WES 22. ANNUAL REPORT on the STATISTICS and SANITARY CONDITION relating to THE CITY OF WESTMINSTER FOR THE YEAH 1908. by FRANCIS J. ALLAN, M.I)., C.M., D.P.H. CAMB., F.R.S. ED. medical officer of health. Printed ly Order of the Council. LONDON: HARRISON AND SONS, PRINTERS IN ORDINARY TO HIS MAJESTY, ST. MARTIN'S LANE, W.C. ill TABLE OF CONTENTS. page Introductory Remarks 1 PART I. A. Statistics. Population 7 Births 10 Report of Health Visitors 11 Deaths 17 Infantile Mortality 18 Deaths in Block Dwellings 23 Deaths in Common Lodging-Houses 23 Tables 25-35 B. Communicable Diseases. (1) Compulsorilv Notifiable— Smallpox 36 Vaccination 36 Statistical Tables 36-41 Scarlet Fever 41 Diphtheria 43 Typhoid Fever 45 Puerperal Fever 46 Cerebro-spinal meningitis 46 Cholera 46 Glanders 46 (2) Voluntarily Notifiable Diseases— Tuberculosis 49 (3) Non-notifiable Diseases— Measles 56 Whooping Cough 57 Diarrhceal Diseases 58 Influenza 59 Schools and Infectious Disease 59 Medical Inspection of School Children 60 Bacteriological Laboratory 63 Disinfection 63 Cleansing of Persons 64 Mortuaries 66 Removal of Human Remains 67 PART II. C. House Inspection, &c. Defects Remedied 68 Legal Proceedings 69 Removal of House Refuse 71 Removal of Offensive Refuse 72 Drainage, &c., Plans 72 Drain Testing 72 Offensive Smells from Sewer Ventilators 73 Interceptors on House Drains 73 PAGE Water Supply 74 Houses Let in Lodgings 74 Revenue Act 75 Smoke Prevention—Special Report.. 75 D. Workshops. Number on Register 81 Defects 82 Ventilation—Gas Stoves 83 Outworkers 85 Infectious Disease 88 Home Workers—Special Report 88 Florists 91 Railway Waiting Rooms 91 Women Clerks 91 E. Food Supply. Food and Market Inspection 92 Restaurants, &c. 92 Maps showing Distribution in City 94-5 New Requirements 94 Certification of Food for Export 95 Bakehouses 95 Bakehouses in Hotels—Legal Decision 96 Slaughter-house 97 Cow-sheds 97 Milk shops 98 Tuberculous Milk 99 Ice Cream Premises 100 Sale of Food and Drugs Acts— Samples Taken, Result of Analysis and Proceedings 100 Milk 101 Cream 102 Appeal re Boric Acid 102 B utter and Margarine 103 Cream Cheese 103 Sausages and Meat Pies 103 Circular re Preservatives 103-4 Prosecution 106-7 Chocolate 107 Preserved Fruits 108 Cider 108 Drugs (Saffron, Oxymel of Squills, Quinine Wine, Fluid Magnesia) 108 Details of Prosecutions 109-16 Appendix. Report on the Sanitary condition of St. John's Ward 117-38 a 2 Annual Report on the Health and Sanitary Condition of the City of Westminster, 1908. 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 1908. Returns required by the Local Government Board, and particulars relating to Factories and Workshops required by the Home Office, are incorporated therein. It is somewhat difficult as the years get further away from the last census period to estimate the correct population of Westminster thereon, or make the usual calculations. This year the Registrar-General has made two calculations by different methods, and there is a difference of 5,000 between the results. Under such circumstances birth and death rates cannot be regarded as reliable, and any conclusions drawn from a consideration of them must be guarded. Apparently the year as a whole has been a healthy one—in the early months the weather was cold and changeable, influenza was prevalent and the number of deaths recorded was up to the average, but the coolness of the summer tended to keep down diseases of an infective character. The mildness of the later months, however, had an opposite effect, and scarlet fever especially was extremely prevalent in Westminster. For the whole year the death rate of London is estimated at 13.8 per thousand persons living, as compared with 15'2 the average of 2 the previous five years. For Westminster the rate was 12.3 per thousand, the average being 13.2. Increased attention has been given during the year to the question of child life. Parliament has passed an Act, one part of which extends the supervision of the County Council to persons taking in any infant to nurse ; previously only those who took in more than one were liable to inspection. The City Council adopted the Notification of Births Act, but were not able to put it in force on account ot' a legal difficulty which the Local Government Board had in sanctioning the employment of a Voluntary Society (the Health Society), to do the work contemplated by the Act. This difficulty has now been overcome by the appointment of the Hon. Secretary as Health Visitor, and the Act came into force in the beginning of 1909. A number of voluntary notifications were made during the year, and the Health Society, by arrangement with the various hospitals, had intimation of 780 confinements before they took place, consequently the delay in putting the Notification Act in force was not so detrimental as otherwise would have been the case. The information which has been obtained shows that the Act will be of value in leading to a more correct registration of births. I have had to call the attention of the Registrars to a number of instances in which births have not been registered within forty-two days, and some persons have moved from the district without registering. The date on which a birth occurred is not infrequently wrongly given to the Registrar, especially by foreign born persons. This is partially due to ignorance or carelessness, but sometimes it has resulted on the parents calculating their dates by the Russian or old style, and on at least two occasions a later date was given purposely, evidently to avoid payment of the fees which the Registrar may claim if the birth is not registered within three months. Considerable attention has been devoted to the methods adopted in the preparation, storage and sale of food. During the last two years the Council has set aside an Inspector for the special supervision of places dealing in food stuffs, with the result that material structural improvements have been effected and the standard of cleanliness has been considerably raised. This has been done solely under the limited powers of the Public Health Act. The requirements of the City Council have, however, been incorporated in the County Council's General Powers Bill which has now become law. Plans are submitted showing the distribution of the numerous places in Westminster in which food is sold or prepared for consumption on the premises. Action was taken in a number of instances in regard to want of cleanliness in milk, two men being prosecuted. The powers of the Council for dealing with premises at which milk is sold have been 3 strengthened by authority having been given for the removal of unsuitable places or persons from the register. This has been done in two instances and several have been refused registration. Important cases have been heard before the Courts on the subject of bakehouses, chocolate, and boric acid in cream and sausages, particulars of which are contained in the body of this report. The relation of the Borough Councils to the Education Authority (the London County Council) has demanded some attention. In view of the requirement that children attending public elementary schools shoidd be medically examined, it was felt to be desirable on the grounds of efficiency and economy, that supervision of such work in each Borough should be in the hands of the Medical Officer of Health, who is in touch with the home conditions under which the children live, but the Education Authority have not seen fit to agree to the suggestion, believing that the Medical Officer of Health of the County will be able to supply the Medical Officers of the Boroughs " with all the necessary information and statistics to keep them fully cognisant of the working of the medical side of education and to enable them to make use of it in their ordinary duties connected with local administration." To give effect; to this, it will be necessary to largely augment the clerical staff at the disposal of the Medical Officer of the County Council. Mere inspection of the children at the schools can be of little benefit to the children and will only lead to the compilation of statistics of defects found. What is required is the removal of the conditions which have produced these defects, and this can best be done through the Borough Councils, who have power to visit at the homes. Even the remedying of the defects found in children cannot be insisted upon by the Education Authority. It will depend largely upon the Borough Councils, aided by the Health Visitors and the Health Societies, if good is to result. In Westminster the relations between the School Care Committees and the Health Society on the one hand and between the City Council and the Health Society 011 the other, are so intimate that satisfactory results may be obtained if these bodies are kept " fully cognisant " of the conditions discovered. It is probable that the work of the Health Societies which are springing up in every Metropolitan Borough, together with that of the official Health Visitors which the Councils are now authorised to appoint, will eventually reduce considerably the number of defects in children of school age. The necessity for the Boroughs being in close touch with the schools is shown in the account of an outbreak of Scarlet Fever in which a number of unrecognised cases acted as a source of infection until they were detected by home visiting. 4 Continued attention has been given to Consumption, which again shows a decrease in the number of deaths. Special methods for dealing with the disease are engaging universal attention, and the machinery for more effectually dealing with the disease is being gradually improved, Schemes for increased notification, the provision of sanatoria in which patients may stay for a few weeks, for training purposes, and the establishment of tuberculosis dispensaries, will, I hope, be considered at an early date. In connection with Epidemic Diarrhoea, there are two new lines of action which appear worthy of consideration, viz., notification of cases during the summer months and the provision of specially prepared milk for infants suffering from this complaint. The inspection of workshops and workplaces occupies a large part of the time of those Inspectors who are 111 the northern half of the City. Details of the defects found are set out in special tables, and particulars are also given relative to houses in which work is carried on by out-workers. There are a large number of these home-workers in Westminster, hence considerable interest was taken in regard to legislation which was proposed in connection therewith. A report on the subject is appended. Special reports are also included dealing with the proposed legislation for the prevention of smoke, and on the sanitary condition of St. John's Ward. This latter has been receiving the careful consideration of the Council and of several of its Committees. In view of the possibility of many of the houses in this Ward being demolished, it has been the policy of the Council to endeavour, by constant inspection, to keep the premises in as good a sanitary condition as possible. This has required the whole time of one inspector and half the time of another for several years. The improvements which have been effected are evident in the greater cleanliness of the houses, but the effect on the health of the inmates as shown by mortality rates is only now beginning to appear. Thus the average death-rate of the Ward for the years 1901-7, after deducting deaths from common lodging-houses, was 20.6 per 1,000; in 1908 it had fallen to about 17. In No. 5 Area the number of deaths was 44, being the lowest number recorded in any year. During 1901-3 the average annual number was 80; then there was a fall, the average of 1904-7 being 60. During 1908, notices to abate insanitary conditions in Nos. 3 and 5 Areas were served in 190 instances (187 in the previous year), of which 81 related to premises in Chadwick Street. Police Court proceedings were necessary to enforce abatement in one instance, and in six instances for failure to maintain sanitary fittings in a proper condition. 5 An important advance has been made in making the daily collection of dust universal throughout the City. A memorandum pointing out the advantages of the system has been circulated among householders and others. I desire to express my appreciation of the able assistance I have received from my staff in the work of the department. I have the honour to be, Mr. Mayor, my Lords and Gentlemen, Your obedient servant, FRANCIS J, ALLAN, Medical Officer of Health. March, 1909. 7 PART I. A. Population. At the census in 1901 the resident population of the City of Westminster was 183,011; for the year 1908 it is taken by the RegistrarGeneral at 170,545. 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. The fluctuations which take place may be seen in the returns which are sent to the Local Government Board each year for the purpose of calculating the population in connection with the Equalisation of Rates Act. The City Comptroller has been good enough to supply me with a copy of these figures, and I have added the populations as estimated by the two methods. These do not take into account the inmates of Westminster workhouses and infirmaries which are outside the city. According to one method the population of Westminster has declined regularly from 183,011 in 1901 to 170,545 in 1908 ; according to the other method a decline is also shown up to 1907, though at different rates each year, but in April, 1908, instead of a decline an increase has occurred, the figure being 175,200, 3,159 more than the estimate in 1907, and 4,655 above the estimate of the Registrar-General on which he calculates his birth and death rates. Consequently if the equalisation of rates method be the more correct, rates calculated on the other estimate will be about 2½ per cent, too high. A point to be noticed is the increase (shown in column two) in houses comprising two or more tenements, these have increased from 231 in 1902 to 361 in 1908, and the number of separate occupiers in them from 8,926 to 11,495. 8 Taking the districts comprising the City separately, it will he seen that St. George's has fluctuated a good deal in the seven years ; that St. Margaret and St. John has shown a steady decrease until 1908 when a marked increase of 1,143 has occurred due to the erection of new buildings by the Ecclesiastical Commissioners, Police Barracks, &c., which brings the population up to that of the year 1903. St. James' which had been decreasing each year has also shown an increase in 1908, due chiefly to premises being sub-divided into flats. St. Anne shows a slight increase, and St. Martin and the Strand have an' increase over 1907 of fifty-two houses and an estimated rise of 440 in population, resulting from the new buildings in the Aldwych neighbourhood. l 2 3 4 5 6 Number of Houses as defined in Local Government Board Schedule. Number of Houses comprising two or more Rateable Properties. Number of Separate Occupations included in Col. 2. Actual Number of Rated Occupiers. Estimated Population Equalisation of Bates Act. Estimated Population BegistrarGeneral's 1st Method. 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 20,394 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 75,410 St. Margaret and St. John 5,420 60 4.545 9,905 48,727 51,960 St. James 2,822 9 219 3,032 20,806 19,730 St. Anne 1,128 45 829 1,912 11,099 11,250 St. Martin and Strand 2,460 64 1,835 4,131 17,840 19,560 The City 21,652 237 9,746 31,061 174,271 177,940 9 l 2 3 4 5 6 Number of Houses as defined in Local Government Board Schedule. Number of Houses comprising two or more Rateable Properties. Number of Separate Occupations included in Col. 2. Actual Number of Rated Occupiers. Estimated Population Equalisation of Rates Act. Estimated Population RegistrarGeneral's 1st Method. 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 1,121 46 833 1,908 11,031 11,000 St. Martin and Strand 2,447 79 1,991 4,359 17,762 19,159 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 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 31,612 172,085 173,905 1907. St. George Hanover Square 9,749 69 2,495 12,175 75,236 74,050 St. Margaret and St. John 5,343 104 5,210 10,449 48,034 49,320 St. James 2,726 19 436 3,143 20,099 19,150 St. Anne 1,105 48 873 1,930 10,873 10,810 St. Martin and Strand 2,450 87 2,087 4,450 17,799 18,889 The City 21,373 327 11,101 32,147 172,041 172,219 1908. St. George Hanover 9,779 69 2,495 12,205 75,468 73,598 St. Margaret and St. John .. 5,470 115 5,342 10,697 49,177 48,506 2,897 36 588 3,419 21,359 19,020 St. Anne 1,114. 48 890 1,956 10,962 10.746 St. Martin and Strand 2,502 93 2,180 4,589 18,239 18,275 The City 21,762 361 11,495 32,896 175,205 170,545 The Equalisation of Rates figures are calculated for the population as at the beginning of April in each year, the other is the estimated population as at the middle of the year. The figure on which the 10 statistics in this Report are based is 172,650, and is obtained by estimating the populations of the several wards, making allowance for the large number of persons resident in Poor-Law establishments beyond the City boundary whose deaths are allocated to the City, and for the temporary residents in hotels and hospitals in the City whose deaths when they occur are excluded. According to the proportion existing at the last census, there are 81,534 males and 94,336 females in the estimated population. It is usual to take the number of births and deaths to the end of the week nearest December 31st, consequently, every few years an extra week has to be included. Thus 1908, for statistical purposes, contained 53 weeks, and allowance has to be made for the births and deaths which occurred. Births. 2,665 births were registered in the City in the 53 weeks ending January 2nd, 1909. On examination, 48 births were found to be referable to other districts. Through the courtesy of the Committees of Management of Endell Street, York Road, Queen Charlotte, and the Clapham Maternity Lying-in Institutions, of the Master of the Strand Workhouse at Edmonton, the Secretary of the French Hospital, the Steward of St. George's Workhouse, Fulham Road, and of other Medical Officers, I have ascertained that 296 children were born in outlying institutions, the home address of whose mothers was in Westminster. 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. 1907. 1908. Conduit 47 46 43 27 30 25 27 25 Grosvenor 153 157 151 148 133 131 145 143 Knightsbridge St. George 163 162 125 164 160 150 150 152 Victoria 836 886 884 862 890 864 846 870 St. Margaret 197 160 162 165 156 141 152 153 St. John 869 953 877 828 908 860 873 854 Knightsbridge Hamlet 68 97 79 77 67 72 66 80 St. Anne 289 278 240 232 242 217 205 184 Regent 213 226 184 143 163 141 129 135 Pall Mall 32 23 22 17 20 18 18 12 Great Marlborough 208 180 162 151 149 137 132 124 Charing Cross 41 26 34 42 38 26 34 31 Covent Garden 163 163 151 156 147 129 135 122 Strand,. 153 104 71 42 17 20 15 28 City of Westminster 3,432 3,461 3,185 3,054 3,120 2,931 2,927 2,913 11 The net number of births was, therefore, 2,913, as compared with 2,927 in 1907; the birth-rate, uncorrected, was 15.1, corrected 16.5 per 1,000 persons. The birth-rate for the County of London for 1908 was 251, the rate during the preceding ten years averaged 28 per 1,000. The birth-rate in England and Wales was 26.5, the average of the preceding ten years being 281. 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:— Parliamentary Divisions. Births. Birth-rate. Deaths, under 1, per 1,000 births. Uncorrected. Corrected. Uncorrected. Corrected. Uncorrected. Corrected. St. George 1,076 1,190 14.2 15.7 103 93 St. Margaret and St. John 993 1,087 19.6 21.4 117 107 Strand 596 636 11.9 12.7 109 102 The City 2,665 2,913 15.1 16.5 109 100 The birth-rate calculated on the number of married women in Westminster, distinguishing the legitimate and illegitimate shows more exact rates. The number of married women between the ages of 15 and 45 in Westminster is estimated to be 18,424, and the unmarried and widows at the same age-period 39,292 for the 53 weeks. Westminster. 1902. 1903. 1904. 1905. 1906. 1907. 1908. Legitimate Births (net) 3,275 3,051 2,920 2,971 2,744 2,764 2,739 17.4 15.6 15.6 16.1 15.0 15.1 14 .8 186 150 134 149 187 163 174 Per 100 Unmarried .. 0.46 0.34 0.34 0.37 0.48 0.42 0.41 London.—Legitimate per 100 Married 22.3 22.3 21.8 21.1 20.8 20.2 19.5 Illegitimate per 100 Unmarried.. 0.69 0.68 0.71 0.68 0.68 0.64 0.66 The Notification of Births Act was adopted, but did not receive the sanction of the Local Government Board until the end of the year, but through the instrumentality of the Health Society information of 780 expected confinements was received from various hospitals and dispensaries. An analysis of the information relating to 1,237 infants of parents whose total weekly earnings are less than 40s. is given in the Society's report, from which the following extracts are made:— Table II shows the influence of Housing, Poverty, Mother's Work, 12 Health and the Mode of Feeding on the rate of infant mortality and ill-heath. Table III shows the influence of Mother's work on her health, confinement, mode of feeding and care of home. Table IV gives the occupation of Mothers, Reasons for Bottle Feeding and Premature Weaning, with list of deaths. It is somewhat difficult to distinguish between the many and various factors. The lowest class families whose extreme poverty is indeed in many cases caused by their own bad habits, intemperance and vice, tend to gravitate into basements or the lowest class of dwellings. It is, however, satisfactory to note that the number of badly housed is less than that of the very poor. Under the heading Mother's Work (Table IId), work away from the home is seen to be an important factor and is also a question closely allied to that of poverty. The man's unemployment is almost without exception the cause of the woman's work, but although immediate needs are thus met, the woman's low and irregular earnings, generally in unskilled trade, are a poor substitute for the man's wages, and the neglect of domestic duties further aggravates the poverty in the home. Insufficient and badly prepared food, uncleanliness, cold rooms, inadequate clothing and want of care, recur with unvarying frequency on the records of these cases (Table IIId). Underfeeding, overwork and. worry undermine the mother's health (Table Ilia), and perhaps entail premature weaning under circumstances in which fresh milk can least be afforded or any care given to the preparation of the child's food (Table IIIc). The high death-rate of infants weaned under six weeks is undoubtedly in many cases traceable to this cause (Table II/). Outwork of this type is chiefly found in South Westminster where the proportion of casual labourers is large and poverty extreme. Conditions of homework in Worth and South Westminster are entirely different. This is almost exclusively carried on in Soho (North) at the tailoring trade or in eating-houses, small shops, &c., where earnings are higher and good conditions, on the whole, prevail. In contrast to the woman at outwork, the tailoress working at her husband's trade takes the place of an extra hand in the busy season and is thus at work when the man's wages are at their height. Money is then plentiful and in many cases a girl is hired to do the house-work and mind the children. The death-rate of infants over one month is very low in this class although it would appear as if long hours sitting at tailoring had some influence on the mother's health and confinement and on still-births and pre-natal defects (Table IIIa b and Table IId). The same influence is also noticeable among mothers going out to work, but here once more the concurrent fact of poverty must be borne in mind. In twelve out of thirty-eight 13 cases where the infant was reported still-born or dead within a few days of birth the mother was at work during the pregnancy. Under Mother's Health (Table IIe), the figures are significant, although per haps little can be inferred from them as to any influence of heredity in determining the health of the infant; exposed to the same conditions this would in any case vary with that of the mother. The following figures are for phthisis. Infanta. Number of Cases. Parent Consumptive. Health. Delicate. Dead. 18 Father 6 5 7 17 Mother 2 9 6 35 8 14 13 Table II. Infants. Number of Cases. Healthy. Delicate. Dead. Number. Per Cent. Number. Per Cent. Number. Per Cent. a. Housing (type of house) — * 385 Block 292 75.8 69 17.9 24 (12) 6.2 813 Tenement 555 68.2 186 22.8 72 (39) 8.5 39 Cottage b. Housing (sanitary conditions)— 31 79.5 6 15.3 2 5.1 700 Good 547 78.1 107 15.3 46 (28) 6.5 359 Indifferent 246 68.5 81 22.5 32 (15) 8.9 159 Bad 69 43.4 70 44.0 20 (8) 12.6 (81) (Basement) (36) (44.4) (37) (45.6) (8) (2) (9.9) 19 Unstated 16 — 3 — — — c. Poverty - 546 Comfortable (over 25s.) 427 78.2 86 15.7 33 (23) 6.0 402 Poor (21s. to 25s. inclusive) 294 73.1 80 19.9 28 (14) 7.0 266 Very poor (under 21$.) 136 51.1 93 35.0 37 (14) 13.9 23 Unstated 21 — 2 — — — d. Mother's Work — 934 No occupation 700 74.9 173 18.5 61 (32) 6.5 135 Home work 94 69.6 31 22.9 10 (7) 7.4 168 Out work 84 50.0 57 33.9 27 (12) 16.1 e. Mother's Health— 926 Strong . 