No. 3. WES 17 City of Westminster Report of the Medical Officer of Health for the Five Weeks ending 4th April, 1903; together with Statistics relating to the First Quarter of the year 1903. Mr. Mayor, My Lords, and Gentlemen, I beg to present my Report for the five weeks ending 4th April, 1903 :— 1. Births.—The number of Births registered was 257, equal to an annual rate of 15.0 per 1,000. The birth-rate for London for the same period was 29.0 per 1,000. 2. Deaths :— (a) The total number of deaths registered was 268. After deducting the deaths of 101 non-citizens in public institutions in the City and adding those of 87 citizens who died in other districts, the corrected total is 254, as compared with 11)9 in the previous four weeks, and is equivalent to an annual death-rate of 14.8 per 1,000. The death-rate for all London during the same period averaged 16.4 per 1,000, being 5 per 1,000 below the mean rate in the corresponding periods of the 10 years 1893-1902. (b) According to the old divisions of the City, the births and deaths were thus distributed. In— BIRTHS. DEATHS. Total. Male. Female. Total Male. Female St. George, Hanover Square 51 49 100 48 46 94 St. Margaret and St. John 50 37 87 41 35 76 St. James, Piccadilly 19 18 37 22 15 37 Strand and St. Martin 17 16 33 23 24 47 137 120 257 134 120 254 The place of death of citizens belonging to the several Wards is shown below :— Place of Death. Total Deaths. 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. 1 2 3 4 5 6 1 8 9 10 11 12 13 14 At Home 136 1 6 2 7 45 l6 22 13 7 2 9 1 5 — Workhouses and Infirmaries 64 1 2 — 3 13 3 18 1 4 — 3 — 7 9 General and Special Hospitals 39 — 1 1 2 11 3 7 2 1 1 5 3 2 — Fever Hospitals 2 — — — — — — — — — — 1 — 1 — Lunatic Asylums 11 — — — — 2 1 3 1 — 1 2 — — 1 River Thames Serpentine, Homeless, &c. 2 — — — — — — — — — — 1 — 1 — Total Deaths 254 2 9 3 12 71 23 50 17 12 4 21 4 16 10 Death Rates per 1,000 Inhabitants 14.8 3.6 4.6 4.1 8.2 18 . 5 17 . 8 16.6 15.7 16.9 13.1 23.0 9. 5 18.8 15.3 2 (c) Causes of, and ages at, death during the five weeks ending 4th April, 1903 :— (Causes of Death. Corrected Deaths in the City at subjoined Ages. Deaths in Wards at all Ages. All ages. Under i. 1 and under 5 5 and under 15. 15 and under 25 25 and under 65 65 and upwards. 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. Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 2 1 1 .. .. .. .. .. .. .. .. 2 .. .. .. .. .. .. .. .. .. Scarlet Fever 2 .. 2 .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. 1 .. Epidemic Influenza 3 .. .. .. .. 3 .. .. 1 .. 1 .. 1 .. .. .. .. .. .. .. .. Whooping Cough 8 5 3 .. .. .. .. .. 1 .. .. 1 1 3 1 .. .. .. .. 1 .. Diphtheria, Memb. Croup 1 .. 1 .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. Croup .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 1 .. .. .. 1 .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. Diarrhoea Dysentery 3 3 .. .. .. .. .. .. .. .. .. 2 .. 1 .. .. .. .. .. .. .. Epidemic Enteritis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteritis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Erysipeals .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 2 .. .. .. 2 .. .. .. .. .. .. .. .. .. 1 1 .. .. .. .. .. Olhtv septic diseases 4 1 .. .. 2 1 .. .. .. .. 1 .. 1 .. .. .. 1 1 .. .. .. Diabetes .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Malarial Diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Rheumatic Fever 1 .. .. 1 .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. Tuberculosis of Meninges 1 1 .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. Tuberculosis of Lungs 34 .. .. .. 6 25 3 .. 1 .. .. 5 6 9 1 .. 2 3 1 3 3 T uberculosis of Peritoneum .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other forms of Tuber culosis 5 2 2 1 .. .. .. .. .. .. .. 2 .. 2 1 .. .. .. .. .. .. Alcoholism.. 6 .. .. .. .. 4 2 .. .. .. 1 2 .. 2 .. .. .. .. 1 .. .. Malignant Growths 18 .. .. .. .. 10 8 .. 1 .. 1 6 .. 5 .. 2 .. 2 .. .. 1 Premature Birth 6 6 .. .. .. .. .. .. .. .. .. 3 1 1 1 .. .. .. .. .. .. Developmental Diseases 12 8 4 .. .. .. .. .. .. .. 1 3 1 4 2 .. .. .. .. .. .. Old Age 13 .. .. .. .. .. 13 1 1 .. 1 3 1 3 1 1 .. .. .. 1 .. Meningitis 2 1 1 .. .. .. .. .. .. .. .. 1 .. 1 .. .. .. .. .. .. .. Other Diseases of Nervous System 8 2 .. .. .. 5 1 .. .. .. 1 3 .. 1 1 .. .. .. .. .. 2 Valvular Diseases of Heart 14 .. 1 .. .. 7 6 .. .. 1 .. 6 1 1 .. 1 .. 1 1 2 .. Other Circulatory Diseases 17 .. .. .. .. 7 10 .. 1 .. 3 4 1 3 1 .. .. .. .. 3 1 Bronchitis 25 2 .. .. .. 9 14 .. 2 .. 1 7 2 6 3 .. .. 2 .. 1 1 Lobar (Croupous) Pneumonia 10 .. .. .. .. 6 4 .. .. .. .. 4 1 1 2 1 .. .. .. .. 1 Lobular (Broncho-) Pneumonia 9 4 4 .. .. 1 .. .. .. .. .. 4 1 1 .. 1 .. 1 .. 1 .. Other RespiratoryDiseases 2 .. .. .. .. 1 .. .. .. .. .. .. .. .. .. 2 .. .. .. .. .. Cirrhosis of Liver.. 4 .. .. .. .. 3 1 .. .. .. .. 2 .. 1 .. .. .. .. .. .. 1 Other Digestive Diseases 11 2 1 .. .. 6 2 .. 1 .. .. 3 2 1 .. 1 .. 1 .. 2 .. Bright's Disease. &c. ii .. .. .. .. 7 4 1 .. 1 .. 3 .. .. 1 1 .. 3 .. 1 .. Generative System Diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Accidents and Diseases of Parturition 2 .. .. .. .. 2 .. .. .. .. .. .. 1 .. .. .. .. .. 1 .. .. Deaths by Accident or Negligence io 4 1 .. .. 5 .. .. .. .. 1 4 1 2 .. .. .. 2 .. .. .. Deaths by Suicide, &c 4 .. .. 1 .. 3 .. .. .. .. .. .. .. 1 .. .. .. 3 .. .. .. All other Causes 3 1 1 .. .. 1 .. .. .. .. .. 1 .. .. .. 1 1 .. .. .. All Causes 254 43 22 3 10 107 69 2 9 3 12 71 23 50 17 12 4 21 4 16 10 3 (d) Of the 254 deaths, 43 were those of children under 1 year of age, and 69 those of persons over 65 years of age ; these are referable as follows :— Ages at Death. Total. 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. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Under 1 year of age 43 — — 1 2 14 4 12 5 1 2 1 — 1 — Over 65 years 69 1 4 1 4 22 6 10 3 4 — 5 1 5 3 Infant mortality in London was equal to 127 deaths per 1,000 births registered, in Westminster the rate was 167 per 1,000. (e) 14 deaths were due to violence, and 10 of them were ascribed to negligence or accident. Inquests were held on the bodies of 22 citizens. 3. Notifiable Diseases.—83 cases of Infectious Disease were notified in the City in March, as compared with 59 in the previous four weeks. They were distributed as follows :— Notifiable Diseases. Total. 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. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Small-pox — — — — — — — — — — — — — — — Scarlet Fever 42 — 1 1 1 5 1 6 9 4 1 6 I 6 — Diphtheria 23 1 1 1 1 7 — 3 3 2 — 3 — — 1 Enteric Fever 7 — — — — — 2 2 — 1 — — 1 — 1 Erysipelas 10 — 1 — — — — 4 1 — — 1 2 — 1 Puerperal Fever 1 — — — — — — — 1 — — — — — — Continued — — — — — — — — — — — — — — — 39 of the Scarlet Fever, 20 of the Diphtheria, 6 of the Enteric, and 1 of the Erysipelas cases were treated in Hospital. Two cases notified as Diphtheria was reported not to be so. The number of notifications of infectious disease in the last five weeks, and in the corresponding period of 1902, were :— Small-pox. Scarlet Fever. Diphtheria. Enteric Fever. Erysipelas. Puerperal Fever In London 1903 13 1,212 821 135 385 18 ,, 1902 2,002 1,528 1,062 149 395 23 In Westminster 1903 0 42 23 7 10 1 ,, 1902 38 32 21 1 12 0 4 Small-pox.—No cases have occurred in the City, but there have been 13 cases notified in other Metropolitan Boroughs. Through the agency pf tramps, the disease has been introduced into districts close to London, and in view thereof I have addressed a letter to those in charge of Casual Wards, Common Lodging Houses, and Shelters in the City, calling their attention to the possibility of persons suffering therefrom obtaining admission to such places, and asking that a look-out be kept for any suspicious cases. 4. Disinfection.—112 Rooms were disinfected in 75 houses during the five weeks and 2,608 articles were disinfected. Commercial Road. Horseferry Road. Denzell Street. Articles .. 1,683 925 — Number of Persons received into Shelter — — — 65 Certificates of Infectious Disease have been sent to School Teachers, and Certificates of each case notified have been sent to each of the Public Libraries in the City. Intimations have been received from School Teachers relating to 19 cases of Whooping Cough, 8 of Mumps, 13 of Measles, and 40 of Chicken-pox. Epidemic Grants for Elementary Day Schools:—Under the Education Code a grant has been made in the past to public elementary schools, to cover the loss which would otherwise occur through the absence of children suffering from or resident in a house in which there was infectious disease. Now, in the recently issued Provisional Code, intimation is given by the Board of Education that after March 31st, 1903, no Special Epidemic Grant will lj)e made in respect of anv diminution of attendance. Under the old conditions, teachers and tnanagers were ready to exclude infected or suspected children, and thereby assisted materially in the prevention of more extensive outbreaks of disease, but when such exclusions! are no longer to be reckoned in calculating the average attendance, school teachers may not be so ready to assist. Besides the injury to public health, and the increased expense thereby incurred, there will be the direct loss to the rates of London of £12,000 annually, which is approximately the amount of the grant paid in past years. I would suggest that the Council make a representation on the Subject to the Board of Education, with the view of having the Article (101*) re-instated. 5. Mortuaries. Horseferry Road. Denzejl Street. Dufour's Place. No of bodies rdmoved to 38 — — No. of inquests 30 — — 6. Water Analysis.— Professor Thorpe, of the Government Laboratory, reports that he has Examined the water supplied to the Metropolis during the month of March by the eight Water Companies. The particulars relating to the four Companies (New River, West Middlesex, Chelsea and Grind Junction) supplying the Citv of Westminster are as follows:— Thirteen samples of each Company's water were examined. The New River Company's water contained a larger quantity of organic matter than usual, due to the flooded state of the Lea, from which part of its supply is drawn. The East London supply from the same cause was very bad. All the Thames-derived supplies contained large amounts of organic matter, due primarily to heavy rains in the Thames Valley, but the waters of the Lambeth and Grand Junction Companies from the insufficient storage possessed by these Companies were most affected. Taking the average amount of organic impurity in a given volume of the Kent Company's water, during the nine years ending 1876 as unity, the proportional amount contained in an equal volume of water supplied by each of the Metropolitan Water Companies was :—Kent, 0.9; New River, 3.7; East London, 9.9 ; Chelsea, 4.9; West Middlesex, 5.1 ; Southwark, 4.7 ; Grand Junction, 6.8 ; and Lambeth, 7.3. 5 7. The following is a summary of the Reports of your Sanitary Inspectors prepared by Mr. Chief Inspector Strutt : - WARDS. 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. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Complaints received and dealt with 6 8 2 3 21 10 7 7 10 3 2 4 5 2 90 Houses and Premises Inspected 40 23 32 27 95 43 90 46 23 7 28 13 15 17 499 Do. Re-inspected Do. (Registered) 111 191 167 176 359 39 181 1l6 145 24 155 87 121 86 1958 Visited — — — — — 6 — 27 5 — 1 — 2 19 60 Workshops Inspected 18 — 1 2 — 1 3 9 41 — 5 — 5 — 85 Do. Visited 10 3 2 4 4 6 4 — 22 — 5 — 20 8 88 Bakehouses Visited 2 7 8 7 20 2 9 32 8 3 2 3 28 3 134 Milkshops Visited — — 3 2 7 4 4 — — — 1 — 1 — 22 Restaurant & Hotel Kitchens Visited — — 7 — — — — — — — — 11 10 3 31 Notices issued(preliminary) 10 15 14 24 29 8 35 15 23 1 11 5 17 18 225 Do. (statutory) — — 1 — 6 — 2 2 — — — — — — 11 Smoke complaints received — — — 1 — — 2 — 1 2 2 — — — 8 Do. observations taken 7 16 11 8 29 15 19 8 52 34 18 6 4 227 Do. Notice issued (preliminary) — — — — 2 1 — — — — — — — — 3 Do. (statutory) — — — — — — — — — — — — — — — Food and Drugs— Samples taken 2 10 4 8 12 8 9 13 5 6 4 10 3 3 97 8. Unsound Food.—The following articles have been condemned as unfit for food :— 8 Tons Turnips. 4½ Tons Bananas. 1 Ton Oranges. 1½ Cwt. Cauliflowers. 2 Tons Tomatoes. 1¼ Cwt. Madeira Beans. I have the honour to be, Mr. Mayor, my Lords and Gentlemen, Your obedient Servant, FRANCIS J. ALLAN, M.D., D.P.H., F.R.S.E., Medical Officer of Health for the City. April 20th, 1903. 6 STATISTICS FOR THE FIRST QUARTER OF THE YEAR 1903. From the Returns of the Registrar-General for the First Quarter of the year, I have extracted the Birth and Death Rates of London as a whole, in order to compare them with those of the City of Westminster. Births.—The Births registered in London were equal to an annual rate of 29.0 per 1,000 of the population; this is 21 per 1,000 below the average rate in the First Quarters of the preceding ten years. The births registered in the City of Westminster were 718, equal to an annual rate of 16.0. A number of births take place in institutions beyond the borders of the City, which should be added to obtain the correct rate. Deaths.—The deaths in London, after distribution of those occurring in public institu* tions, were equal to an annual rate of J 6.7 per 1,000, being 3 per 1,000 below the rate in the corresponding Quarters of the ten preceding years. In the City of Westminster 671 deaths were registered ; after deducting the deaths of 247 non-citizens in public institutions in the City, and adding those of 259 citizens who died in other districts, the corrected total is 683, equal to an annual death-rate of 15.2 per 1,000 as against 18*0 and 209 in the corresponding Quarters of 1901 and 1902, respectively. The place of death of citizens belonging to the several Wards, is shown below :— Place of Death. Total Deaths. 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. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 At Home 340 4 15 11 19 97 28 67 33 14 7 19 4 13 9 Workhouses and Infirmaries 194 2 6 3 6 31 12 55 12 13 — 9 3 13 29 General and Special Hospitals 102 — 3 1 3 26 8 25 6 6 1 9 4 6 4 Fever Hospitals 2 — — — — — — — — — — 1 — 1 — Lunatic Asylums 33 — 5 — 1 5 3 7 3 2 1 3 — 1 2 River Thames,Serpentine, Homeless, &c. 12 — 2 — 1 2 — — — — — 3 1 2 1 T otal Deaths 683 6 31 15 30 161 51 154 54 35 9 44 12 36 45 Death Rates per 1,000 Inhabitants 15.2 4.2 8.2 1 9 7.9 16.1 15.1 19.6 19.0 19.0 11.3 I8.4 110 163 26.6 355 were deaths of males, 328 of females, equal to rates of 16.9 for males, 137 for females. 7 Causes of and ages at, death during the 13 weeks ending 4th April, 1903 :— Causes of Death. Corrected Deaths in the City at subjoined Ages. Deaths in Wards at all Ages All ages. Under 1. 1 and under 5 5 and under 15 15 and under25 25and under6s 65 and upwards 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. Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 3 1 2 .. .. .. .. .. .. .. .. 2 .. .. .. .. .. .. .. 1 .. Scarlet Fever 2 .. 2 .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. 1 .. Epidemic Influenza 12 .. .. .. .. 8 4 .. 1 .. 2 3 1 i .. .. ... 2 2 .. .. Whooping Cough 17 8 8 1 .. .. .. .. 1 .. .. 4 2 7 1 1 .. .. .. .. Diphtheria, Memb. Croup 3 .. 3 .. .. .. .. .. .. .. .. .. .. 1 1 1 .. .. .. .. .. Croup 2 .. 2 .. .. .. .. .. .. .. .. 1 .. 1 .. .. .. .. .. .. .. Enteric Fever 4 .. .. .. 1 3 .. .. .. .. 1 .. .. .. 1 1 .. .. .. .. 1 Diarrhœa Dysentery 8 5 2 .. .. .. 1 .. 1 1 .. 3 .. 2 .. .. .. .. .. .. 1 Epidemic Enteritis 1 1 .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. Enteritis 3 2 1 .. .. .. .. .. .. .. 1 1 .. 1 .. .. .. .. .. .. .. Erysipelas 1 .. .. .. 1 .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. Puerperal Fever 2 .. .. .. 2 .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. Other septic diseases .. 11 4 .. .. 2 2 3 .. .. .. 1 .. 1 .. 1 .. 1 2 .. 2 1 Diabetes 5 .. .. 1 .. 2 2 1 .. 1 .. .. 2 .. .. .. .. ..1 .. .. .. Malalrial Desis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Rheumatic Fever 5 .. 1 2 1 1 .. .. .. .. .. 1 3 3 .. .. .. .. .. .. .. Tuberculosis of Meninges 4 1 2 1 .. .. .. .. .. .. 1 .. 1 1 .. 1 .. .. .. .. .. Tuberculosis of Lungs 82 .. .. 1 7 69 5 .. 1 1 .. 15 12 16 6 .. 2 7 3 4 13 Tubercolusis of Peritoneum 1 .. 1 .. .. .. .. .. .. •• .. .. .. 1 .. .. .. .. .. .. .. Other forms of Tuberculosis 9 2 3 1 .. 3 .. .. .. .. .. 4 .. 3 1 .. .. .. .. .. 1 Alcoholism 10 .. .. .. .. 8 2 .. .. .. 1 3 .. 3 .. .. .. 2 1 .. .. Malignant Growths 39 .. .. .. .. 21 18 .. 2 3 3 10 2 8 3 .. .. 3.. .. .. 3 Premature Birth 17 17 .. .. .. .. .. .. .. .. .. 5 1 4 2 1 1 2 . 1 .. Developmental Diseases 26 22 4 .. .. .. .. .. 2 2 3 5 1 8 4 .. .. .. 1 .. .. Old Age 43 .. .. .. .. .. 43 1 2 1 3 17 4 7 1 1 .. 1 1 2 2 Meningitis 5 3 1 .. 1 .. .. .. .. .. 1 1 .. 2 .. 1 .. .. .. .. .. Other Diseases of Nervous System 28 4 2 .. 3 13 6 .. 2 .. 3 5 .. 9 2 3 .. .. .. 1 3 Valvular Diseases of Heart 26 .. 1 .. 3 12 10 .. .. 1 .. 11 1 5 1 2 .. 1 1 3 .. Other C1rculatory Diseases 47 .. .. .. 1 29 17 1 2 1 3 7 3 10 5 .. 2 .. .. 6 7 Bronchit1s 79 8 4 .. .. 25 42 2 6 1 2 21 7 20 6 3 .. 2 .. 4 5 Lobar (Croupous) Pneumonia 38 .. .. .. 4 22 12 .. 6 .. .. 7 1 11 7 2 .. 1 .. .. 2 Lobular (Broncho-) Pneumon1a 22 7 11 .. 1 1 2 .. 1 1 .. 6 1 7 .. 2 .. 3 .. 1 .. Other Respiratory Diseases 7 .. 1 .. 1 3 2 .. .. .. .. .. 1 2 .. 3 .. .. .. 1 .. C1rrhosis of L1ver 13 .. .. .. .. 10 3 .. .. .. .. 3 1 3 1 .. 1 .. .. 1 3 Other Digest1ve Diseases 19 3 2 1 1 9 3 .. 1 .. .. 5 4 2 1 2 .. 2 .. 2 .. Bright's Disease, etc. 33 .. .. .. .. 23 10 .. 1 1 2 7 1 4 5 2 .. 4 .. 3 2 Generative System Diseases 1 .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. Accidents and Diseases of Partur1t1on 3 .. .. .. .. 3 .. .. .. .. .. 1 1 .. .. .. .. .. 1 .. .. Deaths by Accident or Negligence 29 8 1 2 1 12 5 .. 1 .. 2 9 1 5 3 1 .. 4 .. 2 1 Deaths by Suic1de .. 8 .. .. 1 .. 7 .. .. 1 1 .. .. .. 2 .. .. .. 4 .. .. .. All other Causes 15 1 1 .. .. 10 3 .. .. .. .. 4 1 3 1 .. 2 1 2 .. .. All Causes 683 97 55 11 30 297 193 6 31 15 30 161 51 154 54 35 9 44 12 36 45 8 Ages at Deaths.—Of the total deaths, 97 were those of children under 1 year of age, and 193 of persons over 65 years of age ; these are referable as follows :— Ages at Death. Tot a l. 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. 1 2 3 4 5 6 7 8 9 10 11 12 13 #] Under I vear of age 97 — 2 4 6 24 6 30 9 5 3 4 — 3 1 Over 65 years 193 3 14 5 11 50 14 27 14 10 1 9 5 12 18 The Infant mortality was equal to 127 per 1,000 births in London and 135 in the City. Inquests were held on the bodies of 58 citizens. Compared with London as a whole, the death rates per 1,000 persons living for Phthisis, Diarrhoea, and other Communicable Diseases, were as follows :— LOCALITY. All Causes. Small-Pox. .Measles. Scarlet Fever. Diphtheria. Whooping Cough. Fever. Diarrhoea. Phthisis. County of London 16.7 0.00 0. 57 0.08 0.20 0 . 65 0.07 0.22 1.65 City of Westminster 15.2 - 0.06 0.01 0.06 0.38 0.08 0.26 1 .83 Infectious Diseases Notified.—In London the number of notifications of infectious diseases in the First Quarter of the year, as Compared with those in the corresponding 14 weeks of last year, were as follows :— Small-pox. Scarlet l ever. Diphtheria. Enteric Fever. F rysipelas. Puerperal Fever. In London 1903 3,8 3.183 2,244 435 1,107 63 1902 45,74 4-058 2,823 486 1,167 8l In Westminster 1903 1 113 53 19 24 1 1002 176 96 60 17 12 1 In the City 217 cases were notified in the First Quarter. They were distributed as follows :— Notifiable Diseases. Total. 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. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Small-pox 1 — — — — — — — — — — — — — — Scarlet Fever 113 2 3 1 6 14 9 17 28 9 1 10 2 8 3 Diphtheria 53 2 2 3 3 13 5 6 3 4 — 5 1 4 2 Enteric Fever 19 — 2 — 2 1 3 3 2 1 — 1 1 — 3 Erysipelas 24 — 2 1 2 5 1 7 1 — — 1 3 — 1 Puerperal Fever 1 — — — — — — — 1 — — — — — — Continued Fever 1 — — — — — — — 1 — — — — — — Chicken-pox 5 — — 1 1 1 — 3 — — — — — — — Totals 217 4 9 5 14 34 18 36 37 14 1 1 17 7 12 9 Exclusive of Chicken-pox, the number of cases notified were this year 212, as compared with ^94 in the corresponding Quarter of 1902. The case notified as Small-pox turned out to be Typhoid Fever. Two cases notified as Scarlet Fever and six as Diphtheria afterwards were reported not to be so. WES 17 No. 10 City of Westminster Report of the Medical Officer of Health for the Four Weeks ending 31st October, 1903. Mr. Mayor, My Lord, and Gentlemen, I beg to present my Report for the four weeks ending 31st October, 1903:— 1. Births.—The number of Births registered was 221, equal to an annual rate of 16.1 per 1,000. The birth-rate for London for the same period was 27.4 per 1,000. 2. Deaths :— (a) The total number of deaths registered was 168. After deducting the deaths of 68 non-citizens in public institutions in the City and adding those of 58 citizens who died in other districts, the corrected total is 158, as compared with 198 in the previous five weeks, and is equivalent to an annual death-rate of 11.4 per 1,000. The death-rate for all London during the same period averaged 15 2 per 1,000, being 1.7 per 1,000 below the mean rate in the corresponding periods of the 10 years 1893-1902. (b) According to the old divisions of the City, the births and deaths were thus distributed. In— BIRTHS. DEATHS. Total. Male. Female. Total. Male. Female. St. George, Hanover Square 47 39 86 27 22 49 St. Margaret and St. John 51 34 85 41 27 68 St. James, Piccadilly 9 5 14 6 6 12 Strand and St. Martin 18 18 36 16 13 29 125 96 221 90 68 158 The place of death of citizens belonging to the several Wards is shown below:— Place of Death. Total Deaths. 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. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 At Home 83 — 7 2 6 19 5 22 6 1 1 5 2 6 1 Workhouses and Infirmaries 44 — 1 — — 7 3 !9 — 1 — 2 3 3 5 General and Special Hospitals 17 2 — 1 — 2 6 4 — — — 1 — 1 — Fever Hospitals 3 — — - — 1 — 2 — — — — — — — Lunatic Asylums 6 — — — 1 2 — 1 1 — — 1 — — — River Thames, Serpentine, Homeless, &c. 5 1 — 2 — — 1 — — — — — 1 — Total Deaths 158 3 8 5 7 31 15 48 7 2 1 9 5 11 6 Death Rates per 1,000 Inhabitants 11.4 6.8 5.1 8.6 60.1 10.1 14. 5 19.9 8.0 3.5 4.1 12.1 14 .8 16.1 11.5 2 (c) Causes of, and ages at, death during the four weeks ending 31st October, 1903:— Causes of Death. Corrected Deaths in the City at subjoined Ages. Deaths in Wards at all Ages. 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. Hamlet of Knightsbridge. Knightsbridge St. George. Victoria. St. Margaret. St. John. St. Anne. Great Marlborough. Pall Mall. Regent. Charing Cross. Covent Garden. Strand. Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 2 .. 2 .. .. .. .. .. .. .. .. .. .. 2 .. .. .. .. .. .. .. Scarlet Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Epidemic Influenza .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Whooping Cough 2 1 1 .. .. .. .. .. .. .. .. .. 1 .. 1 .. .. .. .. .. .. Diphtheria, Memb. Croup 2 .. 2 .. .. .. .. .. .. .. .. 1 .. 1 .. .. .. .. .. .. .. Croup .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 1 .. .. .. .. 1 .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. Diarrhoea Dysentery 4 3 .. .. .. .. 1 .. 1 .. .. .. .. 2 .. .. .. .. .. 1 .. Epidemic Enteritis 3 3 .. .. .. .. .. .. 1 .. .. .. .. 1 .. 1 .. .. .. .. .. Enteritis 3 2 .. .. .. 1 .. 1 .. .. .. .. 1 1 .. .. .. .. .. .. .. Erysipelas .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Othor septic diseases 1 .. .. .. .. 1 .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. Diabetes 3 .. .. .. .. 3 .. .. .. .. 1 1 .. .. .. .. .. 1 .. .. .. Malarial Diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Rheumatic Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Tuberculosis of Meninges 1 .. .. 1 .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. Tuberculosis of Lungs 21 .. .. .. 1 17 3 .. 2 .. .. 6 .. 9 1 .. .. .. 1 2 .. Tuberculosis ofPeritoneum .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other forms of Tuberculosis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Alcoholism 2 .. .. .. .. 2 .. .. .. .. .. .. .. 1 .. .. .. .. 1 .. .. Malignant Growths 12 .. .. .. .. 10 2 .. .. .. .. 4 .. 3 .. .. .. 2 .. 3 .. Premature Birth 12 12 .. .. .. .. .. .. .. 1 2 4 1 2 1 .. .. .. .. .. 1 Developmental Diseases 8 8 .. .. .. .. .. .. .. .. 1 .. 2 3 1 .. .. .. 1 .. .. Old Age 6 .. .. .. .. .. 6 .. .. .. .. 2 1 .. 1 .. .. .. 1 1 .. Meningitis 1 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. Other Diseases of Nervous System 7 .. .. .. .. 4 3 .. 1 .. .. 1 1 3 .. .. .. .. .. .. 1 Valvular Diseases of Heart 9 .. .. .. 2 1 6 .. .. 1 .. 2 1 1 1 .. .. 2 .. .. 1 Other Circulatory Diseases' 12 .. .. .. .. 5 7 .. 1 .. .. 2 1 2 1 1 1 2 .. 1 .. Bronchitis 10 1 1 .. .. 2 6 .. .. .. .. 1 .. 5 .. .. .. .. .. 1 3 Lobar (Croupous) Pneumonia 4 1 .. .. .. 1 2 .. .. .. 1 1 1 1 .. .. .. .. .. .. .. Lobular (Broncho-) Pneumonia 3 2 .. .. .. .. 1 .. .. .. 2 .. .. .. .. .. .. .. 1 .. .. Other RespiratoryDiseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cirrhosis of Liver 3 .. .. .. .. 2 1 .. .. .. .. .. 1 2 .. .. .. .. .. .. .. Other Digestive Diseases 7 1 1 .. 1 3 1 1 1 2 .. .. 2 1 .. .. .. .. .. .. .. Bright's Disease. &c. 6 .. .. .. .. 6 .. 1 .. .. .. 1 .. 2 .. .. .. 2 .. .. .. Generative System Diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Accidents and Diseases of Parturition .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Deaths by Accident or Negligence 5 1 .. .. 2 1 1 .. 1 .. .. 2 1 .. .. .. .. .. .. 1 .. Deaths by Suicide 4 .. .. .. .. 4 .. .. .. 1 .. .. .. 3 .. .. .. .. .. .. .. All other Causes 4 .. 1 .. .. .. 3 .. .. .. .. 2 1 1 .. .. .. .. .. .. .. All Causes 158 36 8 1 6 64 43 3 8 5 7 31 15 48 7 2 1 9 5 11 6 3 (d) Of the 158 deaths, 36 were those of children under 1 year of age, and 43 those of persons over 65 years of age ; these are referable as follows:— Ages at Death. Total. 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. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Under 1 year of age 36 — 2 1 4 5 5 12 2 1 — — 2 1 1 Over 65 years 43 — 1 1 2 8 6 8 3 1 — 3 1 5 4 Infant mortality in London was equal to 157 deaths per 1,000 births registered, in Westminster the rate was 162 per 1,000. (e) 9 deaths were due to violence—5 of them were ascribed to negligence or accident—and 4 to suicide. Inquests were held on the bodies of 19 citizens. 3. Notifiable Diseases.—55 cases of Infectious Disease were notified in the City in October, as compared with 66 in the previous five weeks. They were distributed as follows:— Notifiable Diseases. Total. Conduit. Grosvenor. Hamlet of Knightsbridge. Knightsbridge St. George. Victoria. St. Margaret. St. John. St. Anne. Great Marlborough. Pall Mali Regent. Charing Cross. Covent Garden. Strand. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Small-pox 5 — 2 — —- — — 3 — — — — — — — Scarlet Fever 16 1 1 — — 7 1 3 — 2 1 — — — —- Diphtheria 17 — — — — 3 1 6 — 1 — 6 — — — Enteric Fever 3 — — — 1 1 — — — — 1 — — — — Erysipelas 14 — 1 — 1 2 1 2 6 — — — — 1 — Puerperal Fever — — — — — — — — — — — — — — — Continued ,, — — — — — — — — — — — — — — — Pulmonary Phthisis 13 — — — 2 1 1 2 6 — 1 1 — — — 3 of the Small-pox cases, all of the Scarlet Fever, all the Diphtheria, all the Enteric, and 3 of the Erysipelas cases were removed to Hospital. 4 The number of notifications of infectious disease in the last four weeks, and in the corresponding period of 1902, were :— Smallpox. Scarlet Fever. Diphtheria. Enteric Fever. Erysipelas. Puerperal Fever. In London 1903 41 1,002 650 326 380 20 ,, 1902 14 1,721 804 427 537 33 In Westminster 1903 5 l6 17 3 14 0 „ 1902 0 39 22 23 12 0 Smallpox: From the Medical Officer of Ware I learned that a man had been found on a barge there, suffering from Smallpox, and that he had been at a wharf adjoining Millbank for a few days about the 5th October. On enquiry I found that he had kept to his cabin most of the time, but on one occasion at least had visited a public house in the neighbourhood, and a man who visited him on the 5th observed that he had an eruption on his face. A number of persons were kept under observation in consequence ; most of the men employed on the wharf had been re-vaccinated during the last year or two and none of them contracted the disease. Three persons residing in the neighbourhood were seized with illness about the 17th October, which would give the usual incubation period of twelve days. One of these is (a) the manager of a public house (said to have been vaccinated in infancy but with no marks), another (b) an unvaccinated child of five years of age, and the third (c) a married woman aged 38 (since dead) who had had a previous attack of smallpox at the age of 7 years. This woman did some washing, which possibly came from the barge above mentioned. Another case (d) of smallpox came from Wiltshire, the eruption appearing on arrival in London, and a child (e), who had been sleeping in the same bed, has subsequently had a slight feverish attack, probably varioloid in its nature, and treated as such ; a person in an adjoining Borough who had been with (d) in the country also developed smallpox on coming to London. A number of business premises and private houses had been visited by (d), but no further cases have occurred in connection therewith ; the persons therein were either promptly re-vaccinated or had been re-vaccinated during the last two years. Typhoid Fever: Of the three cases notified, there is a history connecting the disease with the consumption of shell-fish in two; in the third there is no history of any kind obtainable. The Fishmongers' Company, finding that the Leigh Cocklers were not carrying out their undertaking as to the deposit and cooking of cockles, on the 14th October wrote to each of them that from that date the sale of cockles from Leigh is absolutely prohibited. There is no doubt, from the reports obtained by the City of London and by the Fishmongers' Company, that shell-fish from other points on the Thames Estuary besides Leigh are polluted, as, for example, at West Shoebury (one of the above cases ate cockles at Gravesend), and the Fishmongers' Company have now prohibited the sale in London of any shell-fish from the Thames estuary. 4. Disinfection.—62 Rooms were' disinfected in 51 houses during the four weeks and 1,415 articles were disinfected. Commercial Road. Horseferry Road. Denzell Street. Articles 1,070 345 — Number of Persons received into Shelter — — — Thirty-three Certificates of Infectious Disease have been sent to School Teachers, and Certificates of each case notified have been sent to each of the Public Libraries in the City. Intimations have been received from School Teachers and others relating to 78 cases of Measles,! of Chickenpox, 1 of Mumps and 2 cases of German Measles. Mortuaries. Horseferry Road. Denzell Street. Dufours Place No. of bodies removed to 23 3 — No. of inquests 24 — — 5 6. Water Analysis —Professor Thorpe, of the Government Laboratory, reports that he has examined the water supplied to the Metropolis during the month of October by the eight Water Companies. The particulars relating to the four Companies (New River, West Middlesex, Chelsea, and Grand Junction) supplying the City of Westminster, are as follows:— Thirteen samples of each Company's water were examined. Taking the average amount of organic impurity in a given volume of the Kent Company's water, during the nine years ending 1876 as unity, the proportional amount contained in an equal volume of water supplied by each of the Metropolitan Water Companies was, on the 19th October:—Kent, 1.0; New River, 6.2 ; Chelsea, 4.0 ; West Middlesex, 3.7 ; Southwark, 8.8 ; Grand Junction, 9.0 ; and Lambeth, 8.8 ; East London (19th October) 8.5, (27th October) 4.4. From these figures it is evident that the water supplied has been anything but satisfactory. Professor Thorpe reports more fully, as follows :— " Of the Thames-derived supplies those of the Chelsea and West Middlesex Companies, taken on the 19th October, contained proportions of organic matter which were not sensibly different from those found in the two preceding months and were of good quality, but the water distributed by the Southwark, Grand Junction, and Lambeth Companies on the same date was of very unsatisfactory quality, the amount of organic impurity present being practically as great as that contained in certain samples taken from these Companies' mains in May and June when the quality of the water was exceptionally bad. The analytical data, however, indicate that the additional organic matter which is washed into the river by the exceptional rains is mainly of vegetable origin. " The New River Company's water obtained from the river Lea and Wells contained an amount of vegetable organic matter much in excess of that usually found in this supply. The organic impurity in the sample taken on the 19th October, although less than that present in some of the Thames-derived supplies, exceeded any amount which had been found in the New River Company's water during recent years. The water was of indifferent quality. " In addition to the above analytical examination, the 105 samples, collected during October at various places in the districts supplied by the several Companies, have been examined, and estimations have been made of the amounts of ' oxygen consumed ' (measure of organic pollution) and 4 albuminoid ammonia ' (measure of nitrogenous organic pollution) the degree of turbidity, if any (indication of inefficiency of filtration or of disturbance in the mains), has also been recorded: " With reference to the five Thames-derived waters, the results show that in all cases the mean proportions of organic matter were much higher than in August and September. The amount of organic impurity in the Chelsea and West Middlesex Companies' supplies was somewhat larger than is usual in October and remained practically constant until the 16th ; after this date it began to rise steadily and continued to do so until the end of the month, when the amounts exceeded those found in June and July, and were the highest recorded this year. A consideration of the data shows that these Companies had made fair use of their storage, and the average quality of their supplies was superior to that of the other three Companies which distribute Thames water. The Southwark, Grand Junction, and Lambeth Companies' waters contained larger mean amounts of organic impurity than had been found in any previous month this year, the Southwark Company being the worst in this respect. On many occasions during the latter half of the month the supplies of these three Companies were of very high colour and unsatisfactory quality. The Water Examiner's Reports show that the storage capacities of the Southwark and Lambeth Companies' unfiltered water reservoirs (expressed in days' supply) are now not very different from those possessed by the Chelsea and West Middlesex Companies, nevertheless my regular examinations of the Metropolitan supplies certainly indicate that the former Companies do not, or are unable to, make the best use of their stored water. 