loes. to ANNUAL REPORT ON THE STATISTICS AND SANITARY CONDITION RELATING TO THE CITY OF WESTMINSTER FOR THE YEAR 1906. 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: HARRISON AND SONS, PRINTERS IN OEDINARY TO HIS MAJESTY, ST. MARTIN'S LANE, W.C. 1ll TABLE OF CONTENTS. page Introductory Remarks 1 PART I. A. Statistics. Population 3 Births 5 Deaths 10 Infantile Mortality 12 Occupational Mortality 15,28, 29 In Block Dwellings 15, 30 In Common Lodging.Houses 15 Tables 18.30 B. Communicable Diseases. (1) Compulsorily Notifiable - Smallpox 31 Vaccination 31 Statistical Tables 32.37 Scarlet Fever 38 Diphtheria 40 School Outbreak 41 Typhoid Fever 44 Puerperal Fever 45 Erysipelas 45 (2) Voluntarily Notifiable Diseases- Tuberculosis 50 (3) Non.notifiable Diseases- Measles 55 Whooping Cough 56 Diarrhœal Diseases 57 Schools and Infectious Disease 58 Bacteriological Laboratory 61 Disinfection 61 Cleansing of Persons 62 Mortuaries 63 PART II. C. House Inspection, &c. Defects Remedied 64 Legal Proceedings 65 Dust from Buildings During Demolition 65 Removal of House Refuse 66 Removal of Offensive Refuse 66 PAGE Drainage, &c., Plans 66 Drain Testing 67 Drainage By.Laws 67 Water Supply 68 Houses Let in Lodgings 68 Housing of the Working Classes- Marshall Street Dwellings 69 St. John's, Westminster, Improvement 70 Vincent Place Buildings 70 Revenue Act 71 Smoke Prevention 72 D. Workshops. Number on Register 73 Defects 74 Outworkers 74 Infectious Disease 78 Factory and Workshops Bill 78 E. Food Supply. Food and Market Inspection 80 Legal Proceedings 80 Bakehouses 80 Ice.cream Premises 81 Restaurants, &c. 81 Slaughter.house 81 Cow.sheds 81 Milkshops 82 Sale of Food and Drugs Acts- Samples Taken, Result of Analysis and Proceedings 84 Milk 85 Sunday Samples 85 Samples Taken in Course of Delivery 86 Warranties 86 Separated Milk 86 Cream 87 Butter and Margarine 88 Potted Meats and Fish 88 Tinned Vegetables 90 Drugs 91 Other Infringements of Food and Drugs Acts 91 Details of Prosecutions 92.100 A 2 Annual Report on the Health and Sanitary Condition of the City of Westminster, 19 06. To the Mayor, Aldermen, and Councillors of the City of Westminster. My Lords 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 1906. Returns required by the Local Government Board, and particulars relating to Factories and Workshops required by the Home Office, are incorporated therein. The year was somewhat peculiar in the meteorological conditions which obtained, and these had a distant effect upon the health of the people. To most the conditions were beneficial, but as they favoured the development of epidemic diarrhoea, scarlet fever and other complaints of this class, their effect was bad for young children. Notwithstanding some increase in infantile deaths from these causes, the death rate for Westminster was the lowest yet recorded. Considerable interest has been taken in the subject of infant mortality. Perhaps the most interesting circumstance of the year, from a hygienic point of view, was a Conference held at Caxton Hall to consider its causes and the best means to be taken for its diminution. I submit particulars bearing on the question, which seem to show that the presence or absence of care and cleanliness on the part of those in charge of infants, is the most important factor to be considered. The rainfall throughout the whole country in 1906 was an average one, but in the Thames Valley it was only 96 per cent.of the average fall of the previous 30 years; in 1905 the fall (22.3) was only 90 per cent. of the average. The total rainfall in Westminster was 24.27 inches. 2 From the accompanying Table (compiled from the Meteorological Office Reports) it will be seen that the first two and the last three months of the year and the month of June had a rainfall above the average, while the other months, especially April, July and August, were particularly dry. As nearly the whole of the rain in June fell on the 29th, that month may also be reckoned as a dry one throughout its greater part. As nearly the whole of the rain in June fell on the 29th, that month may also be reckoned as a dry one throughout its greater part. RAINFALL. TEMPERATURE. 1906. Amount. Inch. Percentage of average. Number of days on which rain fell. Mean. rence from Average. January 4.02 213 18 42.4 + 3.2 February 1 .89 117 20 39.5 .0.9 March 1 .08 67 13 42.4 .0 5 April .51 30 11 47.2 .0'7 May 1.09 63 8 53.8 + 0.4 June 2.89 138 9 59.1 .0.8 July .61 24 8 63.9 0 0 August .87 37 7 65.4 + 3.0 September 1.75 76 8 60.1 + 2.2 October 3.15 111 14 54.7 + 5'5 November 4.20 171 15 47.1 4.3.3 December 2.21 104 18 38.2 .1 .5 Year 24.27 96 149 The temperature of the year was above the average. The mildness of the winter, 1905.6, came to an end in February, and the spring was colder than usual as well as dry. There was, however, much bright sunshine recorded then and during the rest of the year. The temperature maintained a moderate level until the end of August and beginning of September, when there suddenly occurred five days of great heat, the thermometer at the Victoria Street meteorological station recording a maximum of 91.3 degrees on September 2nd, and in the northern parts of the City it was about three degrees higher. Until December the temperature was several degrees above the average. A comparison of the above table with the charts and tables showing the infectious diseases notified and with the records of deaths, especially of those from diarrhoeal diseases, will be found of interest. I have the honour to be, My Lords and Gentlemen, Your obedient servant, FRANCIS J. ALLAN, Medical Officer of Health. 26th February, 1907. 3 PART I A. Population. The resident population of the City of Westminster has been calculated by the Registrar.General at 173,905 for the year 1906. At the census, 1901, the number was 183,011. 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. For the purpose of obtaining approximately exact figures for the Wards, 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 5,550 St. Anne Ward 10,900 Grosvenor Ward 14,800 Great Marlborough Knightsbridge Ward 6,950 St. George Ward 14,700 Pall Mall Ward 2,960 Victoria Ward 39,300 Eegent Ward 9,340 Hamlet of Knights. Charing Cross Ward 4,210 bridge Ward 7,520 Covent Garden St. Margaret Ward 13,100 Ward 8,430 St. John Ward 29,800 Strand Ward 6,340 4 Without a direct census it is impossible to ascertain the correct figures. The Registrar.General, for the purpose of the Equalisation of Rates Act, estimated the population of the City in another way and makes it to be 172,085, without paupers in outlying workhouses and infirmaries. 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, 1904, 1905, and 1906, and I append them so that comparisons may be made:- 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, 1904, 1905, and 1906, 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 Equalisation of Rates Act. Estimated Population Registrar. General's Methods. 1902. St. George Hanover Square 9,838 56 2,236 12,018 75,923 76,424 St Margaret and St. John 5,638 54 3,974 9,558 50,690 52,791 St. James 2,882 7 84 2,959 21,294 21,060 St. Anne 1,135 45 827 1,917 11,168 11,414 St. Martin and Strand 2,708 69 1,805 4,444 19,459 20,200 The City 22,201 231 8,926 30,896 178,489 181,889 1903. St. George Hanover Square 9,848 56 2,253 12,045 76,000 75,715 St. Margaret and St. John 5,474 59 4,347 9,762 49,213 52,284 St. James 2,854 9 202 3,047 21,042 20,094 St. Anne 1,135 45 827 1,917 11,168 11,304 St. Martin and Strand 2,523 69 1,833 4,287 18,282 19,827 The City 21,834 238 9,462 31,058 175,705 179,224 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 1,128 45 829 1,912 11,099 11,250 St. Martin and Strand 2,460 64 1,835 4,131 17,840 19,560 The City 21,652 237 9,746 31,061 174,271 177,940 5  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 Equalisation of Rates Act. Estimated Population Registrar. General's Methods. 1905. St. George Hanover Square 9,786 61 2,405 12,130 75,522 74,800 St. Margaret and St. John 5,357 91 5,082 10,348 48,160 51,256 St. James 2,792 11 239 3,020 20,585 19,400 St. Anne St. Martin and Strand 1,121 2,447 46 79 833 1,991 1,908 4,359 11,031 17,762 11,000 19,150 The City 21,503 288 10,550 31,765 173,060 175,606 1906. St. George Hanover Square 9,736 63 2,413 12,086 75,136 74,355 St. Margaret and St. John 5,354 96 5,002 10,260 48,133 50,420 St. James 2,727 13 256 2,970 20,106 19,250 St. Anne 1,104 48 859 1,915 10,863 10,900 St. Martin and Strand 2,456 86 2,041 4,411 17,847 18,980 The City 21,377 306 10,571 31,642 172,085 173,905 It is noticeable that the population of the Strand group has begun to increase. According to the proportion existing in 1901, there are 80,693 males and 93,212 females in the estimated population. Births. 2,766 births were registered in the City in the 52 weeks ending December 29th, 1906. On examination, 42 births were found to be referable to other districts. Through the courtesy of the Committees of Management of Endell Street, York Eoad, and the Queen Charlotte Lying.in Institutions, of the Master of the Strand Workhouse at Edmonton, and the Steward of St. George's Workhouse, Fulham Eoad, and of other Medical Officers, I have ascertained that 207 children were born in these institutions, the home address of whose mothers was in Westminster. The net number of births was, therefore, 2,931, as compared with 3,120 in 1905; the birth.rate, uncorrected, was 15.9, corrected 16.89per 1,000 persons. The birth.rate for the County of London for 1906 was 26.7, the rate during the ten preceding years averaged 29.0 per 1,000. The birth.rate in England and Wales was 27'0, the average of the preceding ten years being 28.7. 6 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 must vary widely. 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. 1905. 1906. Conduit 47 46 43 27 30 25 Grosvenor 153 157 151 148 133 131 Knightsbridge St. George 163 162 125 164 160 150 Victoria 836 886 884 862 890 864 St. Margaret 197 160 162 165 156 141 St. John 869 953 877 828 908 860 Hamlet of Knights bridge 68 97 79 77 67 72 St. Anne 289 278 240 232 242 217 Regent 213 226 184 143 163 141 Pall Mall 32 23 22 17 20 18 Great Marlborough 208 180 162 151 149 137 Charing Cross 41 26 34 42 38 26 Covent Garden 163 163 151 156 147 129 Strand 153 104 71 42 17 20 The City of Westminster 3,432 3,461 3,185 3,054 3,120 2,931 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:- Divisions. Births. Birth.rate. Deaths, under 1, per 1,000 births. Uncorrected. Corrected. Uncorrected. Corrected. Uncorrected. Corrected. St. George 1,150 1,170 15.4 15.6 107 106 St. Margaret and St. John 973 1,073 19.3 21.2 127 115 St. .Tames and St. Anne 464 513 15.4 17.0 125 113 Strand 179 175 9.4 9 .3 95 97 The City 2,766 2,931 15.9 16.9 116 110 The number of married women between the ages of 15 and 45 is estimated to be 18,178, and the unmarried and widows at the same age.period 38,804. 1902. 1903. 1904. 1905. 1906. Legitimate Births (net) 3,275 3,051 2,920 2,971 2,744 Per 1,000 Married 174 156 156 161 150 Illegitimate Births (net) 186 150 134 149 187 Per 1,000 Unmarried 4.6 3.4 3.4 3.7 4.8 7 The Registrar.General, commenting in his 68th Annual Report, which deals with the year 1905, on the decrease in the birth.rate, points out that during the past thirty.five years the marriage.rate, based on total population, has declined by more than 8 per cent., and when based on the total number of marriageable persons in the community, with corrections for age and sex, 22 per cent. Coincidently with this fall there has been a steady decrease in the ages of the persons married, thereby shortening the period of possible child.bearing; in addition to these there can be little doubt that part of the decrease in the birth.rate is due to the deliberate restriction of child.bearing. Registration of Births.-The increased attention which is now being given to infant life has brought out the disability which hampers the work of local authorities in that births need not be registered for six weeks after they have occurred, and before compulsion could be brought to bear a longer period might elapse. More than one.third of the babies who die under one year of age do so before they are a month old, and therefore before any official knowledge of their existence has taken place. It is evident, if instruction or help is to be given to parents as to the rearing of their children, information of the birth must be given at a much earlier period than is at present the case. Efforts to prevent death or injury to health cannot begin too early. In Scotland the period within which registration should take place is three weeks ; in France three days, and, through a recent Act, Parliament has reduced the limit in Huddersfield to two •days, and a shilling is paid for each notification thereof. The Congress of Infantile Mortality last summer passed a resolution that notification of all births should be given to the Medical Officer of Health of the district within forty.eight hours. The Registrar.General is reported to have come to the conclusion that, whilst it would be unwise at present to disturb the existing organisation of birth registration, a well.devised system of early notification of births-legalised and worked in conjunction with the present registration system on the one hand, and with sanitary administration •on the other-might, along with other motive forces, serve as a most effective and lasting barrier with which to stem the tide of infant mortality. The City of Westminster Health Society state in their Annual Report that they have made arrangements with the various general and lying.in hospitals in the City and neighbourhood, whereby the Society is supplied from time to time with list of impending maternity cases on their books, they are thus able to visit the houses before the confinement takes place; and subsequently they visit once a month, or oftener if required, during the first three months, later on once a quarter. 8 The conclusions which they have been able to draw from such systematic visiting of 400 cases are set forth in the 2nd Annual Report from which the following extract is taken :- Housing Conditions.-These were bad or indifferent in forty.three instances, the causes usually being inadequate ventilation or overcrowding. Out of thirty.two deaths, five occurred in these dwellings, and in twelve instances the infants were unhealthy or did not thrive. The table below shows the relation of the housing conditions on the death.rate of infants and on their health. Death.rate per cent. Delicate infants per cent. Housing bad 11.6 27.9 Housing good 7.2 10.8 Mothers' Work.-It is stated that 120 of the mothers had some occupation. Of the infants of these working mothers, eleven died and thirty were delicate. The high proportion of deaths and unhealthy infants is due largely to the fact that the infants had in many cases. to be prematurely weaned, either partially or completely, owing to the mother's absence at work. Even when the mothers do their work at home, it is probable that they are unable to give their infants sufficient attention, resulting in their being fed at irregular intervals. The mother's occupation also acts disadvantageously on the child's health in that it prevents her looking after the infant when ill. Of the working mothers forty.five had to prematurely wean their children, but the fact of the mothers having to work was not necessarily the cause of this in all instances. The table below shows the differences in the deaths per cent., and in the numbers of delicate children per cent, between the infants of mothers working and of those non.working. Death.rate per cent. Delicate infants per cent. Working 91 25 Non.working 7.5 8.2 Mode of Feeding.-Of the 400 infants, 282 were fed by the breast alone, sixty.three were fed by the breast for a time, varying from a few weeks to several months, after which they were weaned and fed entirely by the bottle, or else there was supplemental food given from about birth, owing to the breast milk being insufficient, or to the mother's absence during the day. In thirty.seven instances the infants were fed by the bottle only from birth. Thus 100 were fed partly or entirely by the bottle. No mention is made of the mode of feeding in eighteen cases. Kind of Food.-Boiled milk and water was the food usually given. Artificial foods were used in seventeen cases, and they disagreed with 9 the infants in six of these : children not thriving in any case. These foods were given in the early months of the infant's life as a substitute for or supplemental to mother's milk. Tubed bottles were used in fourteen instances, and bad effects are noted in six. Effect of Feeding on Infant's Health.-There were eighteen deaths among the 282 breast.fed babies, as compared with fourteen among the 100 bottle.fed. Five, at least, of these latter deaths were due to diarrhoea or to diseases resulting from unsuitable food. Among the fifty.three infants, who were delicate or did not thrive, in twenty.six (or one.half) the disability is attributable to errors in feeding. Death.rate per cent. of breast.fed infants 6.3 „ „ bottle.fed „ 14.0 (partly or entirely) The mother's absence at work may have been a cause of the premature weaning in many instances. Non.thriving Infants.-Fifty.three of the 400 were delicate or did not thrive. The causes were as follows :- (1) Food not agreeing (26). (2) Unhealthy family (constitutional taint). (3) Bad housing conditions. (4) Insufficient attention, due to mother's absence at work. (5) Infantile diseases (adenoids, cleft.palate, eczema, conjunctivitis, &c.). (6) Debility due to prematurity. In many cases it is difficult to say exactly why the infant did not thrive. There was often a combination of several of the causes mentioned above. Infants whose ill.health was due to acute diseases are not included under this head. A separate cot is not often provided for the child. Unhealthy Mothers.-Of the mothers, sixty suffered more or less from ill.health or general debility. In many instances the strain of pregnancy, labour, or lactation was responsible. Drink or poverty are not frequently stated as causes. Scarcity of nourishment during pregnancy or after does not often appear to have been a cause. The points brought out by the summary of the Visitors' Eecords show that ignorance, lack of cleanliness, irregularity of feeding and of habits are the principal causes of infantile ill.health and death, and these factors tell most strongly in the case of bottle.fed babies, where more, rather than less, care is needed if they are to be successfully reared. The systematic visiting carried out by the Society has shown that the difficulties met with are not to be remedied by any one specific. 10 The supply of sterilised milk during the hot months of the year might assist in the reduction of diarrhoea, but probably any benefit which has resulted from its use is due to the fact that it is supplied in clean bottles, each containing sufficient for one feed only, and thus the chance of contamination of the milk is much reduced rather than to the milk being sterilised. So long as those in charge of the children are dirty and careless, even this method will not prevent contamination of the milk. Unfortunately there are many mothers who are unable to. nourish their children; there are other who do not try, or who decline to do so. In these circumstances, parents have to be taught to modify cow's milk, so that it may become suitable. In the majority of instances this can be done at home, but there are cases in which no simple modification of the milk will enable it to be digested. For these it is desirable that there should be facilities whereby parents may obtain skilled advice, and, if necessary, have a prescription of the food ordered, made up. This is necessary in such cases, as sometimes very minute modifications in the amount of the various constituents have to be made before a food can be obtained upon which the child will thrive. The establishment in Vincent Square of the Infant Hospital will doubtless be of material benefit to parents in Westminster. The objects of the hospital are to carry out systematically the treatment and scientific study of infantile malnutrition, and to afford medical practitioners and students adequate opportunity for becoming practically acquainted with the factors governing infantile nutrition; to train infant nurses; and, generally, to investigate in the fullest possible manner the diseases and disorders of infants arising from primary malnutrition. Further particulars on the subject are given below under the. headings of " Deaths under one year of age " and " Diarrhcea." Deaths. 2,482 deaths were registered in the City in the 52 weeks ending the 29th December, 1906. After deducting 1,055 deaths of non.citizens in public institutions in the City, and adding those of 790 citizens who died in other districts, the corrected total is 2,227, and is equivalent to. an annual rate of 12.8 per 1,000 persons. The London death.rate for the same period was 15.1, and for England and Wales 15.4. The rates were in each instance below the average of the preceding ten years to the following extent: The City 3.1 per 1,000, London 2.2 per 1,000, and England and Wales 1.4 per 1,000. 11 The following comparative statement shows at a glance the death. rates per 1,000 persons estimated to be living at certain age.periods during each of the last five years:- Age. Period. 1901. 1902. 1903. 1904. 1905. 1906. No. Rate. No. Rate. No. Rate. No. Rate. No. Rate. No. Rate. Under 5 673 52 .1 652 51.7 559 44.7 491 39 .6 490 40.1 487 40.0 5 to 15 55 2.4 74 3 .3 45 2.1 49 2 .2 47 1 .4 51 2.3 15 „ 25 118 2.7 122 2 .8 95 2.2 89 2 1 85 2 .0 70 1 .7 25 „ 35 192 6 4 200 5 1 167 4.3 157 4.0 170 4 .4 123 3.2 35 „ 45 326 151 328 12 0 250 9.3 225 8.4 219 8 .2 222 8.4 45 ,, 55 383 24.7 388 21 .2 303 16.7 284 15.7 307 17 .2 280 15 .9 55 „ 65 401 42 .8 426 38 .0 320 28.8 340 30.9 325 29 .9 330 30.6 65 and over 754 106 .0 762 109 .0 680 98.8 720 105.7 701 104 4 664 99.4 A Factor for Correction of Death.rates, whereby differences in the age and sex constitution of the population may be removed, is arrived at by obtaining the age and sex distribution of the population of a district at the last census; 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 deaths which would have occurred in the district had similar rates been obtained; thus a . standard. death.rate is obtained. The difference between this rate and that for England and Wales is, on the above assumption, due to differences in the age and sex constitution on the population of the district, and dividing the latter by the former a factor is obtained for correcting the crude death.rate of the district. Applying such factors (1.05107 for London, 1.13926 for Westminster) to the 1906 rates, the figures are:. Standard death.rate. Recorded death.rate. Corrected death.rate. Comparative mortality figure. England and Wales 18.19 15 4 15 .4 1,000 County of London 17 31 151 15.8 1,025 City of Westminster 16 .22 12 .8 14.5 941 For the five previous years, 1901.05, the comparative mortality figures were for the County 1,065, 1,100, 1,032, 1,042, and 1,039, and for the City 1,100, 1,082, 1,025, 940, and 993. 12 Tables II. to XII. show the vital statistics of the City and five groups of districts from 1891 to 1906. Ages at Death..Of the total deaths, 323 were those of children under 1 year of age, and 664 of persons over 65 years of age; these are referable to the various wards, as follows :. 1906 Wards. Under 1 Year of Age. Over 65 YeARS oF Age.] 1st Quarter. 2nd Quarter. 3rd Quarter 4th Quarter. The Year. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. The Year. Conduit . 1 . . 1 3 2 . 3 8 Grosvenor 5 1 4 3 13 10 5 10 12 37 Hamlet of Knightsbridge . 1 4 3 8 3 5 5 14 27 Knightsbridge St. George 2 5 2 3 12 13 10 9 8 40 Victoria 30 15 43 10 98 61 40 38 52 191 St. Margaret 1 3 7 3 14 11 14 2 13 140 St. John 24 25 29 24 102 37 39 23 44 143 St Ann 5 9 5 6 25 11 12 8 8 39 Great Marlborough 5 . 6 2 13 7 8 3 4 22 Pall Mall 1 1 . 2 4 2 3 2 2 9 Regent 3 3 3 7 16 7 8 6 3 24 Charing Cross 1 . 1 1 3 1 3 1 6 11 Covent Garden 5 3 2 2 12 17 10 6 5 38 Strand . 1 . 