721 77.8 155 16.7 50 (18) 5.4 311 Delicate 157 50.5 106 34.0 48 (33) 15.4 f. Mode of Feedingf— 844 Breast 716 84.8 108 12.7 20 (8) 2.3 114 Partly a (under 6 weeks) 49 43.0 46 40.5 19 (1) 16.7 70 „ b (about 3 months) 35 50.0 32 45.7 3 4.3 31 ,, c (about 6 months) 12 38.7 18 58.0 1 3.2 140 Bottle 66 47.1 57 40.7 17 (4) 12.1 1,237 878 70.9 261 21.2 98 (51) 7.9 * Figures in brackets denote infants dying under 1 month. † 38 iufants—20 still-born, 18 dying within 1 week are excluded. b 14 Table III. .Number of -Cases. Mother's Work. (a) Mother's Health. (b.) Confinement. Healthy. Delicate. Normal. Abnormal. 934 No occupation 710 224 865 69 76.0 23.9 92.6 7.3 135 Home work* 95 40 121 14 70.3 29.6 89.6 10.3 168 Out work* 121 47 145 23 72.0 27.9 86.3 13.7 1,237 Number of Cases. (a.) Mode of Feeding.t (d.) Care of Home.‡ Mother's Work. Breast. Partly Bottle. Good. Indifferent. Bad. a. b. c. 934 No occupation 665 78 45 25 95 633 194 93 73.2 8.6 4.9 2.7 10.4 68.8 2 1.0 l0.1 135 Home work* 92 12 10 2 14 77 30 19 70.7 9.2 7.6 1.5 10.7 61.1 23.8 15.0 168 Out work* 87 24 15 4 31 73 44 49 54.0 14.9 9.3 2.4 19.3 43.9 26.5 29.5 1,237 * See Table IV. † 38 infants—20 still-born, 18 dying within 1 week, excluded. ‡ 25 unstated—9 home work, 2 out work, 14 no occupation. The superior health and low mortality of breast-fed infants is very striking in Table II/, and it is satisfactory to find that this mode of feeding is the universal practice among the poor where circumstances permit (nearly 75 per cent, of the babies were breast-fed). The high death-rate of infants weaned under six weeks has already been referred to, but it should perhaps be noted that many infants fall into this class who are already in a dying state at the time of weaning (Table IV). The death rate of infants bottle-fed from birth is again a high one, but in this case also, a certain number of mothers unable to nurse from constitutional weakness (phthisis, heart, &c.), and whose health presumes a high rate of delicacy among their infant?, must be borne in mind (Table IV). Yet after making the fullest allowance for these facts, the death-rate of hand-fed infants remain an unduly high one and is undoubtedly to a large extent directly traceable to the mode of feeding. 15 Table IV. (a) (b.) Reasons for Bottle Feeding from Birth. Reasons for Premature Weaning. 145 mothers unable to continue nursing— 87 mothers unable to nurse— 39 ill-health 6 abscess, inflamed breast 34 poor homes, probably under-fed 3 contracted nipples 16 at work, probably overwork 41 constitutional delicacy, illness 56 no special reason given 37 no reason given 15 mothers at work, deliberate weaning 1 mother's deith 25 infants not thriving, illness 1 mother gone abroad 7 infants removed to hospital 12 mothers out at work 23 unstated 3 infants boarded out 5 infants removed to hospital 215 6 infants unable to suckle (d.) 25 unstated Occupation of Mothers. 140 Home work— 58 tailoring (c.) 9 caretaking Deaths. 11 washing 20 stillborn 13 lodging-house keepers 31 died under 1 month 14 small shops 47 died, from 1 to 12 months— 20 dressmaking 14 broncho pneumonia, pneumonia 2 silver-work 12 marasmus, malnutrition 8 various 2 tuberculosis 1 tabes mesenterica 135 4 tuberculosis meningitis Out work— 2 meningitis 119 charing, office cleaning 2 epidemic enteritis 17 washing 1 whooping-cough 3 servants 2 eczema 5 street-sellers 2 convulsions 4 shop-assistants 2 heart disease 9 dressmaking J rupture 3 tailoring 1 operation 3 caretakers 1 accidental suffocation 5 various 98 168 The proportion of infants dying over one month to that of infants dying under one month is suggestive as an index to the direct influences of environment 011 mortality. The relative figures under Poverty are perhaps the most noteworthy, and indeed, in view of these figures and in view of the constant recurrence of this factor in combination with others, extreme poverty must be regarded as the predominant cause of a high mortality. It will further be observed from Table II that a high death-rate is invariably associated with a high rate of ill-health. The survival of infants permanently enfeebled in mind and body is a problem 110 less important than that of mortality itself. Malnutrition and want of care during the first year are .undoubtedly responsible for much preventible ill-health in later life. And it is perhaps in infancy B 2 16 that the first touch is given towards the manufacture of a degenerate, unemployable, and pauper class which in its own turn saps the vitality of the next generation. Extreme poverty, mental and physical infirmity, drink and immorality are well-nigh insuperable barriers in the way of improvement. Yet even here much can be done to educate and to humanize. The interest and sympathy of the visitor are in themselves an encouragement to the mother to do well and some small sacrifice or effort urged on the mother by the visitor for the benefit of her child may, if met with success, mark the beginning of a new era in the home. Among the better-class mothers ignorance and stupidity are the great difficulties to contend with. The problem for the visitor is again one of education, difficult—yet not so difficult as in the former, and it is in this class that the larger number of marked improvements are noted. The following Table in reference to nationality refers to the northern part of the City only :— Number of Cases. Infants. Healthy. Delicate. Dead. 292 English 211 53 28 161 Jewish 111 35 15 48 Italian 39 6 3 19 Various 13 5 1 The Council have appointed Miss Margaret Horn, the Honorary Secretary of the Health Society, as their official Health Visitor in connection with the Notification of Births Act. About 11,000 visits were paid in connection with infant-life in Westminster in 1908. Dinners for Nursing Mothers.—Through private benevolence, a scheme has been inaugurated whereby expectant or nursing mothers may obtain a good meal daily for 2 months before and 9 months after confinement on payment of one penny. Only women in real want are supplied, and the dinners must be consumed on the premises. A fund has also been provided at the Westminster Hospital, by Lady Campbell Clarke, to provide food for necessitous persons attending the out-patient department, under the direction of the staff. The meals are to be given in the hospital itself, but certain provision is made which will enable such things as milk to be taken away for the benefit of such children who may require it. Infant consultations have been continued during the year with good results. 17 Deaths. 2,437 deaths were registered in the City in the 53 weeks ending the 2nd January, 1909. After deducting 1,089 deaths of non-citizens in public institutions in the City, and adding those of 829 citizens who died in other districts, the corrected total is 2,177, and is equivalent to an annual rate of 12.3 per 1,000 persons. The London death-rate for the same period was 13.8, and for England and Wales 14.7. The rates were in each instance below the average of the preceding ten years to the following extent: The City 1.6 per 1,000, London 2.9 per 1,000, and England and Wales 1.7 per 1.000. 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 (1.0511 for London, 1.12176 for Westminster) to the 1908 rates, the figures are:— District. Standard death-rate. Recorded death-rate. Corrected death-rate. Comparative mortality figure. England and Wales 18.19 14.7 14.7 1,000 County of London 17.31 13.8 14.5 983 City of Westminster 16.22 12.3 13.7 932 The Metropolitan rate thus compares favourably with that of the rest of England. For the seven previous years, 1901-07, the comparative mortality figures were for the County 1,065, 1,100, 1,032, 1,042, 1,039, 1,025, and 1,020, and for the City 1,100, 1,082, 1,025, 940, 993, 941, and 960. Tables VI to XIII show the vital statistics of the City and five groups of districts from 1891 to 1908. The death-rates, according to the old districts of the City, are:— 18 District. Average of Previous 10 Years. 1908. St. George 12.7 11.6 Westminster 17.9 13.6 St. James 14.3 10.1 St. Anne 13.9 10.1 Strand and St. Martin 17.2 14.9 The City 13.9 12.3 Each Ward shows some reduction except the Strand Ward. In this there is an increase of 50 deaths, all of which occurred in hospitals or poor law institutions. Examination shows that 28 additional deaths were recorded in men admitted from Bruce House (L.C.C. Common Lodging House), and the remainder consisted of deaths of persons who had been admitted from the old Clare Market area many years ago. Ages at. Death.—Of the total deaths, 293 were those of children under 1 year of age, and 756 of persons over 65 years of age; these are referable to the various wards, as follows:— 1908. 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 1 3 4 2 2 1 9 Grosvenor 3 2 2 2 9 16 11 5 16 48 Hamlet of Knight-abridge 1 1 1 2 5 3 9 4 5 21 Knightsbridge St. George 6 2 1 - 9 12 7 4 13 36 Victoria 20 19 23 28 90 73 49 38 58 218 St. Margaret 3 3 7 4 17 10 6 7 7 30 St. John 30 14 21 30 95 50 37 20 44 151 St. Arme 5 4 4 4 17 11 6 7 8 32 Great Marlborough 2 3 4 1 10 16 7 8 9 40 Pall Mall - 1 - 1 2 2 1 1 3 7 Regent 5 4 2 2 13 17 2 8 8 35 Charing Cross — 3 2 — 5 5 2 8 5 20 Covenl Garden 4 — 6 4 14 8 13 10 12 43 Strand 2 — — 2 4 18 16 13 19 66 The City 1908 82 56 74 81 293 245 168 135 208 756 1907 106 74 49 74 303 246 159 133 180 718 1906 82 63 106 67 323 193 170 119 182 664 The deaths of young children again were less and those of old persons more than in the previous year, the latter resulting from influenza and chest affections. Infantile Mortality.—The uncorrected rate for the City was 109 deaths per 1,000 births registered in the City, as compared with 133, 19 the average of the previous tea years. The corrected rate was 100, the average of the years 1901-7 being 113. On deducting the births and deaths of illegitimate children, it will be seen below that the infant death-rate has fallen regularly from 125 to 97 per 1,000. The London rate for 1908 was 113, the average being 143. The infantile death-rate in England and Wales was 121, being a little higher than 1907, but still a good deal below the average. Table V, required by the Local Government Board, shows in detail the ages and causes of death of children under 1 year of age. It will be noted in the Table above that the decrease in infant deaths was chiefly in the 2nd Quarter of the year, but deaths in the 3rd Quarter, although more than 1907, were less than the average. 27 deaths in 1908 were those of illegitimate infants. The deathrate of such children is much higher than that of legitimate infants :— Figures for both births and deaths of infants corrected, showing the true rate in each of the last seven years:— Legitimate. Illegitimate. Total Rate. Births. Deaths. Rate per 1,000. Births. Deaths. Rate per 1,000. 1902 3,275 410 125 186 32 172 127 1903 3,035 345 113 150 25 166 116 1901 2,920 320 109 134 40 298 118 1905 2,971 305 102 149 24 161 105 1906 2,744 285 103 187 38 203 110 1907 2,764 269 97 163 34 208 103 1908 Seven years 2,739 266 97 174 27 155 100 20,418 2,200 107 1,143 220 192 112 The following table shows the number of deaths of infants, and their relation to births in the last four years. It also shows the age periods at which they died Deaths per 1,000 born (corrected figures). Age at Death. 1905. 1906. 1907. 1908. No. Rate. No. Rate. No. Rate. No. Rate. Under 1 week 66 21.1 64 21.8 85 29.1 66 21.2 1 month 131 41.9 120 41.0 126 43.1 105 38.3 ,, 3 months 195 62.5 195 66.6 182 62.3 166 60.5 3 to 6 months 38 12.1 53 18.1 57 19.4 47 16.1 6 „ 9 „ 52 16.6 46 15.8 30 10.3 50 17.1 9 „12 „ 44 14.1 29 9.9 31 11.5 30 10.2 Total in year 329 105.4 323 110.4 303 103.5 293 100.5 20 Table Y—Infantile Mortality during the year 1908. 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 Month?. 7—8 Months. 8—9 Months. 9—10 Months. 10—11 Months. 11—12 Months. Total Deaths under One Year. Common infectious diseases— Small-pox — — — — — — — — — — — — — — — — — Chicken-pox — — — — — — — — — — — — — — — — — Measles — — — — — — — — — 1 — 2 1 2 1 1 8 Scarlet fever — — — — — — — — — — — — — — — — — Diphtheria — — — — — — — — — — — — 1 1 — 1 3 Whooping cough — — — — — 1 — — — 1 1 1 — 1 1 — 6 Diarrhoeal diseases— Diarrhoea, all forms — — — — — 1 2 4 2 2 2 1 2 — 2 — 18 Enteritis, muco-enteritis, gastro-enteritis Gastritis, gastro-intestinal catarrh — 1 1 1 3 4 1 4 — 1 1 1 — 1 1 — 17 Wasting diseases— Premature birth 40 4 4 — 48 13 3 — — — — 1 — — — — 65 Congenital defects 4 3 3 1 11 1 — 1 — — 1 — — — — — 14 Injury at birth 10 1 1 — 12 — 1 — 1 — — — — — — — 14 Want of breast-milk, starvation, improper food — — — 1 1 1 2 — 1 1 2 — 1 1 — — 10 Debility from birth 8 2 2 1 13 4 4 1 — — — — — — — — 22 Marasmus 1 — — — 1 — 3 1 1 — 2 — 2 — — — 10 Neglect — — — — — 1 — 1 — — — — — — — — 2 Tuberculous diseases— Tuberculous meningitis — — — — — — 1 — 1 — 1 1 1 1 — — 6 Tuberculous peritonitis, tabes mesenterica — — — — — — — — — 1 — — 1 — — — 2 21 Other tuberculous diseases — — — — — — 1 1 — — 1 1 — 1 — 1 6 Other causes— Erysipelas — — — — 2 — — — 1 — — — — — — — 3 Other Septic — 1 1 — 1 — 1 1 2 — 1 — 1 — — — 7 Syphilis Rickets — — — — — — — — — — — 2 1 2 2 1 8 Meningitis (not tuberculous) — — — — — — — — 1 1 1 — 1 — — 4 Dentition — — — — — — — — — — — — — — — — — Convulsions — 3 — — 3 — — — — — — — — 1 — — 4 Bronchitis — — 2 1 3 2 4 — — 1 3 — 1 — — 1 15 Broncho-pneumonia — — — 1 1 2 3 — 2 4 2 — 2 2 1 1 20 Pneumonia — — 2 — 2 5 — — 2 1 2 1 2 — 2 — 17 Suffocation, overlying 2 — — — 2 1 — — — — — — — — — — 3 Accidents 1 — — — 1 1 — — — — — — 1 — — — 3 Other causes — — 1 — 1 2 — 1 1 — — 1 — — — — 6 66 15 18 6 105 39 26 15 14 14 20 13 17 14 10 6 293 Population, estimated to middle of 1908, 172,900. Births in the year—Legitimate, 2,739 ; illegitimate, 174—Total 2,913. Deaths in the year of legitimate infants, 266 ; illegitimate infants, 27—Total 293. Deaths from all causes at all ages, 2,177 22 56.6 per cent, of the deaths under 1 year of age occurred before the infants were three months old, 35.8 per cent, before the end of the first month of life, and 22 per cent, soon after birth. As many births are not registered within three months, the opportunity of assisting the mother does not occur. This difficulty will be removed in some measure by the notification of births, but there are still a number of children who come into the City soon after birth, of whom we may have no knowledge until death or an infectious illness occurs. The causes of death in each year are given below, together with the relative proportion each group bears to the whole of the infant deaths:— 1905. 1906. 1907. 1908. No. Percent, of total deaths. No. Per cent, of total deaths. No. Per cent, of total deaths. No. Per cent, of total deaths. Common infectious diseases 37 11.2 12 3.7 17 5.5 17 5.8 Diarrhoeal diseases 46 13.9 76 23.5 30 9.9 35 11.9 Premature births aud injury, &c., at birth 84 25.5 72 22.5 96 31.6 93 31.7 Did not thrive — wasting — want of milk—rickets 49 14.8 50 15.4 43 14.0 52 17.7 Tuberculous diseases 17 5.1 18 5.5 15 4.9 14 4.7 Erysipelas and other septic diseases - - 10 3.0 9 2.9 3 1.0 Syphilis 15 4.5 7 2.1 12 3.9 7 2.3 Meningitis, convulsions 11 3.3 13 4.0 11 3.6 8 2.7 Bronchitis and pneumonia 45 13.6 44 13.6 56 18.4 52 17.7 Suffocation—overlying, &c. 5 1.5 6 1.8 6 1.9 6 2.0 Other causes 20 6.0 15 4.6 4 1.3 6 2.0 329 100 323 100 303 100 293 100 It is extremely difficult, even with careful enquiry, to differentiate the correct cause of death; thus, in a case where death is certified as being due to marasmus, or wasting, it may be due to some inhereut defect in the child, preventing the digestion of food, or it may be a result of unsuitable or improper feeding. This latter may be due to the poverty, or insufficiency, or other unsuitable quality of the mother's milk, or to food unsuited for the age of the infant. A number of children born prematurely succumb later in life when illness occurs. Deaths from tuberculosis and from syphilis are probably greater in number than is shown by the figures in the Tables. The question of proper feeding enters into every enquiry in connection with the death of an infant; thus, many pneumonia deaths are the result of malnutrition. Of 33 deaths from diarrhceal complaints, 3 infants only were breast-fed entirely. 23 The Children's Act, 1908, extends the provisions of the Infant Life Protection Act, 1897, to cases in which one infant is nursed out for gain, and raises the age limit from 5 to 7 years. Section 13 provides for the punishment of any person over 16 years of age in the case of the death of an infant under 3 years of age through suffocation (not due to the presence of any foreign body in the throat or air passages) while the infant was in bed with such person and such person was, at the time of going to bed, under the influence of drink. Section 15 requires the provision of a fireguard in a room containing an open fire grate, and renders the person in charge of young children liable to a penalty, if any child is burned or scalded through the absence of such provision. A midwife practising in "Westminster was convicted of an infringement of the Infant Life Protection Act. The attention of the County Council is always drawn to cases in which it appears that the person or place is unsuitable, or insufficient care is being taken. Cause of death at all Ages.—These are set forth in Table IX, and also their distribution in the various Wards of the City. Influenza again caused an excess of deaths, but on this occasion was not accompanied by an increase in the number of deaths from chest diseases. Phthisis deaths show a decrease, but those from cancer an increase over those recorded in 1907. Deaths were fewer from most of the other causes. Statistics of Dwellers in Block Dwellings.—These are set out in Table XIII. A comparison of the births and deaths in the Council's Buildings in Regency Street during the last four years is given below. Year. Population. Births. Rate. Deaths. Rate. Deaths of Infants under one per 1,000 births. 1905 1,138 57 50.0 23 20.2 140 1906 1,150 63 54.7 16 13.9 111 1007 1,163 60 51.6 18 15.5 116 1908 1,155 50 43.2 10 8.6 120 The birth-rate for St. John's Ward, in which the Buildings are situated, is 28.7 for 1908. In the adjoining County Council Buildings at Millbank the rate is 40.7. The death-rate compares favourably with that (17.2) of the Ward. The rate in the Millbank Buildings is 10 per 1,000. Deaths in Common Lodging-houses.—90 deaths occurred in 1908 among inmates of the common lodging-houses and shelters in the City (87 males and 3 females). 31 of the deaths were due to phthisis, 24 and 17 to respiratory diseases. There were 38 deaths in St. John's Ward, 1 in St. Anne's, 3 in Regent, 14 in Covent Garden, and 34 in Strand. The authorised accommodation in the City is 2,375. The following is a list of the common lodging-houses in Westminster, the number for which they are licensed, and the number of deaths which occurred in 1908 among persons alleged to have been inmates:— Men. Deaths. Bruce House, Kemble Street (L.C.C.) 699 32 33, Great Peter Street 397 14 6, 6a, 6b, and 6c, G-reat Smith Street 201 1 Ham Yard Hospice, Great Windmill Street 20 — 11, 12, and 13, Hanover Court 105 14 23 and 25, Millbank Street (S.A. Shelter) 449 3 108, Regency Street 8 — The Schools, Kean Street (S.A. Shelter) 125 2 16, Strutton Ground 217 12 45 and 47, Tufton Street 91 4 Women. 40, Great Peter Street 75 3 In addition, 6 deaths were recorded among inmates of the following premises, the use of which as common lodging-houses has now been given up:—107, Wardour Street, 10, Monck Street, 10, Stanhope Street, 26, Lichfield Street. The latter was given up last year. There is an increase of 28 deaths from persons giving Bruce House as their address. 25 Table VI.—Quarterly and Annual Deatli.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. Period. United Kingdom. England and Wales. County of London. Tlie City. Conduit Ward. Grosvenor Ward. Hamlet of Knight abridge Ward. Kniglitsbridge St. George Ward. Victoria Ward. St. Margaret Ward. St. John Ward. St. Anne Ward. G.reat Marlborough Ward. Pall Mall Ward. Regent Ward. Charing Cross Ward. Covent Garden Ward. Strand Ward. I st Quarter 18.3 17.7 17 .0 15 3 8 .1 12.2 5.8 10.0 20.2 10.1 20.5 12 .1 20.8 4.0 12.1 13 .4 12.3 17.6 2nd Quarter 14 .5 13.8 12 .7 11 2 2.9 7.3 9.6 5.4 14.4 10.1 15.2 9.9 9.8 8.1 7.3 9.6 10.4 20.1 3rd Quarter 13.0 12.8 11 .9 101 5.9 4.0 6.9 4.3 12.4 8.3 13.8 10.4 10.4 9 .4 6.9 11.5 13.7 18.0 4th Quarler 14.7 14 .5 13 .7 12.6 6.1 7.5 7.4 5.3 16.2 7.7 18.9 8.1 11.8 10.0 8.9 7.1 18.0 22.8 TheYear1908 15.5 14.7 13.8 12.3 5.8 7.8 7.4 6.2 15.7 9.0 17.2 10.1 13.2 7.9 9.9 10.4 13.7 19.4 „ 1907 14.7 15.0 14.6 12.9 4.2 9.7 7.9 8.1 15.7 9.4 20.2 10.4 12.8 8.8 8.5 9.8 15.3 11.9 „ 1906 15.5 15.4 15.1 12.8 4.6 7.2 8.2 7.6 15.5 10.6 19.6 13.3 10.7 8.7 9.4 7.1 15.5 11.8 „ 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 9.1 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 16.9 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 16.0 10.3 18.5 26.3 26 Table VII.— City of Westminster.— Monthly and Quarterly Death Rates, 1901.8. Monthly. 1901 1902 1903 1904 1905 1906 1907 January 16.3 18.7 16.6 16.7 16.6 15.0 18.8 February 20 .2 26.8 14.5 15.6 15 .8 13 .3 17.7 March 17.5 17.7 14.8 16.0 13.5 13 1 14 .9 April 17.0 14.1 14.6 12.7 12.2 15.i 12 .7 May 14.3 14.6 13.8 13.3 12.4 12 0 12.1 June 13.0 11.9 11.7 9.7 11.8 12 .6 11.1 July 13.0 14.2 11.9 11.6 11.0 10.0 10.2 August 14.3 11.9 11.6 13 0 13.0 11.9 8.6 September 12.8 12 .5 11.5 j1 2 11.6 12.1 10.6 October 13.9 13.7 11.4 13.1 13.1 10.3 11.1 November 18.6 16.2 14.6 10.7 13.2 12.5 12.6 December 17.3 16.8 15.5 16.0 16.0 15.6 13.5 Quarterly. 17.5 1st 18.0 20.9 15.2 16.1 15.2 13.7 2nd 14.8 13.5 13.2 11.7 12.1 13 1 12.0 3rd 13.4 12.9 11.6 12.1 11.9 11.4 9.8 4th 16.4 15.8 13.9 13.5 14.0 12.8 12.3 Yearly 15.6 16.0 13.5 13.4 13.3 12.9 12.9 Months. London. Westminster. Average of 5 Years, 1903.07. 1908. Average of 5 Years, 1903.07. 1908. January 17.6 17.5 16.7 14.3 February 16.9 17.4 15.4 16.1 March 16.5 16.1 14.4 15.8 April 15.3 14.9 13.4 11.9 May 13.8 12.2 12.7 12.8 June 12.1 10.4 11.4 8.8 July 12.6 10 3 10.9 10.6 August 15.2 12.9 11.6 8.3 September 14.1 12.8 11.4 11.4 October 13.7 12.3 11.8 9.3 November 15.9 14 6 12 .7 13.6 December 17.2 14.3 15.3 15.1 Quarters. 1st 17.0 17 .0 15.5 15 3 2nd 14.1 12.7 12.7 11 .2 3rd 13.5 11 .9 11.3 10.1 4th.. 15 .7 13.7 13.3 12.6 Year 15.2 13.8 13.2 12 3 27 Table VIII.— City of Westminsteb.— Statistics of Births and Deaths during the 53 Weeks from 29th December, 1907, to 2nd January, 1909, giving the Corrected Figures and Rates. 1 2 3 4 s 6 7 8 9 10 11 12 Wards. Population Estimated to Middle of the Year 1908. Births (Corrected). Deaths Under One Year of Age. Deaths at all Ages. Total Registered in City. Deaths of Citizens in Public Institutions. Deaths of NonResidents Registered in City. Deaths of Residents Registered beyond City. Deaths at all Ages. Nett. Average Deathrate 1901-7. Number. Rate.* Number. Rate per 1,000 Birth (Corrected). Number. Rate.* Conduit 5,400 25 4.5 3 120 25 12 8 15 32 5.8 6.2 Grosvenor 14;700 143 9 .5 9 62 79 47 14 52 117 7.8 9.1 Knightsbridge St. George 14,700 152 10.1 9 59 447 31 378 25 94 6.2 8.7 Victoria 39,300 870 21.7 90 103 369 286 28 2J4 635 15.7 15.3 St. Margaret 13,000 153 11.5 17 111 338 48 256 38 120 9.0 13.1 St. John 29,140 854 28.7 95 111 364 287 128 275 511 17.2 20.6 Hamlet of Knightsbridge 7,520 80 10.4 5 62 50 10 3 10 57 7.4 8.7 Pall Mall 2,950 12 3.9 2 166 16 9 3 11 24 7.9 9.3 Regent 9,200 135 14.3 13 96 59 48 17 51 93 9.9 12.6 Great Marlborough.. 6,900 124 17.6 10 80 61 58 19 51 93 13.2 14.6 Charing Cross 4,150 31 7.3 5 161 32 17 8 20 44 10.4 10.1 Covent Garden 8,450 122 14.1 14 114 270 67 214 62 118 13.7 16.5 Strand 6,340 28 4.3 4 142 235 109 204 95 126 19.4 17.6 St. Anne 10,900 184 16.5 17 92 92 51 32 53 113 10.1 12.5 The City 172,650 2,913 16.5 293 100 2,437 1,080 1,089 829 2,177 12.3 13.9 * Rates calculated per 1,000 of estimated population. The uncorrected birth-rate was 15.1, the uncorrected death-rate, 14.4. Note.— The deaths included in Column 7 of this table are the whole of those registered as having actually occurred within the ward. The deaths included in Column 11 are the number in Column 7 corrected by the subtraction of the number in Column 9 and the addition of the number in Column 10. 28 Table IX.—Caioses of', and Ages at, Death during the 53 weeks ending 2nd January, 1909. Causes of Death. Corrected Deaths in the City at subjoined Ages. Deaths in Wards (at all Ages). All ages. Under 1. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. Conduit. Grosvenor. Hamlet of Knightsbridge. Knightsbridge St. George. Victoria. St. Margaret. St John. St. Anne. Great Marlborough. Pall Mall. Regent. Charing Cross. Covent Garden. Strand. Smallpox — — — — — — — — — — — — — — — — — — — — — Measles 26 8 17 — — 1 — — — — — 6 1 17 — — — 2 — — — Scarlet fever 8 — 2 3 2 1 — — 1 1 1 3 1 — — — — — — — 1 Epidemic influenza 50 — — — — 20 30 — 7 2 1 15 6 11 — 2 — 1 — 2 3 Whooping cough 10 6 4 — — — — — — — 1 4 2 1 — — — 1 1 — — Diphtheria, Memb. croup 17 3 9 4 — 1 — — — — 1 5 4 2 1 1 1 — 1 — 1 Cerebro-spinal meningitis 3 2 — 1 — — — — — — — 2 — — — — — 1 — — — Enteric fever 7 — — — 2 5 — — 2 — — 2 — — — — 1 — — 2 — Diarrhoea 11 5 — — — 3 3 — 1 1 — 3 — 2 1 1 — 1 — 1 — Epidemic enteritis 13 13 — — — — — — — 1 — 3 1 7 — 1 — — — — — Enteritis 23 15 1 1 — 2 4 1 — — — 7 2 8 1 — — 1 ] 1 1 Erysipelas 4 — — — — 2 2 — — — — 2 1 — — — — — — — 1 Puerperal fever 3 — — — 1 2 — 1 1 — — 1 — — — — — — — — — Other septic diseases 20 3 — 1 5 9 2 — 2 1 — 3 2 6 2 1 — — 1 2 — Syphilis, &c 15 7 — — — 7 1 1 — — 1 4 1 4 — — — 1 — 1 2 Diabetes 16 — — — 1 12 3 — 1 — 1 7 1 2 2 1 — — — — 1 Malarial diseases — — — — — — — — — — — — — — — — — — — — — Rheumatic fever 7 — 2 1 4 — — — — 2 1 3 1 — — — — — — 29 Tuberculosis of meninges .. 