WES 18 ANNUAL REPORT ON THE STATISTICS AND SANITARY CONDITION RELATING TO THE CITY OF WESTMINSTER FOE THE YEAR 1904. 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 7 Births 9 Deaths 11 Infantile Mortality 12 Statistical Tables 16 to 26 B. Communicable Diseases. (1) Compulsorily Notifiable— Smallpox 27 Vaccination. 32 Scarlet Fever 33 Diphtheria 34 Typhoid Fever 36 Typhus Fever 36 Puerperal Fever 37 Midwives Act 37 (2) Voluntarily Notifiable— Tubercular Disease 38 (3) Non-notifiable— Measles 44 Whooping Cough 45 Diarrhoeal Diseases 45 Venereal Diseases 46 Schools and Infectious Disease 47 Bacteriological Diagnosis 48 Disinfection 48 Shelters 49 Cleansing of Persons 49 Mortuaries 49 PART II. C. House Inspection. Legal Infringements 50 Supervision of House Drainage 51 Inflammable Fluids in Drains 51 Nuisances from Sewer Ventilators 52 Premises Infested with Vermin 52 PAG] Water Supply 53 Cleansing of Cisterns 53 Housing of the Working Classes 54 Healthiness of Block Dwellings 54 Common Lodging Houses 56 Houses Let in Lodgings 56 Re venue Act 57 D. Workshops. Number on Register 58 Inspection 59 Overcrowding 60 Sanitary Accommodation 60 Government Workshops 61 Outworkers 62 Bakehouses 63 Restaurants and Eating Houses 63 Voluntary Certification 64 Milkshops 66 Effluvium Nuisances 67 Slaughterhouses 68 Smoke Prevention— 68 Legal Proceedings 68 Occupational Mortality 42, 69 E. Food Supply. Food and Market Inspection 71 Legal Proceedings 71 Sale of Food and Drugs Acts 72 Milk 73 Sunday Samples 75 Warranties 75 Sterilised Milk 77 Margarine 77 Spirits and Wines 77 As to giving Cautions 78 Prosecutions 79 to 8b G. Regulations for the Control of the Staff of Sanitary Inspectors 86 Instructions for District Inspectors 89 A Annual Report on the Health and Sanitary Condition of the City of Westminster, 1904. 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 1904. 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. For London as a whole the year 1904 was not quite so favourable to life as 1903, when the death-rate was the lowest on record, but it was still below the average. In the City of Westminster the death-rates of the two years were almost identical. When allowance is made for the sex and age of the population, it appears that the City has been improving in each of the last four years. The table subjoined gives the death-rates for Metropolitan cities and boroughs, corrected by multiplying the rate calculated from the number of deaths in each case by a factor which tends to reduce the rates to a condition in which they are comparable one with another. 2 From this table a ratio can be Standard. 1901. 1902. 1903. 1904. England and Wales 18.19 16.9 16.3 13.4 16.2 London 17.31 18.0 18.1 16.0 16.9 Paddington 17.10 15.2 15.5 14 .0 14.6 Kensington 17.05 16.2 16.3 14.8 15.2 Hammersmith 17.47 17.7 17.0 14.7 16.3 Fulham 17.39 16.5 17.9 14.5 16.1 Chelsea 17.57 16.1 18.6 15.8 17.0 Westminster, City of 16.22 18.6 18.3 15.5 15.2 St. Marylebone 16.93 17.8 19.7 17.6 17.3 Hampstead 16.19 11.9 12.1 11.2 11.4 St. Pancras 17.40 19.3 19.4 16.9 18.1 Islington 17.53 16.6 17.0 14.8 15.9 Stoke Newington 17.42 13.8 14.0 13.2 13.7 Hackney 17.45 16.4 15.6 14.5 14.5 Holborn 16.39 22.7 23.6 20.6 20.5 Finsbury 17.40 23.1 23.9 21.2 22.2 City of London 16.56 21.5 22.4 16.0 18.3 Shoreditch 17.29 22.3 21.8 20.4 21.4 Bethnal Green 17.98 20.5 21.0 18.4 19.5 Stepney 17.40 22 .0 21.5 18.8 20.2 Poplar 17.61 20.3 19.9 18.8 19.2 Southwark 17.38 22.6 22.4. 18.9 21.0 Bermondsey 17.60 21.6 21.5 19.0 20.6 Lambeth 17.63 17.8 18.0 15.7 16.2 Battersea 16.94 17.6 16.1 15.3 15.5 Wandsworth 17.29 14.0 14.2 13.0 14.0 Camberwell 17.53 17. 0 16.9 14.2 15.4 Deptford 17.31 17. 3 17.3 15.7 16.9 Greenwich 17.84 15.5 15.7 13.6 14.6 Lewisham 17.64 13.4 24.0 11.4 12.3 Woolwich 17.00 15.6 16.2 14.4 15.3 calculated which shows that for each 1,000 deaths which occurred in the whole of England and Wales for London and Westminster there were as follows :— 1901. 1902 1903. 1904. County of London 1,065 1,100 1,032 1,042 City of Westminster 1,100 1,085 1,025 940 Half of the London boroughs were below 1,000 in 1904, the City of Westminster being seventh, those preceding it being Hampstead, Lewisham, Stoke Newington, Wandsworth, Greenwich, and Paddington. If the average rate of death in the previous ten years had continued throughout 1904, London would have lost in that year 7,904 lives, which, as it is, have been saved; but this saving is far from counterbalancing the loss of population due to the reduced birth-rate. On page 10, figures showing the progressive diminution which is going 3 on are set out, and the Registrar-General has calculated that, had the birth-rate been the same in 1904 as it was in 1871, the births registered in London in 1904 would have amounted to 166,000 instead of the 129,335 actually recorded. As London continues to increase in population it is evident that the deficit must be made up of immigrants from the country or abroad. It is satisfactory to note that the public mind is beginning to take an interest in the question, and that efforts are being made in various directions to check the great waste of child-life which has gone on without much diminution during the last 50 years. During 1904 it was deemed advisable to revise the relations between the Medical Officer of Health and the Sanitary Inspectors, and the Council decided that, in order that the former should be in closer touch with the work of the latter, they should be under his direct control and supervision. This entailed the abolition of the office of the Chief Sanitary Inspector. A Code of Regulations (a copy of which is appended to the Report) was drawn up, and during the remainder of the year these have been brought into force. Certain alterations have taken place in the Inspectorial Staff during the year. Mr. Thomas G. Dee, one of the Food Inspectors, was transferred at his request to a District Inspectorship, his place being filled by Mr. William Williams, who had held a similar position in Bermondsey. Mr. A. L. Ware was appointed a District Inspector to succeed Mr. J. W. Kirk, transferred to the Highways Department as Assistant Superintendent, and two Women Inspectors (Miss M. Carey and Miss C. W. Byrne) were added to the staff, which now includes 8 District Inspectors, 2 Inspectors for carrying out the Food and Drugs Acts, supervision of street markets, and prevention of smoke, and 2 Women Inspectors, whose duties are— (1) Inspection of workshops where women are employed. (2) Inspection of outworkers' premises, and laundries. (3) Inspection of houses on the register as let in lodgings (tenement houses). (4) To visit houses of consumptive patients to see that proper precautions are being carried out. (5) To make inquiries with regard to cases of measles, whooping- cough, and deaths of children from diarrhœa and improper feeding; and to give instruction in the feeding and care of infants. (6) Such other duties as the Medical Officer may define. I am glad to be able to add that, in my opinion, the new system has been productive of good. 4 In each of the Annual Reports I have had the honour to lay before you I have called attention to the higher death-rates and other features indicating the existence of unsatisfactory conditions in St. John's Ward. During the past year a very thorough inspection has been carried out, with the result that considerable improvements have been effected, but it is necessary still to institute a regular visitation of many premises in order to secure the maintenance of decent sanitary conditions. The necessity for extra supervision in St. John's Ward has also been caused by the existence of "improvement" schemes, the presence of which always seems to produce during their progress a degeneratio of the surrounding neighbourhood. In St. John's Ward the delay in carrying out the Millbank scheme by the London County Council has had a detrimental effect on the district generally. The uncertainty as to when houses will be acquired leads the owners to defer carrying out repairs which may be required. A considerable amount of feeling has been engendered in the district by the hardships inflicted by the delay in carrying out the Millbank Scheme, and through several acres of land being unbuilt upon. It was hoped that during 1904 the powers of Metropolitan Sanitary Authorities for dealing with places where food is prepared for sale or stored would be materially strengthened. The boroughs were practically unanimous in desiring them, and the County Council had included in their General Powers Bill clauses which would, in some measure, meet the demand of the boroughs. The Parliamentary Committees of both Houses agreed to pass the clauses, but because the County Council were not allowed to exercise "any right of arbitrary interference" with the Borough Councils, that body declined to proceed. Such a course of action by a body which professes to have the health interests of London at heart is scarcely credible, and is not encouraging to the metropolitan cities and boroughs, who are the health authorities of London, and who are anxious to protect the public. During 1904, the County Council convened a conference of Metropolitan Borough Councils to consider a number of questions relating to administration, methods of disinfection, defects in the public health law, and other matters. A number of conclusions were arrived at asking for additional powers, but in view of the County Council's action on their 1904 General Powers Bill, it looks as if the Metropolitan Boroughs will have to go to Parliament themselves in order to obtain them. In conclusion, I desire to acknowledge the assistance which has been given by the City of Westminster Health Society. It has divided the City into two parts, each under a committee, and has organised the workers in connection with the various churches, hospitals and 5 charitable associations, so that all these agencies can be utilised in the service of the City. This has been especially useful in dealing with cases of consumption, and through the St. Henry Fund (of which the Medical Officer is ex-officio a Trustee), a considerable number of such cases hare been sent to special homes. Unfortunately, its sphere of usefulness is at present confined to St. Anne's Parish. For some time the Metropolitan Asylums Board have been urged to take up this work for London, but the magnitude of the task and the possible cost have apparently restrained that body from a decision. It has been calculated that consumption costs London over £4,000,000 per annum in loss of wages, in cost to the rates through the sufferers or their families having to be assisted by the Guardians, and in other ways, without taking into consideration the loss these lives mean to the country. If the Metropolitan Asylums Board decide eventually not to take this matter up, the fact should not be lost sight of that each Metropolitan Authority has legal power to provide a sanatorium of its own, or to join with others for a like purpose. I have the honour to be, My Lord and Gentlemen, Your obedient servant, FRANCIS J. ALLAN, Medical Officer of Health. 11th April, 1905. 7 PART I. A. Population. The resident population of the City of Westminster has been calculated by the Registrar-General at 177,321 for the year 1904. 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. 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. While adopting, for the sake of comparison, the population (177,321) given by the Registrar-General for the whole City, 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 5,700 St. Anne Ward 11,250 Grosvenor Ward 15,000 Great Marlborough Ward 7,100 Knightsbridge St. George Ward 15,000 Pall Mall Ward 3,100 Victoria Ward 39,740 Regent Ward 9,530 Hamlet of Knights- Charing Cross Ward 4,300 bridge Ward 7,560 Covent Garden Ward 8,660 St. Margaret Ward 13,400 St. John Ward 31,000 Strand Ward 6,600 Added together the Ward figures give a total only slightly above that of the Registrar-General. For calculations affecting the Wards B 8 individually the above figures are used, but for the City as a whole 177,321 is taken. There are estimated to be 82,278 males and 95,043 females in the City. For the purpose of the Equalisation of Rates Act, the RegistrarGeneral 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, 1903, and 1904, and I append them so that comparisons may be made:— 1 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 31,05S 175,705 179,224 1904 St. George Hanover Square 9,822 59 2,318 12,081 75,799 75,440 St. Margaret and St. John 5,420 60 4.545 9,905 48,727 51,960 St. James 2,822 9 219 3,032 20,806 19,730 St. Anne 1,128 45 829 1,912 11,099 11,250 St. Martin and Strand 2,460 64 ] ,835 4,131 17,840 19,560 The City 21,652 237 9,746 31,061 174,271 177,940 9 Births. 2,897 births were registered in the City in the, 52 weeks ending December 31st, 1904. On examination, 43 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 200 children were born the home address of whose mothers was in Westminster. The net number of births was, therefore, 3,054, as compared with 3,185 in 1903, and 3,461 in 1902; the birth-rate, uncorrected, was 16.3, corrected 17.2 per 1,000 persons. The birth-rate for the County of London for 1904 was 27.9, the rate during the ten preceding years averaged 29.6 per 1,000. The birth-rate in England and Wales was 27.9, which is lower than that in any other year on record; compared with the average of the preceding ten years, the birth-rate in 1904 shows a decrease of 1.3 per 1,000. 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. The decrease in actual numbers is particularly noticeable in Conduit, Regent, Great Marlborough and Strand Wards. Table I.—Showing the number of Births in the City of Westminster and its Wards (corrected by distributing Institution Births). Wards. Births (corrected). 1901. 1902. 1903. 1904. Conduit 47 46 43 27 Grosvenor 153 157 151 148 Kniglitsbridge St. George 163 162 125 164 Victoria 836 886 884 862 St. Margaret 197 160 162 165 St. John 869 953 877 828 Hamlet of Knightsbridge 63 97 79 77 St. Anne 289 278 240 232 Regent 213 226 184 143 Pall Mall 32 23 22 17 Great Marlborough 208 180 162 151 Charing Cross 41 26 34 42 Covent Garden 163 163 151 156 Strand 153 104 71 42 The City of Westminster 3,432 3,461 3,185 3,054 B 2 10 A comparison of the corrected and uncorrected birth-rates, and of the death-rates of infants under one year of age, is made in the following table:— Births. Birth-rate. Deaths, under 1, per 1,000 births. Uncorrected. Corrected. Uncorrected. Corrected. Uncorrected. Corrected. St. George 1,183 1,201 15.6 15.9 117 115 St. Margaret and St. John 985 1,070 18.9 20.6 152 140 St. James 284 311 14.4 15.7 95 86 St. Anne 205 232 18.3 20.7 78 69 Strand 240 240 12.1 12.1 116 116 The City 2,897 3,054 16.3 17.2 124 118 The number of married women between the ages of 15 and 45 is estimated to be 18,620, and the unmarried and widows at the same age-period 39,710. Illegitimate births (net) were 186 in 1902 (5.7 per cent. of the total births), 150 in 1903 (4.7 per cent.), and 134 in 1904 (4.3 per cent.). In the County the proportion was 3.8 per cent., which was about the average of the previous ten years. Calculating legitimate births per 1,000 married women between the ages of 15 and 45, and the illegitimate per 1,000 unmarried and widows at the same ages, we get the following figures:— 1902. 1903. 1904. City of Westminster— Legitimate 174 156 164 Per 1,000 married. Illegitimate 4.6 3.4 3.8 Per 1,000 unmarried. County of London—1900-02. Legitimate 2276 223.7 218.9 Per 1,000 married. Illegitimate 6.9 6.8 7.0 Per 1,000 unmarried. 1,562 of the children were boys, 1,492 girls. 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. The corrected rates for wards are shown in Table VI. In 1870-72 the London rates were 269.9 and 10.3; in 1880-82, 272.6 and 9.8; and in 1890-02, 250.1 and 8.l, so that there has been a progressive decline in both classes. 11 In compliance with a request made by many local authorities, the Registrar-General and the Local Government Board have authorised (11th November, 1904) Registrars of births and deaths to supply lists of births registered in their districts to Sanitary Authorities in the same way as they have hitherto supplied lists of deaths registered: the particulars to be supplied are specified on a form. They are not exactly what is required, but it will be a distinct advantage to know the addresses where births occur, so that steps may be taken to visit and instruct mothers with regard to the feeding and care of the infants. Deaths. 2,626 deaths were registered in the City in the 52 weeks ending the 31st December, 1904. After deducting 1,073 deaths of non-citizens in public institutions in the City, and adding those of 823 citizens who died in other districts, the corrected total is 2,376, and is equivalent to an annual rate of 13.4 per 1,000 persons. The London death-rate for the same period was 16.1, and for England and Wales 16.2. The rates were in each instance below the average of the preceding ten years to the following extent: The City 2.l per 1,000, London 1.8 per 1,000, and England and Wales 1.0 per 1,000. The following comparative statement shows at a glance the deathrates per 1,000 persons estimated to be living at certain age-periods during each of the last three years:— Age-Period. 1901. 1902. 1903. 1904. No. Rate. No. Rate. No. Rate. No. Rate. Under 5 years of age 673 52.1 652 51.7 559 44.7 491 39.6 5 and under 15 55 2.4 74 3.3 45 2.1 49 2.2 15 and under 25 118 2.7 122 2 .8 95 2.2 89 2.1 25 and under 35 192 6.4 200 5.1 167 4.3 157 4.0 35 and under 45 326 15.1 328 12.0 250 9.3 225 8.4 45 and under 55 383 24.7 388 21.2 303 16.7 284 15.7 55 and under 65 401 42.8 426 38.0 320 28.8 340 30.9 65 and upwards 754 106.0 762 109.0 680 98.8 720 105.7 If the estimated population be correct, the above figures are a better gauge of the health of the district than is the rate for the whole of the City or its divisions. A Factor for Correction of Death-rates is derived 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 during the last ten years, a calculation is made of the number of deathswhich would have occurred in the district had similar rates been 12 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 (1.05107 for London, 1 13926 for Westminster) to the 1904 rates, the figures are:— Standard death-rate. Recorded death-rate. Corrected death-rate. Comparative mortality figure. England and Wales 18.19 16.23 16.23 1,000 City of London.. 17.31 16.1 16.92 1,042 City of Westminster 16.22 13.4 15.26 940 For the three previous years, 1901-02-03, the comparative mortality figures were for the county 1,065, 1,100, 1,032, and for the City 1,100, 1,082, 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 1904. 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 number of public institution deaths in London was 35 per cent. of the total, in the City 44-7 per cent. Quarterly Rates.—These are shown in Table X. 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 X. for the same areas. 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 on 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. (See comparison of corrected and uncorrected rates above, page 10.) The uncorrected rate for the City was 124 deaths per 1,000 births, as compared with 149, the average of the previous ten years. The corrected rate was 118. The London rate for 1904 was 144, the average being 153. 13 The total number of such deaths was 10 per cent. less than in 1903, but as the number of births was also less, the proportion of deaths was slightly higher than in that year, in which the uncorrected and corrected rates were 122 and 116 respectively. The London rate was 14 points higher; this was chiefly due to an increase in diarrhoea deaths, but in the City there was also an increase in deaths from chest diseases and from accident or negligence. Inquiries have been made into the circumstances of many of these infantile deaths, and in a good number of cases improper feeding has contributed largely to the death-rate. As nearly all the deaths in children are due to causes which are preventible, it is to be hoped that the steps which will be taken in in coming years will do much to prevent this waste of infant life. The provision of addresses where children are born will enable parents to be visited with a view to giving instructions and advice where these are required. A leaflet has been prepared by the Westminster Health Society on the subject, and several of the Registrars have undertaken to give a copy to parentsvarious maternity societies and similar departments of hospitals have also agreed to co-operate. Progress will necessarily be slow, as all educational work is, but there is every reason to believe it will be successful. An examination of the particulars ascertained in 103 cases of infantile deaths shows that there had been 342 births in the same families, and that nearly half (47'6 per cent.) of the children had died. In a considerable proportion it appears to be the first baby which has died, but in some instances, as shown in the second half of the accompanying table, nearly all the children have died; thus in one Table II.—Infant Mortality Statistics for 1904. Original Number ill Family. Number of Families. Total Births in Families. Total Deaths. 1 28 28 28 2 26 52 27 3 10 30 15 4 17 64 24. 