1 2 10 11 6 8 35 The City 82 68 106 67 323 193 170 119 182 664 Infantile Mortality..The meteorological conditions of 1906 were such that a high rate of infantile mortality was expected and actually occurred, but high as it was (compared with recent years) it was not so high as in 1904, when the conditions were somewhat similar, although then the temperature was not so high and more rain fell. The uncorrected rate for the City was 116 deaths per 1,000 births registered in the City, as compared with 143, the average of the previous ten years. The corrected rate was 110. The London rate for 1906 was 130, the average being 149. The infantile death.rate in England and Wales was 133, being 14 per 1,000 below the average. Table II., required by the Local Government Board, shows in detail the ages and causes of death of children under 1 year of age. An examination of the particulars ascertained on inquiry as to infantile deaths during the last 3 years shows that there had been 1,278 children born in 363 families, and that 639 of them had died. Details are given below:. 13 Infant Mortality Statistics for 1904, 1905 and 1906. Original Number in Family. Number of Families. Total Births in Families. Total Deaths. 1 94 94 94 2 86 172 89 3 49 147 69 4 45 180 72 5 20 100 44 6 22 132 65 7 15 105 53 8 7 56 22 9 1 9 4 10 6 60 27 U 6 66 26 12 6 72 27 13 3 39 26 14 1 14 6 16 2 32 15 363 1,278 639 = 50 per cent. of the births in these families. Thirty.eight deaths in 1906 were those of illegitimate infants. The death.rate of such children is much higher than that of legitimate infants:- 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 1905 2,971 305 10.2 149 24 16 .1 1906 2,744 285 10.3 187 38 20 .3 Five years 14,945 1,665 11.1 806 159 19.7 Deaths from whooping cough and measles were fewer in infants under one year of age, but diarrhœal and other stomach complaints caused a considerable increased mortality, there being 88 deaths from such causes, compared with HO in 1905; an analysis of these deaths shows that all the babies except six were bottle.fed. The histories of these six were as follows :- (1) The mother and another child were both ill with diarrhoea before the baby took it. (2) Lived five days, and was apparently injured at birth. (3) Lived ten days, had been given a probably contaminated " comforter " to suck. (4) Had also had occasional " bits of fish and such like." b 14 (5) House very insanitary ; other cases in same house. (6) 16th child, 9 dead, left a good deal with other children to look after. Of the bottle.fed children, 11 were illegitimate, 24 of the mothers were stated to be engaged in work, only three doing it at home, and in three other cases the mother was ill when the baby was seized; nine of the babies were in delicate health before the attack. Improper feeding "was admitted in six instances only. Tube bottles had been in use in more than half the cases. Conyenital Defects and Marasmus.-It is always difficult to know what these terms mean. They seem to cover a number of conditions, such as syphilis, improper and unsuitable feeding, and defective vitality due to the alcoholic condition of the parents, injuries, mental or physical troubles of the mother, &c. Syphilis ought to appear as the cause of death much oftener than it does. From the few deaths recorded, the public are apt to suppose that it is a negligeable quantity, but were still.births registered, it would be discovered that many of these, as well as premature ones were referable to that disease. Medical men are aware of the far.reaching consequences of this disease, as the antecedent of other ailments, as a cause of insanity, and of other defects of the nervous system. Prof. Welander, of Sweden, is quoted in a recent number of the " Lancet" as correctly speaking of syphilis as "the form of disease which during the past four centuries has perhaps of all others occasioned among the peoples of our continent the greatest amount and the highest degree of suffering." As examples of its effects upon the birth.rate of this country, take the following instances (the deaths have not been attributed in the death certificates to syphilis, but a consideration of the circumstances in each case leaves me iu no doubt in the matter):- (a) Mother in wretched health, had 16 children, 11 dead; during the last five years has twice had twins still.born, three other babies (one premature, lived a few hours, one died at four months and one at six months). (b) Mother apparently well, three children healthy, last two dead (one born dead, one lived three weeks). (c) Mother seriously ill, four children, three dead, one ill. Were syphilis to be a notifiable disease, the figures, especially in large towns would be somewhat startling. Of the infantile deaths, other than those due to stomach and bowel affections, in 43 the mothers were stated to be engaged in business in most instances away from home. Deaths from tubercular disease are referred to under the general heading later. 15 Causes of death.-These are set forth in Table X., and also their distribution in the various Wards of the City. There is an increase over 1905 in deaths from diphtheria, erysipelas, diarrhoea, diabetes, alcoholism (including cirrhosis of the liver), meningitis, Bright's disease, and from various forms of violence. Cancer.-During the six years 1901.06 there have been 1,049 deaths from malignant disease in the City; 8 of these were in persons under 25 years of age, 676 between 25 and 65, and 354 in persons over 65. Occupational Mortality.-In Tahle XI. are shown the causes of death among males and females engaged in occupation. For males the list is fairly reliable, but for women it is not so, as the occupation may not be stated in the death certificate, but wherever it has been given it has been recorded. Deaths in Block Dwellings.-These are set out together with the births in Table XII. Deaths in Common Lodging.houses.-93 deaths occurred in 1906 in the common lodging.houses and shelters in the City (91 males and 2 females). As usual, a large proportion (36) of the deaths were due to phthisis; respiratory diseases caused 18 deaths; heart disease, 13; old age, 6; kidney disease, 5; injuries, 3; cancer, 3; insanity, 2; and other complaints, 4. There were 52 deaths in St. John's Ward, 3 in St. Anne's, 2 in Kegent, 22 in Covent Garden, and 14 in Strand. During the year Bruce House has been erected as a common lodging.house at the corner of Kemble Street. The vacant land adjoining Kingsway has again been utilised for shelters, and through the agency of these places a considerable proportion of destitute persons find their way to the poor law infirmaries, and they also add to the death.rate of the district. B 2 16 Table II..Infantile Mortality during the year 1906. Deaths from Stated Causes in Weeks and Months under One Year of Age. CAUSE OF DEATH. Under 1 Week. 1.2 Weeks. 2.3 Weeks. 3.4 Weeks. Total under 1 Month. 1.2 Months. 2.3 Months. 3.4 Months. 4.5 Months. 5.6 Months. 6.7 Months. 7.8 Months. 8.9 Months. 9.10 Months. 10.11 Months. 11.12 Months. Total . Deaths under One Year. All causes. Certified by medical man or coroner 66 24 18 23 131 31 33 16 11 11 22 16 14 10 13 21 329 Uncertified . . . . . . . . . . . . . . . . . Common infectious diseases. Small.pox . . . . . . . . . . . . . . . . . Chicken.pox . . . . . . . . . . . . . . . . . Measles . . . . . . 1 . . . . . . i . 2 4 Scarlet fever . . . . . . . . . . . . . . . . . Diphtheria, croup . . . . . . . . . . . . . . . . . Whooping cough . . . . . . . . . i 2 . . 2 1 2 8 Diarrhœal diseases. Diarrhoea, all forms . . . 1 1 4 11 5 6 2 3 3 2 2 1 2 42 Enteritis, Muco.enteritis, ga.stro.enteritis 1 1 2 1 5 5 4 4 2 2 . . 3 1 1 1 28 Gastritis, gastro.intestinal catarrh . . . 1 1 2 . . . 1 1 . . 1 . . 6 Wasting diseases. Premature birth 36 7 7 3 53 1 1 . . . . . . . . . 55 Congenital defects 4 4 1 . 9 2 1 2 . . . . . . . . 14 Injury at birth 2 1 . . 3 . . . . . . . . . . . 3 Want of breast.milk . . . . . . 1 1 . . . 1 . . . . 3 Atrophy, debility, marasmus 9 5 5 3 22 8 7 3 3 . . . . . . 1 44 17 Tuberculous diseases. Tuberculous meningitis . . . . . 2 . . . 1 4 3 . 1 1 . 12 Tuberculous peritonitis, tabes mesenterica . . . . . 2 . . . . . 1 . . . . 3 Other tuberculous diseases . . . 1 1 . . . . . 1 . 1 . . . 3 Erysipelas . . 1 . 1 . 1 . 1 . 1 . . . . . 4 Other Septic . 2 . 1 3 3 . . . . . . . . . . 6 Syphilis . . 1 . 1 4 1 1 . . . . . . . . 1 Rickets . . . . . 1 . . 1 . 1 . . . . . 3 Meningitis (not tuberculous) . . . . . 1 . . . 1 2 2 . 1 1 . 8 Convulsions 1 1 1 . 3 . . . 1 . . 1 . . . . 5 Bronchitis 1 . . 1 2 . 5 5 5 1 4 1 . 1 3 1 28 Laryngitis . . .. . . . . . . . . . . . . . . Pneumonia 1 1 3 . 5 2 1 . 2 . 1 3 1 1 . . 16 Suffocation, overlying 5 . . . 5 1 . . . . . . . . . . 6 Other causes 4 . . 1 5 1 2 1 1 . . 2 2 . . 1 15 64 22 21 13 120 39 36 22 22 9 20 17 9 11 8 10 323 Births in the year (uncorrected), 2,766. Births in the year (corrected), 2,924. Legitimate, 2,744; illegitimate, 187. Population, estimated to middle of 1906, 173,905. Deaths in the year of legitimate infants, 285; illegitimate infants, 38. Nett Deaths from all causes at all ages, 2,227. 18 Table III.-City of Westminster.-Statistics of Births and Deaths during the 52 Weeks ending 29th December, 1906. 1 2 3 4 5 6 7 8 9 10 11 12 Wards. Population Estimated to Middle of the Year 1906. Births (Corrected). Deaths Under One Tear of Age. Deaths at all Ages. Total. Deaths of Citizens in Public Institutions. Deaths of NonResidents Registered in District. Deaths of Residents Registered beyond District. Deaths at all Ages. Nett. Number. Rate.. Number. Rate per 1,000 Births (Corrected). Number. Rate.. Conduit 5,550 25 4.5 1 40 20 10 6 12 26 4.6 Grosvenor 14,800 131 8.8 13 99 82 40 8 44 118 7.2 Knightsbridge St. George 14,700 150 10.2 12 80 474 29 383 22 113 7.6 Victoria 39,300 864 21.9 98 113 348 274 16 279 611 15.5 St. Margaret 13,100 141 10.7 14 99 368 53 267 39 140 10 .6 St. John 29,800 860 28.8 102 118 313 311 36 310 587 19.6 Hamlet of Knightsbridge 7,520 72 9.5 8 111 36 26 1 27 62 8.2 Pall Mall 2,960 18 6.0 4 222 22 7 4 8 26 8.7 Regent 9,340 141 15.0 16 111 62 42 17 43 88 9.4 Great Marlborough 6,950 137 19.5 13 94 56 41 17 36 75 10.7 Charing Cross 4,210 26 6.1 3 115 43 10 23 10 30 7.1 Covent Garden 8,430 129 15.3 12 93 313 74 246 64 131 15.5 Strand 6,340 20 3.1 2 100 233 58 209 51 75 11.8 St. Anne 10,900 217 19.9 25 115 112 71 38 71 145 13.3 The City 173,905 2,931 16.8 323 110 2,482 1,046 1,045 790 2,227 12.8 . Rates calculated per 1,000 of estimated population. The uncorrected birth.rate was 15'9, the uncorrected death.rate, 14.3. Note.-The deaths included in Column 7 of this fable 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. 19 Table IV. Vital Statistics of Whole Districts during 1906 and Five Previous Years. City of Westminster. 1 2 3 4 5 6 7 8 9 10 11 12 13 Year. Population Estimated to Middle of each Year. Births. Total Deaths Registered in the District. Total Deaths in Public Institutions in the District. Deaths of NonResidents Registered in Public Institutions in the District. Deaths of Residents Registered in Public Institutions beyond the District. Nett Deaths at all Ages belonging to the District. Number (Un. corrected). Rate.. Under 1 Year of Age. At all Ages. Number (net). Rate 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 3,284 17.8 442 134 2,899 15.7 1,129 906 959 2,952 16 .0 1903 179,052 3,017 16 .8 370 122 2,517 14.0 1,086 931 833 2,419 13.5 1904 177,321 2,897 16.3 360 124 2,626 14.8 1,228 1,073 823 2,376 13.4 1905 175,606 2,940 16.7 329 111 2,545 14 5 1,217 1,035 837 2,347 13.3 1906 173,905 2,766 15 .9 323 116 2,482 14 '3 1,223 1,015 790 2,227 12 "8 . Kates in Columns 4, 8, and 13 calculated per 1,000 of estimated population. Note.-The deaths to be included in Column 7 of this Table are the whole of those registered during the year as having actually occurred within the district or division. The deaths to to included in Column 12 are the number in Column 7, corrected by the subtraction of the number in Column 10 and the addition of the number in Column 11. By the term " Non.residents '' is meant persons brought into the district on account of sickness or infirmity, and dying in public institutions there; and by the term " Residents " is meant persons who have been taken out of the district on account of sickness or infirmity, and have died in public institutions elsewhere. The " Public Institutions " to be taken into account for the purpose of these Tables are those into which persons are habitually received on account of sickness or infirmity, such as hospitals, workhouses, and lunatic asylums. A list of the institutions in respect of the deaths in which corrections have been made is given on the next pages. Total population at all ages 183,011 "1 Area of District in acres (exclusive of area covered by water) 2502.7 Number of inhabited houses 18,366 At Census of 1901. Average number of persons per house 8.9 20 Table IV.-continued. I. II. II .-continued. Institutions within tli6 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 (379). Middlesex Hospital. Essex and Colchester Hospital. Westminster Hospital (269). St. Thomas's Hospital. Charing Cross Hospital (222). St. Bartholomew's Hospital. Mount Vernon Hospital. King's College Hospital (194). St. Mary's Hospital. Cheyne Hospital. Sti Peter's Hospital (28). Guy's Hospital. National Hospital. Grosvenor Hospital (17). London Temperance Hospital. St. George's Infirmary, Fulham Road. Heart Hospital, Sobo Square (18). German Hospital. Battersea Infirmary. Women's Hospital, Soho French Hospital. Camberwell Infirmary. Square (12). Victoria Hospital. Islington Infirmary. Throat Hospital, Golden Square (10). General Lying.in Hospital, York Road. Paddington Infirmary. Kensington Infirmary. Gordon Hospital (2). London Hospital. Lambeth Infirmary. Military Hospital, Millbank (1) Evelina Hospital. Edmonton Workhouse. Royal Chest Hospital. St. Giles Workhouse. Queen Alexandra Military Hospital, Millbank (14). Great Northern Hospital. Queen Charlotte's Hospital. St. George's Workhouse, Fulham Road. 9, Grosvenor Gardens (2). Great Ormond Street Central London Sick Asylum, St. George's Workhouse. dren's Hospital. Cleveland Street. Wallis Yard (5). Poland Street Workhouse Cancer Hospital, Chelsea. University College Central London Sick Asylum, Hendon. (21). pital. Banstead Asylum. Sheffield Street Workhouse (9). Brompton Hospital. Belmont Asylum. Hospital of St. John and St. Cane Hill Asylum. 22, George Street, Hanover Elizabeth. Cater bam Asylum. Square, Nursing Home (1). Friedcnheim. Clay bury Asylum. 42, Belgrave Road (2). South.Western Fever Hospital. Colney Hatch Asylum. Darenth Asylum. Western Fever Hospital. Hanwell Asylum. Grove Fever Hospital. Horton Asylum. Royal Hospital Waterloo Road. Leavesden Asylum. Tooting Bee Asylum. Royal Hospital for Incurables. Manor Asylum. Clapham Maternity. III. Ill-continued. Ill - continued. Other Institutions, the Deaths in which have been distributed among the several localities in the District. Other Institutions, the Deaths in which have been distributed among the several localities in the District. Other Institutions, the Deaths in which have been distributed among the several localities in the District. 55, Welbeck Street. St. Thomas's Home. 5, Burwood Place, Paddington. Hostel of God. 7, Mandeville Place, Mary. lebone. St. Joseph's Home. 47, Kenninghall Road, Clapton. 12 and 21, Beaumont Street. 68. Newman Street, Mary. lebone. St. Peter's House. 37, Warrington Road, Paddington. 15, Henrietta Street, Mary. lebone. 12, Hinde Street, Maryle. bone. The Priory, Putney. St. Luke's House, Pem. bridge Square. 20, Bryanston Street, Mary. lebone. H.M. Prison, Holloway. Bookbinders' Asylum, Balls Pond Road. St. Joseph's Hospice, Hackney. 12, Holies Street, Maryle. bone. 21 Table V.-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 December 30th, 1906. Period. United Kingdom. England and Wales. County of London. The City. Conduit Ward. Grosvenor Ward. Hamlet of Knightsbridge Ward. Knightsbridge St. G.eorge Ward. Victoria Ward, St. Margaret Ward. St. John Ward. St. Anne Ward. Great Marlborough Ward. Pall Mall Ward. Regent Ward. Charing Cross Ward. Covent Garden Ward. Strand Ward. 1st Quarter 16 .9 16 .5 16.0 13.7 6 4 10.0 3.7 10 .6 16.3 11 2 19.4 14.3 13 .8 8.1 8.5 8.5 20 .8 13 .8 2nd Quarter 15 .1 146 14 .2 13 1 43 5.9 9.5 8.9 15 5 10 9 20 .5 13 .9 10.3 9.4 11 .9 5.7 14 .2 15 .7 3rd Quarter 14 .2 14.9 14 8 11.4 2 1 6.7 5.8 4.3 15 9 8.5 18 .2 11 0 11.5 9.4 7 9 4.7 13.7 6 .3 4th Quarter 15 .7 15 .6 15.4 12 8 5 7 9.1 13 .8 6.8 14 2 11.9 20.5 13 .9 7.4 8.1 .8.9 9.5 13 2 11.3. The Year 1906 15.5 15.4 15.1 12 8 - - - - - - - - - - - - - „ 1905 15.5 15 2 15 1 13.3 6.2 8.2 9.6 7.4 15 1 10.8 21 0 11.2 12.3 9.6 12.1 10 8 16 .4 12.9 „1904 16 .5 16.2 16 1 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 18.2 16 .2 „ 1903 15.6 15.4 15.2 13.5 4.8 7.5 8.4 8.2 14 .2 12 6 18 8 13.6 14 .4 91 15.7 11.8 15.2 20.0 „ 1902 16.5 16 3 17 .2 16.0 9.8 11 .1 7.8 9.6 l6.9 14.1 23.3 14 .9 18 .1 7.8 16.1 10 .5 16.8 24 .3 1901 . 16.9 17 1 15.6 8 .4 10.3 9.4 11 .2 15.4 13 .7 22.6 12.7 19.8 10 .6 160 10 .3 18.5 26 .3 22 Table YI.-Monthly and Quarterly Death Rates. London. Westminster. Average of 4 Years, 1902.05. 1906. Average of 4 Years, 1902.05. 1906. January 17.6 16.0 17.1 15 .0 February 18.8 15.9 18.2 13.3 March 17.6 16 .2 15.5 13.1 April 15 .9 17 .0 13.4 15 1 May 15.1 13.8 13 .5 12 .0. June 12.7 11 .9 11.3 12.6 July 13 0 11 .3 12.2 10.0 August 15 .5 15.8 12 .4 11.9. September 14 .5 17 1 11.7 12 1 October 13.5 13 .6 12.8 10 .a November 17.4 15.1 13 .7 12 .5 December 17.6 18 .3 16.1 15.6 Quarters. 1st 18 .0 16 .0 16.8 13.7 2nd 14 .5 14 2 12 .6 13 1 3rd 14.5 14 .8 12.1 11.4 4th 16.5 15.4 14.3 12.8 Year 15.9 15.1 14.0 12.8 23 Table VII.—Deaths of Citizens during the Year ending 29th December, 1906, showing Locality at Time of Death. Wards. Locality at Time of Death. Total Deaths (Nett). At Home. Workhouses and Infirmaries. General and Special Hospitals. Fever Hospitals. Lunatic Asylums. Elsewhere. Males. Females. Total. Males. Females. Total. Males. Females. Total. Males. Females. Total. Males. Females. Total. Males. Females. Total. Males. Females. Total. Conduit 5 8 13 2 1 3 4 1 5 - - - 1 1 2 3 - 3 15 11 26 Grosvenor 33 36 69 10 10 20 7 7 14 — — — 3 3 6 6 3 9 59 59 118 Hamlet of Kniglitsbridge 17 18 35 4 3 7 11 8 29 — — — — — — — 1 1 32 30 62 Knightsbridge St. George 30 52 82 3 4 7 10 7 17 1 2 3 — 1 1 2 1 3 46 67 113 Victoria 152 173 325 73 76 149 45 45 90 3 2 5 7 22 29 9 4 13 289 322 611 St. Margaret 43 40 83 11 12 23 17 9 26 1 1 2 1 — 1 3 2 5 76 64 140 St. John 131 132 263 158 63 221 41 32 73 3 6 9 6 2 8 9 4 13 348 239 587 St. Anne 30 44 74 15 14 29 12 10 22 1 2 3 5 2 7 — — — 73 72 145 Great Marlborough 19 14 33 12 7 19 10 5 15 — — — 3 4 7 1 — 1 45 30 75 Pall Mall 7 11 18 — 1 1 3 2 5 — — — — — — 2 — 2 12 14 26 Regent 29 16 45 11 11 22 10 6 16 — — — 1 3 4 1 — 1 52 36 88 Charing Cross 7 11 18 — 4 4 3 2 5 — — — 1 — 1 2 — 2 13 17 30 Covent Garden 32 23 55 31 11 42 14 13 27 — 1 1 3 1 4 2 — 2 82 49 131 Strand 11 4 15 32 16 48 4 2 6 - - - 1 2 3 3 - 3 51 24 75 City of Westminster 546 582 1,128 362 233 595 201 149 350 9 14 23 32 41 73 43 15 58 1,193 1,034 2,227 24 Table VIII (Required by Local Government Board).— Vital Statistics of Separate Localities in 1906 and 15 Previous Years. Names of Localities 1. The City of Westminster. 2. St. George's, comprising Conduit, Grosvenor, Victoria, and Knightsbridge St. George Wards. 3. Westminster, comprising St. Margaret, St. John, and the Hamlet of Knightsbridge Wards. 4. St. James, comprising Kegent.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 (corrected). Deaths under 1 year. Population estimated to middle of each year. Births registered (un- | corrected). 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 (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 (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 67 28,770 606 732 101 1893 198,249 4,255 3,970 699 78,883 1,496 1,217 204 54,783 1,350 1,290 255 23,873 520 470 71 12,334 330 278 58 28,376 559 715 111 1894 197,283 4,017 3,277 587 79,123 1,499 1,096 177 54,349 1,219 1,006 180 23,571 456 390 80 12,290 288 202 41 27,950 555 583 109 1895 196,254 4,155 3,559 683 79,368 1,470 1,185 204 53,915 1,278 1,154 246 23,149 528 407 74 12,246 324 203 48 27,576 555 610 111 1896 194,866 3,968 3,277 642 80,041 1,407 1,117 211 53,481 1,222 987 209 22,955 484 396 72 12,200 292 231 58 26,189 563 546 92 1897 194,120 3,846 3,177 587 80,376 1,365 1,067 183 53,047 1,238 1,005 200 22,576 446 388 75 12,150 314 185 39 25,971 483 532 90 1898 193,304 3,715 3,324 571 80,703 1,411 1,072 172 52,613 1,088 1,093 198 22,200 434 408 73 12,150 290 205 39 25,638 492 546 89 1899 192,452 3,610 3,442 600 81,033 1,348 1,156 177 52,179 1,114 1,174 229 21,827 435 387 69 12,100 296 210 40 25.313 417 515 85 1900 191,269 3,433 3,234 509 81,364 1,295 1,140 146 51,745 1,056 1,097 208 21,457 410 341 62 12,000 273 189 36 24,703 399 467 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 1904 177,321 2,897 2,376 360 75,440 1.183 886 139 51,960 985 813 150 19,730 284 235 27 11.250 205 130 16 19,827 240 312 28 1905 175,606 2,940 2,347 329 74,800 1,162 868 115 51,256 1,057 857 138 19,400 306 229 29 11,000 227 124 21 19,150 188 269 26 Averages of 10 years 1896 to 1905 186,391 3,388 2,944 520 78,334 1,274 1,022 159 52,420 1,111 955 180 21,543 396 342 56 11,715 265 174 33 23,132 367 422 60 1906 173,905 2,766 2,227 323 74,350 1,150 868 124 50,420 973 789 124 19,250 296 189 33 10,900 217 145 25 18,985 179 236 17 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. 25 Table IX.— Vital Statistics of Separate Localities. Birth- and Deathrates per 1,000 Inhabitants, and Death-rates of Lnfants under 1 Year per 1,000 births, calculated from the figures in Table VIII. compared with the Average Rates in the 10 Years 1896—1905. Birth-rate (Uncorrected). Death-rate (Corrected). Deaths under 1 per 1,000 Births Registered in the City. Average, 10 Years. 1906. Average, 10 Years. 1906. Average, 10 Years. 1906. 1. St George's Division— Comprising Conduit, Grosvenor, Victoria, and Knightsbridge St. George Wards 16.4 15.4 13.1 11.6 124 100 2. Westminster Division— Comprising St. Margaret and St. John and the Hamlet of Knightsbridge Wards * 21.3 19.3 18.3 15.6 162 127 3. St. James Division— Comprising Pall Mall, Regent, and Great Marlborough W ards 18.5 15.4 16.0 10.o 141 111 4. St. Anne Ward 22.8 19.9 15.0 13.3 124 115 5. Strand Division— Comprising Covent Garden, Strand,* and Charing Cross Wards 16.0 9.4 18.4 12.3 163 95 The City of Westminster 18.3 15.9 15.9 12.8 143 116 The County of London 29.0 26.6 17.3 15.1 149 130 England and Wales 28.7 27.0 16.8 15.4 147 133 The United Kingdom 28.0 26.8 16.9 15.5 — — * The area of these divisions was altered at the incorporation of the City in 1900. 26 Table X.—Causes of, and Ages at, Death during the 52 weeks ending 29th December, 1906. Causes of Death. Corrected Deaths in the City at subjoined Ages. Deaths in Wabds (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 20 4 15 — — 1 — — — — — 4 1 5 4 1 - 3 — 2 - Scarlet fever 14 - 9 5 - — - - - - 3 3 1 4 2 - - - - 1 - Epidemic influenza 25 1 1 — — 11 12 2 1 2 1 5 1 8 1 — - - — 3 1 Whooping cough 23 8 14 1 — — - — — 1 2 5 1 9 2 1 - 2 - - - Diphtheria, Memb. croup 16 — 15 1 - - - - - - - 2 3 7 2 — - 1 — 1 — Croup - - - - - - - - - - — — — — — — - — — - - Enteric fever 4 - 1 - 2 1 - - - - - 2 1 - - - - - - - 1 Diarrhœa 23 21 5 — — 1 1 - 1 — — 11 — 12 2 - - - - 2 - Epidemic enteritis 47 36 8 - - 2 1 - 1 2 - 16 2 21 - 1 - 2 1 - 1 Enteritis 20 14 - — 1 4 1 - 2 — 2 8 - 2 — 2 - 1 - 3 - Erysipelas 8 4 — — — 3 1 - - — 1 2 - 3 — 1 - 1 - - - Puerperal fever 5 — - — 1 4 - — - — 1 1 - 3 — - - - - - - Other septic diseases 25 6 - - 3 13 3 1 - 1 1 6 2 7 4 1 - 1 1 - - Syphilis, &c. 13 7 - - 1 4 1 - 1 - - 3 2 4 2 - - 1 - - - Diabetes 23 - 1 — 1 14 7 1 3 - - 10 3 5 - - - - - 1 - Malarial diseases 1 — — — — 1 - — — — — — — - — — - - - 1 - Rheumatic fever 8 — - 3 1 3 ] — 1 — — 2 1 3 — — - 1 — - — 27 Tuberculosis of meninges 36 12 16 3 — 5 — — 1 — 1 10 2 11 4 3 — 1 — 3 — Tuberculosis of lungs 237 — 2 2 16 192 25 — 11 2 5 48 9 96 11 8 2 8 2 27 8 Tuberculosis of periloncum 13 3 4 1 — 4 1 — — — — 3 1 6 2 — — — — 1 — Other forms of tuberculosis 25 3 6 6 2 7 1 — . l 1 — 7 1 8 1 2 — 1 — 1 2 Alcoholism 14 — — — — 14 — — — — 1 3 2 2 1 1 — — — 3 1 Malignant growths 168 — — — 1 113 54 2 12 9 10 55 18 29 5 5 — 6 3 9 5 Premature birth 55 55 — — — — — — 2 1 3 14 1 19 6 1 1 4 1 2 — Developmental diseases 71 62 9 — — — — 1 3 2 2 28 4 21 3 2 2 — — 3 — Old age 108 — — — — 6 102 1 3 4 9 45 7 16 6 2 1 6 1 4 3 Meningitis and convulsions 30 13 14 2 — 1 — — — 1 1 10 3 6 3 1 — 2 — 3 — Other diseases of nervous system 101 1 2 5 2 50 41 - 6 2 6 26 6 19 11 5 - 8 - 5 7 Valvular diseases of heart 87 — 1 1 6 41 38 2 4 3 5 25 4 18 7 3 1 2 1 7 5 Other circulatory diseases 196 — — 1 2 106 87 3 10 8 20 59 12 38 8 8 2 8 5 6 9 Bronchitis 207 28 9 — — 63 107 2 11 4 10 45 15 60 18 7 3 6 4 6 16 Lobar (croupous) pneumonia 24 - 1 1 1 13 8 - 4 - - 5 1 2 3 1 2 2 - 3 1 Lobular (broncho-) pneumonia 65 11 17 1 1 6 29 1 3 1 4 16 3 25 4 - - 3 - 4 1 Other respiratory diseases 99 5 5 4 6 40 39 2 5 1 6 33 7 27 3 2 1 1 1 7 3 Cirrhosis of liver 51 — — — — 42 12 2 2 2 2 13 2 9 10 1 1 3 2 4 1 Other digestive diseases 75 7 2 — 8 43 15 2 7 2 5 23 6 11 4 4 1 2 3 4 1 Bright's disease, &c. 120 1 1 2 — 65 51 — 10 7 6 29 3 29 5 5 7 6 2 6 5 Generative system diseases 6 — — — — 5 1 — — — — 1 1 1 1 — 1 — — 1 — Accidents and diseases of parturition 4 - - - - 4 - - - - - 2 - 2 - - - - - - - Deaths by accident or negligence 86 16 5 10 7 34 14 1 7 3 4 13 7 27 7 4 - 1 3 6 3 Deaths by suicide and murder 29 1 - - 3 22 3 3 2 2 2 6 2 7 2 1 1 1 - - - All other causes 37 4 1 2 5 17 8 — 4 1 — 12 5 5 1 2 — 4 — 2 1 All causes 2,227 323 164 51 70 955 664 26 118 62 113 611 140 587 145 75 26 88 30 131 75 28 Table XI.