25 6 12 5 1 1 — — — — 1 6 1 10 2 — — 1 — 3 1 Tuberculosis of lungs 208 — 2 2 19 164 21 — 11 3 5 59 10 65 11 7 — 9 3 15 10 Tuberculosis of peritoneum 11 2 2 3 1 3 — — 1 2 4 — 3 — — — — — — 1 Other forms of tuberculosis 26 6 7 2 5 5 1 1 — 1 10 — 8 1 — 1 1 — 1 2 Alcoholism 15 — — — — 15 — — — 1 1 4 2 — 4 — 1 ,— — 1 1 Malignant growths 201 — — — 3 117 81 2 9 8 13 73 12 39 13 5 2 6 5 7 7 Premature birth 65 65 — — — — — 1 2 1 4 20 2 15 2 5 — 2 2 5 4 Developmental diseases 82 72 10 — — — — 1 4 2 2 28 5 19 8 3 — 6 1 3 — Old age 87 — — — — 2 85 1 2 1 4 16 1 15 6 10 2 6 1 6 16 Meningitis and convulsions 10 6 1 — 1 2 — — — 1 — 1 — 6 — — 1 — 1 — — Other diseases of nervous system 86 — 2 — 2 42 40 2 5 4 3 21 4 15 6 4 1 5 3 5 8 Valvular diseases of heart 77 — — 6 1 39 31 1 12 5 3 14 5 14 3 1 — 4 2 8 5 Other circulatory diseases 228 1 1 1 1 96 128 7 13 4 7 72 8 46 14 13 4 11 6 7 16 Bronchitis 211 14 7 — 1 60 129 1 12 3 13 64 10 50 10 8 — 9 3 17 11 Lobar (croupous) pneumonia 44 6 2 — 2 21 13 — 3 1 2 11 2 7 2 5 — 6 — 3 2 Lobular (broncho-) pneumonia 66 21 19 1 2 9 14 3 3 21 3 22 3 2 3 2 2 2 Other respiratory diseases 106 11 9 — 3 41 42 2 4 2 5 35 4 31 5 1 3 4 1 4 5 Cirrhosis of liver 45 — — — 1 34 10 1 1 2 11 3 12 3 — 1 2 3 1 5 Other digestive diseases Bright's disease, &c. 72 3 3 3 3 38 22 2 10 3 5 20 1 15 2 3 — 1 1 8 1 118 — 2 1 2 56 63 2 5 4 5 34 9 24 6 7 — 3 2 8 9 Generative system diseases.. 14 — — — 1 10 3 2 1 1 2 2 1 2 — — 2 1 — — — Accidents and diseases of parturition 6 — — — — 6 — 1 — — 1 1 — 3 — — — — — — — Deaths by accident or negligence . 79 14 8 5 5 31 16 — 4 2 1 23 8 15 1 8 4 4 2 — 7 Deaths by suicide and murder 26 2 23 1 1 2 — 2 4 1 6 2 2 — 2 1 3 All other causes 36 4 5 2 7 7 11 1 — 3 1 12 5 6 1 2 — 1 — 4 — All causes 2,177 293 125 43 75 885 756 32 117 57 94 635 120 511 113 93 24 93 44 118 126 30 Table X.—Deaths of Citizens during the Year ending 2nd January, 1909, 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 7 10 17 — — 4 5 9 — — — 1 2 3 1 2 3 13 19 32 Grosvenor 35 29 64 12 10 22 9 12 21 1 — 1 1 2 3 4 2 6 62 55 117 Hemlet of Knightsbridge 23 24 47 2 2 4 3 2 5 — 1 1 — — — — — — 28 29 57 Knightsbridge St. George 26 35 61 1 4 5 10 8 18 2 — 2 1 5 6 2 — 2 42 52 94 Victoria 157 183 340 75 58 133 69 44 113 2 2 4 21 15 36 5 4 9 329 306 635 St. Margarat 20 45 9 9 18 11 12 23 4 1 5 1 1 2 5 2 7 50 70 120 St. John 111 110 221 127 57 184 52 40 92 1 1 3 7 10 3 — 3 296 215 511 St. Anne 32 28 60 11 8 19 19 5 24 1 — 1 4 3 7 1 1 2 68 45 113 Great Marlborough 15 15 30 11 23 34 10 7 17 — 1 1 — 6 6 5 — 5 41 52 93 Pall Mall 8 5 13 — — — 3 4 7 1 — 1 1 1 1 1 2 14 10 24 Regent 15 27 42 16 7 23 13 8 21 — — — 2 2 4 2 1 3 48 45 93 Charing Cross 14 10 24 2 3 5 3 5 8 — 1 1 — 3 3 2 1 3 21 23 44 Covent Garden 32 19 51 23 16 39 11 10 21 — — — 1 6 7 — — — 67 51 118 Strand 4 7 11 48 36 84 7 3 10 2 — 2 8 5 13 3 3 6 72 54 126 City of Westminster 499 547 1,046 337 233 570 224 165 389 13 7 20 44 57 101 34 17 51 1,151 1,026 2,177 31 Table XI.— Vital Statistics of Whole Districts during 1901.1908. 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. Deaths Under 1 Year of Age. Total Deaths Registered in the District at all Ages. Total Deaths in Public Institutions in the District. Deaths of Non. Residents Registered in Public Institutions in the District. Deaths of Residents Registered in Public Institutions beyond the District. Nett Deaths at all Ages belonging to the District. Number (Un. corrected). Rate.* Number (net). Bate per 1,000 Births Registered. Number. Rate.* N umber. Rate.* 1901 182,567 3,232 17.8 435 135 2,998 16.3 1,227 1,019 921 2,900 15.8 1902 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 1,045 790 2,227 12.8 1907 172,900 2,732 15.8 303 110 2,396 13.8 1,061 992 833 2,237 12.9 1908 53 weeks 1172,650 2,665 15.1 293 109 2,437 13 .8 1,080 1,089 829 2,177 12.3 * Rates in Columns 4, 8, and 13 calculated per 1,000 of estimated population. Note.— The deaths to be included in Column 7 of this Table are the whole of those registered during the year as having actually occurred within the district or division. The deaths to te included in Column 12 are the number in Column 7, corrected by the subtraction of the number in Column 10 and the addition of the number in Column 11. By the term "Non.residents is meant persons brought into the district on account of sickness or infirmity, and dying in public institutions there; and by the term" Residents " is meant persons who have been taken out of the district on account of sickness or infirmity, and have died in public institutions elsewhere. The "Public Institutions" to be taken into account for the purpose of these Tables are those into which persons are habitually received on account of sickness or infirmity, such as hospitals, workhouses, and lunatic asylums. A list of the institutions in respect of the deaths in which corrections have been made is given on the next pages. Area of District in acres (exclusive of area covered by water) 25027 Total population at all ages 183,0111 Number of inhabited houses 18,366 Average number of persons per house 8.9 At Census of 1901. C 2 32 Table XI.—continued. i. Institutions within the District receiving Sick and Infirm Persons from outside the District. (Total Number of Deabhs in brackets.) II. Institutions outside the District receiving Sick and Infirm Persons from the District. 11—continued. Institutions outside the District receiving Sick and Infirm Persons from the District. St. George's Hospital (378). Westminster Hospital (253). Charing Cross Hospital (184). King's College Hospital (193). St. Peter's Hospital (27). Grosvenor Hospital (14). Heart Hospital, Sobo Square (9). "Women's Hospital, Soho Square (12). Throat Hospital, Golden Square (7). Gordon Hospital (2). Military Hospital, Millbank Queen Alexandra Military Hospital, Millbank (20). St. George's Workhouse Wallis Yard (1). Poland Street Workhouse (25). Sheffield Street Workhouse (23). 22, George Street, Hanover Square, Nursing Home (4). Infants' Hospital (90). Lock Hospital (3). Royal Ear Hospital (4). Royal Western Ophthalmic Hospital (2). 94-6, Belgrave Road (5). 87, Belgrave Road (1). Middlesex Hospital. St. Thomas's Hospital. St. Bartholomew's Hospital. St. Mary's Hospital. Guy's Hospital. Endell Street Lying-in Hospital. Italian Hospital. German Hospital. French Hospital. Victoria Hospital. General Lying-J.n Hospital, York Road. London Hospital. West London Hospital. Queen Charlotte's Hospital. Great Ormond Street Children's Hospital. Cancer Hospital, Chelsea. University College Hospital. Brompton Hospital. Hospital of St. John and St. Elizabeth. South-Western Fever Hospital. Western Fever Hospital. London Fever Hospital. Fountain Fever Hospital. Grove Fever Hospital. Royal Hospital, Waterloo Road. Homoeopathic Hospital. Chelsea Women's Hospital. Royal Hospital for Incurables Mildmay Mission Hospital. Royal Free Hospital. Freidenheim. Belgrave Hospital. National Hospital, Queen's Square Throat and Ear Hospital, Gray's Inn Road. Ian Charles Hospital, Inverallan. Samaritan Free Hospital. Home Hospital, Fitzroy Square. St. George's Infirmary, Fulham Road. St. Pancras Infirmary. Kensington Infirmary. Hoi born Infirmary. Lambeth Infirmary. Marjlebone Infirmary. Edmonton Workhouse. St. Giles Workhouse. St. George's Workhouse, Fulham Road. Central London Sick Asylum, Cleveland Street. Central London Sick Asylum, Hendon. Banstead Asylum. Belmont Asylum. Long Grove Asylum. Camber well House. Bexley Asylum. Cane Hill Asylum. Caterham Asylum. Clay bury Asylum. Colney Hatch Asylum. Darenth Asylum. Hanwell Asylum. Horton Asylum. Leaves j en Asylum. Tooting Bee Asylum. Manor Asylum. Clapham Maternity. Peckham House Asylum. West Riding Asylum. III Other Institutions, the Deaths in which have been distributed among the several localities in the District. III—continued. Other Institutions, the Deaths in which have been distributed among the several localities in the District. III— continued. Other Institutions, the Deaths in which have been distributed among the several localities in the District. 51, Welbeck Street. Hostel of God. St. Joseph's Home. 57 and 49, Beaumont Street. St. Luke's House, Pem- bridge Square. The Priory, Hackney. St. Joseph's Hospice, Hackney. St. Mary's Convent, Putney. Atkinson Morley Home. 62, Cambridge Terrace. St. Joseph's Home, Kensington . 50, Weymouth Street. 52, Bloomsbury Street. 39, Royal Avenue. 7, Colisseum Terrace. St. Peter's House, Lambeth. 25, Bickerton Road, Islington. 33 Table XII (L.G.B. Table).— Vital Statistics of Separate Localities, 1891-1908. Names of Localities 1. The City of Westminster. 2. St. George's, comprising Conduit, Urosvenor, Victoria, and Knightsbridge St. George Wards. 3. Westminster, comprising St. Margaret, St. John, and the Hamlet of Knightsbridge Wards. 4. St. James, compi'ising Regent, Marlborough, and Pall Mall Wards. 5. St. Anne Ward. 6. Strand, comprising Covent Garden, Strand, and Charing Cross Wards. Year. Population estimated to middle of each year. Births registered (uncorrected). D^ai lis at all ages (corrected). Deaths under 1 year. Population estimated to middle of each year. Births registered (uncorrected). Deaths at all ages (c(fi> rected). Deaths under 1 year. Population estimated to middle of each year. Births registered (uncorrected). 1 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 j to middle of each year, j 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 4,377 710 78,649 18,649 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 1,498 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 4,017 587 79,123 1,499 1,096 177 54,349 1,219 1,006 180 23,571 456 390 80 12,290 288 202 41 27,950 583 109 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 3,966 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 3,1I ! 587 80,376 1,365 1,067 183 63,047 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 1,345 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 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 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 1907 172,9C0 2,732 2,237 303 74,100 1,101 905 95 49,920 998 778 142 19,090 258 194 30 10,900 179 114 17 18,890 196 246 19 Averages of 10 years 1898 to 1907 182,233 3,163 2,745 424 77,136 1,220 980 140 51,801 1,061 930 164 20,551 358 294 47 11,460 245 159 27 21,504 302 370 46 1908 172,650 2,665 2,177 293 74,100 1,076 878 111 49,660 993 688 117 19,050 253 210 25 10,900 163 113 17 18,940 180 288 23 1 he 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 tLe figures relating to the added part were obtainable from the reports of the late Medical Officer of Health for St. Giles. 34 Table XII, continued.— Vital Statistics of Separate Localities, 1891.1908.— Bates. Names of Localities 1. City of Westminster. 2. St. George's. 3. Westminster. 4. St. James. 5. St. Anne's. 6. Strand. Year. Births Registered (uncorrected). Rate per 1,000. Deaths at all Ag*s (corrected). Rate per 1,000. Deaths under 1 Year, Rate per 1,000 Births (uncorrected). Births Registered (uncorrected). Rate per 1,000. Deaths at all Ages (corrected). Rate per 1,000. Deaths under 1 Year, Kate per 1,000 Births (uncorrected). Births Registered (uncorrected). Rate per 1,000. Deaths at all Ages (corrected). Rate per 1,000. Deaths under 1 Year. Rate per 1,000 Births (uncorrected). Births Registered (uncorrected). Rate per 1,000. Deaths at all Ages (corrected) Rate per 1,000. Deaths under 1 Year. | Rates per 1,000 Births (uncorrected). Births Registered uncorrected). Rate per 1,000. Deaths at all Ages (corrected). Rate per 1,000. Deaths under 1 Year. Rate per 1,000 Births (uncorrected).) Births Registered (uneo rected). Rate per 1,000. Deaths at all Ages (corrected). hate per 1,000. Deaths under 1 Year. Rite per 1,000 Biiths (uncorrected). 1891 22.2 19.9 164 20.1 16.4 134 26.0 20.6 176 20.4 19.8 165 26.9 23.6 194 20.7 26.6 196 1892 21.9 20.4 162 19'3 16.9 144 25.6 23.4 173 21.4 18.2 145 25.0 21.2 216 21.1 25.5 166 1893 21 .4 20.0 164 18*9 15.4 136 24.6 23.5 188 21.8 19.7 136 26.8 22.6 175 19.7 25.2 198 1894 20.3 16.6 146 18.9 13.8 118 22.4 18.5 147 19.4 16.5 175 23.4 16.4 142 19.8 20.8 181 1895 20.6 18.1 164 18.5 149 138 23.7 21.4 192 22.8 17.6 140 26.5 16.6 148 20.1 22.1 200 1896 20.3 16.8 161 17.5 13.9 149 22.8 18.4 171 21.0 17.2 148 24.0 19.0 198 21 .4 20.8 163 1897 19.8 16*3 152 169 13.2 135 23.3 18.9 161 19.8 17.2 168 25.9 15.3 124 18.5 20.4 186 1898 19.2 171 153 17.4 13.2 121 20.6 20.7 182 19.5 18.3 168 24.0 17.0 134 19.2 21.3 180 1899 18.7 17.8 166 16.6 14 2 132 21.3 22.4 206 19.9 17.7 158 24.5 17.4 135 16.4 20.3 20a 1900 17 9 16.9 148 15.9 14.0 113 20'4 21 '2 196 19.1 15.9 151 22.8 15.8 131 16.1 18.9 187 1901 17.4 15.6 134 15.4 12.9 130 21.2 16.4 134 21.1 16.3 136 24.9 12.7 72 17.3 19.0 111 1902 17.8 16.0 134 15.6 14.0 119 21 .8 19.1 141 18.0 15.6 134 22.3 14.9 136 13.2 18.4 173 19C3 16.8 13.5 122 15.2 11 0 116 20.5 15.7 133 16.1 14.2 120 19.2 13.6 110 12.7 16.1 117 1904 16.3 13.4 124 15.6 11.7 117 20.6 15.6 152 14.4 11 .9 95 18.3 11.7 69 12.1 15.8 116 1905 16.7 13.3 111 15.5 11.6 99 20.6 16.7 131 15.7 11.8 94 20.6 11.2 92 9.8 14.0 138 1906 15.9 12.8 116 15.4 11.6 100 19.3 15.6 127 15.4 10.0 111 19.9 13.3 115 9.4 12.3 116 1907 15.8 12.9 110 14.8 12.2 86 19.9 15.5 142 13.5 10.1 116 16.4 10.4 94 10.3 13.0 96 Averages of 10 years 1898 to 1907 17.2 15.0 134 15.8 12.7 114 20.0 17.9 154 17.4 14.3 131 21.4 13.9 110 14.0 17.2 152 1908 12.3 12.3 109 142 11.6 103 196 13.6 117 13.0 10.1 98 14 .7 10.1 104 9.4 11.9 127 (Corrected birth rates and death rates of children under 1 are shown on Table V. The corrected figures are not available for the City until 1901.) 35 Table XIII.— Vital Statistics relating to Residents in Blocks of Dwellings in the City of Westminster, 1908. 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 1,155 50 10 i 3 2 — — — 1 — — 3 6 — St. James's Dwellings, Ingestre Place, and Marshall Street 163 3 3 _ 1 2 — — Peabody 6,761 174 76 8 14 12 4 7 3 4 3 9 12 19 13 Westminster 187 7 3 — — 1 — 1 — — — 1 — — 2 London County Council— Mill bank 3,043 124 31 3 3 5 2 3 2 1 2 3 7 7 4 Drury Lane 1,000 16 9 1 1 3 1 1 — 1 — — 1 — 2 Improved Industrial 6,878 98 55 2 9 14 2 9 — 3 1 5 10 12 19 Metropolitan Association 757 23 7 2 — 1 1 - - - - - 3 2 2 St. George's Model Dwellings 419 7 8 — 3 1 — — — — 1 1 2 2 4 Clerkenwell and Soho Company 1,184 19 14 1 — 4 — 2 1 2 — 3 1 3 3 (Newport Market) Green coat 119 2 1 1 - - - - - - - - - 1 — Spencer 99 - 2 - — — 1 — — — — 1 — — 2 Chapter Chambers 175 2 4 — 1 — — — 1 — — 1 1 1 2 Alexandra and Castle — 5 3 — — — 1 1 — 1 — — — 1 1 New Buildings — 2 1 - - - - - - - - - - - - St. James's Residences - 16 3 - - 1 - 1 - - - - 1 2 - 36 B. Communicable Diseases. (1) Compulsorily Notifiable Diseases. The details respecting the 946 notifications of infectious disease received by me are set out in the Local Government Board's Return (Table XV), which also shows the number treated in hospital as well as the number of deaths. It should be noted that there were 53 weeks reckoned as forming the year 1908. The number of cases of each disease notified in London since 1890 are shown in Table XIV, 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 on p. 39 indicates the number of notifications of scarlet fever, diphtheria, enteric fever, and erysipelas in each week. There was a diminution under each heading in London as a whole. Three hundred and sixty-seven visits were paid in connection with doubtful cases, contacts, children returning from fever hospitals, &c. Small-pox.—One child was notified to be suffering, but fortunately it turned out to be a severe attack of chicken-pox. Two hundred and fifteen persons were notified as having been in contact with cases of small-pox elsewhere than in the City, and these were kept under observation. Four persons suspected to be suffering from small-pox were seen by me at the request of their medical attendants. Vaccination.—The Vaccination Officers have supplied me with the following particulars relating to vaccination of infants born in 1907:— Vaccination Statistics. 1907. Union. Birth 8. Died Unvaccinated. Successfully Vaccinated. Insusceptible. Vaccination Postponed. Conscientious Objectors. Removed and Vaccination Officer Informed. Not Found. Removed to Address Unknown. 1 St. George.. 2,103 151 1,797 4 8 51 31 61 Westminster 436 26 365 1 1 4 7 32 Strand 204 26 149 O 14 3 6 6 The City .. 2,743 203 2,311 5 23 58 44 99 The following is a summary of the total primary vaccinations performed in the City during the years 1901-08, and of re-vaccinations, in so far as these were made by the Public Vaccinators:— 37 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 2,110 372 145 51 5 397 1907 2,013 443 155 45 7 468 1908 1,898 284 138 37 8 413 * There were also 16 primary vaccinations of persons over 14 years of age. Table XIV.—Infectious Diseases Notified, 1890—1908, 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 8,353 2,465 20 147 347 6,934 54 7 45,848 1893 2,813 36,901 13,694 3,666 22 205 397 9,700 86 4 67,485 1894 1,192 18,440 11,190 3,360 21 162 253 6,080 21 2 40,925 1895 979 19,757 11,223 3,506 14 105 236 5,660 29 3 41,512 1896 225 25,647 13,941 3,190 6 103 279 6,438 13 3 49,845 1897 104 22,848 13,199 3,103 4 65 264 5,800 38 1 45,361 1898 32 16,894 11,855 3,024 16 55 247 5,169 23 1 37,316 1899 29 18,113 13,704 4,463 14 69 330 5,615 15 1 42,353 1900 87 13,800 11,985 4,291 7 73 237 4,762 5 — 35,247 1901 1,700 18,381 12,157 3,194 20 48 253 4,604 3 — 40,360 1902 7,796 18,252 10,731 3,407 4 47 311 5,536 1 2 46,087 1903 416 12,531 7,739 2,339 22 40 233 4,372 — — 27,692 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 1907 8 25,925 8,771 1,394 5 36 255 4,496 — — . 40,890* 1908 1 22,059 9,998 1,350 4 13 230 4,209 - - 35,864† 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 26y 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 — 640 206 47 — 2 9 127 — - 931 1907 — 418 145 51 — 2 3 102 - - 721* 1908 1 617 187 41 - - 6 81 943† There were also notified 132 cases of Cerebro-Spinal Meningitis in London, 4 in Westminster. „ 85 „ „ 3 „ 38 Table XIV—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 0.1 39.9 30.1 9.8 0.0 0.2 0.7 12.3 1900 0.2 30.1 26.1 9.3 0.0 0.2 0.6 10.3 1901 3.7 40.1 26.7 7.0 0.04 0.1 0.5 10.1 Average of 10 years 1892.1901 1.7 49.4 27.2 7.7 0.02 0.2 0.6 13.5 1902 16.7 39.1 23.0 7.3 0.00 0.1 0.6 11.8 1903 0.9 27.1 16.7 5.0 0.04 0.08 0.5 9.4 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 1907 0.01 54.1 18.4 2.9 0.01 0.05 0.5 9.4 1908 (53 weeks) 0.00 45.1 16.3 2.7 0.00 0.02 0.4 8.6 In the City of Westminster. 1891 0.1 19.1 8.8 5.0 0.1 0.4 0.5 7.3 1892 0.7 43.9 17.8 5.0 - 0.4 0.4 9.6 1893 8.4 69.7 18.1 7.5 — 0.3 0.6 11.7 1894 1.1 27.4 13.7 8.5 — 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 1907 - 24.2 8.4 2.9 - 0.11 0.17 5.9 1908 (53 weeks) 0.00 35.6 10.6 2.3 — - 0.34 4.6 39 Notifications of Infectious Diseases during the year 1908. London. City of Westminster. 40 City of Westminster. Table XV.—Local Government Board Table C.—Cases of Infectious Disease Notified during the 53 weeks from 29th December, 1907, to 2nd January, 1909. 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—Tears. Conduit. Grosvenor. Knightsbridge St. George. Victoria. St. Margaret. St. John. Hamlet of Knightsbridge. Pall Mall. Regent. Great Marlborough. Charing Cross. Covent Garden. Strand. St. Anne. Conduit. Grosvenor. Knightsbridge St. George. Victoria. St. Margaret. St. John. Hamlet of Knightsbridge. Pall Mall. Regent. Great Marlborough. Charing Cross. Covent Garden. Strand. St. Anne. Total. 0 to 1. 1 to 5. 5 to 15. 15 to 25. 25 to 65. 65 and upwards. Small-pox— Cases 1 1 - - - - - - - - - - - - - 1 - - - - - - - - - - - - - 1 - - - - - 1 Diphtheria— Cases 187 6 55 71 21 34 — 4 13 13 49 22 40 5 — 3 10 5 10 4 9 3 10 11 47 22 38 4 - 2 10 5 10 4 9 175 Deaths 17 3 9 4 — 1 — — — 1 5 4 2 — 1 — 1 1 — 1 1 Erysipelas— Cases 81 1 i 4 12 55 8 1 3 3 27 8 17 — — 3 6 — 4 3 6 1 2 1 i 1 5 — — 1 3 — 1 2 1 25 Deaths 4 — — ' — — 2 2 — — — 2 1 — — — - — — — 1 — Fevers. Scarlet— Cases 627 3 128 350 101 44 1 5 56 37 130 91 157 13 7 25 28 9 22 8 39 5 54 37 125 82 155 12 6 25 28 9 21 8 39 606 Deaths 8 — 2 3 2 1 - - 1 1 3 1 - 1 - - - - - 1 - Enteric— Cases 41 - - 6 12 23 - - 4 4 7 - 1 1 2 4 2 4 7 1 4 - 3 3 5 - 1 1 2 3 2 4 6 1 3 34 Deaths 7 - - - 2 5 - - 2 - 2 - - - 1 - - - 2 - - Cerebro-spinal— Cases 3 2 — 1 — — — — — — 2 — — — — 1 — — — - — — — — 1 — - — — 1 — — — — — 2 Deaths 3 2 - 1 - - - - - - 2* - - - - 1 - - - - - Puerperal— Cases 6 — — — 3 3 — 1 — - 1 - 1 - - 2 1 — - - - 1 - - 1 — 1 - - 2 1 — — — — 6 Deaths 3 - - - 1 2 — 1 1* — 1 — — — - - - — — — — * Total Cases 946 13 184 432 149 159 9 11 76 57 216 121 216 19 9 39 47 18 43 16 58 10 69 52 186 105 200 17 8 35 46 18 38 15 52 849 24 cases notified as scarlet fever, 20 as diphtheria, 4 as enteric fever and 1 of small-pox were eventually alleged not to he suffering from the disease notified. * One case of diphtheria, 1 of cerebrospinal fever and 1 of puerperal fever were not notified during life, the nature of the illness being discovered after death. There were also cases among soldiers in barracks not notified. 41 Table XVI.—London and the Metropolitan Boroughs.—Notified Cases of Infections Disease in 1908. Cities and Boroughs. Estimated population in the middle of 1907. Small-pox. Scarlet Fever. Diphtheria. Typhus Fever. Enteric Fever. Other Continued Fevers. Puerperal Fever. Erysipelas. Cerebro-spinal Meningitis. Total. Annual rate per 1,000 persons living. County of London 4,795,757 1 22,059 7,998 4 1,351 13 230 4,209 85 35,951 7.3 West Districts. Paddington 150,923 — 682 150 — 31 1 6 105 1 976 6.3 Kensington 182,752 — 439 230 — 36 1 11 129 1 847 4.7 Hammersmith 124,012 — 394 204 31 — 6 70 1 706 5.5 Fulham 171,562 — 596 400 — 39 — 17 127 4 1,183 6.7 Chelsea 75,049 — 170 140 — 17 — 3 53 — 383 5.0 City of Westminster 172,650 1 627 187 — 41 — 6 81 3 946 4.7 North Districts. St Marylebone 126,867 - 411 119 - 33 1 8 127 2 701 5.4 Hampstead 92,654 — 280 64 — 25 1 6 33 — 409 4.3 St. Pancras 237,075 1 952 308 1 61 — 8 159 5 1,494 6.1 Islington 349,091 — 1,410 530 — 98 1 17 238 7 2,301 6.4 Stoke Newington 54,015 — 202 65 — 11 — 4 25 2 309 5.5 Hackney 235,253 — 1,281 389 — 66 — 12 239 7 1,995 8.2 Central Districts. Holborn 54,466 - 193 50 - 25 — 2 46 - 316 5.7 Finsbury 96,007 — 411 170 - 49 — 4 94 3 731 7.4 City of London 19,252 — 53 29 — 7 — 1 9 - 99 5.0 East Districts. Shored itch 115,227 - 600 210 - 106 - 6 127 6 1,055 8.9 Bethnal Green 131,066 — 1,006 278 - 83 - 6 247 2 1,622 12.1 Stepney 310,706 - 2,358 660 3 98 2 9 423 2 3,555 11.2 Poplar 171,516 — 1,280 315 - 61 - 14 191 5 1,866 10.6 South Districts. Southwark 210,442 - 776 270 — 48 - 15 233 6 1,348 6.2 Bermondsey 127,910 - 641 252 - 58 - 9 108 3 1,131 8.5 Lambeth 321,344 — 1,456 348 — 65 3 10 226 14 2,122 6.4 Battersea 183,873 — 1,152 369 — 41 — 9 150 3 1,724 9.1 Wandsworth 289,506 — 1,261 591 — 61 — 13 209 5 2,140 7.2 Camberwell 280,022 —: 1,053 399 — 36 — 10 233 2 1,733 6.0 Deptford 117,539 — 723 207 — 28 — 4 172 — 1,134 9.4 Greenwich 109,110 — 428 223 — 35 - 2 106 — 794 7.1 Lewisham 155.627 — 620 470 — 34 3 6 91 — 1,224 7.6 Woolwich 131,346 — 602 307 — 20 — 6 92 1 1,088 8.1 Port of London — — 1 5 — 7 — - 6 — 19 — Scarlet Fever.—Westminster escaped the outbreak of 1907 to a considerable extent, but in 1908 the number of cases notified was larger than it has been for some years. The notifications are shown in the accompanying chart. The mortality was very low in Westminster as shown below:— Scarlet Fever. 1901. 1902. 1903. 1904. 1905. 1906. 1907. 