6 "The New River Company's water during the past month contained higher maximum and mean proportions of organic impurity than I have previously found, and although the highest amounts present were much less than those contained in certain of the Thames waters, it has been evident that this Company, with its relatively small storage, could not, on a few occasions, avoid the distribution of water of somewhat inferior quality." 7. Bakehouses:— The Home Secretary has issued a Draft Order modifying the proportion of cubic feet of space to be provided in certain bakehouses:— (1) As regards Underground Bakehouses, by raising the amount of cubic feet of space to each person employed from 250 to 500 ; and (2) As regards other Bakehouses where work is carried on at night by Artificial light other than electric light, the amount of cubic space to be 400 feet per person, between the hours of 9 in the evening and 6 in the succeeding morning. 8. The following is a summary of the Reports of your Sanitary Inspectors prepared by Mr. Chief Inspector Strutt:— WARDS. 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  1 2 3 4 5 6 7 8 9 10 11 12 13 14 Complaints received and dealt with 1 7 3 1 3 18 12 1 9 14 1 7 1 3 1 81 Houses and Premises Inspected 13 15 11 29 70 31 87 27 24 8 25 6 11 4 361 Do. Re-inspected Do. (Registered) 115 153 31 236 380 35 129 24 54 29 92 37 129 62 1496 Visited — — — — — 8 4 — 1 — 2 — — 10 25 Workshops Inspected — — — 6 3 — 6 4 8 — 4 — 1 — 32 Do. Visited 6 8 2 4 4 2 4 — — — 1 1 29 2 63 Bakehouses Visited — — 4 9 4 3 7 2 1 1 2 — 9 1 44 Milkshops Visited — — — 5 — 5 6 — 4 — — — — — 20 Restaurant & Hotel Kitchens Visited — — — — — — — 2 2 — — — — — 4 Notices issued (preliminary) 7 3 6 19 38 9 29 10 10 — — 6 11 2 134 Do. (statutory) — — — 1 3 — — — 1 — — 3 3 — 11 Smoke complaints received 1 2 — — — 1 — — 1 — — 2 — — 7 Do. observations taken 4 6 14 18 30 12 26 7 8 7 46 27 8 25 238 Do. Notices issued (preliminary) — 1 — — — — — — 3 — 4 — 1 2 11 Do. (statutory) — — — 3 — 1 — 1 — — — — — 6 Food and Drugs— Samples taken 4 8 — 14 26 10 33 32 14 2 19 1 12 7 1 182 7 9. Unsound Food.—The following articles have been condemned as unfit for food :— 10½ cwts. Pears. 4 tons Bananas. 3/4 tons Grapes. 15 cwts. Apples. 28 lbs. Haddocks. 21 lbs. Eels. 63 lbs. Tinned Spinach. 3 lbs. Mutton. I have the honour to be, Mr. Mayor, my Lord, and Gentlemen. Your obedient Servant, FRANCIS J. ALLAN, M.D., D.P.H., F.R.S.E., 12th November, 1903. Medical Officer of Health for the City. WES 17 ANNUAL REPORT ON THE STATISTICS AND SANITARY CONDITION RELATING TO THE CITY OF WESTMINSTER for the year 1903. BY FRANCIS J. ALLAN, M.I)., C.M., D.P.H. Camb., F.R.S. Ed. MEDICAL OFFICER OF HEALTH. Printed by Order of the Council. LONDON: HARBISON AND SONS, PRINTERS IN ORDINARY TO HIS MAJESTY, ST. MARTIN'S LANE, W.C, iii TABLE OF CONTENTS. page Introductory Remarks 1 PART I. A. Vital Statistics. Population 4 Births 6 Deaths— Infants 9 Various Ages 10 Old Persons 10 Causes of— Statistical Tables 18 B. Communicable Diseases. Notifiable— Smallpox 22 Vaccination 30 Scarlet Fever 31 Diphtheria 32 Bacteriological Diagnosis 32 Typhoid Fever 35 Non-notifiable 39 Diarrhoeal Diseases 9, 18 Measles 39 Whooping Cough 41 Schools and Infectious Disease 41 Disinfection 43 Shelters 44 Cleansing of Persons 44 PART II. C. jHouse Inspection, fyc. Inspection of Houses 45 Legal Proceedings 45 By-laws under Public Health Act 48, 49 Infringements 48 Proposed Amendments 48 Supervision of House Drainage 49 Underground Dwellings 50 Houses Let in Lodgings 51 Revenue Act 61 Housing of the Working Classes— Regency Street Buildings 51 Standard of Occupation of Tenements 51 page Housing Act, 1903 57 Vital Statistics of Block Dwellings 59 Common Lodging Houses 58 D. Workshops, fyc. Number on Register 62 Inspection of Workplaces .. 46, 47, 63 Use of Gas and Oil Stores 63 Temperature 63 Women's Workplaces 64 Outworkers 65 Causes of Death, and Occupations.. 65 E. Food Supply. Bakehouses 68 List of Certified, &c. 68 Order as to Cubic Space 69 Restaurants 70 Proposed Legislation 70 Milk 75 Legal Powers sought 78 IceCreams 71 Aerated Water Manufactories 71 Slaughterhouses 72 Tripe Boilers 72 Food and Market Inspection 72 Prosecutions 73 Unsound Pies 74 Sale of Food and Drugs Acts 74 The Adulteration of Milk 75 Tinned Peas—Circular on 78 Prosecutions 81 Water Supply 85 F. General, Smoke Prevention 86 Prosecutions 87 Locomotives on Railways 88 ,, Highways 89 Mortuaries 89 Gr. Special Report. Distribution of Tubercular Disease in the City during the years 1901, 1902, and 1903, with two Maps showing Population and number of Deaths from Consumption in Census Enumeration Areas 90 Annual Report on the Health and Sanitary Condition of the City of Westminster* 1903 To the Mayor, Aldermen, and Councillors of the City of Westminster. My Lord and Gentlemen, I have the honour to submit to you my Annual .Report on the Health and Sanitary Condition of the City of Westminster during the year 1903. It is drawn up in accordance with the instructions of the Local Government Board, and contains a record of the work of the Department. Returns required by the Local Government Board, and particulars relating to Factories and Workshops required by the Home Office, are incorporated. The year 1903 was remarkable in the exceptionally heavy rainfall which occurred over a large part of England, but especially in the Thames Valley. At the London Eeporting Station of the Meteorological Office, situated at Brixton, the rainfall for the year was 37'95 inches, the average being 24'38 inches. The eight years previous to 1903 all had the rainfall below the average, the aggregate deficiency being 26 inches, while in the twenty years 1883 to 1902 there were only four years with an excess, the total deficiency being 14 inches. B 2 The continuous rain had, however, a beneficial effect in cleansing the air, the streets, and the sewers, although in some low-lying districts it led to flooding of basements of houses, and the water supplied by certain of the Water Companies was of an inferior quality. The year was further characterised by an unusually even temperature, without any periods of really warm or cold weather. The death-rates of the Country generally, and of London, were exceptionally low. The London death-rate, which averaged 18.5 in the ten preceding years, and was 18.6, 17.1, and 17.2 in 1900, 1901 and 1902, was only 15.2 in 1903 ; that means that there were 14,821 fewer deaths in 1903 than would have occurred had the average been maintained. In the City of Westminster the death-rate was also low, being 13.5 per 1,000, the average of the ten years 1893-1902 having been 17.2. For 1901 and 1902 the rates were 16.1 and 16.0 per 1,000. As one death per thousand of population means 180 deaths in the City, the reduction means a saving of 666 lives. Infectious diseases generally were less prevalent, but in the City whooping cough and measles were not apparently reduced. Certain causes of death were quite unaffected, they form a suggestive group— drink, suicides and accidents. Bakehouses, restaurants, kitchens and other places where food is prepared have received special attention during 1903. A Subcommittee of the Public Health Committee drew up a schedule of minimum requirements which they should expect to find in underground bakehouses, and they visited every such bakehouse in the City and settled what should be done. The bakers carried out the works required with good feeling, recognising the justness thereof. In several instances bakehouses which could not reasonably be adapted were closed by mutual consent, and in the great majority of cases more extensive improvements were made than the Committee demanded. In reporting to the Public Health Committee on proposed alterations in by-laws, I drew attention to the need for a daily collection of dust, and they agreed that once a week was too seldom. I also pointed out that the method of daily collection left much to be desired, and was susceptible of great improvement. The method I have suggested for some years as being likely to be most satisfactory has been lately adopted in some American cities. It is, that instead of emptying dust-bins into carts, the dust man should remove the refuse in its bin, and leave a clean bin behind. The full bins are emptied at the depot and properly cleansed. With motor traction suitable conveyance could be devised without much difficulty. Subsequently considerable correspondence on the subject has taken 3 place in the Press, and Sir Henry Thompson and others have protested against the present methods as crude and pernicious. It is not inappropriate that I should here refer to an important movement which took definite shape during 1903, under the then Mayor, Captain H. M. Jessel, M.P. I refer to the " City of Westminster Health Society," the object of which is the improvement of health conditions in the City. An influential committee has been appointed, and has begun work 011 the following lines:— 1. By arranging popular lectures on Health and Sanitation. (a) At Mothers' Meetings, Girls' Clubs, Evening Continuation Schools, &c. (.b) For District Visitors and others who are working among the poor. 2. By the distribution of popular leaflets and pamphlets. 3. By utilising the services of trained local workers and others in giving practical instruction and advice in matters of health and sanitation to the people in their homes. 4 By working in co-operation with the Public Health Authority and with the charitable and social agencies in the City of Westminster. 5. By investigation of local sanitary conditions, and discussion of sanitary questions. 6. By promoting such measures for the improvement of the Public Health as may from time to time appear advisable. The Society, under the presidency of the present Mayor, Mr. Alderman Emden, promises to be of value in disseminating a knowledge of questions affecting health throughout the City. I have in my two previous reports referred to the need of Women Inspectors in the City; no appointment has yet been made, but the question of strengthening the staff of the department in this and other respects is receiving the attention of a Special Committee. I have the honour to be, My Lord and Gentlemen, Your obedient servant, FRANCIS J. ALLAN, Medical Officer of Health loth March, 1904. B 2 4 PART I. A. POPULATION. The resident population of the City of Westminster has been calculated by the Registrar-General at 179,052 for the year 1903. This is arrived at by a calculation based on the assumption that the rate of decrease ascertained at the census taken in 1901 as having taken place since the census taken in 1891 is still continuing. For districts in which little change occurs this may be a ready method of arriving at a fairly reliable estimate, but in Westminster, where improvement schemes on a large scale are in progress, it is obvious that the risk of error may be considerable. There are, moreover, a large number of persons resident in Poor Law establishments "beyond the boundaries of the City, whose deaths are allocated to the City, hence these people should be added in as part of the resident population. To counterbalance this there are many persons in hospitals and hotels in the City who are only temporary residents, and in order to be exact these should be excluded. These alterations affect the various Wards differently, and while adopting, for the sake of comparison, the population (179,052) as given by the Registrar-General, I have added paupers to the various Wards in the proportion in which they were found in the Workhouses and Infirmaries at the time of the census, and deducted a proportion of the persons in hospitals and hotels, with the result that the following figures are arrived at:— Conduit Ward 5,740 Grosvenor Ward 15,025 Knightsbridge St. George Ward 15,150 Victoria Ward 39,760 Hamlet of Knightsbridge Ward 7,558 St. Margaret Ward 13,430 St. John Ward 31,296 St. Anne Ward 11,304 Great Marlborough Ward 7,386 Pall Mall Ward 3,171 Regent Ward 9,537 Charing Cross Ward 4,387 Covent Garden Ward 8,864 Strand Ward 6,756 5 This gives a total of 179,224, which is only a little higher than that adopted for the whole City. For the purpose of the Equalisation of Eates Act, the Registrar-General has to estimate the population of the City in another way. This he does by calculating the number of persons per inhabited house at the time of the census, and applying such to the number of houses found on the rate books in May of each year. The City Comptroller has been good enough to supply me with a copy of the figures sent to the Local Government Board in 1902 and 1903, and I append both so that comparisons may be made:- l 2 3 4 5 6 Number of Houses as defined in Local Government Board Schedule. Number of Houses comprising two or more Rateable Properties. Number of Separate Occupations included in Col. 2. Actual Number of Rated Occupiers. Estimated Population by RegistrarGeneral. Estimated Population by Medical Officer of Health. 1902. St. George Hanover Square 9,838 56 2,236 12,018 75,923 76,424 St Margaret and St. John 5,638 54 3,974 9,558 50,690 52,791 St. James 2,882 7 84 2,959 21,294 21,060 St. Anne 1,135 45 .827 1,917 11,168 11,414 St. Martin and Strand 2,708 69 1,805 4,444 19,459 20,200 The City 22,201 231 8,926 30,896 178,489 181,889 1903. St. George Hanover Square 9,848 56 2,253 12,045 76,000 75,715 St. Margaret and St. John 5,474. 59 4,347 9,762 49,213 52,284 St. James 2,854 9 202 3,047 21,042 20,094 St. Anne 1,135 45 827 1,917 11,168 11,304 St. Martin and Strand 2,523 69 1,833 4,287 18,282 19,827 The City 21,834 238 9,462 31,058 175,705 179,224 It will be observed that while the actual number of rated occupiers in column 4 has increased except in St. Anne, St. Martin and the Strand parishes, the number of "houses" in column 1 has decreased except in St. George, Hanover Square, where there is a slight increase. Possibly this is due to an alteration in the method of rating. There is no change in St. Anne's parish. If 3,051 paupers be added to the Registrar's figures as given in column 5, the three estimates will be found to be fairly approximate. 6 Births. 3,017 births were registered in the City in the 52 weeks endingJanuary 2nd, 1904. On examination, 41 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 209 children were born, the home address of whose mothers was in Westminster. The net number of births was, therefore, 3,185, as compared with 3,461 in 1902; the birth-rate, uncorrected, was 16.8, corrected 17.7 per thousand persons. The birth-rate for the County of London for 1903 was 28.4, the rate during the ten preceding years averaged 29.9 per thousand. The birthrate in England and Wales was 28.4, which is lower than that in any other year on record; compared with the average of the preceding ten years, the birth-rate in 1903 shows a decrease of 2.6 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 in Pall Mall Ward to 28 in St. John's Ward. Table I.—Showing the number of Births in the City of Westminster and its Wards (corrected by distributing Institution Births), with rates per 1,000 population. Wards. Births (corrected). 1901. 1902. 1903. No. Rate. No. Kate. No. Rate. Conduit 47 8.0 46 7.8 43 7.5 Grosvenor 153 9.9 157 10.1 151 10.0 Knightsbridge St. George 163 10.3 162 10.1 125 8.2 Victoria 836 20.5 886 21.6 884 22.2 St. Margaret 197 14.2 160 11.5 162 12.0 St. Jolm 869 27.7 953 29.5 877 28.0 Hamlet of Knightsbridge 63 8.9 97 12.4 79 10.4 St. Anne 289 24.9 278 23.8 240 21.2 Regent 213 21.9 226 23.0 184 19.2 Pall Mall 32 2.7 23 5.6 22 7.0 Great Marlborough 208 27.4 180 23.8 162 21.9 Charing Cross 41 7.0 26' 5.7 34 7.7 Covent Garden 163 17.7 163 17.8 151 17.0 Strand. 153 20.9 104 14.9 71 10.5 The City of Westminster 3,432 18.5 1,706 18.7 3,185 17.7 7 The total births reckoned on the number of married females (between the ages of 15 and 45) work out as follows for London and the City of Westminster:— 1881. 1891. 1901. 1902. 1903. City of Westminster 238 210 178 184 172 County of London 283 259 236 233 237 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, legitimate and illegitimate, The illegitimate births were 186 in 1902 (5.7 of the total births), 150 in 1903 (4.7 of the total births). The legitimate birth-rate calculated on the above lines was equal to 174 per 1,000 married women in 1902, 164 per 1,000 in 1903; the illegitimate rate would equal 4'6 in 1902 and 3'8 in 1903, per 1,000 unmarried women between the ages of 15 and 45. The births are arranged according to the old divisions of the City in Table III., and the comparative rates are shown in Table IV. These are, uncorrected for births outside the City. Deaths. 2,517 deaths were registered in the City in the 52 weeks ending the 2nd January, 1904. After deducting 931 deaths of non-citizens in public institutions in the City, and adding those of 833 citizens who died in other districts, the corrected total is 2,419, and is equivalent to an annual rate of 13.5 per thousand persons. The London death-rate for the same period was 15.2, and for England and Wales 15.4, which is the lowest rate on record, the only previously recorded rates below 17 per 1,000 having been 16.3 in 1902, 16.5 in 1894 and 16.9 in 1901. The rates were, in each instance, below the average of the preceding ten years, to the following extent:—The City 3.7 per 1,000, London 3.3 per 1,000, and England and Wales 2.3 per 1.000. A Factor for Correction of Death-rates.—Following on the method adopted by the Registrar General in dealing with the statistics of the large towns of England and Wales, Mr. Shirley Murphy, the Medical Officer of the County Council, has calculated out a "factor" whereby differences in the age and sex constitution of the population may be removed. This is arrived at by obtaining the age and sex distribution of the population of a district at the last census, and after ascertaining the death-rate for each sex, at each age period, in England and Wales 8 during the last ten years, a calculation is made of the number of deaths which would have occurred in the district had similar rates been obtained, thus a "standard" death-rate is obtained. The difference between this rate and that for England and Wales is, on the above assumption, due to differences in the age and sex constitution on the population of the district, and dividing the latter by the former a factor is obtained for correcting the crude death-rate of the district. Applying such factors to the 1903 rates, the figures are:— Standard death-rate. Recorded death-rate. Corrected death-rate. Comparative mortality figure. England and Wales 18.21 15.4 15.4 1,000 London 17.32 15.2 15.9 1,032 City of Westminster 15.46 13.5 15.8 1,025 Table III., in the form required by the Local Government Board, shows the vital statistics of the City and five groups of districts from 1891 to 1903. I have made out this table in such a way as to maintain as far as possible, consequent on alteration of areas, a comparison of statistics for the old divisions of the City, and in Table IV. I have calculated out the rates therefrom. Table V. shows where citizens were at the time of their death distributed according to their respective Wards. The proportion dying in public institutions is not always an index of the circumstances of the inhabitants of the Wards. The number of public institution deaths in London was 35.4 per cent. of the total, in the City 43 per cent., and in the several wards as follows:— Conduit 32 St. Anne 40 Grosvenor 46 Gt. Marlborough 54 Hamlet 31 Pall Mall 31 Knightsbridge St. George 36 Regent 48 Victoria 38 Charing Cross 51 St. Margaret 44 Covent Garden 47 St. John 49 Strand 74 Quarterly Rates.—These are shown in Table VII. for the City and its several Wards, the County of London, England and Wales and the United Kingdom. Deaths of Males and Females are also shown in Table VII. for the same areas. 9 Deaths under one year of age.—In Table VI. the rate at which infants died, calculated in relation to the number of corrected births, is set out for the City and its Wards. In Tables III. and IV. the rates are calculated 011 the uncorrected births, viz., only those registered in the City for the City and its old divisions, as formerly allowance was not made for births taking place outside the area of the division. The uncorrected rate for the City was 122 deaths per 1,000 births, as compared with 153, the average of the previous ten years. The corrected rate was 116. The London rate for 1903 was 130, the average being 157. In each of the divisions of the City the rate was also much lower than in any previous year. This was chiefly marked in the third quarter, and due to the diminished number of deaths from diarrhoea. The causes of death are shown in Table IX., measles, whooping cough, pneumonia (probably after measles in many cases), diphtheria, tuberculosis, diarrhoea, and improper feeding contributed largely to the death rate. Of all the causes of death those affecting young children are ones which belong to the preventible class, and with a rapidly decreasing birth rate it behoves the nation to bestir itself to save such children as are born to it. The deaths of infants were distributed in the City and Wards as follows:—- City of Westminster. Conduit. Grosvenor. Hamlet of Knightsbridge. Knightsbridge St. George Victoria. St. Margaret. 1st Quarter 97 — 2 4 6 24 6 2nd Quarter 72 — 3 1 2 25 1 3rd Quarter 106 3 1 3 3 29 4 4th Quarter 95 — 2 3 5 30 6 Total 370 3 8 11 16 108 17 St. John. St. Anne. Great Marlborough. Pall Mall. Regent. Charing Cross. Covent Garden. Strand. 1st Quarter 30 9 5 3 4 — 3 1 2nd Quarter 22 5 2 — 4 3 2 2 3rd Quarter 36 6 5 — 8 2 4 4th Quarter 27 4 5 — 3 4 3 3 Total 115 24 17 3 19 9 12 8 10 Illegitimate infants die at much higher rate than do others, thus of 3,035 legitimate children born 370 (11.3 per cent.) died, of 150 illegitimate 25 (16.6 per cent.) died; in 1902 the rates were 12.5 and 17.2 per cent. respectively. Deaths at other ages.—The following comparative statement shows at a glance the rates per 1,000 persons estimated to be living at certain age-periods during each of the last three years:— 1901. 1902. 1903. Under 5 years of age 52.1 51.7 44.7 5 and under 15 2.4 3.3 2.1 15 ami under 25 2.7 2.8 2.2 25 and under 35 6.4. 5.1 4.3 35 and under 45 15.1 12.0 9.3 45 and under 55 24.7 21.2 16.7 55 and under 65 42.8 38.0 28.8 65 and upwards 106. 109.0 98.8 It is evident that the rates in 1903 were lower at each period of life than in the two preceding years. Deaths in persons over 65 years of age.—680 persons over this age died during 1903, against 762 in 1902; 345 were between the ages of 65 and 75, 269 between 75 and 85, and 66 over that age. Causes of death.—These are set forth in Table IX, and also their distribution in a summarised form, in the various wards of the City. In Table X the rates per 1,000 population have been calculated out. In the City there is a reduction in the rate in each group with the exception of measles, whooping cough, alcoholism, cirrhosis of the liver, and deaths due to accidents, neglect, and suicide, in all of which the rate was about the same as in 1902. The reduction is specially marked in connection with influenza and diseases of the respiratory system, being 1.5 per 1,000 inhabitants. 11 Table III (Required by Local Government Board).— Vital Statistics of Separate Localities in 1903 ancl 12 Previous Years. Names of Localities 1. The City of Westminster. 2. St. George's, comprising Conduit, sirosvenor, Victoria, and Knightsbridge St. George Wards. 3. Westminster, comprising St. Margaret, St. John, and the Hamlet of Knightsbridge Wards. 4 St. James, comprising Regent, Marlborough, and Pall Mall Wards. 5. St. Anne Ward. 6. Strand comprising Covent Garden, Strand, and Charing Cross Wards. Year. Population estimated to middle of each year. Births registered (uncorrected). Deaths at all ages (currected). Deaths under 1 year. Population estimated to middle of each year. Births registered (uncorrected). Deaths at all ages (corrected). Deaths under 1 year. Population estimated to middle of cach year. Births registered (uncorrected). Deaths at all ages (corrected). Deaths under 1 year. Population estimated to middle of each year. Births registered (uncorrected). Deaths at all ages (corrected). Deaths under I year. Population estimated to middle of each year. Births registered (uncorrected). Deaths at all ages (corrected). Deaths under 1 year. Population estimated to middle of each year. Births registered (uncorrected). Deaths at all ages (corrected). 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 1,297 246 24,368 n?4 446 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 196,254 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 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 75 1901 185,648 3,241 2,900 435 77,475 1,199 1,007 156 52,851 1,124 871 151 21,403 453 350 62 11,590 289 148 21 22,329 387 425 43 1902 (53 weeks . 180,880 3,284 2,952 442 76,424 1,204 1,074 143 52,791 1,153 1,007 163 21,060 388 327 52 11,414 256 173 35 20,200 283 371 49 Averages of 10 years 1893 to 1902. 192,372 3,745 3,311 575 79,479 1,370 1,113 178 53,175 1,184 1,093 204 22,408 455 384 69 12,047 294 202 41 25,424 466 524 83 1903 179,052 3,017 2,419 370 75,675 1,156 833 135 52,284 1,071 824 143 20,094 325 286 39 11,304 218 154 24 20,007 247 322 29 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 Officers of Health of the separate districts and from those of the Registrar-General. 12 Table IV.— Vital Statistics of Separate Localities. Birth- and Deathrates per 1,000 Inhabitants, and Death-rates of Infants under 1 Year per 1,000 births, calculated from the figures in Table III, compared with the Average Rates in the 10 Years 1893—1902. Birth-rate (Uncorrected). Death-rate. Deaths ander 1 per 1,000 Births Registered in the City. Average, 10 Years. 1903. Average, 10 Years. 1903. Average, 10 Years. 1903. 1. St. George's Division— Comprising Conduit, G-rosvenor, Victoria, and Knightsbridge St. George Wards 17.2 15.2 14.0 11.0 129 116 2. Westminster Division— Comprising St. Margaret and St. John and the Hamlet of Knightsbridge Wards* 22.2 20.5 20.5 15.7 172 133 3. St. James Division— Comprising Pall Mall, Regent, and Great Marlborough Wards 20.3 16.1 17.1 14.2 151 120 4. St. Anne Ward 24.4 19.2 16.8 13.6 139 110 5. Strand Division— Comprising Covent Garden, Strand,* and Charing Cross Wards 18.3 12.7 20.6 16.1 178 117 The City of Westminster 19.4 16.8 17.2 13.5 153 122 The County of London 29.9 28.5 18.9 15.2 157 130 England and Wales 29.4 28.4 17.6 15.4 — 132 The United Kingdom 28.7 — 17.7 15.6 — — *The area of these divisions was altered at the incorporation of the City in 1900. 13 Table V.—Deaths of Citizens during the Year ending 3rd January, 1904, showing Locality at Time of Death. Wards. Locality at Time of Death. Total Deaths. At Home. Workhouses and Infirmaries. General and Special Hospitals. Fever Hospitals. Lunatic Asylums. Elsewhere. Males. Females. Total. Males. Females. Total. Males. Females. Total. Males. Females. Total. Males. Females. Total. Males. Females. Total. Males. Females. Total. Conduit 10 9 19 1 2 3 3 1 4 — — — — — — — — — 16 12 28 Grosvenor 36 25 61 13 6 19 9 7 16 1 1 2 4 5 9 3 4 7 65 48 113 Hamlet of Knightsbridge 16 28 44 2 3 5 4 4 8 — 1 1 — 1 1 3 1 4 26 38 64 Knightsbridge St. George 35 45 80 9 5 11 15 7 22 — — — 3 4 7 3 — 3 64 61 125 Victoria 175 173 348 68 48 116 35 29 64 2 6 8 6 11 17 8 4 12 296 271 567 St. Margaret 49 45 94 17 13 30 15 17 32 — 2 2 1 3 4 8 — 8 90 80 170 St. John 161 137 298 123 69 192 45 28 73 4 4 8 8 6 14 5 1 6 345 245 590 St. Anne 44 47 91 21 13 34 17 5 22 — 1 1 1 5 6 — — 83 71 154 Great Marlborough 19 30 49 13 22 35 n 5 16 — 1 1 1 5 6 — — 44 63 107 Pall Mall 14 6 20 2 — 2 2 1 3 — — — 1 — 1 4 4 22 7 29 Regent 40 37 77 15 15 30 15 12 27 2 — 2 6 2 8 6 1 7 83 67 150 Charing Cross 11 14 25 7 5 12 7 5 12 — — — — — — — 3 3 25 27 52 Covent Garden 32 39 71 22 14 36 6 11 17 — 1 1 2 3 5 4 1 5 66 69 135 Strand 17 17 34 40 38 78 6 3 9 — — — 7 4 11 2 1 3 72 63 135 City of Westminster 659 652 1,311 353 253 606 190 135 325 9 17 26 40 49 89 46 16 62 1,297 1,122 2,419 14 Table VI (Return required by Local Government Board).—Statistics of Births and Deaths during the 52 Weeks from 3rd January, 1902, to 2nd January, 1904. 1 2 3 4 5 6 7 8 9 10 11 13 Wards. Population Estimated to Middle of the Year l903. Births (Corrected). Deaths Under One Year of Age. Total Deaths in the City. Deaths of Citizens in Public Institutions. Deaths of NonResidents Registered in District. Deaths of Citizens Registered beyond District. Deaths at all Ages. Nett. Number. Rate.* Number. Rate per l,000 Births (Corrected). Number. Rate.* Conduit 5,740 43 7.5 3 69 24 7 5 9 28 4.8 Grosvenor 15,025 151 l0.0 8 52 73 47 7 47 113 7.5 Hamlet of Knightsbridge 7,558 79 10.4 11 139 51 16 4 17 64 8.4 Knightsbridge St. George 15,150 125 8.2 16 128 440 44 342 27 125 8.2 Victoria 39,760 884 22.2 108 122 373 208 20 214 567 14.2 St. Margaret 13,430 162 12.0 17 104 363 67 247 54 170 12.6 St. John 31,296 877 28.0 115 132 323 288 23 290 590 18.8 St. Anne 11,304 240 21.2 24 100 129 63 38 63 154 13.6 Great Marlborough 7,386 162 21.9 17 104 78 58 18 47 107 14.4 Pall Mall 3,171 22 7.0 3 136 24 6 4 9 29 9.1 Regent 9,537 184 19.2 19 103 87 68 9 72 150 15.7 Charing Cross 4,387 34 7.7 9 264 41 24 15 26 52 11.8 Covent Garden 8,864 151 17.0 12 79 237 61 161 59 135 15.2 Strand 6,756 71 10.5 8 112 274 99 228 89 135 20.0 The City 179,052 3,185 17.7 370 116 2,517 1,056 931 833 2,419 13.5 * Kates calculated per 1,000 of estimated population. The uncorrected birth-rate was 16.8, uncorrected death-rate, 14.0. Note.—The deaths included in Column 7 of this table are the whole of those registered as having actually occurred within the ward. The deaths included in Column 11 are the number in Column 7 corrected by the subtraction of the number in Column 9 and the addition of the number in Column 10. 15 Table VII.—Quarterly and Annual Death-rates per 1,000 Inhabitants in the City of Westminster (in Various Wards), in the United Kingdom, England and Wales, and the County of London, for the 52 Weeks ending January 2nd, 1904. Period. United Kingdom. England and Wales. County of London. The City. Conduit Ward. Grosvenor Ward. Hamlet, of Knightsbridge Ward. Knightsbridge St. George Ward. Victoria Ward, St. Margaret Ward. St. John Ward. St. Anne Ward. Great Marlborough Ward. Pall Mall Ward. Regent Ward. Charing Cross Ward. Covent Garden Ward. Strand Ward. 1st Quarter 17.4 16.8 16.8 15.2 4.2 8.2 7.9 7.9 16.1 15.1 19.6 19.0 19.0 11.3 18.4. 11.0 16.3 26.6 2nd Quarter 15.4 14.9 14.2 13.2 4.2 7.2 8.4 10.5 14.0 12.2 18.1 12.4 12.4 10.0 13.8 10.0 15.3 20.7 3rd Quarter 14.0 13.9 13.5 11.6 4.2 6.1 8.4 6.8 13.0 8.9 16.4 12.0 14.6 6.3 14.7 9.1 11.3 15.9 4th Quarter 16.3 16.2 16.1 .13.9 7.0 8.5 9.0 8.4 13.6 14.3 21.0 11.0 11.9 8.8 15.9 17.2 18.0 16.5 The Year. Persons 15.6 15.4 15.2 13.5 4.8 7.5 8.4 8.2 14.2 12.6 18.8 13.6 14.4 9.1 15.7 11.8 15.2 20.0 Males — — 16.8 15.5 6.8 10.7 8.8 11.2 16.3 14.0 21.4 14.0 12.4 12.6 17.8 8.8 15.1 22.3 Females — — 14.0 11.7 3.5 5.3 8.2 6.5 12.6 11.3 16.1 13.1 16.4 5.3 13.7 17.4 15.3 18.9 16 Table VIII. (Required by the Local Government Board.) Vital Statistics of Whole Districts during 1903 and Two Previous Years. City of Westminster. 1 2 3 4 5 6 7 8 9 10 11 12 13 Year. Population Estimated to Middle of each Year. Births. Total Deaths Registered in the District. Total Deaths in Public Institutions in the District. Deaths of NonResidents Registered in Public Institutions in the District. Deaths of Residents Registered in Public Institutions beyond the District. Nett Deaths at all Ages belonging to the District. Number (Uncorrected). Rate.* Under 1 Year of Age. At all Ages. Number. Rate.* Number. Rate per 1,000 Births Registered. Number. Rate.* 1901 182,567 3,232 17.8 435 135 2,998 16.3 1,227 1,019 921 2,900 15.8 1902 53 weeks 184,211 3,284 17.8 442 134 2,899 15.7 1,129 906 959 2,952 16.0 1903 179,052 3,017 16.8 370 122 2,517 14.0 1,086 931 833 2,419 13.5 * Rates in Columns 4, 8, and 13 calculated per 1,000 of estimated population. Note.—The deaths to be included in. Column 7 of this Table are the whole of those registered during the year as having actually occurred within the district or division. The deaths to be included in Column 12 are the number in Column 7, corrected by the subtraction of the number in Column 10 and the addition of the number in Column 11. By the term "Non-residents" is meant persons brought into the district on account of sickness or infirmity, and dying in public institutions there; and by the term "Residents" is meant persons who have been taken out of the district on account of sickness or infirmity, and have died in public institutions elsewhere. The "Public Institutions" to be taken into account for the purpose of these Tables are those into which persons are habitually received on account of sickness or infirmity, such as hospitals, workhouses, and lunatic asylums. A list of the institutions in respect of the deaths in which corrections have been made is given on the next pages. Area of District in acres (exclusive of area covered by water) 2502.7 Total population at all ages 183,011 Number of inhabited houses 18,366 Average number of persons per house 8.9 At Census of 1901 17 Table VIII.—continued. I. II—continued. II—continued. Institutions within the District receiving Sick and Infirm Persons from outside the District. ( Total Number of Deaths in brackets.) Institutions outside the District receiving Sick and Infirm Persons from the District. Institutions outside the District receiving Sick and Infirm Persons from the District. St. George's Hospital (347). Victoria Hospital. Central London Sick Asylum, Hendon. Westminster Hospital (261). Lying-in Hospital, Endell Street. Charing Cross Hospital (126.) Banstead Asylum. King's College Hospital (211). General Lying-in Hospital, York Road. Cane Hill Asylum. St. Peter's Hospital (29). Caterham Asylum. Grosvenor Hospital (6). Hospital for Women, Euston Road. Claybury Asylum. Heart Hospital, Sobo Square (14). Colney Hatch Asylum. Seamen's Hospital, Greenwich. Darenth Asylum. Women's Hospital, Soho Square (18). Dartford Asylum. London Hospital. Hanwell Asylum. Male Lock (1). Children's Hospital, Paddington. Horton Asylum. Gordon Hospital for Fistula (3). Leavesden Asylum. West London Hospital. Camberwell House Asylum. Throat Hospital, Grolden Square (4). Queen Charlotte's Hospital. Middlesex Asylum. Great Ormond Street Children's Hospital. Bethnal House Asylum. Station Hospital, Rochester Row (8). Cancer Hospital, Chelsea. III. St. George's Workhouse, Wallis Yard (4). Royal Free Hospital. National Hospital. Poland Street Workhouse (27). Homoeopathic Hospital. Other Institutions, the Deaths in which have been distributed among the several localities in the District. University College Hospital. Bear Yard Workhouse (13). Brompton Hospital. 22, George Street, Hanover Square, Nursing Home (1). Hospital of St. John and St. Elizabeth. Clapham Maternity Home. Friedeuheim. II. Hospital Ships, Long Reach. 51, Welbeck Street. North-Western Fever Hospital. Hostel of God. Institutions outside the District receiving South-Western Fever Hospital. Westminster Almshouses. St. Martin's Almshouses. Sick and Infirm Persons from the District. Grove Fever Hospital. Tailors' Institution, Kentish Town. St. George's Infirmary, Fulham Road. St. Joseph's Home. Wandsworth Infirmary. 41, Boundary Road. Middlesex Hospital. Chelsea Infirmary. 