—Grouped Occupations of Males aged, 10 Years and Upwards, with Causes of Death, in 1906. Total Occupied and Unoccupied. Retired or Unoccupied. Engaged in Occupations. Total Deaths, 1906. Infectious Diseases. Septic. Phthisis. Other Tubercular. Bronchitis. Pneumonia. Other Respiratory. Alcoholism. Cirrhosis of Liver. Other Digestive Diseases. Rheumatic Fever. Valvular Disease. Other Circulatory. Insanity. Other Nervous. Cancer. Diabetes. Bright's Disease. Suicide. Accident. Other Causes. Old Age. General or Local Government 17 - - 2 - - 1 1 - 1 2 - 1 1 - 3 - - 1 - - 1 1 Defence of country 42 — — 2 — — 4 — — 2 2 1 2 7 1 2 7 2 2 1 - 3 4 Professional 54 3 1 4 3 1 3 1 1 3 5 — 1 12 2 - 3 - 3 - 5 2 1 Commercial 40 2 2 5 — 4 3 1 - 1 2 - 2 4 - 1 3 1 3 3 1 1 1 Domestic service 115 3 2 19 1 9 3 - 3 5 6 - 7 19 5 1 14 1 4 5 4 2 2 Conveyance of men, goods, or messages 142 2 3 42 4 8 10 4 — 4 3 1 10 8 2 2 11 2 11 1 6 4 4 Gardeners, florists (not domestic) 1 - - 1 - - - - - - - - - 1 - - - - - - - - - Jewellers, opticians, &c. 12 — — 4 — 2 1 - - - - - - - - - - - - - - - - Metal workers, smiths, &c. 29 1 — 2 — 2 2 — - — 1 - 2 5 1 1 2 2 3 1 - 1 3 Building and works of Construction 70 — — 9 1 10 9 3 — — 3 — 1 12 — 5 5 1 6 — 1 3 1 Wood, furniture, decorations, &c. 12 — — 2 — 1 4 — — — — — — — — 1 1 — 1 — — 2 — Chemicals, oil and grease 3 - - 1 - - 1 - - - - - - 1 - - - - - - - - - Papers, books, stationery 32 1 1 10 — 4 2 — - — 2 — - 2 — 1 2 - 3 1 2 - 1 Textile fabrics 4 — — — — — - - - - - - - 2 - 1 - - - - - - - Tailors 33 1 — 7 — 3 - - - 1 1 - - 6 1 2 2 - 3 2 1 - 3 Boot and shoe makers 18 — - 5 - 4 - - - - - - - 2 1 - 2 - - - 1 1 2 Other workers in dress, &c. 8 - - 1 - 1 - - - 1 2 - - 2 - - - - - - 1 - 1 Skin, leather, fur, &c. 9 - — 1 - — 1 1 - - 2 - - 1 - 1 1 - - - 1 - - Food, tobacco, drink, and lodging 66 2 — 12 — 1 8 — — 8 3 — 1 13 — 3 5 — 2 1 3 1 3 General dealers, hawkers, &c., and labourers (not distinguished) 124 2 4 24 3 14 8 2 - 1 3 4 10 3 4 10 - 6 2 7 7 9 — Gas, water, electricity, and sanitary services 12 1 1 5 — — — — — — — 1 2 — — — — 1 1 — — — — Independent, pensioners, students, &c. 68 4 - 4 2 7 8 2 - 3 3 2 5 - 5 2 - 6 3 6 2 4 - 29 Table XI. continued.—Occupations of Females over 10, with Causes of Death, 1906. Total Deaths. Infectious Diseases. Septic. Phthisis. Other Tubercular. Bronchitis. Pneumonia. Other Respiratory Diseases. Alcoholism. Cirrhosis of Liver. Other Digestive Diseases. Rheumatic Fever. Valvular Diseases. Other Circulatory Diseases. Insanity. Other Nervous Diseases. Cancer. Diabetes. Bright's Disease. Suicide. Accident. Other Causes. Old Age. Government 1 - - - - - - - - - 1 - - - - - - - - - - - - Commercial 2 - - - - - - - - - - - 1 - - - - - - - 1 - - Professional 11 — — — — 3 — — — — 1 — 2 2 - 1 2 — — - - - - Domestic indoor service 71 1 2 4 1 6 6 — 2 — 8 — 6 5 2 5 6 — 3 1 4 1 6 Charwomen 21 1 — — — 3 2 1 — 3 1 — 1 3 — 1 5 - - - - - 1 Laundresses 13 1 — 2 — 1 2 — — — — — 2 1 2 — 3 — — — - - 2 Upholsterers 3 — 1 1 — 1 - - - - - - - - - - - - - - - - - Tailoresses 16 2 2 2 1 — — — — — — — 2 1 — 2 1 - 1 - - 1 - Dressmakers, milliners, &c. 31 1 2 2 — 3 2 — — — 2 — 2 4 3 1 6 — 1 — - - 2 Lodging- and boarding-house keeper 6 — — — — — 1 — — — 1 - 1 1 - - - - - - - 1 1 Inn and hotel service 8 — 1 — — — — — — 21 — — 1 1 — — 1 — 1 — 1 - - Shopkeepers and shop assistants 6 — — 2 — — 1 - — 1 - - 1 - - - - - 1 - - - - Hawkers 5 — - 1 - 1 - - - - - - - - - - - - 1 - - - 2 Others 3 - - - - 2 - - - - - - - - - - - - 1 - - - - c 30 Table XII.— Vital Statistics relating to Residents in Blocks of Dwellings in the City of Westminster, 1906. Buildings. Population. Births. Total Deaths. Infectious Deaths. Tubercular Deaths. Respiratory. Digestive. Circulatory Diseases. Nervous Diseases. Kidney Diseases. Violence. Cancer. Other Deaths. Deaths Under 1. Deaths Over 65. Westminster City Council — Regency Street 1,138 63 16 2 5 1 2 1 1 1 — — 3 7 — St. James's Dwellings and 7, Ingestre Place 71 1 2 - - - - 1 1 — — — — — 1 Marshall Street — 1 — - - — - 1 — — — — — — — Peabody 6,761 186 88 7 20 13 3 12 6 4 3 9 11 14 17 Westminster 187 2 1 — — — — — — 1 — — — — — London County Council— Millbank 3,043 117 41 6 10 6 1 3 3 1 3 1 7 10 5 Drury Lane 1,000 15 14 4 2 3 2 2 1 — — — — 2 4 Improved Industrial 6,878 91 40 1 5 10 — 10 1 — — 5 5 4 14 Metropolitan Association 757 17 15 2 2 5 — — 2 — — 2 2 3 8 St. George's Model Dwellings 419 8 8 — 2 2 — 1 — 1 — — 2 3 2 Clerkenwell and Soho Company (Newport Market) 1,184 17 20 1 3 2 5 1 3 1 1 1 2 4 3 Greencoat 119 - - - - - - - - - - - - - - Spencer 99 — — — — — — — — — — — — — — Chapter Chambers 175 2 3 1 — 1 — 1 — — — — — 1 — Alexandra and Castle — 1 - - - - - - - - - - - - - New Buildings — 1 — — — — — — — — — — — - - St. James's Residences - 14 5 3 1 - - - 1 - - - - 2 - 31 B. Communicable Diseases. (1) Compulsorily Notifiable Diseases. The details respecting the 931 notifications of infectious disease received by me 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 XIII 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 duplicate notifications. The chart below indicates the number of notifications of scarlet fever, diphtheria, enteric fever, and erysipelas in each week. One hundred and eighteen visits were paid in connection with doubtful cases, contacts, children returning from fever hospitals, &c. Small-pox.—There were 31 notifications of this disease in London in 1906; none of these were in Westminster. Twenty-three persons were notified as having been in contact with cases of small-pox elsewhere than in the City, and these were kept under observation. Two persons suspected to be suffering from smallpox were seen by me at the request of their medical attendants. Five chicken-pox contacts were also notified by Port Sanitary Authorities. Vaccination.—The Vaccination Officers have supplied me with the following particulars for 1905:— Vaccination Statistics. 1905. Union. Births. Died Unvaccin ated. Successfully Vaccinated. Insusceptille. Vaccination Postponed. Conscientious Objectors. Removed and Vaccination Officer Informed. Not Found. Removed to Address Unknown. St. George 2,220 174 1,945 4 14 11 25 47 Westminster 539 33 462 0 1 3 23 17 Strand 179 18 135 3 5 0 5 11 The City 2,938 225 2,542 7 20 14 53 75 The following is a summary of the total primary vaccinations performed in the City during 1901, 1902, 1903, 1904. 1905 and 1906, and of re-vaccinations, in so far as these were made by the Public Vaccinators:— c 2 32 Vaccination Returns. Primary Vaccinations under 14 years of age, in the Union District of Re-vaccinations performed by Public Vaccinators in the Union District of St. George's. Westminster. Strand. St. George's. Westminster. Strand. 1901 2,467 1,491 725 4,039 3,317 2,201 1902 2,893 715 450 7,453 6,226 3,910 1903 2,178 369 245 159 9 347 1904 2,065 325 *144 72 13 398 1905 2,162 498 142 47 7 418 1906 1,210 372 145 51 5 397 # There were also 16 primary vaccinations of persons over 14 years of age. Table XIII.—Infectious Diseases Notified, 1890-1906, in London. Year. Smallpox. Scarlet Fever. Diphtheria and Croup. Enteric Fever. Typhus Fever. Other Continued Fevers. Puerperal Fever. Erysipelas. Cholera. Relapsing Fever. Totals. 1890 60 15,330 5,870 2,877 35 237 206 4,598 25 7 30,245 1891 114 11,398 6,412 3,372 27 152 221 4,764 23 39 26,552 1892 423 27,095 8,356 2,465 20 147 347 6,934 54 7 45,848 1893 2,813 36,901 13,694 3,666 22 205 397 9,700 86 4 67,485 1894 1,192 18,440 11,190 3,360 21 162 253 6,080 21 2 40,925 1895 979 19,757 11,223 3,506 14 105 236 5,660 29 3 41,512 1896 225 25,647 13,941 3,190 6 103 279 6,438 13 3 49,845 1897 104 22,848 13,199 3,103 4 65 264 5,800 38 1 45,361 1898 32 16,894 11,855 3,024 16 55 247 5,169 23 1 37,316 1899 29 18,113 13,704 4,463 14 69 330 5,615 15 ] 42,353 1900 87 13,800 11,985 4,291 7 73 237 4,762 5 — 35,247 1901 1,700 18,381 12,167 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 1905 74 19,461 6,482 1,552 9 14 292 4,972 — 1 32,857 1906 31 20,343 8,035 1,606 7 9 297 5,026 2 — 35,356 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 1905 2 370 118 41 - - 12 123 - - 666 1906 - 540 206 47 — 2 9 127 — — 931 33 Table XIII.—continued. 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 0.1 37.6 26.3 6.7 0.0 0.1 0.5 11.5 1899 0.l 39.9 30.1 9.8 0.0 0.2 0.7 12.3 1900 0.2 30.1 26.1 9.3 0.0 0.2 0.6 10.3 1901 3.7 40.1 26.7 7.0 0.04 0.1 0.5 10.1 Average of 10 years 1892-1901 1.7 49.4 27.2 7.7 0.02 0.2 0.6 13.5 1902 16.7 39.1 23.0 7.3 0.00 0.1 0.6 11.8 1903 0.9 27.1 16.7 5.0 0.04 0.08 0.5 9.4 1904 1.0 28.9 15.5 4.0 0.00 0.06 0.59 10.6 1905 0.15 41.5 13.5 3.3 0.02 0.03 0.6 10.6 1906 0.06 43.0 17.0 3.3 0.01 0.01 0.6 10.6 Average of 5 years 1902-06 3.7 35.9 17.1 4.6 0.01 0.05 0.6 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 l 27.4 13.7 8.5 — 0.5 0.1 6.9 1895 1.0 36.9 15.6 5.9 — 0.2 0.2 7.1 1896 0.4 43.1 16.4 6.2 — 0.3 0.4 9.1 1897 0.7 34.3 17.5 5.4 — 0.3 0.3 9.1 1898 0.1 21.5 17.7 5.9 — 0.1 0.3 6.9 1899 — 28.1 14.9 7.5 — 0.1 0.2 9.3 1900 0.1 24.0 15.2 6.2 — 0.1 0.3 6.8 1901 5.5 35.7 13.6 5.6 — 0.1 0.32 6.3 Average of 10 years 1892-1901 1.8 35.5 16.0 6.3 — 0.25 0.31 8.3 1902 12.6 25.8 15.4 7.1 - 0.05 0.32 7.8 1903 2.5 19.6 10.3 3.9 - 0.11 0.27 6.2 1904 0.3 17.6 8.2 2.9 0.05 0.11 0.28 7.1 1905 0.1 21.0 6.7 2.3 — — 0.68 7.0 1906 — 31.0 11.8 2.7 — 0.11 0.51 7.2 Average of 5 years 1902-06 3.1 23.0 10.5 3.8 0.01 0.07 0.41 7.1 34 Notifications of Infectious Diseases during the year 1906. London. City of Westminster. 35 City of Westminster. Table XIV.—Local Government Board Table G.— Cases of Infectious Disease Notified during the 52 weeks ending 29th December, 1906. 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. Cunduit. Grosvenor. Knightsbridge St. George. Victoria. St. Margaret. St. John. Kamlet of Knightsbridge. Pall Mall. Regent. Great Marlborough. Charing Cross. Covent Garden. Strand. St. Anne. Conduit. Grosvenor. Knightsbridge St. George. Victoria. St. Margaret. St. John. Hamlet of Knightsbridge. Pall Mall. Kegent. 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 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Deaths - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Diphtheria— Cases 206 8 71 87 25 15 — 1 9 17 33 20 66 5 3 11 10 2 5 5 19 1 7 14 29 18 63 3 3 11 9 2 5 5 19 189 Deaths 16 — l5 1 — — — — — — 2 3 7 — — 1 — — 1 — 2 Erysipelas— Cases 127 4 1 9 13 86 14 — 4 6 45 9 28 1 — 6 7 6 3 3 9 — 1 2 9 6 11 1 — 2 2 4 2 3 2 45 Deaths 8 4 — — — 3 1 — — 1 2 — 3 — — 1 1 — — — — Fevers. Scarlet— Cases 540 4 135 303 64 34 — 10 28 34 119 36 175 8 6 20 32 4 23 8 37 8 24 32 115 33 171 5 6 19 30 4 23 8 34 512 Deaths 14 — 9 5 - - - - - 3 3 1 4 - - - - - 1 - 2 Enteric— Cases 47 — 2 7 15 23 — 1 3 2 9 3 7 3 - 1 2 1 5 3 7 - 1 - 7 2 6 2 - 1 2 1 2 1 7 32 Deaths 4 — 1 — 2 1 — — — — 2 1 — - - - - - - 1 - Continued— Cases 2 — — 1 1 - - - - - 1 - 1 - - - - - - - - - - - - - 1 - - - - - - - - 1 Deaths - - - - - - - - - - - - - - - - - - - - - Puerperal- Cases 9 — — — 1 8 — — — 1 3 1 4 — — — — — — — — — — 1 — 1 1 — — — — — — - - 3 Deaths 5 — — — 1 4 — — — 1 1 — 3 — — — — — — — — Typhus- Cases - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Deaths - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Total Cases 931 16 209 407 119 166 14 12 44 60 210 69 281 17 9 38 51 13 36 19 72 9 33 49 160 60 253 11 9 33 43 11 32 17 62 782 12 cases notified as scarlet fever, 30 as diphtheria, and 7 as enteric fever were eventually alleged not to be suffering from the disease notified. In addition to the above, 1 case of scarlet fever, 1 of puerperal fever and 1 of enteric fever were not notified. 36 Table XV.— London and the Metropolitan Boroughs.—Births and Deaths of Persons belonging to London and the Metropolitan Boroughs during the 52 Weeks of 1906.*—Prepared by the Registrar-General. Boroughs. Births. Deaths from Deaths under 1 year of Age. All Causes. Small-pox. Measles. Scarlet Fever. Diphtheria. Whooping-cough. Typhus. Enteric Fever. Pyrexia† (Origin uncertain). Diarrhœa. Phthisis. County of London 124,880 71,155 - 1,909 533 691 1,226 — 260 4 4,424 6,775 16,307 West. Paddington 3,375 1,856 — 16 18 15 12 — 7 — 125 167 355 Kensington 3,457 2,499 — 81 11 19 20 — 5 — 144 229 456 Hammersmith 3,112 1,777 — 57 15 27 19 — 8 — 131 151 430 Eulham 4,853 2,214 — 53 18 32 31 - 13 - 241 182 649 Chelsea 1,593 1,168 - 58 9 15 17 - - - 52 117 212 City of Westminster 2,931 2,227 — 20 14 16 23 - 4 1 75 237 323 North. St. Marylebone 2,718 1,910 — 47 14 12 11 — 3 — 77 200 317 Hampstead 1,473 844 — 10 5 8 2 — 3 — 23 60 113 St. Pancras 6,122 3,743 — 96 32 23 70 — 15 1 155 426 753 Islington 8,767 5,071 — 193 37 30 74 — 20 — 201 422 1,089 Stoke Newington 1,105 612 — 11 1 4 17 — — — 25 55 113 Hackney 5,694 3,061 — 65 22 20 39 — 14 - 203 300 676 Central. Holborn 1,239 1,001 - 25 3 6 10 - 1 - 35 132 149 Finsbury 2,938 2,011 — 123 15 23 54 - 14 - 120 212 469 City of London 355 369 - 3 7 2 4 - 1 — 6 37 36 East. Shored itch 3,963 2,275 — 75 19 15 61 - 5 - 187 233 644 Bethnal Green 4,488 2,464 — 60 22 20 63 — 14 - 154 293 697 Stepney 10,811 5,431 — 175 37 61 104 — 26 — 437 526 1,453 Poplar 5,334 2,999 — 108 13 28 52 — 11 — 291 263 821 South. Southwark 6,225 3,768 - 95 45 31 54 - 12 - 225 429 895 Bermondsey 4,075 2,532 — 94 29 34 51 - 4 - 165 258 623 Lambeth 8,270 4,726 - 77 28 51 71 - 22 1 282 430 1,086 Battersea 4,688 2,392 - 41 24 18 78 - 8 - 158 230 591 Wandswort 7,199 3,481 — 66 19 49 60 — 15 - 226 274 873 Camberwell 7,020 3,998 — 112 25 40 77 - 13 - 247 344 910 Deptford 3,292 1,849 - 69 15 20 62 - 6 - 138 148 472 Greenwich 2,672 1,415 - 31 17 29 42 - 5 - 72 125 318 Lewisham 3,466 1,777 — 21 14 21 27 - 1 1 130 122 391 Woolwich 3,549 1,668 - 30 5 22 21 - 9 — 105 169 388 * The Births in this Table have been corrected by distributing those which occurred in the chief Lying-in Institutions to the boroughs in which the mothers had resided previous to admission. In 772 cases the residence was outside the County of London, and these have been excluded from this Table Deaths have been similarly treated. † Called Simple Continued Fever previous to 1901. 37 Table XV1.—London and the Metropolitan Boroughs.—Death-Rates per 1,000 Persons Living, and infantile Mortality, after Distribution of Births in the Chief Lying-in Institutions and of Deaths in Public Institutions, &c., in the Five Years 1901-5, and in 1906.—Prepared by the Registrar-General. Boroughs. All Causes. Small-Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Typhus. Enteric Fever. Pyrexia. Diarrhœa. Phthisis. Deaths under One Year to 1000 Births. 19011905. 1906. 19011905. 1906. 19011905. 1906. 19011905. 1906. 19011905. 1906. 19011905. 1906. 19011905. 1906. 19011905. 1906. 19011905. 1906. 19011905. 1906. 19011905. 1906. 19011905. 1906. County of London 16.1 15.1 0.07 — 0.45 0.41 0.11 0.11 0.20 0.15 0.35 0.26 0.00 — 0.08 0.06 0.00 0.00 0.75 0.94 1.57 1.44 139 131 Paddinglon 13.8 12.5 0.03 - 0.32 0.11 0.07 0.12 0.16 0.10 0.27 0.08 - - 0.07 0.05 - - 0.64 0.84 1.07 1.12 123 105 Kensington 14.5 13.8 0.02 — 0.37 0.45 0.09 0.06 0.12 0.11 0.28 0.11 0.00 — 0.06 0.03 0.00 — 0.60 0.80 1.30 1.27 145 132 Hammersmith 15.4 14.8 0.05 — 0.49 0.47 0.08 0.12 0.21 0.22 0.40 0.16 — — 0.08 0.07 0.00 — 0.82 1.09 1.37 1.25 145 138 Fulbam 15.5 13.7 0.02 — 0.56 0.33 0.10 0.11 0.23 0.20 0.45 0.19 — — 0.08 0.08 0.00 — 1.23 1.49 1.36 1.13 143 134 Chelca 16.2 15.7 0.02 — 0.32 0.78 0.08 0.12 0.10 0.20 0.32 0.23 — — 0.06 — — — 0.50 0.70 1.61 1.57 135 133 City of Westminster 14.5 12.81 0.06 — 0.23 0.17 0.07 0.08 0.09 0.09 0.18 0.13 — — 0.08 0.03 0.00 0.01 0.35 0.43 1.68 1.36 118 110 St. Marylebone 16.6 14.9 0.05 - 0.35 0.37 0.ll 0.11 0.16 0.09 0.24 0.09 - — 0.07 0.02 0.01 - 0.60 0.60 1.76 1.56 134 117 Hampstead 10.2 9.4 0.0l — 0.11 0.ll 0.05 0.06 0.ll 0.09 0.18 0.02 — — 0.06 0.03 — — 0.19 0.26 0.83 0.67 95 77 St. Pancras 17.3 15.9 0.l0 — 0.49 0.41 0.13 0.14 0.27 0.10 0.39 0.30 — — 0.09 0.06 — 0.00 0.58 0.64 1.79 1.81 137 123 Islington 15.3 14.7 0.04 — 0.41 0.56 0.10 0.11 0.20 0.09 0.35 0.22 — — 0.09 0.06 0.00 — 0.50 0.58 1.44 1.23 127 124 Stoke Newington 13.1 11.5 0.04 — 0.22 0.21 0.06 0.02 0.15 0.08 0.24 0.32 — — 0.07 — 0.00 — 0.46 0.47 1.38 1.04 115 102 Hackney 14.7 13.3 0.07 — 0.40 0.28 0.09 0.10 0.25 0.09 0.29 0.17 — — 0.13 0.06 — — 0.77 0.88 1.35 1.30 132 119 Holborn 19.2 18.0 0.26 - 0.43 0.45 0.07 0.05 0.14 0.11 0.28 0.18 — - 0.11 0.02 — — 0.53 0.63 2.93 2.37 138 120 Finsbury 21.0 20.7 0.09 — 0.60 1.27 0.16 0.15 0.22 0.24 0.45 0.56 — — 0.10 0.14 — — 0.98 1.23 2.23 2.18 160 160 City of London 17.8 17.3 0.07 — 0.12 0.14 0.06 0.33 0.19 0.09 0.16 0.19 — — 0.06 0.05 — — 0.24 0.28 1.70 1.74 134 101 Shoreditch 20.4 19.6 0.14 - 0.69 0.65 0.13 0.16 0.19 0.13 0.56 0.53 - - 0.09 0.04 - — 1.31 1.62 2.10 2.01 173 163 Bethnal Green 19.4 18.9 0.11 - 0.57 0.46 0.18 0.17 0.31 0.15 0.42 0.48 — — 0.09 0.ll 0.01 — 0.89 1.18 2.09 2.25 150 155 Stepney 19.3 17.7 0.19 — 0.56 0.57 0.12 0.12 0.24 0.20 0.44 0.34 0.00 — 0.10 0.08 0.00 — 1.07 1.43 1.99 1.72 150 134 Poplar 18.7 17.6 0.13 — 0.58 0.63 0.12 0.08 0.38 0.16 0.49 0.31 — — 0.11 0.06 — — 1.15 1.71 1.70 1.55 154 152 Southwark 19.9 18.1 0.09 - 0.72 0.46 0.15 0.22 0.20 0.15 0.46 0.26 — - 0.09 0.06 o.oo — 1.01 1.08 2.40 2.06 158 144 Bermondsey 19.8 19.7 0.07 — 0.74 0.73 0.19 0.23 0.18 0.26 0.42 0.40 0.00 — o.11 0.03 0.00 — 1.03 1.29 1.86 2.01 159 153 Lambeth 16.1 15.0 0.04 — 0.39 0.24 0.10 0.09 0.13 0.16 0.36 0.23 — — 0.07 0.07 0.00 0-00 0.78 0.90 1.52 1.37 138 131 Battersea 14.9 13.4 0.03 — 0.61 0.23 0.09 0.13 0.11 0.10 0.39 0.44 — — 0.08 0.04 — — 0.84 0.88 1.36 1.28 138 126 Wandsworth 13.1 12.8 0.02 0.37 0.24 0.108 0.07 0.18 0.18 0.27 0.22 — — 0.07 0.06 0.00 — 0.60 0.83 1 .03 1.01 120 121 Camberwell 15.0 14.6 0.05 0.41 0.41 0.11 0.09 0.20 0.15 0.32 0.28 — — 0.07 0.05 — — 0.67 0.90 1.36 1.26 133 130 Deptford 15.7 16.1 0.06 — 0.50 0'.60 0.13 0.13 0.23 0.17 0.36 0.54 0.00 — 0.06 0.105 o.oo — 0.80 1.20 1.26 1.28 136 143 Greenwich 14.3 13.5 0.05 0.36 0.29 0.06 0.16 o.13 0.28 0.33 0.40 — — 0.07 0.05 — — 0.75 0.69 1.21 1.19 131 119 Lewisham 12.3 12.0 0.02 0.23 0.14 0.08 0.09 0.16 0.14 0.24 0.18 — — 0.06 0.01 — 0-01 0 .56 0.8S 0.91 0.82 112 113 Woolwich 14.1 13.1 0.06 — 0.21 0.24 0.07 0.04 0.17 0.17 0.28 0.17 0.07 0.07 0.73 0.83 1.58 1.33 120 109 38 Scarlet Fever.—In London the year 1905 had some 6,000 more cases than .1904, and it was to be expected that the prolonged dryness of 1906 would be accompanied by a further increase in scarlet fever, diphtheria,, erysipelas, and diarrhoea. The figures for both London and Westminster,. ^ unfortunately, agree with the expectation. So far as scarlet fever is concerned, the number of cases (540) notified in Westminster was higher than any year since 1897 (1899 being the nearest with 534).. From the tables below it will be seen that it was chiefly in St. John's and Victoria Wards that the majority of the cases occurred. In 1905 the northern part of the City was attacked, but towards the end of that year Victoria Ward became affected, and then in 1906 it spread to St. John's, being apparently associated with the group of schools on both sides of Vauxhall Bridge Road, at its lower end. Fortunately, so far as fatality was concerned, the type of the disease was of a mild character, but this mildness also contributed to the spread of the disease, as many cases were not recognised until others had been infected from them ; thus 1 find there were four cases in one house in eleven instances, three cases in seventeen instances, and two cases in forty-three instancesThe symptoms in such cases were often so slight and evanescent that no doctor was called in, or they were of an anomalous character that medical men had difficulty in deciding if it was an infectious complaint. Visits were paid to a number of children found to be absent from schools in which cases had occurred, and in several instances whole families were found who had had symptoms, which in the light of an existing well-marked case must have been due to a mild attack. Scarlet Fever, 1906. Conduit. Grosvenor. Hamlet of Knightsbridge. Knightsbridge St. George. Victoria. St. Margaret. St. John. 1st quarter 3 5 3 11 25 11 20 2nd quarter 2 2 4 12 26 12 47 3rd quarter 2 3 — 8 30 3 40 4th quarter 3 18 1 3 38 10 68 Total cases 10 28 8 34 119 36 175 Deaths — — — 3 3 1 4 Attack rate per 10,000population 18.0 18.9 10.7 23.1 30.2 27.4 58.7 Mortality per cent. of cases - - - 8.8 2.5 2.7 2.3 39 Scarlet Fever, 1906. St. Anne. Great Marlborough. Pall Mall. Regent. Charing Cross. Covent Garden. Strand. Totals for City. 1st quarter 12 8 2 6 - 6 1 113 2nd quarter 14 11 4 2 2 10 1 149 3rd quarter 5 3 — 5 1 4 2 106 4th quarter 6 10 — 7 1 3 4 172 Total cases 37 32 6 20 4 23 8 540 Deaths 2 — — — — 1 — 14 Attack rate per 10,000 population 33.9 46.0 20.2 21.4 9.5 27.2 12.6 31.0 Mortality per cent. of cases 5.4 — - - 4.3 - 2.5 Most of the cases notified were in children between 5 and 15 years of age. The incidence of the disease falls principally upon those districts in which there are most children at these ages. Fourteen deaths occurred, as shown in the above Table. This works out at 2.5 per cent. of the notified cases, which is about the same as for all London. Scarlet Fever. 1901. 1902. 1903. 1904. 1905. 1906. Deaths per 100 Cases— The City 1.8 3.3 2.5 2.8 4.0 2.5 The County 3.2 3.0 2.8 2.7 2.8 2.6 Eighty-seven cases occurred in houses, some occupants of which were employed in the clothing trade; in 29 instances the business was carried on in the house by the parents of the affected children. Forty-one cases occurred in houses, some occupants of which were engaged in public catering, 17 being on the premises. Five hundred and twelve of the 540 persons were removed to hospital, and 12 were eventually reported not to be suffering from scarlet fever. As stated above a considerably larger number were not notified. Five children suffered from both scarlet fever and diphtheria at different times during the year. In several instances cases of diphtheria were notified from the same house, at the same time as the scarlet fever cases; some of them proved eventually to be cases of scarlet fever. Return Cases.—In one or two instances it would appear that patients had been discharged from hospital before they were quite free from infection. For example (1) V. H. was notified on the 1st January and removed to hospital, sent home 19th April; on the 27th April he was notified as having an infectious discharge from the ear, and was 40 re-admitted to hospital and retained until September 27th. On April 27th and May 2nd his mother and two brothers were notified. (2) G. Y. returned home from hospital end of December, and his brother and two others in house were notified on the 5 th and 11th January. (3) E. L. discharged 26th February, mother notified March 10th. (4) L. G. discharged 9th March, brother and sister notified 19th March. It is impossible in every case to be certain that no trace of infection exists in the-nose or throat, but the few cases in which "return" cases have resulted, show that considerable care is exercised in the Metropolitan Asylums Board Hospitals. It is even possible that some of the four mentioned above were not the cause of the subsequent cases, as in several instances second cases occurred in houses a few days before the return of the first child from hospital, thus F. L. returned from hospital on April 6th, but a child, F. G., in another family in the house was notified on the 3rd April, and F. L.'s two sisters were notified on the 18th and 23rd. Diphtheria.