1908. Deaths per 100 Cases— The City 1.8 3.3 2.5 2.8 4.0 2.5 2.8 1.27 The County 3.2 3.0 2.8 2.7 2.8 2.6 2.49 2.48 42 The majority of the cases, as usual, were in children of school age, particulars of these with the schools affected are given below. The increase of cases was restricted to Grosvenor, St. Margaret, St. John and St. Anne Wards. The numbers for 1907 and 1908 being respectively, Grosvenor, 39, 56 ; St. Margaret, 22,91; St. John, 88,157; St. Anne, 18, 39. In both the first and second Quarters of the year the number of cases was in excess of 1907; the third Quarter had no excess, but in the fourth there were 120 cases more than the same period of 1907. In the earlier part of the year there was a good deal of Scarlet Fever in connection with the various barracks and army homes. This however, died down before the holiday season. In September 11 cases of scarlet fever were found to be associated directly or indirectly with a girls' class in one of the schools in St. John's Ward. The 38 children in the class were examined, and those reported absent were visited at their homes, with the result that a child was found who had a history of sore throat and enlarged glands on the 28th August, but the illness was not severe, and no doctor had been called in. With the isolation of this child and the prevention of other children in the house attending school, the outbreak ceased. A similar outbreak occurred during October and November in Buckingham Gate School, and 40 cases were notified. The illness was extremely mild and characterised by an absence of rash, so that in several instances no doctor had been in attendance, and in other cases it was impossible for the medical men who were called in to say that the illness was due to scarlet fever. In conjunction with one of the assistant medical officers of the Education Department (L.C.C.), the children in the affected classes were examined. Lists were also supplied me of children who were absent, and these were visited at their homes (the County Council officers are not empowered to visit outside the school), and in this way several cases were detected. Eight or ten persons, other than those included in the above list, were found who had probably suffered from this complaint. In the same months 22 cases occurred at Pulteney School, and 25 in St. George's Road School. Small groups of cases also occurred in connection with other schools, but prompt recognition and removal to hospital checked any spread of the disease. In each of the schools named above, the infection was undoubtedly kept up by slight unrecognised cases, and until these were found fresh cases continued to crop up. To find these cases it was necessary to visit the homes of the children and to see the various members of the family, not limiting the enquiry to scholars. Over 200 families were visited and 14 persons were found, some recently taken ill, others recovering, and a few who 43 had recovered from an attack; several of these were above or below school age; no medical man had been consulted in 8 of the cases. One child had been sent to a convalescent home and was there found to be peeling, a doctor had seen the child some days after the eruption, and had certified her to be convalescent from influenza; but the child was not taken to the home until 7 days after the certificate was signed, so that by that time peeling had set in. No information had been sent in from the school that the child had been excluded. In another instance, a girl employed as a tailoress had a mild attack which was not recognised at the onset, and she was not seen by a medical man until 3 weeks after, when she attended the out-patient department of the Middlesex Hospital and was found to have her skin peeling off. I regard the out-patient departments of hospitals as a distinct source of danger in regard to the spreading of infectious disease. Persons in a weak state of health are exposed in the waiting rooms to the risk of infection from others suffering from scarlet fever, diphtheria, measles, whooping cough, and other maladies of like nature. Not only so, but the medical and nursing staff, and sometimes the in-patients, become infected. During last year seven cases of scarlet fever and two of diphtheria occurred among the staff of one hospital, and instances occur from time to time. It is not an unusual practice, when infectious disease occurs in the family of foreign tailors, for the person to be taken off to a general hospital, partly in the hope that a second opinion will prove the illness not to be infectious, and partly to prevent disinfection and interference with work, as the patient would be sent off to the isolation hospital direct from the general hospital instead of from the home. Where it can be proved that a medical man has already informed those responsible that the illness is an infectious one, legal proceedings should be taken. In 46 instances, 2 cases occurred during the year in the same house; in 15 instances, 3 cases; and in 5 instances, 4 cases. A few cases of scarlet fever appeared to be due to patients returning from hospital in which they had been inmates while still in an infective condition; thus, a child, who had been over seven weeks in hospital, returned home having a nasal discharge; shortly after, his mother developed scarlet fever, and the child was notified as still suffering, and re-admitted to hospital. In other instances, infection seems to revive in a patient- discharged apparently well, after being at home for a week or so. Diphtheria.—Cases of this disease in Westminster were rather more than in 1907, although in London, as a whole, there was a decrease. From the subjoined table it will be seen that the cases of Diphtheria in Westminster were fairly spread over the twelve months. Table XV shows that Victoria, St. Margaret and St. John Wards suffered chiefly. 44 Notification of Diphtheria Cases Received in each Month, 1901-08. January. February. March. April. May. June. July. August. September. October. November. December. Total. 1901 13 10 16 22 19 19 34 19 27 36 21 17 253 1902 27 19 17 17 25 20 39 25 9 27 32 28 285 1903 17 13 23 8 18 14 21 9 13 17 13 20 186 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 1907 20 21 8 11 9 12 18 1 7 18 7 13 145 1908 19 10 14 14 17 12 14 13 13 23 17 21 187 Twenty cases were eventually decided not to be diphtheria; on the other hand, probably more were not discovered. There were 17 deaths. In one instance the cause of death was not found until after death, so it could not be notified. Diphtheria. 1901. 1902. 1903. 1904. 1905. 1906. 1907. 1908. Deaths per 100 Cases— The City 10.0 11.0 8.6 3.4 4.2 7.6 11.0 9.9 The County 10.9 10.8 9.6 10.2 8.6 8.8 8.9 9.0 A death occurred from acute laryngitis in an otherwise healthy child; the circumstances were suggestive of diphtheria, but no membrane having been seen, and no bacteriological examination having been made, the case was not reported as such by the medical man in charge. A number of cases of infectious disease arose while the persons were away on holiday. Information reached me from another borough of an outbreak of diphtheria in a large institution which had been introduced by a child from Westminster. Her parents stated that she had a slight cold while at home, had no medical attendant, but was seen by a doctor before returning to school, and found to be apparently well. On an examination of all the children being made at the school, this girl was found to be suffering from swollen glands, and the diphtheria bacillus was found in her throat. While she was at home, a child living on the next floor was notified to be suffering from diphtheria, and as her illness was soon after, it is probable there was some connection between the cases, or there may have been a "carrier" case friendly with both families. An instance of rapid recurrence of diphtheria was noted in a child of three years of age. The first attack began on 22nd January of this year, he was admitted to hospital on the 23rd, and transferred to Gore 45 Farm on 19th February, during convalescence. He was sent home on 18th March, and on 23rd March was again notified to be suffering from diphtheria. The shortest period during which the protection conferred by an attack lasts, is about five weeks. In three instances 2 cases occurred in one house, and in two instances 3 cases. Bacteriological Examination.—Advantage was taken by medical men of the means provided by the City Council to have the diagnosis of their cases assisted by bacteriological examination of swabbings from the nose or throat in 120 instances. In 10 instances I have had a bacteriological examination made of the throats of the members of families in which a case has occurred, and no medical man was in attendance; the bacillus was present in three of them. The practice is, when there is a private medical attendant, to suggest to him the desirability of taking swabbings from the throats of all who may have been in contact with the patient. If there is no private medical attendant swabbings are taken by the medical officer of health. A difficulty arises to know what to do with persons having the diphtheria organism in their throats able to infect other persons, but not being affected themselves to such an extent as to show any signs of diphtheria. Generally, such organisms disappear promptly under treatment, the person being isolated as far as possible at home meanwhile. If treatment fails then the case is sent into hospital if complete isolation cannot be effected at home. A further difficulty occurs in connection with patients in the outpatient departments of hospitals. At many hospitals swabbings are taken of all cases of sore throat on the patient's first attendance; if there is no definite appearance of diphtheria nothing is said to the patient, who returns home or to work. The report of the bacteriologist is received by the physician next day, who then notifies the case as one of diphtheria if the organism has been found, and the first intimation to the patient is when the fact is announced to him by an officer of the Public Health Department (sometimes the person is found at his place of business.) If there is no means of isolation at home the person is sent to the isolation hospital, and then it may turn out that the treatment had got rid of the organisms in the interval, and the patient is sent home again with a report that he is not suffering from diphtheria, and it is chronicled as an "error of diagnosis." If such cases could be seen again by a medical man it might be possible to decide if they were genuine cases or "carrier" cases which might be dealt with at home. Typhoid Fever.—As usual, a number of these cases resulted from infection contracted out of London, often abroad, 15 of those whose D 46 history could be obtained came under this class. Of the others infection was attributed to eating oysters by 5, mussels by 4, watercress by 1. Two persons apparently contracted the disease through visiting at houses in which the disease already existed. Four of the 41 cases notified were afterwards reported not to be typhoid fever; 2 of them were cases of tuberculosis, but the other 2, and, perhaps, some of the other cases also were probably the result of infection by an organism of the same class. Advantage was taken to obtain the Lister Institute's opinion in 18 cases, in 7 the Widal reaction was reported, but in 11 it was not found. In one case in the Army hospital a test made on the ninth day failed to show the Widal reaction, but the bacteriologist succeeded in isolating the organism from the patient's blood. Puerperal Fever.—Six notifications were received, and three deaths occurred (one of a person not notified). Disinfection was carried out after each case, including the clothing, &c., of those in attendance. All the patients were treated in hospital or infirmary. The illness was thought to be influenza in one patient confined in hospital, in another there was pleurisy existing; the fever was due to an illegal operation in one patient; in one, complaint was made that the nurse (not the midwife) was careless, dirty and drank. The remaining cases were in persons who were badly fed and in poor health before the confinement. It has been suggested that the Metropolitan Asylums Board should provide accommodation in their hospitals for persons suffering from puerperal fever and erysipelas, but no difficulty in obtaining hospital treatment has been experienced in Westminster. Cerebro-Spinal Meningitis.—Eighty-five cases were notified in London, 3 being in Westminster; one other was found after death. One of the cases was wrongly notified, the illness being due to mastoid disease of the ear. Cholera.—This disease has been prevalent in St. Petersburg and neighbourhood during the greater part of last year, and apparently is persisting during the winter, I received notification from the Port Sanitary Authorities of 47 persons coming to Westminster from affected districts, and these were kept under observation. Glanders.—Five intimations of cases of glanders in horses have been received from the Veterinary Inspector of the County Council; this is done in accordance with the provisions of Article 2 of the new Order which came into force on the 1st January, 1908. The necessary steps in connection with the outbreaks together with the cleansing and disinfection of the infected premises are undertaken by the officers of the County Council. In one instance two men employed on infected premises were away 47 ill, their medical attendants were communicated with and apparently neither of them were suffering from glanders. In my Annual Report for 1905 (pp. 55, 56), in commenting on the deaths of two persons in Westminster from this complaint, I drew attention to the desirability of intercommunication between the County and Borough Councils in this matter. In pursuance of Articles 11, 12 and 17 of the Glanders or Farcy Order of 1907 the County Council made the following regulations:— "1. A diseased animal shall be conspicuously marked by or under the direction of a veterinary inspector of the Council with the word "glandered," and with a number, and no person shall remove, deface or in any way obliterate such mark. "2 A suspected animal shall be conspicuously marked by or under the direction of a veterinary inspector of the Council with the words "suspected of glanders," and with a number, and no person shall remove, deface or in any way obliterate such mark. "3. All places used by a diseased animal, and all utensils, mangers, feeding troughs, pens, hurdles or other things used for or about any diseased animal, shall forthwith, after such use, be sprinkled with one of the disinfectants prescribed in Regulation 5, and afterwards washed with water and scrubbed or scoured, and then thoroughly disinfected. "4. Every van, cart or other vehicle which has been used for carrying any diseased animal on land otherwise than on a railway shall, immediately after each occasion of such use, be cleansed and disinfected in the following manner— "(a.) The interior of such vehicle shall be effectually cleansed by the application of steam to all parts thereof. "(b.) The interior of such vehicle shall then be thoroughly washed with water containing one of the disinfectants prescribed in Regulation 5. "5. Every place or thing or vehicle required by these regulations to be disinfected shall be thoroughly coated or washed with— "(a.) A 1 per cent. (minimum) solution of chloride of lime containing not less than 30 per cent. of available chlorine; or "(b.) A 5 per cent. (minimum) solution of carbolic acid (containing not less than 95 per cent. of actual carbolic acid) followed by a thorough sprinkling with limewash; or "(c.) A disinfectant equal in disinfective efficiency to the abovementioned solution of carbolic acid, followed by a thorough sprinkling with limewash. "6. All places, utensils, mangers, feeding troughs, pens, hurdles or other things, vans, carts or other vehicles required to be cleansed and D 2 48 disinfected in pursuance of these regulations shall be so cleansed and disinfected at the expense of the owner, lessee or occupier thereof. "7. Litter used for or about any diseased animal shall forthwith, after such use, be sprinkled with one of the disinfectants prescribed in Regulation 5, and at once removed by the owner from contact with any other animal. "8. Fodder, litter or any other thing that has been in contact with or used for or about any diseased animal shall not be taken out of any stable, building, field or other place until a veterinary inspector of the Council has certified that such fodder, litter or any other thing has been disinfected, and until a license has, when necessary, been granted by the Council, pursuant to Article 15 of the Glanders or Farcy Order of 1907. "9. The carcase of a diseased animal, and of every animal slaughtered under the Glanders or Farcy Order of 1907, shall not be moved except under a licence granted by a veterinary inspector of the Council." Throughout these regulations "animal" means a horse, ass or mule; "glanders" includes farcy; "Council" means the London County Council; and all other words have the same meaning as in the Glanders or Farcy Order of 1907. "Any person guilty of an offence against the foregoing Regulations is liable to a penalty of twenty pounds." 49 (2) Voluntary Notifiable Diseases. Tuberculosis.—The deaths for the last eight 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 1907 232 134 11 6 26 15 20 11 289 167 1908 208 118 11 6 25 14 26 14 270 154 These rates are calculated per 100,000 inhabitants, allowance being made for the extra week included in 1908. For purposes of comparison with the whole of London, differences in the number of males and females, and their relative ages, have to be taken into account. This may be effected by multiplying the rates by a factor (0.89205). The figures are then:— Year. Pulmonary Tuberculosis. Total Tubercular Rates. County. City. County. City. 1901 165 167 229 202 1902 161 159 223 199 1903 155 154 213 178 1904 163 136 217 171 1905 140 131 191 168 1906 144 121 196 158 1907 140 119 187 148 1908 132 105 - 137 The pulmonary consumption rates show a steady decrease both in Westminster and the county. In regard to deaths from other manifestations of the disease there does not appear to have been the same decrease. This, however, is probably due to the enquiries which are made as to deaths of infants, and a transference of deaths which formerly would have been included under "marasmus" or other heading. On account of the number of common lodging houses and shelters of various kinds, a great number of the poorest class are attracted to Westminster, and some eventually find their way into the city infirmaries, so that probably Westminster has more than its share of consumptives. 50 Thirty-eight persons of this class were notified as suffering from consumption on admission to infirmaries, and 31 deaths were recorded. The International Congress on Tuberculosis was held last year at Washington, and the following resolutions were unanimously adopted:— (1) That the attention of the States and Central Governments be called to the importance of proper laws for the obligatory notification by medical attendants to the proper Health Authorities of all cases of tuberculosis coming to their notice, and for the registration of such cases in order to enable the Health Authorities to put in operation adequate measures for the prevention of the disease. (2) That the utmost efforts should be continued in the struggle against tuberculosis, to prevent the conveyance from man to man of tuberculous infection as the most important source of the disease. (3) That preventive measures be continued against bovine tuberculosis, and that the possibility of the propagation of this to man be recognised. (4) That we urge upon the public and upon all Governments the establishment of hospitals for the treatment of advanced cases of tuberculosis; the establishment of sanatoria for curable cases, and the establishment of dispensaries and day and night camps for ambulant cases of tuberculosis which cannot enter hospitals and sanatoria. (5) That this Congress endorses such well-considered legislation for the regulation of factories and workshops, the abolition of premature and injurious labour of women and children, and the securing of sanitary dwellings, as will increase the resisting power of the community to tuberculosis and other diseases. (6) That instruction in personal and school hygiene should be given in all schools for the professional training of teachers. That whenever possible such instruction in elementary hygiene should be entrusted to properly qualified medical instructors. (7) That colleges and universities should be urged to establish courses in hygiene and sanitation, and also to include these subjects among their entrance requirements in order to stimulate useful elementary instruction in the lower schools. (8) That the Congress endorses and recommends the establishment of playgrounds as an important means of preventing tuberculosis through their influence upon health and resistance to disease. The special steps which the City Council has taken in dealing with this matter are specified below:— Notification.—One hundred and fifty-five notifications were received in 1908; the numbers in previous years were: 1903, 123; 1904, 148; 1905,112; 1906, 78; 1907, 110. Sixty-nine of the patients. 51 notified were already inmates of Poor-Law Infirmaries and of these 38 had been admitted from common lodging houses, shelters or casual wards; 7 notifications were duplicates, 5 of them being to notify re-admission, so that the number of new cases was 146, and in two of these it was eventually found that the disease was not due to tubercle. In addition to notifications received from the Poor-Law Authorities, information has also been given by Brompton Hospital, Margaret Street Infirmary, and the General Hospitals. The first-named has also' arranged to see members of the families of patients when this is deemed advisable by the Medical Officer of Health, and this has been taken advantage of in several cases. The Trustees of the St. Henry Fund (of which the Medical Officer of Health is ex-officio one) have sent away 56 persons suffering front phthisis to sanitoria during the six years 1902-1907. I have made an analysis of the results:— Year. Number sent to Sanatoria. Disease Cured or Arrested. Improved. Blight or no Improvement. At end of 1903. 1902 1 — 1 — Lost sight of at end of1903. 1903 15 6 4 5 5 died in 1904. 6 doing well. 1 in infirmary. 3 lost sight of since end of 1905. 1904 12 6 3 3 3 died in 1901. 1 died in 1906. 4 well. 2 fair. 1 lost sight of in 1905. 1 lost sight of in 1906. 1905 11 1 9 1 1 died in 1905. 2 died in 1906. 1 died in 1907. 3 well. 2 fair. 2 lost sight of in 1906. 1906 5 2 2 1 1 died in 1906. 2 well. 1 fair. 1 gone away. 1907 12 4 5 3 3 died in 1908. 4 well. 5 fair. 56 19 24 13 17 dead. 19 well. 11 fair. 9 lost sight of. Difficulty continues to be experienced in securing proper treatment for cases in the early stages, when most good can be done. The St. Henry Fund assists those living in St Anne's Parish, and the Jewish Health Board looks after the Jewish cases; but in the rest of the city. 52 patients unable to get away at their own cost are dependent ou the Invalid Children's Aid Association, the Charity Organisation Society, and Brompton Hospital. With the assistance of the Westminster Health Society help has been obtained where necessary through other Societies in securing allowances for families where the father has had to go away, boarding out children in cases in which it is the mother who has had to leave home, &c. Six patients derived no benefit from the treatment and died while away or soon after their return; 10 left the sanatorium apparently cured and 9 with the disease arrested, 1 of these has gone to Canada and 3 to live in the country, 17 are reported to be in good health and 2 in fair health; 31 left with their conditions improved in varying degrees, of these 11 are known to be alive, 2 in good health and 6 in fair health, and 3 are able to do a little work during summer; several have moved away from Central London to the suburbs and two have recently gone home to Italy; 11 died (mostly within two years) and 9 have been lost sight of (probably 5 or 6 of them are dead). It thus appears that the results of the treatment may be regarded as good in about 33 per cent. of the cases, and that an additional 23 per cent. have derived a certain amount of benefit, having had their lives and working power prolonged. Considerable difficulty exists in finding suitable occupations for patients on their return from sanatorium treatment; if this could be done to a greater extent possibly the results might be better. The above figures may be compared with the results which have been obtained in Germany. Statistics have recently been published showing that of 80,000 patients treated in State sanatoria during nine years (1898-1907) 60 per cent. were discharged as cured, disease arrested or improved, and of these 40 per cent. maintained their health and working power for several years; over 30 per cent. stood the test of four years work after discharge without a relapse. The Local Government Board having made compulsory the notification of consumptives attended by poor law medical officers, or inmates of poor law institutions, information of a larger number of cases will be obtained, but in Westminster, as many of such cases come from shelters, casual wards and common lodging houses, the power to do good is considerably restricted. On receipt of a notification, the house is visited and the sanitary condition and general surroundings of patient examined, a card of advice left if desired by the medical attendant, and then the case is sent on to the Health Society for regular visiting and to make such arrangements as may be found desirable or obtainable. Poor Law Accommodation.—In order to ascertain what steps the Guardian Boards of Westminster had taken in dealing with consumptive 53 cases, the Council addressed communications to them and subjoined is a summary of the replies received:— The St. George's Board has a workhouse and infirmary situated in Chelsea with a casual ward in Wallis' Yard. The Westminster Board has a workhouss in Poland Street, but sick persons are sent to the infirmary in Cleveland Street, St. Pancras, which is shared by the Strand and St. Giles' Unions. Attached to this is a special institution at Hendon. The Strand Board has receiving wards in Sheffield Street, a workhouse at Edmonton, and uses the Cleveland Street Infirmary. St. George's Union.—No cases of tuberculosis are retained in the workhouse. In the infirmary 4 wards are set apart for these patients, accommodating 84 males and 28 females. No consumptives are treated in the other wards of the infirmary unless the special wards are full. Westminster Union.—All consumptives are sent to the infirmary (Central Sick Asylum). Strand Union.—As a rule consumptives are sent to the Central Sick Asylum, but some (at present 15 in number) who are aged, are maintained in the workhouse at Edmonton. No separate wards are set apart for them, they occupy the same wards as the very aged. Central London Sick Asylum:— (a) Cleveland Street.—Consumptives are isolated as far as is practicable. One male ward of 34 beds is generally fully occupied by these cases, and there is a small balcony which can be utilised for 2 beds. If beds in this ward are not required for consumptives they are used for general cases. The few cases among females are treated in a general ward. Where consumptives and other cases are put together, they are separated as far as is practicable, the phthisis cases being placed together at one end of the ward. Milk is allowed in addition to the ordinary diet. (b) Hendon.