £80). White kept one cask on his premises, and sent the other to the Union Cold Storage Company at Blackfriars. At the beginning of October he received an order for 25 gross of tins of the best 102 caviare, to be sent to the Array Canteen, South Africa, and in the execution of this order he used the contents of one of the casks which had previously been returned as unfit. A little of the bad caviare was put at the bottom of each tin, which was then filled up with good caviare. The 25 gross of tins of caviare were subsequently dispatched to South Africa—half to Durban, and the other half to Port Elizabeth. White, anticipating another order for tins of caviare, brought back from the Cold Storage the second cask, and had commenced to pack some more tins in the same way, which, fortunately, I was able to prevent, as previously mentioned, by seizing the cask, and also seven tins, which were left over from the first consignment. Immediately the firm of purveyors who had given White the order were made acquainted with the facts, they cabled to South Africa for the whole consignment to be returned. White was summoned, and appeared before Mr. Fen wick, at Great Marlborough Street, and sentenced to two months' imprisonment in the second division; the Magistrate considered it too bad a case for a fine to be imposed. Notice of appeal was given, and upon the case being heard at the Quarter Sessions, the conviction was upheld, with costs, but the imprisonment reduced to one calendar month. The 25 gross of tins sent to South Africa have since been returned, were seized by me, and destroyed by order of the Magistrate, the whole of them being in a putrid condition. Cowsheds, Dairies, Slaughter-houses, Offensive Trades, &c. Previous to the coming into force of the London Government Act, the duties relating to the above were discharged by the London County Council. The registration, inspection, and enforcement of regulations controlling these places is now the duty of the Public Health Department. The following is a list of such places:— Cowsheds. Slaughter-houses. Offensive Trades. 13, Marsham Street (Richard Morgan). 38, St. George's Place (J. J. Gridlan). William and Henry Gray (Woodford and Co.), tripe boilers, 15, Tothill Street. 7, Arthur Street (Joseph Howell). 14, Regency Street (S. Ward). Brecknell, Turner, and Sons tallow melters, 15 and 18, Peter Street, 28, Winchester Terrace (Mrs. Caroline Bury). Wardour Street. 103 The total number of milkshops registered is 321. These have been visited by the District Inspectors, and notices served where necessary. Water Supply. Notices of withdrawal of water supply has been received from water companies in respect to 340 premises. The supply had been cut off for non-payment of rate, defective fittings, or premises closed. In 116 instances the supply has been reinstated; in 179 the premises are either pulled down or in course of demolition ; and 45 are still empty. Disinfecting. During the epidemic of smallpox the disinfectors were at work from early morning to very late at night, rarely finishing before midnight, and I am glad to be able to testify to their willingness at all times to undertake duties however arduous, and to the care and attention displayed under most trying circumstances. I have the honour to be, Gentlemen, Your obedient servant, Thomas Fredk. Strutt, Chief Sanitary Inspector. 104 APPENDIX II. CITY OF WESTMINSTER. Report by the Medical Officer of Health On the Influence of the Water Supply on Typhoid Fever. To the Public Health Committee. Mr. Chairman and Gentlemen, The City is supplied by four water companies, the West Middlesex, Grand Junction, Chelsea, and New River Companies. The West Middlesex supplies half of the Hamlet of Knightsbridge and the houses in St. Anne's Ward facing Oxford Street. The Grand Junction supplies Grosvenor, Conduit, parts of Regent, Marlborough, and Pall Mall Wards. The Chelsea supplies Victoria, St. John, St. Margaret, Knightsbridge, St. George, part of Charing Cross, Pall Mall, and the Hamlet. The New River Company supplies St. Anne's, Covent Garden, Strand, parts of Charing Cross, Marlborough, and Regent Wards. My predecessor, Professor Corfield, has contended for many years that whereas the seasonal prevalence of typhoid fever is normally in the autumn months, this disease is more prevalent and fatal in London during the winter months. During every year, except 1897, from 1891 to the end of 1900, the monthly average in St. George, Hanover Square, for November and December was higher than for August, September, and October, and he pointed out that this rise was coincident with the increase of orgauic matter in the drinking water supplied by certain companies. In order to estimate the relationship between the supply and typhoid during 1901, I have distributed the 78 cases believed to have been contracted in the City, according to the area of the various Water Companies, and I find that there were:— 0 cases in the area supplied by the West Middlesex Company = 0.00 per 1,000 inhabitants. 14 cases in the area supplied by the Grand Junction Water Company = 0.32 per 1,000 inhabitants. 46 cases in the area supplied by the Chelsea Water Company = 0.45 per 1,000 inhabitants. 20 cases in the area supplied by the New River Company = 0.55 per 1,000 inhabitants. 105 If, however, the 12 cases due to personal and shell-fish infection be deducted, the number to each of the last three' Companies is 13, 37, and 18, and the rate per 1,000 population in area supplied 0.30, 0 36, and 0.49 respectively. Professor Thorpe, of the Government Laboratory, who examines the water supply of the various Companies, has instituted a method of comparison between the water supplied by the Kent Company from deep wells, and that drawn from the Thames and Lea by other companies. Taking the average amount of organic impurity in a given volume of Kent Company's water during nine years as unity, the proportional amount contained in an equal volume of water at oue (and occasionally on two) occasion during each month was as follows in 1901. I have included in this table a note of the net number of actual cases notified during the same period (deducting those in which the disease was contracted abroad), and in the second column the number which probably originated in that month (from 5 to 21 days elapsed between the entry of infection into the system and the beginning of symptoms):— 1901. Month. Cases notified. Cases originated. Water Companies. Kent. New River. West Middlesex. Chelsea. Grand Junction. January 7 5 0.8 1.4 4.3 4.0 6.2 February 3 3 0.9 1.4 4.8 4.3 5.1 March 6 .7 0.9 2.6 4.4 4.6 5.6 April 3 3 0.9 2.3 4.2 3.5 5.7 May 7 8 0.8 1.6 3.7 2.6 3.2 June 