—As with scarlet fever, so with diphtheria, there was also an increase generally, but the notified cases were not so much above the numbers notified in recent years. There were 206 in Westminster (189 went to hospital), and 30 were eventually stated not to be suffering from the complaint (but as to that there is room for some doubt). There were many cases with scarcely any symptoms to attract attention, As an example, the case of a young child might be mentioned who died suddenly, and at the post-mortem examination it was found that the larynx contained a distinct membrane. His brothers and sisters were found playing in the street with others, and one of them was found to have a slightly inflamed throat, which on bacteriological examination yielded pure cultures of the specific organism. There is a further complicating circumstance in connection with diphtheria, in that persons who have been in contact with infected persons may themselves get the organism into their throats, and being insusceptible to the disease may carry it about in their throats without any symptoms or harm resulting to themselves, but may pass it on to other persons not so immune. Again, there is strong evidence that the organism itself may undergo changes, and in some forms (possibly that known as Hoffmann's pseudo diphtheria bacillus, a name which probably covers more than one form) may give rise to an infective form of sore throat, the appearance of which may not be recognised clinically as diphtheria. A further difficulty in dealing with this disease arises from the fact that in a few cases the organism may persist in the cavities of the nose for very long periods, and cases are not unknown where a 41 person has a few months after an attack again become susceptible to the action of the organisms be has been harbouring, and thus apparently has a second attack of diphtheria. In forty instances I have had a bacteriological examination made of the throats of the members of families in which a case has occurred, where no medical man was in attendance, and in five instances the true bacillus was recognised and in six the pseudo-bacillus. In conjunction with the County Education Committee, the Metropolitan Councils have agreed that it is desirable that when children are excluded from school on account of a case of diphtheria, they should not be allowed to return without a certificate of freedom from infection based on a bacteriological examination. The following experience in one of the Westminster Schools during the last year, illustrates some of the points mentioned above:— The French Protestant School, Noel Street, was visited, by request, on October 19th, to inquire into the causes of a number of cases of sore throat which had occurred among the children. The symptoms noticed were soreness and redness of the throat, with vomiting and swelling of the glands in the neck. In some cases, glairy secretion or points of matter were observed. Not all these symptoms were present in every instance. In no case was any sign of membrane observed. History of the Outbreak.—The School was opened after the holidays on the 27th August, and the first case of sore throat occurred on 17th September. The child attacked remained at home until October 1st. The second case occurred on the 19th September, and the child was away until the 15th October. No association of these cases with previous cases of diphtheria was discovered, but the mother and brother of the second child suffered at the same time from some form of sore throat. The attack must have been of some severity, since the child was absent for four weeks. On September 20th three fresh cases occurred, but the attacks must have been very mild, as in each instance the children were absent for only two days. Two more cases occurred on the 24th, and after this date there were none until October 4th, when another child was taken ill. On the 8th, four more children were attacked; cases occurred also on the 11th, 15th and 19th, and there were two more on the 23rd. There appears to have been two distinct outbreaks, separated by an interval of ten days, one lasting from the 17th to the 24th September (7 cases), and the other from the 4th to the 23rd October (11 cases). It is probable that the second outbreak was started by the return to school, on October 1st, of two of the children attacked during the earlier one, and, as will be seen farther on, one of these children was found 42 when examined three weeks later, to have Hoffmann's bacilli in her throat. It it difficult, however, to be certain as to which were the infecting children, because, as already stated, three of the children of the first group were absent only for two days, and may have returned in an infectious state. Only four of the children were absent from school for a foitnight or longer. Three were known to have been attended by a doctor, but in none of them was the diagnosis of diphtheria made, owing apparently to the mildness of the attacks, and to the absence of visible membrane. The children attacked varied in age from 6 to 13 years. Distribution and Incidence.—The outbreak occurred only in the Girls' Department of the school. There were no cases in the Boys' Department, which immediately adjoins and forms part of the same building. There were two classes in the Girls' Department—one for the older pupils containing 29 girls, and one for the younger containing 22 girls. There were 11 cases in the former class and 7 in the latter. The two classes mixed at prayers and used the same towels, basins, and drinking cups. The effect of personal contact on the spread of the disease is shown by the fact that 13 out of the 17 children attacked sat next to one another in class. The accompanying diagram shows the places in class occupied by the sick children:— 43 On the 20th October, with the permission of the parents, swabs were taken from the throats of two of the children. The ones selected were the child who was believed to have been the first attacked, and the child who had been taken ill the 'most recently. The examination proved negative in the case of the former, but Klebs LSffler bacilli were found in the throat of the second child. All children who had been the subjects of a throat attack were then excluded from the school pending the result of a bacteriological examination of their throats. This proved negative in all but two cases. In one of these the specific bacilli were found, and in the other Hoffmann's bacillus was present. The presence of this last named bacillus was thought to point to the possibility of the child having been the subject of an attack of true diphtheria. As already mentioned, the return of this child to school occurred a few days before the second outbreak, and may have been a factor in determining it. In the throat of another child streptococci and staphylococci were found, and it was deemed advisable to exclude her for a few days. From the subjoined table it will be seen that the cases of Diphtheria in Westminster were fairly spread over the twelve months, and Table XIY shows that the southern part of the city suffered chiefly:— Notification of Diphtheria Cases Received in each Month of the Years 1901, 1902, 1903, 1904, 1905, and 1906. 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 9 6 145 1905 7 7 7 12 11 9 6 10 8 14 15 12 118 1906 20 23 11 8 13 20 21 14 13 28 22 13 206 There were 16 deaths, equal to a mortality of 7.6 per cent. of the notified cases; in London the rate was 8.8:— Diphtheria. 1901. 1902. 1903. 1904. 1905. 1906. Deaths per 100 Cases— The City 10.0 11.0 8.6 3.4 4.2 7.6 The County 10.9 10.8 9.6 10.2 8.6 8.8 44 Previous to the introduction of the antitoxin method of treatment, the rate was 22 per cent., but it cannot be too strongly impressed that to be of use it must be used very early in the disease. The rate would be lowered still more if antitoxin was more extensively employed by general practitioners, as it is they who see the cases in the earliest, stages. The mildness of many of the cases may have conduced to the higher mortality this year through the nature of the malady not being recognised in the early stages. In one instance four cases occurred in one house (infected from a baby who died unnotified); in one instance three cases occurred, and in ten instances two cases. Two children were sent back to hospital after discharge:— (1) P. P. admitted with scarlet fever 25th September, 1905, discharged January 3rd. On January 5th the diphtheria bacilluswas found, and she was re-admitted, but the Metropolitan Asylums Board Bacteriologist was unable to find it after four cultures. She was therefore discharged again on January 12th. (2) S. M. notified with diphtheria 28th January, discharged 19th February; discovered to have rhinitis, culture taken and bacillus reported present. Re-admitted to hospital and kept till 8th June. Typhoid Fever.—Since the connection of this disease with certain articles of food liable to be contaminated with infected sewage was recognised, a decided improvement in the number of cases has occurred, especially at sea-side towns. Consequently, persons returning home from a stay at such places do not come back infected with typhoid fever so frequently as formerly. Still a considerable proportion of the cases notified in Westminster have contracted the disease elsewhere frequently abroad, and a certain number of such cases may be expected annually. Forty-seven notifications were received in 1906, but seven persons were eventually stated not to be suffering from this disease. The cases were spread over all Wards as shown in Table XIV. Four deaths occurred. Thirty-two of the notified persons were removed to hospital. Examination for the presence of the Widal re-action was made, at the Council's expense, in sixteen instances; in five it was present, in nine absent, and in two it was doubtful, but both of these were notified; they proved eventually not to be cases of typhoid fever. No history of the source of infection was made out in twenty of the cases; in eighteen the patients were ill on arrival in Westminster; three cases were attributed to infected shell-fish, three to contact with other cases, and several to drinking polluted water (Paris, Naples, New York, &c.). 45 There were two cases of "continued fever" notified. Puerperal Fever.—Nine notifications were received and five deaths ensued. The cases were all in the south-west part of the City. No evidence of want of care of those in attendance was discovered. In one case the illness was evidently due to tuberculosis. Disinfection was carried out after each, including the clothing, &c., of those in attendance. In two instances there were insanitary conditions, existing. In London as a whole there was a slight increase in the number of cases. Erysipelas.—An enquiry has recently been made among Metropolitan Medical Officers of Health with reference to erysipelas by Sir Shirley Murphy. From the replies it appears that disinfection of rooms and of clothing is not generally practised except in special eases. Opinions vary as to the usefulness of notification. One medical officer considers it is not worth the money paid for it, another considers it essential as tending to maintain the health of the borough, and another points out that in 26.6 per cent. of the cases various insanitary conditions in the homes of the patients have been dealt with. Generally the conclusions are in favour of the retention of notification. The sum payable for the notification of erysipelas in the whole of London probably does not exceed £500 a year. In some boroughs, the majority of the cases are derived from common lodging houses, shelters, and Poor Law Institutions, but in other boroughs the number so derived was only 20 per cent. of the total. In Westminster during the last five years only about 8 per cent. of the cases were from common lodging houses or infirmaries, &c., no home address being given. In Westminster disinfection is not carried out after every case. Each is enquired into, and if it is found that the condition of the premises, bedding and clothing require it, or that the erysipelas was associated with a discharging wound, or if a confinement is expected in the house, then disinfection is carried out. In 20 per cent. of the total eases notified disinfection was carried out, but only in 10 per cent. of those notified from private dwellings. In the summary of the replies to the enquiry, except puerperal fever, no connection with other notifiable infectious diseases appears to have been traced ; but as the question only asked if observations were made, there may have been other diseases such as infantile diarrhoea and other septic infections in houses in which erysipelas has occurred, which were not mentioned in the replies. With the view to discover if any apparent connection existed between erysipelas and other diseases of that class I have examined D 46 the records of 630 cases notified during the last five years, and of the houses in which the cases occurred. These only record deaths and notifiable diseases, and there may, in addition, have been many cases of illness in the houses which did not prove fatal, but which may have had some relation to the erysipelas attack, or have been induced by the presence of the same conditions favourable to the production of erysipelas; such cases would not necessarily come to my knowledge. It appears that in twenty-nine houses in which cases had been notified, thirty-one cases of the same complaint were subsequently notified; seventeen of these were attacks in different persons, twelve were second attacks, and two third attacks in the same person. The following are instances of more than one attack occurring in the same house:— (1) 1st case 18th June, 1902; 2nd case on same floor 1st December, 1902. (2) 1st case 5th February, 1904; 2nd case 16th December, 1904. (3) 1st case 12th October, 1904; 2nd case in same rooms, 14th November, 1905. The subsequent attacks all occurred in different persons. Puerperal fever occurred in two houses in which there had been erysipelas. In one case the child had erysipelas on the 16th February, and the mother died of puerperal fever on the 19th February; in the second a case of erysipelas occurred on the 27th January, and a woman died of puerperal fever on the 2nd March of the same year. The reverse occurred in one instance, puerperal fever in January, erysipelas in the following May. In 1906, nine women had puerperal fever, in no instance had there been any erysipelas in the house; five infants died from erysipelas, but in no instance was the mother infected therefrom. In 39 houses scarlet fever cases occurred. In 15 houses diphtheria cases occurred. In 10 houses enteric fever cases occurred. In 12 houses chicken pox cases occurred, and In 1 house small pox (2 cases) occurred. Deaths occurred in the erysipelas houses in the five years as follows:— In two houses deaths from other septic diseases, in fourteen pneumonia, in eight measles, in four whooping cough, in four diarrhoea, and in one rheumatic fever. There is thus not much evidence of relationship between these complaints and erysipelas. Occupation.—Particulars as to the occupations, where stated, have been taken out, and the percentage of the total cases (in persons above 10), occurring in each group is given with the percentage of people employed in that occupation. From this table it does not appear that 47 there is any particular incidence on any one group except among labourers, costermongers, &c. The proportion ot cases in the other groups bears a very close relationship to the number of persons in the group. Erysipelas—Incidence on Occupations. Occupations. No. of Persons so engaged at the Census, 1901. Percentage of Population so engaged. Cases of Erysipelas. Percentage of cases of Erysipelas in each Group. Professional 6,305 3.9 15 2.6 Commercial 4,605 2.9 7 1.2 Domestic Servants 41,230 26.0 104 18.2 Conveyance 8,275 5.2 27 4.7 Building 3,651 2.3 8 1.4 Dress 10,757 6.8 38 6.6 Food, Lodging, &c. 10,430 6.6 22 3.8 Shopkeepers, &c. 2,752 1.7 11 1.9 Labourers, Costermongers, &c. 2,234 1.4 17 2.9 Local Government (Police, &c., &c.) 1,602 1.0 7 1.2 The proportion of females to males attacked is as 7 to 5, whereas the proportion in the total population is about 9 to 8. Females have therefore been attacked in greater proportion than males. Out of 347 cases in which the parts attacked were noted, the face was the site of the complaint in 277, the leg in 53, and the arm in 13. The attacks were most fatal where young children or old persons were concerned. 4.4 per cent. of the cases were fatal, but in Knightsbridge St. George's "Ward, the mortality was as much as 17.6 per cent. due to some extent to the fact that some deaths were due to cellulitis, resulting in some instances from injury. Seasonal Incidence.—The subjoined Table shows the months in which cases occurred. In the five yearly total the distribution of cases seems fairly uniform, except as regards October, which has a large number. The months when the greatest number of notifications occurred were September, 1905, and October, 1906. The maxima did not occur during the period of greatest temperature, but rather at the time when it is on the decline, and when there is an addition of moisture. The maxima of erysipelas seem to coincide with the maxima of scarlet fever. Careful comparison of the numbers notified with meteorological curves would probably show that atmospheric conditions have some influence in determining attacks, since the cases tend to occur in groups about the same dates, followed by intervals of a week or so. d 2 48 Erysipelas— Cases and No. of Deaths at different age periods. Cases. Total. 0 to 1 year. 1 to 5 years. 5 to 15 years. 15 to 25 years. 25 to 65 years. 65 years and over. 1902 144 2 1 9 12 103 17 1903 111 4 3 5 6 84 9 1904 125 2 3 5 19 82 14 1905 123 2 2 14 20 74 11 1906 127 4 1 9 13 86 14 630 14 10 42 70 429 65 Deaths. 1902 5 - - - - 3 2 1903 6 - — — — 5 1 1904 6 — — — — 3 3 1905 3 — — — — 1 2 1906 8 4 — — — 3 1 28 4 - - - 15 9 Rate for 100 cases 4.4% 28.5% — — — 3.5% 13.8% Monthly Incidences based on Date of Onset of Disease in 624 Cases. Year. January. February. March. April. May. J une. July. August. September. October. November. December. Total. 1902 14 6 10 13 9 15 10 12 11 13 12 15 140 1903 9 6 9 10 8 12 12 8 7 17 5 8 111 1904 11 12 7 7 13 10 10 13 10 10 12 10 125 1905 5 5 12 6 9 13 7 13 18 13 13 10 124 1906 13 12 15 5 11 6 9 3 4 18 16 12 124 52 41 53 41 50 56 48 49 50 71 58 55 624 Insanitary Conditions.—Omitting cases in hospitals, common lodging houses, and those occurring in persons long resident in infirmaries or workhouses, insanitary conditions were found to exist in 11 per cent, of the notified cases, but in a number besides, although no actual nuisance was reported at the time, the standard of sanitation was low. Although a number of the cases notified as erysipelas are probably not true cases of the disease, the term being somewhat loosely applied to several affections accompanied by redness of the skin varying in severity from slight erythema, arising from gastric disturbances, to fatal cellulitis, yet on the whole it appears desirable that notification should be continued. 49 ERYSIPELAS-No. of cases in the City and the various Wards during last Five Years. Period. The City. Conduit Ward. Grrosvenor Ward. Hamlet of Knightsbridge Ward Knightsbridge St. G-eorga Ward. Victoria Ward. St. Margaret Ward. St. John Ward. St. Anne Ward. Great Marlborough Ward. Pall Mall Ward. Regent Ward. Charing Cross Ward. Covens Garden. Strand Ward. 1902 144 2 7 8 7 36 10 28 9 12 1 13 2 5 4 1903 111 2 5 1 10 21 8 27 14 1 1 5 3 10 5 1904 125 - 7 4 6 26 4 41 11 3 1 8 3 5 4 1905 123 - 1 5 5 26 10 38 7 4 1 13 3 8 2 1906 127 - 4 1 6 45 9 28 9 7 - 6 6 3 3 Total cases 630 4 24 19 34 154 41 162 50 27 4 45 17 31 18 Deaths 28 - - - 6 6 1 10 2 1 - 2 - - - Deaths pel' 100 cases 4.4 - - - 17 .6 3.9 2.4 6.1 4.0 3.7 - 4. 4 - - - 50 (2) Voluntary Notifiable Diseases. Tubercular Disease.—Deaths from tuberculosis have been decreasing in numbers since 1901. The figures for the last five 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 6 26 14 32 18 341 192 1905 259 147 12 6 31 17 31 17 333 189 1906 237 136 13 7 36 20 25 14 311 178 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 Kates. County. City. County. City. 1901 165 167 229 202 1902 161 159 223 199 1903 155 154 213 178 1904 162 136 - 171 1905 142 131 - 168 1906 144 121 - 158 Were the 35 deaths of inmates of common lodging-houses excluded, the phthisis rate for the City would be reduced from 136 to 116, St. John's Ward (with 21 deaths) would be reduced to 251, Covent Garden (11 deaths) to 189, and the Sirand Ward (3 deaths) to 78. The death-rate for males from tubercular disease was 255 in 1906 per 100,000 male inhabitants, the average of the previous five years being 277. For females, the 1906 rate was 112, the average being 142, apparently an improvement of about 8 per cent. on the rate for males, and 21 per cent. on that for females. It is evident from the figures given above that while pulmonary tuberculosis is diminishing, no improvement is noticeable in other forms of the disease. Reference to Table X. shows that the persons who died, especially from meningeal tuberculosis, were, as a rule, younger than those who died from consumption of the lungs. A Royal Commission was appointed in 1901 to enquire into the relations between human and bovine tuberculosis, and they have issued two interim reports. 51 The tubercular rates per 100,000 for each ward are:- 1 2 3 4 5 6 7 Conduit. Grosvenor. Hamlet of Knightsbridge. Knightsbridge St. George. Victoria St. Margari t. St. John. Pulmonary phthisis - 74 26 34 123 68 323 Other tubercular diseases - 13 13 17 50 30 83 Total - 87 39 51 173 98 406 8 9 10 11 12 13 14 St. Anne. Great Marlborough. Pall Mall. Regent. Charing Cross. Covent Garden. Strand. Pulmonary phthisis 101 115 67 85 47 320 126 Other tubercular diseases 64 71 - 21 - 59 31 Total 165 186 67 106 47 379 157 The appointment of the Commission was due to the announcement made by Professor Koch, at the International Medical Congress held in London in 1900, of his opinion that human and bovine tuberculosis were distinct affections. He asserted on that occasion, as the result of his experiments and enquiries, that the bacillus of human tuberculosis was unable to give rise to tuberculosis in the ox, and maintained that bovine tuberculosis could not be the cause of tuberculosis in man. The Commission, in their first interim report, were able to show that they had succeeded, where Professor Koch had failed, in communicating human tuberculosis to bovine animals, and that his assumptions, even if they had any foundation, were at least too sweeping to be accepted as guides to conduct or to legislation. The present report carries the matter considerably further, the Commissioners say definitely that the effects produced on animals by the injection of tuberculous matter from human sources, appear to them to be absolutely identical with the effects of the bacillus of bovine tuberculosis. They have wholly failed to discover any essential differences between the one and the other; both are equally virulent— i.e., equally able to set up tuberculosis in bovine and other animals. The general results so far attained by the enquiry are summed up in the following conclusions:— "There can be no doubt but that in a certain number of cases the tuberculosis occurring in the human subject, especially in children, is 52 the direct result of the introduction into the human body of the bacillus of bovine tuberculosis; and there also can be no doubt that in the majority at least of these cases the bacillus is introduced through cows milk. Cows milk containing bovine tubercle bacilli is clearly a cause of tuberculosis and of fatal tuberculosis in man. "Of the 60 cases of human tuberculosis investigated by us, 14 of the viruses belonged to group 1—that is to say, contained the bovine bacillus. If, instead of taking all these 60 cases, we confine ourselves to cases of tuberculosis in which the bacilli were apparently introduced into the body by way of the alimentary canal, the proportion of group 1 becomes very much larger. Of the total 60 cases investigated by us, 28 possessed clinical histories indicating that in them the bacillus was introduced through the alimentary canal. Of these, 13 belong to group 1. Of the 9 cases in which cervical glands were studied by us, 3, and of the 19 cases in which the lesions of abdominal tuberculosis were studied by us, 10 belong to group 1. "These facts indicate that a very large proportion of tuberculosis contracted by ingestion is due to tubercle bacilli of bovine source. " A very considerable amount of disease and loss of life, especially among the young, must be attributed to the consumption of cows milk containing tubercle bacilli. The presence of tubercle bacilli in cows milk can be detected, though with some difficulty, if the proper means be adopted, and such milk ought never to be used as food. There is far less difficulty in recognising clinically that a cow is distinctly suffering from tuberculosis, in which case she may be yielding tuberculous milk. The milk coming from such a cow ought not to form part of human food, and indeed ought not to be used as food at all. "Our results point clearly to the necessity of measures more stringent than those at present enforced being taken to prevent the sale or the consumption of such milk." The enquiries which are made into the circumstances of each case in Westminster show that in a considerable proportion the infection is undoubtedly of human origin. Typical examples of such in infants are the following:- (a) Father and grandfather died of phthisis; two sisters have it; one other dead from tuberculosis of bowels. (b) Father out-patient at Brompton; one child died in 1905 of meningitis. (c) Father consumptive; previous child died from tubercle. (d) Father consumptive. (e) Mother consumptive. (f) Father consumptive. (g) Mother consumptive; previous baby died from tubercular meningitis. 