—One ward of 35 beds for males is used for openair treatment, and another ward of 35 beds is always half full of such cases. One ward of 8 beds for females is set aside for open-air treatment, and one ward of 35 beds is always about half full of phthisis cases. Where consumptives and other cases are put together, the phthisis cases are grouped together. There is also a children's ward to which children are at once sent from Cleveland Street; there is a balcony on which beds are placed out in summer, and that occasionally a tent is erected for women and children. The conditions are favourable, and the food supplied is more nourishing than the ordinary dietary. 54 In addition, the Metropolitan Asylums Board have at Partington an institution to which 120 children suffering from tuberculous affections may be sent by the Guardian Boards, one at Margate with accommodation for 130 Cases of surgical tuberculosis, and that shortly the hospital at Carshalton will be available for 1,000 sick and debilitated children, including those suffering from pulmonary and other forms of tuberculosis. While the Poor Law Infirmaries are probably suitable for advanced cases, with the exception of the Hendon establishment, they cannot be regarded as of any value for early cases or for such as it is possible to improve. The expense of dealing with every case by sending to a sanatorium for a lengthy period is doubtless prohibitive, and, moreover, many cases are discovered too late to ensure complete cure, but considerable value might be obtained if patients could be sent to such places for a month's training. This method was tried with much success at Brighton under the direction of Dr. Newsholme (now Chief Medical Officer of the Local Government Board) and is one which might be considered by this Council. Tuberculous Milk.—See under "Milk" below. Disinfection.—One hundred and forty-five rooms in 106 houses and 666 articles were disinfected by the Council's staff, and general cleansing of the premises was carried out after each death, or on removal from one house to another. Subjoined is a list of the occupations of persons who have died during the last eight years:— Occupations of Adult Males and of Husbands or Parents of Persons who died from Tuberculous Disease in the 8 years 1901-8. Occupation. Adult Males. "Wives and Children of. Occupation. Adult Males. Wives and Children of. General or Local Government— Professional—contd. Journalists.. 3 1 Police 3 18 Engineers 4 5 Postmen and sorters 12 2 Draughtsmen 3 — Paviors and sweepers 10 6 Surveyors 1 1 Sewermen 1 — Photographers 4 — Watchmen 3 — Musicians 9 9 Defence of Country— Artists — 3 Soldiers 24 10 Actors 5 1 Professio nal— Nurse 1 — Clergymen 2 — Commercial— Barristers 2 1 Merchant 4 2 Solicitors 3 1 Accountants 2 1 Medical men 2 1 Commercial travellers and agents 11 9 Veterinary surgeons 3 — Teachers 4 2 Clerks 70 11 Translators.. 2 — Collectors 1 3 55 Occupation. Adult Males. Wives and Children of. Occupation. Adult Males. Wives and Children of. Domestic Services or Offices— Printers, Stationers, &c.— Cooks (male) 23 8 Compositors, printers 35 13 Other Male servants 26 12 Machine rulers 1 — Coachmen 26 22 Relief stampers 1 — Gardeners 4 4 Print colorers 2 — Waiters, carvers 66 19 Bookbinders 4 2 Billiard markers 3 1 Circular folders 1 — Hall and hotel porters, and messengers 41 18 Ticket writers 1 — Publishers' assistants 2 — Bath, lavatory, and office attendants and cleaners 5 2 Booksellers 1 2 Newsvendors 20 3 Caretakers 4 1 Paper bag maker — 1 Conveyances of Men and Goods— Dress— Halters 1 1 Railway porters 9 6 Tailors 56 39 Cab, 'bus and motor drivers 18 18 Collar cutter 1 1 Carmen 28 29 Shoemakers and leather workers 34 12 'Bus conductors 3 2 Stablemen, grooms 61 22 Hairdressers 5 3 Carriage and cab attendants 4 — Stickmounters — 1 General porters 52 29 Dyer 1 — Sailors 2 4 Drapers 2 — Lightermen 5 2 Food, Tobacco, Drink, and Lodging— Shop porters 22 2 Market porters 34 6 Dairymen 2 3 Drapers and tailors' porters 7 — Butchers 5 4 Warehousemen and packers 32 21 Bakers 7 3 Metals, Machines, Implements and Conveyances— Fishmongers 3 2 Provision merchants and grocers 10 5 Metal workers 26 16 Coach builders 1 5 Ice cream vendors 1 — Lamp maker — 1 Brewer 1 — Precious Metals, Instruments, Games— Lodging house and chambers keepers 16 7 Silversmiths and refiners 11 3 Coffee house keepers — 1 Instrument makers 4 1 Lodging house deputies 4 - Clock and watchmakers 1 1 Licensed victuallers 8 2 Tennis racquet makers — 1 Barmen, potmen, cellarman 44 18 Building, &c.— Mineral water bottler 1 — Builders and masons 31 8 Tobacconists 2 — Carpenters 17 22 General Workers and Dealers— Scatfolders 3 1 Plasterers 1 4 Shopkeepers 34 23 House painters 36 13 Hawkers 48 11 Glaziers, paperhangers 4 2 Firemen, engine drivers 1 4 Plumbers and gasfitters 15 3 Stokers 4 2 Wood, Furniture, Fittings, &c.— Chimney sweeps H / 4 Modeller 1 — Furniture makers 6 5 Window cleaners 5 1 French polishers 4 3 Bottle labelled 1 — Upholsterers 5 6 Superintendents — 1 Glass— Scene shifters, 13 3 Glass blower 2 — Basket makers — 1 Skins, Leather, &c.— Brush makers 1 1 Trunk maker 2 — Gasworkers — a Saddler 1 3 Labourers 166 87 Tarpaulin maker 1 Wood chopper — 1 Shoeblack 1 — Blacklead maker 1 56 Occupations of Adult Females where separately stated. Teacher 2 Dancer 1 Nurse 3 House keeper, manageress 9 Cooks 22 Other servants 71 Charwomen 55 Laundresses 23 Waitresses 7 Clerk L Upholsteress 2 Furniture dealer 1 Printer's ruler 1 Book folders, sewers 2 Paper sorter 1 Tailoresses 22 Milliners 3 Dressmakers, sempstresses 45 Staymakers 2 Wigmaker 1 Cigarette maker 1 Dairy assistant 1 Seed sorter 1 Incandescent mantle makers 2 Flower sellers, market women 6 Hawker 8 Packer 1 Shop assistants 4 Jewel case maker 1 Telephone operator 1 (3) Non-notifiable Diseases. Measles.—Twenty-six deaths were attributed to this cause in 1908 in the City. During the year 566 cases came to my knowledge, 554 having been notified by school teachers (particulars as to schools affected are given later). The deaths per 1,000 calculated on the total population were:— Westminister- 1902. 1903. 1904. 1905. 1906. 1907. 1908. Cases notified 294 316 181 412 362 554 566 No. of deaths 43 47 23 44 20 22 26 Rate per 1,000 population 0.23 0.26 0.3 0.25 0.11 0.12 0.13 London 0.51 0.44 0.49 0.37 0.41 0.38 0.31 The five-yearly average death-rate being 0.42 for London, 0.17 for Westminster. As 25 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:— Westminster 3.3 3.7 1.8 3.5 1.4 1.7 2.0 London 4.6 4.0 4.4 3.3 3.4 3.4 2.8 The death-rates per 1,000 persons in each of the four quarters were:— 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Westminster 0.11 0.06 0.04 0.34 London 0.29 0.40 0.21 0.35 57 Disinfection of 60 rooms in 34 houses, and of 522 articles, was carried out by the Council's staff; 24 rooms in schools were also disinfected after measles. Visits were paid by the lady inspectors in all cases notified from schools. Whooping Cough—This complaint was responsible for 10 deaths, all of them of children under five years of age. Sixty-two cases were notified to me, all from schools (for particulars as to schools affected see list below). Disinfection was carried out in 5 rooms. The death-rates per 1,000 persons in each of the four quarters were:— 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Westminster 0.04 0.02 0.11 0.04 London 0.33 0.28 0.13 0.07 Particulars relative to this disease for the years 1902-8 are:— 1902. 1903. 1904. 1905. 1906. 1907. 1908. Westminster— Cases notified 145 83 56 210 92 251 62 Deaths 34 33 17 35 23 27 10 Deaths per 1,000 population 0 18 O.l8 0.09 0.19 0.13 0 15 0 05 London 0 40 0 35 0 33 0 32 0.26 0.38 0.20 The five-yearly average death-rate being 033 for London, 0.15 for Westminster. Calculated on the number of children under five years of age, the death-rates per 1,000 were :— Westminster . 2.65 2.63 1.37 2.8 1.6 2 .2 0. 8 London 3.65 3.22 2.9 2 .9 2.3 3 .4 1.8 Leaflets giving instructions with reference to the care necessary to be taken in cases of measles and whooping cough are freely distributed to parents. Attention is also called to the danger of exposing children to infection, but apparently without much result. The practice of taking children suffering from whooping cough to the out-patient departments of hospitals is not one that should be encouraged. 58 Diarrhceal Diseases—In London, deaths from the epidemic or infective form of this disease numbered 2,592, and were fewer than the corrected average by about 900, but the rate for the year was higher than that of 1907, viz., 0.53, as compared with 0.32. In Westminster, however, the number (24) of deaths was slightly less than 1907, and considerably lower than the average (97). The figures for several years are shown below. Deaths from other forms of enteritis numbered 23, which is above the average; 15 were of infants. Probably this form was due to cold, improper feeding, defective powers of digestion, and in some instances this condition resulted from a previous attack of the epidemic form. The following table exhibits the particulars:— Westminster. 1901. 1902. 1903. 1904. 1905. 1906. 1907. 1908. Epidemic diarrhcea 79 37 59 42 27 28 20 11 Epidemic enteritis 18 24 38 20 47 7 13 Other forms of enteritis 13 27 14 16 17 20 19 23 Total deaths 110 88 73 96 64 95 46 47 Number under 1 year of age 78 63 52 72 42 71 27 33 Number of births 3,432 3,461 3,185 3,054 3,120 2,931 2,927 2,913 Deaths of infants per 1,000 births 22 .7 18.2 16.3 23.5 13 .4 24.2 9.2 11.4 Fifteen of the deaths were in St. John's Ward, 13 in Victoria. The rates per 1,000 persons for each quarter for epidemic diarrhcea and enteritis were as follows:— 1908. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. The Year. Westminster .. 0.09 0.02 0.37 0 .06 0.13 London 0.17 0.15 1.36 0.46 0.53 Meteorological conditions again played a part in keeping down the rate. Although there were long spells of dry weather, yet the rainfall during the summer was above the average. There was a recrudescence of the complaint in October, when the weather was unusually hot. Two lines of special action have been initiated in other Boroughs, and their example might be followed with advantage in Westminster. By one, notification of this form of illness has been secured during the summer months in Woolwich with good results; by the other, arrangements have been made by voluntary effort in Paddington to supply children suffering with "citrated" and other forms of modified milk. This proved of value in preventing fatal results. 59 Influenza—This complaint prevailed during the first half of the year, but especially in the first three months. In London the deaths recorded from this complaint began to rise at the end of January. During that month they averaged about 26 a week; they rose to a maximum of 141 deaths in the fourth week of February, after which they slowly declined. These figures, however, only represent a proportion of the deaths brought about by this complaint, many others being attributed to secondary causes resulting from influenza. In Westminster 50 deaths were ascribed to this cause, 27 of them being in the first quarter of the year. All the deaths were those of adults. 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. Measles. Mumps. Whoopingcough. Chickenpox. Measles, Mumps. Whoopingcough. Charing Cross Road 9 3 1 3 7 1 _ 1 1 ringworm. Horseferry Road 3 — 6 3 4 — — — 6 ringworm. Buckingham Gate 31 10 3 1 14 10 - - f 2.German measles. 1.7 ringworm. Pulteney 13 34 3 6 3 24 - — 1 ringworm. St. George's Row 20 64 4 3 10 38 3 — 19 ringworm. Millbank 11 117 48 5 3 32 2 - 57 ringworm. 9 German measles. Tower Street - 2 — — 1 — — — Wild Street 1 12 — 12 2 3 — 4 11 ringworm. Brompton Higher Grade — — 3 — — 3 2 — Christ Church — 1 — — 3 1 — — Holy Trinity St. Anne's 7 54 — — 5 51 — — 1 ringworm. 5 38 4 — 4 18 — — 8 ringworm. St. Anselm's — - 6 — — — 7 — 2 German measles. St. Barnabas —- — — 17 — — — 3 8 ringworm. St. Clement Danes —- — 1 — 3 — — — 3 ringworm. St. Edward's, Dufour's Place - - - - - 4 ringworm. 1 German measles. St. Gabriel's 4 11 12 9 6 15 10 5 St. George's, South Street — 1 3 2 1 — — — St. James the Less 3 8 - - 2 1 - - 7 ringworm. 1 German measles. St. Margaret's — 12 — — — 2 — — St. Martin's, Adelaile Place — 8 — — — 4 — St. Martin's, Castle Street — 6 — — — 2 — St. Mary's, 43, Great Peter Street — - - - - - - 7 ringworm. 11 German measles. St. Mary's, Hide Place 20 21 8 - 8 11 1 - St. Matthew's 4 20 — — 9 — — 14 riag»vorm. St. Michael's - - - - - 1 - St. Paul's 6 — 28 — — — 4 — 2 ringworm. 1 German measles. St. Peter's, Lower Belgrave Place 4 3 25 1 - - 6 - St. Peter's and St. James' 26 1 — — 9 5 — — St. Stephen's 36 17 7 — 15 11 1 — Wesleyan Training 4 22 2 — 1 19 1 — 2 German measles. Westminster Jews' Free — 1 — — — 1 — — 1 ringworm. 210 491 159 62 101 257 38 13 There were 17 cases of German measles. A copy of each notification of fever, diphtheria, &c., received from 60 medical men is sent to the head teacher of the school attended by the patient (if a child), or by any child who is an inmate of the same house as the patient. In this way 717 notifications were sent out during 1908 to school teachers as follows:— School. Small Pox. Scarlet Fever. Diphtheria. Enteric Fever. Charing Cross Road - 4 - 1 Horseferry Road — 12 — — Buckingham Grate. . — 31 5 — Pulteney — 20 2 1 St. George's Row — 16 4 — Millbank — 11 3 — Great Wild Street — 2 — 1 Brompton Higher Grade — 5 — — Christ Church — 3 3 — Curzon — 10 — — French Protestant — — — — Holy Trinity — 3 — — St. Anne's — 7 1 — St. Anselms — 8 2 — St. Barnabas — 3 2 — St. Clement Danes — — 1 — St. Edward's, Dufour's Place — — 1 — St. Gabriel's — 4 2 — St. George's, South Street — 13 — — St. James the Less — 7 4 — St. Margaret's St. Martin's, Adelaide Place — 10 3 — — 8 4 — St. Martin's, Castle Street — 4 1 — St. Mary's, 48, Great Peter Street — 10 1 - St. Mary's, Hide Place — 12 4 - St. Matthew's — 12 3 — St. Michael's — 4 4 — St. Paul's, Caroline Street — — — — St. Paul's, Wilton Place — 18 1 - St. Peter's, Lower Belgrave Street St. Peter's and St. James's — 4 2 1 — 7 1 — St. Stephen's — 25 2 — Wesleyan Training College — 14 — — Westminster Jews' Free — - - - Seventy-five rooms in 8 schools were disinfected, together with 312 books and 141 other articles. Improvements in the drainage and sanitary arrangements of 5 schools were effected during the year. Medical Inspection of School Children—I pointed out in my Report for 1907, that the County Council has a staff of medical men attending to schools working independently of the Local Authorities, both being in ignorance of what the other is doing. Various Borough Councils as well as the Society of Medical Officers of Health suggested to the County Council:— " That it is desirable on grounds of efficiency, economy, and harmony, that the work of medical inspection should be carried 61 out in intimate conjunction with Public Health Authorities as enunciated in paragraphs 5 and 6 of the memorandum of the Board of Education, and that of the Metropolitan Cities and Boroughs should for this purpose be made units of administration; that Medical Officers of Health of the Metropolitan Cities and Boroughs be appointed by the London County Council as to the local administrative officers, co-operating for this purpose with the Medical Officer of Health of the County of London; that it is desirable that the necessary executive assistants should be appointed by the London County Council and allocated to the Metropolitan Cities and Boroughs, such assistants to be under the control of and to receive instructions from, and to report directly to the Medical Officers of Health of the Cities and Boroughs ; and that it is desirable that the Medical Officer of Health should report directly to the London County Council in all matters relating to the administration of the Education (Administrative Provisions) Act." The Education Committee did not view the suggestion with favour and reported that:— "No doubt advantage would result from such an arrangement in so far that it would provide the Medical Officers of Health with knowledge of the conditions affecting the children, and would enable them to consider those conditions in relation to those obtaining at home. Desirable as this would be, the Education Committee could not regard as a practicable measure the employment for this purpose of officers appointed and paid by other authorities. In view of the heavy responsibility resting on the Council under the Act, the Committee were of opinion that it would be necessary for the Council to retain in the hands of officers directly responsible to it, whom it appointed and paid, the direction and supervision of the whole of the work. Moreover, the sanitary areas of London were not like those of provincial counties, which are often widely separated from each other, the schools of each Sanitary Authority being attended solely by the children living in that area. Further, the inspection in question must also relate to the needs of the Council as the Education Authority, and therefore it was necessary that the direction and supervision of the Inspecting Officers should be undertaken by officers appointed by and responsible to the Council. The Medical Officer of Health, who was in close touch with the various local Medical Officers of Health, would be able to supply such officers with all the necessary information and statistics, to keep them fully cognisant of the working of the medical side of education, and to enable them to make use of it in the ordinary duties connected with local administration" E 62 This conclusion is to be regretted as it is probable that a scheme could have been arranged whereby the co-operation of the Education Committee, the Borough Councils, and voluntary agencies such as the Health Societies might have been secured, so not only would medical inspection be provided for, but steps would have been taken to secure assistance to those children who were found suffering. It is quite impracticable for the Medical Officer of the County to supply the daily amount of information which the Borough Officers require without a very large increase in his clerical staff, moreover the officers of the County Council lose the opportunity of the information which the local authorities can give them, for the Borough Councils are now in possession of a considerable amount of information relating to the families resident in their areas which would have been of value in dealing with the problems of ill-health or defects which inspection may discover. In view of the great expense it is probable some modified scheme giving only a partial inspection will have to be adopted. Meanwhile, much good work has been done unofficially in Westminster through the co-operation of the Health Society with the School Care Committees, and it is hoped that this will extend to the whole City as the work becomes more organised, for the school work is inextricably mixed with health work. The Care Committees refer all medical cases suitable for home visiting to the Health Society, whose visitors see that the School Medical Authorities' directions re special hospital treatment, or home treatment, are carried out whenever possible. " The delicate infant, the ailing school child and the phthisis case, are, to a great extent concentrated in certain low-class and insanitary streets in the district, often in a comparatively small number of degenerate and poverty-stricken families already known to the Medical Officer of Health, with whom co-operation in the work is essential. By a careful system of indexing, overlapping can be prevented to a great extent, and the accumulated knowledge of the different workers can be made use of. " It is easy to realise the great value of the School Medical Officers of the records kept from birth by the Health Societies of the children with whom they have to deal. The necessity for this early watching and care of children cannot be too strongly emphasised in order to stop the supply of the Invalid Aid and the Care Committee type of child. Heretofore in many instances, the child has been irretrievably damaged for life by the time it has arrived in School. The. points which are to be specially dealt with by School Doctors—eyes, ears, throats, and teeth, start from infancy in the majority of instances."(Report of Health Society.) A list of 196 cases is given in the Report in which special action had to be taken, but, exclusive of Jewish cases in Soho, some 400 other School children were dealt with. 63 Bacteriological Laboratory. During the year 175 examinations have been made at the Lister Institute at a cost of £23 8s. 4d., with the subjoined results. The number of examinations in previous years were : 1902, 251 ; 1903, 181; 1904, 75 ; 1905, 132 ; 1906, 180; 1907, 155. Disease Persons. Examinations. Results. Positive. Negative. Diphtheria— Suspected cases 120 123 30 93 Contacts 9 14 3 11 Returned from hospital with nasal or aural discharges. . 1 1 — 1 130 138 33 105 Typhoid Fever 18 18 7 11 Tuberculosis 19 19 11 8 Hoffman's pseudo-diphtheria bacillus was found in 14 instances of suspected diphtheria; staphyloeci only were found in three instances; in which the appearance of the throat was similar to that found in diphtheria. Several organisms besides the Kleb's Loffler may cause death of the mucous membranes of the throat. Such conditions have been found in scarlet fever, typhoid fever, &c. In two instances children had suffered from sore throats, but no suspicion was raised that they were diphtheritic in origin until other persons developed the disease. Bacteriological examination then gave negative results. One case of suspected typhoid, in which the Widal reaction was. obtained, was returned from hospital as not suffering from that disease- In addition to those mentioned above, many medical men and hospitals obtain reports on their cases from private or hospital laboratories. Disinfection. Below is shown the number of rooms and articles disinfected by the Staff of the Department. The premises included 75 rooms in 8 schools and 4 sets of offices; 5 vehicles were also disinfected. In 8 cases of infectious disease treated at home the laundry linen was collected weekly and disinfected. Disinfection was carried out after all cases of the notifiable diseases, except as regards erysipelas (in which disinfection was performed in. 25 instances, when the circumstances of the case required it), and also after '60 cases of measles, 3 chicken-pox, 20 cancer, 8 influenza, 1 mumps, 5 whooping cough, and 145 phthisis. In 9 cases the premises, &c., were disinfected privately, certificates being produced to that effect. E 2 64 Shelters.—Five persons were admitted to the temporary shelters at Horseferry Road while disinfection was being carried out, three being nurses after attendance on puerperal cases. The following table gives a comparative statement of the above work during the past six years:— 1902. 1903. 1904. 1S05. 1906. 1907. 