40, Beaumont Street. St. Thomas's Hospital. Edmonton Workhouse. 13, Bulstrode Street. St. Bartholomew's Hospital. St. Giles Workhouse. 14, Pembridge Square. St. Mary's Hospital. Lambeth Workhouse. 5, Bentinck Street. Guy's Hospital. Holborn Workhouse. 55, Welbeck Street. London Temperance Hospital. Shoreditch Infirmary. H.M. Prison, Brixton. Camberwell Infirmary. H.M. Prison, Holloway. German Hospital. Paddington Infirmary. St. Anne's House, Stoke Newington. French Hospital. Central London Sick Asylum, Cleveland Street. Italian Hospital. St. Elizabeth's Home. c 18 Table IX.—Causes of, and ages at, death during the 52 weeks ending 2nd January, 1904:— Causes of Death. Corrected Deaths in the City at subjoined Ages. Deaths in Wards (at all Ages). All ages. Under 1. 1 and under 5. 5 aud under 15. 15 and under 25. 25 and under 65. 65 and upwards. 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. Smallpox 3 — — — 1 2 — — — — — — 1 2 — — — — — — — Measles 47 14 32 1 — — — — — — — 17 1 20 — 1 — 5 2 1 — Scarlet fever 9 — 7 2 — — — — i — — 3 — 2 — — — 2 — 1 — Epidemic influenza 26 — 1 — — 16 9 1 3 2 3 5 2 1 1 — — 5 2 1 — Whooping cough. 33 17 15 1 — — — — 2 — 1 9 3 12 2 1 — 1 — 1 1 Diphtheria, Memb. croup 16 — 14 1 i — — — 1 1 — 4 1 5 1 2 — — 1 — — Croup 2 — 2 — — — — — — — — 1 — 1 — — — — — Enteric fever 15 — — — 4 11 — — 2 — 1 2 2 1 2 1 1 1 1 — 1 Diarrhœal diseases 73 52 11 — 1 4 5 1 3 2 2 17 5 30 3 4 — 1 2 1 2 Gout 11 — — — — 7 4 — — — 1 2 2 — 1 — 2 1 — 2 — Erysipelas 6 — — — — 5 1 — — — 1 2 1 1 1 — — — — — — Puerperal fever 4 — — — 1 3 — — — — — — 2 1 1 — — — — — Other septic diseases 18 2 — 1 5 7 3 — 1 — — 1 1 6 2 1 — 2 — 3 1 Diabetes 19 — — 1 2 11 5 1 2 2 2 4 2 2 — — — 2 — 2 — Venereal diseases 9 7 — — — 1 1 — — — 1 1 — 5 — — 1 — 1 — Rheumatic fever 11 — 2 3 2 4 — — 1 2 — 3 1 3 1 — — — — — — Tuberculosis of meninges 23 5 13 5 — — — — — — 3 4 2 4 4 1 — 3 — 1 1 Tuberculosis of lungs 309 — 5 5 26 250 23 2 6 7 7 76 25 76 26 8 4 18 6 16 32 Tuberculosis of peritoneum 9 4 3 1 1 — — — — — — 4 — 3 1 — — — — — 1 Other forms of tuberculosis 19 2 4 1 4 8 — — — — — 7 1 3 2 2 — 1 1 1 1 Alcoholism 31 — — — 2 25 4 — 1 2 2 7 2 7 — 2 2 2 3 — 1 Malignant growths 179 — — — 3 112 64 2 10 8 17 36 9 40 11 6 — 10 2 14 14 19 Premature birth 72 72 — — — — — 1 1 1 2 24 3 18 4 3 1 6 2 2 4 Developmental diseases 100 85 15 — — — — 2 4 2 6 25 6 33 8 2 — 1 3 8 — Old age 140 — — — — 1 139 1 5 6 6 44 14 26 5 9 1 6 3 5 9 Meningitis and convulsions 42 25 12 2 2 — 1 — — — 3 12 4 10 4 2 — 3 — 3 1 Other diseases of nervous system 110 — — 3 1 58 48 — 8 — 7 25 3 26 5 8 — 5 1 12 10 Valvular diseases of heart 92 — — 5 8 47 32 1 1 3 6 15 7 21 9 6 1 8 3 9 2 Other circulatory diseases.. 218 1 — 1 4 114 98 4 8 3 20 49 20 50 12 6 7 10 4 11 14 Bronchitis 211 21 10 1 — 58 121 2 15 5 8 48 14 61 11 11 2 5 1 10 18 Lobar (croupous) pneumonia 27 3 2 — 2 16 4 — 2 1 — 3 2 6 3 2 — 3 — 3 2 Lobular (broncho-) pneumonia 64 26 22 2 — 7 7 — 3 3 4 12 2 18 5 3 — 10 1 3 — Other respiratory diseases.. 97 3 4 — 4 56 30 1 8 2 8 19 7 25 8 4 — 5 1 4 5 Cirrhosis of liver 47 — — — — 37 10 3 3 — 1 8 3 10 3 2 2 1 3 3 5 Other digestive diseases 74 8 7 3 6 37 13 1 5 3 2 20 11 9 4 7 1 4 — 3 4 Bright's disease, &c. 100 — — — 1 66 33 3 5 2 2 24 4 18 6 8 3 11 3 8 3 Generative system diseases 7 — — — — 6 1 — — — — 1 1 1 — — — 2 — 2 — Accidents and diseases of parturition 5 1 — — — 4 — — — — — 2 — — — — — — 3 — — Deaths by accident or negligence.. 80 16 5 6 8 32 13 1 5 3 5 21 4 16 6 1 — 9 2 4 3 Deaths by suicide, &c. 28 1 — — 2 23 2 1 5 4 — 2 1 6 1 — 1 6 1 — — All other causes 33 5 3 — 4 12 9 — 2 — 4 8 3 10 1 3 — 1 1 — — All causes 2,419 370 189 45 95 1,040 680 28 113 64. 125 567 170 590 154 107 29 150 52 135 135 c 2 20 Table X.—Death-rates per 1,000 Inhabitants in the City and Wards from, Various Causes, 1903. Causes op Death. Deaths in Wards at all Ages. Total. Conduit. Grosvenor. Hamlet of Knightsbridge. Knightsbridge St. George. Victoria. St. Margaret. St. John. St. Anne. Great Marlborough. Pail Mall. Regent. Charing Cross. Covent Garden. Strand Small-pox 0.016 — — — — — 0.07 0.06 — — — — — — — Measles 0.26 — — — — 0.43 0.07 0.64 — 0.13 — 0.52 0.45 0.11 — Scarlet fever 0.05 — 0 06 — — 0.07 — 0.06 — — — 0.21 — 0.11 — Epidemic influenza 0.14 0.17 0.19 0.26 0.20 0.12 0.14 0.03 0.08 — — 0.52 0.45 0.11 — Whooping cough 0.18 — 0.13 — 0.06 0.22 0.22 0.38 0.17 0.13 — 0.10 — 0.11 0.14 Diphtheria, Memb. croup 0.09 — 0.06 0.13 — 0.10 0.07 0.16 0.08 0.27 — — 0.23 — — Croup 0.01 — — — — 0.02 — 0.03 — — — — — — — Enteric fever 0.08 — 0.13 — 0.06 0.05 0.14 0.03 0.17 0.13 — 0.10 0.23 — 0.14 Diarrhœal diseases 0.41 0.17 0.19 0.26 0.12 0.43 0.37 0.95 0.26 0.54 0.31 0.10 0.45 0.11 0.29 Grout 0.06 — — — 0.06 0.05 0.14 — 0.08 — 0.63 1.10 — — — Erysipelas 0.03 — — — 0.06 0.05 0.07 0.03 0.08 — — — — — — Puerperal fever 0.02 — — — — — — 0.06 0.08 0.13 — — — — Other septic diseases 0.10 — 0.06 — — 0.02 0.07 0.19 0.17 0.13 — 0.21 — 0.34 0.14 Diabetes 0.10 0.17 0.13 0.26 1.12 0.05 0.14 0.06 — — — 0.21 — 0.22 — Venereal diseases 0.05 — — — 0.06 0.02 — 0.16 — — 0.31 — — 0.11 — Rheumatic fever 0.06 — 0.06 0.26 — 0.07 0.07 0.09 0.17 — — — — — — Tuberculosis of meninges 0.13 — — — 0.20 0.10 0.14 0.13 0.35 0.13 — 0.31 — 0.11 0.14 Tuberculosis of lungs 1.72 0.34 0.40 0.92 0.46 1.92 1.86 2.42 2.30 1.09 1.26 1.89 1.37 1.80 4.73 Tuberculosis of peritoneum 0.05 — — — — 0.10 — 0.09 0.08 — — — — — 0.14 Other forms of tuberculosis 0.10 — — — — 0.17 0.07 0.09 0.17 0.27 — 0.10 0.23 0.11 0.14 Alcoholism 0.17 — 0.06 0.26 0.12 0.17 0.14 0.23 — 0.27 0.63 0.21 0.68 — 0.14 21 Malignant growths 0.99 0.34 0.66 1.05 1.12 0.91 0.67 1.28 0.97 0.81 — 1.04 0.45 1.58 2.07 Premature birth 0.40 0.17 0.06 0.13 0.12 0.61 0.22 0.57 0.35 0.40 0.31 0.63 0.45 0.22 0.59 Developmental diseases 0.56 0.34 0.26 0.26 0.40 0.13 0.45 1.05 0.71 0.27 — 0.10 0.68 0.90 — Old age 0.78 0.17 0.33 0.80 0.40 1.11 1.04 0.83 0.44 1.22 0.31 0.63 0.68 0.56 1.33 Meningitis and convulsions 0.23 — .— — 0.20 0.30 0.29 0.32 0.35 0.27 — 0.31 — 0.34 0.14 Other diseases of nervous system 0.61 — 0.53 0.46 0.63 0.22 0.83 0.44 1.09 — 0.52 0.23 1.36 1.47 Valvular diseases of the heart 0.51 0.17 0.06 0.39 0.40 0.38 0.52 0.67 0.79 0.81 0.31 0.84 0.68 1.01 0.29 Other circulatory diseases 1.22 0.69 0.53 0.39 1.32 1.24 1.49 1.60 1.06 0.81 2.20 1.04 0.91 1.24 2.07 Bronchitis 1.17 0.34 0.99 0.66 0.52 1.22 1.04 1.95 0.98 1.49 0.65 0.51 0.23 1.12 2.66 Lobar (croupous) pneumonia 0.15 — 0.13 0.13 — 0.07 0.14 0.19 0.26 0.27 — 0.31 — 0.34 0.29 Lobular (Broncho.) preumonia 0.35 — 0.19 0.39 0.26 0.30 0.14 0.57 0.44 0.40 — 1.04 0.23 0.34 — Other respiratory diseases 0.54 0.17 0.53 0.26 0.52 0.48 0.52 0.79 0.71 0.54 — 0.51 0.23 0.45 0.74 Cirrhosis of liver 0.26 0.52 0.19 — 0.06 0.21 0.22 0.32 0.26 0.27 0.63 0.10 0.68 0.34 0.74 Other digestive diseases 0.41 0.17 0.33 0.39 0.12 0.51 0.82 0.28 0.35 0.95 0.31 0.42 — 0.34 0.59 Bright's disease, &c. 0.56 0.52 0.33 0.26 0.12 0.61 0.29 0.57 0.53 1.09 0.94 1.15 0.68 0.90 0.44 Generative system diseases 0.04 — — — — 0.02 0.07 0.03 — — — 0.21 — 0.22 — Accidents and diseases of parturition 0.03 — — — — 0.05 — — — — — — 0.68 — — Deaths by accident.or negligence 0.48 0.17 0.33 0.39 0.33 0.52 0.29 0.51 0.53 0.13 — 0.95 0.45 0.45 0.44 Deaths by suicide, &c. 0.15 0.17 0.33 0.52 — 0.05 0.07 0.19 0.08 — 0.31 0.63 0.23 — — All other causes 0.18 — 0.13 — 0.26 0.22 0.22 0.32 0.08 0.40 — 0.10 0.23 — — All causes 13.5 4.8 7.5 8.4 8.2 14.2 12.6 18.8 13.6 14.4 9.1 15.7 11.8 15.2 20.0 22 B. Communicable Diseases. (1) Compulsorily Notifiable Diseases. During the 52 weeks of 1903, 772 notifications of infectious disease were received by me. The details respecting them are set out in the Local Government Board's Return (Table XIV.), 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 XII., together with cases notified during the same period in the different divisions which, with some modifications, now form the City. These figures are exclusive of chicken-pox, of which there were 741 cases in 1902 and 5 in 1903, and exclusive of duplicate notifications. A comparison is made of the various years and of the ten-year's average (1892-1901). . The chart on p. 24 indicates the number of notifications of scarlet fever, diphtheria, enteric fever, erysipelas, and small-pox in each week. Four persons notified as suffering from small-pox, nine from scarlet fever, seventeen from diphtheria, and one from enteric fever, were eventually stated not to be suffering from the disease notified, but there is an element of doubt in connection with a number of scarlet fever and diphtheria cases, from the mild type which these diseases may assume. In addition, two cases of small-pox, one of puerperal fever, one of diphtheria, and one of enteric fever, were not notified. Two medical men were cautioned for delaying to notify cases, and one was summoned for failing to notify, and was fined £1 and 5s. 7d. costs. Several persons were cautioned for moving patients to hospitals after they had been informed of the nature of the case. Most of the persons were foreigners, with an imperfect knowledge of English, and in one case the patient was moved with the intention of preventing it being known that the case had occurred in a tailor's workroom. Small-pox—Cases of this disease were notified in London and in Westminster as follows during 1903:— London. Westminster. London. Westminster. January 14 — July 55 20 February 11 — August 39 3 March 13 — September 27 1 April 48 — October 41 5 May 53 — November 33 8 June 61 December 22 6 23 Table XII.—Infectious Diseases Notified, 1890.1903, in London. Year. Small.pox. 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 41,512 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 1902 7,796 18,252 10,731 3,407 4 47 311 5,536 1 2 46,087 1903 416 12,531 7,739 2,339 22 40 233 4,372 — — 27,692 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 1 76 — — 1,140 1900 2 453 287 118 — 4 5 129 — — 998 1901 102 475 253 104 — 2 6 117 — — 1,059 1902 232 475 285 132 — 1 6 144 — — l,275 1903 45 352 186 71 — 2 5 111 — — 772 Case.rates per 10,000 Living in London. Year. Small.pox. Scarlet Fever. Diphtheria. Enteric. Typhus. Other Continued Fevers. Puerperal. Erysipelas. 1891 0.3 27.1 15.2 8.0 0.1 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 0.1 0.5 0.9 22.6 1894 2.7 42.5 25.9 7.7 0.0 0.4 0.6 14.0 1895 2.2 45.2 25.7 8.0 0.0 0.2 0.5 12.9 1896 0.5 57.0 30.7 7.1 0.0 0.2 0.6 14.3 1897 0.2 51.2 29.6 7.0 0.0 0.1 0.6 13.0 1898 0.1 37.6 26.3 6.7 0.0 0.1 0.5 11.5 1899 0.1 39.9 30.1 9.8 0.0 0.2 0.7 12.3 1900 0.2 30.1 26.1 9.3 0.0 0.2 0.6 10.3 1901 3.7 40.1 26.7 7.0 0.04 0.1 0.5 10.1 Average of 10 years 1892.1901 1.7 49.4 27.2 7.7 0.02 0.2 0.6 13.5 1902 16.7 39.1 23.0 7.3 0.00 0.1 0.6 11.8 1903 0.9 27.1 16.7 5.0 0.04 0.08 0.5 9.4 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 0.1 21.5 17.7 5.9 — 0.1 0.3 6.9 1899 — 28.1 14.9 7.5 — 0.1 0.2 9.3 1900 0.1 24.0 15.2 6.2 — 0.1 0.3 6.8 1901 5.5 35.7 13.6 5.6 — 0.1 0.32 6.3 Average of 10 years 1892.1901 1.8 35.5 16.0 6.3 — 0.25 0.31 8.3 1902 12.6 25.8 15.4 7.1 — 0.05 0.32 7.8 1903 2.5 19.6 10.3 3.9 — 0.11 0.27 6.2 24 City of Westminster. Notifications of Infectious Diseases during the year 1903. 25 City of Westminster. Table XIII. Local Government Board Table C.— Cases of Infectious Disease Notified during the 52 weeks from 3rd January, 1903, to 2nd January, 1904. 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 all Ages. At Ages—Years. Conduit. Grosvenor. Knightsbridge St. George. Victoria. St. Margaret. St. John. Kamlet 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. 0 to 1. 1 to 5. 5 to 15. 15 to 25. 25 to 65. 65 and upwards. Smallpox— Cases 45 — 2 7 11 25 — — 2 — 19 5 18 — — — — — — — 1 — — — 19 5 18 — — — — — — — 1 43 Deaths 3 — — — 1 2 — — — — — 1 2 — — — — — — — — Diphtheria— Cases 186 4 73 63 27 10 — 4 7 12 2 9 29 6 1 24 17 4 8 7 16 4 5 9 42 8 29 4 1 22 17 4 8 7 14 174 Deaths 16 — 14 1 1 — — — 1 — 4 1 5 1 — 2 2 1 — — 1 Erysipelas— Cases 111 4 3 5 6 84 9 — 5 10 21 8 27 1 1 5 1 3 10 5 14 — 1 3 6 1 8 — — — — — 4 1 1 25 Deaths 6 — — — — 5 1 — — 1 2 1 1 — — — — — — — 1 Chicken-pox— Cases 5 1 1 3 — — — — — 1 1 — 3 — — — — — — — — — — — — — — — — — — — — — — — Deaths — — — — — — — — — — — — — — — — — — — — — Fevers. Scarlet— Cases 352 3 126 16?, 41 20 — 3 16 2l 67 17 44 7 4 42 48 3 21 6 53 3 15 17 61 17 42 6 3 38 48 3 19 5 50 327 Deaths 9 — 7 2 — — — — 1 — 3 — 2 — — 2 — — — 1 — Enteric— Cases 71 — 1 11 22 37 — 3 5 5 12 6 11 — 1 3 3 3 5 7 7 2 2 4 9 6 11 — 1 1 2 2 3 5 6 54 Deaths 15 — — — 4 11 — — 2 1 2 2 1 — 1 1 1 1 — 1 2 Continued— Cases 2 — — — 1 1 — — — 1 — — — — — — — — — — 1 — — 1 — — — — — — — — — — 1 2 Deaths — — — — — — — — — — — — — — — — — — — — — Puerperal— Cases 5 — — — 3 2 — — — — — — 3 — — — — — — — 2 — — — — — 2 — — — — — — — 1 3 Deaths 4 — — — 2 2 — — — — — — 2 — — — 1 — — — 1 Total Cases 777 12 206 251 111 188 9 10 35 50 162 45 135 14 7 74 69 13 44 25 94 9 23 34 137 37 110 10 5 61 67 9 34 18 74 628 4 cases notified as smallpox, 9 as scarlet fever, 17 as diphtheria, and 1 as enteric fever were eventually stated not to be suffering from the disease notified. In addition to the above, 2 cases of smallpox, 1 of puerperal fever, 1 of diphtheria, and 1 of enteric fever were not notified. Chicken-pox ceased to be notifiable on 6th January, 1903. 26 The figures for the City refer to real cases of the disease. Thus no cases were notified in the City until July, but as through the agency of tramps, the disease had been introduced into districts close to London, I addressed a letter to those in charge of Casual Wards, Common Lodging Houses, and Shelters in the City, calling their attention to the possibility of persons suffering therefrom obtaining admission to such places, and asking that a look-out be kept for any suspicious cases. Notices were received from Port Sanitary Authorities or from other Boroughs, of persons proceeding to or living in Westminster, who had been in contact with cases. They were communicated with and kept under observation; no cases resulted therefrom. Information was also sent me by the Medical Officer of Health of Battersea with respect to a man living in that Borough but employed in Westminster. It appears that he was taken ill about the 2nd May, with what was certified to be chicken-pox, and he remained at home until the 6th, when he returned to work among two hundred other men. After ten days, his wife took ill, and her illness was diagnosed as small-pox ; the husband was then found to have the remains of the eruption upon him, and there is no doubt that he had also suffered from it. There had been a number of cases of small-pox in the vicinity of his home. His fellow-workmen were kept under observation, and any absent from work were visited. Some had been re-vaccinated last year and others were re-vaccinated now. Fortunately no other cases have occurred. In July last a sharp outbreak occurred, the history of which is as follows:— A case of small-pox in Gloucester Street, Pimlico, was notified to me on the 2nd July, and on investigation an unvaccinated child, aged 4, was discovered in the same house just recovering from an attack. No medical man had been in attendance, and the mother thought it was a case of chicken-pox. Two older children occupied the same room, both had been vaccinated and so escaped, but they were instrumental in conveying the infection to their schoolmistress and to two unvaccinated children in their class. A second case occurred in the house next day, and subsequently sixteen additional cases occurred. The child who was first taken ill had been allowed out in the street while still infectious, and doubtless some of the cases must have been contracted through coming in contact with her, but in several instances the persons affected had not been near Gloucester Street. The difficulty was cleared up by the occurrence of two cases at a pawnshop, and an examination of the books showed that several of the persons affected had been there on a certain date, and as the same period intervened before the appearance of symptoms, it is pretty certain that both they and the pawnbroker's assistants contracted the disease from some person there at the same time; although the 27 mother of the child first mentioned denies that she had ever been to this shop, one of the assistants stated that he knew her as a customer and was able to give her address. In one instance the back garden of a house in which a patient lived adjoined that of the Gloucester Street house, and possibly infection was contracted by contact with the child who played in the small garden. How this child, who had not been out of the neighbourhood, became infected has been somewhat difficult to determine. She was taken ill about the 14th June, and as symptoms do not appear until 12-14 days after infection, she must have been infected in the end of May, or beginning of June. There had been cases in Battersea and Wandsworth, and also a serious outbreak among the men in Bowton House, Vauxhall, in the Borough of Lambeth, about this time; two or three of these were employed in Westminster, but their movements were traceable, and persons who had been associated with them were kept under observation. The field was therefore narrowed down to the existence in the neighbourhood of either an unsuspected case or to the possibility that one of the Bowton House men had been in the district. The former theory appeared improbable, as with a resident undetected case other cases would have occurred earlier in June, but to make sure, a house to house visit was made in the infected streets and those adjoining, fortunately without discovering such a case. Enquiries were then set on foot with respect to the movements of one or two persons notified about the beginning of June in other Boroughs, and eventually I applied to Dr. Ricketts at the Hospital Ships, and he kindly interviewed a patient from Rowton House, Lambeth, whom I suspected as a possible source of infection, his illness having been notified on the 2nd June. Dr. Ricketts elicited the fact that on two occasions, viz., on May 30th and on June 2nd, this man was in Gloucester Street, Pimlico, close to the house where the first case occurred, and as this unvaccinated child was playing about on the pavement, there is little doubt that the infection was conveyed in this way. Two persons were notified as doubtful small-pox, who after further observations were decided to be suffering one from chicken pox and the other from measles. One man was isolated at the Shelter for a week, when he became ill and was removed to the Hospital. He had been re-vaccinated some days after being infected with small-pox, with the result that the disease was stopped at an early stage and he was able to leave Hospital at the end of 14 days, the average residence of non-fatal cases in the previous epidemic being 34½ days; none of these cases proved fatal, but four of them were in hospital for about eleven weeks each. A teacher at a school in Westminster, who had to pass through affected streets, was notified to be suffering from small-pox in Wandsworth, where her home is. One patient had been at Margate, and while 28 there his wife had an illness which was looked upon as the result of eating ice-cream while overheated, but it was evident that it was a mild attack of small-pox. Mr. Elkerton, the Vaccination Officer, made inquiries as to the number of unvaccinated persons in the schools and houses affected. A considerable portion of the adult population were re-vaccinated last year, and thus less interference was necessary with regard to persons going to work than was the case in 1902. In August, an unvaccinated young woman, a servant at an hotel, a patient in one of the general hospitals, was found to be suffering from small-pox, which she had probably contracted when on a visit to friends in an infected area outside the City. A man and his wife both contracted the complaint from visiting a daughter ill with it in Lambeth. In October, two fresh cases of infection occurred, one of which was restricted to three cases, but the other gave rise to eighteen others. In the former the case came from Wiltshire, the eruption appearing on arrival in London, and a child, who had been sleeping in the same bed, has subsequently had a slight feverish attack, probably varioloid in its nature, and treated as such; a person in an adjoining Borough who had been with these persons in the country also developed small-pox on coming to London. A number of business premises and private houses had been visited by them, but no further cases have occurred in connection therewith; the persons therein were either promptly re-vaccinated or had been re-vaccinated during the last two years. The latter outbreak arose as follows:— From the Medical Officer of Ware I learned that a man had been on a barge there, suffering from small-pox, and that he had been at a wharf adjoining Millbank for a few days about the 5th October. On enquiry I found that he had kept to his cabin most of the time, but on one occasion at least had visited a public-house in the neighbourhood, and a man who visited him on the 5th observed that he had an eruption on his face. A number of persons were kept under observation in consequence; most of the men employed on the wharf had been re-vaccinated during the last year or two and none of them contracted the disease. Three persons residing in the neighbourhood were seized with illness about the 17th October, which would give the usual incubation period of twelve days. One of these was (a) the manager of a public house (said to have been vaccinated in infancy but with no marks), another (b) an unvaccinated child of five years of age, and the third (c) a married woman aged 38 (since dead) who had had a previous attack of small-pox at the age of 7 years. This woman did some washing, which possibly came from the barge above mentioned. 29 Someone who had been in contact with this bargeman patronised a barber in the City, and one (d) of the assistants apparently had a mild attack, but this was not discovered until he had recovered, when another assistant (e) developed the complaint. This also was of so mild a nature that he continued his work for three days with the eruption out on him, when a medical man whom he was shaving recognised the malady. No further cases came to my knowledge as a result of these two cases. Still, the disease spread in other directions from one or other of the cases infected by the bargeman. The first of these was a young woman (f) living in Laundry Yard, and she was followed by two sisters (g and h) and a niece (i). In connection with this group of cases considerable difficulty was encountered in ascertaining the number of persons in the house, in obtaining admission, and finding where the girl (h) was employed. The first case (f) was at home for eleven days after the beginning of the illness, and this last ease was concealed for a week after the appearance of the eruption, and eventually it was discovered that she had been to work as an ironer at a large laundry in the City, and had infected a woman (j) who worked beside her. A boy (k) who played with the brothers of (g) and (h) was found by me in a large tenement house, being treated by a medical man for measles. The rash bad evidently been out for a week, and was of a most typical description. Another case (l) was a resident in a common lodging-house in the neighbourhood, and was probably infected from (a). His case proved fatal. A second man (m) was notified in the same house three days after (l), but he had only arrived there the day before from one of H.M. prisons, where he had been for seven days, and there is no history of his having been in the neighbourhood during the preceding week. Five cases occurred in the City during December. One of these (m) has already been referred to in the previous report; two other cases (n and o) were traceable to the Laundry Yard group, one a man, the other an unvaccinated child. Three other cases were apparently infected while inmates of a general Hospital by a visitor; both left the Hospital on the 5th December, one went to a Convalescent Home at Birchington-on-Sea, the eruption came out on the 12th, she was not seen by any medical man, and travelled up to London on the 15th by train, returning to the Hospital when she was at once notified. The other woman went into St. George's Infirmary, where she eventually developed the complaint. Three additional cases occurred in the same neighbourhood in the early part of January, 1904, and finished this series of cases. In connection with the circumstance mentioned above, in the Laundry Yard group of cases, the Council summoned the mother for 30 failing to notify the cases of small-pox which was discovered at her house; but the Magistrate, while expressing the opinion that the Council was right in bringing the case forward, was unable to convict, as he held that the husband was the proper person to be summoned; on the other hand, it was pointed out that the Council could not prove that the husband knew anything about the matter, as he had never been seen at the house. The case is one which exemplifies the need for further power, especially in regard to the concealment of information and the giving of false information. Including two cases not notified, and deducting four which were not small-pox, the net number of cases was 43 with three deaths. The cases occurred in 32 houses, one being a common lodging-house; 23 had one case only, eight had two cases, and one had four cases. Vaccination.—The Vaccination Officers have supplied me with the following particulars for 1902:— Table XIV.— Vaccination Statistics. 1902. Union. Births. Died Unvaccinated. Successfully Vaccinated. Insusceptible. Vaccination Postponed. Conscientious Objectors. Removed and Vaccination Officer Informed. ound. Removed to Address Unknown. St. George 2,323 214 1,949 11 14 13 32 88 Westminster 642 42 513 1 3 6 30 47 Strand 279 21 205 0 11 1 10 31 The City 3,244 277 2,667 12 28 20 72 166 The following is a summary of the total primary vaccinations performed in the City during 1901, 1902 and 1903, and of revaccinations, in so far as these were made by the Public Vaccinators:— Table XV. Union. Primary Vaccinations under 14 years of Age. Re-vaccination. 1901. 1902. 1903. 1901. 1902. 1903. St. George 2,467 2,893 2,178 4,039 7,453 159 Westminster 1,491 715 369 3,317 6,226 9 Strand 725 450 245 2,201 3,910 347 The City 4,683 4,058 2,792 9,557 17,589 515 31 Scarlet Fever.—There were 12,531 cases notified in London in 1903, as compared with 18,252 in 1902, and 352 in the City, as compared with 475 in each of the two previous years. These figures give rates of 27*1 per 10,000 of population for London, against 39;1 in 1902, and 19"6 for Westminster, against 25'8 in 1902. In certain of the Wards, however, scarlet fever was prevalent to a marked extent—in St. Anne Great Marlborough and Eegent Wards: as in the previous year, it affected St. John and Victoria Wards. It began in the first quarter of the year in St. Anne's, and spread in the second and third quarters to the neighbouring wards. This is shown in detail as follows:— Scarlet Fever, 1903. Conduit. Grosvenor. Hamlet of Knightsbridge. Knightsbridge St. George. Victoria. Sc. Margaret. St. John. 1st quarter 2 3 1 6 14 9 17 2nd quarter — 7 5 9 19 2 7 3rd quarter — 5 — 4 12 2 9 4th quarter 1 1 1 2 22 4 11 Total eases 3 16 7 21 67 17 44 Deaths — 1 — — 3 — 2 Attack rate per 10,000population 5.2 10.6 9.2 13.9 16.8 12.6 14.0 Mortality per cent, of cases — 6.2 — — 4.4 — 4.5 Scarlet Fever, 1903. St. Anne. Great Marlborough. Pall Mall. Regent. Charing Cross. Covent Garden. Strand. Totals for City. 1st quarter 28 9 1 10 2 8 3 113 2nd quarter 12 16 2 21 1 4 3 108 3rd quarter 8 18 — 8 — 8 — 74 4th quarter 5 5 1 3 — 1 . — 57 Total cases 53 48 4 42 3 21 6 352 Deaths — — — 2 — 1 — 9 Attack rate per 10,000 population 46.0 65.0 12.6 44.0 6.8 23.7 8.8 19.6 Mortality per cent, of cases — — — 4.7 — 4.7 — 2.55 As the majority of cases are in persons under 15 years of age, and some wards contain a larger proportion of young persons than others, it would be more instructive to calculate the rate on the number of persons at these ages in each ward, but, unfortunately, the census figures only give the details for the Union districts. Taking these for comparison, we get:— 32  Rate per 1,000 Persons under 15 years. Deaths per 100 Cases. 1901. 1902. 1903. 1901. 1902. 1903. St. George's Union 11.2 11.6 7.1 1.3 3.2 3.4 Westminster Union 15.6 20.0 22.2 0.9 2.2 1.3 Strand Union 15.1 8.8 5.1 6.4 6.0 3.3 The City 12.7 12.9 10.1 1.8 3.3 2.5 The County 13.4 13.2 9.1 3.2 3.0 2.8 There were 29 houses with two cases of scarlet fever, and in all but 4 instances the patients were members of the same family; 10 houses had 3 cases in each, in 4 instances 1 of the patients was of a different family to that first affected. Of the 36 second cases, 22 were notified simultaneously or within a week of the first case, 4 between the fifteenth and thirtieth day after the first case, and 12 at intervals of from three to nine months after, of these last 4 occurred within a few days of the first patient's return from hospital. Of the 10 third cases, 5 were simultaneously or within a few days of the first case, 3 of the second case, and 2 within ten days. There is no doubt that school infection was the means by which the disease was spread (see p. 43). Scarlet fever occurs nowadays in such a mild form that cases are not recognisable, having often no rash. These mild undetected cases go about and infect others ; it is only when a susceptible person is infected and develops the disease in a typical form that a doctor is called in and the case is notified. Diphtheria.—186 cases of diphtheria were notified during 1903, equal to a rate of 10'3 per 10,000 inhabitants, as compared with 15.4 in 1902, with 16 0 the rate in the ten years 1892-1901, and with 16.7 the rate for all London for 1903. There were 16 deaths, equal to a mortality of 8.6 per 100 cases, as compared with 10 per cent. in 1901, and 11 for 1902. The London rate for 1903 was 9.8 per cent. Bacteriological Diagnosis.—The arrangements made with the Jenner Institute for the bacteriological examination was taken advantage of with regard to 39 persons who were suffering from throat affection or had been exposed to infection; 44 examinations and re-examinations were made by the Jenner Institute, but many others were made at hospitals and in private laboratories. In nine of the above instances the bacillus was found, and in one the pseudo-diphtheria bacillus (a modified, less virulent organism) was present on first examination; five subsequent examinations were made in cases treated at home, and a positive report was obtained in one instance, negative in four. The organism sometimes persists for long periods in patients 33 apparently recovered, but there are, however, many cases which are at the other extreme, and yield readily to treatment, and it is probable that this was so in a considerable proportion of the 11 cases returned from hospital as not suffering from this disease; most of these were out-patients at general hospitals, and had their throats examined bacteriologically there. By the time the report was ready and the cases admitted into an isolation hospital, the treatment under which they had been put proved sufficient to remove the cause of the disease, and thus a second examination proved them not to be then suffering. It has been found in families in which a case occurs that, not infrequently, other members get the diphtheria organism in their throats, and may or may not develop symptoms according to their susceptibility and the state of their health; but if they do not develop symptoms they may pass the organism on to other persons. If diphtheria is to be got rid of, it will be necessary to examine children and others in affected families, especially in tenement houses, so that they may not go about spreading the disease. The throat after scarlet fever is in a condition specially adapted for the growth of the diphtheria organism, and a number of cases occur in which diphtheria supervenes thereon, but several cases point to the possibility of scarlet fever patients conveying the diphtheria bacillus in their throats to other persons, without themselves developing the disease. Bacteriological examination was made of the throats of two patients returned home from hospitals as well, but in neither was the diphtheria organism found ; in one case there was a suspicion that the infection had been conveyed to other children, in the other the examination was made as the child was being admitted to an institution. Attention having been drawn to the fact that discharges from the ears after scarlet fever might form suitable soil for the growth of diphtheria bacilli, a look out was kept for such cases, with the result' that one child was found who, although apparently well on leaving hospital, developed a discharge from the ear within a day or two. Examination was made of this discharge, and the report was that it contained modified forms of the diphtheria bacillus, and on the same day on which the report was received a sister was found to be suffering from diphtheria, which rather confirmed the bacteriological report. In only eleven houses was there more than one case notified, and all were confined to members of the family attacked. In one house there were four cases, in another three cases, and in nine houses two in each; except in four instances (in the last group) they were all notified at the same time. These four exceptions have certain noteworthy features:— Group (a) case, notified in January, and was in hospital until August; a playmate had scarlet fever in the country, and was considered " not to D 34 have properly recovered " ; the second case of diphtheria occurred on the 9th February, and the medical man in charge of the case was of opinion that the complaint had been conveyed to the child from a cat, which was also seriously ill, and had a discharge from its nose; he had the cat killed and buried. By the time the information reached me the cat had been buried about three days, but I had it exhumed and examined, but no definite results were obtained. Group (b).—One month elapsed between the return from hospital of the first case (he had been in hospital fifteen weeks) and the occurrence of the second, and no history of sore throat could be obtained among the other members of the family ; it is possible that the first case still had some of the bacilli in his throat, and this appears probable, as a playmate living in the same block of buildings was notified with it on the same day as the second case. Group (c).—Four months elapsed between the return of the first case from hospital and the occurrence of the second; no definite connection between the two cases was observed. Group (d).—The first case was notified on the 26th March, the second on the 4th May; the former was aged 5 years, the latter 3 years, yet both had had diphtheria previously, the former in March, 1902, the latter in November, 1901, when living at another address. It is possible for the organisms to have remained in their throats until the period of protection conferred by the first effects was ended, or it may have been that one or both were subject to fresh infection; they were in hospital for the second attacks for nine and thirteen weeks respectively. Notifications of Diphtheria Cases Received in each Month of the Years 1901, 1902 and 1903. January. February. March. April. May. June. July. August. September. October. November. December. Total. 