53 Occupations of Adult Males and of Husbands or Parents of Persons who died from Tubercular Disease in the 6 years 1901-6. Occupation. Adult Males. Wives and Childr'n of. Occupation. Adult Males. Wives and Childr'n of. General or Local Government- Conveyances of Men and Goods-contd. Police 3 9 Tailors' porters 6 - Po3tmen and sorters 8 2 Warehousemen and packers 28 15 Defence of Country- Metals, Machines. Implements and Conveyance- Smiths - 1 Soldiers 20 8 Professional- Clergymen 2 - Other metal Workers 24 9 Barristers 1 1 Coach builders - 5 Solicitors 3 1 Precious Metals, Instruments, Games- Surgeons 1 1 Veterinary surgeons 3 - Silversmiths and refiners 10 1 Teachers 3 1 Instrument makers 2 1 Translators 1 - Clock winders 1 ... Journalists 3 - Watchmakers - 1 Engineers 4 5 Tennis racquet makers - 1 Draughtsmen 2 - Building, &c.- Surveyors 1 1 Builders and masons 20 5 Photographers 3 - Carpenters 13 19 Musicians 7 5 Scatfolders 2 1 Artists - 1 Plasterers - 3 Actors 4 - House painters 27 11 Domestic Services or Offices- Grlaziers, paperhangers 4 2 Cooks (male) 21 7 Plumbers and gasfitters 14 3 Other Male servants 20 9 Paviors and sweepers 10 2 Coachmen 2i 20 Wood, Furniture Fittings, &c.- Gardeners 2 3 Waiters, carvers 52 15 Furniture makers 3 3 Billiard markers 3 1 French polishers 3 2 Hall and hotel porters, and messengers 33 14 Upholsterers 5 3 Glass- Bath, lavatory, and office attendants and cleaners 3 1 Grlass blower 1 - Skins, Leather, &c.- Caretakers 2 - Trunk maker 1 - Commercial- Saddler - 3 Merchant - 1 Printers, Stationers, &c.- Accountants 1 1 Compositors, printers 26 10 Commercial travellers and agents 9 7 Machine rulers 1 - Relief stampers 1 - Clerks 55 8 Print colorers 1 - Collectors - 3 Bookbinders 3 2 Conveyances of Men and Goods- Circular folders 1 - Ticket writers 1 - Railway porters 4 6 Publishers' assistants 1 - Cab, bus and motor drivers 16 11 Booksellers 1 2 Carmen 22 24 News vendors 16 3 'Bus conductors 2 1 Dress- Stablemen, grooms 52 17 Hatters 1 1 Carriage and cab attendants 3 Tailors 45 31 Collar cutter 1 - General porters 41 22 Seamstresses - 1 Sailors 2 2 Shoemakers and leather workers 30 12 Lightermen 5 2 Shop porters 19 2 Hairdressers 4 2 Market ,, 30 4 Stickmounters - 1 54 Occupation. Adult Males. Wives and Childr'n of. Occupation. Adult Malts. Wives and Childr'n of. Food, Tobacco, Drink, and Lodging- General Workers and Dealers- Dairymen 2 3 Other shopkeepers 28 16 Butchers 3 3 Hawkers 37 5 Bakers 4 1 Firemen, engine drivers 1. 4 Provision merchants and grocers 8 1 Stokers i 2 Chimney sweeps i 4. Ice cream vendors 1 - Modeller i - Brewer 1 - Window cleaners 4 1 Lodging house and chambers keepers 14 7 Bottle labeller 1 - Superintendents - 1 Coffee house keepers - 1 Scene shifters, 13 3 Lodging house deputies 4 - Basket makers - 1 Licensed victuallers 2 - Paper bag maker - 1 Bnrmen, potmen, cellarman 40 14 Brush makers 1 - Mineral water bottler 1 Labourers 135 69 Gras workers - 3 Occupations of Adult Females where separately stated. Dancer 1 Tailoresses 16 Nurse 1 Milliners 2 House keeper, manageress 5 Dressmakers, sempstresses 34 Cooks 13 Staymakers 2 Other servants 51 Wigmaker 1 Charwomen 43 Cigarette maker 1 Laundresses 16 Dairy assistant 1 Waitresses 5 Seed sorter 1 Clerk 1 Incandescent mantle makers 2 Upholsteress 2 Flower sellers, market women 3 Furniture dealer 1 Hawkers 5 Printer's ruler 1 Packer 1 Book folders, sewers 2 Unknown 79 Paper sorter 1 It is evident, therefore, that even if the sale of milk from tuberculous cows be stopped tuberculosis in children will not be entirely prevented. Another point which ought to be considered is the question of the employment in the handling of milk of persons suffering from consumption. In the list of occupations of persons who have died from consumption will be found three persons engaged in this business. It. is difficult to imagine that they would not infect the milk they wereselling. Notification.-Seventy-eight notifications were received in 1906; the numbers in previous years were: 1903, 123; 1904, 148; 1905, 112. The cost was £3 4s. 6d. Ninety-four visits were paid in connection with consumption cases, but in addition thereto 122 cases were visited from time to time by the Health Society's visitors. Seventy-seven rooms in 64 houses and 864 articles were disinfected by the Council's staff, and general cleansing of the premises was carried out after each death, or removal from one house to another. 55 (3) Non.notifiable Diseases. Measles.—Twenty deaths were attributed to this cause in 1906 in the City. During the year only 362 cases came to my knowledge, 347 having been notified by school teachers (105 being from Millbank School). The deaths per 1,000 calculated on the total population were:- 1901. 1902. 1903. 1904. 1905. 1906. City of Westminster— Cases notified 523 294 346 181 412 362 No. of deaths 59 43 47 23 41 20 Rate per 1,000 population 0 32 0 23 0.26 0.13 0.25 0.11 County of London 0.43 0.51 044 0.49 0.37 0.41 As 19 of the deaths in Westminster, and the bulk of those in London, occurred 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:— City of Westminster 4 6 3 .3 3.7 1 .8 3 .5 1 .4 County of London 3 .7 4.6 4.0 4.4 3.3 3.4 The death-rates per 1,000 persons in each of the four quarters were:— 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. City of Westminster 0.09 0.13 0.18 0 .04 County of London 0.58 0.65 0.21 0 .18 Disinfection of 81 rooms in 39 houses, and of 1,142 articles, was carried out by the Council's staff. 472 visits were paid in connection with cases of measles and whooping cough. 56 Whooping Cough.—This complaint was responsible for 23 deaths, 22 of them of children under five years of age. It was most prevalent in the first part of the year, and was a continuation of an outbreak which began in the autumn of 1904, and 210 cases were notified from schools. 1901. 1902. 1903. 1904. 1905. 1906. City of Westminster— Cases notified 8 145 83 56 210 92 Deaths 48 34 33 17 35 23 Deaths per 1,000 population 0.26 0.18 0.18 00.9 0.19 0.13 County of London 0.35 0.40 0.35 0.33 0.32 0.26 Calculated on the number of children under five years of age, the death-rates per 1,000 were:- City of Westminster 3.67 2.65 2.63 1.37 2.8 1.6 County of London 3 .23 3.65 3.22 2.9 2.9 2 .3 The death rates per 1,000 population in each quarter of the year were:- 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. City of Westminster 0.16 0.23 0.06 0.06 City of London 0.29 0.34 0.17 0.15 57 Diarrhœal Diseases.—During the last six years the deaths in the City have been as follows:— 1901. 1902. 1903. 1904. 1905. 1906. Diarrhœa 79 37 59 42 27 28 Epidemic enteritis 18 24 38 20 47 Other forms of enteritis 13 27 14 16 17 20 Total deaths 110 88 73 96 64 95 Number under 1 year of age 78 63 52 72 42 71 Number of births 3,432 3,461 3,185 3,054 3,120 2,931 Deaths of infants per 1,000 births 22.7 18.2 16.3 23.5 13.4 24.2 The Wards in which deaths occurred from diarrhoea, or other forms of enteritis, and the rate per 1,000 births are:— Ward. Total Diarrhœal Deaths. Deaths of Inlants. Death Rate of Infants per 1,000 Births. St. John 35 28 32.5 Victoria 35 22 25 .0 Covent Garden 5 3 23.2 Grosyenor 4 3 22.9 Gt. Marlborough 3 3 21.9 Regent 3 3 21.2 Knightsbridge, St. George 2 2 13 .3 Hamlet of Knightsbridge 2 2 27.7 St. Anne 2 1 9 .2 St. Margaret 2 2 14.1 Charing Cross 1 1 38.4 Strand 1 1 50 .0 The 4,424 deaths from diarrhoea and epidemic enteritis in London, were more than 1,000 in excess of the average number. In the 3rd quarter there was an excess of about 800 deaths over those recorded in the same quarter in 1905. The rates per 1,000 persons for each quarter were as follows:- 1906. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. The Year. Westminster 0.02 0.13 1.33 0.22 0.43 London 0.14 0.17 2 .96 0.49 0.94 58 Schools and Infectious Disease. School Teachers are required to notify me when they exclude children on account of infectious disease. The following list shows how far this was carried out and the nature of the cases notified:- School. Actual Cases. Infection in House. Other Causes. Chickenpox. Measels. Mumps. Whoopingcough. Chickenpox. Measels. Mumps. Whoopingcough. Charing Cross Read 2 28 1 - 1 32 3 - 2 blight. Horseferry Road 1 - 3 2 1 6 - - 5 ringworm. 1 eczema. Buckingham Gate 2 5 . 1 3 11 - - 1 ringworm. Pulteney 1 5 1 1 - 6 - 2 1 eczema. 1 ringworm. St. George's Row 5 . . . 6 1 1 - 22 ringworm. Millbank 20 105 8 29 6 39 . 2 1 eczema. Tower Street 3 7 . 4 3 . . . 1 blight. Great Wild Street 17 23 . 2 20 15 . 1 2 biight. Brompton Higher Grade 1 3 . . . 2 . - Christ Church 8 . 7 . 4 - - - 2 ringworm. Holy Trinity 4 22 4 1 2 28 2 . Pimlieo Rooms - - - - - - - - 1 ringworm. St. Anne's . 15 . . 3 18 . . St. Anselm's . 1 . . . 4 . . St. Barnabas 25 7 15 - 9 5 2 - 9 ringworm. 1 eczema. St. Clement Danes 3 6 . - 1 3 . . 1 ringworm. St. Edward's, Dufour's Place 11 3 . - 2 2 . - St. Gabriel's 11 1 4 2 24 6 2 7 11 ringworm. 2 eczema. St. George's - 1 8 12 . 1 12 3 . 2 ringworm. St. James the Less 6 24 1 9 1 . . 2 ringworm. St. John's, Tufton Street . 10 1 1 . 16 . . St. Margaret's - - - - - - - - St. Martin's, Castle Street 6 7 . . 8 - . - St. Mary's, 48, Great Peter Street . . . . . 7 . . St. Mary's, Hide Place 11 7 . 16 14 7 . 2 2 ringworm. St. Mary's, Johnson Place . 2 . 1 4 . . . 5 ringworm. St. Matthew's 1 2 . . 6 1 . . St. Michael's . 1 2 . . 1 . . 4 ringworm. St. Paul's . 1 . . . 2 . . 2 ringworm. St. Peter's, Lower Belgrave Place 3 17 1 . 3 20 . . St. Peter's and St. James' 2 8 . 9 2 5 - . St. Stephen's 4 28 4 . 3 15 2 . 4 ringworm. Wesleyan Training . 8 . 2 . 7 . 2 Westminster Jews' Free 1 - - - - - - - 148 347 60 92 126 280 15 16 The infants' department of the following schools were closed on account of infection during the year:- Millbank, St. Mary's Hide Place, and Holy Trinity National. Copies of 736 certificates relating to teachers or children attending at the following schools notified by medical men to be suffering from illness during 1906, were sent to school teachers during 1906:- 59 School. Small Pox. Scarlet Fever. Diphtheria. Enteric Fever. Charing Cross Road - 10 - 1 Horseferry Road - 4 - - Buckingham Grate - 3 1 - Pulteney - 14 2 - St. George's Row - 6 3 - Millbank - 30 14 Great Wild Street - 7 1 1 Brompton Higher Grade - 1 3 - Christ Church - 2 3 - Curzon - 1 - - French Protestant - 2 2 1 Holy Trinity - 33 1 - St. Anne's - 15 2 - St. Anselins - 1 - - St. Barnabas - 8 - 1 St. Clement Danes - 1 1 - St. Edward's, Dufour's Place - 2 1 - St. Gabriel's - 17 7 - St. George's, South Street - 20 3 St. James the Less - 25 4 St. John's, Tufton Street - - - - St. Margaret's - 2 3 - St. Martin's, Castle Street - 5 - - St. Mary's, 48, Great Peter Street - 7 - St. Mary's, Hide Place - 12 6 - St. Mary's, Johnson's Plaee - 2 - - St. Matthew's - 9 4 - St. Michael's - 8 5 - St. Paul's, Caroline Street - - 2 - St. Paul's, Wilton Place - 3 4 - St. Peter's, Lower Belgrave Street - 8 2 1 St. Peter's and St. Edward's - 3 1 - St. Peter's and St. James's - 2 3 - St. Stephen's - 10 3 - Pimlico Rooms - 1 - - Weslevan Training College - 15 1 - Westminster Jews'Free - 2 1 The London Education Committee have adopted the following rules with reference to infectious diseases, for the guidance of teachers:- Diphtheria,-During the presence of diphtheria in any district, the Committee authorised to refuse the re-admission to school of children excluded on account of diphtheria or sore throat until such children shall have obtained a medical certificate of freedom of infection, based on a bacteriological examination. The certificate of freedom from infection, based on bacteriological examination, will be accepted either from general practitioners or from the medical officer of health. Measles.-Children suffering from measles must be excluded from school for at least one month. Children coming from houses where measles exists, but who are not themselves suffering from the disease, should be dealt with as follows :A child attending other than an infants' school who lias had measles need not be excluded from attendance at school. 60 A child attending other than an infants' school who has not had measles must be excluded from attendance at school until the Monday following the expiration of fourteen days from the occurrence of the first case. A child attending an infants' school, whether or not it has had measles, must be excluded from attendance at school until the Monday following the expiration of fourteen days from the occurrence of the last case. Children suffering from the following diseases must be excluded from school for the undermentioned periods :—- Mumps, for one month. Chicken-pox, for at least two weeks or until every scab has fallen off the scalp or body. Whooping-cougli, for as long as the cough continues, and not less than five weeks from the commencing of the whooping. Children coming from houses in which either mumps, chickenpox, or whooping-cough exists must be dealt with as follows:— (a) Children in schools other than infants' schools who have not had the disease, and all children in infants' schools must be excluded. (b) Children in schools other than infants' schools who have had the disease need not be excluded. Children living in infected houses and excluded from school under a and b must absent themselves for the undermentioned periods:— Mumps, for such time as the medical attendant dealing with the case deems necessary, or in cases where there is no medical attendant for three weeks. Chicken-pox, for two weeks. Whooping-cough, for two weeks. The sanitary arrangements of 13 schools were improved or re-constructed during the year, and the use of one building as a school was given up. It is probable that certain schools will be discontinued, as it is impossible to make them comply with modern requirements. 61 Bacteriological Laboratory. During the year 180 examinations have been made at the Lister Institute at a cost of £24 13s.7d., as follows:- Disease. Persons. Examinations. Results. Positive. Negative. Doubtful. Diphtheria- Suspected cases 91 93 30 (H1) 63 (SPyl) - Contacts 40 50 5 45 (H 6) - Returned from hospital with nasal or aural discharges 7 10 2 8(H1) - 138 153 37 116 - Typhoid Fever 16 16 5 9 2 Tuberculosis 10 12 4 8 Contacts.-The value of examining children who have been exposed to diphtheria infection is shown by the fact that five cases were thus detected, in three of which the parents did not think there was anything wrong, and were allowing the children to associate with others. Hoffmann's pseudo-bacillus was reported to be present in eight instances, and the streptococcus pyogenes in one instance, where a bad throat developed after exposure to a case of erysipelas. Seven persons returning from hospital after treatment for scarlet fever or diphtheria, with discharges from nose or ears, were examined, and in two instances the diphtheria organism was reported as present; both were returned to hospital, in one instance further examination in hospital failed to discover the organism, but the other was retained in hospital for 3½- months. The two cases in which the Widal reaction was doubtful were returned from hospital as not typhoid fever. In addition to those mentioned above, many medical men and hospitals obtain reports on their cases from private or hospital laboratories. Disinfection. During 1906,1,627 rooms in 961 houses were disinfected by the Staff of the Department, 47,805 articles were subjected to disinfection in the City Disinfecting Stations. The premises included 11 schools and 20 sets of offices, 1 cab, 2 private carriages, and 3 undertakers' carriages were also disinfected. In addition, a number of rooms and their contents were disinfected to the satisfaction of medical men by private firms. 195 articles were destroyed by fire at the request of the owners. e 62 Disinfection was carried out after all cases of the notifiable diseases, except as regards erysipelas (in which disinfection was performed in 36 instances, when the circumstances of the case required it), and also after 39 cases of measles, 4 chicken-pox, 8 cancer, 2 influenza, 1 mumps, and 64 phthisis. 363 books were disinfected. Books belonging to the public libraries are, as a rule, treated by the librarians, a copy of each certificate of infectious disease being sent to the Chief Librarian. Shelters.—One person, a nurse, was admitted to the temporary shelter at Horseferry Eoad, while her clothing was being disinfected, after attendance on a case of puerperal fever. The following table gives a comparative statement of the above work during the past six years:- 1901. 1902. 1903. 1904. 1905. 1906. Premises 834 1,097 709 581 667 96 1 Rooms 1,287 1,836 1,039 935 1,177 1,627 Articles disinfected 32,218 39,965 27,766 29,107 34,703 47,865 Articles destroyed 58 37 126 52 151 195 Books disinfected 95 24 16 10 52 363 Number admitted to shelters.. 13 20 19 39 6 1 Cleansing of Persons.— Under the provisions of this Act three persons received a free bath and had their verminous clothing disinfected. Since the closing of the Denzell Street premises there has been no proper accommodation for this work, but provision is to be made at the new central station. The Guardians have dealt with freq uenters of their Casual Wards at their own establishments, thus at Bear Yard about ten cases are dealt with daily. Verminous Houses.—Forty-two rooms in twenty-nine houses were fumigated with burning sulphur by the staff, and 205 articles were passed through the disinfecting apparatus; 28 articles were dealt with as being in such a condition as likely to cause disease. Mortuaries. The number of bodies removed to the Council's mortuaries under order of the Coroner, or to await burial, was 345; in eight instances death was the result of infectious disease. Inquests were held in 283 instances at Horseferry Road, where the Coroner's Court is situated; seven adjourned inquests were held. Postmortem examinations were made in 189 instances. 63 It appears that the total number of dead bodies taken to the mortuaries is steadily declining. The diminution is among the inquest cases. The figures for the last six years are:- Total For Inquest. To await Burial. Total. For Inquest. To await Burial. 1901 438 370 66 1904 388 322 59 1902 389 345 44 1905 370 307 61 1903 393 341 55 1906 345 283 61 During 1906 steps were taken to make more generally known the existence of various places in the City where dead bodies might be taken to await burial. Of the 61 bodies admitted for this reason, 48 were taken to Horseferry Road, 8 to Dufouv's Place, 5 to Drury Lane, and none to either Ebury Bridge or Mount Street resting places. The number of bodies taken in at Horseferry Road since 1897 has, been:— Year. Bodies. Year. Bodies. Year. Bodies. 1897 131 1901 391 1904 365 1898 165 1902 371 1905 344 1899 273 1903 371 1906 332 1900 309 The total number of bodies received at Horseferry Road to await burial has increased from 22 in 1901 to 48 in 1906. e 2 64 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:- 1906. 1906. Complaints received and dealt with 798 Sanitary Work completed :Water-closets:- Premises inspected on complaint, &c. 1,729 Constructed 1,150 Repaired 807 „ „ re-inspected 20,361 Ventilated 556 „ (registered), visits to 1,905 Separated from rooms 95 Cleansed or limewashed 847 Sanitary Work completed :- Waste Pipes:- Houses:- To sinks, baths, lavatory Closed under H.W. Classes - basins, &c. Act Closed under P.H. (London) Fixed 694 Repaired or unstopped 235 Act 2 Cleansed throughout 233 Water Supply:- „ partially 661 Provided 219 Overcrowding abated 69 ,, additional 152 Light or ventilation improved 168 Reinstated 75 Cisterns fixed 339 Roofs repaired 297 „ cleansed 231 Floors and staircases repaired 248 „ covered 316 Underground rooms vacated 29 „ defective, abolished 75 Yards, areas, paved or repaired 535 Taps off main provided 102 Pipes repaired 95 Damp walls remedied 46 Offensive refuse removed 199 Dust Bins:- Keeping of animals Provided 312 continued 10 Repaired 36 Verminous premises cleansed 55 Fixed, abolished 142 Filthy bedding 2 Stables:- Drains:- Drained 31 Constructed 396 Paved 32 Amended and repaired 485 Cleansed 21 Tested 1,334 Dung receptacles provided 14 Dung pits abolished 1 Rainwater Pipes:- Dung accumulations removed 80 Fixed or repaired 598 2,180 preliminary notices and 149 statutory notices were issued. 65 Proceedings in respect thereof were taken in nine instances with regard to seven premises. Date. Place. Offence. Result of Proceedings. 1906. 23rd January 41, Dean 3treet Non-compliance with Magistrate's Order, re Cleansing, &c. (7 th Nov ember, 1905) Fined £1 and 25. costs. 8th March 11, Portland Street Drains defective; Order to abate within 7 days, and £1 2s. costs. w.c.'s choked; refuse in cellars; dirty walls; defective skylight of workshop 12th March 76, Old Compton Street Drain defective; Order to abate within 7 want of light and ventilation to w.c.; days, and £1 1s. costs. defective paving; cistern dirty; walls dirty; insufficient w.c. accommodation 12th March 165a, Strand Absence of rainwater-pipes, causing dampness in adjoining buildings Order to abate within 7 days, and 10s. costs. 11th April Do. Non-compliance with Magistrate's Order Fined £1 and 4s. costs. 17th July Do. Do. Fined £7 and 4s. costs. 13th July 58, Wilton Eoad Defective drains Order to abate nuisance in 28 days 8th November 13, Berwick Street, W. Dirty walls; choked rain - water - pipes; defective sink Adjourned for 14 days to allow completion of work. £2 2s. costs. 3rd December 35, York Street, S.W. Illegal occupation of underground room For permitting occupation, tenant fined £2 and 2s. costs. Occupier fined 10s. and 2s. costs. Duht from Buildings during Demolition.—Considerable annoyance frequently arises from buildings during demolition, and in old buildings the dust may be a source of danger. The City Engineer lias been in the habit of inserting in licenses for hoardings a clause that in cases where a hoarding projects more than two feet on the public footway the licensee shall undertake to keep all materials well watered to prevent dust arising. The Council, after consideration, have agreed that a condition might, with advantage, be inserted in all licences issued for hoardings erected on the public way irrespective of the extent of the encroachment, requiring that during the demolition of premises, proper and sufficient screens shall be provided, and compelling the use of water for preventing nuisance from dust. 66 Removal of House Refuse.—Much consideration was given to this subject by the Public Health and Highways Committee, and the following streets were added to those in which a daily collection of dust is made, viz., Sackville Street, Carlisle Place, Chadwick Street, and Vauxhall Bridge Road. In each of these streets the fixed dust-bins have been removed, and moveable ones provided. In addition, in a number of instances, fixed bins have been found in bad positions, improperly constructed or defective. The owners have been recommended in each case to do away with them, but except where the position was such that a nuisance existed, the Public Health Act does not give power to the Council to compel such removal. The majority, however, complied with the suggestion, and 142 were abolished (530 fixed brick-bins had been abolished in the previous five years); 36 were repaired and made more accessible for the dustmen. Where there is not a daily collection of dust, householders ought to be advised to burn waste matters liable to decomposition. Removal of Offensive Refuse.—Complaints were made of offensive smells in a number of instances occurring during the removal of kitchen refuse from hotels, &c. Ten persons were cautioned and the following were prosecuted for removing refuse during prohibited hours :- Date Name and Address of Defendant Result of Proceedings. 14th June H. Hunt, Bath Road, Harlington, Mid- Fined 3s. and 2s. costs, dlesex 13th July Michael Hanlon, Lonesome, Mitcham .. Fined. 