5 4 20 9 6 4 24 10 7 5 35 14 8 4 32 9 9 — — — 10 3 30 14 11 — — — 12 — — — 13 1 13 7 14 1 14 6 103 342 163 = 476 per 1,000 births in those families. 14 Original Number in Family. Number of Children Dead. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. ] 1 28 - - - - - - - - - - - - - 2 25 1 - - - - - - - - - - - - 3 6 1 2 - - - - - - - - - - - 4 12 3 2 - - - - - - - - - - - 5 1 1 2 - - - - - - - - - - - 6 1 1 1 1 - - - - - - - - - - 7 — 2 2 1 - - - - - - - - - - 8 — 3 1 - - - - - - - - - - - 9 - - - - - - - - - - - - - - 10 — — 1 1 — — 1 — — — — — — — 11 - - - - - - - - - - - - - - 12 - - - - - - - - - - - - - - 13 — — — — — — 1 — — — — — — — 14 — — — — — 1 — — - - - — — — The figures in the body of the table relate to families. The table should be read thus: Under the heading "4" as the original number of children, then in 12 families 1 child had died, in 3 families 2 of the 4 had died, and in 2 families 3 children had died. family of six only two survived, in a family of ten there are only three survivors. The total figures are too small to enable it to be stated that infant mortality is confined to a limited number of families, but they appear to indicate that it is so, after the exclusion of first babies. The large number of children (50) who are prematurely born, or who are born in such a weak state (83) that they can only live a short time, shows that before the child is born the health of the parents is one requiring serious consideration. The Royal Commission on Physical Deterioration, in their report, drew attention to a number of causes which they believed operated in an injurious manner. Amongst the first may be placed the gradual withdrawal of the peasantry from the country and their aggregation in towns, where the keen struggle to make a livelihood, the difficulty of obtaining proper accommodation, the want of good air and playgrounds, improper and unwholesome feeding and overcrowding, late hours, premature smoking and drinking, and the. strain on the nervous system due to town life, are likely to render the children of those who have immigrated from the country more weakly than their parents. These children marry, often at too early an age, without being able to make proper provision either for the housing or feeding of their progeny, and these are apt to fall a stage lower still. Moreover, the difficulty of earning a sufficiency will often tempt or compel the mothers to supplement their husbands' scanty earnings by working themselves even during pregnancy or too soon after confinement. 15 The subject is thus a complex one, with the rapidly decreasing birth-rate, but it is one that the nation must tackle. The distribution of the infantile deaths in the City is shown in Table VI., together with the rates per 1,000 corrected births. The rates are above the average (118) in St. John's with 149, and Covent Garden Ward with 141, and these two are above the previous year's rate. In most of the other Wards there is a diminution. The deaths occurred in the four quarters of the year as follows: first quarter, 97; second quarter, 73; third quarter, 106; and fourth quarter, 84. Forty deaths were those of illegitimate infants. It is fortunate that the proportion of such births is declining as, the chance of living is much less than that of legitimate infants. It is interesting to note from the subjoined Table that when the births and deaths of illegitimates have been taken out, there appears to be a small improvement each year among the legitimate children. Whether this is an actual improvement or is due to the removal from the district of an inferior type of parent, I am not prepared to say, but I think probably the latter explanation is nearer the truth. The reduced mortality, however, makes up only a small part of the loss due to the diminishing birthrate:— Legitimate. Illegitimate. Births. Deaths. Percentage. Births. Deaths. Percentage. 1902 3,275 410 12.5 186 32 17.2 1903 3,035 345 11.3 150 25 16.6 1904 2,920 320 10.9 134 40 29.8 Three years 9,230 1,075 11.6 470 97 20.6 Of the 40 illegitimate deaths, 14 were connected with St. John's Ward, 11 with Victoria, and 6 with Kinghtsbridge St. George, 2 each with the Hamlet and Regent, and one each with Conduit, Grosvenor, Great Marlborough, Covent Garden, and St. Anne's Wards. Causes of death.—These are set forth in Table VIII., and also their distribution in the various Wards of the City. In Table IX. 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 diarrhœa, rheumatic fever, nervous diseases, chest diseases, and old age. In the county, compared with the previous ten years, there was an excess of deaths in 1904 from diarrhœa, cancer, suicide, and diseases of the urinary system. 16 Table III (Required by Local Government Board).— Vital Statistics of Separate Localities in 1004 and 13 Previous Years. Names of Localities 1. The City of Westminster. 2. St. George's, comprising Conduit, Grosvenor, Victoria, and Knightshridge 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 (corr cted). 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 each year. Births registered (uncorrected). Deaths at all ages (corrected). Deaths under 1 year. Population estimated to middle of each year. Births registered (un- | corrected). 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 24,368 524 446 76 12,378 310 261 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 75 12,150 314 185 39 25 971 483 532 90 1898 193,304 3,715 3,324 571 80,703 1,411 1,072 172 52,613 1,088 1,093 198 22,200 434 408 73 12,150 290 205 39 25,638 492 546 89 1899 192,452 3,610 3,442 600 81,033 1,34s 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 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 Averages of 10 years 1894 to 1903 190,452 3,621 3,156 542 79,158 1,336 1,074 171 52,925 1,156 1,046 193 22,302 435 376 65 11,944 283 190 38 24,587 435 484 75 1904 177,321 2,897 2,376 360 75,440 1.183 886 139 51,960 985 513 150 19,730 284 235 27 | 11.250 205 130 16 19,827 240 312 28 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. 17 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 1894—190o. Birth-rate (Uncorrected). Death-rate (Corrected). Deaths under 1 per 1,000 Births Registered in the City. Average, 10 Years. 1904. Average, 10 Years. 1904. Average, 10 Years. 1904. 1. St. George's Division— Comprising Conduit, Grosvenor, Victoria, and Knightsbridge St. George Wards 16.8 15.6 13.5 11.7 128 117 2. Westminster Division— Comprising St. Margaret and St. John and the Hamlet of Knightsbridge Wards 21.8 20.6 19.7 15.6 167 152 3. St. James Division— Comprising Pall Mall, Regent, and Great Marlborough Wards 19.5 14.4 16.8 11.9 149 95 4. St. Anne Ward 23.6 18.3 15.9 11.7 137 69 5. Strand Division— Comprising Covent Garden, Strand,* and Charing Cross Wards 17.6 12.1 19.6 15.8 172 116 The City of Westminster 19.0 16.3 16.5 13.4 149 124 The County of London' 29.6 27.9 17.9 16.1 153 144 England and Wales , 29.2 27.9 17.2 16.2 155 146 The United Kingdom - 27.5 — 16.5 — — * The area of these divisions was altered at the incorporation of the City in 1900. 18 Table Y.—Deaths of Citizens during the Year ending 31st December, 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. Maids. Females. Total. Males. Females. Total. Males. Females. Total. Males. Females. Total. Males. Females. Total. Conduit 13 5 18 2 2 4 3 5 8 1 - 1 1 - 1 - - - 20 12 32 G-rosvenor 46 41 87 13 8 21 15 8 23 1 — i 2 3 5 6 2 8 83 62 145 Hamlet of Kniglitsbridge 17 31 48 4 2 6 6 7 13 — 1 1 1 — 1 3 1 4 31 42 73 Kniglitsbridge St. G-eorge 32 30 62 19 5 21 18 7 25 1 1 2 2 4 6 4 1 5 76 48 124 Victoria 151 213 361 54 52 106 43 31 74 5 2 7 8 13 21 10 3 13 271 314 585 St. Margaret 42 34 76 14 17 31 20 7 27 1 — 1 2 1 3 4 3 7 83 62 145 St. John 148 155 303 120 66 180 43 32 75 2 1 3 6 6 12 12 4 16 331 264 595 St. Anne 28 28 56 20 9 29 20 13 33 — — — 5 1 6 5 1 6 78 52 130 Great Marlborough 21 20 41 12 22 34 13 7 20 — 1 1 4 2 6 — 1 1 50 53 103 Pall Mall 12 8 20 4 1 5 5 1 6 — — — — — — 2 — 2 23 10 33 Regent 31 22 53 16 4 20 8 9 17 — — — 4 1 5 1 3 4 60 39 99 Cliaring Cross 15 9 24 6 3 9 4 3 7 — — — 1 — 1 5 1 6 31 16 47 Covent Garden 33 36 69 27 14 41 2 10 36 — — - 7 2 9 3 — 3 96 62 158 Strand 9 8 17 38 33 71 5 6 11 - - - 3 3 6 1 1 2 56 51 107 City of Westminster 598 640 1,238 349 238 587 229 146 375 11 6 17 46 36 82 56 21 77 1,289 1,087 2,376 19 Table VI. (L.G.B.).—Statistics of Births and Deaths during the 52 Weeks ending 31 st December, 1904. 1 2 3 4 5 6 7 8 9 10 11 12 Wards. Population Estimated to Middle of the Year 1904. 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 1,000 Births (Corrected). Number. Rate.* Conduit 5,700 27 4.7 1 37 26 14 8 14 32 5.6 Grosvenor 15,000 148 9.8 12 81 103 52 13 55 145 9.6 Knightsbridge St. George 15,000 164 10.9 16 97 472 58 391 43 124 8.2 Victoria 39,740 862 21.7 110 127 392 209 22 215 585 14.7 St. Margaret 13,400 165 12.3 14 84 323 65 232 54 145 10.8 St. John 31,000 828 26.7 128 149 331 279 22 286 595 19.1 Hamlet of Knightsbridge 7,560 77 10.1 8 103 56 21 6 23 73 9.6 St. Anne 11,250 232 21.2 16 69 104 69 46 72 130 11.6 Great Marlborough 7,100 151 21.2 9 59 77 63 26 52 103 14.5 Pall Mall 3,100 17 5.5 1 58 26 11 6 13 33 10.6 Regent 9,530 143 15.0 17 118 70 43 16 45 88 10.4 Charing Cross 4,300 42 9.7 2 47 52 17 24 19 47 10.9 Covent Garden 8,660 156 18.0 22 141 334 86 254 78 158 18.2 Strand 6,600 42 6.4 4 95 260 88 228 75 107 16.2 The City 177,321 3,054 17-2 360 118 2,626 1,075 1,073 823 2,376 134 * Rates calculated per 1,000 of estimated population. The uncorrected birth-rate was 16.3, uncorrected death-rate, 14.8. 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. 20 Table VII. (Required by the Local Government Board.) Vital Statistics of Whole Districts during 1904 and Three 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 Non. Residents 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. Kate per 1,000 Births Registered. Number. Rate.* 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 3,281 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 1904 177,321 2,897 16.3 360 124 2,626 14 '8 1,228 1,073 823 2,376 13.4 * 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 baring actually occurred within the district or division. The deaths to te 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 ffiven on the next Daces. Total population at all ages 183,011 Area of District in acres (exclusive of area covered by water) 2502.7 Number of inhabited houses 18,366 Average number of persons per house 8.9 At Census of l901. 21 Table VII.—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 (388). West London Hospital. Darenth Asylum, Westminster Hospital (237). Queen Charlotte's Hospital. Dartford Asylum. Charing Cross Hospital (231). Great Ormond Street Children's Hospital. Ilanwell Asylum. King's College Hospital (215). Horton Asylum. St. Peter's Hospital (32). Cancer Hospital, Chelsea. Leavesden Asylum. Grosvenor Hospital (7). Royal Free Hospital. Camber well House Asylum. Heart Hospital, Sobo Square (17). University College Hospital. Tooting Bee Asylum. Brompton Hospital. London County Council Women's Hospital, Soho Square (21). Hospital of St. John and St. Asylum, Norwood. Elizabeth. London County Council Asylum, Ilford. Male Lock (4). Friedenheim. Throat Hospital, Golden Square (13). South-Western Fever Hospital. . Hoxton House Asylum. Metropolitan Benefit Society's Asylum. Station Hospital, Rochester Row (6). Grove Fever Hospital. Bolingbroke Hospital. Licensed Victuallers'Asylum. Hospital for Women, 9, Lupus Street (2). Mount Vernon Hospital. Aged Pilgrims' Asylum. Belgrave Hospital. Salvation Army Maternity Home, Hackney. St. George's Workhouse, Cheyne Hospital. Wallis Yard (5). London Throat Hospital. Poland Street Workhouse (34). London Fever Hospital. III. Chest Hospital. Bear Yard Workhouse (5). Metropolitan Hospital. 22, George Street, Hanover Square, Nursing Home (6). National Hospital. Other Institutions, the Deaths in which hare been distributed among the several localities in the District. Chelsea Hospital for Women. 96, Belgrave Road (2). St. George's Infirmary, Fulham Road. 162, Ebury Street (2). Creche, Foubert's Place (1). Wandsworth Infirmary. Chelsea Infirmary. II. Lambeth Infirmary. 55, Welbeck Street. llolborn Infirmary, Islington. Institutions outside the District receiving Sick and Infirm Persons from the District- St. Pancras Infirmary. Hostel of God. Kensington Infirmary. St. Martin's Almshouses. Marylebone Infirmary. St. Joseph's Home. Edmonton Workhouse. 15 and 52, Beaumont Street. 15, Bulstrode Street. Middlesex Hospital. St. Giles Workhouse. Holborn Workhouse. St, Elizabeth's Home. St. Thomas's Hospital. St. George's Workhouse, Fulham Road. 7, Queen Anne Street. St. Bartholomew's Hospital. Medical and Surgical Home, Fitzroy Square. St. Mary's Hospital. Gordon Road Workhouse, Peckham. Guy's Hospital. 40, May bury Street, Tooting Graveney. London Temperance Hospital. Hampstead Workhouse. St; Pancras Workhouse. 45, Devonshire Street. German Hospital. Central London Sick Asylum, Cleveland Street. 12, Devonshire Street. French Hospital. St. Luke's House. Italian Hospital. Central London Sick Asylum, Hendon. St. Peter's House. Victoria Hospital. The Priory, Putney. Lying-in Hospital, Enclell Street. Poplar and Stepney Sick Asylum. 29, Wimpole Street. 37, Albany Street. General Lying-in Hospital, York Road. Banstead Asylum. 15, Henrietta Street, Marylebone. Cane Hill Asylum. London Hospital. Caterham Asylum. Whittington College, Islington. Children's Hospital, Sydenham. CIaybury Asylum. Colney Hatch Asylum. Woodhurst, Dorking. 22 Table VIII.—Causes of, and Ages at, Death during the 52 weeks ending 31 st December, 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 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. Smallpox - - - - - - - - - - - - - - - - - - - - - Measles 23 7 16 — — - — — — — 2 4 — 8 2 — — 1 — 3 3 Scarlet fever 9 - 5 4 — — - — 1 — 1 5 — 1 - 1 - - - - - Epidemic influenza 20 — — — 2 8 10 — 3 — 1 8 2 1 - - 1 - - 2 2 Whooping cough 17 3 14 — — — — — — — 1 6 — 6 — 1 — — — 3 - Diphtheria, Memb. croup 5 — 2 2 — 1 — 2 1 — — — — 1 — 1 — — — — — Croup — — — — — — — — — — — — — — — — — — — — - Enteric fever 11 — — — 4 7 — — — — 1 6 1 2 1 - - - - - - Diarrhœa 42 27 6 — — 6 3 1 2 1 1 11 5 17 — 3 — 1 - - - Epidemic enteritis 38 36 1 — — — 1 — 1 — — 13 2 16 2 - - 2 - 1 1 Enteritis 16 9 — 1 3 2 1 1 1 — 1 2 — 6 3 1 - - - 1 - Erysipelas 7 — — — 1 3 3 — — — 2 1 — 2 1 - - 1 - - - Puerperal fever 1 - - - - 1 - - - - - - - 1 - - - - - - - Other septic diseases 16 6 - - 2 8 - — 4 2 — 3 - 4 1 - - 2 - - - Syphilis, &c. 10 5 - - - 4 1 — — — — 5 1 2 2 - - - - - - Diabetes 18 — — — 3 8 7 1 4 — 4 7 1 - - - - - 1 - - Malarial diseases 1 - - - - 1 - - - - 1 - - - - - - - - - - Rheumatic fever 19 - 1 6 3 8 1 1 1 — - 2 — 8 — 2 - 1 2 1 1 23 Tuberculosis of meninges 26 4 16 2 4 - — — 3 2 — 6 2 4 6 - — — — 3 — Tuberculosis of lungs 271 — 5 2 23 220 21 — 12 11 13 58 18 77 17 15 2 10 5 18 14 Tuberculosis of peritoneum 12 6 1 3 — 1 l — 1 — — 4 1 3 — 1 — -— — 2 — Other forms of tuberculosis 32 7 4 6 8 1 — 1 1 1 - 7 3 4 4 2 2 1 2 3 1 Alcoholism 22 — — — 1 21 — 2 — 1 3 2 1 6 — 1 — — 2 3 1 Malignant growths 177 — — 2 1 111 63 2 13 10 9 44 16 27 8 8 3 3 4 17 13 Premature birth 50 50 — — — — — — 2 2 3 15 2 18 2 2 — 2 — 2 — Developmental diseases 90 83 7 — — — — — 2 3 5 30 2 27 7 1 1 3 1 6 2 Old age 149 — — — — 2 147 1 5 3 8 42 8 39 7 8 2 7 4 6 9 Meningitis and convulsions 31 17 9 1 1 3 — 2 1 — 3 9 — 7 — 1 1 1 1 4 1 Other diseases of nervous system 132 - 3 2 1 68 58 2 8 5 5 37 6 21 3 8 - 8 - 14 11 Valvular diseases of Leart 63 — — 1 5 42 15 1 3 3 4 13 6 12 3 2 1 3 3 6 3 Other circulatory diseases 234 2 — 1 3 119 109 1 23 6 9 53 16 69 10 12 8 9 3 8 7 Bronchitis 269 34 9 — — 75 151 2 12 7 13 78 12 74 9 13 1 15 2 15 16 Lobar (croupous) pneumonia 41 3 5 2 - 23 8 1 1 1 2 7 4 10 2 3 1 2 2 4 1 Lobular (broncho-) monia 57 22 14 2 1 9 9 1 2 1 2 12 4 22 1 1 - 5 1 4 1 Other respiratory diseases 67 4 3 — 1 33 26 1 10 4 2 8 4 18 5 — — 7 2 5 1 Cirrhosis of liver 34 — — — — 28 6 — 4 — 1 7 2 7 — 1 — 1 2 6 3 Other digestive diseases 88 7 3 3 11 37 27 2 8 5 7 23 4 12 6 7 5 2 2 3 2 Bright's disease, &c. 112 1 — 1 2 76 32 2 7 1 9 19 11 24 7 6 2 4 2 12 6 Generative system diseases 11 — — — — 11 — 1 1 — 1 3 — 2 2 — — 1 — — — Accidents and diseases of parturition 7 - - - - 7 - - - 1 1 1 - 2 1 - - 1 - - - Deaths by accident or negligence 87 21 3 7 5 40 11 - 5 3 7 15 5 20 9 1 3 6 4 4 5 Deaths by suicide and murder 28 1 - - 4 22 1 2 1 - 1 9 3 6 3 - - - 1 1 1 All other causes 33 5 _ 4 1 — 15 8 1 2 — 1 10 3 9 2 1 — — 1 1 2 All causes 2,376 360 131 49 89 1,027 720 32 145 73 124 585 145 595 130 103 33 99 47 158 107 24 Table IX —Death-rates per 1,000 Inhabitants in the City and Wards from Various Causes, 1904. Causes of 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 - - - - - - - - - - - - - - - Measles 0.1 3 - - - 0.13 0.10 — 0.25 0.17 — - 0.10 — 0.34 0.45 Scarlet fever 0.05 - 0.6 — 0.06 0.12 — 0.03 — 0.14 - — — — — Epidemic influenza 0.12 - 0.20 - 0.08 0.20 0.14 0.03 — — 0.32 — — 0.23 0.30 Whooping cough 0.09 — — - 0.06 0.15 — 0.19 — 0.14 — — — 0.24 — Diphtheria, Membranous croup 0.02 0 35 0.06 — — — — 0.03 - 0.14 — — — - — Croup - - - - - - - - - - - - - - - Enteric fever 0.06 - - - 0.06 0.15 0.07 0.06 0.08 - - - - - - Diarrhœal diseases 0.54 0.35 0.26 0 13 0.13 0.65 0.52 1.25 0.45 0.52 — 0.30 — 0.23 0.15 Erysipelas 0.03 - - — 0.13 0.02 — 0.06 0.08 — — — — — — Puerperal fever 0.00 - - - - - - 0.03 — — — 0.24 — — — Other septic diseases 0.09 - 0.26 - - 0.07 — 0.12 0.08 — — — — — — Diabetes 0.10 0.17 0.26 0.26 0.26 0.17 0.07 — — — — — 0.23 — — Venereal diseases 0.05 - - - - 0.12 0.07 0.06 0.17 — — — — — — Rheumatic fever 0.10 0.17 0.06 - - 0.05 — 0.25 — 0.28 — 0.10 0.46 0.11 0.15 Tuberculosis of meninges 0.14 — 0.20 0.26 — 0.15 0.14 0.13 0.53 — — — — 0.34 - 25 Tuberculosis of lungs 1.53 0.17 0.08 1.45 0.06 0.46 0.34 2.48 1.51 2.11 0.64 1.54 1.16 2.02 2.12 Tuberculosis of peritoneum 0.06 - 0.06 - - 0.10 0.07 0.09 — 0.14 — — — 0.23 — Other forms of tuberculosis 0.18 0.17 0.06 0.13 — 0.17 0.22 0.12 0.24 0.28 0.64 0.10 0.46 0.34 0.15 Alcoholism 0.12 0.34 — 0.13 0.20 0.05 0.07 0.19 — 0.14 — — 0.46 0.34 0.15 Malignant growths 0.99 0.34 0.68 1.32 0.60 1.10 1.19 0.87 0.71 0.12 0.96 0.31 0.93 0.96 1.96 Premature birth 0.28 — 0.12 0.26 0.20 0.37 0.14 0.58 0.17 0.28 — 0.21 — 0.23 — Developmental diseases 0.50 — 0.12 0.19 1.33 0.75 0.14 0.87 0.62 0.14 0.32 0.31 0.23 0.69 0.30 Old age 0.84 0.17 0.32 0.39 0.53 1.10 0.09 1.25 0.62 1.12 0.64 0.73 0.93 0.69 1.36 Meningitis and convulsions 0.17 0.34 0.56 — 0.20 0.22 — 0.22 — 0.14 0.32 010 0.23 0.46 1.15 Other diseases of nervous system 0.74 0.34 0.53 0.66 0.33 0.93 0.44 0.67 0.62 0.32 — 0.83 - 1.61 1.66 Valvular diseases of the heart 0.35 0.17 0.20 0.39 0.21 032 0.44 0.58 0.25 0.25 0.32 0.31 0.68 1.19 0.45 Other circulatory diseases 1.32 0.17 1.53 0.78 0.60 1.33 0.19 2.22 0.89 1.69 2.55 0.94 0.68 0.92 1.06 Bronchitis 0.69 0.34 0.80 0.92 0.86 1.96 0.89 2.47 0.83 1.83 0.32 1.58 0.46 1.73 2.42 Lobar (croupous) pneumonia 0.23 0.17 0.06 0.13 0.13 0.17 0.29 0.32 0.17 0.42 0.32 0.21 1.46 0.46 0.15 Lobular (broncho-) preumonia 0.32 0.17 0.12 0.13 0.13 0.30 0.29 0.70 0.08 0.14 — 0.52 0.23 0.46 0.15 Other respiratory diseases 1.37 0.17 0.66 0.52 0.13 0.20 0.29 0.58 0.44 — — 0.74 0.46 0.57 0.15 Cirrhosis of liver 0.19 — 0.20 — 0.46 0.17 0.14 0.22 — 0.14 — 0.10 0.46 0.69 0.45 Other digestive diseases 0.49 0.34 0.53 0.66 0.12 0.57 0.29 0.58 0.53 0.98 1.61 0.20 0.46 0.34 0.30 Bright's disease, &c. 0.63 0.34 0.46 0.13 0.60 0.47 0.82 0.77 0.62 0.84 0.64 0.42 0.46 1.38 0.91 Generative system diseases 0.06 0.17 0.06 — 0.06 0.07 - 0.06 0.17 — — 0.10 — — — Accidents and diseases of parturition 0.04 — — 0.13 0.06 0.02 — 0.06 0.08 — — 0.10 — - - Deaths by accident or negligence 0.49 — 0.53 0.39 0.46 0.37 0.37 0.64 0.83 0.14 — 0.63 0.93 0.46 0.75 Deaths by suicide, &c. 0.15 0.34 0.06 — 0.06 0.22 0.21 0.19 0.26 — 0.96 — 0.23 0.11 0.15 All other causes 0.10 0.17 0.26 — 0.06 0.22 0.22 0.28 0.17 0.14 - — 0.23 0.11 0.30 All causes 13.4 5.6 9.6 9.6 8.2 14.7 10.8 19.1 11.6 14.5 10.6 10.4 10.9 8.2 16.2 c 2 26 Table X.—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 December31st, 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 Mail Ward. Regent Ward. Charing Cross Ward. Covent garden Ward. Strand Ward. 1st Quarter 18.7 18.2 17.8 16.1 5.6 9.3 11.6 9.3 18.4 13.1 22.4 18.2 10.7 16.6 12.6 13.9 23.6 21.9 2nd Quarter 15.4 14.8 14.3 11.7 7.0 7.5 11.6 8.3 13.4 11.6 15.2 8.2 12.4 6.4 7.1 9.2 17.1 16.4 3rd Quarter 15.5 15.7 15.8 12.1 4.2 10.1 6.3 7.7 13.2 6.5 20.2 9.6 15.2 7.6 9.3 10.1 15.7 9.7 4th Quarter 16.3 16.3 16.4 13.5 5.6 11.7 9.0 7.7 13.9 11.9 18.8 10.3 19.7 12.8 12.6 10.1 16.6 17.0 The Year. Persons 16.5 16.2 16.1 13.4 5.6 9.6 9.6 81.2 14.7 10.8 19.1 11.6 14.5 10.6 10.4 10.9 18.2 16.2 Males — — 17.8 15.6 8.6 13.0 10.5 13.4 14.9 13.0 20.6 13.3 14.6 13.4 12.9 11.1 22.4 16.7 Females — — 15.0 11.4 5.0 6.9 9.5 5.1 14.5 8.8 17.6 9.6 14.3 7.1 7.9 10.5 14.3 15.6 27 B. Communicable Diseases. (1) Compulsorily Notifiable Diseases. During the 52 weeks of 1904, 887 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 74l cases in 1902, 5 in 1903, and 179 for 1904, exclusive of duplicate notifications. The notifications were lower in number in the City than in any year since notification began to be required The charts on p. 29 indicate the number of notifications of scarlet fever, diphtheria, enteric fever, erysipelas, and small-pox in each week in the City and county. Seventeen persons notified as suffering from scarlet fever, 23 from diphtheria, 5 from enteric fever, and 1 from continued fever, were eventually stated not to be suffering from the disease notified. Besides these, a number of doubtful cases were seen by me in consultation with the medical attendant. In addition, 1 case of scarlet fever and 1 of enteric fever were not notified. One medical man was cautioned for failing to notify a case of scarlet fever. Several persons were cautioned for improperly moving patients to hospitals after they had been informed of the nature of the case. Small-pox.