6 7 0.7 1.3 2.7 2.0 2.4 July 7 4 1.2 1.2 2.3 2.1 2.9 August 3 4 0.7 0.9 2.3 2.6 2.7 September 9 9 0.8 2.2 2.6 2.3 2.2 October 8 13 1.1 0.9 2.6 2.1 2.3 November 14 7 1.1 1.3 2.8 2.6 2.9 December 5 8 0.9 1:7 2.4 2.2 2.4 5.4 At first sight it does not appear as if the quality of the water had influenced the occurrence of typhoid fever, and that the Royal Commission were right in their conclusion that infection was most unlikely to occur through drinking Thames water, on account of the large dilution to which any poison must be subjected. But it must be kept in mind that the infective agent in typhoid fever is a living organism, and cannot be diluted in the same way as a poisonous chemical, and if it exists in Thames water the filtration to which it is subject will not keep it out of the supply. For it is evident (8545) H 106 from the above figures that there are serious differences in the amount of organic matter found in the water supplied by the three Companies (West Middlesex, Chelsea, and Grand Junction), all of these drawing water at the same part of the river. The West Middlesex and Chelsea are nearly alike, but the Grand Junction figures are, as a rule, higher. The explanation of this difference is that the Grand Junction has only a storage reservoir for unfiltered water equal to 2.9 days, whereas the Chelsea has 14 and the West Middlesex has 18.7 days' supply. The storage and subsidence reservoirs of the West Middlesex Company are 117½ acres, that of the Grand Junction only 15 acres. The Grand Junction have the means during floods of pumping from the gravel beds adjoining . the Thames, and it is claimed that "this is practically equivalent to an addition to their storage resources." That this is not so the above table is evidence, for it is in those months when the Thames was reported as being "turbid and discoloured" that the increase of organic matter occurred. These were January, 12 days; March, 12 days; April, 17 days; and December, 13 days. During periods when the river is not in flood the water which soaks through the natural gravel beds is said to be in excellent condition, but during times of flood, not only these gravel beds, but the filters themselves may be submerged, and as it is only lately that cesspools have been done away with in Sunbury and Hampton, where the intakes of the Companies are, when a flood came the contents of the cesspools were carried into the river, hence there was always the possibility of infection being in the water, and of that water being imperfectly filtered. Professor Corfield has no doubt " that the unseasonable prevalence of typhoid fever in November and December in London is due to the distribution of inefficiently filtered river water, containing the poison of the disease in sufficient amount, however, only to attack the most susceptible persons among the population." This view is supported by Mr. Shirley Murphy, in his report to the London County Council for 1894, and by the experience of certain towns on the River Merrimac (narrated in the reports of the State Board of Health of Massachusetts), which drew their supplies from that river. Infected sewage entered the river several miles above the intakes of the Water Companies, and typhoid fever broke out on more than one occasion as a result. The Thames Conservators have recently made improvements at their locks, &c., whereby water may get away more readily at times of flood, and the Joint Committee of the Water Companies has a very large reservoir in construction at Staines, which will bring the Grand Junction Company up to the same level as the Chelsea and West Middlesex. 107 But it is also evident that none of the three Water Companies taking their supply from the Thames provide so pure a water as the New River and the Kent Company, and it is a question whether taking water from a polluted source they can so filter it as to prevent it being a source of danger to the consumer. Apparently they cannot do so, as your analyst, Mr. C. E. Cassal, points out that the words "anomaly" and "abnormality" are terms constantly used in the reports made by the Companies' analysts to explain adverse chemical results. The principal explanations offered to account for these "anomalies" and "abnormalities" are:— (a) A sudden increase of (so-called) harmless microbes took place in all the Companies' waters. Cause unexplained. (b) Defective filters. (c) Temporary defect in a filter. (d) A purely local cause in one of the filters, and so on. It is thus admitted by the Companies that absolute reliance is not to be placed in the filters, and even when working in their usual way adequate purification of the water is not secured. The provision of large subsidence reservoirs is probably a very important factor in obtaining greater security, but still, so long as the source of supply is polluted, there must always be the risk of "the temporary defect" in the filter. That risk may be probably a small one, but if a defect occurs at a moment when the typhoid or cholera organism is in the water, the result will be serious. The New River Company has supplied water of such superior quality that I viewed with some uneasiness the scheme of intercommunication which was eutered into between the Metropolitan Companies a few years ago in order to assist the East London Company, and I wrote to the New River Company on the subject in 1899, pointing out that by mixing Thames water from the Grand Junction and West Middlesex Companies with their own, they were lowering its quality and adding an element of danger. The Company, in reply, relied on the Report of the Royal Commission that there was no evidence of danger. I find that during 1901 the New River Company supplied the East London Company during part of July, August, and September, and in turn received from the Grand Junction and West Middlesex Companies, in July, an amount which, if spread equally over the month, averaged 4,965,313 gallons daily. In August 7,749,481 gallons daily, and in September 3,726,195 gallons daily. The effect of this 108 is seen in the higher proportion of organic matter in New River water, and Dr. Thorpe, in his report for September, called attention to it. The derivation of water from the Thames by this Company is likely to increase, as the water level in the wells from which much of their water is taken is believed to be much reduced. From the fact that the Company has joined with the other Companies in the building of the Staines Reservoir, it is probable that, in the future, this Company may not maintain the "excellent" report its water has generally received. I have the honour to be, Your obedient servant, FRANCIS J. ALLAN, M.D., Medical Officer of Health.