5-9. and 2s. costs. Drainage, &c., Plans.—Six hundred and nine sets of plans were examined during 1906. 508 of these resulted from notices served by the Public Health Department, and 101 were plans of new buildings or re-constructions, the drainage of which is under the supervision of the City Engineer, with the exception of such matters as come under the Public Health Act and by-laws made thereunder in respect of water closets, water supply, ventilation, &c. In 140 instances the plans had to be amended, and sanction was refused altogether with regard to two of them. Failure to send in plans as required by law occurred ten times. Infringement of the by-laws in connection with the erection of buildings occurred in four instances, and in each case the persons responsible were cautioned by the Public Health Committee. 67 Testing Drains.—One thousand three hundred and thirty-four drainage systems were tested during the year, of which 339 with smoke or water were carried out under the supervision of the Sanitary Inspectors by the men of the disinfecting staff. The routine is to test a drain first by means of chemicals, and if necessary, subsequently with smoke, air, or water. After re-laying, drains below ground are tested with water, pipes above ground with smoke or air. The numbers of each test employed were:- Chemical 532 Water 567 Smoke 169 Air 147 Drainage By-laws.—In reply to a request from the London County Council to be informed whether any difficulty has arisen in the City in connection with the administration of the London County Council By-laws made under Section 202 of the Metropolis Management Act, 1855, and asking for any suggestions with regard to the amendment of these by-laws, the following report was made to the Public Health Committee by the City Engineer and Medical Officer:— We have carefully considered these by-laws, and beg to report that very little difficulty has been experienced in connection with their administration. If they are being amended, we think it might be advisable to make some alterations:— (a) By-Law 3.—The word bath should be added so that it reads " slop or other sink, bath or lavatory." (b) Waste pipes from lavatories, sinks, &c., should not be taken into an open hopper head, but should be connected to the down pipe by proper junctions. (c) A sink, bath or lavatory waste pipe might be allowed to discharge into a rain-water pipe, if head of rain-water pipe is above and sufficiently far away from any window, and the rain-water pipe is sound and constructed of heavy metal with joints of molten lead properly caulked. (cl) By-Lav; 5c.—It is frequently impossible, owing to the whole of the basement of a building being covered in, for gullies to be fixed in the open air to take the discharge from rain-water pipes and waste pipes—a gully with a sealed cover inside the building has to be used, but this does not appear to be provided for by the by-laws. It is also suggested that the pipes connected therewith, especially rain-water pipes, should be so constructed that the joints are quite air-tight, i.e., the pipes might be lead or heavy iron with caulked lead joints. 68 or joints equally good. There would appear to be adequate sanitary protection if this were done. (e) We are of opinion that iron soil-pipes are safer inside houses than lead ones. (No. 11.) (f) Double sealed covers should be required for inspection chambers inside premises. (No. 6.) (g) The by-laws should specify that joints of soil and other pipes are to be constructed in a sound and efficient manner, and that the soil-pipes themselves should be sound. (h) Anti-syphonage pipes from w.c.'s, urinals or slop sinks must not be taken into any other pipes but a soil-pipe. (i) As a 3½-inch pipe is accepted as sufficient size for ventilating a 4-inoh drain (by-law No. 8, last paragraph"), we consider by-law No. 8 (iv) should be altered from 4 inches to 35 inches also. (j) We consider 3 inches too large for the minimum size specified for a urinal waste. Intercepting Traps.—We also considered a suggestion by the Lewisham Borough Council that the insertion ol' an intercepting trap between the house drain and the sewer should not be required in future, and recommended the Council not to agree with the suggestion. Water Supply. Applications were received for certificates that the water supply of twenty new buildings was sufficient, and were granted in each instance. 150 notices of withdrawal of water supply were received from the Metropolitan Water Board, and in 75 instances it was reinstated. Additional sources of water supply were provided to houses in 152 instances ; this includes the provision of water on the upper floors of tenement houses. The Water Board having provided a laboratory and appointed Dr. Houston, director of water examinations, a much more thorough chemical and bacteriological examination of the water supplied to London is now carried out than was the case under the companies. The water is also examined by Dr. Thorpe on behalf of the Local Government Board. Westminster is supplied from the New Biver, Chelsea, Grand Junction, and West Middlesex Divisions, and during 1906 the supply was of good quality, though still capable of improvement. The more extensive use of stored water during times of flood has a beneficial effect in maintaining greater uniformity of quality. Houses Let in Lodgings. The demolition of property which continues, especially in St. John's Ward, continues to reduce the number of houses on the register. At 69 the end of 1905 the number was 1,641, 12 were added in 1906, and 46 removed, leaving 1,602 at the end of the year. 1,905 visits were paid, nearly all by the women Inspectors. Overcrowding was found in 10 instances, and other defects 240. Housing of the Working Classes. Marshall Street Dwellings.—The City Council have added to the dwellings under their control a block of 20 tenements on a site of about 3,255 square feet in their possession in Marshall Street, which was lately occupied by three small houses. The cost of the buildings (exclusive of the value of the site, £2,700) amounted to £4,635. The building is five storeys in height, including half basement and attic storey. There are 10 three room tenements and ten two room tenements; the former being let at 1 1s. to 1 1s. 6d. per week, the latter at 8s. to 8s. 6d. per week. These rents include chimney sweeping and the free use of Venetian blinds. The living rooms are 148 feet super., and the bedrooms vary from 103 feet to 113 feet super. The height being 8 feet 6 inches. All the tenements are self-contained, i.e., each has a separate scullery and w.c. Every tenement is entered from a lobby so as to give absolute privacy to the respective tenants, and from this lobby access is obtained to the scullery and w.c., which are completely cut off from the living room. These lobbies are provided with shelves, hat and coat hooks, &c. Each kitchen is supplied with a self-setting close range fitted with removable oven, a cupboard divided into two parts, the upper part for the storage of food and properly ventilated, the lower part as a receptacle for household utensils. A dresser or rows of shelves has also been provided. All the bedrooms have been fitted with a mantel register and supplied with a good sized cupboard with hooks for hanging clothes. Each scullery is fitted with a copper for boiling linen, a glazed stoneware washing trough, and a gas cooking stove. There is also a large coal bunk next the sink, the top of which serves as a draining board to the sink. Every tenement is lighted by gas on the penny-in-the-slot system. The staircase walls have been faced with marble mosaic to ensure an absolutely smooth and clean surface requiring no annual expense for distempering, and the staircase is made attractive by the use of ornamental panelled balusters instead of plain bars. The floors throughout are of fireproof construction, and the pavings and landings are formed of granolithic materia). The lavatories are paved with mosaic, and the walls thereof have a dado of similar material. The dwellings have been occupied since early in August by 20 families, comprising 72 persons. The terms of letting require that 70 tenants shall be members of the working classes, of British nationality, employed at limited wages in the City of Westminster. St. John's Westminster Improvement.—The London County Council in 1900 began the Millbank Improvement Scheme, and have been since then employed in buying and pulling down the property necessary to give effect thereto. A syndicate (The-Victoria Embankment Contract Syndicate) have now obtained an Act of Parliament (6 Edw. 7, ch. clxxv) whereby in addition to obtaining a lease of the County Council's surplus land, they will be able to acquire additional property, and will thus have control of the square block bounded by Wood Street, Horseferry Road, Millbank and Laundry Yard. The works authorised include a widening of Marsham Street on both sides for the whole length of the street, a widening of Wood Street and Great Peter Street on the southern sides thereof, between St. John Street and the west side of Laundry Yard, and the formation of a new street from Horseferry Road to Wood Street. This will necessitate the closing of a number of small streets and courts, and the demolition of many houses which have required a very considerable amount of sanitary supervision in the past—to which reference was made in my Annual Eeport for 1905. The area of the improvement includes Nos. 2 and 3 and part of No. 5 Enumeration Districts of the Census Registration District, and at the last Census in 1901 the whole of this area contained 460 houses with a population of about 5,250. Probably about 3,000 of these lived in that part of the area now to be dealt with by the Syndicate; but the numbers have in the meantime been reduced to some extent. The County Council state that the number of persons of the working classes displaced under the Millbank Scheme was 2,242, but that accommodation for them was provided on the Millbank Estate (the total accommodation there being now 4,430). It has been ascertained that the further improvement now authorised by the above-named Act will have the effect of displacing 1,846 persons of the working classes. Nothing is said in the Act as to making provision for these persons, but the Housing of the Working Classes Act, 1903, requires re-housing accommodation to be provided where as many as 30 persons of the labouring classes are displaced under the provisions of any Act. Vincent Place Buildings.—The Ecclesiastical Commissioners have completed a block of buildings on a site at Regency Street, Chapter Street, Frederick Street, and Hide Place, containing 42 tenements, 15 of two rooms each, 9 of three rooms, and 18 of four rooms. The dwellings are now occupied by 42 families, comprising 148 persons, 51 being children. The site was formerly occupied by 12 small 71 houses of an inferior type to the dwellings now erected. They contained 75 rooms, and acccommodated about 110 persons. A number (39) of cottages in Willow Street have been, or will shortly be, demolished, displacing about 200 persons of the working class; and adjoining is an area for sale which contains 27 houses occupied by 260 persons. The houses will probably be demolished also in the near future. There is, however, much empty or partially unlet property in the adjoining Pimlico district. Many houses there originally intended for one family in each, have been converted into tenement houses without the addition of those conveniences which are obtainable in a modern dwelling of the type described above. It would effect an improvement in this class of property if no owner were allowed in future to convert a one-family house into a tenement house without obtaining the sanction of the sanitary authority, who should see that sufficient and suitable arrangements had been made as regards storage of food, cooking, water supply, w.c. accommodation, &c. Revenue Act. Applications have been received by me in respect of 14 sets of premises, including in them 144 tenements. These have been inspected by me, with the result that the certificate was granted in 79 instances, 62 were deferred pending certain works to be carried out, -and in three instances the certificates were refused. The premises in which the tenements are situated for which application was made are as follows :— 21, Bourdon Street. Talbot House. 26, Grosvenor Mews. Newport House. Wardour House. Lyric Chambers. Marshall Street Dwellings. Caere Chambers. Charing Cross Mansions. Carey Mansions. Burleigh Mansions. Nos. 2, 15, 16, 30 and 31, G-arden Street. •64, Cambridge Street. Mercer Chambers. 72 Smoke Prevention. The City is divided into two parts for purposes of smoke inspection, under Inspectors McNair and Williams. The following is a summary of the work done in connection therewith:- North District. South District. Total. Complaints received 24 13 37 Observations taken 1,360 1,362 2,722 Notices issued— Preliminary 69 24 93 Statutory 14 11 25 Summonses 6 2 8 The result of the police-court proceedings under the Public Health (London) Act was:- Date. Name and Address of Defendant. Result of Proceedings. 1906. 11th January Gabriel Sedlmayr, Piccadilly Spaten Restaurant, Piccadilly Circus Fined £10 and 2s. costs. 24th January Westminster Electric Supply Corporation, Ltd., 39, Eccleston Place Fined £1 and 2s. costs. 26th February Secretary, Gaiety Restaurant, Strand Fined £10 and£l 3s. costs- 12th April Bonthron and Co., 50, Glasshouse Street Fined £5 and 2s. costs. 19th April Callard Stewart and Watt, 176, Piccadilly Fined £10 and 2s. costs. 23rd March P. Degiuli, Pall Mall Restaurant, 10, Hay market Fined £5 and 2s. costs. 29th June Westminster Electric Supply Corporation, Ltd., Eccleston Place, S.W. Fined £2 and £L 3s. costs. (b) 16th J une .. Savoy Hotel, Ltd., Savoy Court Fined £5 and 2s. costs. The total fines imposed amounted to £48, the costs awarded to£2 18s. A comparison with previous years is given below:- 1902 1903 1904 1905 1906 Complaints 81 52 55 52 37 Observations 2,728 2,731 3,191 2,715 2,722 Notices Issued:— Preliminary 58 68 142 121 93 Statutory 18 18 26 26 25 Proceedings 6 3 5 11 8 73 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 register of workshops at the end of 1906:- Workshops on the Register (s. 131) at the end of the Year. Number. Number of Inspections. Laundries 32 81 Bakehouses 97 222 Tailors, Dressmakers, &c. 1,519 2,901 Other workshops 1,204 Workplaces— Where food is prepared 700 843 Other 70 Total number of workshops on Register 3,622 4,047 There are undoubtedly many more workshops in the City; they are gradually being discovered, but at the same time the occupation of premises already on the register is constantly changing. Thus about 600 changes were recorded during the year. The number of inspections of workshops (including factories) and workplaces is shown in the above Table, and also in those following. 117 complaints were received from the Home Office and were duly investigated. Inspection. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (Including factory laundries.) 128 10 — Workshops (Including workshop laundries.) 3,204 445 2 Workplaces 843 32 2 Total 4,175 487 4 74 Defects found. Particulars. Number of Defects. Number of cutions. Found. Remedied. Nuisances under the Public Health Acts :- Want of cleanliness. 246 246 - Want of ventilation 57 57 - Want of ventilation of gas stoves 58 58 - Overcrowding 28 28 - Want of drainage of floors 9 9 . - Other nuisances 70 70 3 Sanitary accommodation- Insufficient 20 20 - Unsuitable or defective 204 204 - Not separate for sexes 69 69 - Offences under the Factory and Workshop Act:- Illegal occupation of underground bakehouses - - - (Sec. 101) Breach of special sanitary requirements for 1 1 1 bakehouses (Sees. 97 to 100). Other offences - - - Total 762 762 4 * Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act as remediable under the Public Health Acts. Other Matters. Class. Number. Matters notified to H.M. Inspector of Factories: - Failure to affix Abstract of the Factory and Workshop Act (Sec. 133) 211 Action taken in matters referred by H.M. Inspectors as remediable under the Public Health Acts but not under the Factory and Workshop Act (Sec. 5)- Notified by H.M. Inspector 117 Reports (of action taken) sent to H.M. Inspectors 117 Other 4 Workrooms measured 240 Underground bakehouses (Sec. 101):- Certificates granted during the year 3 In use at the end of the yrar 81 Outworkers.-Firms giving out work in certain trades are required to send in a list twice a year of those they employ. Outworkers are constantly changing their addresses and their employers, so that it is difficult to maintain a correct register. The Order issued by the Home Office applies to the following classes of work:- 75 (a) The making, cleaning, washing, altering, ornamenting, finishing, and repairing of wearing apparel and any work incidental thereto. (b) The making, ornamenting, mending, and finishing of lace and of lace curtains and nets. (c) Cabinet and furniture making and upholstery work. (d) The making of electro-plate. (e) The making of files. (f) Fur-pulling. (g) The making of iron and steel cables and chains. (h) The making of iron and steel anchors and grapnels. (i) The making of cart gear, including swivels, rings, loops, gear buckles, mullin bits, hooks, and attachments of all kinds. (j) The making of locks, latches, and keys. (k) The making of covers for, and the covering, finishing, altering, or repairing of, umbrellas, sunshades, parasols, and articles of a similar character, and any work incidental thereto. (l) The making of paper bags and of paper boxes. (m) Brushmaking, and (n) The making of stuffed toys. A list must be kept in the form and with the particulars specified in the factory or workshop or place from which the work is given out, and must be open to inspection by H.M. Inspectors and the officers of the local authority; and a copy of the list signed and dated and corrected up to that date must be forwarded to the local authority of the district on or before the first day of February and the first day of August in each year. Section 110 of the Factory Act, which prohibits home work in places where there is infectious disease, applies to the above, with the exception of (d), (e), (g), (A), (i), (j). The following table gives particulars of the outworkers whose addresses were received in 1906. Considerable difficulty is experienced in obtaining these returns. Notwithstanding that notices are published in the local and trade newspapers, that notices are sent to employers, and visits of reminder are paid by Inspectors, yet there is repeated failure on the part of employers to send in the lists at the stated times. The Home Secretary recently addressed a letter to Local Authorities to bring specially before them the question of enforcement of the provisions of the Act which deal with home work, that is, work in the manufacture, or repair, &c. of articles of the kind specified above in the worker's own house. 76 OUTWORKERS. FEBRUARY LISTS, 1906. AUGUST LISTS, 1906. Trade. Number of Lists. Number of Outworkers. Authorities. Received from Authorities. Live in City. Number of Lists. Number of Outworkers. Sent to other Authorities. Received from Authorities. Live in City. A. Tailoring 115 1,465 443 128 1,150 135 1,782 648 132 1,264 16 195 119 44 120 11 133 93 38 78 A. Theatrical costumiers 1 20 8 12 1 20 9 — 11 2 34 8 26 2 4a 13 — 29 A. Shirt making 11 49 27 2 24 12 67 32 5 40 A. Boot making 1 36 24 9 21 2 67 39 10 38 A. Baby linen — — 1 1 — — — — — A. Brace making — — 1 1 — — — — A. Hat making _ — — — — — — — 2 2 A. Gold lace making - — — — — 1 19 18 — 1 A. Embroidery 2 49 37 15 1 9 8 1 2 L. Paper bag and box making 1 2 2 1 1 1 2 2 1 1 C. Church furnishers 1 16 8 8 - — — — — D. Electro plating - — 1 1 - — - 1 1 - - - - - 2 4 4 3 3 M. Brush making — — — 1 1 - - - --- - 150 1,866 767 191 1,381 168 2,145 868 193 1,470 147 firms sent in lists on both occasions giving a total of 3,729 outworkers, 24 sent in once in the year, the number on their lists being 282. 77 The object of this part of the Factory and Workshop Act is to prevent work being done in dwellings which are injurious or dangerous to the health of the workers themselves, e.g., through overcrowding, want of ventilation, or other insanitary conditions, or in which there is dangerous infectious disease. The importance of this with regard to articles of clothing will be readily appreciated. Two hundred and thirty-four notices were sent out to employers reminding them of their duty in the matter, notwithstanding which 20 employers failed to send in lists at the February period and 19 on the 1st August. The Council has given instructions, that if after notice and a visit from the Inspector default continued, that legal proceedings should follow. Seventy-eight visits were paid to ascertain whether outworkers were employed. The system does not appear to be altogether satisfactory, as the persons employed as outworkers are not engaged continuously or regularly, and it may happen that when the lis^s are sent in business is at the moment slack, and few outworkers are being employed. It would probably be better to require employers to send in the names and addresses of new outworkers at the time they are taken on, so that their homes or places of business might be at once inspected, if not already on the Council's Register. Frequently a worker may have been employed during the year by several firms, either at one time or successively, so that the number of names returned does not necessarily coincide with the actual number of workers. In one instance a man was on ten lists. About 1,200 visits were paid to outworkers' premises. The defects found are included under the heading "Workshops," as the terms are synonymous in a great many instances. At one time a man may be doing a little work on his own account, without employing any assistance except perhaps from members of his own family, his place is then a " domestic workshop " ; at another time he may be employing other persons, when it becomes an ordinary " workshop "; and at either period he may be receiving work from other firms, or from a middleman, when he becomes an " outworker." During 1905, cases of notifiable infectious disease occurred in 45 families engaged in clothing trades at home, and in 7 families of other home workers. F 78 The details are:— Clothing Trades. Scarlet Fever. Diphtheria. Typhoid Fever. Erysipelas. Total. (a) Business in family affected 29 5 3 8 45 (1) Business in other parts of house 30 11 - 2 43 (c) Persons from infected houses employed in clothing business elsewhere 28 9 1 2 40 87 25 4 12 128 Other home workers :— (a) Business in family 5 2 — — 7 (S) Business in other part of 3 — — — 3 In addition, in connection with Laundries there were cases of the above three classes:— (a) (i) (c) In Receiving Shops — Diphtheria (1) — Mangling only Scarlet Fever (1) — — -rrr t . x » f Scarlet Fever (1) Scarlet Fever (3) Diphtheria (2) Washing, Ironing, &c. Erysipelas ft __ Erysipelas (1) In all these cases the patients were removed to hospital and the premises disinfected. In no instance was it found necessary to stop work being given out to workers in premises which were in an insanitary condition, any such defects found were forthwith remedied, and none of them were of a serious character. Sixty visits were paid to Domestic Workrooms, i.e., where no work was being taken in from another business firm, and no one outside the family was ever employed. Factory and Workshops Bill (116).—This Bill was introduced into Parliament last Session to amend and strengthen certain of the sections of the existing. Act. I reported on it as follows:— " Clause 1 relates to outworkers, and would apply all the provisions of existing Acts to the places to which work is sent to be done, and would treat the giver out of the work as the occupier of the place. Apparently this is intended to bring ' domestic workshops under the Act,' but it would be impracticable to make the giver out of the work responsible for cleansing, &c., of the premises to which he may give out work. " Sub-clause 5 asks for lists of outworkers to be sent in four times a year instead of twice, as at present. There is sufficient trouble now 79 to get the lists, and as the object sought for is to obtain the names of outworkers who may be taken on for short intervals, it would be better to require lists to be sent in once a year, and further require employers to send in the names of any other outworkers they may take on during the year. "Clause 6. Underground Workshops.