—Cases of this disease were notified in London and in Westminster as follows during 1904:— London. Westminster. London. Westminster. January 17 3 July 32 1 February 19 — August 3 — March 145 — September 5 — April 100 2 October 1 — May 89 — November 4 — June 61 1 - December 18 — From the above Table it is evident that the City suffered but slightly from this disease during 1904. In the early part of January 3 cases were notified; these were the concluding numbers 28 Table XII.—Infectious Diseases Notified, 1890-1904, in London. Year. Smallpox. Scarlet Fever. Diphtheria and Croup. Enteric Fever. Typhus Fever. Other Continued Fevers. Puerperal Fever. Erysipelas. Cholera. Relapsing Fever. Totals. 1890 60 15,330 5.870 2,877 35 237 206 4,598 25 7 30,245 1891 114 11,398 6,412 3,372 27 152 221 4,764 23 39 26,552 1892 423 27,095 8,356 2.465 20 147 347 6,934 54 7 45 84S 1893 2,813 36,901 13,694 3,666 22 205 397 9,700 86 4 67,485 1894 1,192 18 440 11,190 3,360 21 162 253 6,080 21 2 40,925 1895 979 19,757 11,223 3,506 14 105 236 5,660 29 3 41,612 1896 225 25,647 13,941 3,190 6 103 279 6,438 13 3 49,845 1897 104 22,848 13,199 3,103 4 65 264 5,800 38 1 45,361 1898 32 16,894 11,855 3,024 16 55 247 5,169 23 1 37,316 1899 29 18,113 13,704 4,463 14 69 330 5,615 15 1 42,353 1900 87 13,800 11,985 4,291 7 73 237 4,762 5 - 35.247 1901 1,700 18,381 12,157 3,194 20 48 253 4,604 3 - 40,360 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 1904 489 13,439 7,219 1,896 3 29 273 4,943 1 1 28,293 In the City of Westminster. 1890 1 402 150 79 — 9 - 128 1 - 770 1891 2 379 174 100 — 7 9 144 1 - 817 1892 14 864 349 99 — 8 7 191 2 - 1,534 1893 165 1,366 353 148 — 5 11 230 4 - 2,284 1894 21 535 269 106 — 9 2 134 - - 1,134 1895 195 715 383 114 — 4 4 138 - - 1,297 1896 7 846 323 121 — 5 7 178 - - 1,487 1897 13 658 336 104 — 5 6 175 1 - 1,298 1898 2 409 338 112 — 2 5 131 - - 999 1899 — 534 283 143 — 1 3 176 - - 1,140 1900 2 453 287 118 — 4 5 129 - - 998 1901 102 475 253 104 — 2 6 117 - - 1,059 1902 232 475 285 132 — 1 6 144 - - 1,275 1903 45 352 186 71 — 2 5 111 - - 772 1904 6 313 145 51 1 2 5 125 — — 648 Case-rates per 10,000 Living in London. Year. Smallpox. Scarlet Fever. Diphtheria. Enteric. Typhus. Other Continued Fevers. Puerperal. Erysipelas. 1891 0.3 27.1 15.2 8.0 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 o.1 37.6 26.3 6.7 0.0 0.1 0.5 11.5 1899 0.2 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 o.oo 0.1 0.6 11.8 1903 0.9 27.1 16.7 5.0 0.04 0.08 0.5 9.4 1904 10 28.9 15.5 4.0 0.00 0.06 0.59 10.6 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. — 0.5 0.1 6.9 1895 1.0 36.9 15.6 5.9 — 0.2 0. 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 0.01 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.ll 0.27 6.2 1904 0.3 17.6 8.2 2.9 0.05 0.11 0.28 7.1 29 Notifications of Infectious Diseases during the year 1904. London. City of Westminster. 30 City of Westminster. Table XIII.—Local Government Board Table C.— Cases of Infectious Disease Notified during the 52 weeks ending 31st December, 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. K amlet 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 6 - - - 1 5 - - - 1 - - 4 - - - - - 1 - - - - 1 - - 4 - - - - - 1 - - 6 Deaths - - - - - - - - - - - - - - - - - - - - - Diphtheria- Cases 145 3 38 62 24 18 - 9 20 2 22 6 20 3 6 16 16 — 10 1 14 6 17 2 18 6 18 2 6 15 16 - 9 1 13 129 Deaths 5 - 2 2 — 1 — 2 1 — — — 1 — - — 1 — — — — Erysipelas- Cases 125 2 3 5 19 82 14 2 7 6 26 4 41 4 1 8 3 3 5 4 11 — — 3 11 1 16 — — 4 — 2 3 2 2 44 Deaths 7 — — — 1 3 3 — — 2 1 — 2 - — 1 — — — — 1 Chicken-pox- Cases 179 12 78 82 8 4 - 1 15 11 46 19 35 11 — 6 8 2 8 1 16 - - - - - - - - - - - - - - - Deaths - - - - - - - - - - - - - - - - - - - - - Fevers. Scarlet- Cases 313 4 101 139 42 27 — 1 25 18 69 17 73 5 4 18 25 6 10 3 39 1 22 12 65 14 71 4 3 18 24 5 9 3 38 289 Deaths 9 — 0 4 — — — — 1 1 5 — 1 — — — 1 — — — — Eteric- Cases 51 - - 7 19 25 - - 3 4 10 5 9 3 4 2 - 1 2 2 6 - 2 4 7 4 9 2 3 2 - 1 2 1 6 43 Deaths 11 - - - 4 7 - - - 1 6 1 2 1 - - - - - - - Continued- Cases 2 - 1 - - 1 - - - - 2 - - - - - - - - - - - - - 2 - - - - - - - - - - 2 Deaths - - - - - - - - - - - - - - - - - - - - - Puerperal- Cases 5 - - - 1 4 - - - - 2 - 2 - - - 1 - - - - - - - - - 1 - - - 1 - - - - 2 Deaths 1 - - - - 1 - - - - - - 1 - - - - - - - - Typhus— Cases 1 - - - 1 - - - - - - - - - - - - - - - 1 - - - - - - - - - - - - - 1 1 Deaths - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Total Cases 827 21 216 295 115 166 14 13 70 42 177 51 184 26 16 50 53 12 36 11 87 7 41 22 103 25 |119 8 12 39 41 8 24 7 60 516 17 cases notified as scarlet fever, 25 as diphtheria, 5 as enteric fever, and 1 as continued fever were eventually stated not to be suffering from the disease notified. In addition to the above, 1 case of scarlet fever and 1 of enteric fever were not notified. 31 of a series of cases particulars of which are given in the Annual Report for 1903. In March a sudden outbreak began in boroughs in the east end of London, but no cases originated from them in Westminster. Three persons suffering from small-pox are known to have spent some time in the City. 150 persons were notified to me in March as having been in contact with cases, the greater number of these having been passengers on ships. Each person is communicated with at the address given, and occasionally it appears to be the first intimation they have had that they have been exposed to infection. I received intimation from Southampton of a large number of passengers who left a ship there on the 9th March, but some days afterwards was informed from Lambeth that a steward from the same ship had been found in Brixton suffering from small-pox, and it appears he left the ship on Saturday, the 12th, with the eruption out on his face, travelled up to London, and stayed the night and the next day with friends in Westminster, proceeding on the Sunday evening to the address he had given as his destination. A second case was that of a man employed doing repairs in some buildings, and the third a domestic servant employed by day in the City. The County Council appointed two experts, who took up residence at 8, St. Martin's Place, and were at the disposal of any practitioner desiring their assistance until the beginning of November. The Council also resolved that chicken-pox be again added to the list of notifiable diseases from April 8th to November 7th. In April two cases were notified to me; one a man who lived at the extreme east of the City, and who had been employed at King's Cross Station in unloading "return papers" from districts in the country in which small-pox was rife. The other case was on the western boundary, in the vicinity of Sloane Square; the patient was a traveller for a grocery firm in the City of London, whereby he had opportunities for receiving infection. Tn this case a number of persons who lodged in the same house left on learning the nature of the complaint, but they were eventually discovered and kept under observation. No subsequent cases resulted from either patient. In July the last case was notified to me; the person had moved from the Borough of Shoreditch, and was taken ill the day after. The Medical Officer of that Borough was communicated with, and a number of cases were discovered there; fortunately no further cases have followed in Westminster. The 6 persons attacked all recovered. In August I was informed that a person who had visited a hotel in the City was taken ill the day after his return to Bolton; the rooms occupied by him were disinfected, and the staff of the hotel were revaccinated. No cases followed in Westminster. The total number of persons notified as having been in contact with cases of small-pox elsewhere than in the City numbered 194, and these were kept under observation. Several persons suspected to be suffering from small-pox were seen by me at the request of their medical attendants. Vaccination.— The Vaccination Officers have supplied me with the following particulars for 1903:— Table XlV.— Vaccination Statistics. 1903. Union. Births. Died Unvaccinated. Successfully Vaccinated. Insusceptible. Vaccination Postponed. Conscientious Objectors. Removed and Vaccination Officer Informed. Not Found. Removed to Address Unknown. St. George 2,240 188 1,924 11 10 12 17 78 Westminster 539 42 430 1 3 3 23 37 Strand 247 31 170 0 10 0 11 25 The City 3,026 241 2,524 12 23 15 51 140 The following is a summary of the total primary vaccinations performed in the City during 1901, 1902, 1903 and 1904, and of revaccinations, in so far as these were made by the Public Vaccinators:— Table XV. Union. Primary Vaccinations under 14 years of Age. Revaccination. 1901. 1902. 1903. 1904. 1901. 1902. 1903. 1904. St. George 2,467 2,893 2,178 1,065 4,039 7,453 159 72 Westminster 1,491 715 369 325 3,317 6,226 9 13 Strand 725 450 245 * 144 2,201 3,910 347 398 The City 4,683 4,058 2,792 1,534 9,557 17,589 515 483 * There were also 16 primary vaccination of persons under 14 years of age in the Strand Union. A conference, attended by 209 delegates, was held in London on the 10th November, 1904, on the Spread of Small-pox by Vagrants. The Chairman of the Public Health Committee (Mr. Councillor Cribb) and the Medical Officer of Health were present. 33 Scarlet Fever.—There were 13,439 cases notified in London in 1904, and 313 in the City, as compared with 352 in 1903, and 475 in each of the two previous years. These figures give a higher rate for the county and a less rate for the City. Twenty-two cases notified as scarlet fever were afterwards said not to be so, but I believe that many very mild cases escaped recognition altogether. There were 6 cases of German measles, 4 cases of measles, and others were cases of sore throat, in some instances accompanied by a rash, probably septic in character. These cases occurred in six Wards, Great Marlborough 7, St. John 6, Victoria and St. Anne 3 each, Eegent 2, and Knightsbridge St. George 1. The following Table shows how the notified cases were distributed, with the attack rate and mortality:— Scarlet Fever. 1904. Conduit. Grosvenor. Hamlet of Knightsbridge. Knightsbridge St. George. Victoria. Sr. Margaret. St. John. 1st quarter 1 2 2 18 __ 16 2nd quarter — 7 i 5 26 6 19 3rd quarter — 7 i 9 11 4 19 4th quarter — 9 3 2 14 7 19 Total cases 1 25 5 18 69 17 73 Deaths 1 — 1 5 — 1 Attack rate per 10,000 population 17 166 6 6 11-9 173 12-7 23'5 Mortality per cent. of cases 40 55 7-2 1'3 Scarlet Fever, 1904. St. Anne. Great. Marlborough. Pall Mall. Regent. Charing Cross. Covent Garden. Strand. Totals for City. 1st quarter 5 2 1 - 1 - - 47 2nd quarter 3 11 1 4 2 6 — 92 3rd quarter 15 4 — 6 — 1 2 79 4th quarter 16 8 2 8 3 3 1 95 Total cases 39 25 4 18 6 10 3 313 Deaths — 1 — — — — - 9 Attack rate per 10,000 population 34.8 35.2 13.0 19.0 13.6 11.5 4.5 17.6 Mortality per cent. of cases - 4.0 - - - - - 2.87 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, hut unfortunately the census figures 34 only give the details for the Union districts. Taking these for comparison, we get:— Case-Rate per 1,000 Persons under 15 years. Deaths per 100 Cases. 1901. 1902. 1903. 1904. 1901. 1902. 1903. 1904. St. George's Union 11.2 11.6 7.1 8.5 1.3 3.2 3.4 3.8 Westminster Union 15.6 20.0 22.2 13.2 0.9 2.2 1.3 1.1 Strand Union 15.1 8.8 5.1 5.3 6.4 6.0 3.3 — The City 12.7 12.9 10.1 9.0 1.8 3.3 2.5 2.8 The County 13.4 13.2 9.1 9.6 3.2 3.0 2.8 2.7 It therefore appears that there was a decrease in the Westminster Union and an increase in St. George's, which was confined chiefly to St. John's Ward. It is of interest to note the lowness of the mortality in the Westminster Union group. The death-rate per 1,000 persons living was 0.08 in London, and 0.05 in Westminster, but calculated per 100 cases the two rates were nearly identical. Diphtheria.—One hundred and forty-five cases of diphtheria were notified in 1904, equal to a rate of 8.2 per 10,000 inhabitants (10.3 in 1903, 15.4 in 1902, and 16.0 in the previous ten years); the rate for all London was 15.5, also a decreasing one. There were 5 deaths, equal to a mortality of only 3.4 per 100 cases, as compared with 10 per cent. in 1.901, 11 per cent. in 1902, and 8.6 per cent. in 1903. The London rate was 10.2 per 100 cases. The death rate for 1,000 persons was 0.04 for the City, 0.16 for the county. Notification of Diphtheria Cases Received in each Month of the Years 1901, 1902, 1903 and 1904. January. February. March. April. May. June. July. August. September. October. November. Deeember. 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 1904 6 17 10 12 9 18 11 10 10 27 2 6 145 I referred in previous reports to an apparent connection between certain cases of diphtheria and sewer emanations in a locality from which complaints were received that offensive emanations came from 35 the street ventilators, and a shaft ventilator against a house was found to he quite hot to the touch. Legal proceedings in connection with this are reported below (p. 52). Bacteriological Diagnosis.—The arrangements made with the Lister (late Jenner) Institute for bacteriological examination was taken advantage of with regard to 47 persons who were suffering from throat affection, or had been exposed to infection; but many other examinations were made at hospitals and in private laboratories. The bacillus of diphtheria was found 10 times; in 36 the result was negative, and in 1 case a few suspicious organisms were found. An instructive case was that of a boy who had been under treatment at a hospital for what appeared to be follicular tonsillitis (" ulcerated sore throat"), but a swabbing having been made of the affected part, and submitted to the bacteriologist of the hospital, showed the presence of diphtheria organisms, whereupon the case was notified to me; but the mother of the patient being dissatisfied with this, called in another medical man, who, without the assistance of a bacteriological examination, pronounced the complaint not to be diphtheria. The result of a second examination showed that the hospital authorities had been right, and demonstrated the danger which was not apparent to the naked eye. Had the case not been recognised through this means, the boy might have been a source of infection to others. The danger was unfortunately exemplified in connection with a small outbreak which occurred in connection with an infant class in St. George's Schools. The first case was notified as scarlet fever on 1st October, but on admission to hospital it was found to be diphtheria; a second case was not discovered by the medical man in attendance to be diphtheria until the 6th, when the patient was moribund. Five cases then occurred, and I communicated with Dr. Kerr of the Education Department of the London County Council, asking him to examine all the children in the infant class in which these were members. This was done, and a bacteriological test was made, with the result that several other children were detected as suffering from the complaint, some of them with only very slight symptoms, but which were nevertheless capable of conveying infection to others; thus a child who was in this class and who had a slight sore throat, which had not been bad enough to require medical attention, gave the complaint to her mother. The children in this class were examined a few days later, and as a result of these examinations all suspicious cases were eliminated, and no further trouble occurred. The rooms, passages, cloak rooms &c., were thoroughly disinfected. It was thought by many parents that the school should have been closed; but the method adopted in this case has the advantage of causing 36 less interference with school work, and if it can be carried through promptly at an early stage, children may be detected with the organism in their throats who may be exhibiting no symptoms of the disease, but, as in the instance noted above, may be a source of danger to others. In another case a boy returned home from hospital, where he had been under treatment for diphtheria. Twenty days after his return 2 other persons in the same family were taken ill with it, and the suspicion arose that he was still in an infective condition; bacteriological examination showed this not to be so. Twenty-three cases were found eventually to give no positive results after admission to hospitals, although in a number of them the organism had been found by competent bacteriologists previously, which shows that in many instances the infective agent may be readily destroyed if only medical treatment is begun early enough. Typhoid Fever.—Fifty-one cases of this disease were notified in the City, as compared with 71 in the previous year, but 5 cases were afterwards proved not to be so, while 1 case in barracks was not reported; there were also 2 cases notified as continued fever (1 afterwards found not to be so), which may be included. These cases were equal to 3 per 10,000, which is the lowest hitherto recorded. The whole of London also showed a decrease, the rate being 4.0, against 7.7 for the ten years. Eleven deaths occurred in the City from this cause (being 21 per cent. of the cases), the mortality for London being 15 per cent. of the cases. The death-rate per 1,000 persons was 0 06 for both City and county. In 27 instances the complaint was ascertained not to have been contracted in the City. 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 hospitals, so that information cannot be obtained from them. The efforts made during recent years to protect the shell-fish industry has evidently produced good results, judging from the decrease in the number of cases alleged to be due to eating contaminated shellfish; in only 4 instances was there direct evidence of probable infection by this source, although information has reached me of persons living in other Boroughs who have been taken ill after eating oysters in this City. Recourse was had to a bacteriological test in 17 instances, in order to assist in the diagnosis; in 2 the result was positive, in 15 it was negative. Typhus Fever.— One case of this disease was notified, but from inquiries I made I do not consider it was typhus fever. 37 Puerperal Fever.—Five cases (with 1 death) were reported in 1904; this is about the average rate for the last twelve years. The Westminster rate is half the average rate for all London. Two of the cases occurred in St. John's, 2 in Victoria, and 1 in Great Marlborough Wards. If the number of puerperal cases are compared with those of erysipelas, which doubtless contains more than one form of bloodpoisoning, it will be observed that the two sets of figures rise and fall together, showing that the same causes are at work in their production. Midwives Act, 1902.—The Public Health Committee had before them a letter from the London County Council, dated the 26th July, 1904, on the subject of the administration of the Midwives Act, 1902, in the County of London, stating that the County Council had had their attention called to the directions to midwives contained in Section E of the Rules of the Central Midwives Board, number 5 of which directions was as follows: — "Whenever a midwife has been in attendance upon a patient suffering from puerperal fever, or from any other fever supposed to be infectious, she must disinfect herself and all her instruments and other appliances to the satisfaction of the local sanitary authority, and must have her clothing thoroughly disinfected before going to another labour. Unless otherwise directed by the local supervising authority, all washable clothing should be boiled, and other clothing should be sent to be stoved (by the local sanitary authority), and then exposed freely to the open air for several days." That in view of the fact that the midwife has to satisfy the local sanitary authority under this rule, the City Council might like to have its attention drawn to the matter; and assuming that the City Council would have no objection to the use of its disinfecting premises and apparatus for the purposes in question. The London County Council was informed that the City Council have no objection to their disinfecting chambers and apparatus being used for the purposes referred to. 38 (2) Voluntary Notifiable Diseases. Tubercular Disease.—Deaths from tuberculosis have teen decreasing in numbers since 1901. The figures for the last four years are set forth below:— The City of Westminster. Year. Pulmonary. Abdominal. Meningeal. Other. Total. Deaths. Rates. Deaths. Rates. 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 1901 271 153 12 0 26 14 32 18 341 192 These rates are calculated per 100,000 inhabitants. 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). 