1901 13 10 16 22 19 19 34 19 27 36 21 17 253 1902 27 19 17 17 25 20 39 25 9 27 32 28 285 1903 17 13 23 8 18 14 21 9 13 17 13 20 186 An apparent connection between certain cases of diphtheria and sewer emanations was discovered, but as several other kinds of infectious disease were located in the same locality, the connection would appear to be rather that of a predisposing influence than of direct causation. Complaints were received that offensive emanations came from the street ventilators with steam, and a shaft ventilator against a house was found to be quite hot to the touch. The temperature of the sewage was ascertained by the City Engineer to be 175° F., and in a drain 35 discharging into the sewer, 207° F. The County Council were communicated with, it being their duty to prevent persons discharging water or other matters into the sewers above a certain temperature and the condition eventually seemed to have been remedied. Typhoid Fever.—Seventy-one cases of this disease were notified in the City, as compared with 132 in the previous year, but three cases were afterwards proved not to be so, while one case in barracks was not reported ; there were also two cases notified as continued fever, which may be included. These cases were equal to 4 per 10,000, which is the lowest hitherto recorded, the average of the previous ten years being 7 per 10,000. The whole of London also showed a decrease, the rate being 5.0 against 7'7 for the ten years. Fifteen deaths occurred from this cause (being 21 per cent. of the cases), the mortality for London being 16'5 per cent. of the cases. In twenty-nine instances the complaint was ascertained not to have been contracted in the City. It is not surprising that such occurs, as a long period may elapse between the reception of infection and the appearance of symptoms, long enough to allow people to travel to Westminster from distant parts; thus of these twenty-nine, three came from America, four from Paris, one from Ostend, three from Dublin, twelve from various parts of England, and the remainder from othei parts of London. Probably others might be included among these, but the information was not obtained. In many cases it is very difficult to discover the manner in which the disease was contracted. This is due to several reasons, such as the long period between the inception of infection and the appearance of symptoms, and the removal of patients to Metropolitan Asylums Board hospitals, so that information cannot be obtained from them. I have gone over the list of cases, and so far as possible I have divided them into classes:—In twenty-nine instances no sufficient cause was discoverable ; four cases probably contracted the disease from other cases; in fifteen cases there appeared to be a direct connection with the •eating of shell-fish (thirteen oysters, one mussels, one cockles); in one with fried fish ; one fried fish or watercress; two with ice-cream ; five with water (four abroad) ; five (two hospital nurses) were the result of infection from other cases ; and in six serious sanitary defects were found in the premises. I find that among the patients were four cooks and twelve other persons (butlers, waiters, &c.) who might in the course of their duties have to handle shell-fish or other contaminated food; in only six was there a history of sliell-fish having been eaten. Seven patients were scholars; two ate ice-cream, one fried fish, one fried fish and watercress, one mussels, and one cockles. Letters were addressed to all the clergy d 2 36 and others organising excursions to the seaside, asking them to warn those going of the danger of eating shell-fish, especially in a raw condition, and in most instances this was acted upon. In one of the above cases I found that the boy went with 401 scholars to Littlehampton 011 July 23rd, and that fourteen boys and two girls ate shell-fish, mussels chiefly ; only the one boy suffered. During the year I have reported as follows with regard to shell-fish in relation to typhoid fever:— (a) In a case in this city and in several cases in other boroughs, a history of having eaten oysters in Westminster was obtained, and in view of the possible connection with the illness, I made enquiries as to the sources from which the oysters were obtained. I submitted the names of the merchants supplying the tradespeople to the Fishmongers' Company, who have jurisdiction over all fish brought to London for sale. Eventually the Company informed me that they had watched certain beds at Emsworth, known to be polluted, had seen oysters removed from them, and traced them to Portsmouth and to London (to a merchant supplying Westminster dealers). Those sent to London were sent under a designation implying that they came from a pure source. The Fishmongers' Company promptly seized the oysters which they had traced, but as the seizure had not been carried out by a sanitary authority, it appears that no proceedings can be taken in London against the owner of the incriminated beds. These beds are not the ones the oysters came from which led to the outbreaks last year at Winchester and elsewhere, but they adjoin them. (b) On June 23rd I received a letter from the Medical Officer of Health of the City of London, stating that, as a result of a communication that oysters procured from a certain sonrce had been eaten by a person who thereafter developed typhoid fever, he had seized two sacks containing 1,600 oysters on the premises of Mr. Ullmann, oyster merchant, which he believed came from a polluted source. On application being made for the condemnation of the oysters seized, it wasstated on behalf of Mr. Ullmann that the oysters seized did not come from the storage pit (which had been previously condemned, but were taken straight from the' oyster beds at South Deep. In view of this statement, the Alderman to whom application was made decided that samples of these oysters should be examined, both by Dr. Klein and by anyone whom Mr. Ullmann might employ for that purpose. On June 25th the further hearing of the summons took place, and evidence was given that a dozen oysters had been taken from each of the sacks and submitted to bacteriological examination, with the result that of the 24 oysters thus obtained, 11 were found to contain dangerous bacilli. The analysis conducted on behalf of Mr. Ullmann practically coincided 37 with that made on behalf of the City authorities. The Alderman accepted the statement made on behalf of Mr. Ullmann, that he had taken every precaution, but granted the condemnation order asked for. On hearing from Dr. Collingridge, I at once saw Mr. Ullmann, and visited his three shops in the City of Westminster, and he made a similar statement to me, but undertook not to dispose of the oysters at these establishments until the result of the examination was ascertained. The examination proving unfavourable, the oysters (250 in all) at his shops were destroyed by Mr. Ullmann. (c) I understand that Portuguese oysters have on more than one occasion been found to be sewage-polluted, and that there are strong suspicions that the pollution takes place before they are relaid in this country, and that even after relaying in clean beds for a considerable period they do not get rid of the contamination. British-born oysters, of Portuguese origin, remain absolutely unpolluted, when raised in proper localities. In view of the opening of the oyster season, the Fishmongers' Company have issued a notice stating that a number of oyster merchants and others have pledged themselves to use every effort in their power to insure that none but healthy oysters from uncontaminated sources should be placed upon the market for sale. So far this is satisfactory, but it does not go far enough, as there is no guarantee to the purchaser that oysters he may be buying are from the above sources. What is required, alike in the interests of the public and the trade itself, is that the purchaser may be assured that he is buying an article of food which it is safe for him to eat. The Fishmongers' Company, finding that the Leigh Cocklers were not carrying out their undertaking as to the deposit and cooking of cockles, on the 14th October wrote to each of them that from that date the sale of cockles.from Leigh is absolutely prohibited. There is no doubt, from the reports obtained by the City of London and bv the Fishmonger's Company, that shell-fish from other points on the Thames Estuary besides Leigh are polluted, as for example at West Shoebury (one of the above cases ate cockles at Gravesend) and the Fishmongers' Company have now prohibited the sale in London of any shell-fish from the Thames Estuary. Several cases having been traced at times to a particular place of business in the City, communications were made to the persons supplying this dealer. Enquiry into the case showed that the dealer dealt with two wholesale men, and more regularly with one than the other, and the evidence pointed to the latter as the source of the infected oysters. The facts were communicated to the Fishmongers' 38 Company, and the dealer undertook to purchase only the one class of oyster (from Brightlingsea), which seemed to he free from suspicion. Fried Fish.—A case which occurred in November appears to be one of a group of about twenty occurring coincidently, the others being in the adjoining Borough of Holborn, in which all the persons had partaken of fried fish from one shop. Careful enquiry has failed to discover the exact source of infection, but probably one batch of fish bought on a certain day had been contaminated. The Royal Commission on Sewage Treatment deals very fully in its Fourth Report (dated 28th December, 1903) with the contamination of shell-fish in tidal waters by the discharge of sewage therein, having been prompted to a consideration of the subject by the growing demand for legislative action made by, among others, the City of Westminster. They recommend:— " 1. Purification of sewage before its discharge into tidal waters. o o " 2. The seizure and destruction of unwholesome shell-fish exposed for sale. " 3. The setting up of a competent authority to deal with all tidal waters, with power to control foreshores, to close dangerous beds, pits, ponds, and layings, and in certain circumstances to require treatment of sewage. " It is proposed that the Central Authority should be a new department under the Local Government Board. In connection with foreign shell-fish, they seem to consider it sufficient to ask for a guarantee on the part of each Government concerned that ' all oysters or other shell-fish imported into this country for human consumption have been procured from localities where they were not likely to be contaminated with sewage or other objectionable filth.' " Army Blankets and Typhoid Fever.—Notice was received from the Medical Officer of the City of London that a large consignment of Army blankets which had been used in South Africa had been returned to this country, that ten cases of typhoid fever had occurred on board the training ship " Cornwall," and it was believed the infection came from certain of those bankets, which had been recently taken into use. On investigating the cause of the outbreak, attention was directed to stains on the blankets, and examination by Professor Klein proved that they were swarming with typhoid germs in active condition. 596 of these blankets had been purchased by five firms in the City of Westminster; 500 of these had been shipped to various ports on the West Coast of Africa, and had not been brought into this City at all; the firm, on becoming acquainted with the possibility of the blankets being 39 infected, cabled instructions to their representatives that they should be destroyed on arrival. I also advised the Colonial Office. Twelve blankets had been sent by another firm into two other boroughs, and the officials were duly informed. The remainder, 84 in number, were secured, disinfected by steam, and returned to their owners. No marks of staining were observed, but some blankets which had not been used were found to be very dusty. No bad results occurred among the persons who had been handling these blankets. Bacteriological Examination.—Advantage was taken of the Council's arrangement with the Lister Institute in seventeen instances: to have a drop of blood from a suspected case examined; in seven cases a positive result was obtained (the reaction is not always obtained early in the disease), but none of the others were eventually notified as typhoid fever Enteric Fever and Watercress.—A copy of a report by the Medical Officer of Health of Hackney, on the subject of Enteric Fever and Watercress, was considered by the Council, together with the following recommendations thereon adopted by them " 1. That the Local Government Board should be asked to make an inquiry as to the sources of the watercress supplied to the metropolis in relation to the possibility of this article causing disease. " 2. That copies of the report of the Medical Officer of Health should be forwarded to all Metropolitan Borough Councils and the London County Council, and that they be asked to support the applications made by the Borough of Hackney to the Local Government Board. " 3. That a copy of the report be sent to the County Borough of West Ham, and their attention drawn to the manner in which watercress is grown in that borough, and that they be requested to adopt such measures as may be necessary to ensure that such watercress shall be free from pollution." The Council concurred in these views, and addressed a communication on the lines suggested to the Local Government Board. (3) Non-notifiable Diseases. Measles.'—Forty-seven deaths were attributed to this cause in 1903 in the City, but probably a large proportion of the fifty deaths from broncho-pneumonia, at the same age periods, originated in measles. With one exception all the deaths in Westminster were in children under five years of age. Reckoned on the number of children living at this period, the death-rates for measles are :— 40  1901. 1902. 1903. City of Westminster 4.6 3.3 3.7 County of London 3.7 4.6 4.0 During the year 761 cases came to my knowledge, 523 having been notified by school teachers, 238 by medical men and others. The mortality on these is equal to 6.1 per cent., but with the bronchopneumonia deaths it would be double. The majority of these were in St. John and Victoria Wards (see Infectious Diseases and Schools, p. 42). The deaths were distributed as follows :— Measles, 1903. Victoria Ward. St. Margaret's Ward. St. John Ward. Regent Ward. Great Marlborough Ward. Charing Cross W ard. Covent Garden Ward. 1st Quarter 2 — — — — — 1 2nd Quarter 6 1 2 — 1 2 — 3rd Quarter 3 — 7 4 — — — 4th Quarter 6 — 12 1 — — — 17 1 21 5 1 2 1 Calculated on the number of children under five years of age Jiving in the three Union Districts of the City, the rates are 4.4 per 1,000 in St. George, Hanover Square, 0.24 in Westminster, and 0.15 in the Strand. The County Council made an order on January 20th, 1903, whereby the provisions of sections 60, 61, 62, 63, 64, 65, 68, 70, 72, 73 and 74 of the Public Health Act with respect to infectious diseases were extended to measles. These relate to cleansing and disinfection of dwellings, &c., exposure of persons suffering from the disease, the keeping of the bodies of persons who have died from measles in a dwelling-room, sleepingroom or workroom for more than forty-eight hours, and for the prevention of infection generally. Notification is not required under this Order. The Infant Department of St. Gabriel's School was closed by the School Board for a fortnight on account of measles. In one of the schools in St. John's Ward, which had a number of children affected a second time within the year, an attempt was made to find out those who had suffered from measles and those who had not, with a view to exclude those only who had not had the complaint. This plan has been suggested by Dr. Kerr, the Medical Officer of the School Board, and in this instance it was easily carried out and worked 41 successfully, but in other cases it was found impracticable, from the difficulty of obtaining reliable information. The plan, however, is one which deserves trial, as it interferes less with the work of the school than absolute closure. It had previously been tried by me with respect to small-pox with satisfactory results, and was found of value this year also. W hoopisg Cough.—This complaint was responsible for 33 deaths, and, as with measles, these with one exception were in children under five years of age. It was most prevalent in the early part of the year, and 95 cases were notified from schools (see p. 42). The fatal cases were distributed in the Wards thus :—Grosvenor, 2 ; Knightsbridge, 1; Victoria, 9; St. Margaret's, 3; St. John's, 10; Gt. Marlborough, 3; St. Anne's, 2 ; Covent Garden, 1 ; and Charing Cross, 2. The deaths calculated on the total population are :— 1901. 1902. 1903. City of Westminster 0.26 0.18 0.18 County of London 0.35 0.26 0.35 Calculated on the number of children under five years of age, the rates per 1,000 were:— 1901. 1902. 1903. City of Westminster 3.67 2.65 2.63 County of London 3.23 3.65 3.22 For the Union districts, the corresponding rates for 1903 would be:— St. George, 2.8 ; Westminster, 2.0 ; Strand, 2.3. 42 Schools and Infectious Diseases. The teachers of Board Schools are required to notify me when they exclude children on account of infectious disease; the teachers of "Voluntary Schools have heen invited to do likewise. The following list shows how far this has been carried out and the cases notified:— School. Actual Cases. Infection in House. Other Causes. Chickenpox. Measles. Mumps. Whoopingcough. Chickenpox. Measles. Mumps. Whoopingcough. Board schools :— Charing Cross Road 6 3 2 1 3 5 — — Horseferry Road — 24 2 — — 34 1 3 4 ringworm. James Street — 24 27 2 35 7 2 1 „ Pulteney — 23 — — 1 23 — 1 Millbank 48 105 5 4 29 6 — — 7 ringworm. St. George's Row 4 40 4 22 1 23 2 3 18 „ Vere Street — — — — — — — — 1 ophthalmia. Great Wild Street 3 1 — — 2 — — — Voluntary schools:— Brompton Higher Grade 7 ringworm. 1 eczema. 4 influenza. Holy Trinity, Vauxhall Bridge Road 21 21 7 2 5 30 — — St. Anne's, Dean Street 1 1 — 4 — — — — 1 ringworm. St. Clement Danes 1 4 11 11 5 3 — — 11 ringworm. 1 ophthalmia. St. Gabriel's 1 9 7 37 2 6 — 3 11 ringworm. St. John's, Tufton Street — — 1 — — — — — 1 „ St. Mary's, Hide Place — 59 — — — — — — St. Paul's, Wilton Place — 11 — — — 3 — — St. Paul's, Caroline Street 3 — — — 1 — — — St. Peter's,. Lower Belgraye Street — — 37 — — — — — St. James the Less — 1 — — — 1 — — St. Martin's, Castle Street 1 20 2 — — 8 — — 1 ringworm. 89 346 105 83 49 177 10 12 The system of giving a grant to schools for absence of pupils on account of epidemic disease has now been given up, as the Board of Education consider that under the new Education Acts the administration will be in the hands of the local authorities. Copies of 510 certificates relating to various notifiable diseases were sent to school teachers during 1903. Teachers or children attending at the following schools were notified to be suffering from illness during 1903 :— 43  Small Pox. Scarlet Fever. Diphtheria. Enteric Fever. Charing Cross Road Board School — 8 1 — Horseferry Road Board School 1 1 2 — James Street Board School — 2 2 — Pulteney Board School, Berwick Street — 18 6 1 St. George's Road Board School — 4 4 1 Vere Street Board School — 1 — Millbank Board School — 5 1 — Tower Street Board School — — — 1 Great Wild Street Board School — 2 — Brompton Higher Grade School 4 — — Christ Church School, Buckingham Gate 2 1 — Holy Trinity School, Vauxhall Bridge Road — 2 — — St. Anne's National School — 22 5 — St. Anselm's School, Davies Street — 1 — — St. Barnabas's School, Pimlico Road — 1 — 4 St. Clement Danes School — 4 1 — St. Gabriel's School, Glasgow Terrace — 15 5 — St. George's Higher Grade School, South Street, Park Lane — 3 4 — St. James-the-Less School, Upper Garden Street 3 2 1 — St. John's School, Tufton Street 3 3 3 — St. Mark's, Balderton Street — — 1 — St. Martin's Northern School, Castle Street — 1 — — — 2 — 1 St. Mary's, Johnson Place — 2 — — St. Matthew's, Great Peter Street 3 4 4 — St. Michael's, Buckingham Palace Road — 4 7 — St. Patrick's, Great Chapel Street — 3 1 — St. Peter's, Lower Belgrave Street — 3 — 1 St. Peter's and St. James's, Great Windmill Street — 29 3 — St. Stephen's, Rochester Row — 2 2 — 44 Proceedings were taken against one person for removing and selling to a second-hand furniture dealer articles which had been exposed to infection from scarlet fever, and which had not been previously disinfected. Pined Is. and 3s. 6d. costs on each of the two summonses. During 1903, the Washington-Lyons apparatus at Dufour's Place was removed to the Commercial Road Station, to replace the apparatus there which had become worn out. The City has now three Disinfecting Stations:—Horseferry Road, Commercial Road, and Denzell Street. It would be much better if the disinfecting were all done at one place, and I had hoped to have been able to report that a Central Disinfecting Station had been erected. The County Council have been required by the Council to provide a site for a Central Disinfecting Station in place of that at Denzell Street required for the Holborn to Strand street. Shelters.-—Nineteen persons were admitted to the temporary shelters (Horseferry Road and Dufour's Place) during 1903. £4 was spent in food for necessitous persons. Cleansing of Persons.—Under the provisions of this Act 18 persons received a free bath and had their clothing baked in the disinfecting chamber at Denzell Street. 45 PART II. C. House Inspection, &c. Inspection of Houses.—The Chief Sanitary Inspector has prepared a summary of the sanitary work completed during the year 1903, which will be found appended hereto. 4,739 dwelling-houses in the city have been inspected during the year, and in 2,127 instances preliminary notices have been sent calling notice to defects requiring attention. 81statutory notices were served, and legal proceedings had to be taken to enforce these orders in the following instances:— Name and Address of Defendant. Offence. Result. Henry Hanson, New Yard, Great Q,ueen Street Failing to comply with notice to cleanse rooms at 42, Stanhope Street Fined £1 and 6s. costs, and ordered to carry out the work within 14 days. T. J. Gawthorp, 16, Long Acre Non - compliance with notice to remedy ventilation to soil-pipe and provide separate w.c. accommodati on Work completed. Summons withdrawn on payment of costs. Mr. Apsey, 4. Godolphin Road, W. Failing to provide sufficient w.c. accommodation at 26, Dean Street Fined £5, and 2s. costs. Tod Heatley, 8, Carlton Street Failing to comply with notice to remedy defective drain Summons withdrawn in consequence of work having been satisfactorily carried out. G. Wallis, 7, Park Place, St. James Failing to comply with j notice to remedy defective drains at 64, Long Acre At first hearing summons adjourned for work to be completed. Work being completed by the date of the second hearing, summons withdrawn on defendant paying costs—2s. Messrs. Hardisty, Rhodes and Co., 48, Great Marlborough Street Failing to comply with notice to remedy defective drains at 1, Aberdeen Mews Work completed before date of hearing. Summons withdrawn on payment of 3s. costs. Mr. G. Brittou, 66, Wardour Street Failing to comply with notice to remedy defective drains at 70, Old Compton Street Work completed before date of hearing. Summons withdrawn on payment of 3s. costs. A. H. D. Hamilton, 11, Routh Road, Wandsworth Common Failing to comply with notice to remedy bad ventilation, lighting and defective drains at 5 and 6 Warwick Place Mews Summons adjourned to enable defendant to comply with notice, and withdrawn on 12th. June on payment of costs, the work having been satisfactorily completed. Mrs. Muller, 58, Dean Street Failing to comply with a notice to remedy defective drains at 58, Dean Street Adjourned to 4th June to enable work to be executed. Again adjourned to 25th June, on which date the summons was withdrawn on payment of 2s. costs, the work having been satisfactorily completed. 46 Name and Address of Defendant. Offence. Result. Max "Oilman, 39, Floral Street. Failing to comply with notice to remedy defective rainwater pipes at 39, Floral Street. Summons adjourned to enable defendant to complete work. On 15th July, the nuisance having been abated, the summons was withdrawn on payment of 3s. costs. 1902. 1903. 1902. 1903. Complaints received and dealt with.. 912 907 Sanitary Work Completed :— Water-closets:— Houses and premises inspected 5,313 4,739 Constructed 1,724 1,176 ,, „ re-inspected 16,993 17,678 Repaired 557 535 ,, (registered), visits to 386 493 Ventilated 725 536 Notices issued (preliminary). 2,117 2,127 Cleansed or limewashed 710 982 „ „ (statutory) .. 115 128 New pans fixed 2,100 1,555 Sanitary Work completed:— Pans and traps cleansed 261 333 Houses:— Obstruction removed 98 105 Closed under H.W. Classes Act 11 1 Traps ventilated.. 1,290 1,134 Water supply provided 652 724 Closed under P.H. (London) Act 1 2 Flushing apparatus fixed 2,046 1,705 „ repaired 488 468 Cleansed throughout 321 382 Waste Pipes:— Cleansed partially 635 653 To sinks, baths, lavatory basins, &c. Overcrowding abated 59 55 Light or ventilation improved 209 231 Fixed 3,057 1,622 Repaired or unstopped . 142 331 Roofs repaired 276 344 Disconnected from drain 511 507 Floors and staircases repaired 254 272 Trapped 2,858 1,575 Ventilated 1,822 1,166 Underground .rooms vacated 13 28 Water Supply :— Provided . .. 313 353 Yards, areas, paved or repaired 494 659 Reinstated 71 191 Cisterns fixed 370 282 Offensive refuse removed 243 200 „ cleansed 607 504 Keeping of animals discontinued 22 17 „ covered 232 444 ,, old, defective, Drains:— abolished 150 86 Constructed 757 654 Disconnected from w.c. Amended and repaired.. 271 346 supply 171 148 Disconnecting traps fixed 769 687 Dust Bins :— Ventilated 718 654 Provided 594 380 Tested 1,890 1,889 Repaired 25 116 Unstopped or cleansed 130 268 Old, abolished 97 100 Gully traps fixed 2,882 2,441 Stables:— Inspection chambers built 1,729 1,360 Drained 150 97 Paved 153 91 Inspection chambers repaired or cleansed 214 374 Cleansed 115 87 Dung recepl acles provided 41 73 Inspection chambers, cover fixed or sealed 1,640 1,409 Dung receptacles repaired 6 14 Soil pipes fixed or repaired 871 796 Dung pits abolished 5 16 Dung accumulations removed 126 119 Ventilating pipes fixed or repaired 594 582 Urinals constructed — 6 Rainwater Pipes :— Private Mews Paving Fixed or repaired 310 763 paired 1 Disconnected from drain 165 515 47  WARDS. 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. Complaints received and dealt with 87 60 30 37 189 113 59 67 92 17 93 24 26 13 907 ffouses arid premises inspected 194 223 261 369 846 420 824 425 283 98 476 131 89 100 4,739 Do. re-inspected 1,175 1,590 1,135 2,164 3,497 390 1,174 1,219 1,051 430 1,151 668 1,395 639 17,678 Do. (registered), visited — — — 13 — 120 8 127 26 — 23 1 28 147 493 Workshops inspected 31 6 13 25 18 4 33 95 214 — 77 6 32 8 562 Do. visited 58 23 16 37 51 54 22 94 157 — 73 7 275 50 917 Bakehouses visited 10 27 45 76 83 29 82 127 67 18 26 9 156 17 772 Milkshops visited — 1 28 33 76 44 71 5 12 3 16 4 7 13 313 Restaurant and hotel kitchens visited 2 — 25 4 1 — — 8 11 — 2 38 134 27 252 Notices issued (preliminary) 119 100 136 243 377 113 224 152 153 15 132 67 188 108 2,127 48 Infringement of By-laws.—Proceedings were taken against builders and others for neglecting to give notice before erecting or altering water-closets, drains, &c., in two instances with the following results:— Davis and Bennett, for constructing w.c. and soil-pipe, without giving notice, at 23 and 24 Henrietta Street. Fined £2 and 2s. costs. M. Pearson for constructing w.c. and soil-pipe, without giving notice, at 17, Lower Belgrave Street. Pined £1 and 2s. costs. A number of others were cautioned by the Public Health Committee. Amendment of By-laws.—The Council have had under consideration the By-laws made by the County Council under Sections 16 and 39, on which I submitted a special report. The Public Health Committee recommended:— By-laws under Section 16 (2). By-laws Nos. 1 and 2. [Also No. 25 of By-laws under Sec. 39 (1).] —That the By-laws be altered so as to permit of offensive refuse being removed between the hours of 12 midnight and 9 a.m. all the year round, and that under any circumstances the following exemption clause be inserted:— " This By-law shall not apply to any person removing or carrying, or causing to be removed or carried, such fecal or offensive or noxious matter or liquid, deposited in an impervious air-tight receptacle or receptacles, and removed or carried in the same impervious air-tight receptacle or receptacles—such receptacle or receptacles being cleansed periodically as required." By-law No. 8.—That the word " suitable " or " properly covered" be added before the words " movable receptacle." By-law No. 9.—That instead of once, twice a week all the year round be insisted on, in regard to the removal of house refuse. That it is desirable that a daily collection of house refuse be instituted in neighbourhoods where houses are of the tenement class. That the occupier of any premises shall give free access to the Sanitary Authority or others acting on their behalf for the purpose of the removal of house refuse. On this suggestion the "Works and Highways Committees reported :— With regard to the suggested amendment, the Council are at present under a liability with penalties to remove dust at least once a week. As a matter of fact a daily removal is carried out in a considerable part of the City, and as opportunity offers this system is being gradually extended although at an increased cost. Dust is removed from many premises twice and three times a week. Cases of complaint of non-removal of dust at less periods than once a week are few and far between, and, while agreeing with the Public Health Committee that a 49 daily collection is a standard which the City Council is endeavouring to obtain, it must be pointed out that this will entail much more cost to the Council, and also that there appears no immediate demand for it. Therefore, while the removal of dust is being gradually extended, it would not appear advisable to place the Council under a legal obligation and penalties to remove dust more often than once a week. By-laivs under Section 39 (1). By-law No. 1.—That words be introduced which would allow of w.c.'s being placed on the top floors of houses where the roof might be' taken as the external wall with proper louvred lights, and with a view also to meeting the difficulty introduced by the Building Act, which permits of the ground floor of a building being entirely built over, the roof of such building might be taken as the external wall when the area of part of the ground floor extending beyond the main building is not less than 40 feet in extent and efficient ventilation is obtainable. That in the last paragraph, the words " constructed below the surface of the ground, and " be omitted. That it is desirable that the floors of all water-closets be constructed, of impervious material. By-law No. 2.—That the area of the window prescribed, viz.. 2 square feet, is insufficient for the purpose of effectively lighting the w.c., and should therefore be increased. By-law No. 14.—That a new By-law be made that would prevent any subsequent • structural alterations being made in premises which would in any way cause non-compliance with these By-laws. That By-law No. 14 be amended so as to require the giving of notice to the Sanitary Authority of any structural alterations that may be made to a w.c. subsequent to its erection, as well as the giving of notice in regard to its erection, &c. By-law No. 25.—[Also No. 1 of By-laws under Section 16 (2).]—That where the receptacle is a suitable covered carriage, cart, or other contrivance in which the dung of horses or other cattle with stable litter is stored, and which is removed without disturbing the contents, this By-law should not apply. The Works and Highways Committees reported on these suggestions that " from an engineering and constructional point of view, the suggestions of the Public Health Committee are satisfactory and reasonable," and eventually, with the exception of that under No. 9, the Council adopted the recommendations. Drainage Works.—In my report for 1902, I reported on the confusion which sometimes arose as to which department should e 50 supervise drainage work during 1903, the Council amended their By-laws as follows:— i. The- supervision of all drainage works which are required to be executed pursuant to a Nuisance Notice or Order; and the construction of all water closets, soil pipes, and other apparatus which are the subject of the provisions of the Public Health (London) Act, 1891, and the By-laws made thereunder; and the approval of all plans relating thereto, shall stand referred to the Committee (i.e., the Public Health Committee) and the Public Health Department. ii. He (i.e., the Medical Officer of Health) or officers duly authorised by him, shall visit daily the Works Department, and shall inspect all Drainage Plans and notices of Drainage Plans, Water Closets and Soil Pipes, and shall afford to the City Engineer such facilities of access to Drainage Plans and notices of Drainage Plans, &c., in the Public Health Department, and to the possession thereof, as may be necessary for the due compliance with the By-laws and Standing Orders. Underground Dwellings. When the City was re-incorporated 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 (under the powers given by the Public Health (London) Act, Section 96, sub. sees. 3 and 4) 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 their being vacant, they were, on no account, to be re-let separately for living purposes. The use of such dwellings has been gradually decreased in accordance with the instructions of the Council, with the result that of the original number only five basement rooms are now occupied separately. Notices have been served with reference to the illegal use of underground rooms in 1901 in twenty-five instances, in 1902 in thirteen intances, and in 1903 in nineteen instances. It should be pointed out that these figures do not imply that in every case the use of the underground room has been given up for living purposes. The law still permits the use of an underground room so long as it is occupied in conjunction with a room on another floor. 