1908. Premises 1,097 709 581 667 96 L 840 1,067 Rooms 1,836 1 ,039 935 1,177 1,627 1,455 1,568 Articles disinfected 39,965 27,766 29,107 34,703 47,865 36,115 31,915 Articles destroyed 37 126 52 151 195 1,660 233 Books disinfected 24 16 10 52 363 136 557 Number admitted to shelters 20 19 39 6 1 5 5 Cleansing of Persons-The Guardians have dealt with the frequenters of their casual wards, who are the persons most troubled with vermin, at their own establishments. Five persons were specially treated at Horseferry Road; 23 children were dealt with on account of verminous conditions reported from schools; 50 visits in connection therewith were paid to the houses and 12 to schools. Verminous Houses—Twenty-six rooms in six houses were fumigated with sulphur and 388 articles were passed through the disinfecting apparatus on account of their verminous condition. In addition 126 premises were purified by the owners for like conditions after notice by the Council. A letter was received by the City Council from the London County Council, dated the 12th February, 1908, drawing attention to Sections 36 and 37 of the London County Council (General Powers) Act, 1907, with reference to the Cleansing of Verminous Persons, pointing out that Section 36 gives statutory power to the County Medical Officer or any other person authorised by him (a) to examine the person and clothing of any child attending any school provided or maintained by the County Council, to ascertain whether the person or clothing of such child is infested with vermin, or is in a foul or filthy condition; (b) to require the parent or other person responsible for such child to effect the cleansing of the person and clothing of the child within 24 hours of the notice to that effect, and (c) on default of such parent or other responsible person, to remove the child from the school and to cause the person and clothing of such child to be properly cleansed in suitable premises and with suitable appliances, and to detain there such child until such cleansing has been effected; and that Section 37 enables the Medical Officer or any other person authorised by him (a) to enter any lodging house and examine the person and clothing of any person whom lie has reason to suspect of being infested with vermin or in a foul or 65 dirty condition, (b) to require such person to submit his person and clothing to be cleansed at specific suitable premises within 24 hours of notice of such requirement, and (c) on default of such person, to remove him to suitable premises for the purpose of effecting the cleansing and to detain him there until it has been effected. The County Council state that they believe that the Westminster City Council will agree that it is absolutely necessary that any arrangements made for carrying the Act into effect shall provide for dealing separately, not only with men and women, but also with boys, and girls, and that the County Council recognise that children, in most cases, belong to an entirely different class from that to which the adult person requiring cleansing belongs, and separate days or hours should be appointed for their reception, or particular rooms allocated to them, in order to avoid the risk of the children coming into contact with obviously undesirable adults. The County Council add that these are the more important points arising in connection with the new powers conferred upon the County Council; that, before making any definite arrangements to put the Act into force, it is necessary that the County Council should obtain the fullest possible information as to the extent of the provision already existing; the method of disinfection of verminous clothing and of dealing with a verminous condition of the hair; the arrangements in regard to the supervision by the cleansing staff; and the facilities which the Metropolitan Borough Councils would be prepared to afford the County Council in the matter; and asking that the City Council will favour the County Council at the earliest possible moment with information on the points referred to, and will indicate also what facilites can be afforded to them in their administration of the sections of the Act mentioned. In reply the London County Council was informed that the City Council have under consideration plans of a new Disinfecting Station in the south-western part of the City, and have included therein certain accommodation for dealing with this class of case; that the proposed station will be situated at the extreme end of the City boundary, and obviously could only be of use, so far as children are concerned, to such as live in the neighbourhood ; that the Council would be pleased to allow the officials of the London County Council who are dealing with this matter, to inspect the plans in order that they may see what it is proposed to do, with a view to seeing if the accommodation would be serviceable for the requirements of the County Council; that it is not thought desirable that children should be brought to the same place to be cleansed as persons from Common Lodging Houses; that the Council note that the County Council have to provide means for the 66 cleansing of both classes of person, and it is not thought that the proposed new station would be convenient for the use of the class of person from Common Lodging Houses, which are mostly located in the St. John and Strand Wards of the City; that if the County Council desire to utilise the proposed new Station, it might be available for school children in the neighbourhood; that the City Council might consider if they would retain, for the use of the County Council, for the inmates of the Common Lodging Houses near by, the existing Disinfecting Station with the Shelter at the Coroner's Court, Horseferry Road, which it was originally intended to remove, if the County Council think that it would bo suitable for their requirements, but that it would not be desirable for school children to use these premises for cleansing purposes. Some years ago I suggested that the owners of Common Lodging Houses should be required to provide means whereby their inmates could have baths and their clothes stoved, and apparently the County Council adopted the suggestion in their lodging house (Bruce House) in Westminster, and the Salvation Army have also made similar provision in one of their houses. If this were required in other lodging houses the difficulty which the County Council have would be got over. With regard to children, Section 122 of the Children's Act, 1908, confers power on the local Education Authority, similar to those contained in the General Powers Act, 1907, but it obliges a sanitary authority which has provided any premises or appliances for cleansing persons infected with vermin to allow the Education Authority the use thereof upon such payment as may be agreed, or failing agreement, as may be settled by the Local Government Board. Mortuaries. The number of bodies removed to the Council's mortuaries under order of the Coroner, or to await burial, was 364; in 11 instances death was the result of infectious disease. Two hundred and ninety-nine inquests were held at Horseferry Road, where the Coroner's Court is situated; 13 adjourned inquests were held. Postmortem examinations were made in 198 instances at Horseferry Road. An increase has taken place in the deaths due to traffic accidents; 44 enquiries were held into deaths from this cause. The number of dead bodies taken to the mortuaries for purposes of inquest and to await burial during the last eight years are:— Total. I'or Inquest. To await Burial. Total. For Inquest. To await Burial. 1901 438 370 66 1905 370 307 61 1902 389 345 44 1906 315 283 61 1903 393 341 55 1907 358 281 77 1904 388 322 59 1908 384 293 66 67 Of the 66 bodies admitted to await burial, 50 were taken to Horseferry Road, 12 to Dufour's Place, 3 to Drury Lane, and 1 to Ebury Bridge 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 1905 344 1898 165 1902 371 1906 332 1899 273 1903 371 1907 341 1900 309 1901 365 1908 348 Removal of Human Remains.—In the course of rebuilding operations in Meard Street, Soho, some human remains were found at the rear of a chapel which had recently been pulled down. Under Section 25 of the Burial Act, 1857, the Home Secretary sanctioned their removal under the supervision and to the satisfaction of your Medical Officer. The remains filled four cases, which were removed and re-interred in the Westminster burial ground at Woking with the usual precautions. 68 PART II. C House Inspection, &c. Below is a list of details of the work done in connection with insanitary conditions. some of the work specified was in premises part of which was occupied as workshops:— 1908. 1908 Complaints received and dealt Sanitary Work completed:— with 883 Drains:— Premises inspected on complaint, &c. Manholes built 559 883 repaired and House to house inspection 4,259 cleansed 208 Subsequent visits 22,612 covers fixed or Premises (registered), visits to 3,007 repaired 583 Overcrowding found 31 Tested by smoke 274 Other infringements 349 chemical.. 462 Sanitary Work completed water 391 Houses:- air 29 Closed under H.W. Classes Fresh air inlets fixed or Act — repaired 328 Closed under P.H. (London) Petrol traps provided 9 Act 4 Soil Pipes:— Cleansed throughout 268 Fixed 364 „ partially 880 Ventilated 265 Overcrowding abated 89 Repaired 238 Light or ventilation Tested by smoke 233 proved 173 chemical 197 Roofs repaired 365 air Water-closets:— 30 Floors and staircases repaired 281 Underground rooms vacated 40 Constructed 1,192 Yards, areas, paved or Repaired 1,039 paired 498 Ventilated and light Damp walls remedied 183 proved 606 Offensive refuse removed .. 268 Cleansed or limewashed 818 Keeping of animals Ventilated lobbies provided 332 continued 21 Unstopped 116 Verminous premises cleansed 132 Traps ventilated 847 Verminous and filthy Flushing cisterns fixed 1,378 ding, &c 9 repaired 431 Drains:— Waste Pipes Constructed 288 Constructed 870 Amended and repaired 382 Repaired 222 Ventilated 260 Unstopped 67 Unstopped and cleansed 184 Trapped 861 Interceptor traps fixed 233 Ventilated 402 Cleansed and sealed off from Disconnected 173 sewer 153 Rainwater Pipes Gully traps fixed 1,075 Fixed or repaired 371 Defective traps abolished 215 Disconnected from drains 124 69  1908. 1908. Sanitary Work completed : — Sanitary Work completed:— Urinals:— Dust Bins:— Constructed 86 Provided 301 Repaired or improved 41 Repaired 22 Cleansed 56 Fixed, abolished 93 Water Supply:— Provided 303 Stables:- additional in Drained 22 ment houses 281 Paved 29 Reinstated 25 Cleansed 15 Cisterns fixed 102 Dung receptacles provided 2 cleansed 181. Dung accumulations covered 223 moved 69 defective, abolished 83 Taps off main provided 424 Pipes repaired 128 3,341 intimations of nuisances, &c., and 186 statutory notices were issued; 2,271 letters were written, and 681 interviews took place at the Office. Police court proceedings for failure to comply with Statutory notices were taken with the following results :— Premises. Offence. Result. 15, Aylesford Street (tenement house) Insufficient dust-bin accommodation, and the sink waste pipe not discharging over a trapped gully Ordered to abate the nuisance within 14 days and to pay 6s. costs. 44, Vauxhall Bridge Road (tenement house) The verminous condition of rooms and insufficient water supply to upper part of house Ordered to abate the nuisance within 14 days and to pay 6*. costs. 26, Carnaby Street (tenement house and workshops) The absence of a proper and sufficient supply of water to rooms on upper floors Ordered to abate within 14 days and to pay 6s. costs. 7, Laundry Yard (tenements) Dirty condition of walls and ceilings of ground floor; no water supply to upper part of house The work was completed and the costs of 2s. paid in each case before hearing of summonses, which were withdrawn. 12, St. John Street (tenements) Absence of sufficient water supply ; defective flushing cisterns 8, Eccleston Place (dwelling house) Drinking-water cistern inside w.c. apartment; w.c. pan broken; washhouse floor defective The work having been done before the hearing of the summons, the magistrate made an order for 12s. 6d. costs. 14, Johnson Place (tenement house) The absence of proper water supply to upper floors Order to abate within 14 days and 6s. costs. 92, Brompton Road (workshop) Damp workroom ; inefficient ventilation ; gas stoves in three workrooms being unventilated Order made for the abatement of the nuisance within 7 daysand for payment of 12s. 6d. costs. 38, Pulford Street (tenement house) Absence of water supply to upper part of the house Order made for work to be done within 14 days, and 6s. costs. 70 Premises. Offence. Result. 53, Soutli Molton Street (business premises and workshops) Untrapped sink waste pipes connected to trap of w.c.; foul condition of waste pipes between w.c. pans and traps; w.c.'s supplied from (istern supply taps, and want of separation of cisterns from w.c.'s; defective soil pipe; defective brick drain to sewer Order made for works to be done in a month, and for payment of 6s. costs. 18, Pulford Street (tenement house) The dirty condition of house generally, and of walls and ceilings of staircase throughout, washhouse, w.c., yard and area, and of rooms in basement and on top floor; the cistern for drinking water being liable to contamination, and the absence of water supply to upper part of house; the illegal occupation of the room in basement Overcrowding Abatement order made and 6s. costs in respect of the nuisance and fine of £4 and £1 3s. costs in respect or the illegal occupation of the underground room. '9A, Robert Street (tenements) Allowed four weeks. 2a, Robert Street (tenements) The generally dilapidated condition of walls, floors, windowframes and grates; the dirty and verminous condition of rooms; the defective rain-water pipe and paving of yard, the rain-water pipe not being carried to gully, allowing water to enter the house; the dirty state of drinking-water cistern 3A, Robert Street (tenements) The overcrowded state of the house; the damp state of parlour over washhouse, owing to steam percolating through the floor; dangerous condition of staircase Order to abate in each instance and 6s. costs. 4A, Robert Street (tenements) The dirty and verminous condition of house throughout; dangerous condition of staircase 5A, Robert Street (tenements) The defective condition of paving of yard; the accumulation of refuse in yard 6A, Robert Street (tenements) The dirty state of walls and ceilings of parlours and top floor back room, and of walls of yard and w.c.; the defective paving of washhouse ; defective flush-pipe to w.c., and defective window-frames Legal proceedings were taken in seven instances for offences under the By-laws with regard to water-closets, as follows :— 71 Premises. Offencc. Result. 23, Chadwick Street Failure to keep w.c. supplied Fined 10s. and 2s. costs. with water 31, Chadwick Street Do. do. Do. do. 35, Chadwick Street Do. do. The workmen who had been paid for doing the work, neglected to do it. 2s. costs. 5, Chadwick Street Do. do. Fined 10s. and 2s. costs. 13, Chadwick Street Do. do. Do. do. 24, Chadwick Street Do. do. 2, Horse Shoe Alley Do. do. 2s. costs. Work completed before summons heard. Removal of House Refuse—The Council has resolved to extend the system of daily collection to the whole of the City. Dust is also being removed earlier in the day. The following memorandum was circulated among householders together with particulars as to kind of receptacle most suitable:— " The City Council having resolved to carry out the daily removal of household refuse, it is desired to draw the attention of householders to the considerations which have led the Council to adopt this procedure, and to the benefits which are likely to accrue therefrom. "It is well recognised that accumulation of refuse in the vicinity of dwellings are detrimental to the health of the occupiers. This is particularly the ease where the refuse is kept in small, confined backyards, or close to the windows of living rooms, as in such situations it is not only liable to give rise to obvious nuisance, such as offensive smells, but to poison the air breathed by the occupiers, and to produce symptoms of ill-health. "Food, especially milk, readily becomes contaminated by air tainted with the products of decomposition of refuse and with the dust arising therefrom, and when taken may give rise to diarrhoea and sickness, young children being peculiarly susceptible to these influences. "Refuse not infrequently contains the germs of infectious disease, and as it offers great attraction to flies, these germs and putrefying matter can be conveyed by the flies into houses and on to foodstuffs. "It will therefore be readily understood that the longer refuse is kept upon the premises the greater its power for evil, and conversely it may be anticipated that the benefits of a daily removal will be shown by:- "(1) Greater purity of the air in the vicinity of dwellings and consequent improvement in the general health of the occupiers. "(2) Lessened risk of contamination of foodstuffs so that they will keep good longer. 72 (3) Comparative freedom from flies. (4) Diminution of infectious diseases and of diairhoea and sickness. (5) Absence of offensive smells. " Francis J. Allan, " Medical Officer of Health." A list of the number of fixed dustbins removed on the initiative of the Public Health Department, and movable tins provided, is given above ; notices were issued in a number of instances requiring the site on which the fixed bin stood to be made good. 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. One person was cautioned for removing refuse during prohibited hours. Drainage, &c., Plans.—Five hundred and seventy-two sets of plans were examined during 1908. 455 of these resulted from notices served by the Public Health Department, and 117 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. Failure to send in plans as required by law occurred in eleven instances. Infringement of the by-laws in connection with the erection of buildings occurred in eight instances. Proceedings against the persons offending were taken (1) by the Works Department, for failure to comply with the Council's order as to the drainage of Nos. 418-422, Strand. An appeal was taken to the High Court. The Divisional Court dismissed defendant's appeal, so far as it related to the conviction for failure to provide a vent-pipe to one of the manholes, but the conviction for not having provided at least two untrapped openings was quashed, as the Court was of opinion that the conviction was technically incorrect; (2) by the Public Health Department, for failure to give notice of intention to construct a w.c., and constructing it in a manner contrary to the By-laws, at the Mayfair Garage. Fined 40s. and 23s. costs on one summons, and 10s. and 2s. costs on the other. Testing Drains.—One thousand one hundred and fifty-six tests were applied to 1,121 drains, soil-pipes, &c., during the year, of which 410 with stroke 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 reconstruction, drains below 73 ground are tested with water, pipes above ground with smoke or air. The numbers of each test employed were:— Chemical 462 Water 391 Smoke 274 Air 29 Offensive Smells from Sewer Ventilators.—A number of complaints were investigated, and the attention of the County Council called thereto, where the ventilators were on main line sewers; the others were dealt with by the Works and Highways Departments of the City Council, and special attention was given to the prevention of accumulations of foul gases at particular spots. Interceptors on House Drains.—A Departmental Committee has been appointed by the Local Government Board to inquire with regard to the use of intercepting traps on house drains, and incidentally on the question of ventilation of sewers. The City Council had already considered the question of abolishing the use of intercepting traps between the house and the sewer in 1906, and resolved that so far as Westminster is concerned they ought to be required (Minutes, pp. 326 and 338). I was authorised to give evidence before the Committee, and in doing so pointed out that very few of these traps were found obstructed in Westminster; that where obstruction occurred it was due to one of the following reasons: improper setting, want of sufficient fall to drain, want of proportion of trap to drain, obstruction in sewer preventing outflow of drain contents. The experience of the Council's sanitary inspectors is that constant supervision has to be exercised in order to prevent drains and traps being improperly constructed or laid. It has been suggested that the interceptors should be done away with, in order that each house drain and soil pipe should act as a ventilator for the sewer. This is quite unnecessary ; the proper remedy is to have the sewers properly constructed and kept clean. Under such circumstances the amount of ventilation required is, in the absence of abnormal conditions, very small, and street openings into the sewers would cease to be a nuisance. The difficulty in obtaining such ideal conditions is doubtless that of expense, hence engineers have had to make openings in the roadway to render the sewers tolerable for the men employed in them. As, however, this leads to annoyance and injury to the public, and is prohibited by law (Metropolitan Management Act, 1855, Section 71), various methods have been tried to obviate this. In Westminster, the use of screens of iron and of canvas have been used with success ; these act by sectionizing the sewer, and, in the case of the canvas, partly by filtering the air. The use of a water-spray for washing the 74 air escaping from a ventilator has given satisfactory results, as germs, moulds, &c., are thrown down, and probably offensive gases are dissolved and carried down also. Another method, which has also been serviceable, is by burning the air from the sewer in a special form of street lamp. Reference was also made to a paper on the subject, in which replies from a number of local authorities were summarised (Public Health, ix, p. 250, May, 1897). Watek Supply. Applications were received for certificates that the water supply of eleven new buildings was sufficient, and were granted in each instance. 147 notices of withdrawal of water supply were received from the Metropolitan Water Board, and in 25 instances it was reinstated. Additional sources of water supply on the upper floors of tenement houses were provided in 281 instances. Legal proceedings to enforce this were taken in six instances. At the end of March, a change was effected in the mode of charging for water. Instead of a rate plus extras for baths, lavatories, and high service, a standard charge of 5 per cent. on the rateable value is now made, so that where it is required to lay on water to the upper floors of tenement houses no extra annual charge will be incurred, as would have been the case under the old system. Houses under £20 a year are entitled to a 20 per cent. compounding allowance, bringing the rate down to 4 per cent. Premises not paying inhabited house duty and being assessed at more than £300, are also entitled to 20 per cent. discount. Sanction has been given to the expenditure of £13,000 by the Water Board upon a scheme for the improvement of the supply to the district of Mayfair. It is proposed to abandon the reservoirs at Campden Hill, and to lay a new 18-inch main through Hyde Park from the Marble Arch to Regent Street by way of Brook Street. Houses Let in Lodgings. The number of houses at the end of 1908 was reduced by 24 through closure, and as none were added in that year, the number on the register at the end of the year was 1,548. To these 3,007 visits were recorded as having been paid to this class of house, but many more were actually paid. Overcrowding was found in 31 instances, and 349 other defects were found and remedied. Proceedings were taken in respect of several registered houses for failure to maintain w.c.'s in proper working order and supplied with water (see list of " Legal Proceedings," ante). 75 Revenue Act. Certificates under this Act relieve the recipient from the payment of Inhabited House Duty. Applications were received by me in 5 instances comprising 40 tenements, and 1 application for 4 tenementswas outstanding at the end of the year pending structural alterations. Certificates were granted in each instance. The premises for which certificates were granted are:— 83, 87 and 91, Victoria Street (Marlborough Mansions). 6 and 7, Cowley Street. 13, 35 and 48, Greycoat Gardens. 1, Robert Street, Strand. 152, Vauxhall Bridge Road. 120, Wardour Street. Such certificates were intended as a stimulus to property owners to improve the condition of tenement houses, but in several of the above the accommodation for which application was made was intended for servants and caretakers in blocks of high-class mansions. 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 :— 3909. North District. South District. Total. Complaints received 23 12 35 Observations taken 984 1,378 2,362 Notices issued— Preliminary 54 62 116 Statutory 10 2 12 Summonses A comparison with previous years is given below :— 1902 1903 1904 1905 1906 1907 Complaints 81 52 55 52 37 48 Observations 2,728 2,731 3,191 2,715 2,722 2,417 Notices Issued: — Preliminary 58 68 142 121 93 106 Statutory 18 18 26 26 25 15 Summonses 6 3 5 11 8 2 The Public Control Committee of the County Council have had under consideration the question of obtaining an amendment of the law with a view to dealing more effectively with nuisance from smoke ; the Committee recognise that the existing law is largely ineffective, and that 76 many sources of nuisance are at the present time untouched; it seemed, therefore, to be desirable that the County Council and the several Local Authorities should have more extensive powers for enabling them to deal with the evils arising from smoke, and a draft scheme for the amendment of the existing law has accordingly been prepared by this Committee for consideration; the scheme, briefly, is:— (a) That dense smoke discharged from any building, vessel, stationary or locomotive engine, place or premises (other than a private dwellinghouse) within the area of the City and County of London and the surrounding urban districts to a distance of twelve miles of Charing Cross or upon the waters of the Port of London and its tributaries within sucli area shall be a nuisance for which a fine not exceeding £10 may be imposed, with cumulative penalties for subsequent offences at the discretion of the Magistrate; (b) That the Council shall have power to make By-laws, subject to the approval of the Home Office or the Local Government Board :— (i) To bring under the terms of the provision set out in conclusion (a) other instances of avoidable smoke nuisance. (ii) To prescribe and revise from time to time a standard of smoke nuisance, to further define emissions of smoke to be liable to penalties. (iii) To prohibit the adoption in new or reconstructed factories, premises, or buildings, of any furnace or grate, or other fuel-consuming apparatus of a type which shall have been proved to the satisfaction of the Council to produce an unnecessary amount of smoke. (iv) To prescribe any additional measures or requirements necessary for the suppression and prevention of smoke nuisance. (v) To provide a penalty for the breach of any such By-law, not exceeding the penalty specified in conclusion (a). (c) That exemption from liability to penalties implied or expressed in favour of Crown property or premises of Electric Power Corporations be repealed. (d) That it shall be the duty of the several Sanitary Authorities to enforce the provisions of the law and any By-laws made by the Council. (e) That the Council shall have joint authority with the several administering bodies to enforce the law and any By-laws within the area as above defined, with power to recover from the Sanitary Authority, when it has been in default, the expenses of proceedings not recovered by Order of a Court and not incurred in unsuccessful proceedings. 