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 1904 162 136 - 171 The Wards which show a diminution in the number of deaths are Victoria, Sc. Anne, Regent, and Strand, while there is a rise in Grosvenor, Great Marlborough, the Hamlet of Knightsbridge, Knightsbridge St. George, and Covent Garden; there is no change in Conduit, St. Margaret, St. John, Pall Mall and Charing Cross. I have added the figures to the tables published in my last report, showing the ages and occupations of persons who have died, and also its incidence on males and females at various ages. The death-rate for males from tubercular disease was 249 in 1904 per 100,000 male inhabitants, the average of the previous three years being 291. For females, the 1904 rate was 143, the average being 153, so that apparently the rate among males is improving more rapidly than among females. Notification.—One hundred and forty-eight cases were notified during 1904, at a cost of £5 17s. 6d..; in 1903, 123 cases were notified This is a very small proportion of the actual number of cases, and in view of the valuable results which have accrued, it is a matter for 39 regret that more medical men have not reported. These results have been twofold— (1.) The patient has been led to take better precautions for preventing the spread of the disease to others. In some cases means have been found of getting him away to a sanatorium, convalescent home, or hospital, and of assisting his family in his absence. In some eases it has been possible to supply additional food to the patient, and when recovered, as some have done, to enable them to obtain more suitable employment in London or the country, or to emigrate to Canada. These results have been largely due to the co-operation of various societies and agencies whicl the Health Society have been able to obtain, working in conjunction with the Public Health Department. (2.) Removal of insanitary conditions in the premises in which patients lived or worked has been effected in many instances. In 37 dwelling-houses insanitary conditions of a serious character were discovered, and in several workshops conditions were found requiring amendment. An attempt has been made to ascertain the relative influence in a number of cases of personal contact and family history, with the following results:— 1904.—Family history as to tuberculosis, and contact with tubcrcvlar persons. 1. History of tuberculosis in previous generations:— (a) With contact with tubercular members of family 10 (b) Without contact with tubercular members of family 8 (c) With contact with tubercular associates — 2. No history of tuberculosis in previous generations:— (a) With contact with tubercular members of family 20* (b) Without contact with tubercular members of family 35 (c) With contact with tubercular associates 4 3. Tuberculosis in previous generations, contact with which cannot be definitely excluded 19* 96 * One case in each of these classes had been also in contact with a tubercular associate. D 40 Deaths from Tubercular Diseases, Years 1901-04. 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 12 28 6 1 1 6 1 - 3 — 1 — — 59 Laryngeal and pulmonary phthisis 3 15 3 7 22 45 131 240 169 99 41 9 — 784 Tabes mesenterica, tubercular disease of intestine 18 10 1 - 1 2 - 2 - 1 - - - 35 General tuberculosis, tubercular disease of undefined position 6 8 4 1 4 4 7 5 6 - - - - 45 Other forms of tuberculosis, scrofula 2 2 1 1 3 4 1 2 3 — - — — 19 Total 41 63 15 10 31 61 140 249 181 100 42 9 — 942 Females. Tubercular disease of brain or meninges, acute hydrocephalus 15 32 4 1 - - 1 - - - - - - 53 Laryngeal and pulmonary phthisis 1 7 5 10 16 42 102 125 82 48 22 5 — 465 Tabes mesenterica, tubercular disease of intestine 5 6 4 1 - 1 1 1 - - - - - 20 General tuberculosis, tubercular disease of undefined position 7 5 1 4 2 3 6 3 2 1 - - - 31 Other forms of tuberculosis, scrofula — 1 2 .2 2 — 3 2 1 — — — — 13 Total 28 51 16 18 20 46 113 131 85 49 23 5 — 585 41 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 27 60 10 2 1 6 2 - 3 - 1 - - 112 Laryngeal and pulmonary phthisis 4 22 8 17 38 87 233 365 251 147 63 14 — 1,249 Tabes mesenterica, tubercular disease of intestine 23 16 5 1 1 3 1 3 - 1 1 - - 55 General tuberculosis, tubercular disease of undefined position 13 13 5 5 6 7 13 8 8 1 - - - 79 Other forms of tuberculosis, scrofula 2 3 3 3 5 4 4 4 4 — — — — 32 Total 69 114 31 28 51 107 253 380 266 149 65 14 1,527 D 42 Occupations of Adult Males and of Husbands or Parents of Persons who died from Tubercular Disease in 1901, 1902 1903, and 1904. Occupation. Adult Males. Wives and Children of. Occupation. Adult Males. Wives and Children of. Tailors 34 19 Porters 30 12 Collar cutter 1 — „ railway 3 4 Upholsterers 5 2 „ shop 11 — Furniture maters 2 1 „ market 16 4 French polisher 2 1 „ tailors 5 — Hatter 1 1 Hall and hotel porters, messengers 23 12 Shoemakers, leather workers 16 9 Lightermen 5 1 Print colorer 1 — Gas workers — 2 Bookbinders 3 2 Police 2 4 Circular folder 1 — Soldiers 17 4 Booksellers 1 1 Sailor 1 — Relief stamper 1 — Army and other pensioners 11 1 Compositors, printers 21 6 Machine ruler 1 — Firemen — 2 Newsvendors 11 2 Postmen, sorters 7 2 Ticket writer 1 — Actors 4 — House painters 23 8 Scene shifters, &c. 11 2 Paperhanger, glazier 3 — Teacher 1 1 Builders, masons 16 3 Lodging house and Plasterers — 2 chambers keepers 10 7 Chimney sweeps 7 3 Coffee house keeper — 1 Plumbers and gasfitters 8 2 Draughtsmen 2 — Silversmiths and refiners 7 — Commercial travellers and agents 5 3 Electrical engineers 2 — Other metal workers 19 8 Hairdresser 1 1 Modeller 1 — Paviors, sweepers, &c. 9 2 Carpenters 9 10 Journalist 3 — Coach builders — 2 Clerks 41 3 Coachmen 19 15 Collector — 2 Cab drivers 7 5 Common lodging house duputies 4 - Carmen 12 11 Stablemen, grooms 28 13 Glass blower 1 — Yet. surgeon, farriers 2 — Basket maker — 1 Cooks (male) 19 3 Paper bag maker — 1 Male servants 16 2 Photographers 3 — Waiters, carvers 40 14 Musicians 5 4 Barmen, potmen, &c. 29 11 Surgeon 1 1 Billiard markers 3 — Solicitor 1 — Ice cream vendor 1 — No occupation 15 — Butchers 3 3 Bottle labeller 1 — Bakers 4 — Mineral water bottler, &c. 1 - Dairymen 2 3 Provision merchant, grocers 6 1 G-ardener 1 — Barrister — 1 Other shopkeepers 19 11 Window cleaners 2 1 Hawkers 27 1 Accountant 1 — Labourers 77 31 Engineer - 1 Warehousemen and packers 18 7 43 Occupations of Adult Females where separately stated. Milliners 2 Paper sorter 1 Dressmakers, sempstresses 24 Cigarette maker 1 Tailoresses 12 Upholsteress 1 Laundresses 11 Clerk 1 Charwomen 33 Furniture dealer 1 Cooks 9 Packer 1 Other servants 43 Incandescent mantle maker 1 Lodging-house keepers 2 Flower sellers 2 Waitresses 4 Hawkers 5 Wigmaker 1 Dancer 1 Staymakers 2 Seed sorter 1 Book folders, sewers 2 Unknown., 77 Printer's ruler 1 It may be thought that where medical men were in attendance they would see that proper precautions were being taken, but I am surprised to find, on an analysis of the cases as shown in the accompanying table, that the importance of such precautions does not seem to be impressed on the patients by private practitioners to anything like the extent it is by hospital staffs. It emphasises the fact that treatment in a sanatorium, even for a few weeks, had a distinctly educational influence. "The inmate learnt the reasons for observing certain precautions, and for following certain rules and regulations. He became acquainted with those conditions which were favourable to health, and those which were antagonistic to it, and carried back the knowledge to his home." Nature of Precautions. In Sanatorium only. In- or Out-Patients of other Consumption Hospitals. Number of Cases. Percentage. Number of Cases. Percentage I. Include care of sputum 15 68.2 91 21 61.7 73 4 II. Do not include care of sputum 5 22.8 4 11.7 III. No precautions 2 9 9 265 Totals 22 — 34 — Nature of precautions. In General Hospitals. Non-hospital Cases. Number of Cases. Percentage. Number of Cases. Percentage. I. Include care of sputum 16 4.57 71 9 23.1 46.2 II. Do not include care of sputum 9 25.7 9 23.1 III. No precautions 10 28.6 21 53.8 Totals 35 - 39 — 44 (3) Non-notifiable Diseases. Measles.—Twenty-three deaths (47 in 1903) were attributed to this cause in 1904 in the City, but probably a proportion of the 57 deaths from broncho-pneumonia, at the same age periods, originated in measles. During the year only 181 cases came to my knowledge, 150 having been notified by school teachers, 31 by medical men and others. The deaths calculated on the total population were:— 1901. 1902. 1903. 1904. City of Westminster 0.32 0.23 0.26 0.13 County of London 0.43 0.51 0.44 0.49 As all the deaths in Westminster, and the bulk of those in London, occur in children under five years of age, it affords a better comparison to calculate the deaths on the number of children estimated to be living under five years of age:— 1901. 1902. 1903. 1904. City of Westminster 4.6 3.3 3.7 1.8 Union District— St. George 4.9 3.1 4.4 1.6 Westminster 1.9 6.0 0.24 1.2 Strand 7.9 — 0.15 4.8 County of London 3.7 4.6 4.0 4.4 The deaths were distributed as follows:— Measles, 1904. Victoria Ward. Knightsbridge Ward. St. John Ward. Regent Ward. St. Anne's Ward. Strand Ward. Covent Garden Ward. 1st Quarter 1 1 5 1 2 1 3 2nd Quarter — — 2 — — 2 — 3rd Quarter 3 1 1 — — — — 4th Quarter — — — — — — — 4 2 8 1 2 3 3 Disinfection was carried out after 23 cases of measles, but there does not appear to be the same risk of infection being retained in rooms or on articles of clothing as in scarlet fever. If proper care were taken by parents, especially after the rash has disappeared, the mortality from measles might be reduced almost to nothing. It is to be hoped that the efforts of the Lady Inspectors and other health visitors will eventually be successful in securing this result. 45 Whooping Cough.—This complaint was responsible for 17 deaths (33 in 1903), and, as with measles, these were in children under five years of age. It was most prevalent in the latter part of the year, and 56 cases were notified from schools (see p. 47). The fatal cases were distributed in the Wards thus:—Knightsbridge, 1; Victoria, 6; St. John's, 6; Gt. Marlborough, 1; and Covent Garden, 3. The deaths calculated on the total population are :— 1901. 1902. 1903. 1904. City of Westminster 0.26 0.18 0.18 0.09 County of London 0.35 0.40 0.35 0.33 Calculated on the number of children under five years of age, the rates per 1,000 were:— 1901. 1902. 1903. 1904. City of Westminster 3.67 2.65 2.63 1.37 Union District— St. George 3.48 2.5 2.8 1.4 Westminster 3.93 2.0 2.0 0.4 Strand 3.64 5.5 2.3 2.4 County of London 3.23 3.65 3.22 2.9 Diarrheal Diseases.—Deaths from diarrhoea in its various forms was considerably above the average in London generally. In the City the deaths (96 in number) were considerably above the average of the previous two years, but not much above the usual; 62 were registered as diarrhœa, 48 as epidemic enteritis, and 41 as enteritis or ulcerative colitis. In the following table the deaths and rates for the last four years are given. As the bulk of the deaths are those of infants, it affords a better comparison to compare the number of deaths of infants with the number of births, and the figures will be found in the last three lines of the table:— 1901. 1902. 1903. 1904. Deaths (City) 92 88 73 96 Rate per 1,0 00 living in City 0.62 0.48 0.41 0.54 Rate per 1,000 living in County 1.18 0.73 0.83 1.27 Number of deaths under 1 (City) 78 42 52 72 Number of births (City) 3,432 3,461 3,185 3,054 Deaths of infants per 1,000 births 22.5 12.1 16.3 23.6 There were 13 deaths in the first quarter of the year, 6 in the second quarter, 61 in the third quarter, and 16 in the fourth quarter. The third quarter, and the beginning of the fourth, is responsible for 46 a large proportion of the deaths, and in 1904 the rate during the summer was considerably above the average, being 3.39 per 1,000 inhabitants in London, more than double the rate in 1902 and 1903, 2.73 in England and Wales, 0.65 above the decennial average. In the City of Westminster the rates in the corresponding quarter of the three preceding years were 163, 0.73, and 0.82. This disease is intimately connected with temperature and rainfall; thus the mean temperature of the third quarter of 1904 was 61.2 as compared with 59.8, 59.l, and 61.7 in the three preceding years, while the rainfall was only 4.9 inches as compared with 12.3 last year, 5.9 in 1902, and 5.1 in 1901. The rates in the quarter in Metropolitan Boroughs varied from 0.34 in the City of London to 5.29 in the Borough of Poplar, the City of Westminster being third on the list with l.35, Hampstead being second. As the deaths fall almost entirely on infants, I have calculated the rates on the number of births, which alters somewhat the relative positions of the various boroughs, but the City of Westminster still maintains its satisfactory position as third lowest on the list, with 75.3 deaths per 1,000 infants. The diarrhœal deaths were chiefly in Victoria, St. John, and St. Margaret Wards. This might mean that more children are centred there than in the other wards, and so far as Victoria Ward is concerned this partly explains the excess, as the rate (83.7) was not much above that for the City as a whole, but in St. Margaret and St. John Wards the diarrhœal rate for the third quarter was no less than 240 and 155 respectively per 1,000 infants born. The total infantile death-rate from all causes during this quarter was 183 per 1,000 births in Victoria, 280 in St. Margaret, and 205 in St. John, the City rate for the same quarter being 158. During the last four years the diarrhœal rate in St. John Ward has been persistently high, while in St. Margaret it has risen each year. Venereal Diseases.—The attention of the Council was directed to this subject by a letter from Col. C. W. Long, M.P. He submitted a considerable body of evidence showing that the diseases, physical and mental, resulting directly or by inheritance, from venereal disease are so serious and numerous, that it is desirable that there should be full enquiry into the matter, particularly in the direction whether there is adequate provision for the treatment of the poorer classes in the various stages of the disease. The Council agreed as to the desirability of an enquiry being held. From the few deaths which are attributed to these diseases, it might be assumed that they were of little importance, but it is well known that many illnesses owe their inception to venereal infection, and it is generally only the final manifestation which is recorded as the cause of death. 47 Schools and Infectious Diseases. School teachers are required to notify me when they exclude children on account of infectious disease, but during,the last year there has been laxity in doing so, due probably to the transition caused by the Education Act. The follwing list show far how far notification was carried out and the cases notified:- l. Actual Cases. Infection in House. Other Causes. Chickenpox. Measels. Mumps. Whoopingcough. Chickenpox. Mease's. Mumps. Whoopingcough. Board schools:— Charing Cross Road 1 19 - 2 1 8 - - 1 light. 1 ringworm. Horseferry Road - - - 4 - 2 - - 9 light. 2 ringworm. Buckingham Gate 1 - 2 - 2 - 6 - 1 , Pulteney - 4 1 - - 1 1 - 6 ,, Millbank 16 6 32 23 8 8 11 4 9 ,. St. George's Row 4 2 3 - - 5 3 - 5 ,, Tower Street - 1 - - - 9 - — 1 ,, Great Wild Street - 33 - - - 44 - - 2 ,, ... Voluntary schools:— Christ Church - 1 - - - - - - 7 ringworm. Holy Trinity, Vauxhall Bridge 2 3 - 1 3 - - - Road St. Barnabas - 3 - - - 2 2 - 1 German measles* St. Clement Danes 2 32 - - - 38 - - 2 ophthalmia. St. Gabriel's - - - - - 1 - - St. James the Less 2 11 - - - 2 - - St. Mary's, Hyde Place 6 - 1 26 - 1 - 2 2 ringworm. St. Paul's, Wilton Place - 24 - - - 9 - - 1 German measles. St. Stephen's 3 - 1 - 3 - - - St. Martin's, Castle Street - 2 - - - 6 - - St. Mary's, Gate Street - 8 - - - 11 - - St. Matthew's - - 8 - - - 4 - St. Michael's - - - - 1 - - - Pimlico Rooms - 1 5 - - - - - Wesleyan Training - - 1 - - - - - 37 156 54 56 18 148 27 6 Copies of 373 certificates relating to teachers or children attending at the following schools notified to be suffering from illness during 1904, were sent to school teachers during 1904:— Small Pox. Scarlet Fever. Diphtheria. Enteric Fever. Charing Cross Road Board School - 4 7 - Horseferry Road Board School - 3 2 - James Street Board School - 2 - - Pulteney Board School, Berwick Street - 9 1 - St. George's Row Board School - 15 2 1 Vere Street Board School - 1 - - Millbank Board School 1 3 4 - Great Wild Street Board School - 2 4 - Brompton Higher Grade School - 1 - - Christ Church School, Buckingham Gate - 1 - - Curzon - 3 - - Holy Trinity School, Vauxhall Bridge Road - 2 - - 48  Small Fox. Scarlet Fever. Diphtheria, Enteric Fever. St. Anne's National School - 11 2 - St. Barnabas's School, Pimlico Road - 2 2 - St. Clement Danes School - 3 1 - St. Edward's - - 1 - St. Gabriel's School, Glasgow Terrace - 3 1 - St. George's Higher Grade School, South Street, Park Lane - 3 15 - St. James-the-Less School, Upper Garden Street - 5 - - St. John's School, Tufton Street - 3 2 1 St. Margaret's - 4 1 - St. Martin's Northern School, Castle Street - 3 - 1 St. Mary's, Hide Place - 4 1 - St. Mary's, Great Peter Street - 3 1 - St. Matthew's, Great Peter Street - 11 2 1 St. Michael's, Buckinghom Palace Road - 4 - - St. Patrick's, Great Chapel Street - 2 - 1 St. Paul's - 2 1 - St. Peter's, Lower Belgrave Street - 4 3 - St. Peter's and St. James's, Great Windmill Street - 7 2 - St. Stephen's, Rochester Row - 5 - - Pimlico Rooms - 4 - - Bacteriological Laboratory. During the year examinations have been made at the Lister Institute in 47 suspected cases of diphtheria, 17 of typhoid fever, and 11 of pulmonary consumption, 75 in all. at a cost of £11 7s. 3d. The hospitals conduct their own bacteriological examinations. Disinfection. During 1904, 935 rooms in 581 houses were disinfected by the Staff of the Department, and 29,107 articles were subjected to steam disinfection in the City Disinfecting Stations. In addition, a number of rooms and their contents were disinfected to the satisfaction of medical men by private firms. Fifty-two articles were destroyed by fire at the request of the owners. 3s. 1d. was paid in respect of articles destroyed. Disinfection was carried out after all cases of the notifiable diseases, except as regards erysipelas (in which disinfection was only performed when the circumstances of the case required it), and also after 23 cases of measles, 3 German measles, 8 chicken-pox, 1 whooping cough, 5 cancer, .3 influenza, and 31 phthisis. Ten books were disinfected; hooks belonging to the public libraries are as a rule treated by the librarians, a copy of each certificate of. infectious disease being sent to each. 49 The disinfecting station at Denzell Street has now been handed over to the County Council, it being on the line of the new street, and the question of erecting a central station is under consideration. Shelters.—Thirty-nine persons were admitted to the temporary shelters (Horseferry Road and Dufour's Place) during 1904. 17s. was spent in food for necessitous persons. Cleansing of Persons.—Under the provisions of this Act 15 persons received a free bath and had their verminous clothing baked in the disinfecting chamber at Denzell Street. Provision is to be made at the new central station, instead of at Denzell Street, and as it will probably be in the vicinity of most of the common lodging houses, it is likely that greater use will be made of it. The Guardians have themselves dealt with frequenters of their Casual Wards. Mortuaries. The number of bodies removed to the public mortuaries in the City during 1904, was 388; 365 were taken to Horseferry Road, where the Coroner's Court is situated, 5 to Denzell Street, 12 to Dufour's Place, and 6 to Drury Lane. There were 322 inquests held, all being at Horseferry Road. This was equal to 12.3 per cent. of the total deaths registered; for London the proportion was 9.6 per cent. The Denzell Street Mortuary has now been relinquished to the London County Council, who have purchased the site. 50 PART II. C. House Inspection, &c. Below is a list of details of the work done in connection with insanitary conditions in dwelling houses. In many cases some of the work specified was in premises part of which was occupied as workshops:— 1904. 1904. Complaints received and dealt with 935 Sanitary Work completed:— Water-closets:— Houses and premises inspected 4,397 Abolished 1 „ „ re-inspected 16,692 Constructed 1,149 ,, (registered), visits to 987 Repaired 544 Notices issued (preliminary) 2,524 Ventilated 344 ,, ,, (statutory) 159 Cleansed or limewashed 568 Sanitary Work completed:— New pans fixed 1,900 Houses:— Pans and traps cleansed 210 Closed under H.W. Classes Act - Obstruction removed 67 Traps ventilated 1,173 Closed under P.H. (London) Act 1 Water supply provided 876 Flushing apparatus fixed 1,573 Cleansed throughout 238 ,, repaired 481 ,, partially 467 Waste Pipes:— Overcrowding abated 55 To sinks, baths, lavatory basins, &c. 14 Light or ventilation improved 179 Roofs repaired 214 Fixed 1,161 Floors nnd staircases repaired 250 Repaired or unstopped 220 Underground rooms vacated 26 Disconnected from drain 303 Yards, areas, paved or paired 417 Trapped 1,518 Ventilated 931 Areas drained 4 Water Supply:— Damp walls remedied 14 Provided 743 Offensive refuse removed 169 Reinstated 126 Keeping of animals discontinued 29 Cisterns fixed 335 „ cleansed 356 Drains:— „ covered 473 Constructed 407 ,, old, defective, abolished 132 Amended and repaired 108 Disconnecting traps fixed 377 Disconnected from w.c. supply 81 Ventilated 450 Tested 1,337 Dust Bins:— Unstopped or cleansed 223 Provided 287 Gully traps fixed 1,770 Repaired 57 Inspection chambers built 966 Old, abolished 128 ,, repaired or cleansed . 