51 Houses Let in Lodgings. After considerable correspondence with the Local Government Board, the By-laws governing houses let in lodgings or occupied by more than one family were eventually approved, but not to the satisfaction of the Council, who desired greater discretionary power than the By-laws permit. In one particular these By-laws differ from any others made by local authorities, and that is as regards the rent limit imposed. The circumstances of the City render it necessary that the limit of exemption should be high in the more central parts, and thus a lodging house is not exempted from the operation of these By-laws unless the rent or charge payable by the lodger is exclusive of furniture, 15s. per week or upwards, inclusive of furniture, 18s. per week and upwards. The amount of cubic space required to be provided for each person is based on an extremely low standard, viz., 300 cubic feet for each person over ten years, for a room used exclusively as a sleeping compartment; 400 cubic feet where the room is not used exclusively as a sleeping compartment. For children under ten years of age the allowance is 200 cubic feet per head. Many complaints of overcrowding are received, which on investigation are found not to be so when judged by the above, standard. It is evident that from the point of view of the public the Local Government Board standard is too low, and this is also shown by the scale adopted by the various authorities dealing with the provision of tenement houses. Housing of the Working Classes. The Council's scheme of building three blocks of dwellings in Regency Street has made good progress, and the buildings will be ready for occupation early in 1904. At the request of the Housing Committee I prepared the following report on the number of persons who may occupy these buildings:— "In accordance with your instructions of the 22nd June that I should report on the number of persons who may be allowed to occupy the tenements in Regency Street, I now beg to lay before you the following particulars. " I have applied. to the London County Council, the Peabody Trustees, and the Guinness Trustees, and have been favoured with the scales in operation in the Buildings under their control. I have made a summary of these replies, and have also stated the cubic space allowed by the By-laws for Houses let in Lodgings:— e 2 52 London County Council have two standards:— (1) In letting all tenements no applicant is accepted the number of whose family would exceed two persons per room, including in the word person both adults and children. The minimum floor space is: for a bedroom, 96 square feet; for a living room, 114 square feet; and the height is uniformly 8 feet 6 inches, giving 1,224 cubic feet for a living room, and 816 for a bedroom. (2) The Council takes a census once a year for the purpose of ascertaining and dealing with cases of overcrowding ; any tenement occupied by more than two persons per room is considered to be overcrowded, but in this case no child under the age of 5 years is reckoned to be a person, and children between the ages of 5 and 10 years are reckoned as one half a person only. Tenants whose families exceed the number of two persons per room on this basis are found further accommodation at the earliest moment consistent with the avoidance of the infliction of hardship. "Peabody Donation Fund.—The nominal scale of accommodation is based on the number of persons to each room, so that the cubic space would vary slightly according as to whether the rooms were large or small. The maximum limits are as follows :— One room Man, wife, with one child not over 6 years old. Two rooms Man, wife, with four children under 12 years old. Three rooms Man, wife, with six children under 12 years old. Four rooms Man, wife, with eight children under 12 years old. " A child over 12 years old counts as two children under 12. " The average size of the Peabody rooms is considerably larger than that of the London County Council. " The Guinness Trust.—Each person over 7 years of age is allowed 400 cubic feet. " Each person under 7 years is allowed 200 cubic feet. " In determining the number of rooms which any applicant must take, the sex as well as the age of the children is, of course, considered. " By-laws for Houses let in Lodgings.—300 cubic feet of free air space is required for each person over 10 years of age, and 200 cubic feet for each person under 10 years of age, in a room used exclusively as a sleeping apartment. For rooms not used as a sleeping apartment exclusively (i.e., a room used both as a sleeping and living room), the limits are 400 cubic feet and 200 cubic feet respectively. " I find that, in Glasgow, houses of three rooms and under containing less than 2,000 cubic feet are ' ticketed,' and there must be at least 400 cubic feet for each adult or child over 10 years old. In one-room 53 dwellings 800 to 1,200 cubic feet is required, and in two-room dwellings, 700 cubic feet. " The Architects have been good enough to supply me with the measurements of the various rooms in the Regency Street Dwellings, and I have made a number of calculations on the basis stated above, to ascertain the number of persons who may occupy them. " Certain considerations must be taken into account before definitely coming to a conclusion in the matter. In the first place it will be noted that the standards which guide the various bodies owning dwellings vary considerably, thus, to begin with, the London County Council would allow two persons per room, making a total of 1,506 persons, but later, when two children are allowed to count as one person, as many as 2,550 persons could be accommodated. On the Guinness basis, the maximum works out to the same number, viz., 2,550 ; on the Peabody basis, 2,229 would be the maximum; while if the standard of the By-laws be taken 3,276 (or even more) might be admitted. I take it, however, that the Council will not adopt this low standard; besides, in fixing the number regard must be had to the legal requirement that not less than one water-closet must be provided for every twelve persons, and as only the four-roomed tenements are selfcontained, i.e., each having its own separate laundry, lobby, and W.C., while the others are associated, two water-closets being provided for each group of four tenements, it follows that no more than twenty-four persons may occupy each floor. The number of bedrooms provided in each tenement must also be taken into consideration. In two-roomed tenements, the bedroom and living room may be reckoned as one room, but with three- and four-roomed tenements this is not practicable, and the number of persons who may occupy them must be governed largely by the number of bedrooms provided. " Fuur-roomed tenements.-—These are contained in M Block, and constitute the whole of that block. The size of each room is as follows:— Numbers. Living Room. Bedroom. Bedroom. Bedroom. Total. Semi-basement 261 and 262 Cubic feet. Cubic feet. Cubic feet. Cubic feet. Cubic feet. 1,282 932 850 782 3,846 Ground floor 263 and 264 1,282 932 850 782 3,846 1st floor 265 and 266 ] ,360 956 858 799 3,973 2nd floor 267 and 268 1,360 926 858 799 3,943 3rd floor 269 and 270 1,360 913 835 799 3,907 4th floor 271 and 272 1,283 882 780 718 3,663 " I would recommend that the maximum number to be allowed in each of these tenements be two persons over the age of 10, and eight under, or six persons over the age of 10 and two under. 54 " This would mean:— Two over and one under 10 1st bedroom Two over and one under 10, or four under 10 2nd bedroom Two over 10 or three under 10 3rd bedroom " Practically these figures work out at 300 cubic feet for persons over 10, 200 for those under, calculated on bedroom accommodation only; and any variations in the relative numbers of persons over 10 and under 10 would be worked out on this basis. " On the fourth floor where the rooms are smaller the numbers should be two over and seven under 10 years, or six over and one under 10 yeais. " Tliree-roomed Tenements.—Thirteen blocks contain these sets of rooms. They may be divided into two groups; the tenements in each group vary in size according to the floor. They are:— " Blocks A, E, F, K, P. Numbers. Living Room. Bedroom. Bedroom. Total. Semi-basement 4, 97, 124, 217, 321.. Cubic feet. 1,205 Cubic feet. 1,033 Cubic feet. 803 Cubic feet. 3,041 Ground floor 8, 101, 128, 221, 325 1,220 1,052 813 3,081 1st floor 12, 105, 132, 225, 329 1,250 1,079 842 3,171 2nd floor 16, 109,136, 229, 333 ] ,250 1,073 850 3,173 3rd floor 20, 113, 140,233,337 1,250 1,07L 838 3,159 4th floor 24, 117, 144, 237,341 1,192 1,032 833 3,057 " Blocks B, C, D, G, H, J, N, 0. Numbers. Living Room. Bedroom. Bedroom. Total. Semi-basement 25, 28, 49, 52, 73, 76, 145, 148, 169, 172, 193, 196, 273, 276, 297, 300 Cubic feet. Cubic feet. Cubic feet. Cubic feet. 1,283 1,020 795 3,098 Ground floor 29, 32, 53, 56, 77, 80, 149, 152, 173, 176, 197, 200, 277, 280, 301,304 1,299 1 ,029 797 3,125 1st floor 33, 36, 57, 60, 81, 84, 153, 156, 177, 180, 201, 204, 281, 284, 305, 308 1,339 1,075 829 3,243 2nd floor 37, 40, 61, 64, 85. 88, 157, 160, 181, 184, 205, 208, 285, 288, 309, 312 1,339 1,073 829 3,241 3rd floor 41, 44, 65, 68, 89, 92, 161, 164, 185, 188, 209, 212, 289, 292, 313, 316 1,339 1,071 829 3,239 4th floor 45, 48, 69, 72, 93, 96, 165, 168, 189, 192, 213, 216, 293, 296, 317,320 1,232 1,006 844 3,082 55 " I would recommend that the maximum number to be allowed in the above three-roomed tenements be four over and three under 10 years, or two over and six under 10 years. As in the four-room tenements, this works out at 300 cubic feet for persons over 10, and 200 for those under 10, calculated on the bedroom accommodation only, and any variation other than those mentioned should be calculated on this basis. "Two-roomed Tenements.—These are distributed throughout all the Blocks except M. As may be seen from the particulars given below, the cubical contents of living and sleeping rooms vary from 2,141 cubic feet to 2,349 cubic feet, and for purposes of calculating the number of inhabitants, the capacity of the bed and sitting-rooms may be reckoned together, as both during the day and night the door between the two rooms will likely be open. " Blocks A, E, F, K, P. Numbers. Living Boom. Bedroom. Total. Semi-basement 1, 98, 121, 218, 322 Cubic feet. Cubic feet. Cubic feet. 1,194 947 2,141 Ground floor 5, 102, 125, 222, 326 1,243 964 2,07 1st floor 9, 106, 129, 226, 330 1,280 1,028 2,308 2nd floor 13, 110, 133, 230, 334 1,280 1,028 2,308 3rd floor 17, 114, 137, 234, 333 1,280 1,023 2,308 4th floor 21,118,141,238,342 1,239 1,038 2,27 Semi-basement 3, 100, 123, 220, 324 1,258 892 2,150 Ground floor 7,104,127,224,328 1,277 903 2,180 1st floor 11,108,131,228,332 1,334 926 2,260 2nd floor 15, 112, 135, 232, 336 1,327 919 2,246 3rd floor . 19, 116, 139, 236. 340 1,318 905 2,223 4thloor 23,120,143,240,314 1,272 905 2,177 " Blocks B, C, D, G, H, J, N, O. Numbers. Living Room. Bedroom. Total. Semi-basement .. 26, 27, 50, 51, 74, 75, 14-6, 147, 170, 171, 191, 195, 274, 275, 298, 299 Cubic feet. Cubic feet. Cubic feet. 1,275 952 2,227 Ground floor 30. 31, 54, 55, 78, 79, 150, 151, 174, 175, 198, 199, 278, 279, 302, 303 1,297 964 2,261 1st floor 34, 35, 58, 59, 82, 83, 154, 155, 178, 179, 202, 203, 282, 283, 306, 307 1,337 1,012 2,319 2nd floor 38, 39, 62, 63, 86, 87, 158, 159, 182, 183, 206, 207, 286,287,310,311 1,330 1,002 2,332 3rd floor 42, 43, 1.6, 67, 90, 91, 162, 163, 1-6, 187, 210, 211, 290,291,314,315 1,322 992 2,314 4th floor 46, 47, 70, 71, 94, 95, 166, 167, 190, 191, 214, 215, 294,295,318,319 1,271 934 2,205 56 "Block L. Numbers. Living Room. Bedroom. Total. Cubic feet. Cubic feet. Cubic feet. Ground floor 241 1,235 955 2,190 1st floor 245 1,301 1,019 2,320 2nd floor 249 1,301 1,019 2,320 3rd floor 253 1,301 1,019 2,320 4th floor 257 ] ,244 934 2,178 "I would recommend that the maximum number to be allowed in the above two-roomed tenements be two over and four under 10 years of age. These figures might be modified according to requirement on the basis that one person over 10 takes the place of two under 10. "One-roomed Tenements.—These are contained in Blocks A, E, F, K, P, one on each floor, and in Block L, three on each floor. They vary in size from 1,240 to 1,385 cubic feet. "Blocks A, E, F, K, P. Numbers. Cubic Feet. Semi-basement 2, 99, 122, 219, 323 1.240 Ground floor 6, 103, 126, 223, 327 1,258 1st floor 10, 107, 130, 227, 331 1,279 2nd floor 14, 111, 134, 231, 335 1,282 3rd floor 18, 115, 138, 235, 339 1,258 4t.h floor 22, 119, 142, 239, 343 1,310 "Block L. Number. Cubic Feet. Number. Cubic Feet. Ground floor 242 1,258 243 1,352 1st floor 246 1,318 247 1,385 2nd floor 250 1,313 251 1,385 3rd floor 254 1,303 255 1,378 4th floor 258 1,228 259 1,295 Ground floor 244 1,343 — — 1st floor 248 1,343 — — 2nd floor 252 1,343 — — 3rd floor 256 1,343 — — 4th floor 260 1,343 — — "I understand that the intention of the Committee is that these rooms are to be occupied by one person, or by elderly couples. The maximum allowance should not be more than that allowed under the Peabody rules, viz., a man, wife and child, under 10, or an adult and two children, one at least being under 10. 57 "In determining the number of rooms any applicant must take, the sex as well as the age of the children must be considered. "On the above basis the maximum number permissible would be 2,229 divided up as follows:- Over 10. Under 10. Total. Average per Tenement. Persons. 45 one-roomed tenements 90 45 135 3 161 two-roomed tenements 322 644 966 6 126 three-roomed tenements 252 756 1,008 8 12 four-roomed tenements 24 96 120 10 688 1,541 2,229 27 "In certain of the blocks where the tenements on a floor consist of two three-roomed and two two-roomed tenements, the above maximum cannot be obtained, as there would be 28 persons on the floor, which would be four in excess of the number for which w.c. accommodation is provided; thus, the maximum number for whom accommodation can be found on the above basis will be 2,037. "It will be desirable at first to keep well within the above limits, so as to save disturbing tenants whose families increase in number." Laundry Yard.—A special report was made on the condition of the houses in this court, but the evidence was not sufficient to justify action under the Housing Acts. Individual houses were dealt with under the Public Health Act. Siddons and Stirling Buildings.—These two premises, calculated to house 210 and 180 persons respectively, were opened by the County Council in May and June, 1903. These adjoin the buildings already erected in Dukes Court, and are to provide accommodation for some of the persons displaced by the Holborn to Strand improvement. Certificates under the Revenue Act were granted. Housing Act, 1903.—An amending Act was passed during last Session of Parliament extending the maxim time for the repayment of loans; rendering it unnecessary, where a house was not reasonably capable of being made fit for human habitation, to have to call on the owner to make it so; giving power to recover costs of demolition of houses ordered to be closed; giving power to local authorities to provide, in connection with dwellings they may erect, shops or otherwise to make provision in other ways which may be benefical to the persons for whom the dwellings are provided. This is a provision likely to be of considerable value in the City. 58 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 the 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. The accompanying Table XXII shows the number of births and deaths in 1903, with the causes of death, and the number of deaths of infants and persons over 65. Common Lodging-houses. 77 deaths occurred in 1903 in the common lodging-houses in the City, equal to a death-rate of 38 per 1,000 on the authorised number of lodgers (2,000). In 1902 the rate was 50 per 1,000. 51 of these were attributed to St. John's Ward, 15 to the Strand, 8 to Covent Garden. 2 to Regent, and 1 to St. Anne's Ward. 67 were men, and the causes of death were—consumption 15, respiratory diseases 13, cancer 11, heart disease 9, kidney diseases, 3, small-pox 1, and other complaints 15. 10 were women, and death was due to—consumption 5, respiratory disease 3, other causes 2. In view of the licensing Of all common lodging-houses by the County Council, which now has to be done annually, I made a special examination of those in the City and reported upon them, and various suggestions that I made were ordered to be carried out by the City Council previous to granting the licence. I think it would be well if the County Council required that rooms in such houses should be painted in lighter colours, which would materially affect the light of the rooms besides rendering them more cheerful for the inmates. Steps should also be taken to prevent the indiscriminate spitting which goes on:— "The street improvements which are taking place in the Strand and in St. John's Ward will lead to the closing and demolition of several houses which have hitherto been used as common lodging-houses, viz,, 14 and 15, White Horse Yard; 25, Stanhope Street; 17, St. Ann's Street, which have afforded accommodation for 132 women; 45 and 47, Tufton Street; 30, Romney Street; 1 and 2, St. Mary's Buildings; 22, Vere Street; 29 and 30, Yere Street; and 26 to 28, Vere Street, accommodating 474 men. "For other reasons it is probable that the lodging-houses at 2, Harvey's Buildings, and 16, Snow's Rents, accommodating 139 men, will also be closed in the near future. It is, therefore, unnecessary to require serious alterations to be carried out in the above buildings. 59 Table XXII.— Vital Statistics relating to Blocks of Dwellings in the City of Westminster, 1903. Buildings. Population. Births. Total Deaths. Infectious Deaths. Tubercular, Deaths. Respiratory. Digestive. Circulatory Diseases. Nervous Diseases. Kidney Diseases. Violence. Cancer. Other Deaths. Deaths Under 1. Deaths Over 65. Peabody 6,761 187 103 12 11 19 6 14 8 2 4 8 19 19 26 London County Council— Millbank 3,043 152 41 11 5 6 1 3 1 1 1 3 8 16 1 Drury Lane 1,000 17 19 3 2 7 — — 3 2 1 — 1 4 4 Improved Industrial 6,878 115 41 4 9 8 — 3 4 1 3 5 4 7 6 Metropolitan Association 757 23 11 — 3 1 1 2 1 — — — 3 4 2 St. George's Model Dwellings 419 11 6 1 1 — — — — — 1 1 2 1 — Clerkenwell and Soho Company (Newport Market) 1,184 25 19 — 8 4 1 3 1 — 1 — 1 5 3 St. James Residences 494 20 5 — 1 1 — — — — — — 3 2 — „ Dwellings 71 2 2 — 1 — — — — — — 1 — — — Westminster 187 6 2 — — 1 1 — — — — — — — 1 Greencoat 119 2 1 1 — — — — — — — — — — — Spencer 99 1 — — — — — — — — — — — — — Chapter Chambers 175 4 1 1 — — — — — — — — — — — St. John's „ — 7 8 1 2 3 — 1 — — — — 1 — — 60 "The County Council has fixed that for each bed there shall be 300 cubic feet of air space and 30 feet super. In many of the houses this will result in a substantial decrease in the number of occupants. The total reduction in the houses which will remain will amount to about 86. "The houses, with few exceptions, are unsuitable, either from position or construction, for the purposes for which they have been used, and the improvements, although substantial, which the County Council are affecting under this Act can only be regarded as a compromise. "If it is necessary to provide accommodation for the particular class, it would be well that houses should be built by the Local Authorities specially designed for the purpose, which would enable the present unsuitable style of house to be gradually extinguished." Licences were granted as follows:— Address. Name of Occupier. Licensed for Former Number of Beds. 6. 6a, 6b and 6c, Great Smith Street Frederick Storey 201 men 218 11, 12 and 13, Hanover Street G.H.Burns 105 „ 118 2, Harvey's Buildings George Salvage 35 „ 52 26, Litchfield Street John E. Biss 53 „ 54 10 and 11, Monck Street Mary Horrigan 64 „ 64 108, Regency Street Henry Smith 8 „ 18 45 and 47, Tufton Street Emma Cook 91 „ 105 107, Wardour Street Leopold O. Roper 87 „ 87 *22, Vere Street William R. Smith 48 „ 48 *27 and 28, Vere Street George Campbell 48 „ 48 *29 and 30, Vere Street Do. 176 „ 176 16, Strut ton Ground Emanuel Levy 211 „ 228 33, Great Peter Street T. and G. Oyler 401 „ 424 For One Year— *9 and 10, Stanhope Street William Booth vation Army) 120 „ - *These houses are scheduled under the Holborn to Strand Improvements Scheme, and therefore no requirements have been made in respect thereto. Licences were refused in respect of No. 16 Snow's Bents and No. 40 Great Peter Street. The owners of these houses appealed to the Magistrate sitting at Rochester Row, and I prepared evidence relating thereto. In regard to the former the appeal was not allowed on account of the danger from fire objections; in the latter, decision was adjourned in order to allow the owner to submit a scheme for the reconstruction of the house. The ground floor rooms were unsuitable for habitation, and it would have been necessary for the City Council to have taken action in the matter if the London County Council had not done so. After many conferences 61 a scheme has been agreed to which will meet the objections of both Councils. This is the only house left in the City for women (single women and married couples). It is now to have women only, and the number of inmates to be reduced from 86 to 75. Ham Yard Soup Kitchen and Hospice is under consideration of the Courts as to its being a common lodging-house. It has two dormitories, with ten beds in each. The police magistrate has decided in favour of the County Council. New by-laws have been sanctioned for the control of common lodging-houses in the County of London. These are enforced by the County Council. Revenue Act, 1903. In 1890 Parliament passed the Customs and Inland Revenue Act (53 Vict., cap 8) in which (Sec. 26.2) they granted exemption from inhabited house duty for houses used solely for providing separate dwellings at rents not exceeding 7s. 6d. a week for each dwelling, if there is a certificate of the Medical Officer of Health that the house is so constructed as to afford suitable accommodation for each of the families or persons inhabiting it, with due provision for their sanitary requirements. The Medical Officer must examine such premises on request, for the purpose of ascertaining whether such certificate can properly be given, if the person making the request would be liable to pay house duty were it not discharged by the production of the certificate. This exemption was in order to encourage the erection of artizans' dwellings on good lines. In 1891 Parliament extended the benefits of the Act, and last year the provisions were again extended and embodied in a new section (Revenue Act 1903, Sec. 11), the previous enactments being repealed except in regard to the mode of obtaining the certificate. The exact words of the section are:— 11. (1) Where a house, so far as it is used as a dwelling-house, is used for the sole purpose of providing separate dwellings— (a) The value of any dwelling in the house which is of an annual value below twenty pounds shall be excluded from the annual value of the house for the purposes of inhabited house duty; and (b) The rate of inhabited house duty in respect of any dwelling in the house of an annual value of twenty pounds but not exceeding forty pounds shall be reduced to three pence ; and (c) The rate of inhabited house duty in respect of any dwelling in the house of an annual value exceeding forty pounds but not exceeding sixty pounds shall be reduced to sixpence. 62 2. The provisions of this section, as respects dwellings of an annual value not exceeding forty pounds, shall not take effect with regard to any such dwelling, unless such a certificate as to accommodation and sanitary condition is produced to the General Commissioners as defined by Section 5 of the Taxes Management Act, 1880, as is mentioned in Sub-section 2 of Section 26 of the Customs and Inland Revenue Act, 1890, and the provisions of that sub-section as to the certificate shall apply for the purpose. It is not now stated in the marginal note that the intention is to encourage the erection of artizans' dwellings. The new Act includes them, but it also brings in houses let in tenements or flats. The Medical Officer is entitled to have information supplied to him that houses he may be asked to examine for the purpose of granting a certificate come under Sub-sections a and b; that is to say, that the various tenements or flats are rated separately, and that their respective annual value (rateable value for inhabited house duty) does not exceed forty pounds. D. Workshops. Section 132 of the Factory and Workshops Act directs that "The Medical Officer of Health of every District Council shall in his annual report to them report specifically on the administration of this Act in workshops and work-places and he shall send a copy of his annual report or so much of it as deals with this subject to the Secretary of State," and forms have been supplied giving a summary of what is required. It is, however, a matter of difficulty to apportion work, especially as workshops and dwellings are so intermingled. The following shows the state of the registers:— Class of Work. On Register at end of 1902. Added in 1903. Removed in 1903. On Register at end of 1903. Number of Inspections. Number of Notices. Prosecutions. Bakehouses 107 2 18 91 312 1 - Restaurant and hotel kitchens - - - 368 216 6 - Milkshops 340 4 41 303 313 — — Cowsheds 3 — — 3 14 — — Icecream shops — — — 108 220 1 1 Slaughterhouses 1 — — 1 14 — — Aerated water manufactories 5 - - 5 10 - - Offensive trades 2 — 2 — 4 — — Other workshops 2,037 163 — 2,200 16 1 — Out-workers' premises 1,532 - - 3,472 60 special - - 63 Defects were found and remedied as follows:— 1901. 1902. 1903. Notices Served. Prosecutions. Bakehouses, visits to- - 228 772 - - Milkshops, visits to 445 390 313 — — Restaurant and hotel kitchens, visits to - 304 216 - - Icecream shops, visits to — — — — — Aerated water manufactories, visits to - - 10 - - Other workshops inspected 1,115 692 562 — — Other workshops visited 1,569 1,091 917 — — Workshops measured 199 298 164 — — Improved sanitary accommodation provided 32 29 6 1 Light and ventilation improved 47 98 111 4 - Cleansing 279 233 485 5 — Overcrowding abated 57 50 24 — — Gas stoves ventilated — 66 87 — — Want of drainage of floors — — 3 — — Other defects — — 87 8 — Protected persons reported to Home Office 10 — 4 — — Gas and Oil Stoves.— These are largely used in workshops for warming the rooms and for heating irons, cooking, and in printers' rooms for melting lead in connection with certain machines. In eighty-seven instances, means of ventilation have been provided for such stoves. These stoves, as well as gas jets, give off gases which are injurious to health, especially in rooms in which the ventilation is not well maintained. Breathing these products leads to headache, giddiness and anaemia. It is claimed for some stoves that a flue is not necessary, as the products of combustion are in great measure consumed or condensed. Experiments made in the Government Laboratory show that each of the five varieties tested (three gas and two oil stoves) gave off a certain proportion of carbon monoxide (C.O.), a very poisonous gas as well as a larger quantity of carbonic acid gas (carbon di-oxide, C.O2). It is, therefore, of importance that special attention be given to the use of such stoves. It not infrequently happens also that gas burners are relied upon to afford warmth to rooms, and when such is the case it is almost always found that doors, windows and other means of ventilation have been closed, thereby infringing the Act in two particulars. Temperature of Workrooms.—Although this question in intimately associated with that of ventilation, it is under the supervision of the Home Office, while ventilation is under that of the Sanitary Authority. It is not laid down in the Act as to what is to be considered a reasonable 64 temperature, but recently a case from the City of Westminster has been heard at the County of London Sessions which deals with the point:— "Messrs. Peter Robinson, Ltd., appealed against two convictions by Mr. Plowden, sitting at Marlborough Street Police Court, at the instance of Miss Lucy Deane, one of His Majesty's Inspectors of Factories, for failing to keep a certain workshop in conformity with the Factory and Workshops Act, 1901, in that adequate measures were not taken for securing and maintaining a reasonable temperature. The appellants were fined 20s. and 26s. costs on one summons, 20s. and 2s. costs on the other, and were ordered to remedy the alleged defects before 1st October, 1903. "The premises in question were situated between Regent Street and Argyll Street, W., and consisted of twenty-two workrooms on the floors over the shop, in which 350 persons, most of them women, were employed in cutting and making ladies' garments. The rooms, which were heated by steam pipes, were visited on 4th February and again on 18th February by Miss Deane, and it was alleged that they were then too cold, the temperature varying from 54 deg. to 61 deg. in the different rooms. In some of them gas lights were burning. Dr. Legge, Chief Inspector of Factories, and other medical witnesses stated that in their opinion the temperature in workshops used for sedentary occupations should be from 60 deg. to 65 deg., and that if the gas was used for heating purposes it would vitiate the atmosphere. Mr. Avory stated that the appellants had spent £500 in putting steam pipes into these rooms three years ago. He called medical and other witnesses, who said that they considered 56 deg. to 60 deg. a reasonable temperature, and both the forewomen of the several rooms, who proved that none of the workpeople complained of the cold, and that the gas was burned only when additional light was required. The appeal was allowed, with costs, and the convictions and order were quashed." The Education Department recommended a temperature of between 56 and 60 degrees, and in the regulations of the London School Board instructions are given that the temperature of the schools is not to, exceed 60 degrees. Inspection of Workplaces where Women are Employed.—I have again to point Out the need for Women Inspectors; there are 46,000 females living in the City engaged in occupations; deducting 26,000 who are in domestic or like service, there are 2,352 laundry women, 5,299 milliners and dressmakers, 2,390 tailoresses, and 1,256 other workers in textile fabrics, but in addition there is a large number of female workers who live in other districts and come into the City to business. In about. 65 70 per cent. of the 2,200 (registered) workshops in the City both men and women are employed, and in 10 per cent. women only. There are besides, more than 3,000 outworkers residing in the City whose houses it is the duty of the Sanitary Authority to visit. Besides which, there is the inspection of houses let in lodgings and other work in connection with domestic hygiene, which can be best done by women. Outworkers.—Firms giving out work in certain trades are required to send in a list of those they employ. Outworkers are constantly changing their addresses and their employers, so that it is difficult to maintain a correct register. List of Outworkers (S. 107). Class of Homework. 1903. Number of Lists Received. Number of Addresses of Outworkers. Up to 1st February. Up to 1st August. Forwarded to Other Authorities.. Received from Other Authorities. Number of Lists. Number of Outworkers. Number of Lists. Number of Outworkers. Wearing Apparel— Tailoring 129 2,005 190 2,796 319 260 Dressmaking and Ladies' Tailors 40 640 51 750 99 20 Bootmaking 2 50 2 49 37 17 Shirtmaking 1 6 1 6 10 9 Drapery 1 4 1 5 9 5 Lace 1 39 1 47 41 3 Cabinet making 1 2 1 2 2 10 Fur pulling — — — — — — Other — — — — — — Total 175 5,746 247 3,655 517 334 Inspection of their houses has not been made except in so far as the Inspectors have been able to include it in their ordinary work. I had 60 places specially examined, and in 17 instances it was necessary to take action, thereby showing the need of inspection; besides, such inspection is a statutory duty, and the Council may prevent work being given out to persons using places which are unsuitable. Causes of Death and Occupation.—The accompanying Tables XXIII. and XXIV. show the causes of death among males and females engaged in occupation. For males the list is fairly reliable, but for women it is not so, as the occupation may not be stated in the death certificate, hut wherever it has been given it has been recorded. F 66 Table XXIII.-Grouped Occupations of Males aged 10 Years and Upwards, with Causes of Death, in 1903. Population. Total Deaths, 1903. CAUSES OF DEATH. Infectious Diseases. Septic. Phthisis. Other Tubercular. Bronchitis. Pneumonia. Other Respiratory. Alcoholism. Cirrhosis of Liver. Other Digestive. Rheumatic Fever. Valvular Disease. Other Circulatory. Insanity. Other Nervous. Cancer. Diabetes. Bright's Disease. Suicide. Accident. Other Causes. Old Age. Total Occupied and Unoccupied 72,811 Retired or Unoccupied 9,613 Engaged in Occupations 63,198 General or Local Government 3,010 19 1 - 5 - 2 1 1 1 1 1 - - - 1 1 1 - 2 — - - 1 Defence of country 4,571 56 3 1 4 — 3 9 1 1 1 5 1 1 9 — 3 5 1 — 2 1 1 4 Professional 3,750 53 2 2 9 — 3 3 1 — 5 3 — 1 — 1 3 6 2 1 - 5 1 5 Commercial 4,605 55 1 1 10 1 2 5 - 3 3 3 — 4 3 — 4 8 1 2 - 1 2 1 Domestic service 12,276 58 3 — 11 — 2 3 3 3 1 2 — 4 6 - 4 4 - - 3 2 3 4 Conveyance of men, goods, or messages 8,275 192 2 4 39 1 16 14 1 3 5 - 1 10 32 5 5 23 3 5 - 6 6 11 Gardeners, florists, &c. 178 4 - - 1 - - 1 - - - - - 1 - - - - - 1 - - - - Dealers in coal, stone, &c. 107 11 — — 1 — 1 3 — — 1 — — — 3 — — — — — — 1 — 1 Jewellers, watchmakers, &c. 1,283 11 — — 3 — 1 1 — — — — — — — — 2 1 — 2 — — — 1 Engineering and machine making 1,948 45 1 1 10 1 6 3 1 — 1 1 — 3 2 2 3 — — 2 3 1 1 3 Building and works of Construction 3,792 45 — 3 11 — 3 3 2 — — — — 1 4 — — 3 — 2 — 2 3 6 Wood, furniture, fittings, and decorations 1,155 33 1 — 1 1 4 2 1 — — — — 2 4 2 — 2 — 3 — 1 6 3 Papers, hooks, prints, and stationery 1,731 29 — — 16 — — 1 — — . — 1 — 3 1 1 — 3 — — — — 1 2 Textile fabrics 1,396 14 — — 1 — — 2 — — — — — 1 3 1 — 1 — 2 — 1 2 — Tailors 2,568 43 — — 8 — 2 1 — — 1 — — 1 3 — 2 8 — — 3 1 3 10 Boot and shoe makers 670 27 — — 6 — 7 3 — — — — — — 3 — 1 — — 4 — 1 1 1 Other workers in dress, &c. 830 5 — — — — — 1 — 1 1 — — — — — 1 — — 1 — — — — Food, tobacco, driuk, and lodging 7,556 98 3 — 20 2 5 6 — 5 5 9 — 4 9 3 — 2 3 7 3 3 5 4 General dealers, hawkers, &c. 3,247 101 1 3 18 — 13 4 — 1 5 — — 4 9 6 4 9 — 4 4 3 6 7 Independent, &c. — 42 5 — 1 — 1 3 — 2 2 — — 3 7 — — 7 — 3 — — 6 3 67 Table XXIV.—Grouped Occupations of Females aged 10 Tears and Upwards, with Causes of Death in 1903. Population. Total Deaths, 1903. CAUSES OF DEATH. Unmarried. Married or Widows. Total at Census. Infectious Diseases. Septic. Phthisis. Other Tubercular. Bronchitis. Pneumonia. Other Respiratory Diseases. Alcoholism. Cirrhosis of Liver. Other Digestive Diseases. Rheumatic Fever. Valvular Diseases. Other Circulatory Diseases. Insanity. Other Nervous Diseases. Cancer. Diabetes. Bright's Disease. Suicide. Accident. Other Causes. Total Occupied and Unoccupied 49,110 36,748 Retired or Unoccupied 12,537 26,933 Engaged in Occupations, Unmarried 36,573 9,811 Commercial, professional teaching, &c. 2,961 705 3,666 8 1 - 1 - 1 - - - - - - - - 1 - 2 1 - - - 1 Domestic indoor servants 22,539 2,438 24,977 102 7 2 21 — 10 6 — — 2 7 1 5 10 2 5 8 — 2 — 5 9 Charwomen 264 1,355 1,619 44 — — 13 - 8 3 — — 1 — — 4 8 — 2 2 — — — — 3 Laundry, washing service, &c. 921 1,437 2,352 17 1 — 4 — 1 1 — — - 1 — — 1 1 2 1 - - - - 4 Paper, prints, hooks, and stationery 506 146 652 7 1 — 1 1 - 1 - - 1 - - - 1 - 1 - - - - - - Upholsterers, &c. 113 71 184 3 - - 1 - - - - - - - - 1 - - - - - - - - 1 Textile fabrics 971 75 1,046 2 - - - - - - - - - 1 - - 1 - - - - - - - - Hair and feather workers 17 9 26 5 - - 1 - 1 - - - - 1 - - - - - 1 - - 1 - - Tailoresses 1,366 1,024 2,390 44 3 3 6 — 3 — — — — 1 — 2 7 1 2 3 — 2 — 1 10 Milliners, dressmakers, &c. 3,927 1,372 5,299 40 — 2 6 — 4 1 1 — — — — 1 11 — 1 6 — 1 — — 6 Eating and lodging house keepers and dealers in food 598 564 620 18 — 1 1 — 1 1 — — — — — 1 3 - - - 2 1 1 3 2 Inn and hotel service 1,391 202 1,593 9 2 — 1 — 1 — 1 — — — — 1 — — 1 — — — — 2 General dealers, &c. 294 243 537 10 - - 3 - 4 - - - - - - - 2 - - - - - - - 1 Others 705 415 1,120 2 - - - 1 - - - - - - - - - - 1 - - - - - F 2 68 E. Food Supply. Bakehouses.