—It is proposed that such workshops shall not be used unless certified in the same way as bakehouses have been. This would be useful, especially if extended to include ' workplaces,' which would bring in many places where food is prepared; but as no provision is made in this Bill or in the FactoryAct for the withdrawal of such certificate if at any time the premises are found not to comply with the requirements, a clause should be introduced giving a magistrate power to close an underground bakehouse or workshop on being shown that it was unsuitable for use. " Clause 34 prohibits the employment of a woman within two months, and eventually within six months after the birth of a child. The Conference on Infant Mortality recommended that the period be three months, but also goes further in prohibiting the employment of a woman for a similar period before her confinement. " Clause 69 extends the sanitary provisions of the Factory Act to men's workshops. One of the sections of the Act which would be applicable is No. 9, which requires ' proper separate accommodation for persons of each sex.' This is a very useful power for buildings which are wholly occupied as workshops or factories, but it presses very hardly in the case of a single workshop (perhaps only one room) in a house let out in tenements. Were there no workshop one w.c. for twelve persons would be provided irrespective of Sex, but so soon as women are employed separate accommodation must be found for them. If this section is extended to male employees then a workshop in a tenement house will require to have a w.c. set apart for the men. In my opinion, the application of the section in such cases should be left to the discretion of the Local Authority." The Bill was eventually withdrawn. F 2 80 E.—Food Supply. The food exposed for sale in shops and on stalls in the street markets has been regularly inspected every day (including Sundays). The following list shows the quantity of food condemned and destroyed during the year. The bulk of it was submitted by the owners or purchasers for the opinion of your officers:— Articles of Food Submitted. Tons. Cwts. Lbs. Tons. Cwts. Lbs. Apples 0 13 84 Grapes 0 8 0 Bananas 33 17 84 G-reengages 0 7 0 Beans 1 12 0 Limes 0 1 0 Blackberries 0 O 14 Oranges ,. 1 8 o Cauliflowers 0 4 0 Peas 0 2 0 Cherries 0 0 10 Pears 7 10 56 Currants, Black 0 0 39 Plums 2 18 0 Custard Apples 0 0 20 Strawberries 0 1 0 Damsons 0 10 56 Tomatoes 0 15 84 Crabs 50 1 cwt. Lobsters 75 Fish (various) 2 cwt. ^ Salt Fish 2 cwt. Preserved vegetables 56 lbs. Anchovies 24 bottles. Sardines 1,160 tins. Pork (68 lbs.) and 1 Pig's Head (Tuberculous). Articles of Food Seized. 42 lbs. Pork and a Pig'8 Head, Tuberculous Fine of £5 and £1 3s. costs. Pig's Head, Tuberculous No fine, £3 3s. costs. 3 Pig Carcases—Unsound, result of bad packing Carcases destroyed and consignor cautioned. 30 lbs. various kinds of meat Magistrate was of opinion that the meat was not intended for sale. 20 lbs. Unsound Plums No line, 12s. 6d. costs. Above-ground Bakehouses.—During 1906 there have been no additions to the above-ground bakehouses, but No. 99, Horseferry Eoad, No. 48, Eomney Street, and No. 72, Vauxhall Bridge Eoad are not at present being used as bakehouses; there are, therefore, 16 now in use. Underground Bakehouses.—There are 81 now being used in the City. Three in use at the passing of the Act have been certified and added to the list, viz.: No. 173, New Bond Street, No. 162, Victoria Street and Hyde Park Hotel. Four which were in use in 1905 have been discontinued, viz.: No. 78, Berwick Street, No. 1, Old Compton Street, No. 76, Wardour Street (demolished), and No. 415, Oxford Street. 81 Five owners failed to carry out the cleansing at the times appointed in Spring and Autumn, but complied on receipt of a warning letter from the Public Health Committee, except in the case of No, 78, Berwick Street, against the owner of which proceedings were taken for not having the necessary cleansing work carried out and also for allowing the premises to get into such a state as to be unfit for use as a bakehouse. A fine of forty shillings was imposed on the summons taken out under Section 98 of the Factory and Workshops Act. The use of the bakehouse was given up. It appears that under the Factory and Workshops Act no power is given to a Magistrate to make a Closing Order with regard to bakers' premises which have been allowed to become unfit for use, unless action, be taken through the nuisance sections of the Public Health Act. As a rule the bakehouses are well conducted. It would be an improvement, which would be appreciated by the public, if bakers generally would follow the example of those who now send out loaves, and rolls for delivery each enclosed in a paper bag. It would prevent; the occurrence of such contamination as is related by a member of a West-End Club in a letter to the Lancet; he " was in the habit of taking a walk before breakfast, and daily passed two well-known bakers' shops, and saw, most mornings, loaves in trays placed on the pavement with dogs prowling round, hand carts with baskets full of bread suspended from the handles and frequently bumping in the mud, and sometimes loaves fell off into the roadway and were replaced unwiped." Two hundred and twenty-two visits were paid in 1906 to the 97 bakehouses. Ice Cream Premises.—Places (116) where ice-creams are manufactured or sold were visited 180 times during the year. In two instances notices were served that the places were not suitable for the purpose, and steps were taken to make them comply with legal requirements. Street vendors were also looked after, and one was cautioned for not having his name affixed to his barrow. Restaurants, Eating Houses, &c.—516 visits were paid to premises of this description. Five restaurants received certificates that they complied with the conditions of sanitary fitness specified in the Annual Report for 1905. Other places engaged in the preparation of foods and mineral waters were also frequently inspected. Slaughter-house.—There is only one (14, Regency Street) which is used occasionally. It was visited weekly. Covjsheds.—There are only two cow-keepers (13, Marsham Street, 19 cows; 7, Arthur Street, 12 cows) in the City. Their premises were visited 34 times each during the year. 82 Milkshops.—At the end of 1905 there were 299 on the Register, 34 new names have been added and 1 removed, making 332 at the end of 1906. 397 visits were paid by the District Inspectors to the premises in addition to visits at regular intervals to the milk-shop itself by the Inspectors under the Sale of Food and Drags Acts. No name is placed on the register until the sanitary condition of the premises has been examined. Notices requiring them to register were sent to a number of persons who had been found selling milk. Proceedings were about to be taken against one vendor, but as he was arrested for stealing milk-cans and sentenced to imprisonment, as well as being evicted from the rooms he occupied, no further action was taken. Two cases of enteric fever and one of diphtheria occurred on premises in which were milk-shops ; persons from two houses, in one of which a case of enteric fever, and in the other one of scarlet fever occurred, were employed in milk-shops : in each instance steps were taken to prevent contamination of the milk by disinfection, prompt removal of the cases to hospital, and suspension from work of contacts. Forty notices were served with respect to defects in premises on which milk was sold. Unclean Milk.—The Council of the Metropolitan Borough of Wandsworth forwarded on the 13th August, 1906, a copy of certain resolutions passed at a conference of the Public Health Committee of that Council and dairymen and keepers of milkshops in that Borough on the 17th July last. The resolutions were:— "(1) That the Board of Agriculture be urged to bring into force and carry out the Dairies, Cowsheds, and Milkshops Order in the country, with such variations as are applicable in various districts. (2) That the Board of Agriculture be requested to take steps to ensure that the udders of the cows and the hands and arms of the person milking shall be clean at the time of milking, and that the vessel used shall be clean and be kept solely for the purpose of milking. (3) That in the opinion of this Conference all Railway Companies carrying milk should provide proper insulated trucks, as now used by the London and North-Western Railway Company for the purpose. (4) That the Board of Agriculture be urged to take steps to ensure the carriage of milk in sealed churns. (5) That in the opinion of this Conference all dairies should be licensed annually, and only licensed dairies should sell milk for consumption on or off the premises, and that all milk on the 83 counter for sale in open vessels should be covered with muslin or other suitable cover. (6) It was generally admitted that preservatives are not necessary." The City Council concurred with the suggestions contained in the resolutions referred to, and further expressed the opinion that it is desirable that sealed bottles should be substituted for the metal cans now in use for the retail delivery of milk. As some doubt has been expressed as to the powers given by the Regulations for Milkshops, it is interesting to note that in the Borough of Woolwich a prosecution was recently instituted against a General Dealer, who, inter alia, sold milk, for failing to keep his shop in a cleanly condition ; it was proved that the Defendant retailed over the counter small quantities of milk, which he kept in an uncovered receptacle; the shop was in a dirty condition and the milk was therefore liable to contamination; the Defendant was convicted, and, upon his undertaking to stop the further sale of milk in his shop, was let off with a small fine. 84 Sale of Food and Drugs Acts. Samples Purchased under the Sale of Food and Drugs Acts, showing result of Analysis and subsequent Proceedings. Number. Articles of Food. Number of Samples Purchased. Genuine. (Inferior in brackets.) Adulterated. Prosecutions. Convictions. Warranty or Disclosure. Fines. Costs. £ s. d. £ s. d. 1 Milk 806 599 (88) 119 56 35 26 90 0 0 31 13 0 2 do. Separated . 7 7 3 do. Skimmed 3 2 1 4 do. Machine Skimmed condensed 1 1 5 Cream 39 1 38 12 6 6 0 0 9 8 6 6 do. Ice 37 37 7 Butter 200 175 (8) 17 13 11 1 17 15 0 7 5 0 8 Margarine 39 39 2 1 — 0 10 0 0 12 6 9 Coffee 69 67 (1) 1 1 1 — 1 0 0 0 12 6 10 do. and chicory 16 14 2 1 — — — 2 2 0 31 Cocoa •• 54 51 3 12 do. Extract 1 — 1 13 do. Mixture 3 3 14 Chocolate 1 1 15 Oil, Almond 18 17 (1) 16 do. Olive 36 33 (1) 2 2 2 — 4 10 0 1 5 0 17 do. Salad 1 1 18 Barley 8 8 19 Rice 18 6 (1) 11 20 Biscuits, cheese 1 1 21 Cinnamon 2 1 1 22 Almonds, ground 1 1 23 Oatmeal 9 9 24 Honey 50 49 (1) 25 do. and marmalade 1 1 2G Syrup, golden 5 5 27 Greengages, preserved 1 1 28 Meats and fish, potted 96 61 (6) 29 29 Mustard 20 19 1 1 1 — 3 0 0 0 12 6 30 Pepper 11 11 31 Vinegar 46 41 (3) 2 32 Gherkins 2 2 33 Capers 7 7 34 Olives, preserved 5' 5 35 Peas, preserved . 28 6 22 2 2 — 4 0 0 1 15 6 36 Beans, preserved 9 2 7 37 Spinach, preserved 11 1 10 10 9 45 10 0 10 3 0 38 Beer 27 27 39 Brandy 13 9 (2) 2 40 Whiskey 9 9 41 Linseed 3 3 42 do. Meal 6 6 43 Prescription 17 15 2 44 Cod liver oil 27 27 45 Glycerine 11 11 46 Quinine 3 3 47 Camphor 8 8 48 do. Spirit of 1 1 49 Camphorated oil 2 2 50 Quinine sulphate 6 6 51 Liquorice powder 2 2 52 Rhubarb powder 3 3 Totals 1,800 1,417 (112) 271 98 62 33 172 5 0 65 9 6 85 Milk.—806 samples of ordinary milk were taken during the year. Of these 119 (14.7 per cent.) were reported by the Analysts to be below the standard of the Board of Agriculture, but 88 samples were just on the border line, making a total of 25.6 per cent, of the samples. The percentage of adulterated is above the average (11.3 per cent.), as compared with 10.7 per cent, in 1905,21.5 percent. in 1904, and 12 per cent, in 1903. The Analysts have graded the samples submitted to them into four groups:— Good quality, in which the fat was over 3.8 per cent.; fair quality, in which the fat was between 33 and 3.8 per cent.; and poor or inferior quality, in which the fat was between 3 per cent, (the official standard) and 3.3 per cent., or in which the non.fatty solids were between 8.5 and 8.6 (if the fat was also below 3.8). Adulterated are below the standard. The official standard is 3 per cent, for fat and 8"5 for solids not fat. District. Total. Good Quality. Fair Quality. Poor Quality. Adulterated. No. Percent. No. Percent. No. Per cent. No. Per cent. South 353 135 38.2 105 30.0 72 20.2 41 116 North ,. 453 132 291 147 32.4 96 211 78 172 1906 .. 806 267 331 252 31.2 168 20.8 119 14.07 1905 .. 831 305 36.7 281 338 153 18.4 92 1107 Fifty.three prosecutions were taken with regard to adulteration— 36 for fat abstracted, 14 for added water, one for both offences in the same sample, and one for the addition of boric acid (44.72 grains per gallon). Warranties or disclosures were proved in 26 instances. Cautions were given to sellers whose milk contained less than 5 per cent, of added water, or had less than 5 per cent, of fat abstracted. It has been suggested that the dry weather which prevailed had the effect of reducing the quality of the milk, but this does not appear to be correct; there is no doubt, however, that the quantity supplied was less than usual, especially in the autumn. Notwithstanding this, the amount of inferior milk supplied to Westminster was not much above the usual; 64"3 per cent, of the samples were of good or fair quality, well above the official standard, as compared with 70.5 in 1905, Details of the proceedings taken are appended. Sunday Samples—One hundred and thirty.one of the samples of milk were taken on thirteen Sundays during the year; 15 (10.5 per cent.) were found to be adulterated and 4 (3 per cent.) were inferior, an improvement on 1905, when the figures were 14.6 and 39 respectively. Sunday used to show a larger percentage of adulteration than week days. 86 Samples taken in course of Delivery— (a) At Railway Stations.—-Sixty-eight samples of milk were taken on arrival at Victoria and Charing Cross Railway Stations; eight of these were found to have been consigned as separated milk, but no label was affixed to the churns. Of the remaining sixty, 44 were reported of good quality, 8 fair, 3 poor, and 5 adulterated (8'3 per cent.). The amount of adulteration was not above 3 per cent, in each instance. (b) On Delivery at Shops.—Twenty-nine samples of milk were taken as it was being delivered to retail customers. Of these samples, 14 were good, 9 fair, 1 poor, and 5 adulterated. These samples were taken in consequence of the milk sold by the retailer having been previously Sampled and found below the limit. Warranties.—A conference of representatives of Metropolitan Borough Councils as to milk warranties, &c., was held at the Town Hall, Southwark, on Wednesday, the 30th May, 1906. The following resolutions were passed:— (1) That in the opinion of this Conference, the provisions of Section 25 of the Sale of Food and Drugs Act, 1875, and Section 20 of the Food and Drugs Amendment Act, 1899, operate to the prejudice of the purchaser and the public health, and should be repealed, leaving the seller of milk to his remedy at. common law against the person from whom he purchases it. (2) That notices in shops, &o., to the effect that milk sold therein is not warranted as pure shall be no defence. (3) That the act of mixing water or separated milk with whole milk for the purpose of sale should be made a penal offence. Particulars of all cases in which warranties are proved are forwarded by the Council to the Local Government Board. In one instance proceedings were taken unsuccessfully against the giver of a warranty, but the case showed how desirable it would have been had the magistrate been able to deal with the matter as a whole, on one summons. However, a sample taken at Vauxhall Railway Station by the Lambeth Borough Council was found deficient, and the farmer was summoned and fined. Samples in other cases were also taken, by request, by Lambeth and Paddington Borough Councils at railway stations. Separated Milk.—A considerable quantity of separated milk is consigned to dealers in the City, and while there are legitimate uses for it, I have a strong suspicion that it is also used to dilute milk of good quality. As this separated milk is sent up in churns, without any label to show the nature of its contents, the Council addressed a communication to the Board of Agriculture and Fisheries forwarding particulars of a case in which a sample of milk taken at Victoria Station, whilst in 87 course of delivery, was, upon analysis, found to be separated milk, the Inspector also being informed, subsequent to his taking the sample, that it was separated milk, suggesting that the Board should consider the question of the desirability of issuing a leaflet to farmers and others concerned, pointing out the advisability of churns containing ■separated milk being so labelled. The Board of Agriculture and Fisheries, in reply, pointed out that when a sample of milk is taken on delivery under the Food and Drugs Acts, the material point is not as to the label, if any, on the churn, but as to what is the nature of the contract in pursuance of which the milk is delivered, and suggesting that, in view of this fact, it is doubtful if .the labelling of churns in the manner suggested would, so far as samples thus taken are concerned, assist either the farmer or the Inspector of the Local Authority, and adding that nearly all the separated milk sent into London is received not from farmers but from factories. The City Council informed the Board they are still of opinion that were churns containing separated milk so labelled, it would be a means of saving the sampling officer's time and also the expense incidental to the taking and analysing of such samples. Cream.—Thirty-nine samples of cream were taken, and in 38 instances it was found to contain boric acid. No proceedings were taken when the amount did not exceed the limit (17 J grains per lb.) laid down in the report of the Departmental Committee on the Use of Preservatives, &c., in Food. Twelve prosecutions were taken for amounts varying from 22 89 grains to 53'053 grains per lb., with the result that in six instances warranties were proved, and in one the summons was dismissed. In this ease one of the City Analysts, Mr. Cassal, reported the presence of 23-548 grains; the portion left with the vendor was analysed by Mr. Stokes, who stated that he found a much smaller amount, and the third portion was sent to Somerset House, who gave a result higher than that of Mr. Stokes, but under the 17^ grains limit. It appears that there are several methods •employed by analysts for the determination of boric acid, but none of them give the total amount of the acid in milk, although they may do so when the acid is dissolved in pure water. When other substances are present, the actual amount discoverable varies considerably with the method adopted. That usually employed by analysts, and which is understood to be the process adopted by the Government Analysts, does not show the total acid present, but when carefully carried out, gives a fairly constant return. Usually analysts check it by making three estimations. Mr. Cassal has devised a method whereby a larger quantity of boric acid can be recovered than by any other method, but from the published description it appears to involve a considerable number of 88 delicate operations, which require much time and care to accomplish satisfactorily. If the Local Government Board would state the method employed by the chemists at Somerset House, it would tend towards uniformity. Butter and Margarine.—Two hundred samples were bought as butter and 175 were reported to be genuine, although with regard to. eight of them there was some dubiety in the mind of the analyst; 10 prosecutions were undertaken for substituting margarine for butter,, and three for an excess of water (1.48, 3.1 and 8.l per cent. in excess of the legal limit, which is 16 per cent.). A warranty was proved in one case and in another the defendant absconded. The butter, which contained l.48 excess of water, also contained 0.53 per cent. of starch; a warranty was pleaded, but was not proved, the alleged warrantor disputing that the warranty referred to this butter. The presence of starch is unusual, but it is of interest to note that the Belgian Government requires the addition of a small percentage of starch and of sesame oil to each pound of margarine. In one instance a prosecution was taken fur selling margarine in a plain wrapper; the same person was also summoned for exposing margarine for sale without a proper label, but as the actual purchaser was not clear on this point, the magistrates convicted on the first summons only. Potted Meats and Fish.—Ninety.six samples in all were purchased and 29 of these were found to contain boric acid; no legal proceedings. were taken, as the majority of the samples were taken in compliance with a request from Dr. Buchanan, the Inspector for Food, &c., of the Local Government Board, suggesting that samples of tinned foods might be taken by the Council and submitted without sub.division to the analysts. In accordance with the instruction of the Public Health Committee, forty samples of eighteen kinds of food put up by twenty firms were purchased and examined. The articles and the number of each bought were:— 6 potted liara and chicken. 3 brawn. 3 potted chicken and tongue. 1 galantine boar.s head. 2 chicken and veal pate. 2 beef loaf. 2 potted turkey and tongue. 2 preserved beef. 2 potted veal and ham. 5 corned beef. 2 potted salmon and shrimp paste. 2 veal loaf. 1 potted ham and tongue, 1 devilled ham. 1 potted game, ham, and tongue. 1 Vienna sausage. 3 tongue. 1 herrings in.tomato sauce. Apparently the ingredients were found to be as stated on labels, but twelve were reported to contain boric acid in quantities varying from. a trace to 163.t> grains per pound. These were:— 89 3 ham and chicken paste, 5.2 grains, 5.5 grains, and 114.5 grains. 2 chicken and tongue, 4 8 grains and 110 grains. 2 turkey and tongue, 5.5 grains and 163.6 grains. 1 veal and ham pate, 71.5 grains. 2 salmon and shrimp paste, 13 grains and 145-7 grains. 1 ham and tongue, 5.2 grains. 1 brawn, traces. The brawn in one case was bad through a defect in the edge of the ;glass vessel in which it was put up. The attention of the firm was called thereto. Of the seven kinds of preparations, twelve of which contained boric acid, nineteen samples were taken. Assuming that the addition of some preservative is necessary, the large amounts of boric acid found are clearly excessive. But the fact that other firms can put up similar preparations without the addition of chemical preservatives shows that their use is quite unnecessary. In the chicken and ham put up by one of the firms, notwithstanding that 114.5 grains of boric acid were present, there was a fungoid growth under the fat. The attention of the firms concerned was called to the presence of boric acid in their goods, and they have been informed that the Council proposes to take action if large amounts are found in such preparations in the future. Several of the firms that have been communicated with on the •subject replied to the effect that they were ignorant of the fact that boric acid was present in their respective goods, that they had not added any acid during the process of potting, and that its presence must have been due to the hams, tongues, or other ingredients sold to them which had been cured by means of boric acid instead of salt. In the case of the sample certified as containing 163.6 grains per pound, the vendors have written stating that they are causing the sale of such articles to be withdrawn from all their branches. The above explanation is feasible for the smaller amounts of the acid found, but would not account for the extraordinarily large amounts, viz., 163.6, 145.7, 114-5 and 110 grains per pound, discovered in some of the samples, which could only be accounted for by the wilful addition of the acid, or by gross carelessness in not removing from the surface of the hams the acid which is frequently dusted over them to protect them during transit. The Council directed that further samples of such foods be purchased and analysed, but the manufacturers had evidently profited by the warning and had taken steps to see that excessive quantities of preservative were kept out of their preparations. 