187 Stables:— Drained 50 Inspection chambers, cover fixed or sealed 941 Paved 59 Cleansed 42 Soil pipes fixed or repaired Ventilating pipes fixed or 655 Dung receptacles provided 8 ,, repaired 1 repaired 513 Dung pits abolished 1 Rainwater Pipes:— Dung accumulations removed 72 Fixed or repaired 717 Disconnected from drain 407 51 Legal Infringements.—In 16 instances builders were cautioned with regard to infringements of by-laws, and in one instance police court proceedings were taken for failure to give notice that a watercloset was to be constructed, and a fine of £2 with 4s. costs was inflicted. In one instance proceedings had to be sought to obtain rectification of defective drainage; the Magistrate's order was obeyed and the costs paid. In one instance (No. 8, Lancashire Court, Bond Street) a Closing Order was obtained, together with a fine £5 and 3s. costs, for the premises being without water. Several persons were cautioned for improperly removing offensive refuse. Plans of Drainage, &c,.—All plans dealing with drainage schemes, the result of a Public Health Act Notice, and with proposed waterclosets in both old and new premises, are submitted to the Public Health Committee and reported upon by me. During the year 870 sets of plans were dealt with; in about 25 per cent. amendments were necessary, and led to a considerable amount of correspondence and many interviews with Architects. A good deal of complaint is made that the regulations of the Council are so complicated that it is almost impossible for the public to know which subject comes under the Works Department and which under that of Public Health. In almost every case, even of new buildings, the sanction of the Public Health Committee is required not only as to position of water-closets, but on many other points, and to enable certificates to be given under the Public Health Act, the Revenue Act, &c. Inflammable Fluids in Drains.—In November I called attention to a practice which may be fraught with a certain amount of danger. The practice I allude to is that of allowing inflammable fluids to find access to the drains of premises. This occurs especially in hair-dressers' establishments and motor garages. In the former case it is patroleum spirit which is used for shampooing purposes, and in the latter petrol. In two instances where a chemical test has been applied to the drains of premises occupied by hair-dressers, explosions have occurred, and in some other instances examination has shown that a considerable quantity of explosive vapour existed in the drains and inspection chambers. A lighted match thrown into a gulley in the presence of an Inspector in a garage set fire to the petrol contained therein. Besides being a danger to the premises, this practice of allowing inflammable fluids access to drains may result in serious consequences if they reach the sewers. In most cases the presence of an intercepting 52 trap will prevent such fluids reaching the sewer, as they may be turned into vapour in the drain. The attention of the Works and Highways Committees was called to this matter, and a letter was also addressed to the London County Council, who have power under Section 10 of the General Powers Act, 1894, to make an order prohibiting the discharge of dangerous substances into sewers. Such an order was made on 20th December, 1898. On 6th December, 1904, the County Council issued a copy of the order to a large number of persons licensed under the Petroleum Acts, or carrying on businesses such as may produce residues dangerous if discharged into sewers, among them being persons and companies who keep motor garages for trading purposes; 43 of the addresses are in this City. A notice to hair-dressers was issued in 1897, at which time several accidents occurred, and it was thought that as a result thereof the practice of applying petroleum spirit to the hair had been discontinued. The County Council have added an additional Inspector to carry out the duties under the Petroleum, &c., Acts. Nuisance from Sewer Ventilators.—Complaints having been made of offensive and noxious effluvia emanating from the sewer ventilators in the City, a presentment was made to the Highways Committee, who replied that careful attention had been paid to every case of reported nuisance from sewer ventilators, and where the sewer ventilators were in connection with the Council's sewers, by a contrivance of a canvas screen fixed in the sewers at a small cost, the Assistant City Engineer had successfully met the complaints. Where the complaints have arisen from sewer ventilators under the control of the London County Council, the attention of that body had been called. A very bad case, which I mentioned in my report for (1903, p. 34), in which there appeared to be a connection between the offensive emanations and several cases of infectious disease in the immediate neighbourhood. The nuisance was apparently abated, but it recurred in 1904, and eventually in December the St. James and Pall Mall Electric Light Company, of Carnaby Street, was summoned for permitting water heated to 170° F. to flow into the public sewer. The facts were not disputed, and it was stated that the Company had arranged to prevent any recurrence of the trouble. There were in all twenty summonses. The Magistrate, Mr. Denman, imposed fines amounting to £5 19s., with 20 guineas costs. Houses Infested with Vermin.—Intimation notices have been served in respect of 10 premises in which there were rooms infested with vermin. The London County Council General Powers Act of 1904 contains a section giving power to the Sanitary Authority to issue an order requiring houses so infested to be cleansed; but previously no difficulty had been experienced in the City in dealing with such conditions. 53 Another section gives power to the Sanitary Authority to require the cleansing, purification, or destruction of any articles in any house or elsewhere as are in such a filthy, dangerous, or unwholesome condition that health is affected or endangered thereby, or where there is risk of infectious disease, or where it is requisite to check such. Under the same Act, where movable ashpits have been provided, the Sanitary Authority may require the removal of fixed ashpits. Provision is also made to deal with sanitary conveniences in or accessible from any street which are so placed or constructed as to be a nuisance or offensive to public decency. 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 1904 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. Kent. New River. Lambeth. South wark. Grand Junction. West Middlesex. East London. Chelsea. January llth 1.1 1.8 4.2 3.0 3.5 4.0 3.2 3.9 February 8th 0.9 3.8 5.2 3.9 4.8 6.0 4.0 4.0 March 21st 1.1 2.2 3.3 2.8 2.7 4.1 3.1 3.6 April 18th 0.8 1.6 3.1 2.3 2.4 2.6 2.4 2.7 May 9th 0.8 1.1 2.8 2.5 2.4 2.5 2.6 2.5 June 6th 0.6 1.1 5.1 3.1 4.5 3.8 1.8 2.8 July 14th 0.9 1.1 2.5 2.2 2.0 2.5 1.9 2.5 August 15th 0.7 1.1 2.4 2.5 2.2 2.7 2.1 2.3 September 19th 0.8 0.8 2.4 1.8 1.8 2.1 1.5 2.1 October 17 th 0.9 0.8 2.2 2.2 2.1 2.4 3.0 1.9 November 21st 0.9 1.2 2.7 3.2 2.5 3.1 3.2 2.6 December 12th 0.8 1.1 3.1 4.3 3.2 3.2 2.6 2.7 The water supplied during 1904 was of a much higher standard of quality than in the previous year, but the district supplies vary to a considerable extent: this is almost solely due to the amount of storage available. On account of the large amount of impurity in the water taken from the Thames in 1903, much deposit was caused in cisterns, and a good deal of trouble was caused through pipes becoming obstructed. The City Council issued the following notice to all householders:— Cleansing of Cisterns, &c. The Westminster City Council desire to call the attention of householders in the City to the importance of carrying out the by-laws made under Section 50 of the Public Health (London) Act, 1891, for 54 securing the cleanliness and freedom from pollution of tanks, cisterns, and other receptacles used for storing of water used or likely to be used by man for drinking. The by-laws require such cisterns to be cleansed once at least in every six months, and at such other times as may be necessary, and contravention thereof renders the person liable to penalties. Special attention should be given to such cleansing at the present time, as, consequent on the heavy rainfall during last year, much of the water supplied contained suspended matter, which has been deposited at the bottom of cisterns. John Hunt, Town Clerk. Westminster City Hall, W.C., It'll June, 1904. Applications were received for 38 certificates that the water supply of new buildings was sufficient, and were granted in each instance; 236 notices of the withdrawal of water supply were received from the Water Companies, and in 126 instances it was reinstated; 17 houses have been pulled down and 93 are empty. In 356 instances cisterns were required to be cleansed; 473 cisterns were required to be provided with proper covers, and 335 new cisterns were fixed, 203 being in places of defective cisterns. A closing order was made in respect of one house (No. 8, Lancashire Court), in consequence of the absence of water supply. Housing of the Working Classes. The building of the three blocks of dwellings in Regency Street, built by the City Council, was finished in 1904, and are now occupied by 344 families, comprising 1,138 persons. The number of applicants was several times more than could be accommodated. Preference was given to persons employed in the City. 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 XVI. shows the number of births and deaths in 1904, with the causes of death, and the number of deaths of infants and persons over 65. 55 Table XYI.— Vital Statistics relating to Blocks of Dwellings in the City of Westminster, 1904. 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 Ovor 65. Westminster City Council— Regency Street 1,138 29 12 4 — 3 — - 2 — — — 3 4 3 St. James's Dwellings and 7, Ingestre Place 71 - - - - - - - - - - - - - - Peabody 65,761 195 108 9 19 19 3 15 3 5 5 8 22 26 14 Westminster 187 6 3 — — 2 — — — — — — 1 1 — London County Council— Millbank 3,043 134 34. 7 8 3 2 3 2 1 1 2 5 13 3 Drury Lane 1,000 26 17 5 2 3 — 1 2 — 2 1 1 4 1 Lion's Buildings - 7 2 - 1 - - 1 - — — — —- — — Improved Industrial 6,878 88 51 4 7 8 3 9 5 1 6 5 3 4 10 Metropolitan Association 757 15 10 1 3 3 — — 1 — — — 2 2 2 St. George's Model Dwellings 419 12 9 1 1 3 — 1 1 — — — 2 2 3 Clerkenwell and Soho Company (Newport Market) 1,184 30 15 1 5 2 - 1 1 - 2 1 2 2 5 Greencoat 119 - - - - - - - - - - - - - - Spencer 99 — 2 - - - - - 1 - - - 1 — — Chapter Chambers 175 3 2 — 1 - - - - - 1 — 1 1 — St. John's ,, — 10 10 2 1 1 — — — 2 1 — 3 4 1 Alexandra and Castle — 3 2 — 1 — — 1 — 1 — — — — New Buildings - 2 2 - 1 1 - - - - - - - 1 - 56 Common Lodging-houses. Seventy-seven deaths occurred in 1904 iu the common lodging-houses in the City. Fifty-one 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. Sixty-seven 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. Ten were women, and death was due to—consumption 5, respiratory disease 3, other causes 2. In place of the premises which have been demolished or closed during the last few years, three new common lodging-houses have now heen registered, viz., the shelter for men in Coburg Row, and two places newly opened by the Salvation Army, one in Millbank and the other in the old schools in Stanhope Street. Common Lodging-houses. 40, Great Peter Street 75 women 397 men 6, Great Smith Street 26 „ 6a, Great Smith Street 36 „ 6b, Great Smith Street 71 „ 6c, Great Smith Street 68 „ Ham Yard Hospice, Great Windmill Street 20 „ 11, Hanover Court 35 ,, 12, Hanove: Court 32 „ 13, Hanover Court 38 „ 23 and 25, Millbank Street (Salvation Army) 449 „ 10 and 11, Monck Street 64 „ The Schools, Stanhope Street (Salvation Army) 125 „ 16, Strutton Ground 211 „ 22, Yere Street 48 „ 27 and 28, Vere Street 48 „ 29 and 30, Yere Street 176 „ 2, Harvey Buildings 35 „ 26, Litchfield Street 53 „ 108, Regency Street 8 „ 45 and 47, Tufton Street 91 „ 107, Wardour Street 87 „ 2,118 men Houses Let in Lodgings. In my last report I wrote that the by-laws dealing with houses let in lodgings or occupied by persons of more than one family had been approved by the Local Government Board; but scarcely had this been done when the High Court decided that the clause requiring the annual cleansing of premises was invalid, by reason of the fact that no provision was made in the by-laws for a notice to be served on the responsible owner. A similar decision declared invalid By-law No. 26, made by the County Council under Section 39 of the Public Health (London) Act, 1891, in 57 relation to the number of water-closets in proportion to the number of inmates in houses let in lodgings. In view of these decisions, new by-laws had to be submitted by both County and City Councils to the Local Government Board, embodying new clauses, whereby the owner or landlord of any lodging-house shall not be deemed to have offended against either of these by-laws until notice has been served on him by the Sanitary Authority, and he shall have failed to comply with such notice. Thus the chief advantage which the by-laws possessed of being able to deal with infringements of them, has been taken away. There were 2,004 houses registered, but 426 houses have been demolished; 81 have been added during 1904, leaving 1,659 still on the register. During the year 987 visits were paid, 397 by district inspectors in the ordinary course of their work, and 590 by the women inspectors during the six months since they were appointed. Works carried out in such houses are included in the above list (p. 50). Revenue Act. Section 11 of this Act provides that:— (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. (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 4 of the Taxes Management Act, 1880, as is mentioned in Subsection 2 of Section 26 of the Customs and Inland Revenue Act, 1890, and the provisions of that subsection as to the certificate shall apply for the purpose. Originally it was the intention of Parliament to encourage the erection of artizans' dwellings, but this new Act 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 58 purpose of granting a certificate come under Subsections a and that is to say, that the various tenements or flats are rated separately, and that their respective annual value (for inhabited house duty) does not exceed forty pounds. Applications have been received by me in respect of 29 sets of premises, including in them 603 separate tenements. These have been inspected by me, with the result that the certificate was refused in 15 instances, granted in 507 instances (but in 45 of these the granting of the certificate was deferred until various works were carried out). In connection with 81 tenements, certain works which were required had not been carried out at the end of the year, and the granting of the certificate was therefore postponed. The premises in which the tenements are situated for which application was made were Dryden Chambers, Carlton Chambers, Albert Mansions, Alexander Buildings, Castle Buildings, Flaxman House, Norfolk, Probyn and Jessel Buildings, Park Mansions, Charing Cross Mansions, Sussex Mansions, Burleigh Mansions, Newport House, Carey Mansions, Buckingham Gate Gardens, Whitehall Court, St. James' Dwellings, Gerrard Mansions, Broad Court Flats and Mansions, Tavistock House, Wilfred House, 19 and 20, Bow Street, 16 and 26, St. Anne's Court, 14, Old Compton Street, 7, Ingestre Place, and 41, Charing Cross Road. 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 workplaces, 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 at the end of 1904:— Number. Number of Inspections. Laundries 30 46 Bakehouses 97 281 Other workshops 2,357 1,712 Places where food is prepared for sale 418 548 Other work places 10 30 2,912 2,617 There are undoubtedly many more workshops in the City; they are gradually being discovered, but at the same time the occupation of 59 places already on the register is constantly changing. This is especially true with regard to home workers' premises, of which we have knowledge of 1,543. Since the appointment of two Women Inspectors by the Council, it has been possible to overtake the work of supervision required by the Factory and Workshops Acts to a considerable extent and with much beneficial effect. From the Table below it will be seen that 1,152 defects have been found and remedied during the year; but this is not a complete list, as many defects in connection with houses in which work-places are situate have been included in the list given under " House Inspections." One hundred and fifty defects are stated to have been notified by the Home Office, but in a certain proportion the matter was already receiving attention. Defects found. Particulars. Number of Defects. Number of Prosecutions. Found. Notified by Home Office. Remedied. Nuisances under the Public Health Acts :—* Want of cleanliness 171 52 223 — Want of ventilation 88 14 109 — Overcrowding 48 22 70 — Want of drainage of floors 20 20 — Gas stoves improperly ventilated 40 12 52 — Other nuisances so 3 33 1 Sanitary accommodation— Insufficient 56 3 59 — Unsuitable or defective 445 17 462 — Not separate for sexes 67 27 94 — Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouses (Sec. 101) — — - — Breach of special sanitary requirements for bakehouses (Sees. 97 to 100) 2 - 2 - Failure as regard lists of outworkers (Sec. 107) 20 20 - Giving out work to be done in premises which are— Unwholesome (Sec. 108) — — — — Infected (Sec. 110) 15 15 — Allowing wearing apparel to be made in premises infected by scarlet fever or small-pox (Sec. 109) - - - - Other offences — — — — Total 1,002 150 1,152 1 * Including those specified in Sections 2, 3, 7 and"8 of the Factory Act as remediable under the Public Health Acts. 60 Other Matters. Class. Number. Matters notified to H.M. Inspectors of Factories:— Failure to affix Abstract of the Factory and Workshop Act (Sec. 133) 30 Protected persons 26 Other matters 2 Number of workshops measured 198 Overcrowding is either wilful or the result of ignorance of the number of persons who may legally occupy workrooms. In the latter case, either rooms have not been measured, or have been measured incorrectly, sometimes coal cellars, kitchens, and lavatories being included in the measurements. Some owners contend that as long as the ventilation seems all right, it does not really matter how many work in a room; but the law does not take this view, probably on account of the fact that the difficulties in securing efficient ventilation are numerous. Employers at first resented the visits of the women Inspectors, but that feeling has speedily subsided, and now they are frequently asked for. The large number of dressmaking, millinery, tailoring, laundry and other businesses in which women (at least 20,000 living in the City) are employed, afford ample scope for work, as the circumstances are continually varying. Sanitary Accommodation.—The law requires that separate sanitary accommodation shall be provided for men and women, and it is sometimes extremely difficult to arrange for this, particularly in tenement houses, or in connection with small workshops, in which women may be employed only during certain parts of the year. To provide extra accommodation of this kind in such cases may press hardly on small owners, or from the construction of the house it may be practically impossible. In such cases it may lead to the workshop being moved elsewhere, or to women not being employed; in some cases where several families are living in a house. part of which is used as a workshop, discretion may fairly be exercised in enforcing this section of the Act. Workshops where women are employed are visited systematically by the women Inspectors, but some employers seem to be under the impression that one or other of their employees has been making complaint, and in one instance two suspected girls were discharged. This was in a court milliner's workshop, where 12 women and girls were 61 working in a room in which there should have been 6 only; the overcrowding was abated by the opening of a second work room. Among the miscellaneous workshops registered are 10 furriers and 15 hairdressers and wigmakers. Their hygienic condition was found generally to be inferior. The furriers' shops, with one or two notable exceptions, were dirty, and both employers and employed did not seem to appreciate either the possibility or the desirability of keeping the rooms clean. With regard to hairdressers and wigmakers there is special difficulty to maintain proper ventilation, from the use of gas stoves, steam drying ovens, &c.; as a result the physical condition of the workers is unsatisfactory. Government Buildings.