—In anticipation of the coming into force on the 1st January, 1904, of the law that no underground bakehouse might continue unless certified to be fit for the purpose, the Council, by a Sub-committee of the Public Health Committee, visited every underground bakehouse in the City. At the beginning of 1903 there were 107 bakehouses in the City, of which 97 were reckoned as underground and 10 above ground; 3 of the latter were "factories." At the end of the year there were 91 bakehouses, of which 79 were underground and 12 above ground (one of these being a factory). Appended is a list of them:— Certified Underground Bakehouses. Brewer Street, 36 Broad Street, 39 Broad Street 1 Bessborough Place, 12 Brompton Road, 124 Brook Street, Claridge's Hotel Carnaby Street, 22 Chapel Street, 38 Charlwood Street, 2 Charles Street, 15 Curzon Street, 46 Churt on Street, 2 Chandos Street, 7 Eaton Terrace, 40 Ebury Street, 160 Elizabeth Street, 48 Foubert's Place, 4 Frith Street, 11 Floral Street, 44 Gillingham Street, 1 Glasshouse Street, 50 and 52 Greek Street, 34 Greek Street, 28 Greek Street, 47 Great Windmill Street, 22 Horseferry Road, 106 Hindon Street, 38 James Street, (Whitcomb Street), 12 Jermyn Street, 78 Lexington Street, 41 Lupus Street, 5 Lupus Street, 65 Lupus Street, 109 Little Pulteney Street, 31 Little Pulteney Street, 4 Little Newport Street, 33 Lower Belgrave Street, 16 Moreton Street, 44 Moreton Street, 18 Mount Street, 121 Marsh am Street, 63 Marsh am Street, 38 Macclesfield Street, 4 Motcomb Street, 11 New Street, 13 New Street, 26 Nassau Street, 12 North Audley Street, 41 Oxford Street, 167 Oxford Street, 197 and 199 Oxford Street, 415 Oxford Street, 159 Old Compton Street, 1 Old Compton Street, 32 Piccadilly, 176 Piccadilly (Berkeley Hotel), 77 Pimlico Road, 69 Portland Street, 29 Ponsonby Terrace, 35 Park Street, 51 Raphael Street, 36 Regency Street, 9 Regent Street, 65 Regent Street, 227 Regent Street, 106 Rochester How, 84 Semley Place, 2a Sutherland Terrace, 7 Sussex Street, 15 St. Martin's Lane, 79 Strand (Hotel Cecil) Tachbrook Street, 2 Vauxhall Bridge Road, 40 Warwick Street, 48 Warwick Street, 19 Westmoreland Street, 3 West Strand (Charing Cross Hotel) Whitaker Street, 4 Wardour Street, 76 Bakehouses Above Ground. Belgrave Road, 12 York Street, 42 Buckingham Gate, 60 Strutton Ground, 6 Great Peter Street, 44 Horseferry Road, 99 Romney Street, 48 Vauxhall Bridge Road, 72 Horse and Dolphin Yard, 1 Shepherd's Market, 10 Montpelier Row, 23 Peter Street, 27 New bakehouses above ground are being constructed at the Savoy Hotel and in Little Dean Street. 69 Underground Bakehouses in use at the time of the passing of the Factory and Workshop Act, 1901 (17th August), but not now in use:— Dover Street, 5 Old Bond Street, 46 East Chapel Street, 2 Knightsbridge, 195 Eccleston Street, 24 Motcomb Street, 23 Cambridge Street, 56 Pimlico Road, 6 *Clare Court, 5 *Drury Lane, 86 *Stanhope Street, 50 Carnaby Street, 34 *Clare Street, 13 Ebury Street, 207 Great Chapel Street, 7 Strutton Ground, 26 Regency Street, 51 St. James Street, 7 Hay market, 54 Strand, 442 *Strand, 93 *Long Acre, 42 *Blackmore Street, 18 *Vere Street, 9 *Clare Street, 16 Brompton Road, 116 Nine of these bakehouses (marked *) are to be pulled down in connection with street or other improvements. It may be desired to use some of the others at some future time, in which case they would have to be put into condition satisfactory for certification by the Council. Underground bakehouses at the following premises were not in use at the date of the passing of the Act, and are thereby debarred from use as such in future:— Little Chester Street, 5 Churton Street, 35 Regency Street, 115 Wardour Street, 128 Moor Street, 16 Bear Street, 12 Bow Street, 2 Ponsonby Place, 81 Rochester Row, 52 Coventry Street, 18 and 19 Order by Home Secretary modifying amount of cubic space for persons employed in bakehouses, dated 30th December, 1903. The Order is made in pursuant of Section 3 (2) of the Factory and Workshop Act, 1901, and came into force on the 1st January, 1904. The modifications are:— (1) As regards underground bakehouses, by the substitution of "500 cubic feet of space to every person" for "250 cubic feet of space to every person" and (2) As regards bakehouses (other than such as are underground) where work is carried on at night by artificial light other than electric light, by the substitution of, in respect of the period between nine in the evening and six in the succeeding morning, "400 cubic feet of space to every person" for "250 cubic feet of space to every person." This Order came in force on the 1st January, 1904, and a copy thereof was sent by the Council to each baker in the City. I have gone through the list of bakehouses and compared the amounts of cubic space with the number of persons employed and find that it will affect one or two bakehouses, but only to the extent of one person each employed occasionally. 70 Restaurants and Ealing Houses.—There are 368 places of this class, irrespective of bakehouses, milk shops, and ice-cream vendors, but the number is constantly changing. The following is a summary of the work done in connection therewith:- 1902. 1903. Visits 304 216 Number of premises found satisfactory on inspection 90 103 Number of premises at which sanitary defects were found 214 113 Number of cases in which statutory notices were served — 6 The sanitary defects which had to be remedied were mostly that the walls, ceilings, &c., required cleansing, but in the following instances additional matters required attention in 1903:— Defective drainage and sanitary fittings 19 Defective ventilation 7 Defective flooring and ing 2 Absence of proper receptacles for refuse 5 Dirty cisterns 2 W.C. not properly separated from kitchen 1 The defective sanitary fittings include such things as untrapped sinks and gullies, defective manhole covers. In one case a sink discharged on to the floor of the larder and the waste had to flow over the floor to a gully. One kitchen was rebuilt. The County Council propose to ask Parliament in the coming session to pass the following regulations for premises used for sale, &c., of food for human consumption:— (1) From and after the passing of this Act the following provisions shall apply to any room or place in any sanitary district in or upon which any article whether solid or liquid intended for the food of man is sold or exposed for sale or deposited for the purpose of sale or of preparation for sale or with a view to future sale:— (a) No sanitary convenience or ashpit shall be within or directly communicate with such room or place; (b) Every cistern for supplying water to such room or place shall be separate and distinct from any cistern for supplying water to any sanitary convenience; (c) No drain or pipe for carrying off fcecal or sewage matter shall have any inlet or opening within such room or place; (d) No such room or place shall be used as a sleeping place and no sleeping place shall communicate directly with such room or place; 71 (e) No act or thing shall be done or permitted in any such room or place likely to expose any such article to infection or contamination. (2) If any person lets or suffers to be occupied or occupies any room or place or does or permits any act or thing therein in contravention of this section he shall be liable on summary conviction to a fine not exceeding for a first offence twenty shillings and for every subsequent offence five pounds and to a further fine not exceeding twenty shillings for every day on which he continues an offence after conviction thereof. Ice-creams.—Premises where ice-creams are manufactured or sold were frequently inspected during the year; there are 108 premises other than hotels and restaurants where ice-cream is manufactured and sold. Proceedings were taken against Peitro Necchi, 36, Berwick Street, under the London County Council General Powers Act, 1902, for manufacturing ice-cream in a room used as a sleeping room, and he was fined £2 and £2 2s. costs. At present fines inflicted for infringement of the provisions of Part VIII (Ice-creams) of the General Powers Act, 1902, are not payable to the City Council, but it is proposed to obtain power to make them so payable. Every itinerant vendor of ice-cream, &c., is required to exhibit the name and address of the manufacturer on his barrow. One man was cautioned under this section. Lists of such vendors were prepared in several Boroughs, and the Medical Officers of Health gave one another information with regard to the places where the ice-cream was made. There were eighteen persons selling it in the City during the year, of these seven resided in the City, the others came from Finsbury (4), Holborn (3), Chelsea (3), and Lanrbeth (1). In one case the Medical Officer of Chelsea informed me that the place in which the mixture was prepared was dilapidated, with w.c. obstructed, and defective paving of scullery. In another (in Holborn) proceedings were taken for making ice-cream in a living and sleeping room. Aerated Water Manufactories.—There are five establishments where mineral waters are made in the City of Westminster. Two of these are on a small scale, operations being carried out in basements. Being factories all are under control of the Home Office, but the supervision appeared to be confined chiefly to securing efficient protection of machinery and bottling apparatus. In only one of the five could no faults be found, in the others improvements were effected as follows:— 72 (a) Great Marlborough Ward Rotten wooded floor in front cellar replaced with cement. (b) Do. Wall protected from damp; general cleansing and repair of walls, ceilings and floors. (c) St. John's Ward Paving of yards, removal of refuse, cleansing of floors, limewashing of walls. (d) Victoria Ward Repairing of general yard and of stable yard, removal of manure. The London County Council had a special report made to them by Dr. Hamer on the subject in 1903, on account of a suggestion from the trade that it is desirable that no one should be allowed to manufacture aerated waters without a special permit—a system recently adopted in New York—and under regulations. Slaughter-houses.—There is now only one slaughter-house in the City, viz., at 14, Eegency Street. It was visited fourteen times. Offensive Trades.—No places in the City are now licensed for the carrying on of trades which come under this category. During the year the last two, both tripe-boilers, discontinued the business. Four visits were paid to them before they were given up. Food and Market Inspections. The markets and places where food is sold have been inspected every day (including Sundays), and the vigilance displayed by the Inspectors in previous years has been maintained. The following list shows the quantity of food seized, condemned, and destroyed as unfit for food during the year:— Fruit and Vegetables. Apples 1½tons Horseradish 16 cwt. Asparagus 1 ton Onions 8 cwt. „ (tinned) 22 tins Oranges 1¼ tons. Bananas 17 tons Peaches 3 cwt. Beans 2¾ tons Pears 2 tons „ Madeira 1¼ cwt. Peas, Green 20 lbs. „ (tinned) 1,359 tins Plums 14½ tons Cauliflowers 2½ cwt. Potatoes 5 cwt. Cherries 3 cwt. Rice 16 lbs. Chestnuts 1½ tons Spinach 63 lbs. Chillies ¼ cwt. Strawberries 11¾ cwt. Cocoa-nuts 11½ cwt. Tomatoes 8 tons Cucumbers ¾ cwt. Turnips 8 tons Grapes 1 ton 4 cwt. 73 Fish. Anchovies 45 lbs. Mixed Fish 7¾ cwt Fish (tinned) 13 tins Smoke d Salmon 2 tins Herrings 4 cwt. Whiting 21 lbs. Meat. Bear hams 2½ cwt. Sausages 75 lbs. Mutton 3 lbs. Sheeps' lungs 6 pairs Ox tongues 300 Legal Proceedings. —Prosecutions were taken in two instances:— Name. Offence. Fine. Alexander Strohalm Exposing for sale 11 pieces of meat, the same being unfit for the food of man £5, and 12s. 6d. costs. Morris Miller, 89, Wardour Street Exposing for sale 10 tins of anchovies and 2 tins of salmon, the same being unfit for the food of man £1, and 12s. 6d. costs. In two instances tinned food was seized in a state unfit for human food; and in each case the owner alleged that it had been set aside and was not to be sold. The evidence either way was not strong, and no proceedings followed. It was suggested that where a seller of such goods had a restaurant in connection with his business, he might (if unscrupulous) get rid of such unsound food in that way. In order that dealers in foodstuffs might not be ignorant of the law on the matter, a circular letter was sent out to them with an extract from the Act. The letter was as follows:— "The attention of all dealers in foodstuffs is hereby urgently called to the provisions of Section 47 of the Public Health (London) Act, 1891, a copy of which is hereto annexed. "Express attention is called to the provisions of Sub-section 8, and dealers are informed that a written notice addressed to the Medical Officer of Health at the City Hall, Charing Cross Road, will ensure the prompt removal as trade refuse of any unsound food to which such notice relates. "Having regard to these facilities, there can be no excuse for the retention, upon shop premises, of any unsound food whatever, and dealers are informed that, should proceedings at any future time be taken in consequence of the seizure of any unsound food within the City of Westminster, against any person npon whom this notice has 74 been served, evidence will be given that the attention of the defendant has been expressly called to Sub-section 8." Unsound Pies.—On several occasions complaints have been made in this and other districts, that pork and other pies which have been sold in public-houses have turned out bad. Careful inspection has been made regularly at places where such pies are made, and it has always been found that the greatest care is taken in the manufacture; that the manufacturers call several times a week on their customers, and are always willing to exchange pies left on a previous occasion for fresh ones. The fault appears to be rather in the manner in which their commodities are kept in the retail shops; placed in a shop window with the gas burning all the evening, or on a bar counter, even when under a glass cover, the conditions are as favourable as can be for the introduction and growth of organisms. Sale of Food and Drugs Acts. Samples Purchased under the Sale of Food and Drugs Acts, together with the number found Adulterated. Also a List of Prosecutions with the result of same. Number. Articles of Food. Number of Samples Purchased. Genuine. (Inferior in brackets.) Adulterated. Prosecutions. Convictions. Warranty or Disclosure. Fines. Costs. £ s. d. £ s. d. 1 Milk 608 464 (73) 71 26 23 3 43 0 0 16 6 0 2 Cream 27 3 24 3 Condensed milk 55 48 (3) 4 1 1 — 0 10 0 0 14 6 4 Butter 261 243 (5) 13 9 9 — 23 0 0 6 10 6 5 Margarine 54 52 2 1 1 — 0 10 0 0 12 6 6 Cheese 75 75 7 Lard 80 60 (16) 4 2 2 — 10 0 0 1 7 0 8 Brandy 28 22 (3) 3 9 Whisky 121 100 (5) 16 2 2 — 4 0 0 1 7 0 10 Grin 18 15 3 11 Rum 30 28 2 12 Cocoa 51 39 12 1 1 — 3 0 0 0 12 6 13 „ mixture 3 3 14 Coffee 103 92 (1) 10 5 5 — 8 0 0 3 10 6 15 „ mixture 2 2 16 Arrowroot 9 9 17 Bread 9 9 18 Gringer 18 18 19 Sweets 31 26 (4) 1 20 Ice cream 46 29 (7) 10 21 Tinned peas 9 - 9 3 3 — 13 0 0 3 9 0 22 Olive oil 80 68 (5) 7 5 5 — 14 0 0 3 2 6 23 Pepper 26 25 (1) 21. Milk of sulphur 33 31 2 25 Iron pills 10 10 26 Camphorated oil 13 12 (1) Totals 1,800 1,483 (124) 193 55 53 2 119 0 0 37 12 0 75 Milk.—11.6 of the ordinary milk samples were adulterated, as compared with 11.8 in 1902, but the proportion of milk marked genuine but inferior was higher, being 12 per cent., as compared with 8 per cent. in 1902. The attention of the House of Commons has been directed by Mr. Kearley, M.P., to the administration of the Food Adulteration Acts, and in particular to the adulteration of milk in London. He stated that the average percentage of adulteration of milk in the twenty largest towns, excluding London, was 8.3 per cent., and that in the whole of the Metropolis it was 15.2 per cent. He pointed out that in Manchester, where the Acts had been efficiently administered, for some years the percentage of adulteration of milk was only about 3½ per cent., and suggested that the Local Government Board should appoint special inspectors in order that the serious adulteration of milk in London might be diminished. In the course of his reply Mr. Walter Long, President of the Local Government Board, is reported to have stated that "to do the work of the London County Council or London Borough Councils by Government agency at Government cost would be the very worst thing in the interest of the Adulteration Acts. There had undoubtedly been a want of activity in London, and his business was to urge the Municipal Authorities in London to do their work properly and at their own cost." The London County Council has no jurisdiction whatever under these Acts, but they have prepared a statement as to the working of the Acts in London for the years 1900-2, and in certain large towns of England for the year 1902. The following extract is taken from this Eeport:— "There has, in recent years, been a marked increase in the number of samples purchased in London for analysis. Thus for every 10,000 of the population the numbers purchased during the years mentioned were as follows:— Table A. Total Samples. Milk Samples. 1900 29.8 13.5 1901 34.3 15.6 1902 39.4 18.4 "In 1902 the number of samples purchased for analysis per 10,000 of the population of large towns of England having 200,000 inhabitants and upwards was as follows:— 76 Table B. Town. Total Samples. Milk Samples. Town. Total Samples. Milk Samples. Birmingham 24.9 8.9 Bristol 22.4 8.2 Liverpool 26.0 13.9 Sheffield 19.4 11.3 Manchester 33.1 17.9 Nottingham 20.1 6.6 Bradford 16.6 4.0 Salford 33.0 13.5 West Ham 37.9 21.9 Leicester 19.9 9.6 Leeds 12.2 8.8 Newcastle 9.2 1.9 Hull 26.8 7.1 London, therefore, in point of number of samples purchased during 1902, was not exceeded by any of the large towns referred to in respect of total samples, and only by West Ham in respect of milk samples. "The following table shows in proportion to population the number of samples purchased in each of the Metropolitan Boroughs, both total and milk:— Table C. Borough. Total Samples per 10,000 Population. Milk Samples per 10,000 Population. Borough. Total Samples per 10,000 Population. Milk Samples per 10,000 Population. Battersea 30.7 9.2 Lambeth 23.1 10.2 Bermondsey 58.3 29.9 Lewisham 34.6 17.4 Bethnal Green 30.2 15.8 London, City of 488.3 236.3 Camberwell 30.8 12.1 Paddington 36.5 22.1 Chelsea 23.2 12.7 Poplar 21.8 8.9 Deptford 26.9 14.1 St. Marylebone 42.8 15.3 Finsbury 55.3 27.3 St. Pancras 21.5 11.1 Fulham 24.7 10.3 Shoreditch 23.8 13.0 Greenwich 21.5 13.7 Southwark 93.6 51.1 Hackney 27.0 14.0 Stepney 39.5 18.3 Hammersmith 34.8 12.2 Stoke Newington 22.8 8.5 Hampstead 37.6 8.0 Wandsworth 24.2 8.9 Holborn 68.7 30.2 Westminster, City of 99.7 31.7 Islngton 27.6 17.4 Woolwich 42.5 31.3 Kensington 28.2 11.6 London, County of 39.4 18.4 "Of total samples the average of the County of London was for last year 39.4 per 10,000. The City of London heads the list with 488.3, and is followed by the City of Westminster with 99.7. The two boroughs with the lowest proportions are St, Pancras and Greenwich, with 21.5 each. Of milk samples, the highest proportions were 236.3 in the City of London and 51.1 in Southwark, and the lowest 8.0 in Hampstead and 8.5 in Stoke Newington. "The proportion of total and milk samples found to be adulterated in London was as follows:— 77 Table D. Total Samples. Milk Samples. Per cent. Per cent. 1900 9.8 14.1 1901 11.4 15.1 1902 11.9 15.6 "London, in point of proportion of samples adulterated during the year 1902, was exceeded by Bradford, West Ham, and Leeds, and by Birmingham, Leeds, and Newcastle in respect of milk samples. "Comparison may be made between the Metropolitan Boroughs in respect of adulteration in 1902. "Table E shows that the following districts had the lowest and highest percentage of adulteration respectively:— Table E. Lowest. Highest Borough. Total Samples. Milk Samples. Borough. Total Samples. Milk Samples. St. Marylebone 3.9 6.9 Shoreditch 25.3 29.9 Woolwich 4.1 4.8 Hackney 23.8 33.2 Hampstead 5.4 4.5 Stepney 21.9 30.4 Hammersmith 6.0 5.0 St. Pancras 20.7 32.1 "It will be seen that there are great differences between the extent to which the provisions of the Food and Drugs Acts are carried out in the several London districts, and, in respect of milk, it will be noted that St. Pancras and Lambeth, in which large railway stations are situated, purchase, in proportion to their resident population, fewer samples than the average of London. The annual report of the Medical Officer of Health of Islington shows that, as the result of analysis of milk taken in Islington at the railway stations and elsewhere, the former was found to be much less adulterated than the latter, and this would accord with the fact that there are fewer opportunities for the adulteration of milk up to the time of arriving at the railway stations than of milk subsequently taken to milk vendors' premises. Nevertheless, there ought to be abundant analysis of milk arriving at stations, and which is subsequently to be distributed over London. Sanitary authorities cannot purchase samples under the Act outside their own districts, and it is obviously unfair to expect sanitary authorities of districts in which are large railway stations to purchase milk for analysis when the milk is only in transit through their districts." 78 "In conclusion, the Medical Officer expresses the opinion that 'it would be desirable for some system to exist which would enable an authority dealing with the whole county to secure, at their own expense, the analysis of milk entering London, and there would be,' he thinks, 'further advantage if some system existed by which a central authority could ensure that the Acts were administered on a sufficiently comprehensive scale in each district.' "We concur in this view, but before reporting to the Council as to the steps which it would be desirable to take with the object of securing an amendment of the law in the direction indicated, we should like an expression of the Council's opinion on the subject. We therefore recommend the Council to pass a resolution in the following terms:— "That it is desirable that application should be made to Parliament for powers to enable the Council, as the authority dealing with the whole county, to secure, at its own expense, the analysis of samples of milk arriving at railway stations in London and subsequently distributed in the county, and that there would be further advantage if some system existed by which the Council, as the central authority, could ensure that the Sale of Food and Drugs Acts should be administered on a sufficiently comprehensive scale in each sanitary district within the county." This view is not that taken by the Westminster City Council. They are of opinion that the Local Government Board or the Board of Agriculture is the proper central authority to see that these Acts are enforced, and that local authorities should have power to take samples of milk destined for distribution in their district at the point of arrival. Cream.—In twenty-four out of the twenty-seven samples preservatives were present in small quantities. Similar conditions existed in ten of the forty-six ice-creams analysed. Butter.—Thirteen samples sold as butter were not genuine. The Board of Agriculture issued a circular to local authorities giving directions as to the preservation and transmission of samples of butter for analysis. The method recommended is that already carried out in the City. Tinned Peas. —Samples were taken of preserved peas and all were found to contain sulphate of copper; three successful prosecutions resulted in the case of those containing more than two grains per pound. The Council thought it desirable to call the attention of vendors of preserved peas to the matter, and sent the following letter "Preserved Peas.—The Westminster City Council recently instituted summary proceedings against certain vendors of food stuffs in the City 79 for selling preserved peas containing sulphate of copper, added to give the peas a 'good colour.' The proceedings resulted in the vendors being fined £5 with costs in one case, and £4 with costs in each of two other cases. "Further samples were subsequently taken in other parts of the City, and, upon analysis, were also found to contain sulphate of copper. "The percentage of the chemical in these particular cases not being to such an extent as in the previous cases, the City Council refrained from taking summary proceedings in respect thereof, but directed cautionary letters to be addressed to the several vendors. "The City Council have directed me to call your attention to these facts, and to state that they have given instructions to their Inspectors to continue to purchase samples of preserved peas in the City for analysis, and that, should samples of such peas be so purchased at your premises, and be found to contain sulphate of copper, the fact of this communication having been sent to you will be adduced in evidence in any proceedings which the City Council may think fit to institute in respect of the offending sample." By most of the vendors of these articles the notice was appreciated, and a number of them took steps to have the preserved peas in stock analysed, in order that they might know exactly how much copper they contained; but evidently this attitude was not adopted by everyone, as a letter was received from the Local Government Board, dated the 24th July. 1903, forwarding extract from a letter received by the Board from the London Chamber of Commerce with reference to the use of preservatives in peas, mentioned in the circular letter issued by the Council on the subject in May last, and requesting the Council's observations in the matter. The extract referred to is as follows:— "Botolph House, Eastcheap, "London, E.G. "17th July, 1903. "Sir- ****** "I am now instructed by the Chamber to forward to you the enclosed original of a circular letter issued by the Westminster City Council to a number of retailers, grocers, &c., within the district under its control, the issue and substance of which the Chamber desires specially to bring to your notice. It is held that in the present state of uncertainty as to the exact law governing the sale of preserved green vegetables, the issue of such a circular by a local body is quite out of order, and is practically an attempt to manufacture evidence for use in future cases against any defendants to whom a copy of the circular may have been sent, and 80 this action is most strongly deprecated as contrary to the whole practice of English jurisdiction. Also, the Chamber is advised that the subject matter of the circular is incorrect and misleading, as, for instance, in the first paragraph it is stated inter alia that the sulphate of copper is added to give the peas a 'good colour'; this is not the case, the chemical being used simply to fix the natural colour, and it is impossible to restore old or faded peas by its use. ****** "Your obedient Servant, "(Signed) Kenneth Murray, "Secretary. "The Rt. Hon. W. H. Long, M.P., "President, Local Government Board, " Whitehall, S.W. The Local Government Board was informed that it was upon the advice of the City Solicitors that the circular referred to was distributed, and that since its distribution many persons receiving it had taken steps to ascertain the amount of copper (if any) in the peas supplied to them for sale, and had expressed their appreciation of the action of the Council in drawing their attention to the matter; that the statement that it was impossible to restore old or faded peas by the use of copper sulphate was contrary to the information in the possession of the Council, as one of the City's Public Analysts, acting on the suggestion of the Medical Officer of Health, made some old dried peas assume a green colour by treating them with copper sulphate. 81 Ward. Name and Address of Defendant. Court and Name of Magistrate. Offence. Result. Milk. Covent Garden Alfred John Smith, 14, Mercer Street. Bow Street (Sir A. de Rutzen). Selling milk 9 per cent. of added water. Fined £1 and 12.9. 6d. costs. Great Marlborough Lockhart's Ltd., 25, Coventry Street Great Marlborough Street (Mr. Kennedy) Selling milk 11 per cent. of added water. Fined £2 and 12s. 6d. costs. St. John John Staples, 4, Bowden Street, Kennington Road, S.E. Westminster (Mr. Sheil) Selling milk having 23 per cent. of its fat abstracted Fined £1 and 14s. 6d. costs. St. John Moses D. Williams, 7, Regency Street Westminster (Mr. Sheil) Selling milk containing 8 per cent. of added water Defendant relied on a warranty, but failed to give notice in time. The Magistrate allowed costs, amounting to 14s. 6d. Great Marlborough P. Zerbini, 25, Carnaby Street Great Marlborough Street (Mr. Kennedy) Selling milk containing 12 per cent. of added water Fined £2 and 12s. 6d. costs. Charing Cross Carlo Negrotti, 25, Whitcomb Street Great Marlborough Street (Mr. Kennedy) Selling milk containing 18 per cent. of added water Fined £2 and 12s. 6d. costs. Victoria John J. Pearl, 312, Vauxhall Bridge Road Westminster (Mr. Sheil) Selling milk with 22 per cent. of fat abstracted Fined £1 and 14s. 6d. costs. St. John T. J. Hailes, 29, Strutton Ground Westminster (Mr. Sheil) Selling milk, from which 16 per cent. of fat had been abstracted Fined 10s. and 14s. 6d. costs. St. Anne Phiiip Townsend, 15, Dean Street Great Marlborough Street (Mr. Kennedy) Selling milk containing 9 per cent. of added water Fined £4 and 12s. 6d. costs. Victoria John Lilly white, 5, Ranelagh Road Westminster Mr. Sheil) Selling milk containing 20 per cent. of added water Fined £5 and 14s. 6d. costs. Victoria N. Cutlini, 16, Little Newport Street Westminster Mr. Sheil) Selling milk having 14 per cent. of its fat abstracted Fined £1 and 12s. 6d. costs. Victoria G. W. Dancocks, 23 Buckingham Palace Road, S.W. Westminster (Mr. Sheil) Selling milk containing 10 per cent. of added water Fined £2 and 14s. 6d. costs. Knightsbridge St. George C. Roberts, 40, Graham Street Westminster Mr. Sheil) Selling milk containing 10 per cent. of added water Fined 10s. and 14s. 6d. costs. Covent Garden G. Cullen, 11, Mercer Street Bow Street (Mr. Marsham) Selling milk containing 10 per cent. of added water Fined £1 and 14s. 6d. costs. G 82 Ward. Name and Address of Defendant. Court and Name of Magistrate. Offence. Result. Regent Annie Harris, 3, Little Pulteney Street Great Marlborough Street (Mr. Plowden) Selling milk containing 11 per cent. of added water Fined 5s. and 12s. 0d. costs. Charing Cross Griffith Jones, 7, Blue Cross Street Great Marlborough Street (Mr. Plowden) Selling milk from which 28 per cent. of fat had been abstracted Fined 5s. and 12s. 6d. costs. Great Marlborough J. Bird, 18, Brewer Street Great Marlborough Street Mr. Lane) Selling milk having 16 per cent. of its fat abstracted Fined £1 and 14s. costs. Great Marlborough P. Zerbini, 25, Carnaby Street Great Marlborough Street (Mr. Lane) Selling milk having 16 per cent. of its fat abstracted Warranty proved. Summons withdrawn. Strand Agnes Barber, 9, Portsmouth Street Bow Street (Sir A. de Rutzen) Selling milk having 12 per cent. of its fat abstracted Fined £3 and 14s. 6d. costs. St. Margaret Austin Buss, 17, Old Queen Street Westminster (Mr. Sheil) Selling milk having 24 per cent. of its fat abstracted Fined £3 and 14s. 6d. costs. Regent J. Bird, 18, Brewer Street Great Marlborough Street (Mr. Plowden) Selling milk containing 6 per cent. of added water Warranty proved, summons withdrawn. Victoria Messrs. Dancock, 23, Buckingham Palace Road Westminster (Mr. Sheil) Selling milk containing 14.3 per cent. of added water Fined £5 and 14s. 6d. costs. Victoria John Lillywhite, 50, Ranelagh Road, S.W. Westminster (Mr. Sheil) Selling milk containing 24 per cent. of added water. Fined £5 and 14s. 6d. costs. Victoria Mary Reed Westminster (Mr. Sheil) Selling condensed milk having 96 per cent. of its fat abstracted Fined 10s. and 14s. 6d. costs. Butter. St. John Grosvenor Dairies, Ltd., 7 and 9, Moreton Street Westminster (Mr. Sheil) Selling butter containing 82.8 per cent. of foreign fat Fined £5 and 14s. 6d. costs. St. John Moses D. Williams, 7, Regency Street Westminster (Mr. Sheil) Selling butter containing 84 per cent. of foreign fat Fined £2 and 14s. 6d. costs. Grosvenor T. J. Davies, 4, Shepherd's Place, W. Great Marlborough Street (Mr. Marsham) Selling butter consisting entirely of margarine Fined £2 and 14s. 6d. costs. Great Marlborough Mrs. Lazareek, 40, Berwick Street Great Marlborough Street (Mr. Marsham) Selling butter containing 18.5 per cent. excess of water Fined £1 10s. and 14s. 6d. costs. Great Marlborough Mary Roth, 32, Broad Street, W. Great Marlborough Street (Mr. Marsham) Selling butter containing 10.5 per cent. excess of water Fined £1 10s. and 14s. 6d. costs. Great Marlborough Harris Goldstein, 12, Broad Street Great Marlborough Street (Mr. Marsham) Selling butter containing 4 per cent. excess of water Fined £1 and l4s. 6d. costs. 