77 (/) That the Council shall be the paramount authority for the whole area above defined, and, as such, shall have power to expend money for the purpose of (i) Promoting a knowledge of the principles of (a) Combustion of fuel. (b) Furnace and grate construction. (c) Stoking. (ii) Encouraging the study of the scientific heating of houses or the use of smokeless fuels with a view to the reduction of nuisance from the open fire-grate. (iii) Determining, generally, the best means for securing the prevention of smoke in the consumption of fuel. At the request of the Public Health Committee I submitted the following report:— " The law, whereby smoke nuisance in London may be dealt with, is contained in Sections 23 and 24 of the Public Health (London) Act, 1891. They refer to factories and other business premises and steamboats, and in Section 23 and Sub-section (a) of Section 24 there is a proviso that any complaint shall be dismissed if the Court is satisfied that the fireplace or furnace is constructed in such a manner as to consume its smoke as far as practicable, having regard to the nature of the manufacture or trade, and has been carefully attended. As it is difficult to prove defective construction or negligent use, action is generally taken under Section 24 (b), which does not contain the above proviso, but provides that any chimney (not being the chimney of a private dwelling house) sending forth black smoke in such quantity as to be a nuisance shall be a nuisance punishable under the Act. " Before action can be taken under 24 (b) the chimney must he sending forth smoke— " (1) That is black ; " (2) In such quantity as to he a nuisance ; and then proceedings cannot be taken against an offender until notices have been served. " As a rule, smoke in London is black, and only occasionally is smoke of a brown or bluish hue observable. It may, however, vary considerably in density and volume, and consequently, if the black particles are widely separated from one another, allowing daylight to pass between, the smoke may have a grey appearance. Such smoke may be given off in considerable volume, as where there are a number of furnaces, each consuming its own smoke fairly well, but all discharging into one chimney. Smoke which appears to be quite opaque at the point of exit from the chimney may not be of great volume, but usually f 78 opacity and volume go together. As the sections dealing with smoke are taken from the Statutes of 1853 and 1866, it is probable that it was intended that proceedings should only be taken in regard to black smoke which was opaque at the point of exit, but if a magistrate is satisfied that the smoke is a nuisance then the facts as to density and volume should be considered by him in assessing the penalty to be imposed. The greyer the smoke, the less should be the fine. It has been proved by experience that the emission of smoke from furnaces can be completely prevented by proper construction, the use of various appliances, suitable coal, and effective stoking. Further, this can be effected with a considerable saving, as a cheaper coal can be burned. " Smoke as Nuisance.—Sufficient facts have been accumulated to show that smoke, in any quantity, is a nuisance—destructive of health, of vegetation, of buildings, works of art, &c. The Hon. Rollo Russell has calculated that smoke costs London over £5,000,000 annually, nearly all of which could be saved if coal smoke could be excluded from the atmosphere. A comparison of the amount of sunshine enjoyed in Westminster and at Kew shows that the latter has 30 per cent. more than Westminster (see Annual Report for 1907, p. 7). The fall of soot has been estimated to amount to 40 cwt. per acre per annum. Soot consists, to a certain extent, of particles of unburnt carbon, but, in addition, every million cubic feet of chimney gases from an ordinary domestic fire contains about 5½ lbs. of heavy oily substances, which condense on the carbon particles. In addition there is a considerable quantity of sulphuric acid given off from the combustion of coal (coal contains about 2 per cent. of sulphur, and in the process of conversion into sulphuric acid, each atom of sulphur takes away from the air 3 of oxygen). It has been calculated that nearly half a million tons of this corrosive acid is poured out in gaseous form from the chimneys of London annually; much of this adheres to the particles of soot. " It is unnecessary to enumerate the evils which result from the presence of this quantity of corrosive, tarry soot, they will occur at once to the mind, but residents in London have become so accustomed to them that, it is, probably, only in periods of fog that their attention is directed to the question. Sir Oliver Lodge, writing on the subject of ' Fog,' gays: ' A fog which consists solely of condensed aqueous vapour ought to be evaporated and cleared up by the general warmth of a great city, so that dwellers in a well-drained town should be freer from the nuisance than those who live in open country or on the sea-board. That it is intensely worse is due to its adulteration with the products of imperfect combustion. A very considerable proportion of this contamination of the air arises from domestic and office fires. A great part of the coal thrown on office fires is not burnt at all, but is merely distilled 79 up the chimney.' This was shown by an analysis of a sample of the snow which fell on the roof of the Lancet Office in Bedford Street during the heavy fall which occurred on December 26th, 1906. Notwithstanding the fact that most of the business places were closed, each gallon of melted snow contained 5.6 grains of solid matter, 1.4 grains of tarry matters, and 1.73 grains of sulphuric acid, while an equal quantity of snow collected in Kent contained only 1.68 grains of solids, a trace of tarry matters, and the acid was in such minute quantity that it could not be detected (Lancet, January 5th, 1907). " So far as Westminster is concerned, the amount of smoke given off by factories, hotels, &c., is not large, and considerable care is exercised to keep it under control, but office and household fires must contribute a considerable amount. Action may occasionally be taken where chimneys are in close proximity to the windows of other dwellings, such action being taken under Section 2, regarding it as a general nuisance. Possibly, smoke from ordinary fireplaces in official and business premises may not be exempt under Section 24(b), but there does not appear to have been any decision thereon. Smoke, however, may be blown from some distance, and, in this way, much gloom is caused in the West-end of London when the wind is in the east, bringing with it the smoke from the factories in the neighbourhood of Stratford. With west and south-west winds the smoke from the Electric Power Station in Chelsea, and from large works in Lambeth, blows into Westminster. It is obvious, therefore, that some power is required to deal with cases like these. " The Chelsea Borough Council have recently taken proceedings in connection with the Electric Power Station, but failed, as the smoke was alleged not to be black.* The Lambeth Council, I understand, were unable to stop the smoke from certain works on the ground that, having regard to the nature of the manufacture, the furnace was constructed in such a manner as to consume its smoke as far as practicable. " The County Council suggest that they should have power to make By-laws, as set out in their communication, for the County of London and the surrounding district to a distance of 12 miles of Charing Cross, and that they should be the paramount authority for the whole area above defined, and, further, that they should have joint authority with the several administering bodies. " So far as the Metropolitan Boroughs are concerned, the County Council has already power under Sections 100 and 101 of the Public Health Act to deal with any Borough in which they may consider the * Since the hearing of this case, however, the processes have been so improved that almost no coloured smoke escapes, except from some accidental occurrence as the sudden shutting off of the current. F 2 80 administration to be lax, and under Section 100 may themselves prosecute in smoke cases. It is, therefore, unnecessary to give further powers, and the existence of such conjoint administration has generally been found prejudicial to good government. If the County Council considers any Borough Council has been lax in carrying out their duties in regard to smoke nuisances, and has not taken action, then the County Council must also have been remiss in carrying out its statutory obligations. It seems desirable that the County Council should have power to contribute towards the expenses of any action taken by a Borough Council at the special request of the Council Council, as in the recent Chelsea case. " Under Section 14, Public Health (London) Act, a Borough Council has power to take proceedings as to nuisances arising or caused without the area of the Borough which affect the inhabitants thereof. This power is not limited to nuisances arising within London only. I am not aware that this power has been exercised by any Borough Council, but it would be desirable to confer on the London County Council similar power to deal with smoke nuisances arising outside the County which affected the inhabitants of London. It is not likely that Parliament would give the London County Council power to make By-laws for districts outside the County, but it might give the Local Government Board power to frame such By-laws as are indicated in the Council's scheme, and to require their adoption in London and in any other area. " As regards the suggestion under (a), I may remind the Committee that in 1903 (Minutes, p. 922 and p. 1,264) this Council considered the subject, and recommended that the omission of the word ' black ' from Section 24 (b) of the Act would be of great advantage in checking the nuisance, and I am of opinion that it would be better to amend this Sub-section in this way than by introducing the word ' dense.' A further intention, however, is that the sending forth of black smoke should be an offence, and not a nuisance to be dealt with by notice. Both methods have defects, and some middle course appears desirable, such as one whereby an offender should receive a caution in the first instance, and if structural works had to be carried out, he should have time to adopt such improvements before a prosecution was ordered." 81 D. Workshops, &c. 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 in Westminster to apportion work done, as workshops and dwellings are so intermingled. The following shows the state of the register of workshops at the end of 1908 Workshop. Total Number. Number in which Women are Employed. Tailors, outfitters, shirt makers, hat, cap, and helmet makers 1,580 961 Dressmakers, milliners, embroiderers, lace makers, blouse makers, costumiers, lingerie makers, childrens' outfit makers, feather dying, corset makers, furriers, &c. 728 728 Leather workers, boot and shoe makers, harness makers, &c. 66 29 Carpentry, upholstery, carvers, gilders, &c. 25 15 Surgical and dental instrument makers 5 5 Tobacco manufacturers 14 12 Wig makers and hair workers 39 39 Printing, bookbinding, lithographers, envelope making, stationers, publishers, &c. 56 36 Jewellers, silversmiths and burnishers, diamond cutters and polishers, engravers, &c. 74 22 Metal workers 45 — Miscellaneous—Basket making, fancy work, shoe ornaments, hat pins, stamp sorters, postcard tinters, fan makers, artificial flower makers, &c. 33 33 Florists 26 26 Laundries 49 49 Bakehouses 84 — "Workplaces where food is prepared 1,033 1,000 Workplaces, other 110 - New workshops are always being discovered, at the same time the occupation of premises on the register is constantly changing. Thus the use of 306 registered workshops was discontinued, and 323 additions were made to the register during the year; 163 visits of enquiry were made at places where women were likely to be employed. The number of inspections of workshops and workplaces is shown in the accompanying tables. One hundred and twenty-six complaints were received from the Home Office and were duly investigated; 24 matters were referred to the Home Office relating to insufficient warming of rooms, infringement of Truck Acts, working overtime, smells from gas 82 irons, &c. In addition, notice was sent of 221 workshops in which Abstracts were not affixed. Inspection. Premises. Number of Inspections. Defects Found. Intimation Notices. Statutory Notices. Prosecutions Factories (Including factory laundries) 74 108 22 1 — Workshops (Including workshop laundries) 2,543 1,600 805 55 4 Workplaces .. (Including restaurant kitchens, &c.) 2,252 870 411 19 3 Total 4,869 2,578 1,238 75 7 In addition, 3,858 re-inspection visits were paid. Defects found.—1908. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. *Nuisances under the Public Health Acts :— Want of cleanliness.. 834 834 1 Want of ventilation 189 189 Want of ventilation of gas stoves 236 232 — Overcrowding 58 58 — Want of drainage of floors 66 66 1 Other defects 468 460 — Sanitary accommodation— Insufficient 22 22 2 Unsuitable 115 113 Defective 450 450 1 Not separate for sexes 140 138 — Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouses (Sec. 101) — - 1 Breach of special sanitary requirements for bakehouses (Sees. 97 to 100). — - — Other offences — - — Total 2,578 2,562 6 * Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act as remediable under the Public Health Acts. 83 Other Matters. Class. Number. Matters notified to H.M. Inspector of Factories: — Failure to affix Abstract of the Factory and Workshop Act (Sec. 133) 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)— 221 Notified by H.M. Inspector 126 Reports (of action taken) sent to H.M. Inspectors 126 Other 24 Workrooms measured 733 Underground bakehouses (Sec. 101) :— Certificates granted during the year — In use at the end of the year 71 Ventilation.—This is a difficult problem in many instances. The Home Office has issued a circular to employers, from which the following is an extract:— " Occupiers are required by the Act of 1901 to provide sufficient means of ventilation. The inspectors are instructed to pay special attention to this. In the absence of mechanical ventilation it is incumbent upon the occupier to see that the other means upon which he relies for adequate ventilation of each room are sufficient for the purpose, and maintained in use throughout the working hours. This is especially necessary where the average air-space of each worker is small, say under 500 cubic feet, and in all workrooms in which gas is consumed. Reliance should not be placed upon occasional ventilation by doors or windows not always kept open, or upon any other ventilating openings which the workers are allowed to close. The means must be such as in practice to secure at all times during working hours reasonable purity of the air, and the occupier is responsible not only for providing them, but for seeing that they are used. All permanent airinlets, whether by windows or special ventilating openings, should be so arranged that the current is directed upwards and does not impinge directly upon any worker; this is essential, and can be secured by simple arrangements at small cost. " The same observations apply to mechanical ventilation by fans. This, whether for purposes of general ventilation or for the removal of dust or fumes, should be installed under the advice of a competent engineer. Many installations have failed to give satisfactory results, owing to faulty planning, or omission to provide adequate counteropenings. The whole question of ventilation has been the subject of a 84 special inquiry by a Departmental Committee, whose reports contain much information and advice which should be of the greatest assistance to occupiers. Reference may also he made to the report of Sir H. P. Freer-Smith, dealing with methods of dust extraction in factories and workshops." In workrooms in which there is no mechanical means of ventilation, it is often difficult to secure adequate ventilation. This is especially so in small rooms. The Chief Inspector of Factories, referring to this point, says: " Windows, doors, and even ordinary ventilators are too readily closed, and, even apart from this, the delivery of fresh air is dependent upon wind outside, and upon differences of internal and external temperatures. Some constant ventilation is assured when open fires, stoves with flues, or even ventilated gas burners are in use, and these are most available in cold weather, when the tendency to close other openings is greatest." Closely connected with the question of ventilation is that of the temperature of workrooms; but while ventilation comes under the supervision of the local authority, temperature is under the Home Office. The Act requires adequate measures to be taken for securing and maintaining a reasonable temperature without interfering with the purity of the air. The Home Office consider that for sedentary occupations the temperature should not be less than 55 degs. Fah. In many instances it has been found that no provision has been made other than unventilated gas jets, which necessarily contaminate the air. Flueless gas-stoves are open to the same objection, although it has been contended that some of them consume the products of combustion ; but both methods fail to effect any ventilation. The danger of poisoning from carbonic oxide is also pointed out in a recently issued Memorandum (Form 827, Dec., 1908) by the Home Office, especially where the public gas supply is largely charged with water gas. Carbonic oxide poisoning may also arise in laundries from the use of gas irons, and in workrooms from defective gas fittings (such as absence of stop pins indicating the cutting off of gas, leaky joints, the use of india-rubber gas tubes, &c.). The absence of a chimney in a room greatly increases the risk. The symptoms of carbonic oxide poisoning begin with throbbing of the bloodvessels of the head, giddiness, palpitation of the heart, and weakness of the limbs. Long continued breathing of the gas, in amount too small to produce immediate effects, produces headache (worse on rising in the morning), foul taste in the mouth, indigestion, abdominal pains, lassitude, anaemia, and defective nutrition. A person affected feels better in the fresh air. An additional reason for requiring efficient ventilation is that the reports of the Gas Examiners show that since the passing of the 85 London Gas Act, 1905, a very noticeable increase has taken place in the amount of sulphur contained in the gas supplied. Previously 17 grains per 100 cubic feet in summer and 22 in winter was recognised as the standard, but the 1905 Act having removed the restrictions requiring purification by means of lime, 35 grains is now about the average amount, and even that has been exceeded (L.C.C. Minutes, 26th May and 7th July, 1908). In several tenement houses unventilated gas cooking stoves have been found in bedrooms, a situation likely to be a source of serious danger. In one instance which has come to my knowledge, a child who had been left in a room in which was such a stove was found deeply affected, and some birds in a cage hanging in the room were dead. It is a matter of some difficulty to ventilate gas cooking stoves satisfactorily; the provision of a hood with a flue may be sufficient if there is no other means of exit for the hot air, and a supply of fresh air is provided, but if there is a coal fire, or some other form of exhaust drawing air from the room in which the gas fire is placed, a down draught will be set up, and the provision of a hood communicating with the open air will be useless. 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. Considerable trouble is still experienced in getting in the lists, and in many instances they are obtained only after advertising, circularising, visiting, and, finally, threatening with proceedings. There are still many employers who appear never to have heard that lists have to be sent in. Eighty-eight visits of enquiry to ascertain if outworkers were employed were made by the lady sanitary inspectors. The accompanying table gives the details of the returns made in Westminster in 1908. 665 lists were sent in by employers, as compared with 654 in 1907 and 318 in 1906. The number of names on the lists have increased from 4,011 in 1906 to 8,232. Of these 3,321 were sent to other local authorities in whose jurisdiction the persons lived, which shows that a considerable amount of work, chiefly tailoring, is sent out of Westminster to be done in other boroughs. Five hundred and five addresses were received of persons in Westminster taking in work from other boroughs. They were distributed thus :— 86 Sent from Westminster. Received. Sent from Westminster. Received. Battersea 156 18 Islington 82 2 Bethmal G-reen 50 — Kensington 118 62 Chelsea 40 112 Lambeth 106 6 Camberwell 64 4 Lewisham 34 Chiswick 14 — St. Marylebone 1,012 166 Croydon 4 — St. Pancras 508 25 City of London 52 72 Paddington 132 15 Deptford 22 — Stepney 222 18 Edmonton 4 — Southwark 108 10 East Harr 16 — Shoreditch 26 Finsbury 60 12 Tottenham 8 — Fulham 68 10 Wimbledon 35 - Hampstead 22 16 Wandsworth 90 4 Hackney 20 — Willesden 18 — Holborn 110 50 West Ham 15 4 Hammersmith 94 — Workers are frequently in the employ of several firms, so that the number of names returned does not necessarily coincide with the actual number of workers. All those living in Westminster were visited, and the sanitary condition, not only of the rooms occupied, but of the whole house, was inquired into. The actual number of houses in which outwork was being done was 1,062. 456 notices were served in respect of 776 defects discovered in 371 houses. They may be summarised thus :— Sanitary accommodation— Insufficient .. 11 Not kept separate 37 Apparatus defective 86 ' Requiring cleansing 58 Ventilation defective 8 Drains defective 55 Walls and ceilings dirty 262 Rooms verminous 32 Rooms overcrowded 18 Rooms badly ventilated 13 Gas stoves and heaters unventi- lated 47 Other defects 149 In 32 instances statutory notices had to be served before the work required was done. In several instances where the rooms were dirty or verminous the outworker was seriously warned, and in two instances work was stopped until the conditions were improved. 87 City of Westminster. Outworkers. 1908. FEBRUARY LISTS. AUGUST LISTS. Trade. Number of Lists. Number of Outworkers. Received from other Authorities. Sent to other Authorities. Addresses in City. Number of Lists. Number of Outworkers. Received from other Authorities. Sent to Addresses other in Authorities. City. A.Tailoring 254 3,380 200 1,132 2,448 269 3,351 173 1,199 2,325 A. Dressmaking 16 203 28 166 65 16 232 42 129 145 A.Theatrical costumiers 1 13 3 8 8 1 21 - 16 5 A.Waterproofing 2 46 10 36 2 55 - 18 37 A.Shirt making and hosiers 28 112 12 80 44 27 108 5 56 57 A.Boot making 16 255 11 199 67 18 325 16 232 109 A.Veil Spotting 1 2 — 2 — 1 2 — 2 — A. Corset making 1 1 — — 1 1 2 — 2 — A.Hat making 1 2 1 3 1 3 — 3 — A.Gold lace making 1 7 4 3 1 50 — 28 22 A.Embroidery 2 28 2 16 14 2 19 2 11 10 A.Glove making - __ 1 2 — 2 — B. Lace making 1 7 — — 7 — — 1 — 1 D. Electro plating — — 2 — 2 — — — — - F. Fur pulling 1 1 4 1 4 1 1 — 1 - K. Umbrella mating — — 1 — 1 — — — — - L. Paper bag and box mating 1 2 1 2 1 1 2 - 2 - 326 4,059 266 1,620 2,705 342 4,173 239 1,701 2,711 323 firms sent in lists on both occasions giving a total of 8,091 addresses, 19 firms engaged in mating wearing apparel sent in once in the year, the number on their lists being 141. 88 Infectious Disease.—A list of the cases of notifiable infectious diseases which occurred in families engaged in the making, &c., of wearing apparel, are given below. It was unnecessary to stop their work except temporarily during the time disinfection was being carried out:— Scarlet Fever. Diphtheria. Typhoid Fever. Erysipelas. Total. Clothing trades :— (a) Business in family affected. 31 5 4 4 44 (b) Business in other parts of house 43 8 a 10 64 (c) Persons from infected houses employed in clothing business elsewhere 92 19 14 4 129 166 32 21 18 237 Other home workers trades: — (a) Business in family 1 - - - 1 (b) Business in other part of house 2 2 (c) Elsewhere 4 - — - 4 Doubtless more than 31 cases of Scarlet Fever occurred in tailors' families, as the type of the disease was extremely mild, and probably other cases may not have been recognised. Thus, there was the case of a young woman, working as a tailoress, who was notified as suffering from Scarlet Fever, the complaint having reached the stage when the skin peels off. She had attended the out-patient department of a hospital at the beginning of the illness, but there was then no clear indication of the disease from which she was suffering. She did not return to the hospital for three weeks, when her condition was at once detected, but meanwhile. she had continued her work. In connection with Laundries there were cases in two of the above three classes:— (a) (b) (c) In Receiving Shops — — — Mangling only — Scarlet Fever (1) — Washing, Ironing, &c. Scarlet Fever (1) — 3 Statutory notices were served in respect of two laundries. One laundry in which the conditions were unsatisfactory was closed voluntarily. In connection with proposed legislation dealing with home workers, I submitted the following report to the Council:— " Home Workers.