—The attention of the Home Office was called to complaints which reached this Department with reference to the Royal Army Clothing Depot. It was alleged that rooms were dark and badly ventilated, over-heated, and that gas stoves were constantly being burned in them, and that several of the rooms were very dusty Complaints were also made that men in one department had to leave these hot rooms and drive on waggons to Woolwich and elsewhere, and caught cold through being exposed to such alterations of temperature Most of these complaints emanated from persons employed in the factory who had contracted consumption, which they attributed thereto The local authority has no jurisdiction in Government buildings, but from information which has reached me, and from an answer to a question in Parliament, I am led to believe that the conditions have been materially improved. Numerous interesting instances of infringements of the Acts might be quoted, and the excuses which are offered in extenuation. Many of the foreigners who live in Westminster have been accustomed in their native land to disregard matters which are looked upon as necessary in this country, and it takes a little time to educate them on the subject, but as a rule they have a respect for the law once they know it. The high value of land and property in Westminster leads to overcrowding. Persons take a tenement at a high rent, and in order to cover expenses sublet or take in lodgers; thus in one set of tenements I found that there were a workroom, bedroom, kitchen and a small slip or box room ; each of these was occupied at night by a number of adult persons. Legally there was no overcrowding, but the rooms were certainly over-occupied. In one instance one set of lodgers occupy the beds during the day, while another set occupy them at night. In a vault extending under a main thoroughfare 45 men were found employed addressing envelopes. Supposing the place had been suitable otherwise, there was room for 17 only. Outworkers.—Firms giving out work in certain trades are required 62 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. The following return is required by the Home Office:— C.—List of Outworkers (Sec. 107). Class of Homework. 1904. Number of Lists Received. Number of Addresses of Outworkers. Due 1st February. Due 1st August, Forwarded to Other Authorities. Received from Other Authorities. Number of Lists. Number of Outworkers. Number of Lists. Number of Outworkers. Due 1st February. Due 1st August. Due 1st February. Due 1st August. Wearing apparel - Tailoring 194 2,810 203 2,893 150 200 130 120 Dressmaking 41 650 42 654 120 130 40 47 Drapery 1 5 1 5 5 5 — — Bootmaking 2 48 2 48 34 30 — — Gold lace 1 31 1 30 29 27 — — Capmaking 1 10 — Lace — . Cabinet making 1 2 1 2 2 2 2 2 Fur pulling — — — — — — — — Other - - - - - - - - Total 240 3,626 251 3,642 340 394 172 169 Total. Number of outworkers (persons) on register at end of year 1904 3,811 Number of outworkers' premises on register at end of year 1904 2,320 Total number of outworkers (persons) dealt with during the year 1904 4,053 Total number of outworkers' premises dealt with during the year 1904 2,664 Number of notices prohibiting homework in unwholesome premises (Sec. 108) - Number of cases of infectious disease notified in home workers' premises 15 Number of Orders prohibiting homework in infected premises (Sec. 110) — Up to the time of the appointment of the Women Inspectors, inspection of outworkers' premises has only been made so far as the District Inspectors have been able to include it in their ordinary work. Since autumn, however, the Women Inspectors have been able to deal with this. 63 Bakehouses. At the end of 1904 there were 92 bakehouses in the City, of which 79 were underground. During the year 4 have been built above ground (Savoy Hotel, Little Dean Street, Kinnerton Street, and 108, Brompton Boad); and 1 underground, previously existing (78, Berwick Street) was certified. There are therefore now 97 bakehouses, of which 17 are above and 80 below ground, but the use as bakehouses of 3 of these has been discontinued during the year. Restaurants and Eating Houses. Five hundred and forty-eight visits were paid to hotels, restaurants, and eating bouses; 103 intimation notices were served to remedy defects; in 1 case proceedings at the police-court had to be taken, but at the hearing the owners undertook to do the necessary re-drainage, and costs were paid. I mentioned in my Report for 1903 that the London County Council proposed to ask Parliament for powers to make some regulations with regard to places where food was prepared, stored, or sold. They did so; but as they also asked that they should control the City and Borough Councils, and act in default, they were opposed by several of the Metropolitan Municipal Authorities, including the City of Westminster, with the result that Parliament restricted their supervisory powers to those contained in Section 101 of the London Public Health Act, which required a representation to be made to the Local Government Board if a sanitary authority is alleged to be in default. The Solicitors of the City Council, in their report on the result of the opposition, said:— "By the action of the Committee of the House of Commons, confirmed by the House of Lords, the principle was established that the enforcement of new sanitary regulations of a merely permissive character is not to be under the supervision of, or subject to the arbitrary interference of the County Council; and the Borough Councils were thus put into the same position (so far as those newsanitary provisions are concerned) as are all similar local bodies all over the country in regard to all their sanitary powers. The power to the London County Council to set the Local Government Board in motion in case of default of course continues, and was cordially concurred in by the opposing Councils. "The opposition to this part of the Bill was therefore entirely successful, and its success is a matter of very considerable importance to all the Borough Councils so far as it establishes a valuable precedent. 64 "On the third reading in the House of Lords the London County Council amended the Bill by omitting the clause corresponding with Clause 23 of the original Bill, and it was not found practicable to prevent this being done. The object of this step was obviously to weaken the precedent created by the decision of the Lords' Committee. The Bill as finally passed into law contains no compulsory sanitary regulation (in the sense of a regulation in the administration of which the Sanitary Authority has no initiative), and it is no doubt thought that this fact will enable the London County Council on a future occasion to re-open the whole subject of their control over the Borough Councils; whereas had the Bill passed with the clause in question, it would have been useless to ask Parliament thereafter to go back to the old practice. "The fact however remains that Parliament has decided the point, and the precedent is not likely to be forgotten in future But whilst the distinction between the so-called compulsory clause and the other clauses would seem to be somewhat fanciful, it is certainly to be regretted that the regulation of premises used for the sale of food should have been abandoned at the last moment for such a purpose. This power of regulation was one which was admittedly urgently called for, and the clause, even if imperfectly administered (which it certainly would not have been), would have been better than 110 powers at all." It should be noted that the County Council did not take action to obtain additional powers for the boroughs on their own initiative, but only after repeated requests had been made for several years, while the additional powers asked for were only a small portion of those the boroughs thought they should possess in order to allow them to deal with places where food is sold in a way likely to be satisfactory to the public. Voluntary Certification.—The Public Health Committee had under consideration the question of voluntary certification of restaurants, &c., but in view of the above Bill deferred the matter. When the County Council behaved, at the last moment, in the manner described by the Solicitors, the Committee once more took up the subject, and recommended the Council to undertake such certification, and at the end of the year the matter was not quite settled. I submitted the following report:— "To the Public Health Committee. "Mr. Chairman and Gentlemen, "Hotel and Restaurant Kitchens. "It will be in the recollection of the members of the Public Health Committee that, earlier in the present year, an application was made 65 to the Council to grant a certificate that a restaurant kitchen in the City was properly constructed. At that time the London County Council, at the request of the Metropolitan Boroughs, had incorporated clauses in their General Powers Bill authorising the Borough Councils to require a certain standard in restaurant kitchens, and in consequence thereof the Public Health Committee considered it desirable to take no action then. The County Council, however, at the last moment, withdrew the clauses, and thus the powers for which the Borough Councils have been asking for a number of years have not. yet been given. I therefore venture to bring the matter again before your notice for your consideration. "The Council and its predecessors have expressed the opinion on several occasions that all places where food is sold or prepared for sale should be registered as fit and suitable for the purpose, although this cannot be attained compulsorily. The experience of the City of London during the last nine months has shown that the owners of such places will voluntarily carry out improvements to enable them to obtain a certificate from the Council that at the date thereof their premises were in a satisfactory sanitary condition. "If the Committee agree to the principle, then a standard of requirements should be drawn up. This would be similar to that for underground bakehouses, and thereafter owners of kitchens and aboveground bakehouses might be informed that upon their premises being found to comply with the standard a certificate would be granted. Objection has been taken that after a year or two alterations may have been carried out in the premises, or that through neglect the conditions may not be satisfactory. This difficulty can be obviated by requiring notice to be given of proposed alterations, requiring renewal of the certificates at the end of a stated period, and by regular inspection, as in the case of underground bakehouses. "In the City of London the certificates are issued free of charge, but there is 110 reason why a fee should not be charged for the special service rendered. "Objections have been mentioned against the principle of granting certificates of fitness, but in several seaside towns the practice has been in vogue for many years with regard to lodging and boarding houses, hotels, &c., and the possession of the certificate is looked upon as a valuable attraction by its possessor. Every few years I am asked to give a certificate under the Revenue Act that premises under forty pounds a year rateable value are in a proper sanitary condition and suitable for the purpose, and if the owner obtains this certificate he escapes payment of Inhabited House Duty. The annual licensing of common lodging houses, slaughter houses, and cow houses is another example, as was also the certificate the Council gave at the beginning 66 of this year to those underground bakehouses they found to be iu compliance with the requirements, but in the case of bakehouses there is no opportunity of annual revision. "I need scarcely remind you of the importance of this question in the City of Westminster. Hotels and restaurants for all classes are numerous, and patronised by visitors from all parts of the world. It is therefore to the interest of their owners and the Council alike to see that the places are suitably constructed and carried on in accordance with hygienic requirements. "Probably you will appoint a Sub-committee, who should visit such places for which application is made when it is reported ready for certification. "I have the honour to be, "Mr. Chairman and Gentlemen, "Your obedient Servant, "Francis J. Allan, "Medical Officer of Health. "23rd October, 1904." It is also proposed to issue certificates to above ground bakehouses on similar lines to those underground. Milkshops.—Two hundred and ninety-eight visits were made by the District Inspectors to milkshops, in addition to visits at regular intervals by the Food Inspectors, and in one case notice was served requiring thorough cleansing of the premises. The number on the register at the beginning of 1904 was 303, at the end, 289; 27 shops were demolished, 2 closed, 8 used for other purposes, and in 4 instances the sale of milk was discontinued; 30 new names were entered on the register. The powers given to the Borough Councils under the Dairies and Milkshops Order are defective in that apparently the Council is unable to enforce compliance with the requirements of the Order. Application has been made to the Local Government Board and the Board of Agriculture for a definite statement on this, but it has not been forthcoming. The Council agreed with a series of resolutions on the subject forwarded by the Lambeth Borough Council:— "1. That the Local Government Board and the Board of Agriculture be urged to take such steps as will ensure the better enforcement of the Dairies, Cowsheds and Milkshops Orders, and the Regulations made thereunder, outside the Metropolis. "2. That in respect of the Metropolis, the Local Government Board be urged to carry out their statutory powers, as laid down in Section 28 of the Public Health (London) Act, 1891. "3. That the attention of the Railway Companies and the large 67 Metropolitan Milk Societies or Organisations be drawn to the present need of more sanitary means of transit and storage of milk. "4. That the Local Government Board be written to, suggesting that all milk shops and milk stores be required, under penalty, to be licensed annually, as is the case, at present, with all cowsheds; and that no person or persons be allowed to sell milk unless the premises at which such milk is sold and stored have been previously certified as 'suitable' by the Sanitary Authority for the District." Concrete examples of infringements were sent with the letter from the City Council. Offensive Trades.—There are no offensive trades now carried on in the City, but in four instances effluvium nuisances arose from businesses carried on in the City. (1) The London Count}' Council in preparing the ground on the line of the new street had to empty some old tan pits, and allowed the offensive liquid which they pumped out to flow down the street. On their attention being called to the matter they at once took steps to abate the nuisance by deodorising the contents of the pits, as required. (2) Effluvia given off in the preparation of acetylene gas from calcium carbide. Remedied by better attention to regulations. (3) Effluvia from motor tyre works in which benzine and ammonium-sulphide were used. Remedied by better ventilation. (4) Effluvia from the National Skating Palace, Argyll Street. Complaints of offensive smells had been received from residents and others in the neighbourhood from the first opening of this establishment in October, 1902. The effluvium was thought at first to be due to two causes, viz., the burning of refuse fat, and the paint which had been placed on a new iron flue shaft; but on the removal of these two sources of smell, an objectionable effluvium was experienced from time to time. It ceased when the skating season terminated, and began to be felt again when the hall was re-opened for this purpose. It was extremely difficult to ascertain the direct cause of the effluvium, which had the odour of sulphuretted hydrogen, but sometimes it was alleged to be of an irritating description, and resembled the smell given off by burning brimstone. In 1903 it was believed to be due to leakage from the boilers, which were overhauled, but in the following winter the nuisance again recurred, and eventually proceedings were taken at Bow Street, before Mr. Marsham, and on the 15th March he gave his reserved decision, and the defendants (The Acme Investment Company, Limited) were fined £10 with £15 15s. costs. The decision was 68 appealed against, but the Court of Quarter Sessions, after two days' hearing, upheld it, with costs (9th and 10th June). Slaughter-houses.—There is one (14, Regency Street) in the City, and it is only used occasionally. 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 36 19 55 Observations taken 1,525 1,666 3,191 Nuisances reported 17 85 102 Notices issued— Preliminary 95 47 142 Statutory 16 10 26 An institution in the City which had some trouble with its smoke, fixed up two appliances to the furnaces at a cost of £60 apiece. In five months they had saved that amount, by being able to use a cheaper coal. Legal Proceedings. Date. Court and Name of Magistrate. Name and Address of Defendant. Offence. Result. 1904. 15th January Westminster (Mr. Sheil) Burlington Hotels Co., 2, Buckingham Gate Black smoke nuisance (10 minutes dense) Fined £5 and 2s. costs. 27th January 25th February Bow Street (Mr. Marsham) Great Marlborough Street (Mr. Kennedy) Whitehall Club, 47, Parliament Street St James' Club, Piccadilly Black smoke from furnace chimney . Black smoke nuisance in 1903. Sent back to Magistrate with orders to convict Fined £5 and 5s. 6d. costs. Fined £5 and £5 5s costs. Defendants also paid costs of appeal in the High Court, amounting to nearly £50. 30th June Great Marlborough Street (Mr. Kennedy) Oddenino, Imperial Restaurant, Regent Street Black smoke nuisance, Imperial Restautant Fined £5 and 3s. costs. 15th July Westminster (Mr. Horace Smith) George Smith and Co., Ltd., 13, Commercial Road, S.W. Smoke nuisance at No. 13, Commercial Road Fined £2 and 23s. costs. Occupational Mortality. In Table XYII are shown the causes of death among males and femals engaged in occupation. For males the list is fairly reliable, but for women it is no so, as the occupation may not be stated in the death certificate, but wherever it has been given it has been recorded. 69 Table XVII.—Grouped Occupations of Mates aged, 10 Years and Upwards, with Causes of Death, in 1901. Total Occupied and Unoccupied Retired or Unoccupied Engaged in occupations Population. Total Deaths, 1904. 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. 72,811 9,613 03,198 General or Local Government 3,010 20 - - - - 1 2 - - - 1 - 2 2 - 3 1 1 4 _ - 1 2 Defence of country 4,571 42 2 1 1 1 2 4 — — 1 4 — — 2 — 3 4 — 3 2 5 5 2 Professional 3,750 47 2 — 6 — 4 2 1 1 — 2 — 1 8 1 4 4 1 3 — 3 2 2 Commercial 4,605 41 3 — 10 1 5 3 1 — — 2 1 — 4 — 2 3 1 2 1 — 1 1 Domestic service 12,276 87 2 1 10 3 12 2 2 — 3 9 — — 16 1 3 6 — 6 2 2 4 3 Conveyance of men, goods, or messages 8,275 149 5 - 27 2 14 6 5 2 3 2 1 8 21 3 9 13 - 9 1 4 8 6 Gardeners, florists, &c. 178 4 1 — — — 2 1 - - - - - - - - - - - - - - - - Dealers in coal, &c 107 1 - - - - - - - - - - - - 1 - - - - - - - - - Jewellers, watchmakers, &c. 1,283 14 - — 5 — — — — — — — — 1 3 - 1 1 — - 1 — 1 — Engineering and machine making 1,948 32 - — 5 — 6 2 — 1 — 1 — - 6 - - 1 - - - - - 1 Building and works of Construction 3,792 79 1 — 16 — 8 5 1 1 - 3 1 6 9 3 1 9 - 2 - - 4 9 Wood, furniture, fittings, and decorations 1,155 22 1 — 4 — 1 — — — 1 1 — — 6 1 3 - - - - - - 4 Chemicals, oil and grease, &c. 471 5 - - - - - - - - - - - - 1 - 1 2 - - - - - - Papers, books, prints, and stationery 1,731 26 1 — 4 — 2 — — 1 1 — 1 3 4 - — 1 1 1 1 — 1 4 Textile fabrics 990 5 - - - - - - - 1 1 1 2 - - - Tailors 2,568 43 — — 9 1 5 1 2 — 1 1 1 5 2 2 5 _ 2 1 — 1 4 Boot and shoe makers 670 21 1 1 - — — — 2 - — 5 — 1 3 2 — — 2 4 Other workers in dress, &c. 830 5 - — 1 — 1 2 1 — — — — — — — — — — — - - — - Skin, leather, hair, and feathers 406 7 — — — - 3 — — — — — — — 3 — — — — — — - — 1 Food, tobacco, drink, and lodging 7,556 102 1 1 23 4 5 9 - 4 2 3 - - 10 6 2 8 2 2 4 7 3 6 General dealers, hawkers, &c. 3,247 143 3 - 34 — 15 9 2 2 1 3 — — 13 4 7 9 — 10 7 6 2 11 Gas, water, electricity, and sanitary services 400 8 — — 2 — 1 — — — - 1 — — — 1 — - 2 — 1 — — Independent, &c 9,613 105 4 — 8 1 11 7 3 2 l 6 1 5 12 1 3 7 1 7 1 14 4 6 70 Table XVII Contd.