83 Sr. John Arthur Leonard, 26, Ponsonby Place (Mr. Sheil) Selling butter containing 24 per cent. of foreign fat Fined £3 and 14s. 6d. costs. St. John R. J. Janes, 28, Ponsonby Place (Mr. Sheil) Selling butter containing 24 per cent. of foreign fat Fined £5 and 14s. 6d. costs. Margarine. Regent J. Evans, 1, West Street Great Marlborough Street (Mr. Plowden) Selling margarine containing 20 per cent. of butter fat Fined 10s. and 12s. 6d. costs. Lard. Regent Miss Ann Davies, 21, Little Pulteney Street Great Marlborough Street (Mr. Kennedy) Selling lard containing 30 per cent. of fat other than lard Defendant's solicitor proved that the lard was bought as pure, and the Magistrate thought that the justice of the case would be met by the defendant paying the costs, viz., 12s. 6d. St. John R. H. Rees, 8, Strutton Ground Westminster Mr. Sheil) Selling lard containing 90 per cent. of fat other than the fat of lard Fined £10 and 14s. 6d. costs. Olive Oil. Great Marlborough Giovanni Parmigani, 58, Wardour Street. Great Marlborough Street Mr. Kennedy) Selling olive oil containing 48 per cent. of oil other than olive oil Fined £5 and 12s. 6d. costs. Regent Henry Hall, 16, Berwick Street Great. Marlborough Street (Mr. Kennedy) Selling olive oil containing 85 per cent. of oil other than olive oil Fined £3 and 12s. 6d. costs. Great Marlborough George Ward, 10, Foubert's Place Great Marlborough Street (Mr. Kennedy) Selling olive oil containing 90 per cent. of oil other than olive oil Fined £3 and 12s. 6d. costs. Grosvenor E. Elliott, 11, Shepherd's Market, W. Great Marlborough Street (Mr. Kennedy) Selling olive oil containing not less than 75 per cent. of oil other than olive oil Fined £2 and 12s. 6d. costs. St. Anne G. Edmond, 56, Wardour Street Great Marlborough Street (Mr. Kennedy) Selling olive oil containing not less than 55 per cent. of oil other than olive oil Fined £1 and 12s. 6d. costs. Preserved Peas. Great Marlborough Alfred Douglas, 27, Carnaby Street Great Marlborough Street (Mr. Kennedy) Selling peas coloured with 2.82 grains of sulphate of copper per lb. Fined £4 and 23s. costs. G2 84 Ward. Name and Address of Defendant. Court and Name of Magistrate. Offence. Result. Regent Chas. Manzel, 6, Coventry Street Great Marlborough Street Mr. Kennedy) Selling peas coloured with 3.09 grains of sulphate of copper per lb. Fined £5 and 23s. cost . Charing Cross Cocoa. Spencer, 24, Panton Street Great Marlborough Street (Mr. Kennedy) Selling peas coloured with 2.82 grains of sulphate of copper per lb. Fined £4 and 23s. costs. Regent R. H. Bodilly, 19, Air Street Great Marlborough Street (Mr. Kennedy) Selling cocoa containing 40 per cent. of sugar, 27 per cent. of added starch, and 15 per cent. of red oxide of iron Fined £3 and 12s. 6d, costs. Coffee. Strand P. Jansen, 4, Exeter Street, W.C. Bow Street (Mr. Marsham) Selling coffee containing 90 per cent. of chicory. Fined £2 and 14s. 6d. costs. St. Anne C. W. Easey, 89, Shaftesbury Avenue Great Marlborough Street Mr. Kennedy) Selling coffee containing 35 per cent. of chicory Fined £1 and 12s. 6d. costs. St. John Jessie Lee, 81, Ponsonby Place Westminster (Mr. Sheil) Selling coffee containing 90 per cent of chicory Fined £2 and 14s. 6d. costs. Victoria Albert Kent. 9, Aylesford Street Westminster (Mr. Sheil) Selling coffee containing 50 per cent. of chicory Fined £2 and 14s. 6d. costs. St. Anne W. Penlove, 9, Meard Street Great Marlborough Street (Mr. Horace Smith) Selling coffee containing 60 per cent. of chicory Fined £1 and 14s. 6d. costs. Whisky. Charing Cross Arthur C. C. Beach, St. Martin's Street Great Marlborough Street (Mr. Kennedy) Selling whisky 15 degrees below the legal limit of strength Fined £2 and 12s. 6d. costs. St. Margaret D. H. S. Alldridge, 23, Great Chapel Street, S.W. Westminster (Mr. Sheil) Selling whisky containing 31.46 per cent. of added water Fined £2 and 14s. 6d. costs. Milk of Sulphur. St. John Littlewood Bros., 102, London Road, S.E. Westminster (Mr. Sheil) Selling milk of sulphur containing 48.5 per cent. mineral matter Fined £2 and 14s. 6d. costs. St. John A. Fitzgerald, 47, Marsham Street Westminster (Mr. Horace Smith) Selling milk of sulphur containing 46.4 per cent. of nonvolatilizable mineral matter Fined 5s. and 14s. 6d. costs. 85 Water Supply. Taking the average amount of organic impurity in a given volume of the Kent Company's Water during the 9 years ending December, 1876, as unity, the proportional amount contained in an equal volume of water supplied by each of the Metropolitan Water Companies during each month of 1902 is shown in the following table, extracted from the monthly reports of the Analyst (Prof. Thorpe) of the Local Government Board:— Proportional Amount of Organic Impurities in Waters. Rent. New River. Lambeth. Southwark. Grand Junction. West Middlesex. East London. Chelsea. January 12th 1.1 2.1 8.5 3.6 7.3 4.9 2.2 3.9 February 9th 0.9 2.4 4.9 4.4 4.9 5.5 4.5 4.9 March 17th 0.9 3.7 7.3 4.7 6.8 5.1 9.9 4.9 April 20th 0.8 1.7 3.0 2.4 4.0 4.6 3.4 4.1 May 18th 0.8 2.7 7.3 4.5 6.9 4.6 3.9 6.1 June 9th 0.9 1.1 4.4 4.1 4.6 4.1 5.2 3.4 July 20th 0.7 1.3 3.2 2.7 3.4 4.9 4.2 4.4 August 19th 0.8 1.9 4.9 4.0 3.6 3.6 4.2 3.7 September 9th 0.8 2.3 4.6 5.7 4.8 4.1 4.8 4.2 October 9th 1.0 6.2 8.8 8.8 9.0 3.7 8.5 4.0 November 16th 1.1 3.8 5.7 5.0 5.9 8.1 4.6 8.4 December 8th 0.8 4.2 6.2 6.6 6.5 5.5 4.1 4.6 The water supply of London has been extremely bad during the whole year. During March the Thames-derived water supplied by several of the Companies was very inferior in quality, due to the flooded condition of the Thames and inefficient filtration, but in April the organic matter in the filtered supplies steadily decreased in amount,, and at the end of April, the samples contained less organic impurity and greater freedom from colour than they had done at any time since the beginning of the year. But this improvement did not continue, as the Thames was again in flood during the early part of May, and those Companies which possess comparatively little storage sent out very imperfectly filtered water of very unsatisfactory quality. This condition of things persisted more or less throughout the whole year, and in autumn the amount of organic matter exceeded all previous experience, and even the New River Company's water in October contained higher maximum and mean proportions of organic impurity than Prof. Thorpe had previously found, and although the highest amounts present were much less than those contained in certain of the Thames waters, it has been evident that this Company, with its relatively small storage, could not, on a few occasions, avoid the distribution of water of somewhat inferior quality. Complaints were made by the City Council to the Metropolitan Water Board and the Companies, but without any satisfactory result. The Metropolitan Water Board said that as the Water Undertakings had not yet passed into their hands, they are not 86 at present in a position to satisfactorily investigate the complaint made by the Council, and suggested that the Council should avail themselves of the opportunities afforded by the Metropolis Water Act, 1897, by laying complaints before the Railway and Canal Commission. The Council replied that they considered it would be a waste of public money on their part to lay a complaint before the Railway and Canal Commissioners as suggested, as the late Vestry of Battersea made a complaint to the Railway and Canal Commissioners with respect to the water supplied to that district by the Southwark and Vauxhall Company, and Mr. Justice Wright, who presided, said that the only powers the Commissioners had was to tell the Company to make arrangements to prevent a bad supply being given in the future, and as the Company was building new storage reservoirs which would probably prevent such bad water being again delivered, nothing could be gained by making a complaint to the Railway and Canal Commissioners. Each side had to bear its own costs. Curiously no bad effects seems to have resulted from the use of this impure and imperfectly filtered water, and the only explanation I can offer is that frequent floods at the end of the previous year and beginning of the next had so scoured the river bed and the sources from which contamination might reach it that typhoid and allied organisms had been swept away. Applications were received for 48 certificates that the water supply of new buildings was sufficient, and were granted in each instance. 300 notices of the withdrawal of water supply were received from the Water Companies, and in 191 instances it was reinstated; 24 houses have been pulled down and 85 are still empty. In 504 instances cisterns were required to be cleansed. 444 cisterns were required to be provided with proper covers, and 282 new cisterns were fixed, 86 being in place of defective cisterns. F. General. Smoke Prevention.—The City is divided into two parts for purposes of smoke inspection, and the following is a summary of the work done in connection therewith:— North District. South District. Total. Complaints received and dealt with 40 12 52 Observations taken 1,663 1,068 2,731 Nuisances reported 95 11 106 Notices issued:— Preliminary 37 31 68 Statutory 11 7 18 87 Prosecutions.—In two instances prosecutions failed against clubs, the magistrates holding that they were dwelling-houses, and therefore specially excluded from the operation of the Act. An appeal was taken and heard before Lord Alverstone, L.C.J., Lawrance and Kennedy, J.J., on December 9th, 1903. As this is an important case, I give a report of the case:— McNair v. Baker. "This was a case stated by a Metropolitan magistrate on the hearing of information by a Sanitary Inspector for the City of Westminster, which alleged that the defendant had made default in complying with a notice of the City Council requiring him to abate a nuisance arising from black smoke having been allowed to issue from a furnace chimney at his premises, situate and being St. James's Club. The defendant was the Secretary of the Club. "The magistrate found as facts that the respondent did not abate the nuisance or otherwise comply with the notice, and that the chimney sent forth black smoke in such quantity as to be a nuisance. But he held that the chimney was the chimney of a private dwelling-house within the meaning of Section 24 of the Public Health (London) Act, 1891, and dismissed the summons with costs. The plaintiff appealed. Section 24 (b) of the above Act provides that 'any chimney (not being the chimney of a private dwelling-house) sending forth black smoke in such quantity as to be a nuisance ' shall be a nuisance liable to be dealt with summarily under the Act. " The facts stated in the caso were that the Club consisted of 750 members, was managed by a Committee, had occupied the premises for thirty or forty years, previously to which they had been used as the French Embassy. These premises comprised the ordinary accommodation of a West End Club, with five bedrooms for the use of members, and eight other bedrooms for the use of the staff. In the basement of the premises there were several covered-in cooking ranges, a large roasting grate, and a vertical boiler with furnace attached. The smoke from these discharged into one flue, which was the chimney complained of. 'Macmorran, K.C. (Joseph Hurst with him) appeared for the appellant, and relied on the case of Queen Anne Residential Mansions and Hotel Go. v. Mayor of Westminster 46 Sol. J., 70. Boydell Houghton appeared for the respondent. "Lord Alverstone, L.C.J., said that the appeal must be allowed. On the facts found by the magistrate it was impossible to come to the conclusion that the premises were a private dwelling-house. Having regard to the section of the Act, he thought that it was not the construction of 88 the premises but their use that must be considered, and he was of opinion that using them as a club was not using them as a private dwelling-house. The case must therefore be sent back to the magistrate with a direction to convict.* "Lawrance and Kennedy, J.J., concurred." The only other case in which proceedings were taken was the Cafe Royal, 68, Regent Street. Fined £10 and 2s. costs. Smoke Nuisance from Railway Locomotives.—A considerable amount of nuisance is caused by the smoke from engines on Hungerford and Victoria Bridges. The London County Council has authority to enforce the provisions of the Railway Clauses Consolidation Act, 1845, Section 114, which requires that every locomotive shall be constructed on the principle of consuming its own smoke, and of the Regulation of Railways Act, 1868, which enacts that if a locomotive is constructed to consume its own smoke, but fails to do so as far as practicable at the time charged in the complaint, the railway company using such locomotive shall be deemed guilty of an offence. The Public Control Committee of the London County Council, in a report submitted during 1903, stated that:— "Considerable difficulty has been experienced in obtaining the necessary evidence to secure convictions. Until 1902 legal proceedings were usually taken only when a locomotive was seen smoking for several minutes, as when standing in sidings, at platforms, or on the line waiting for the signal to proceed. This meant, of course, that in only a small proportion of the cases reported were proceedings taken, as in most instances the nuisance arises from locomotives in motion. Proceedings are now taken with regard to locomotives in motion when the nuisance is believed to have continued for some time." It way be well to recall the fact that serious nuisance from railway locomotives is of quite recent date. Prior to the year 1898 most of the railway companies supplied smokeless coal for the use of their locomotives employed in the London and suburban traffic, but when the strike of the "Welsh colliers in that year forced the companies to use bituminous coal, such a reduction in the coal bill was effected that the companies were reluctant to return to smokeless coal. The majority of the railway companies now endeavour to comply with the law, but the nuisance caused by the engines of the London, Brighton, and South Coast Company and the South-Eastern and Chatham Railway Company continues to be serious. Both these companies have reported at recent half-yearly meetings large savings in their coal bill during the year 1902. The South-Eastern Railway Company stated that £43,000 was * Tbe magistrate subsequently imposed a fine. 89 saved during the first half of the year, and the Brighton Company reported a saving of about £45,000 during the year. During the last two or three months there has been some slight improvement in the South-Eastern, but none with regard to the Brighton Company, and most of the complaints received by the Council recently are of nuisance from the Brighton Company's locomotives. The maximum penalty is at present only £5, but if a system of cumulative penalties were provided it would probably be the means of securing an abatement of the nuisance. It may be added that, in respect of smoke nuisance from locomotives, New York is in a much more satisfactory position than London, as locomotives running into that city are not allowed to use bituminous coal under any circumstances. Smoke from Locomotives on Highways.—Section 30 of the Highways and Locomotives (Amendment) Act, 1878, requires that any locomotive used on any turnpike road or highway shall be constructed on the principle of consuming its own smoke, and provides that any person using any locomotive not so constructed, or not consuming as far as practicable its own smoke, shall be liable to a fine not exceeding £5 for every day during which such locomotive is used on any such turnpike road or highway. This Act is enforced by the London County Council. Mortuaries. The number of bodies removed to the public mortuaries in the City, during 1903, was 393; 368 were taken to Horseferry Boad, where the Coroner's Court is situated, 15 (one of these being a person who died of an infectious disease) to Denzell Street, 9 to Dufour's Place, and 1 to Drury Lane. There were 326 inquests held, all being at Horseferry Boad. 90 SPECIAL REPORT ON THE DISTRIBUTION OF TUBERCULAR DISEASE IN THE CITY OF WESTMINSTER. In accordance with the instructions of the Public Health Committee, I beg to submit certain particulars relating to the distribution of tubercular disease in the City. Maps.—I have endeavoured to reproduce the maps which I have prepared in the office each year, showing approximately the neighbourhood to which the persons belonged who died from this complaint. The small size of the map and the number of deaths in the three years has prevented the position of the house or even of the street being localised; but I have been able, with the co-operation of the Assistant City Engineer, Mr. Ventris, to mark out a number of small (enumeration) areas, of which the actual population at the last census is known, and we have shown it in each of the areas by green spots, each of which represents one hundred persons, living at the time of the census in the respective areas. Each red spot represents one death from consumption or other tubercular disease, and in certain neighbourhoods where space is limited or deaths many, a red cross has been inserted to represent ten deaths. Thus the population of each enumeration area can be ascertained in round numbers (fractions of 100, less than 50 persons, are not shown; between 50 and 100 are shown as 100) and the number of deaths from tubercular disease which have occurred in connection with that area during the three years 1901, 1902, and 1903. The number of divisions (enumeration areas) into which the City is divided is 145, and thus closer enquiry into the distribution of cases can be made than is possible with parishes or even wards. Death-rates.—It may first be useful to compare the death-rates of past years as it affected the old divisions of the City. For this purpose I have gone through the reports for ten years, and have calculated out the rates at per 100,000 of population. I have taken this standard, as thereby fractions are dispensed with in respect of the smaller numbers. For some years the deaths for consumption of the lungs only are available, but for the last seven years the rates for all deaths from tubercular diseases are given. It has been the practice to compare only the phthisis rates, but although the bulk of deaths from tubercle are ascribed to lung affection, yet it is extremely difficult to state which part of the body is the primary seat of the disease. Post-mortem examination generally reveals that in the end glands and organs in various parts of the body have been affected. Hence in dealing with the prevalence of the complaint 91 it is desirable to take into consideration the total deaths caused by the disease. In discussing the mode of infection it is useful to know the part first affected, but this also is difficult to determine during life, as the discovery that a certain part of the body is affected does not necessarily imply that the cause thereof found its way to that spot by the nearest route. Experiments and careful post-mortem examinations show that while the chief manifestation of the disease has been in the lungs, abdomen or head, the original part to be affected may have been a small gland in some other part of the body. London.—The first table shows the rates for London as a whole. Taking phthisis alone the death rate has decreased since 1861-1870. Deaths from Tubercular Disease. The Rates are for 100,000 of Population. The County of London. Phthisis Death Rates. Ten Yearly Periods. Five Yearly Periods. 1851-60 286 1891-95 183 1861-70 284 1896-1901 175 1871-80 251 1881-90 208 1891-1900 179 Total Tubercular Rates. Year. Pulmonary. Abdominal. Meningeal. Other. Total. 1881-90 203 35 54 297 1891-94 185 29 51 265 1895 178 29 52 259 1896 170 24 49 243 1897 173 22 26 22 243 1898 173 22 27 23 245 1899 182 22 25 21 250 1900 173 18 26 24 241 1901 165 18 23 23 229 1902 161 14 23 20 223 1903 155 14 24 20 213 Total Tubercular Death Rates. 1891-1895 (5 years' average) 264 1896-1900 (5 years' average) 244 1881-1890 (10 years' average) 297 1891-1900 (10 years' average) 254 92 Deaths from abdominal forms have decreased considerably, but in meningeal and other forms of the disease the decrease is much less in degree. The total rate has steadily improved. Thus between 1881-1890 it averaged 297 each year. In the next ten years, 1891-1900, the average mortality was 254 per 100,000, being 264 in the first half of the decade, 244 in the second half, and during the last three years the rate has further sunk to 229, 223, and 213. City of Westminster.—The rates for the City of Westminster are given for 1901, 1902, and 1903, and show a decrease all round:— The City of Westminster. Year. Pulmonary. Abdominal. Meningcal. Other. Total. Deaths. Rates. Deaths. Bates. Deaths. Rates. Deaths. Rates. Deaths. Rates. 1901 341 187 16 10 31 16 25 12 413 226 1902 328 178 18 9 32 17 35 17 413 224 1903 309 172 9 5 23 13 19 10 360 200 Three years 978 179 43 8 86 15 79 13 1,186 216 The figures are then:— Year. Pulmonary Tuberculosis. Total Tubercular Rates. County. City. County. City. 1901 165 167 229 202 1902 161 159 223 199 1903 155 154 213 178 For purposes of comparison with the whole of London, differences in the number of males and females, and their relative ages, have to be taken into account. This may be effected by multiplying the rates by a factor (0.89205). While a diminution in the deaths in the City as a whole is taking place, it is by no means equable, as will be seen by examining the figures for the old divisions of the City, then the wards, and finally the 145 smaller enumeration areas. The rates vary to a great extent in the old divisions. St. George Hanover Square Division—The phthisis rate for ten years and the total rate for seven years show slight variations. The 93 St. George, Hanover Square Division. Year. Pulmonary. Rates. Other Forms. Total. Case?. Rate. Abdominal. Meningeal. 1894 97 131 — — — — 1895 105 132 — — — — 1896 104 128 — — — — 1897 93 118 10 21 14 165 1898 105 120 7 15 6 150 1899 110 136 4 14 15 170 1900 110 137 9 13 21 182 1901 90 116 5 11 13 146 1902 97 126 10 11 7 156 1903 91 119 5 9 9 142 Average of ten years 100 126 7* 14* 12* 158* * Average for seven years. Conduit Ward. Year. Pulmonary. Other Forms. Total. Cases. Rate. Cases Rate. Cases. Rate. 1901 3 51 1 17 4 68 1902 1 17 2 34 3 51 1903 2 34 — — 2 34 Grosvenor Ward. 1901 8 52 5 32 13 85 1902 12 79 2 13 14 92 1903 6 40 — — 6 40 Knightsbridge, St. George Ward. 1901 11 70 4 25 14 95 1902 15 98 3 19 18 117 1903 7 46 3 20 10 66 Victoria Ward. 1901 68 167 13 30 81 198 1902 69 171 18 43 87 216 1903 76 192 15 37 91 230 94 rates are not high compared with the City as a whole, and there is a tendency towards improvement during the last three years, but this may be due to an over-estimation of the population. However, when statistics for the wards in this division are examined, it will be seen that while in Conduit, Grosvenor and Knightsbridge Wards there is a decrease, in Victoria Ward the tubercular mortality is slightly increasing, in actual numbers as well as in the estimated rates. It should be noted that one death in 1902 and three in 1903 occurred in Chelsea Barracks. In the three first named wards the persons affected were nearly all domestic servants (male and female) or persons living in Mews. No. 2 area of Knightsbridge St. George Ward has an excessive number of cases, and Nos. 15 and 22, partly in this and partly in Victoria Ward, also show an extra number of cases. (See Map.) In Victoria Ward, areas Nos. 14, 29, 30, 31, 34, 35, 38, 39, 40 and 43, have especially heavy rates. In some of these and other areas certain streets are principally affected, thus Cumberland Street in Nos. 30 and 31 had ten cases, Pulford Street (in 43) eleven cases, Aylesford Street (also in 43) six cases, Westmoreland Street (in 29 and 33) ten cases, Hanover Street (in 34 and 35) ten cases, Winchester Street and Place (in 30 and 31) eleven cases, West Street (in 22) five cases, Sutherland Street (in 29) five cases. Colchester Street (in 41) had five deaths, and is the only street affected in that area. With few exceptions the deaths in this ward from tubercular disease are in the families of artisans, labourers, waiters, clerks, coachmen, and carmen, needlewomen, &c. In thirteen instances two deaths occurred in the same house. In visiting in this ward I find that a change is taking place in the occupancy of the houses. Houses at one time occupied by one family, or at most by two or three, have been converted into a series of tenements of one or two rooms. As this process goes on it is not improbable that the phthisis as well as the general death-rate will increase. Fortunately the houses are of good construction and are surrounded by a considerable amount of open space and the streets are wide. Some of them, however, are beginning to exhibit a neglect of cleanliness and want of proper supervision, which will require special attention from the Women Inspectors the Council are going to appoint. St. Margaret and St. John Division.—The tubercular rate in this division of the City has been higher than the average for many years, but lately the total rate has begun to fall. The conditions of the three wards comprised in this division are so dissimilar that more attention must be given to the smaller areas. Thus the Hamlet of Knightsbridge has only a few cases, altogether yielding an average total rate of 65, while St. John's Ward has had an excessive death rate. 95 St. Margaret and St. John Division. Year. Pulmonary. Abdominal. Meningeal. Other Forms. Total. Cases. Rate. 1891 137 251 - - - - 1895 125 232 — — — — 1896 122 224 — — — — 1897 143 270 25 25 19 342 1893 138 263 13 34 19 334 1899 172 331 17 31 8 382 1900 124 233 11 17 29 302 1901 127 210 18 18 15 291 1902 128 212 18 22 26 310 1903 108 206 5 11 7 231 Average 10 years 132 249 16* 23* 18* 313* * Average of 7 years. St. Margaret Ward. 1901 19 136 4 28 23 165 1902 23 168 7 51 30 221 19J3 25 186 3 21 28 208 St. John's Ward. 1901 108 345 18 55 163 400 1902 104 329 28 88 132 417 1903 76 242 10 31 86 274 Hamlet of Knightsbridge Ward. 1901 - - 6 78 6 78 1902 1 13 1 13 2 26 1903 7 92 — — 7 92 St. John's Ward differs from the Hamlet and from the wards in St. George's Division, in that it contains a number of common lodging houses which materially affect the death rate. On an average one third of the deaths occurring in connection with common lodginghouses is from consumption. There were nine such houses in St. John's Ward accommodating 1,143 persons, and yielding in the three years 44 deaths from phthisis; deducting these deaths from the total, and also making a corresponding reduction in the population, would bring the average rate for the three years down from 363 to 261, 96 and the total number of deaths in each year to 148, 114 and 75, but even this is still a higher figure than the average for the City. Undoubtedly, however, there is another factor in the reduction, viz., the removal of poorer class property for the erection of better dwellings and for street improvements. Examination of the map, and a comparison of the number of deaths with the population, show that considerable differences exist in the respective enumeration areas in St. John's Ward, and that the high rate is largely maintained by a few centres. I have calculated the rates per 100,000 inhabitants for each of the 20 enumeration areas of this ward, with and without population and deaths in common lodging houses and the Guards' hospital. St. John's Ward. Area. Population. Deaths. Rate. Rate without Common Lodging Houses, &c. 1 642 0 0 - 2 2,173 27 414 - 3 2,841 42 492 450 4 735 10 454 — 5 2,831 76 895 798 6 2,067 24 387 304 7 1,324 9 226 100 8 1,904 21 367 — 9 1,099 8 242 — 10 2,321 21 301 — 11 605 9 497 — 12 2,202 1 151 — 13 1.386 9 216 - 14 2,935 22 249 — 15 1,014 6 197 — 16 853 3 117 — 17 1,061 6 189 122 18 838 4 159 45 19 539 4 247 — 20 600 9 500 166 Nos. 2, 3, 4, 5, 6, 8 and 11 have heavy rates, even where all allowances have been made. No. 2 includes the area being dealt with by the London County Council (Millbank Improvement), and many of the houses here are being pulled down. No. 3 includes Tufton Street and half of Marsham Street, the former consisting chiefly of tenement property; part of this is also included in the Millbank improvement scheme, which will do away with a number of unhealthy dwellings, such as Lions Buildings, which had 8 deaths from tubercular disease in 1901 and 1902, with a population of about 160 ; Tufton Street in addition had 16 deaths in those two years, but only 2 in 1903, 97 No. 4 contains parts of Horseferry Road, Page and Johnson Streets, mostly made up of tenement houses. No. 5. After deducting 19 deaths which occurred in two common lodging-houses (452 persons) there still remain 57 deaths, giving a rate of no less than 798. Chadwick Street is responsible for 31 of these deaths, the remainder being distributed among the adjoining streets and courts, except Arneway Street, in which no death from consumption occurred. Chadwick Street has a population of about 600, and the majority of the people have been there for some years (two families for 38 and 31 years respectively); there is undoubtedly a floating population who stay only for a few months or even weeks, but even allowing for a population of double the above number, the tubercular deathrate is extremely high. The total number of deaths recorded in this street during the 3 years was 84, so that those due to tubercular disease constituted more than one-third. I find from enquiries made previously that there are 41 houses in this street divided into 218 tenements, nearly all of which (197) are single rooms, accommodating 500 persons (170 men, 200 women, and 130 children under 15 years of age), the remainder consist of 12 sets of two rooms (67 persons), 3 of three rooms (15 persons), 2 of four rooms (11 persons), 1 of six rooms (4 persons). That the inhabitants are generally poor is also shown by the fact that 40 of the 84 deaths took place in the infirmary and 7 in hospitals. It is evident that steps must be taken to deal with the condition of things which exist here. The adjoining streets fortunately show a somewhat better record than does Chadwick Street. Area No. 6 contains some large blocks of model buildings, with a population of 1,430, among whom there were 7 deaths from tubercular disease in the 3 years, equal to 163 per 100,000 ; also a common lodging-house with 86 inmates and 6 deaths, leaving 11 deaths among 551 persons in part of Strutton Ground, St. Ann's Street, St. Ann's Lane, St. Matthew Street, and Great Peter Street. Area No. 8 includes part of Horseferry Eoad, Grosvenor Eoad, Earl Street, Johnson Street, Page Street, Vincent Street, and Hudson's Terrace. The deaths are chiefly distributed in Johnson Street, Page Street, Vincent Street, and Hudson's Terrace. No. 11 contains the site of the City's new buildings in Regency Street and parts of Page Street, Vincent Street, Chapter Street and Douglas Street. Eegency and Douglas Streets had four deaths each. St. John's Ward during the last three years has suffered ar.d is still doing so from the unsettled condition which always results when extensive alterations are in progress or are anticipated. The displacement of large numbers of people leads to overcrowding of other streets in the neighbourhood, and the knowledge that a house is near the end h 98 of its lease or likely to be acquired for the purpose of an improvement scheme tends to a laxity in the way in which it is kept, so that repairs, cleanliness, and general supervision are apt to be neglected. This may account for the high mortality of St. John's Ward to a certain extent, but not for all of it. It is sometimes assumed that the position of St. John's Ward near the river, and built on what was originally marsh land, is responsible for higher death-rates than other more favourably situated districts, but the experience of the various blocks of model buildings in the ward shows that it is not, so much the site as the suitability of the buildings upon it and their mode of use. The state of affairs brought out by this survey shows the pressing need there is for better supervision of what may be called domestic hygiene as compared with municipal hygiene. The appointment of women inspectors for this purpose and the enforcement thereby of the by-laws for houses let in lodgings are clearly indicated as necessary here to obtain a more intimate knowledge of individual conditions. Notification of cases of consumption must also prove a valuable adjunct when more fully utilised than it is at present. St. Margaret Ward.—Although the rates in this ward are low, they apparently show some tendency to increase. The enumeration areas are Nos. 21 to 31. Area. Population. Deaths. Bate. Area. Population. Deaths. Rate. No. 21 617 2 108 No. 27 1,587 8 168 „ 22 845 4 157 „ 28 826 3 121 „ 23 1,300 15 357 „ 29 828 1 40 „ 24 602 2 110 „ 30 1,761 4 75 „ 25 2,732 24 292 ,, 31 1,845 11 242 „ 26 841 3 118 No. 23 calls for some details; of the 15 deaths, 7 occurred in connection with Parker Street, and 4 (in 1901 and 1902) with Lewisham Street. Parker Street consists of very old houses, which have been cut up into small tenements, and have now reached a stage when they should be pulled down, and it is probable that this will happen during 1904. No. 25 contains a small common lodging-house (86 beds, 2 deaths), now closed, and Wellington Barracks (1,197 men, 5 deaths), deducting these gives a population of 1,149 with 7 deaths, with a rate of 161. Six of these deaths occurred in one block of dwellings with a population of about 600, which gives a rather high rate (333) for this class of property. 99 No. 30. Three of the 4 deaths occurred in connection with an institution for destitute children with 171 inmates. St. James' District.—This district, as a whole, shows an improving rate throughout the last 7 years Year. Phthisis. Deaths. Rate. Abdominal Rate. Meningeal Rate. Other Forms Rate Total. Rate. 1894 46 200 — — — — 1895 35 150 — — — — 1896 41 189 — — — — 1897 51 226 13 40 22 301 1898 42 198 5 36 27 266 1899 46 211 5 18 5 239 1900 35 161 14 9 23 207 1901 38 177 4 28 18 219 1902 35 166 9 9 14 199 1903 30 149 19 — 14 184 Average for ten years 40 1827 10* 20* 18* 230* * Average for seven years. The actual number of deaths have declined with the continuous displacement of the population which is going on, and one would not be suprised to find that the overcrowding which resulted therefrom produced a higher tubercular rate, such indeed, does seem to have occurred in Regent and St. Anne's Wards. St. James has 1 common lodging-house of 87 beds, in connection with which 8 deaths have been recorded during the last 3 years: allowance for these would reduce the rate. Deaths in the workhouse have been distributed to the ward in which the persons lived prior to admission. Pall Mall Ward consists of enumeration areas Nos. 10, 11, and 12. There were 6 deaths in 1901, 3 in 1902, and 4 in 1903, This gives an average rate of 150. The persons affected are nearly all caretakers and house porters, or their relatives. Regent Ward includes enumeration areas Nos. 1, 2, 3, 4, 5, and 7. The rates for this Ward for the three years were:— Year. Phthisis Deaths. Rate. Abdominal Rate. Meningeal Rate. Other Forms Rate. Total Rate. 1901 16 164 2 4 22 225 1902 18 186 1 — 19 197 1903 18 189 1 3 22 230 The deaths were distributed in the smaller areas as follows:— h 2 100 Area. Population. Deaths. Rate. Number of Families. Number of Tenements less than Five Rooms. No. 1 909 6 220 214 122 „ 2 1,148 7 203 291 222 „ 3 2,083 10 160 449 322 „ 4 1,162 4 115 262 64 „ 5 1,045 3 96 195 70 „ 7 2,726 31 378 631 560 Area No. 7 contains a common lodging-house with 87 beds and 8 deaths, amended for these the rate for No. 7 equals 290. The occupations with which these persons were directly or indirectly connected were tailoring (8 deaths), porters (7), clerks (5), warehousemen (3), housekeeping (3), domestic servants (3), waiters (2), public-house (2), stage carpenters (2), bootmakers (2), the remaining deaths being distributed among a variety of occupations, one to each. The proportion of small tenements are given to show the relation to the tubercular rate. Great Marlborough Ward includes the remaining enumeration areas in St. James' district, viz., Nos. 6, 8, and 9. The rates were:— Year. Phthisis Deaths. Rate. Abdominal Rate. Meningeal Rate. Other Forms Rate. Total Rate. 1901 18 237 1 2 21 276 1902 15 202 5 - 20 269 1903 8 189 2 1 11 230 The deaths were distributed in the enumeration areas as follows:— Area. Population. Deaths. Rate. Number of Families'. Number of Tenements of less than Five Rooms. No. 6 2,172 14 214 524 428 „ 8 3,920 30 255 894 752 „ 9 1,224 4 109 199 99 Certain streets in this ward have contributed largely to these rates:—Portland Street, with 35 houses, had 9 deaths; Broad Street, 7 deaths; Livonia Street, 14 houses, 5 deaths; Carnaby Street, 58 houses, 4 deaths; Canton Street, 26 houses, 4 deaths; Berwick Street, 62 houses, 4 deaths. Fifteen of the deaths were in tailors' families, 5 porters, 3 engravers'. In these two wards more than two-thirds of the families live in tenements of less than 5 rooms. 