90 A copy of the report presented, together with full particulars as to the vessels in which the food was put up, labels, &c., was forwarded to Dr. Buchanan. The Metropolitan Branch of the Incorporated Society of Medical Officers of Health passed the following resolutions on the subject, and they were also adopted by the City Council:— " That it is necessary, in order to secure better protection for the public in regard to tinned and preserved foods, that legislation should be passed embodying the following important reforms ":— 1. The name and address of the manufacturer and the date of canning shall be impressed on the cans. 2. It shall be unlawful to sell for any purpose canned goods that are unfit for human consumption, and it shall be the duty of any person in possession of unsound canned foods to notify and surrender same to the local authority, who shall destroy such unsound food free of charge. 3. A certain number of tins (say 1 per cent.) from each consignment shall be opened on importation and the contents examined under the supervision or instructions of the Sanitary Authority concerned, prior to such canned foods being placed on the market. 4. Tins which are known in the trade as "doubtfuls" shall be deemed to be unfit for human consumption. 5. Food intended for canning shall be inspected by independent officials prior to being canned, and all foods shall be canned under strictly hygienic conditions. 6. In the opinion of the branch, the use of preservatives in canned foods is unnecessary, and should under no circumstances be permitted. The importance of leaving the date of canning on the tins has been emphasised by a report made by Dr. Buchanan on a large consignment of beef essence returned from South Africa, where it had been for some years. Although sterile, the contents had undergone changes which entirely altered their food value. It has also been found that manufacturers do not always place their names on the cans, and there is, therefore, a difficulty in tracing their source of origin. Tinned Vegetables and Fruit.—Sixty-three samples were taken as shown on list, and, except peas and spinach, were found free from adulteration. Both peas and spinach show a marked improvement in the amount of copper now added to them; only 2 samples out of 28 of peas, and 8 out of 11 of spinach showing copper above the limit. In a number of instances no copper had been added at all. 91 Drugs.—Calcium chloride was included in certain proscriptions which were made up for analysis, and a marked deficiency was found in several samples, varying from 18 to 40 per cent. This drug is of a deliquescent nature, and should be kept in small quantities and in closely-stoppered bottles or in solution, otherwise prescribers finding the doses ordered insufficient for the purpose for which the drug was ordered, may be led to use larger doses, and if these happen to be made up of a full strength drug, there may be unfortunate results. The attention of chemists was called to the matter. Other Infringements of the Food and Drugs Acts.—In addition to the prosecutions for adulteration, proceedings were taken for the following:— (1) Neglecting to have name on milk can. Fined £2 and 12s. 6d. costs. (2) Refusing to serve. (a) Milk.—Dismissed. Magistrate refused to convict master as he was not present when his servant refused. (b) Milk.—The vendor refused to serve the inspector from a can out of which he had previously served a customer, and poured into it milk from another can. A sample of the mixture was eventually obtained and found then to have 9 per cent, of added water. Fined £5 and 2s. costs for refusal to sell, £20 and £5 5s. costs for the adulteration. (c) Spinach.—Tins were exhibited for sale in the shop window, but as a successful prosecution had taken place on account of the copper in the spinach, the then owner refused to sell. Fined £3 and £2 2s. Od. costs. (3) Obstructing Inspector.—The manager of a shop seized a tin of spinach which the Inspector had bought and refused to allow him to have it again. Fined £10 and £3 3s. Od. costs. The net amount of penalties and costs, after deducting the costs paid in cases dismissed, was £231 5s. 6d, Seventy-five per cent, of the samples were purchased by the Inspectors by means of agents. Particulars of each case are appended :— 92 Legal Proceedings Under the Food and Drugs Acts during 1906. Date of Hearing. 1 Court and Magistrate. 2 Name and Address of Defendant. 3 Offence. 4 Result. 5 1906. 12tli February .. MILK Bow Street (Mr. Marsliam) (Including- Refusal to Sell Cecil Ansley Greet, Arthur F. Ablett (trading as the Arcade Restaurant Company), 52, Strand and want of Name on Can). Selling two glasses of milk with 29 per cent, of fat abstracted (ION) Fined £2 and 12s. 6d. costs. 12tli February .. Bow Street (Mr. Marsliam) William Stephens, 15, Drury Lane, W.C. Selling milk at 51, Lincoln's Inn Fields, with 12 per cent, of added water (25 N) To pay 12*. 6d. costs. 12th February .. Bow Street (Mr. Marsliam) John Evans, 13, Bedfordbury Selling milk with 8 per cent, of added water (2 N) Warranty proved. Summons dismissed. 15th February .. Marlborough Street (Mr. Kennedy) Samuel Ede, 29, Beak Street.. Selling milk with 16 per cent, of added water (47 N) Fined £3 and 12-9. 6d. costs. 22ncl February .. Bow Street (Sir Albert de Rutzen) A. A. Williams, 50, Chandos Street, W.C. Milk. 30 per cent, of fat abstracted (54 N) Fined £1 and 12s. 6d. costs. 1st March Marlborough Street (Mr. Kennedy) Ada Mary Parker, 25, Great Marlborough Street Milk. 30 per cent, of fat abstracted (97 N) Fined 15s. and 12s. 6d. costs. 1st March Marlborough Street (Mr. Kennedy) Arthur Williams, 22, Poland Street Milk. 9 per cent, of added water (98 N) Fined £2 and 12s. 6d. costs. 9th March Westminster (Mr. Curtis Bennett) Howard Kowin, 77, Lupus Street Selling milk with 14 per cent, of fat abstracted (99 S) Warranty proved. Summons dismissed. 23rd March Westminster (Mr. Curtis Bennett) Thomas Davies, 4, Shepherd Place, Upper Brook Street, W. Selling 1 pint of milk with 10 per cent of added water (157 N) Fined £2 and 12s. 6d. costs. 5th April Marlborough Street (Mr. Kennedy) Pietro Necchi, 101, Charing Cross Road Milk. 31 per cent, of fat abstracted (219 N) Fined £2 and 12s. 6d. costs. 12th and 19th April Marlborough Street (Mr. Kennsdy) Philip L. Townsend, 26, Frith Street Milk. 5 per cent, of fat abstracted (206 N) Warranty proved. Summons dismissed. 27th April Westminster (Mr. Curtis Bennett) Alice Wright, St. George's Mansions, Vauxhall Bridge Road Selling milk from which 51 per cent, of fat had been abstracted (203 S) Fined £1 and £1 3s. costs. 93 25th March Westminster (Mr. Curtis Bennett) John Adams, 9, Moreton Street Selling milk 15 per cent, of fat abstracted (236 S) Warranty proved. Summons dismissed. 11th May Westminster (Mr. Paul Taylor) Morgan Morgan, 52, Rochester Row Selling milk with 3 per cent, of added water and 20'56 per cent, of fat abstracted (221 S) Warranty proved. Summons dismissed. 14th May Bow Street (Mr. Marsham) Caroline Burry, 17 and 19, Causton Street, Westminster Selling, at St. James's Park, milk from which 14 per cent, of fat had been abstracted (286 N) Fined 10s. and 12s. 6d. costs. 14tli May Bow Street (Mr. Marsham) Aerated Bread Co., Ltd., 14, Eastcheap, E.C. Selling at 454, Strand, milk from which 10 per cent, of fat had been abstracted (292 N) Fined 20s. and 12s. 6d. costs. The defendants relied on a warranty, but were unable to show that they had sold the milk in the same-state as they had received it. 14th May Bow Street (Mr. Marsham) James C. Pearson, 72, North End Road, Eulham Selling at Whitehall Court, milk which had 15 per cent, of fat abstracted (288 N) Fined 20s. and 12s. 6d. costs, 17th May Marlborough Street (Mr. Kennedy) Slaters, Ltd., 18 and 20, Kensington High Street Selling milk from which 16 per cent, of fat had been abstracted (314 N) Warranty proved. Summons dismissed. 17th May Marlborough Street (Mr. Kennedy) Hermann Appenrodt, 9, New Coventry Street Selling milk from which 3 0 percent, of fat had been abstracted (310 X) Warranty proved; summons dismissed. 31st May,. Marlborough Street (Mr Kennedy) James Torrie, 78, Jermyn Street, W. Selling milk with 6 per cent, fat abstracted (328 N) Fined 20s. and 12s. Qd. costs. 8tli June.. Westminster (Mr. Curtis Bennett) John Staples, 4, Bowden Street, Kennington Cross Selling milk in Cambridge Street, Pimlico, from which 27 per cent, of fat had been abstracted (283 S) Fined £10 and £3 3s. costs, or 6 weeks in default. 15th June 28th June Westminster (Mr. Curtis Bennett) Marlborough Street John Adams, trading as Adams and Co., 9, Moreton Street Selling millc 28 per cent, of fat abstracted (301 S) Warranty proved. Summons dismissed. 28th June (Mr. Plowden) Marlborough Street Pasquale Malangone, 52, Old Compton Street Selling milk with 16 per cent, of added water ^463 N) Fined 40s. and 12s. 6d. costs. (Mr. Plowden) Letita Bennett Jones, 24, Dean Street, Soho, W. Selling milk 15 per cent, of fat abstracted (456 N) Fined 10s. and 12s. 6d. costs. q 10th July Marlborough Street (Mr. Kennedy) Carlo Negrotti, 25, Whitcomb Street Selling milk at No. 25, Oxenden Street, containing 19 per cent, added water (527 N) Fined £5 and 12s. 6d. costs. lOtli July Marlborough Street (Mr. Kennedy) Carlo Negrotti, 25, Whitcomb Street Selling milk at 25, Whitcomb Street, containing 20 per cent, added water (526 N) Fined £2 and 12s. 6d. costs. 94 Date of Hearing. Court and Magistrate. Name and Address of Defendant. Offence. Result. 1 2 3 4 5 1906. lOthJuly Marlborough Street; (Mr. Kennedy) Henry James Rimell and John Rex worthy (trading as Clewley and Co.), 3 and 4, Buckingham Street, Strand Selling, at St. Martin's Lane, milk deficient of fat 23 per cent. (620 N) Ordered to pay £2 2s. costs. 10th July Marlborough Street (Mr. Kennedy) Phillip L. Townsend, 26, Frith Street, Soho Selling at 25, Whitcomb Street, milk containing 17 per cent, added water (663 N) Warranty proved. Summons dismissed. 12tli July Marlborough Street (Mr. Kennedy) George Churchill, 51, Lexington Street Selling milk 8 per cent, of fatabstracted (468 N) Fined 5s. and 12s. 6d. costs. 26tli July Marlborough Street (Mr. Kennedy) Nereo Ccscotti, 4, St. Ann's Court. Soho Selling milk 37 per cent, of fat abstracted (584 N) Fined £1 and 12s. 6d, costs. 26th July Marlborough Street (Mr. Kennedy) Richards Bros., Q2, New Compton Street Selling milk 8 per cent, of fat abstracted (516 N) Fined £1 and 12s. 6d. costs. 26tli J uly Marlborough Street (Mr. Kennedy) H. Goldstein, 38, Upper Rathbone Place, W.C. Selling milk, in Wardour Street) 9 per cent, of fat abstracted (552 N) Fined £i and 12s. 6d. costs. 27th July W estminster (Mr. Curtis Bennett) Callow Park Dairy Co., Ltd., 79, Copenhagen Street, Caledonian Road, N. Selling, in Horseferry Road, milk from which 26 per cent, of fat had been abstracted (400 S) Warranty proved. Summons dismissed. 28 th J uly Westminster (Mr. Curtis Bennett) A.J. Thorn, Lime Kiln Farm Astwick, Oakhill, Bath Giving false warranty to Adams and Co. on 10th May, 1906, in respect of this sample of milk (301 S) One of the witnesses did not attend, and the chain of evidence was incomplete and the summons was dismissed. 7th August Bow Street (Mr. Marsham) Lyons and Co., Ltd., Cadby Hall, Kensington • Selling milk at 35, Strand, from which 10 per cent, of fat had been abstracted (572 N) Warranty proved. Summons dismissed. 21st August Bow Street (Mr. Marsham) Virgillo Guidotli, 11, Bridge Street- Selling milk 18 per cent, of fat abstracted (427 S) Fined £2 and 12s. 6rf. costs. 5th October Marlborough Street (Mr. Kennedy) Mary Heath, 16, Ramillies Street Selling milk 13 per cent, of fat abstracted (730 N) Fined 10s. and 12s. 6d. costs. 5th October Marlborough Street (Mr. Kennedy) Frank Shoobrook, 28, Portland Street Selling milk 17 per cent, of added water (726 N) Warranty proved. Summons dismissed. CO Ol 9th October Bow Street (Mr. Marsham) Henry E. Attrill, 23, Villiers Street Selling milk 68 per cent, of fat abstracted (754 N) £7 fine, 12s. 6d. costs. 9th October Bow Street (Mr. Marsham) Pietro Macario, 25, Villiers Street Selling milk 40 per cent, of fat abstracted (753 N) .64 fine, 12s. 6d. costs. 12th October Westminster (Mr. Curtis Bennett) Mrs. Clara Martin, 47, Yauxhall Bridge Road Selling milk with 15 per cent, water added (520 S) Fined £2 and 12s. 6d. costs. 12th October Westminster (Mr. Curtis Bennett) John Adams, 9, Moreton Street Selling milk 19 per cent, of fat abstracted (522 S) Warranty proved. Summons dismissed. 12th October Westminster (Mr. Curtis Bennett) Gordon Hotels, 450, West Strand Selling at Victoria Station Refreshment Rooms milk minus 22 per cent, of fat (549 S) Warranty proved. Summons dismissed. 12th October Westminster (Mr. Curtis Bennett) John Adams, 9, Moreton Street No name on can Fined £2 and 12s. 6d. costs. 19th October Westminster (Mr. Curtis Bennett) Moses D. Williams, 7, Regency Street Selling milk deficient in fat to the extent of 12 per cent. (521 S) Fined £2 and 12s. 6d. costs. 26th October Westminster (Mr. Curtis Bennett) Robert Brown, 95, Lupus Street Selling milk containing 5 59 grains of boric acid per pint (571 S) Fined £2 and 12s. 6d. costs. 26th October Westminster (Mr. Curtis Bennett) John Lilly white, 50, Ranelagh Road Selling milk containing 9 per cent, of added water (574 S) Fined £20 and £5 5s. costs. 26th October Westminster (Mr. Curtis Bennett) John Lilly white, 50, Ranelagh Road Refusing to serve Inspector from can out of which lie had previously served a customer Fined £5 and 2s. costs. 1st November .. Marlborough Street (Mr. Kennedy) Hermann Appenrodt, 8, New Coventry Street Selling milk 10 per cent, of fat abstracted Warranty proved. Summons dismissed. 2nd November .. Westminster (Mr. Curtis Bennett) Alice Jones, 15, Brewer Street Selling milk deficient in 11 per cent, of fat Fined £1 and £1 3s. costs. 8th November .. Marlborough Street (Mr. Kennedy) G. Cattini, 16, Little Newport Street Refusing to serve Inspector with sample of milk Summons dismissed. The Magistrate holding that as Cattini was not present when his servant refused to serve he could not legally be said to have refused to serve. 7tli December .. Westminster (Mr. Curtis Bennett) The J.P. Restaurants, Ltd., 266, High Holborn, W.C. Selling hot milk with 8 per cent, of added water at 3, Victoria Buildings, Victoria Station (676 S) Warranty proved. Summons dismissed. 29th December .. Marlborough Street (Mr. Plowden) Marshall's Dairies, Ltd.., St. Mary's Chambers, 14, St. Mary Axe, E C. Selling milk 16 per cent, of fat abstracted. The sample was procured whilst in course of delivery (872 N) Warranty proved. Summons dismissed. 96 Date of Hearing. Court and Magistrate. Name and Address of Defendant. Offence. Result. 1 2 3 4 5 1907. 4tli January Bow Street (Sir Albert de Rutzen) Cabins, 1901, Ltd., 46, Queen Victoria Street, E.C. Selling milk deficient in fat 23 per cent., at 353, Strand (967 N) Warranty proved. Summons dismissed. 11th January Westminster (Mr. Curtis Bennett) David Davies, 19, Kensington Place Selling milk deficient in fat 7 per cent. (759 S) Warranty proved. Summons dismissed. 11th January Westminster (Mr. Curtis Bennett) A. Newlands, 16, Causton Street Selling milk with 10 per cent, of added water (760 S) Fined £2 10?. and £1 5 sr. costs. 25th J anuary Westminster (Mr. Curtis Bennett) Slaters Ltd., Victoria Street .. Selling hot milk deficient in fat 14 per cent. (775 S) Summons dismissed. Magistrate said that as the evidence of the analysts for the prosecution and for the defence on the effect of boiling were so diametrically opposed he could not convict, but should not allow costs. 1906. CREAM. 20th July Westminster (Mr. Curtis Bennett) Robert Prett (trading as Prett and Co.), 64, Elizabeth Street Selling cream with 27*892 grains of boracic acid per lb. (367 S) Warranty proved. Summons dismissed. 2nd November .. Westminster (Mr. Curtis Bennett) Adams and Co., 35, Palace Street Selling cream containing boric acid equivalent to 53*053 grains per lb. (582 S) Fined £1 and £2 4 s. costs. 2nd November .. Westminster (Mr. Curtis Bennett) S. S. Dancocks, 23, Buckingham Palace Road Selling cream containing boric acid equivalent to 42*397 grains per lb. (578 S) Fined £1 and £2 4s. costs. 2nd November .. Westminster (Mr. Curtis Bennett) Alice Jones, 15, Brewer Street Selling cream containing boric acid equivalent to 25*389 grains per lb. (576 S) Fined £1 and £2 4s. costs. 2nd November .. Westminster (Mr. Curtis Bennett) London and Provincial Dairy Co., Ltd., 4, West Halkin Street, Belgrave Square Selling cream containing boracic acid equivalent to 47*355 grains per lb. (595 S) Warranty proved. Summons dismissed. 2nd November .. Westminster (Mr. Curtis Bennett) Henry Bui beck, 22, Sussex Street Selling cream containing boracic acid equivalent to 22*314 grams per lb. (382 S) Fined £1 and £2 4.s. costs. ID 16th November Westminster (Mr. Curtis Bennett) Belgravia Dairy Company, 2, Exhibition Road, South Kensington Selling cream containing 41.5241 grains boric acid per lb. (631 S) Warranty proved. Summons dismissed. 16th November Westminster (Mr. Curtis Bennett) Elizabeth Day, 1 and 3. Artillery Row, Westminster Selling cream containing 40*28 grains boric acid per lb. (611 S) Warranty proved. Summons dismissed. 30th November Westminster (Mr. Curtis Bennett) Charles Thos. Cowley, 229, Knightsbridge Selling cream containing 52*066 grains of boric acid per lb. (641 S) Warranty proved. Summons dismissed. 30th November Westminster (Mr. Curtis Bennett) Williamson Brothers, Palace Street Selling cream containing 23548 grains boric acid per lb. (580 S) Summons dismissed with £3 3 s. Od. cost against the Council (third portion of sample was sent to Somerset House, Mr. Stokes, a Public Analyst, having stated that the amount of boracic acid in the cream was less than 17| grains per pound). 7th December Westminster (Mr. Curtis Bennett) George Hardy, 143a, Ebury Street Selling cream containing boric acid 22*89 grains per lb. (679 S) Warranty j) roved. Summons dismissed. 7th December . Westminster (Mr. Curtis Bennett) William Davies, 6, Westbourne Street Selling (ream containing boric acid 2975 grains per lb. (684 S) Fined £2 and 12.?. 6d. costs. 1906. BUTTER. 15tli February Marlborough Street (Mr. Kennedy) Samuel Ede, 29, Beak Street Selling margarine for butter (48 N) Fined £2 and £1 costs. 16th February Westminster (Mr. Curtis Bennett) Thomas Hinley and Charles Hinley (trading as Hinley Bros.), 10, Regent Place Selling as butter an article containing 72 per cent, of foreign fat (15 S) Fined £3 and 12.?. 6d. costs. 23rd February Westminster (Mr. Curtis Bennett) Mary Ann Brookes, 41, Wood Street Butter, 3'1 per cent, excess of water (23 S) Fined £1 10-9. and 12?. 6d. costs. 14th June Marlborough Street (Mr. Plowden) Louisa Carn, 46, Carnaby Street Selling as butter an article which contained 50 per cent, of margarine (382 N) Fined 10?, and 32-?. 6d. costs. 24th June Westminster (Mr. Horace Smith) Mark Briggs, 29, Moreton Street Butter containing 60 per cent, of foreign fat (410 S) Fined 5s. and 12s. 6d. costs. 25th June Westminster (Mr. Horace Smith) Samuel Gascoigne, 16, Sussex Street Butter containing 82 per cent, of foreign fat (444 S) Fined £1 and 12s. 6^. costs. 5th October Marlborough Street (Mr. Kennedy) Thomas Jones, 26, Broad Street Selling margarine as fresh butter (746 N) Fined £2 and 12s. 6d. costs. 98 Date of Hearing. Court and Magistrate. Name and Address of Defendant. Offence. Result. 1 2 3 4 5 1906. 5th October Marlborough Street (Mr. Kennedy) Thomas Jones, 26, Broad Street Selling margarine as salt butter (747 N) Fined £2 and 12s. 6d. costs. 12th October Westminster (Mr. Curtis Bennett) T. E. Osborne, 1a, Warwick Street Selling butter containing an excess of at least 8*1 per cent. of water (537 S) Warranty proved. Summons dismissed. 16th November Westminster (Mr. Curtis Bennett) Thomas Jn. Haile, 38, Strutton Ground Selling as butter an article containing 80 per cent of fat other than butter fat (629 S) Fined £3 and 12s. 6d. costs. — Bow Street Percy Barnard, 22, Bedfordbury Selling margarine for butter (922 N) Summons not served, defendant absconded. 1907. 14th January Bow Street (Mr. Marsham) Percy J. Watt, 2, Little Essex Street, Strand Selling butter containing 148 per cent. of water in excess of the legal limit (16 per cent) and 0 53 per cent. of starch (985 N) Fined £2 and 12?. 6d. costs. 24th January Marlborough Street (Mr. Hopkins) Wm. Henry Neve, 32. Rupert Street Selling margarine for butter (993 N) Fined 10s. and 12s. 6d. costs. MARGA RINE. 11th January Westminster (Mr. Curtis Bennett) Sarah Baleman, 131, Lilling- ton Street (1) Selling margarine in plain wrapper (2) Exposing for sale margarine without label (762 S) Fined 10s. and 12s. 6cZ. costs. COF FEE. 23rd February Westminster (Mr. Curtis Bennett) Maria Brooman, 2, Carey Street Selling coffee which contained 40 per cent. of chicory (36 S) Fined £1 and 12s. 6d. costs. 99 20th June Marlborough Street (Mr. Plowden) COFFEE AND Home and Colonial Stores, Ltd., 2 and 4, Paul Street, Finsbury CHICORY. Selling, at 87, Wardour Street, a mixture containing 23 per cent. of chicory beyond the amount stated on the notice given with the article (356 N) Dismissed with £2 2s. costs. The summons in this case stood adjourned from the 31st ult., pending the result of the Government analysis. This analysis practically confirmed that of the pity analyst* The magistrate held that as the purchaser had been told that the article was coffee and chicory, and had agreed to buy that, the mere fact of the wrapper in which the article was sold, containing a statement of the percentage of coffee and chicory, which was incorrect, did not prejudice the purchaser and that there was no offence. MUS TAED, 23rd February .. Westminster (Mi*. Curtis Bennett) Alfred Thake, 74, Buckingham Gate Mustard, 30 per cent. starch (51 S) Fined £3 and 12s. 6d. costs. OLIVE OIL. 17 th May Marlborough Street (Mr. Kennedy) Mrs. L. Fogelman, 60, Berwick Street, W. Selling as olive oil, oil containing 80 per cent. of oil other than olive oil (307 N) Fined 10?. and 12?. 6d. costs. 10th July Marlborough Street (Mr. Kennedy) Marie Schatz, 34, Church Street, Soho. Selling as olive, oil containing 100 per cent. of oil other than olive oil, and having the characters of cotton seed oil (595 N) Fined £4 and 12?. 6d. costs. PRESERVED PEAS. 6th July Westminster (Mr. Curtis Bennett) Sarafino Gelio, 9, Churton Street Selling peas containing 0'00935 per cent. of copper (316 S) Fined £2 and £1 3s. costs, or 1 month's imprisonment. 26th July Marlborough Street (Mr. Kennedy) W. S. Chapman and Co., Ltd., 62, Aldersgate Street, E.C. Copper in peas, -0102 per cent., equivalent to 2822 grains per lb. at 27, Little Pulteney Street (484 N) £2 and 12s. 6d. costs. 100 Date of Hearing. Court and Magistrate. Name and Address of Defendant. Offence. Result. 1 2 3 4 5 1906. PRESERVE D SPINACH. 1st March Marlborough Street (Mr. Kennedy) Caesar Matto, 58, Old Compton Street Spinach with 3 90 grains of copper per lb. (86 N) Fined £2 and 12s. 6d. costs. 1st March Marlborough Street (Mr. Kennedy) Emil Reggazoni, 15, Old Compton Street Spinach with 4*14 grains of copper per lb. (84 N) Fined £3 and 12s. 6d. costs. 8tli March Marlborough Street (Mr. Kennedy) Luigi Varesio, 14, Moor Street Copper in spinach—3*04 grains per lb. (112 N) Fined £5 and 12s. 6<f. costs. 8th March Marlborough Street (Mr. Kennedy) Giovanni Parmigiani, 58, Wardour Street Copper in spinach—5'81 grains per lb. (110 N) Fined £10 and 12s. 6d. costs. 15 tli March Marlborough Street (Mr. Kennedy) Max Collins, 34, Church Street, Soho, W. Obstructing Inspector whilst carrying out the provisions of the Sale of Food and Drugs Acts. Manager of premises seized a tin of spinach which had been duly purchased and refused to allow Inspector to have it. Fined £10 and £3 3s. 0^. costs. •5 th April Marlborough Street (Mr. Kennedy) Vegetable Meat Co., Ltd., 37, Old Compton Street Spinach, 2'68 grains of copper per lb. (187 N) Fined £10 and 12s. 6d. costs. Robert Teroni, 56, Frith Street Selling spinach containing 4*28 grains of sulphate of copper per lb. (225 N) Summons not served; the whereabouts of defendant not being known :28th June Marlborough Street (Mr. Plowden) Thomas Hooper, 15, Shepherd Street, Shepherd Market, W. Selling spinach containing 3'80 grains of crystallised sulphate of copper per lb. (428 N) Fined 10s. and 12s. 6d. costs. •6th July Westminster (Mr. Curtis Bennett) Sarafino Gelio, ,9, Churton Street Selling spinach containing 0'0195 per cent of copper (315 S) Fined £2 and £1 3s., costs or 1 month's imprisonment. 13th July Westminster (Mr. Curtis Bennett) Giovanni Tos, 9, Churton Street Refusing to supply spinach contained in a tin to inspector, contrary to the Act Fined £3 and £2 2s. costs.