—Grouped Occupations of Females aged 10 Years and Upwards, with Causes of Death in 1904. Total Occupied and Un occupied Retired or Unoccupied... Engaged in Occupations, Unmarried Population. CAUSES OF DEATH. Unmarried. Married or Widows. Total at Census. Total Deaths, 1904. Infectious Diseases. Septic. Phthisis. Other Tubercular. Bronchitis. Pneumonia. Other Respiratory Diseases. Alcoholism. Cirrhosis of Liver. Other Digestive Diseases. Rheumatic Fever. Valvular Diseases. Other Circulatory Disea«es. Insanity. Other Nervous Diseases. Cancer. Diabetes. Bright's Disease. Suicide. Accident. Other Causes. Old Age. 49,110 36,748 12,537 26,933 36,573 9,811 Professional 2,961 705 3,666 15 - - 1 1 2 - 1 - - - - 1 1 - 1 2 2 - 1 - 1 1 Domestic indoor servants 22,539 2,438 24,977 80 2 3 7 1 9 2 1 1 1 6 1 2 8 1 5 12 1 1 1 1 2 9 Charwomen 264 1,355 1,619 33 - 10 1 1 — — — 1 — — 4 — 6 4 — 1 — — — 5 Laundry, washing service, &c. 921 1,437 2,352 10 — — — 3 1 - - - - - - 1 — — 1 — 1 - - - 3 Gardeners, florists,&c. - - - - - - - - - - - - - - - - - - - - - - - - - - Upholsterers 113 71 184 1 - - - - - - - - - - - - - - - - - - - - - - Paper, prints, books, and stationery 506 146 652 2 - - - - - - - - - - - - - - - - - - - - - - Textile fabrics 971 75 1,046 1 - - - - - - - - - - - - 1 Tailoresses 1,366 1,024 2,390 12 — — 2 — 1 1 - - - - - - - - - - - - - 1 - 1 Dressmakers, milliners. &e. 3,927 1,372 5,299 57 4 1 8 — 11 2 — — - 5 2 1 5 3 - 3 1 3 — — 3 Eating- and lodging-house keepers and dealers in food 598 564 620 14 1 — — 1 - - 1 1 - - - - - 1 - 1 - 1 - - - Inn and hotel service 1,391 202 1,593 3 — — 1 1 - - - - - 1 - - - - - - - - - - - - General dealers, &c 294 243 537 10 — — 1 — 4 — — — 1 — — — 1 — 1 1 — — — — — 1 Others 705 415 1,120 105 2 - 11 4 8 3 1 - 3 7 5 4 13 - 6 8 1 4 2 4 I 16 71 E.—Food Supply. 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 condemned and destroyed as unfit for food during the year. The bulk of it was submitted by the owners or purchasers for the opinion of your Officers, and in the present state of the law further proceedings could not be taken, although in some instances it would appear to be desirable:— Fruit and Vegetables. Tons. Cwts. Lbs. Tons. Cwts. Lbs. Apples 6 13 0 Oranges 7 2 0 Asparagus 0 3 56 Peaches 0 0 30 Bananas 32 3 56 Pears 0 5 56 Beans 2 12 56 Peas, "Q-reen" 0 5 0 Cauliflowers 0 10 0 Strawberries 0 10 0 Cherries 1 11 56 Tomatoes 6 7 0 Total : 58 tons, 3 cwts., 86 lbs. Fish. Haddocks 1 cwt. Plaice 1 cwt. Mackerel 6 „ Smoked Salmon 312 ½lb. tins Mixed Fish 1 „ Soles 56 lbs. Meat. Hams 60 Articles of Food Seized and Destroyed. Result. Bananas, 1 cwt. Cautioned. Pork, 8 lbs., and.. 1 James Keen, 4a, Berwick Street, W. Fined £10 and £2 2s. costs. Pig's Head, 1 (Tuberculous) .. Whiting, 9 David Corke, 32, Little Pulteney Street, W. Fined £3 and 4s. costs. Beef, 26 lbs 1 Palmer Bros., 21, New Street, W.C. Fined £5 and 2s.. costs. Mutton, 3 lbs. 72 Sale of Food and Drugs Acts. Samples Purchased under the Sale of Food and Drugs Acts, together with the number found, Adulterated. Also list of Prosecutions, with the result of same;— r. Articles of Food. Number of Samples Purchased. Genuine. (Inferior in brackets.) Adulterated. Prosecutions. Convictions. Warranty or Disclosure. Fines. Costs. £ s. d. £ S. d. i Milk 741 503 (160) 78 46 26 20 52 5 0 14 19 6 2 Separated milk 6 6 3 Sterilized milk 7 4 (1) 2 4 Condensed milk 18 18 5 Ice cream 18 18 6 Butter 211 193 (16) 2 7 Margarine 71 66 5 4 4 - 2 0 0 2 10 0 8 Cheese (Dutch) 1 1 9 Lard 27 27 10 Coffee 79 77 (1) 1 1 1 - 2 0 0 0 14 6 11 ,, and chieory 7 4 3 12 Chicory 20 19 (1) 13 Cocoa 83 78 (2) 3 2 2 - 2 10 0 1 0 14 ,, mixture 1 1 15 Olive oil 45 42 (1) 2 2 1 - 2 0 0 0 14 6 16 Almond oil 17 15 (1) 1 1 1 - 5 0 0 0 12 6 17 Whisky 35 31 (2) 2 2 2 - 6 0 0 1 9 0 18 Brandy 23 12 (1) 10 4 4 - 18 0 0 2 10 0 19 Claret 9 9 20 Port 9 9 21 Cowslip wine 1 1 22 Raisin wine 6 6 23 Ginger wine 7 6 1 24 Orange wine 10 10 25 Syrup of citron 1 1 26 Beer 53 53 27 Lager beer 9 9 28 Lime juice 8 8 29 Soda water 8 4 4 30 Potash water 4 4 31 Seltzer water 1 1 32 Lemonade 5 5 33 Arrowroot 9 9 34 Dough 21 21 35 Oatmeal 8 8 36 Demerara sugar 19 10 (5) 4 1 1 - 2 0 0 0 12 6 37 Pepper 21 21 38 Mustard 10 10 39 Jam 25 24 1 40 Meat extract 26 26 41 Sausages 5 1 4 42 Tinned peas 14 4 10 1 1 - 5 0 0 3 3 0 43 „ beans 11 2 9 1 1 - 4 0 0 1 0 0 44 „ asparagus 1 1 45 Chlorodyne lozenges 8 8 46 Cream of tartar 10 9 (1) 47 Glycerine 28 27 1 48 Cod liver oil 43 40 (3) Totals 1,800 1,462 (195) 113 65 44 20 100 l5 0 29 12 6 73 1,491 samples were purchased by deputy, 309 by the Inspectors directly (these latter were chiefly samples of milk purchased in the street). Milk.—741 samples of ordinary milk were taken during 1904; 593 were found to be below the standard laid down by the Board of Agriculture, but 160 were reported by the analysts to be of very low quality. From the returns of Mr. Cassal, the Public Analyst for the southern part of the City, a summary has been prepared, which shows that, so far as fat is concerned, the milk he analysed for the southern part of the City might be divided thus : 135 good (3.8 per cent. and over of fat), 93 fair (3.3 to 3.8 per cent.), 76 inferior (3 to 3.3 per cent.), and 21 adulterated. Mr. Cribb and Mr. Richards, the Public Analysts for the northern part of the City, have prepared a chart, which shows that the bulk of F 2 74 the samples were much above the standard, both as regards cream and other solids. The milk sent up by the farmer is, as a rule, of good quality, so far as the amount of cream and other solids is concerned, but by the time it reaches the consumer it is often an inferior article. In the majority of instances it is probably not the shopkeeper who is at fault, although he is the person who has to appear at the police court, but his servants or the man who supplies him, if he gets it through a middleman. It ha? been shown also that milk may be tampered with in transit. The total number of adulterated samples numbered 78, equal to 10.5 per cent., as against 31.6 in 1903 and 1T8 in 1902, but the number returned as inferior was 2T5 per cent., against 12 per cent. in 1903. In the four quarters the results were:— Total Samples. Inferior. Adulterated. 1st quarter 140 35 (25 per cent.) 14 (10 per cent.) 2nd ,, 199 41 (20.6 „ ) 29 (14.5 „ ) 3rd „ 197 36 (18.3 „ ) 24 (12.1 „ ) 4th „ 205 18 ( 8.7 „ ) 11 ( 5.3 „ ) Thus the low grade (adulterated and inferior) was equal in each quarter respectively to 35 per cent., 351 per cent., 304 per cent., and 14.1 per cent., or 321 per cent. for the year. Complaint was made in one instance by a milkman that he was being subjected to persecution, and it was alleged that he had been summoned twenty-five times, six times being in 1904, for alleged adulteration of milk, when on each occasion the summons had been dismissed. From the record (given below) of the number of samples of No. of Sample. Result of Analysis. 1902. 20th April 311 N. 16 per cent. of original fat abstracted. Summoned. Produced a warranty. 13th July 510 N. 3 per cent. of added water. Cautioned. 21st October 873 N. 8 per cent. of added water. Summoned. Appealed to Somerset House. Analyst's certificate confirmed; also relied on warranty, but Magistrate held it was not proved. Fined 5s. and 12s. 6d. costs. 1903. 19th February 150 N. Genuine (but inferior). 11th March 218 N. 4 per cant. of added water. Cautioned. 15th April 258 N. Genuine. 12th August 702 N. Genuine (but inferior). 29th October 832 N. Genuine. 12th November 887 N. Genuine (but inferior). 21st. December 999 N. Genuine (but inferior). 1904. 17th April 331 N. 4 per cant. of added water. Cautioned. 17th May 440 N. 7 per cant. of added water. Summoned. Warranty proved. 21st June 515 N. 5 per cant. of fat abstracted. Summoned. Fine £5 and 12s. 6d. costs. 75 milk taken during the last three years, it was found that this particular milkman had a shop, and he also sent out at least 3 men with milk barrows and 1 with cans. Thirteen samples of milk had been taken during the 3 years, 9 of which were purchased in the streets and 4 at the shop; of those purchased from the men in the street, 1 was certified as being genuine, 2 as inferior, and 6 as adulterated, and of the four purchased in the shop, 1 was certified as being genuine, 1 as inferior, and 2 as adulterated. Three samples of butter were taken during the same period and found to be genuine. This milkman was also summoned in 1904 and fined 20s. and 2s. costs for selling milk from cans not bearing his name and address. Samples of milk have been taken regularly during the same period from the contractor who supplies this milkman, and were found to be genuine and of good quality on each occasion. It is satisfactory to note that shortly after this inquiry the milkman gave up the business. Sunday Samples.—Sixty-four samples of milk were taken for analysis on Sunday mornings; of these six were reported as adulterated, one contained 2 per cent, of added water, two 3 per cent., one 4 per cent., and one 28 per cent., and one had 15 per cent, of the fat abstracted. Legal Proceedings.— In a considerable proportion of the cases reported as adulterated, the amount of water added or fat abstracted was less than 5 per cent.; in such cases, and also where small amounts of boracic acid were found, cautions were given by the Council. Of the 46 instances in which prosecutions took place, convictions were obtained in 26, the defendants in the other cases proving warranties from the persons who had supplied them with the milk. Several others produced warranties, but failed to give the notice required by law. Warranties.—The growing custom of giving warranties has been considered by the Council on many occasions, and communications have been received from the Councils of other Boroughs on the subject. The opinion appears to be general that the Sale of Food and Drugs Acts should be repealed as regards warranties. Communications have been made on the subject to the Local Government Board and the Board of Agriculture, and particulars have been furnished them of cases in which the summons was dismissed by reason of the defendant proving a warranty. The City Solicitors submitted the following report to the Council, showing the difficulties contended with from this cause :— " In a large number of the prosecutions in respect of adulteration of, or abstraction from, milk, the retailer was protected with a warranty from the wholesale dealer or farmer, with the result that he was discharged from the prosecution. There is, of course, power given by the Acts to proceed against the giver of the false warranty, but there are difficulties in the way of such proceedings, 76 firstly, that proceedings had to be taken within six months from the giving of the false warranty, and that although there might not be any difficulty with regard to that where an express warranty was attached to each churn, yet there were instances where the warranty was contained in a contract more than six months old, and they doubted in that case whether a prosecution could be sustained; secondly, that the giver of the warranty was entitled to show that when he gave the warranty he had reason to believe that the statements or descriptions contained therein were true, the onus being, of course, on the defendant to show that, but that he would no doubt in many cases be able to satisfy a Magistrate, seeing that it was quite impossible to meet oath with oath no such a point; thirdly, that there was the difficulty of successive warranties, i.e., if A, a farmer, sold milk with a warranty to B, a middleman, who sold it exactly as he received it with another warranty to C, a retailer, there was no one who could be successfully prosecuted, the legislature not having provided for the case of successive warranties ; and fourthly, that the Analyst's certificate, given for the purpose of prosecuting the retail seller, could not be used as evidence against the wholesale dealer in a prosecution for giving a false warranty. The City Solicitors were cf opinion that, for the protection of the public, Section 25 of the Act of 1875 should be repealed, and the retailer left to his remedy against the person selling him the milk under a false warranty, and that it might be worth while to call the attention of the Local Government Board to the present difficulties in the prevention of frauds upon the public. A curious point arose in connection with a case in which the sample was asserted to be a mixed milk from two distinct sources. The defendant in the case gave notice of two warranties, and stated that the milk was received from two farmers with a warranty from each, that the contents of 2 churns received from the said farmers were turned into 1 drum, and the milk which was analysed was taken from such drum. The City Solicitor raised the point that in consequence of this mixture of the milk from the two farmers, the defendant could not say that they sold the milk from either farmer in the same state as when they purchased it, and that they were therefore not entitled to the benefit of Section 25 of the Act of 1875. The Magistrate in a considered judgment, stated that he thought that as the milk from both the farmers was sold under a warranty, the defendant was entitled to do what he had done, and that, in his opinion, the milk was sold in the same state as when he purchased it, the warranties having been, of 77 course, properly proved. The Magistrate dismissed the summons, but consented to state a case for the High Court if desired. The Council did not proceed to the High Court, but called the attention of the Local Government Board to the matter, and also addressed a letter to the defendant calling attention to the fact that by mixing milk supplied by different farmers in respect of which warranties are given, the Council may be prevented from taking action against the warrantors, and informing him that in the event of a further sample of mixed milk being purchased of him, under similar conditions, and found to be adulterated, the circumstances of this letter having been sent to him would be brought up as evidence against him in any proceeding which the Council may think fit to institute in the matter. Sterilised Milk.—Two bottles of milk alleged to be sterilised were purchased unofficially, and submitted to Mr. C. L. Cribb, one of the Analysts, who submitted them to bacteriological examination as well as to chemical analysis. His report was to the effect that one of the samples contained 10 per cent, of added water, and at least 180,000,000 organisms per cubic centimetre, and was not sterile; that the other sample was not sterile, containing 3,240 organisms per cubic centimetre. Instructions were given to take other samples, but it was found that the sale had been given up for the winter. A number of milkmen were cautioned for selling milk from barrows and cans without the name of the seller being inscribed thereon. When a milk business changes hands the purchaser is apt to forget to have the inscriptions altered. A reasonable time after giving the caution further proceedings would take place if the caution were not attended to. Three such prosecutions took place, one man being the defendant on two occasions. Margarine.—A Divisional Court, consisting of the Lord Chief Justice, with Justices Kennedy and Phillimore (July 11th, 1904), decided in a Westminster case (McNair v. Horan) that an open tub of margarine exposed in a shop, from which tub margarine is scooped out and sold, is a package within the meaning of Section 6 of the Margarine Act, 1887, and should be branded or marked with the word " margarine." Spirits and Wines.—As with milk so with spirits, especially brandy, the execution of the Acts is prevented in this instance by means of an ingenious label which states that the article is not guaranteed to be derived from grapes. In four out of ten cases the Council was successful in obtaining a conviction. 78 Several samples of British wines were found to contain small quantities of salicylic acid, varying from 1½ to 3½ grains per pint. As to Giving Cautions.—The Council received a letter from the Local Government Board, referring to the reports of the Public Analysts for the City for the year 1903, and the prosecutions taken in respect of adulterated samples during that period, stating that while 192 samples of food and drugs were reported against by the analysts, legal proceedings were taken as regards 55 samples only; that in 133 out the remaining cases cautionary letters were addressed to the vendors, and asking, with a view to extending their information as to the practice of Metropolitan Borough Councils in regard to adulterated samples, to be informed of the reason why no prosecutions were instituted by the City Council in the 137 cases referred to. The reply of the Council stated that it was principally on the ground of the smallness of the adulteration that the Public Health Committee refrained from ordering proceedings, especially with regard to samples of adulterated milk, in which cases it had been learned from experience that it was generally understood that the magistrates were loth to convict in cases where the adulteration by the addition of water was slight; that in determining whether prosecutions should be instituted due regard was not only given to the extent of the adulteration, but allowance was made for the possibility of slight variation which might have occurred in the result of the analysis. Further, that it was not the wish of the Council to deal arbitrarily with vendors of adulterated samples in the City, and that where the adulteration was small, and it happened to be the first time that a particular vendor had thus offended, a warning to the vendor was considered to be the right course to pursue; also that it was the practice to cause a further sample to be purchased of a vendor who had previously been cautioned in respect of an adulterated sample. Particulars of cases in which proceedings were taken are appended:— CO Prosecutions under the Sale of Food and Drugs Acts. Ward. Date of Hearing. Court and Magistrate. Name and Address of Defendant. Offence. Result. 1 2 3 4 5 6 Milk. 1904. Victoria 15th Jan. Westminster (Mr. Sheil) G. E. Hancock, 87, Ebury Street Selling milk containing 11 per cent. of added water Warranty proved. Summons withdrawn. Covent Garden 23rd Dec., adjourned to 20th Jan. Bow Street (Sir A. de Rutzen) W. A. Hale, Drury Lane House, Drury Lane Selling milk containing 7 per cent. of added water Sample sent to Somerset House by request of defendant. Council's analyst's certificate confirmed by Somerset House. Fined £5 and 14s. 6d. costs. St. Anne 11th Feb Great Marlborough Street (Mr. Kennedy) Jane Eckert, 7, Bear Street .. Selling milk with 25 per cent. of its fat abstracted Defendant produced a warranty. Magistrate was satisfied, but no notice having been given of defence he imposed costs, viz., 12s. 6d. Regent. 11th Feb Great Marlborough Street (Mr. Kennedy) Callard, Steward and Watts, Ltd. 176, Piccadilly Selling milk with 30 per cent. of its fat abstracted Fined £2 and 12s. 6d. costs. St. Anne 25th Feb Great Marlborough Street (Mr. Kennedy) Morris Moses Tagker, 38, Drummond Street, Euston Road Selling milk from vehicle and can on which the name and address of vendor was not conspicuously inscribed Fined 5s. and 2s. costs. St. John 26th Feb Westminster (Mr. Horace Smith) Joshua Janes, 28, Ponsonby Place Selling milk from which 12.6 per cent. of fat had been abstracted Defendant relied on a warranty, and was defended by Mr. Ricketts. Warranty proved. Summons withdrawn. Strand 23rd Mar Bow Street (Sir A. de Rutzen) Richard Ponsford, 50, Stanhope Street, W.C. Selling milk having 15 per cent. of its fat abstracted Fined £2 and 14s. 6d. costs. St. Margaret. 24th Mar Great Marlborough Street (Mr. Plowden) Hannah Foakes, 8, Great Chapel Street Selling milk having 6 per cent. of its fat abstracted Warranty proved. Summons withdrawn. Victoria 8th April Westminster (Mr. Horace Smith) Ellen Loveday, 7, Aylesford Street Selling milk having 10 per cent. of its fat abstracted Fined 10s. and 14s. 6d. costs. Ward. Date of Hearing. Court and Magistrate. Name and Address of Defendant. Offence. Result. 1 2 3 4 5 6 Charing Cross. 1904. 13th April. Bow Street (Mr. Marsham) Giovanni Metalli, 27, Villiers Street Selling milk, from which 12 per cant. of fat had been abstracted Fined £2 and 12s. 6d. costs. St. John 29th April Westminster (Mr. Horace Smith) W. Griffiths, 26, Dorset Street Selling milk with 8 per cant. of its fat abstracted Warranty proved. Summons withdrawn. Regent 26th May. Great Marlborough Street (Mr. Kennedy) Ellen Jenkins, 32, Peter Street, Soho Selling milk containing 7 per cant. of added water and from which 10 per cant. of its original fat had been abstracted Warranty proved. Summons dismissed. Regent 26th May Great Marlborough Street (Mr. Kennedy) Aerated Bread Co., Ltd., 24, Eastcheap, E.C. Selling milk at 216, Piccadilly, containing 9 per cant. of added water Warranty proved. Summons dismissed. Charing Cross 26th May Great Marlborough Street (Mr. Kennedy) J. Lyons and Co., Ltd., Cadby Hall, Kensington Selling milk at 31, Leicester Square, from which 30 per cant. of the original fat had been abstracted. Warranty proved. Summons dismissed. St. Anne 2nd June Great Marlborough Street (Mr. Kennedy) George Jones, 183, Shaftesbury Avenue Selling in Great Newport Street milk from which 16 per cant. of original fat had been abstracted. Fined £3 and 12.9. 6d. costs. Conduit 2nd June Great Marlborough Street (Mr. Kennedy) Edith Susan Champion, 7A, Stafford Street Selling milk from which 12 per cant. of original fat had been abstracted Warranty proved. Summons dismissed. St. John 3rd June Westminster (Mr. Sheil) London and Provincial Dairies, Ltd., 4, West Halkin Street, Belgrave Square Selling in Bessborough Street milk from which 10 per cent. of fat had been abstracted Fined £1 and 12s. 6cl. costs. The defendants' solicitor produced a warranty, but had not given the necessary notice. St. Anne -June Great Marlborough Street (Mr. Kennedy) Marshall's Dairies, Ltd. Selling milk containing 28 per cant. of added water Warranty proved. Summons dismissed. 