101 St. Anne's Ward.—This ward formed part of the district of the Strand Board of Works, but from its situation and character it is more allied to the St. James' district, and together with it forms the Westminster Union. Year. Pulmonary. Other Forms. Total. Deaths. Rates. Deaths. Rates. Deaths. Rates. 1891 26 212 9 73 35 285 1895 23 188 12 99 35 286 1898 26 213 11 90 37 303 1897 25 206 6 50 31 256 1898 30 247 5 41 35 289 1899 27 224 5 41 32 264 1900 32 266 8 66 40 333 1901 29 2.50 4 33 33 284 1902 16 141 7 60 23 201 1903 26 230 7 60 33 290 Average of ten years 26 217.7 7 61.3 33 279 It does not appear from the above figures that the death-rate from tubercular disease is declining; the population is decreasing, but the number of deaths maintain the same level. This is peculiar, as the number of deaths from all causes and the rate have declined during the same period (see Table III, p. 11). Seven deaths occurred in connection with a common lodging-house (54 beds), and 5 of these were in 1901, 2 in 1902. This house is situated in No. 3 area, which had an average rate of 361 for the last 3 years; on adjustment this is reduced to 223. The adjoining area, No. 2, consists almost entirely of Newport Buildings, which have an average rate of 281. Area No. 6 has an average rate of 320; it includes Bateman's Buildings with 5 deaths, parts of Dean Street, Greek Street, Frith Street, and Soho Square; the rate would be reduced to 263 by deducting 3 deaths in an institution. Ten deaths were in connection with the tailoring trades, 10 waiters, cooks, charwomen, shoemakers and porters 5 each, public-house employees, packers, labourers and carmen 3 each. St. Anne's Ward has now the advantage of a bequest left by Mrs. Eliza Roberts, and known as the St. Henry Fund (of which the Medical Officer of Health is an ex-officio trustee), whereby persons living or employed in this ward may be sent away to convalescent homes, and in the case of consumption it has been possible to extend the stay in many instances over several months at open-air sanatoria with much benefit. 102 The Strand Division.—The area of the Strand Union consists of St. Martin's, St. Clement Danes, St. Mary-le-Strand, and St. Paul's Parishes, the Liberty of the Rolls and the Precinct of the Savoy. Since the amalgamation of these parishes in the City they have been redivided into wards, one of which—Covent Garden—was partly in the old Strand District and partly in St. Martin's. There was, moreover, an interchange of property with St. Giles, which varied the area of the Strand and Covent Garden Wards. In order to maintain the continuity of the statistics, I have recast the figures for the two old divisions of the Strand Union, viz., St. Martin's and the other parishes. St. Martin-in-the-Fields shows an improving rate, but the Strand Parishes do not do so; the tendency is rather towards higher rates. This is due to the extensive clearances which have taken place, whereby many persons went into the workhouse, and those who are left are, in large proportion, inmates of common lodging-houses, and others of a migratory type. The common lodging-houses in this Union had accommodation for 647 persons, 170 of that number being in St. Martin's, the rest in the Strand. There were 9 deaths in the former, 30 in the latter. Of the 99 deaths from phthisis in the Strand District, only 8 occurred in houses which are not included in the Clare Market or Holborn to Strand Scheme. In the future, therefore, the tubercular rate in the Strand Parishes will decrease considerably. Charing Cross Ward has a low rate and does not call for remarks. Covent Garden Ward (comprising areas 1 to 6, part of 7, and St. Paul's No. 10) has a higher but improving rate. This improvement is due to the removal of insanitary houses, and the erection of other more suitable ones. The ward contains two common lodging-houses, 170 beds, with 9 deaths in the three years. The Strand Ward.—Although much of the population has disappeared from this ward, the number of tubercular deaths is the same in each of the last three years, the explanation being that it is largely the class who recruit the tuberculous ranks who have been left behind. Thus from the common lodging-houses, 8, 11, and 9 deaths occurred in 1901, 1902, and 1903 respectively. With few exceptions the deaths from tuberculosis occurred in connection with houses which were included in the Clare Market insanitary area or in the streets adjoining the houses which have been during the last three years, or will shortly be, pulled down. When I moved the County Council to deal with this area in 1894, by a representation under the Housing of the Working Classes Act, I was able to show that the phthisis and tubercular disease rate was equal to 650 per 100,000 in the five preceding years. Subsequently, in 1898 and 1899, I pointed out that persons who were being displaced were finding accommodation in adjoining houses, which were 103 quite unsuitable for letting out in tenements, and that the sickness rates in those streets was going up while the houses deteriorated. A certain proportion of the displaced persons went into the workhouse, and thus for some time after the death rate is seriously influenced thereby. St Martin-in-the-Fields Parish. Year. Pulmonary. Abdominal. Meningeal. Other Forms. Total. Deaths. Rate. 1894 35 250 — — — — 1895 24 181 — — — — 1896 26 197 — — — — 1897 33 260 — 8 8 276 1898 22 177 8 24 8 217 1899 22 182 16 8 8 214 1900 28 229 — 8 8 245 1901 21 207 7 7 — 221 1902 23 178 7 7 7 199 1903 23 181 7 7 — 195 Average 10 years 26 204 6.4* 9.8* 5.5* 224* * Average 7 years. St. Clement Danes, St Mary-le-Strand, St Paul, Liberty of the Rolls, and Precinct of the Savoy. Year. Pulmonary. Other Forms. Total. Deaths. Rate. Deaths. Rate. Deaths. Hate. 1894 43 338 15 118 58 456 1895 50 396 19 151 69 547 1896 48 384 12 95 60 479 1897 49 398 10 80 59 479 1898 51 416 17 139 68 557 1899 39 327 11 103 50 420 1900 46 400 6 50 52 450 1901 31 423 3 40 34 464 1902 29 425 5 52 34 498 1903 32 473 3 42 35 515 Average 10 years 41.8 398 10 87 52 486 104 Charing Cross Ward (areas 8, 9, and 10, and part of 7). Year. Pulmonary. Other Forms. Total Cases. Total Rate. Deaths. Rate. 1901 4 68 1 5 85 1902 7 158 1 8 180 1903 6 137 1 7 160 Covent Garden Ward (areas 1, 2, 3, 4, 5, 6,10 (St. Paul's), and part of 7) 1901 22 240 2 24 261 1902 17 189 5 22 245 1903 16 180 2 18 202 Strand Ward (areas 1 to 9). 1901 31 423 3 34 463 1902 29 425 5 34. 498 1903 32 473 3 35 515 Voluntary Notification of Phthisis.—Twelve months have now elapsed since the City Council adopted a plan of voluntary notification of pulmonary tuberculosis (phthisis, consumption). The object in doing so was:— 1. To instruct consumptives and their families, personally and by hand-bills, in the precautions required to prevent the spread of infection. 2. To remove or destroy the infection already accumulated, and for that purpose to determine in each case the precise kind and amount of disinfection required. 3. To prevent, as far as possible, the future recurrence of ness in households where individuals are afflicted by pulmonary tuberculosis. 4. To collect evidence of the accumulation of phthisis when those necessary precautions are neglected; to gauge the effect of different classes of occupation, and so to show what further action is required; and generally to determine under what conditions the disease is communicated. It is necessary to collect and sift such materials, so that we may not waste our efforts, but concentrate on the points of real danger. 5. To ascertain the effect of insanitary conditions, such as crowding, and as far as possible to remedy them. 105 In requesting the assistance and co-operation of medical men, it was pointed out that no official interference with the patient was contemplated as the result of notification, either at his home or in connection with his employment. The measures taken on behalf of the Council are confined, mainly, to inspection of the house, disinfection and the distribution of information with reference to the disposal of sputum, and the general precautions proper to be observed with a view to prevent the spread of disease, and no visit is paid where the medical attendant considers it unnecessary or inexpedient. Notification began on 6th April, 1903, and in the twelve months 128 notifications were received relating to 124 cases. With the exception of 23 cases, the notifications were received from 28 medical men at a cost of £8 1s. 6d. Investigation was made by myself into each case, but in a number the amount of information, for various reasons, was small; several persons had only been lodgers in the City for a few days or weeks and had then gone into hospital, others were in the Infirmary and had no relatives who could furnish information. However, from the others information of a useful nature has been obtained. The facts elicited bear out conclusions arrived at from previous experience. These may be shortly stated:— Tubercular disease may be regarded as a disease which is communicable, but it appears only to be so within confined quarters, such as the house or work-place, and moreover before the organism on which it depends can develop the disease, the persons attacked by it must be in such a state of health that he or she cannot resist. Ordinarily the human body is able to resist and destroy the tubercular organism, and we know this because it is found after death that a very large proportion of persons show signs in their lungs of the damage inflicted there by this organism. The knowledge of this fact is encouraging, as showing definitely that consumption may be cured in its early stages, and it indicates that in order to do this, it is necessary to strengthen the forces of the body by the removal of all the conditions tending to weaken it, and the supply of such means as will tend to improve the physical standard. Inability to resist the invasion of the tubercular organism may be (1) inherent or (2) acquired. (1) Inherent want of resistance.—At one time consumption was believed to be hereditary, that is to say, if parents died from it the children would very probably also have it. We know now that where parents have died from consumption the children may be less able to resist inl'ection than others, but so much importance is not now attached to heredity in relation to consumption as was at one time the case, for this reason, that in so many instances the disease has been communicated 106 by direct infection. Still greater care should be taken to protect persons of known phthisical tendency or parentage. (2) Acquired want of resistance.—Overcrowding, living or working in ill-ventilated rooms or in damp houses, dusty occupations, and any condition which lowers vitality predispose to consumption. Among these may be mentioned excessive consumption of alcohol, insufficient food, other illnesses, over-training, prolonged suckling of children, and frequent child bearing. Unfortunately I can give examples of each of these from the experience of the last year. (See details of typical cases appended). It must be kept in mind, however, that these conditions have not in themselves caused consumption. They may induce conditions of general bad health, but in the absence of the tubercle bacillus they cannot cause tuberculosis. There are, therefore, two lines of action which can be taken to prevent tubercular disease. (1) To raise the standard of health by the removal of such conditions as I have enumerated above, and (2) To prevent the possibility of debilitated persons being infected. Both of these are important. It is the object of the existence of sanitary authorities to take such steps as may be necessary to ascertain the existence and obtain the removal of such conditions as tend to lower the public health. It is too often thought by the public that matters affecting the general well-being of the people at large should be left entirely to those who are elected as representatives on Borough Councils and their officers, but it is no less the duty of everyone to take a share in the work of removing those conditions which promote the development and spread of disease. In order for this to be done it is essential that the public should be educated and their interest stimulated. It is therefore a matter for congratulation that there is in the City of Westminster active movement in this direction. Cases of Tubercular Disease. Source of Infection ascertained in 44 cases. Husband 5 Wife 3 Brother or sister 7 Son or daughter 3 Father or mother 10 Other relative 2 Lo'ger 1 Neighbour 1 Fellow worker 12 Predisposing influences in 48 cases. Condition induced or aggravated by. Dusty trades 6 Exposure 3 Alcoholism 4 Insufficient food 4 Damp houses 3 Overcrowding 3 Defective ventilation 4 Injuries 2 Previous illness 15 Over exertion (racing, cycling, &c.) 4 It is further urgently necessary that provision be made in London for the prompt recognition and early treatment of consumptive cases. 107 In the provinces sanatoria are being erected, but London has no place to send such patients, and as so many of them are of the poorer classes, it is impossible for them to obtain the treatment which might save their lives. They are compelled to struggle on at their work as long as they possibly can do so in order to support themselves and those depending on them. Attempts have been made to induce the Metropolitan Asylums Board to adapt some of their unused buildings for this purpose, but hitherto without success; it may be that each Borough Council may have to make independent arrangements. In the City of Westminster there is a fund, known as the Pest House Charity, which might very well be utilised for the purpose of sending consumptive patients to suitable places where there was a probable chance of cure. Frequent appeals are made to me for information as to sanatoria by patients and their friends, but except in St. Anne's Ward, where the St. Henry Fund is available, it is generally found that the cost which would have to be incurred is far above the means of the patients, and thus they have to remain at home. A further difficulty exists where the patient has others dependent upon him or her, as the course of treatment extends over several months. In Germany the Friendly Societies have themselves founded sanatoria for their members, as they find that it pays them to do so; and as all workmen are required to be insured against sickness their families are provided for during their absence. The Friendly Societies in this country are considering the question with a view to taking action. It is claimed that 70 per cent. of the cases may be cured by sanatorium treatment. This depends largely on the care exercised in selecting early and suitable cases; a number of people go to sanatoria who are beyond the hope of cure, although in some instances the disease may be arrested to some extent. In Brighton the Corporation have adopted a plan whereby consumptive patients are admitted to a sanatorium for a month or so; during that time they are carefully instructed in the precautions necessary to be taken for the improvement of their own health and for the prevention of danger to others. The Borough of Woolwich maintains two beds in a sanatorium in the country for the use of male consumptive patients. A further difficulty is in finding suitable work for patients afterwards. The good that may have been effected would often be undone if the patient returned to the business in which he was formerly engaged— say that of a tailor, compositor or clerk. Advanced Cases.—Hospitals or homes are needed for advanced cases who have no home or no facilities for their care. Such patients are apt to be centres of infection in their homes or in the Poor Law Infirmaries, into which they drift. Some Boards of Guardians have taken steps to 108 provide special accommodation for such patients, separate from the ordinary infirmary ward, but according to replies (printed in my report for 1902) furnished by the Boards, nothing in this way seems to have been attempted by the Guardians of the three Unions in the City. Regular visitation of home cases is necessary in order to see that precautions are being carried out. Patients who have been in a hospital or sanatorium have learned their importance, and are, as a rule, careful; but the great majority of affected persons have not had this training, and many of them take no precautions whatever. I appeal to the medical practitioners in the City to help in this matter. They can urge upon relatives the extreme importance of cleanliness and fresh air, of spitting into proper receptacles, of destroying the expectorated matter, of the patient having a separate bed, and where practicable a separate room, and can explain how these simple precautions which are essential may be carried out. Consumptives appear to change their addresses with some frequency, forced often by the rreed of obtaining cheaper rooms; it is important to know when rooms are vacated by such persons in order to secure thorough cleansing before new tenants occupy them. Disinfection and Cleansing.—The necessity for disinfection at intervals during the progress of the disease, as well as after rooms have been vacated, has been amply demonstrated, even with the most careful patient. The matter which is coughed up from the lungs and throat swarms with the tubercle bacillus, but even in the act of speaking or coughing it is found that the fine spray which is thrown off in the breath contains these organisms which may be thrown a distance of about four feet from the patient. These soon dry up and are converted into a fine dust which may be readily thrown into the air and inhaled by other people. The tubercle bacillus is a very resistant organism, and is not killed by drying, and if kept in a dark badly ventilated room will survive for long periods without losing its virulence. These facts show the danger of continuous close contact with consumptives and the need for the frequent removal of this infected dust in a manner which will not distribute it throughout the air of the room. They also show the need for admitting fresh air and sunshine, because, although the bacillus can stand drying, it cannot survive fresh air and sunshine for many hours. The danger of infection may thus be reduced to an almost negligible degree. If these precautions could only be enforced, we should witness a startling reduction in the number of cases. Berlin hopes to get rid of consumption in ten years. If Berlin can do so, London might do so also. Methods of Disinfection.—The tubercle bacillus is not so reaildy destroyed by chemical disinfectants as it is by direct sunshine, and 109 probably in poorer-class houses the most satisfactory method is to have the rooms renovated throughout after the walls and woodwork have been washed down with a reliable disinfectant solution. Formaldehyde in gaseous form may be used in cases where it is deemed unnecessary to strip the walls, followed by washing of floors and woodwork ; and it is always advisable to have disinfected by steam the bedding, carpets, mats, clothing, and articles which cannot be disinfected at home by boiling and washing. During the course of the complaint,rooms should be cleansed with dusters damped with a disinfectant solution, and walls may be rubbed down with dough, or rooms much occupied may be disinfected with formaldehyde at such intervals as may be required. Workplaces, &c.—Greater care seems necessary in workshops and other places where people are likely to be thrown into contact with consumptives for some time. Notices cautioning against "spitting," to hang up in such places, have been prepared, and a considerable number have been issued, but there is need for greater cleanliness in many workshops, warehouses, offices, schools, &c. In some places the floors are sprinkled every morning with some disinfectant; this ought not to prevent them from being washed out regularly. Public-house Floors.—Statistics show that persons employed in publichouses are specially liable to consumption, and it has been suggested that this is induced by consumptive persons who frequently spend a considerable part of their time in public houses and spit on the floors. The sputum of such persons contains quantities of the infective germ, and as it dries these germs may be disseminated through the air in the form of dust (especially when the floors are swept out), and inhaled by other persons. In order to test the possibility of this, I obtained permission to take, after closing time, some samples of the expectorated matter on the floor of the public bar in a house in a district in which a number of deaths from consumption have occurred. These were submitted to Professor Klein, who informs me that he found the organisms in active condition therein. I have suggested the desirability of the floors being sprinkled with some fluid disinfectant at closing time ; this would in a measure prevent the sputum drying up and might, if used in suitable strength, destroy the infection before the time for opening the house in the morning. Not only is the tubercle germ by itself difficult to kill but the disinfection of sputum is comparatively difficult to accomplish on account of its tenacious nature and its albuminous composition; a satisfactory method of dealing with such floors would be to have them thoroughly scrubbed or mopped out with a hot solution of washing-soda (½ lb. to 3 gallons of hot water), to which a reliable disinfectant might be added. Experiments are being 110 made to determine which disinfectants are best suited for this purpose, the strengths in which they should be used, and the length of time necessary for successful action. Agents are known which will kill the tubercle bacillus with considerable promptness, but they are of a highly poisonous nature, and it is essential that a disinfectant which is to be used by the public should be as nearly non-poisonous as possible. By-law as to Spitting.—Some time ago the County Council made a By-law which prohibits spitting on the floor, side, or wall of any public carriage or of any public hall, public waiting room, or place of public entertainment, but it was not clear who could take proceedings against offenders. The County Council have now taken legal opinion on the subject, and are advised that, under Section 23 (5) of the Municipal Corporations Act, 1882, any offence against the By-law may be prosecuted summarily; and that as such offence, being an offence against public policy, it is competent for any person to take proceedings, and societies may instruct their officers to apply as common informers for summons under the By-law. Tuberculous Meat and Milk.—From the supervision which is exercised over the slaughter-houses and markets, the amount of meat affected with tubercle which is sold in London must be comparatively small; but, from examination which has been made of the milk sold in the various districts, we know that a considerable quantity of milk from tuberculous cows is distributed. During the year 1901, one hundred samples of milk were examined bacteriologically in this City, and in eleven instances the tubercle bacillus was found. The whole of the infected samples were from country farms. The dairyman, middleman, and farmers were communicated with and steps were taken by several large firms to have the cows examined at the inculpated farms by their own veterinary surgeon. Without frequent examination of milk and systematic enquiry, it is impossible to say how many persons are infected through milk. Possibly it plays a part in infecting children and persons in a debilitated state of health. It was at one time suggested that tubercular milk was the chief source of infection in children, 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. Employment of Consumptives.—This is a question which has led to some very extreme views being taken and to great hardships being inflicted on persons afflicted with consumption, The experience of the consumptive hospitals shows that under proper hygienic circumstances 111 persons may associate with consumptive patients practically without risk for many years, but in the absence of these conditions there is little doubt that much more danger exists. It is. therefore, a matter of the first importance, both to the patient himself and those with whom they associate, that consumptives should not remain in rooms which are close, badly ventilated, dark, damp or unclean. While recognising that there are many occupations which can be engaged in by consumptive persons under proper conditions with safety, I think very strong objection must be taken to their employment in the preparation or distribution of food, especially of food which may be consumed in an uncooked condition, such as milk. No matter what precautions he may take, a man engaged in distributing milk, as were two of those who died during the last three years, cannot avoid contaminating the milk, and I look upon the presence in milk of tubercle bacilli from a human source as likely to lead to much more serious results than if the bacilli came from the cow. The list of occupations of persons who have died of consumption discloses a number of persons who had been bakers, butchers, waiters, cooks (both male and female) and other domestic servants. The large number of domestic servants in the list (and it is possible that others have gone to their homes in the country with the same complaint) suggest that the conditions under which they work are not all that could be wished, or more probably that the sleeping apartments set apart for them are defective in many respects. Waiters and other persons employed in restaurants are kept for long periods in rooms which are often not well ventilated. Many of them live in lodgings; one, two or more in a room, but as a rule these houses are not overcrowded and are in fair condition, probably better than many servants have provided for them. There is, of course, the risk of them infecting one another, but I am inclined to believe that other factors are at work in inducing consumption among them. Their mode of life and their association, more or less, with the liquor trade play important parts Many investigators have shown the intimate relations which exist between alcohol and consumption. It may be that the nature of the disease or the depressing conditions which precede it lead to the taking of stimulants, but after making due allowance for this there is undisputable evidence that alcoholism is a potent predisposing cause of tuberculosis. I trust that this inquiry (limited although it is) will show that the result of the work of the Sanitary Authorities is sufficiently encouraging to lead them to increased efforts in the future. 112 Occupations of Adult Males and of Husbands or Parents of Persons who died from Tubercular Disease in 1901, 1902 and 1903. Occupation. Adult Males. Wives and Children of Occupation. Adult Males. Wives and Children of. Tailors 24 14 Other shopkeepers 17 4 Collar cutter 1 — Hawkers 19 1 Upholsterers 5 2 Labourers 58 18 Furniture makers 2 1 Warehousemen and packers 15 4 Hatter 1 — Shoemakers, leather workers 15 7 Porters 24 3 „ railway 3 4 Print colorer 1 — „ shop 11 — Bookbinders 2 1 ,, market 12 2 Circular folder 1 — ,, tailors 4 — Booksellers 1 1 Hall and hotel porters, messengers 21 4 Relief stamper 1 — Compositors, printers 18 5 Lightermen 5 — Machine ruler 1 — Gras workers — 2 News vendors 9 2 Police 2 3 Ticket writer 1 — Soldiers 15 4 House painters 20 4 Army pensioners 4 — Paper hanger, glazier 2 — Firemen — 1 Builders, masons 13 3 Postmen. sorters 7 1 Plasterer — 1 Actors 4 — Chimney sweeps - 2 Scene shifters, &c. 10 2 Plumbers and gas fitters 5 2 Teacher 1 — Silversmiths 5 — Lodging house a'd chambers keepers 8 5 Electrical engineers 2 — Other metal workers 12 3 Coffee house keeper — 1 Modeller 1 — Draughtsmen 2 — Carpenters 4 7 Commercial travellers Coach builder — 1 and agents 5 2 Coachmen 15 5 Hairdresser — 1 Cab drivers 4 3 Paviors, sweepers, &c. 6 1 Carmen 8 9 Journalist 1 — Stablemen, grooms 21 7 Clerks 33 3 Vet. surgeon, farriers 2 — Collector — 1 Cooks (male) 13 3 Common lodging house deputies 4 - Male servants 13 — Waiters, carvers 32 8 Glass blower 1 — Barmen, potmen, &c. 22 4 Basket maker — i Billiard markers 3 — Paper bag maker — i Ice cream vendor 1 — Photographers 2 — Butchers 2 3 Musicians 2 4 Bakers 2 — Surgeon 1 1 Milkmen 2 2 Solicitor 1 — Provision merchant, grocers 3 — No occupation 14 — Occupations of Adult Females where separately stated. Milliners 2 Paper sorter 1 Dressmakers, sempstresses 17 Cigarette maker 1 Tailoresses 11 Upholsteress 1 Laundresses 11 Clerk 1 Charwomen 23 Furniture dealer 1 Cooks 7 Packer 1 Other servants 35 Incandescent, mantle maker 1 Waitresses 2 Flower seller 2 Wigmaker 1 Hawker 4 Slayrnaker 1 Unknown 70 Book folder 1 Deaths from Tubercular Diseases, Years 1901-03. Causes of Death. Ages. All Ages. 0— 1— 5— 10— 15— 20- 25— 35- 45— 55— 65— 75- 85— Males. Tubercular disease of brain or meninges, acute hydrocephalus 11 20 6 1 - 3 1 - 3 - 1 - - 46 Laryngeal and pulmonary phthisis.. 2 13 2 7 18 34 106 192 124 76 32 7 — 613 Tabes mesenterica, tubercular disease of intestine 14 9 - - 1 2 - 2 — 1 - - - 29 General tuberculosis, tubercular disease of undefined position 3 7 2 1 2 3 5 3 5 - - - - 31 Other forms of tuberculosis, scrofula 2 2 1 1 3 3 1 2 3 — - — — 18 Total 32 51 11 10 24 45 113 199 135 77 33 7 — 737 Females. Tubercular disease of brain or meninges, acute hydrocephalus 12 23 3 1 - - 1 - - - - - - 40 Laryngeal and pulmonary phthisis 1 5 4 9 13 36 74 105 62 39 13 4 - 365 Tabes mesenterica, tubercular disease of intestine 3 6 2 1 - 1 - 1 - - - - - 14 General tuberculosis, tubercular disease of undefined position 4 2 - 3 - 2 5 1 1 1 - - - 19 Other forms of tuberculosis, scrofula — 1 1 1 2 - 3 2 1 — — — — 11 Total 20 37 10 15 15 39 83 109 64 40 13 4 — 449 113 Deaths from Tubercular Diseases—continued. Causes of Death. Ages. All Ages. 0— 1— 5— 10— 15— 20— 25 — 35— 45— 55 — 65 — 75— 85— Both Sexes. Tubercular disease of brain or meninges, acute hydrocephalus 23 43 9 2 - 3 2 - 3 - 1 - - 86 Laryngeal and pulmonary phthisis 3 18 6 16 31 70 180 297 186 115 45 11 — 978 Tabes mesenterica, tubercular disease of intestine 17 15 2 1 1 3 - 3 - 1 - - - 43 General tuberculosis, tubercular disease of undefined position 7 9 2 4 2 5 10 4 6 1 - - - 50 Other forms of tuberculosis, scrofula 2 3 2 2 5 3 4 4 4 — — — — 29 Total 52 88 21 25 39 84 196 308 199 117 46 11 - 1,186 The average death rates for males at all ages during the 3 years were for pulmonary phthisis 242 per 100,000, for tubercular of other parts of the body 49, giving a total of 291 per 100,000 males. For females the average death rates were for pulmonary phthisis 124, other forms 29, giving a total of 153 per 100,000 females. 114 115 Some Typical Cases. No. 1. Female, 31, married; ill 4 years, no family history of consumption, infected by husband (still alive), who was phthisical before marriage. No. 25. Male, 43, cooper; father, sister and brother died of consumption ; one brother has been ill, but has recovered, married, wife and eight children, all well. No. 28. Female, 33, married. Swiss. No family history; was healthy at time of marriage, infected by husband (ill for 3 years previously), a tailor. No. 39. Male, 41, brass-worker. Belgian. Ill for 8 years. Alcoholic. Infected by first wife, who died; married second wife, infected her, she died; married third wife, still healthy. No. 46. Male, 50, builder. No family history, infected by second wife, who died of acute phthisis soon after marriage. No. 79. Male, 30, single. Pattern tracer (using lead paint), father previously employed at same work and brother died of phthisis ; alcoholic; careless in his habits; suffered also from lead poisoning. No. 97. Male, 38, single. House-painter. Ill 5 years, no family history; at end of 3 years infected brother, who died after short illness. No. 106. Male, 42. Father and brother died of phthisis; infected daughter, who came home in good health from situation to act as nurse. No. 107. Female, 41. Book-folder. Widow. Ill 6 years. Infected by brother, whom she nursed immediately before being taken ill herself. No. 117. Male, 24, single. Steel engraver. Infected by fellow workman in badly ventilated office; infected brother who slept with him, and subsequently the father also became infected with acute phthisis ; all 3 died within 10 months. No. 2. Female, 31, married. No family history. While recovering from influenza a woman with phthisis became a lodger, and they were much together for 4 months ; became ill at end of 3 months. 116 No. 12. Male, 32, wheelwright. Twelve years in Army, developed phthisis after enteric fever in South Africa in 1900; brother died of phthisis. No. 13. Male, 34, married, bootmaker. Developed phthisis after influenza; infected daughter after attack of measles; house damp, dirty and badly ventilated. No. 27. Female, 39, charwoman. Badly off; was in poor health when she went to act as charwoman at office where a clerk worked who suffered from phthisis, and used to spit in waste-paper basket and on floor : phthisis thereafter developed ; no family history. No. 24. Female, 41, married. Polish Jewess. No family history; husband, tailor; 8 children, eldest 14, youngest lj, two youngest suffered from rickets, another has tuberculous glands; live in 3 rooms, one being used as living room and tailor's workroom, kitchen in basement dark and damp. No. 52. Male, 25, Coffee-blender. Over-training for running; no family history. No. 73. Male, 49, married. Labourer. Burst blood vessel carrying heavy weight, phthisis developed thereafter; no family history. No. 91. Male, 19. Vanguard. Chest injured in accident, phthisis developed twelve months afterwards. No. 100. Male, 24, single. Clerk in stuffy office, other clerks in good health; no family history; was constantly catching cold. FRANCIS J. ALLAN, Medical Officer of Health. Westminster City Hall, Public Health Department. May, 1904. harrison and sons, printers in ordinary to liis majesty, st. martin's lane. CENSUS 1901. Deaths from ® 100 Persons Tubercular Disease Registration District of (Consumption, etc.) S†George,Hanover Square N°4during the years Sub District 1901,1902,1903 Belgrave • = one death Enumeration Districts + = ten deaths Noss I to 45 Population 55,815 Deaths from Tubercular Disease (Consumption, etc.) during the years 1901,1902., 1903 • = one death † = ten deaths CENSUS 1901 • =100 Persons Registration District of St George, Hanover Square,N°4 Sub District N° 3 S' Margaret and S' John Enumeration Districts Nos I to 31 Population 43,698 Note This Figure includes Shipping 19