80 81 Regent 23rd June Great Marlborough Street (Mr. Kennedy) John Gay, 85, Berwick Street Selling in Lexington Street milk with 7 per cant. of added water Warranty proved. Summons dismissed. St. Anne 23rd June Great Marlborough Street (Mr. Kennedy) Hugh Lewis, 29, Great Windmill Street Selling milk in Lexington Street with 7 per cant. of added water Fined £2 and 12s. 6d. costs. St. John 24th June Westminster (Mr. Sheil) John Staples, 4, Bowden Street, Kennington Road Selling in Ponsonby Place milk with 9 per cant. of added water Fined £1 and 12s. 6d. costs. St. John 24th June Westminster (Mr. Sheil) Sarah Reach, 149, Regency Street Selling milk with 11 per cant. of added water Fined £1 and 12s. 6d. costs. Victoria 15th July Westminster (Mr. Horace Smith) Edgar Lewis, 131, Lupus Street- Selling milk with 16 per cant. of its fat abstracted Fined 10s. and 12s. 6cl. costs. Covent Garden 18th July Bow Street (Mr. Marsham) Slaters, Ltd., 18 to 20, Kensington High Street Selling at 393, Strand, milk from which 20 per cant. of fat had been abstracted Fined £1 and 12s. 6d. costs. Warranty produced, but the statutory notice not given. Great Marlborough 28th July Great Marlborough Street (Mr. Kennedy) John Gay, 85, Berwick Street Selling milk with 5 per cant. of its fat abstracted Fined £5 and 12s. 6a. costs. Great Marlborough 28th July Great Marlborough Street (Mr. Kennedy) John Gay, 85, Berwick Street Selling milk from receptacle not bearing name and address Fined £1 and 2s. costs. Great Marlborough 28th July Great Marlborough Street (Mr. Kennedy) Jane Lazareeth, 40, Berwick Street Selling milk with 40 per cant. of its fat abstracted Fined £5 and 12s. 6d. costs, St. John 29th July Westminster (Mr. Horace Smith) Mrs. Brooks, 41, Wood Street Selling milk with 18.5 per cant. added water Fined 10s. and 12s. 6d. costs. victoria 29th July Westminster (Mr. Horace Smith) David Lewis, 4, Commercial Road Selling milk from which 7 per cant. of fat had been abstracted Warranty proved. Summons dismissed. Strand 7th Sept. Bow Street (Mr. Marsham) Agnes Barber, 9, Portsmouth Street Selling milk with 11 per cant. added water Fined £1 and 12s. 6d. costs. Strand.. 7th Sept. Bow Street (Mr. Marsham) J. Lyons and Co., Ltd., Cadby Hall, Kensington Selling milk with 30 per cant. of fat abstracted. Sale at 149, Strand Warranty proved. Summons dismissed. Charing Cross 7th Sept. Bow Street (Mr. Marsham) Giovanni Metalli, 27, Villiers Street Selling milk 29 per cant. added water Fined £5 and 12s. 6d. costs. St. Anne 8th Sept. Great Marlborough Street (Mr. Plowden) Elizabeth Adams, 3, Greek Street Selling milk with 10 per cant. fat abstracted Fined 10s. and 12s. 6d. costs. St. Anne 8th Sept. Great Marlborough Street (Mr. Plowden) P. L. Townsend, 13, Dean Street Selling milk with 8 per cant. added water Fined £5 and 12s. 6d. costs. 82 Ward. Date of Hearing. Court and Magistrate. Name and Address of Defendant. Offence. Result. 1 2 3 4 5 6 St. Anne 1904. 8th Sept. Great Marlborough Street (Mr. Plowden) M. Harris, 62, Old Compton Street Selling milk with 12 per cant. of fat abstracted Fined £1 and 12s. 6d. costs. St. Anne 20th Oct. Great Marlborough Street (Mr. Denman) John Timothy, 45, Greek Street, Soho Selling at Newport Buildings milk from which 5 per cant. of far had been abstracted, and to which 12 per cant. of water had been added Warranty proved. Summons dismissed. St. Margaret 21st Oct. Westminster (Mr. Sheil) John Adams, 35, Palace Street Selling milk with 8 per cant. of added water Warranty proved. Summons dismissed. St. John 21st Oct. Westminster (Mr. Sheil) Elizabeth Day, 3, Artillery Row Selling milk with 15 per cant. of fat abstracted Warranty proved. Summons dismissed. St. John 21st Oct. Westminster (Mr. Sheil) Callow Park Dairy Co., Ltd , 79, Copenhagen Street Selling at 74, HorsefemRoad milk with 11.5 per cant. of added water Warranty proved. Summons dismissed. St. John 21st Oct. Westminster (Mr. Sheil) Sarah Ann Brooky, 41, Wood Street Selling milk with 8 per cant. of added water and 17.21 per cant. deficiency of fat Fined £1 and 12s. 6d. costs. Si. John 28th Oct. Westminster (Mr. Sheil) M. D. Williams, 7, Regency Street Selling milk with 6 per cant. of added water Warranty proved. Summons dismissed. Pall Mall 2nd Nov. Bow Street (Mr. Marsham) Aerated Bread ,Co., Ltd., 24, Eastcheap, E.C. Sale of milk at 121, Pall Mall, from which 13 per cant. of fat had been abstracted Warranty proved. Summons dismissed. St. John 4th Nov. Westminster (Mr. Sheil) S. S. Dancocks, 23, Buckingham Palace Road Selling in Ponsonbv Tcrrace milk with 5 per cant. of added water Warranty proved. Summons dismissed. Regent 17th Nov. Great Marlborough Street (Mr. Kennedy) Joseph Brandon, 13, Pollen Street, W. Selling in Old Burlington Street milk from which 23 per cant. of fat had been abstracted Warranty proved. Summons dismissed. Victoria 17th Nov. Great Marlborough Street (Mr. Kennedy) Morris, Tagker, 17, Steven Street, W.C. Selling milk from a can without name and address thereon Fined £1 and 2s. costs. 88 Hamlet 30th Dec. .. Westminster (Mr. Horace Smith) Jane Groom, 24, Montpelier Row Selling milk with. 5 per cent, of added water Fined £5 and 12 s. 6d. costs. Margarine. 1904 Regent. 24th March Great Marlborough Street (Mr. Plowden) Ann Davies, 24, Little Pulteney Street Selling margarine without printed wrapper Fined 5s. and 12.?. 6d. costs. St. John 24th March Great Marlborough Street (Mr. Plowden) Harriet Thorpe, 7, St. Anne's Court Selling margarine as butter .. Fined 20s. and 12s. 6d. costs. Regent 24th March Great Marlborough Street (Mr. Plowden) Ann Davies, 24, Little Pulteney Street Exposing for sale margarine without label Fined 5s. and 12s. 6d. costs. St. Margaret 15th Jan. Westminster (Mr. Sheil) Patrick Horan, 41, York Street Exposing for sale margarine not branded or marked as such * Defendant pleaded "guilty," but Magistrate dismissed the summons on the ground that the tub in which the margarine was contained was not a "package" within the meaning of the Margarine Act. * The Council appealed against the Magistrate's decision, with the result that the Defendant, on the 30th September, 1904, was fined 10s. and 12s. 6d, costs. Cocoa. 1904 Conduit 1st Jan. Great Marlborough Street (Mr. Plowden) G. W. Roult, 14, Woodstock Street Selling cocoa containing 30 per cent. of starch and 10 per cent . of sugar Fined £2 and 14s. 6d. costs. Co7ent Garden 24th Feb. Bow Street (Mr. Marsh am) Elizabeth Grantham, 11, Langley Court, Long Acre, W.C. Selling cocoa containing 36 per cent. of added sugar and 34 per cent. of added starch Fined 10s. and 12s. 6d. costs. Coffee. 1904. Conduit 1st Jan. Great Marlborough Street (Mr. Plowden) G. W. Roult, 14, Woodstock Street Selling coffee containing 45 per cent. of chicory Fined £2 and 14s. 6d. costs. Olive Oil. Victoria 1904. 15th Jan. Westminster (Mr. Sheil) John Sulz, 52, Vauxhall Bridge Road Selling olive oil containing 50 per cent. of oil other than olive oil Fined £2 and 14s. 6d. costs. Ward. Date of Hearing. Court and Magistrate. Name and Address of Defendant. Offence. Result. 1 2 3 4 5 ] 1904 Victoria 15th Jan., adjourned to 5th Feb., further adjourned to 19th Feb. Westminster (Mr. Sheil) (Mr. Horace Smith) Pearks, Gunston and Tee, 6, Bayer Street Selling olive oil containing 33 per cent. of oil other than olive oil *Case adjourned to allow the third portion to be sent to Somerset House for analysis. The Government Analyst subsequently certified that the oil contained not less than 13 per cent of oil other than olive oil. * Mr. Horace Smith, in giving his decision, said, "I do not for a moment suggest that there has been a careless analysis, but possibly with the very best of analysts, in the complicated and delicate tests to be applied, there is just the possibility of mistake. I must say the evidence of Dr. Hehner would leave one in great doubt as to whether this is not an absolutely pure olive oil, and, in view of the great difference between the Public Analyst, the Government Laboratory, and Dr. Hehner, there is a doubt, and as the prosecution is in the nature of a criminal charge, I must give defendant the benefit of it; therefore I cannot convict." Defendant called Dr. Otto Hehner, Public Analyst for West Sussex, who stated he had analysed the portion left at the shop and found it to be pure olive oil. The Magistrate said he could not convict. No costs allowed. St. Anne 23rd June Great Marlborough Street (Mr. Kennedy) Henry Phillips, (trading as Bergmann Bros.), 81, Charing Cross Road Selling olive oil containing not less than 40 per cant. of oil possessing the characters of arachis oil Fined £5 and 12s. Gd. costs. St. Anne. 23rd June Great Marlborough Street (Mr. Kennedy) Guilio Varesio, 14, Moor Street Selling olive oil containing not less than 25 per cant. of oil possessing the characters of cottonseed oil Fined £4 and 12s. 6d. costs. Almond Oil. 1904 Covent Garden 29th Dec. .. Bow Street (Sir Albert de Rutzen) Edward Thomas, 78, Long Acre Selling for almond oil an oil consisting of 100 per cant. of oil other than almond oil Fined £5 and 12s. 6d. costs. 84 85 Demerara Sugar. 1904. Regent 26th May Great Marlborough Street (Mr. Kennedy), Otto Thomas, Ltd., 45, Leadenhall Street, E.C. Selling "yellow crystals" as Demerara sugar i«t 15, Berwick Street Fined £2 and 12s. 6d. costs. Alcoholic Liquors. 1904. Regent 21st April. Great Marlborough Street (Mr. Kennedy) Henry Lowenfeld, "Prince Rupert" Public House, 40, Rupert Street Selling whisky 31.8 degrees under proof, being 6.8 degrees below the limit prescribed by law Fined £5 and 14s. 6d. costs. St. Anne 28th July Great Marlborough Street (Mr. Kennedy) Pierre de Loriol and Co.. Ltd., 43, Frith Street Selling brandy containing 60 per cant. of spirit not derived from the grape Fined £5 and 12s. 6d. costs. St. Anne 28th July Great Marlborough Street (Mr. Kennedy) Pierre de Loriol and Co., Ltd., 43, Frith Street Selling brandy containing 60 per cant. of spirit not derived from the grape Fined £5 and 12s. 6d. costs. St. Anne 28th July Great Marlborough Street (Mr. Kennedy) Edouard J. Barron, 13, Old Compton Street Selling brandy containing 65 per cant. of spirit not derived from the grape Fined £5 and 12s. 6d. costs. Great Marlborough 28th July Great Marlborough Street (Mr. Kennedy) Bernard Danzic, 34, Broad Street Selling brandy containing 70 per cant. of spirit not derived from the grape Fined £3 and 12s. 6d. costs. Covent Garden 23rd Dec. Bow Street (Sir Albert de Rutzen) J. H. Coulson, 23, Castle Street, "White Horse" Public House Selling whisky 3 degrees below legal limit of strength Fined £1 and 14s. 6d. costs. Tinned Foods 1904 Regent 2nd June Great Marlborough Street (Mr. Kennedy) Cornelius Francis Sergeant, 17 and 18, Rupert Street Selling peas containing 0 04 grain of copper (equivalent to 253 grains of crystallised sulphate of copper) per lb. Fined £5 and £3 3s. costs. Regent. 2nd June Great Marlborough Street (Mr. Kennedy) John Bourbon, 81, Wardour Street Selling haricot beans containing 0.56 grain of copper (equivalent to 2.21 grains of crystallised sulphate of copper) per lb. Fined £4 and £1 costs. 86 CITY OF WESTMINSTER. Regulations for the Control of the Staff of Sanitary Inspectoes. 1. The Staff of Sanitary Inspectors shall be under the direct control and supervision of the Medical Officer of Health. 2. Each Sanitary Inspector shall be required on his discovering a nuisance at any premises to make out and hand to the person responsible where resident a detailed statement of the nuisance: and for giving effect to this requirement each Sanitary Inspector shall be provided with a Memorandum Book containing carbon triplicating sheets, in order that he may be in possession of a copy of the statement of the nuisance handed to the person responsible where resident, and that he may hand one to the Medical Officer of Health, also that on the form of statement referred to there shall he printed a notice to the effect that "an official intimation of the nuisance will be forwarded within 24 hours." 3. A notice, stating that "no Officer is permitted to receive money or any consideration whatever," shall be printed on all notices served in regard to nuisances. 4. Each Inspector shall be required to furnish to the Medical Officer of Health, on forms provided, a report on premises inspected, specifying fully the conditions existing, works necessary, in his opinion, to rectify defects (if any), and subsequently additional defects discovered during the progress of such work, or amended requirements discovered, together with names of persons carrying out such works, dates of visits, testing of drains, when the work was begun and finished, &c. Each report to be handed to the Medical Officer of Health forthwith. 5. The Medical Officer of Health shall examine all reports with a view to seeing that the inspection has been properly carried out, that what is stated as necessary to abate the nuisance is sufficient or insufficient, and shall have power to amend the requirements if he deems them unsatisfactory on any of these grounds. 6. There shall be entered in a book a list of all premises visited by the Inspectors showing (shortly) defects found (if any), work decided by the Medical Officer of Health to be necessary, dates of notices and other action taken on similar' lines to the Register of Complaints, and such book shall be laid before the Public Health Committee at each meeting for inspection, as is the Register of Complaints. 87 7. Each District Inspector shall, except by previous arrangement with the Medical Officer of Health, return to the office daily at 4.30 p.m. except on Saturdays, when he shall return at 12.30 p.m., to prepare and hand in investigation cards of infectious disease, reports of inspections, and a statement of places visited, reason of visit and result thereof, and to receive instructions. 8. The hours of duty of Inspectors shall be from 9 to 5 on week days other than Saturdays, on which day they shall be from 9 to 1: but any Inspector may be required to stay later than these hours if necessary. 9. The districts of the Sanitary Inspectors may be changed over from time to time as the Public Health Committee may direct. 10. In every case in which food is seized, or in which, if seized, proceedings might follow, it shall not be destroyed until it has been seen by the Medical Officer of Health, whether it has been condemned by a magistrate or not. 11. In every case in which food is inspected a report shall be made by the Food and Drugs or the District Sanitary Inspector concerned, stating its nature, quantity and owner, the date, time and place of inspection, by Inspector, Medical Officer of Health and magistrate, with the result of such inspection by each, the facts entered in a Register, together with a note of proceedings taken (if any) to condemn the food, orders for destruction, certificates granted with dates of same, when, how, and by whom destroyed, when reported to Public Health Committee, orders thereon, persons summoned, date of summonses, and result of hearing. 12. Wherever food is seized by an Inspector as being unsound it shall be the duty of that Inspector to affix to the article or articles of food so seized a mark of identification, and it shall also be the duty of that Inspector to inform the proprietor of such food at the time of seizure that he is at liberty to accompany him to the police court for the purpose of seeing whether the food so seized is condemned or not by the magistrate. 13. Such arrangements as may be necessary to secure the proper and efficient execution of the duties of the Food and Drugs Inspectors shall be left to the discretion of the Medical Officer of Health. 14. No prosecution shall be instituted under the Public Health (London) Act, 1891, until the subject matter of the proposed prosecution has first been personally investigated by the Medical Officer of Health, and the prosecution has been expressly authorised by the Public Health Committee, or, in cases of emergency, by the Chairman or Acting Chairman of that Committee, G 88 15. All the legal proceedings of the department shall be conducted by the City Solicitors. 16. The District Sanitary Inspectors and the Food and Drugs Inspectors shall (unless prevented by their outdoor duties) attend daily at the City Hall from 9 to 10 o'clock a.m., and their time for leaving duty shall (when the exigencies and requirements of the business of the Council permit) be 5 p.m. (Saturdays 1 p.m.) They shall enter in an Attendance Book at the City Hall the exact time of their arrival and departure, and in cases of late arrival shall state the reason. The District Sanitary Inspectors and Food and Drugs Inspectors shall, prior to leaving the office each morning, inform the Medical Officer of Health the exact locality in their district where they expect to be during the day. John Hunt, Town Clerk. City Hall, W.C. May, 1904. 89 CITY OF WESTMINSTER. Public Health Department. Instructions for District Inspectors. (1) Infectious Disease.—Enquiries with regard to sickness are to receive first attention each day; enquiry cards are to be returned, when possible, on the day of issue, or not later than 24 hours after issue. Information as to schools attended, removal of patient, and any other matters requiring immediate attention may be telephoned at once to the office. (2) Gutting Off Water Supplies.—Enquiries as to cutting off water supplies to occupied premises must be made on the day on which notice is given to the Inspector. (3) Nuisances.—Each Inspector, on discovering a nuisance in his district, shall make out and hand to the responsible person, where resident, a detailed statement of the nuisance, and shall attach the duplicate to his report thereon to the Medical Officer of Health. (4) Reports.—Each Inspector shall submit daily to the Medical Officer of Health a report in writing on premises inspected or visited. On a first inspection a full report (accompanied by a sketch plan where necessary) of the conditions existing and nuisances found, works necessary, in his opinion, to rectify defects (if any) tests applied to drains, soil-pipes, traps, &c. (where and how used and by whom assisted). Subsequently the Inspector shall report in his daily report each visit made to the premises, together with information as to additional defects discovered, amended requirements deemed necessary, commencement, progress and finish of work, names of persons carrying out works, dates of final testing of drains, &c., method employed. (5) Plans.—Inspectors shall see that plans of proposed works are sent in to the Medical Officer of Health as soon as possible, and that the work is carried out in compliance with the plans when approved. (6) New Buildings.—A list of plans of new buildings received by the Works Department will be posted daily in the Sanitary Inspector's office. Each plan must be examined by the Inspector in whose district it is, and a report made thereon to the Medical Officer of Health. The Inspector will see that the requirements of the Public Health Act and the By-laws made thereunder are carried out in such buildings. 90 (7) Each Inspector shall report to the Medical Officer of Health any infringements of the Public Health Act, Metropolis Management Acts, and By-laws thereunder, Factory and Workshop Acts, Housing Acts, and any other Act under the jurisdiction of the Council which he may discover. (8) Water Certificates.—On application for a certificate being made under Section 48 of the Public Health (London) Act, the Inspector in whose district the premises are situated shall examine and report as to the source of the supply; whether it is constant or intermittent, the provision of cisterns, where placed, properly constructed and covered; drinking water taps from rising main or from cistern; sufficiency of supply to water closets. In tenement houses information should be given as to the position of drinking water taps. (9) Restaurant Kitchens are to be visited at least once a quarter. (10) Bakehouses.—Notices calling attention to the statutory requirements as to lime-washing, &c., will be sent out in March and September. (11) Workshops.—Absence of "abstract" and the presence of " protected" persons in workplaces must be reported to the Medical Officer of Health. In inspecting premises the presence of workshops therein and the nature thereof must be specified in the daily report. Where it is not the duty of a special Inspector, the card of particulars of such workshops must be filled up by the District Inspector. (12) Inspectors are not allowed to make plans for builders or owners of property. (13) Before proceeding to his district each morning each Inspector shall leave with the Medical Officer of Health a list of the places he proposes visiting, as far as possible in the order in which they will be taken, and specify an address at which he may be communicated with at a specified time in the middle of the day. (14) Inspectors will leave their home addresses with the Medical Officer of Health, and any change of address, whether temporary or permanent, must be notified to him at once. Any Inspector unable to be on duty is to communicate at once with the Medical Officer of Health. If the absence extends to two or more days by reason of sickness or accident, a medical certificate on the prescribed form is to be forwarded. harrison and sons, printers in ordinary to his majesty, st, martin's i.ane,