—A Bill dealing with home workers was recently before the Public Health Committee, but consideration of it was 89 adjourned until the Select Committee on Home Work had reported to the House of Commons. This has now been done. " In the above-mentioned Bill it was proposed that the premises occupied by every home worker should be licensed twice a year by the Sanitary Authority, after inspection as to its sanitary condition. This method of dealing with the problem is condemned as impracticable. It would entail an enormous addition to the staff of Inspectors, and would place serious obstacles in the obtaining of work. The Select Committee are of opinion that much might be accomplished by far less drastic measures. Complete lists of home workers might be obtained by requiring that every home worker must register his or her name, occupation, and address with the Local Authority, and obtain a certificate of such registration before receiving work to do at home for the first time, such certificate to remain valid until any change of residence. It could be made an offence for any employer to give out work to be done at home unless a certificate of registration were produced. No conditions as to cleanliness of persons or dwelling need be required as a condition of registration. The certificate of registration should be issued immediately the application was made, and no fee of any sort should be charged either for registration or certification. As the offices of the Local Authority would be the place of registration, everyone would know where they were, and they would always be accessible without delay or serious inconvenience. The aim would be to obtain Complete and accurate registration. This would not supersede, but supplement, the keeping of lists of outworkers by employers. " The Committee are of opinion that it is desirable that the responsibility of supervision as to structural and domestic cleanliness, in these cases, should rest primarily with the Local Authority, inasmuch as these are sanitary matters, and refer to dwelling houses; but power should be given to the Factory Inspector to secure the enforcement of the law if the Local Authority failed in the performance of their duties. " The recommendations in regard to this matter are summarised thus " (a) That all home workers who are employed by other persons in producing or preparing articles for sale should be required to register their name, address, and class of work at, and receive a certificate of such registration from, the offices of the Local Authority, and that the keeping of accurate outworkers' lists by employers should be strictly enforced. " (b) That it should be an offence for any person to employ any home worker to produce or prepare any articles for sale by another person unless the worker produce a certificate of registration. 90 " (c) That the provisions of Section 9 of the Public Health Act, 1875, with regard to factories and workshops which are not kept clean or are ill-ventilated or over-crowded, should be extended to rooms in which home work is done, and power should be given to sanitary and factory inspectors to inspect them, and secure the enforcement of the law. "The Acts affecting London appear sufficient to effect the inspection of home workers' premises, and the removal of insanitary and unwholesome conditions, but there is not sufficient power to prohibit work being done in the premises until unwholesome conditions which may exist are remedied. It is desirable that powers similar to those contained in Section 110 of the Factory and Workshop Act, which gives the Sanitary Authority power to prohibit work being given out or carried on in premises in which there is infectious disease, should be given where serious conditions exist likely to be detrimental to the health of the workers, or where articles of clothing are liable to convey contamination by vermin, &c. Section 108 of that Act was evidently intended to deal with places likely to be injurious to the persons employed therein, but a month must transpire after the making of the order before an offender could be summoned for non-observance, and there is no means of punishing him for having exposed his workpeople to such conditions during that month, if he removes the insanitary state of affairs before the summons is heard. With good class of employers giving out work it is usually sufficient to intimate to them that a representation is to be made to the Council with a view to an Order being made under Section 108, but it is conceivable that there might be employers who would not act on such warning. Where this Section 108 is applied to home work, it can hardly be said that the employer ' exposes' the workpeople to the insanitary conditions that may prevail in their homes, nor is it in his power to 'remove the insanitary state of affairs' in premises over which he has no control. At the same time, if the conditions were so serious as to necessitate the stopping of work, it should be in the power of the Council to enforce their Order within a less time than a month. " Further, there is no power to require persons taking work home to give the names of those from whom they receive it. Such an employer may not have sent in a list of the persons he employs, or he may have taken on others after the date when he has to send in his list, so that the Sanitary Authority would not have the new names until several months had elapsed. Employers, instead of sending two lists a year, might be required to send one list at the beginning of each year, and to notify the Sanitary Authority at once when a new outworker was employed or an old one changed his address. 91 " With regard to the recommendation that home workers should register their names and receive a certificate of the same, it might be desirable to make it an offence to lend or transfer such certificate. It would be well, also, to require a home worker to return his certificate when he permanently gave up taking such work. "Recommendation (b) makes it an offence for any person to employ a home worker who has not produced a certificate of registration ; it should also be an offence for an unregistered home worker to take such work. It would be difficult to prove that an employer had not seen what he believed to be a certificate." Florists.—decision of the High Court (Hoare v. Robert Green, Ltd.) has placed retail florists within the provisions of the Factory and Workshops Act, 1901, but an Order of the Local Government Board has since released them from some requirements as to hours of employment, &c. The sanitary provisions still hold good. Besides the shops in Covent Garden, there are twenty-six others which have been visited. It appears from a decision by Mr. Mead, in a case taken by the Home Office, that where a florist's establishment is installed in a hotel it is not a " workshop" under the Act. This decision was founded on the decision in a case in the Scottish High Court, in which it was held that a laundry in a hotel was not under the Act; fresh legislation has now remedied this defect. (See also Magistrate's judgment under " Bakehouses.") Railway Waiting Fooms.—A special inspection has been made of the ladies' waiting rooms and the sanitary accommodation attached thereto in the various railway stations in Westminster. There are nineteen stations, some being combined ones, but waiting rooms are not provided at all of them. Improvements were found necessary at a number of them. Sanitary Accommodation for Women Clerks. — Several complaints have been investigated, and additional accommodation provided. The attention of architects and others is always called to the need of such provision in new buildings where both sexes are likely to be employed. 92 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 18 81 Melons O 25 0 Asparagus 0 1 0 Oranges 5 10 56 Aubergines 0 0 56 Peaches 0 2 0 Bananas 10 1 56 Pears 1 14 0 Beans 0 1 0 Plums 0 10 0 Cabbage 0 2 O Pineapples 0 1 0 Cherries 0 2 56 Potatoes 2 22 0 Currants, Black 0 10 56 Raspberries O 0 56 Grapes 0 4 104 Tomatoes 1 17 0 Grrape Fruit 1 0 0 Turnips 0 10 0 Medlars 0 2 56 Fish (various), 10 cwts. 56 lbs.; Beef, 2 cwts. 56 lbs.; one rabbit; Camembert cheese, 56 lbs. The following articles were seized and condemned; appended is a note of the action taken. Article. Name and Address of Defendant. Result. Milk, 35 gallons, dirty, some of it putrid Abraham Harris, 23, Meard Street Fined £3 and 23s. costs. (Fined also for dirty condition of shop.) Eels, two lots, in Robert Street, Pimlico Greorge Mayne, 9, Sheepcote Lane, Battersea Fined £2 and 5s. costs on each summons or one month hard labour in each ease, to run concurrently. Herrings, 200, at Turpentine Lane W. Vincent, 43, Lochington Road, Battersea Park Road Fined 10s. and 2s. costs. Pork Pies, at 356, Strand Hermann Appenrodt, 1, Coventry Street Fined £20 and £3 5s. costs. Anchovies, 7 cwts.; Tomatoes (in tins) 1½ cwt.; Fat Pork, ¾ cwt.; Dried Sausage, 1¾ cwt. Giovanni Parmigiani, 58, Wardour Street Proceedings were taken under the General Powers Act, 1908 Restaurants, &c.—The systematic examination of restaurants and other places where food is cooked, prepared, or stored for sale, has been continued during 1908. There are now on the register 1,033 such premises, including:— 93 (a) Restaurants of all kinds, including ham and beef shops and pork butchers' premises where food is cooked for sale, fried fish shops, &c. (b) Places where potted meats are prepared. (e) Places where ices and mineral-waters (aerated and non-aerated) are prepared. Maps have been prepared, and are here reproduced, showing the distribution of these premises in the City. Milkshops not serving light refreshments, and public-houses where food is not prepared for sale, have not been included. The majority of the 1,033 premises are grouped in the northern part of the City, chiefly in the area of the Strand Parliamentary Borough. The inspection begun by Inspector Dee has been continued by Inspector Sanderson, with the result that 988 premises were inspected, and 1,963 visits of re-inspection were paid ; 862 defects were found in 411 of these premises, and may be summarised under the following headings:— General dirty condition of premises 10 Walls and ceilings requiring cleansing 295 Defective ventilation of kitchens 75 Gas stoves used for cooking purposes requiring special ventilated hoods to carry off fumes 38 Food stored so as to be liable to contamination 25 Water-closets connected directly with:— Kitchens, larders, or dining rooms 77 Water-closets:— (a) Not ventilated to external air 14 (b) Defective, without water, or dirty 49 (c) Absence of separate accommodation 10 Defects in drains, waste pipes, and fittings 144 Refuse bins without proper covers or in improper positions 23 Accumulation of refuse 18 Absence of proper water supply 4 Dirty cisterns 22 Floors defective 5 Overcrowding 1 Persons sleeping in kitchens 12 Statutory notices were served in 19 instances, and police court proceedings had to be taken in 3 cases, mentioned below. The action of the Council in endeavouring to secure healthy conditions in restaurant kitchens and other places where food is prepared has been fortified by Parliament having granted the subjoined powers:— G 94 New Requirements for Premises in which Food is Sold or Prepared for Sale.—The Council issued a circular calling the attention of occupiers of restaurants, dealers in food, architects, and builders to the provisions of Section 8 (1) and (2) of the London County Council (General Powers) Act, 1908, which came in force on the 1st August 1908. The requirements are as follows :— "(1) From and after the passing of this Act the following provisions shall apply to any room shop or other part of a building within the County in which any article whether solid or liquid intended or adapted for the food of man is sold or exposed for sale or deposited for the purpose of sale or of preparation for sale or with a view to futuresale:— "(a) No urinal water-closet earth closet privy ashpit or other like sanitary convenience shall be within such room shop or other part of a building or shall communicate therewith except through, the open air or through an intervening ventilated space. "(b) No cistern for supplying water to such room shop or other part of a building shall be in direct communication with and directly discharge into any such sanitary convenience. "(c) No drain or pipe for carrying off fcecal or sewage mattershall have any inlet or opening within such room shop or other part of a building. "(d) No such room shop or other part of a building shall beused as a sleeping place and so far as may be reasonably necessary to prevent risk of the infection or contamination of any such article as aforesaid no sleeping place shall adjoin such room shop or other part of a building and communicate therewith except through the open air or through an intervening ventilated space. "(e) Befuse or filth whether solid or liquid shall not be deposited or allowed to accumulate in any such room shop or other part of a building except so far as may be reasonably necessary for the proper carrying on of trade or business. "(f) Due cleanliness shall be observed in regard to such room shop or other part of a building and all articles apparatus and utensils therein aud shall be observed by persons engaged in such room shop or other part of a building. "(2) If any person occupies or lets or knowingly suffers to be: occupied any such room shop or other part of a building wherein any of the conditions prohibited by this Section exist or does or knowingly permits any act or thing therein in contravention of this Section he shall be liable on summary conviction to a fine not exceeding for a first offence twenty shillings and for every subsequent offence five pounds. and in either case to a daily penalty not exceeding twenty shillings." 95 Acting under these powers, proceedings were taken against a dealer in Italian goods for making sausages in the basement of a shop in which a quantity of unsound food was found; in addition the floor and walls were dirty, and fluid was dropping through the ceiling from a water-closet apartment above. The owner was summoned for allowing, refuse to accumulate, and for not observing due cleanliness. He stated! that he had given up the use of the basement for sausage making, and! promised not to allow refuse to accumulate in future. He was fined 20s. with 30s. costs. Proceedings were also taken as follows:—- Date. Name and Address of Defendant. Offence. Result. 10th Mar. Owner of 13, West Street The want of ventilation to kitchen stove and kitchen The work having been finished prior to the hearing, summons withdrawn on payment of 2s. costs. 7th Aug... Mrs. Weymouth, 83, Eccleston Square Dirty walls and ceilings of basement; and part of corridor partitioned off and used as a bedroom, being unventilated Combination of Abatement and Prohibition Order made, with costs. The Council has decided that as by the end of March, 1909, the special inspection of these places will have been finished, the duty of seeing that the improved conditions are maintained shall be carried out by the district inspectors. In addition to the work of the Special Inspector, visits were paid by other officers, making a total as shown below. Dairies and Milkshops 590 Ice cream makers 317 Hotels, Restaurants and Eating houses 2,252 Food preserving works 55 Greengrocers and Fruiterers 114 Fishmongers 282 Confectioners 16 Meat shops (various) 817 Coffee roaster 1 Provision shops 171 Aerated water makers 4 Bakehouses 246 Certification of Premises, &c.—The Medical Officer of Health has been appointed Certifying Officer for the City of Westminster for all meat foods prepared or packed for export to the United States, the Philippine Islands, and the Argentine. Certificates have been granted during 1908, 89 for the United States and Philippine Islands and 5 for the Argentine. Bakehouses.—At the end of 1907, there were 15 above-ground bakehouses and 77 underground. One of the former has been closed. G 2 96 According to the decision of the magistrates, given below,6 of those underground and 2 of the above ground are not to be reckoned as bakehouses, so that the correct number at the end of the year is 12 above ground and 71 underground. All the bakehouses were inspected, and cleansing carried out twice a year. In several instances there was some delay in having the work done, and proceedings were threatened. Two bakers were also warned that they were not keeping the floors, &c., as clean as they ought to do. Bakehouses in Hotels.—In 1907 it was discovered that a place for baking bread had been built underground at the Ititz Hotel. It was contended that it was not a bakehouse under the Factory and Workshop Act (1901), but part of the kitchen. The matter was submitted to Mr. Mead, at Marlborough Street Police Court, and he gave a considered judgment on April 2nd, 1908, dismissing the case without costs. The subjoined extract deals with the principal points in his judgment:— " The prohibition is 'An underground bakehouse shall not be used as a bakehouse unless it was so used at the passing of this Act.' It is conceded by the Defence that literally this is an underground bakehouse ; but it is contended it does not fall within either definition which might be applicable. To take what I considered was the wider definition, that is Sub-section 23 of the Schedule where the interpretation is bakehouse, that is to say, any place in which are baked bread, biscuits, or confectionery from the baking or sale of which a profit is derived, I considered the baking was to meet those cases where provisions were taken to a bakehouse and were there baked, and where nothing was sold. Those circumstances do not arise here at all, therefore it seems to me I can eliminate that part of the Section altogether. But even supposing it applied, I do not think there was any profit in this case from the baking, because I think it means a direct profit, and there is nothing to show on the books, or anything else, that there was a profit derived from the baking. Of course there was an indirect profit, if there is a profit in the hotel at all, because that is part of the general business, and the general business, we may assume, results in a profit. The next point is: Supposing the expression 'baking' is eliminated, whether there is any sale, and I am clearly of opinion that there was no sale. First of all, I must look at what is the substantial •object of this bakehouse. It is not for the sale of bread. The substantial object is not for the sale of bread in any sense at all, because only a quarter of the bread baked is supplied to the customers, the remaining three-quarters is consumed by the servants, therefore the substantial object of the bakery is to supply the servants and not to supply the customers. (The Queen v. Gardner, Ct. Cr. Cases Resd., 25 "Law Journal," Magistrates' Cases, p. 100.) 97 "With regard to the general principle, there is the Caledonian Hotel case, where there was a laundry, and it seems that this case falls within the spirit of that case. The spirit of that case seems to me to be this, that where something is done in the hotel which if it was done independently would be a trade, it cannot be considered a trade if it is done in the ordinary course, and as part of the domestic policy of the hotel. So, although that case does not directly bear upon it, I think it is some sort of guide, and with reference to the 'dust' case, which was a case as to the nature of the dust which was carried away, whether it was domestic dust or trade dust, the High Court came to the conclusion that it was really domestic dust; so, though that can be distinguished from this case, and also the laundry case, still the spirit there does lurk that where something is done, as I say, as part of the internal economy of the hotel, that cannot be dealt with as if it was an independent trade, or independent business. On the whole, although I think there is considerable doubt surrounding the case, I come to the conclusion that the prosecution is not sustained, and the summons must be dismissed." According to this judgment, and a similar one in a case taken by the Home Office with regard to a florist's business in a hotel, any subsidiary business carried on in a hotel is exempt from special legislation contained in the Factory Acts. They are still, however, workplaces, and can be dealt with by the general sections, and by the Public Health Act. Parliament, however, in the 1907 Factory and Workshops Act, made laundries in hotels amenable to the special provisions governing such places. Infectious Disease in Places where Food is Prepared or Sold (Hotels, Restaurants, Clubs, (fee.), not including Milkshops. Scarlet Fever. Diphtheria. Typhoid Fever. Erysipelas. Total. (a) Illness in persons connected with the business 12 8 4 6 30 (b) Business in other parts of house . 7 3 - 1 11 (e) Persons from infected houses employed elsewhere 50 15 5 — 70 69 26 9 7 111 Slaughter House.—There was only one (14, Regency Street) which was used occasionally until Midsummer. No application was made for a renewal of the license at the autumn meeting of the County Council. Cowsheds.—There are only two cow-keepers, at 13, Marsham Street (licensed for 19 cows), and at 7, Arthur Street (licensed for 12 cows, but 98 only two or three have been kept during the year). These premises were visited 56 times. Milk Sho2)s.—At the end of 1907, 386 names of persons selling milk were upon the register; 31 new names were added during 1908, and 73 removed, leaving 344 at the end of the year. 590 visits were paid. 108 milkshops were also restaurants or refreshment rooms. Hitherto, when premises were not deemed suitable for the sale of milk it was only by persuasion that its discontinuance was obtained. But, under the General Powers Act, 1908, power is given to refuse to register milksellers whose premises are not satisfactory, and to remove names from the register under similar conditions. These powers have already been put in force in two instances. Notices requiring improvement of existing conditions were served in a number of instances, and proceedings were taken against milksellers as follows:— Name and Address of Defendant. Offence. Result. Abraham Harris, 23, Meard Street Failing to keep milkshop in a cleanly condition Fined £1 and 10s. costs. Abraham Harris, 23, Meard Street Depositing for the purpose of sale milk unsound and un6t for the food of man Fined £3 and 23s. costs. Abraham Cohen, 54, Broad Street Failing to keep milkshop in a cleanly condition Fined £3 and 10s. costs. It transpired at the hearing of the first case that milk carmen are allowed to take away milk which has gone sour, and that they sell it at the rate of 3s. 6d. a churn to Jewish milk dealers, who convert it into cheese or sell it for use in cakes, and as a medicine. The bulk of the milk in this case had gone beyond the stage of sourness, and was in an offensive condition. The rest of the milk contained in one churn was sour and not putrid, but it was contaminated with dust, &c. In Eastern countries sour or curdled milk forms an important article of diet, and the use of lactic acid in such milk has been found of value in checking intestinal putrefaction and fermentation. It is essential, however, in London that such milk should be protected from contamination. In the former of these two cases the sale of milk was given up ; in the latter the Council removed the name from the register ; 35 applications for registration were made, 31 were granted on the premises beingfound or rendered suitable, and 4 were refused. Four enquiries were made into complaints received of milk supplied in a dirty condition: in 2 instances the contamination had resulted after delivery of the milk at the customers' houses; in both the others a considerable amount of 99 coal and other dust was found on the surface of the milk in the churns on arrival from the railway stations. The attention of the wholesale dealers was called to these cases, and no further complaint has been made. Tuberculous Milk.—The County Council were unable to put into force the powers granted under their 1907 Act until July 1908. They have now issued a statement that they had taken 416 samples of milk sent to London from the following counties:—Bedford, Berkshire, Buckinghamshire, Cambridgeshire, Derbyshire, Dorset, Essex, Gloucestershire, Hampshire, Herefordshire, Huntingdonshire, Leicestershire, Norfolk, Northamptonshire, Oxfordshire, Rutlandshire, Somerset, Staffordshire, Suffolk, Wiltshire, and Worcestershire. The samples were taken principally from churns at stations of the Great Western, Great Eastern, Great Central, Midland, Great Northern, Metropolitan, London and North-Western, and London and South-Western Railway Companies. In the first quarter's working 23.9 per cent. of the samples gave a positive result; in the second quarter 285 samples were examined, and 22 samples (or 7.7 per cent.) were proved to be tuberculous. In addition, 52 other samples were reported by the bacteriologist as having caused the death of guinea pigs by an acute infection, before sufficient time had elapsed to ascertain whether tuberculosis had developed. The Veterinary Inspector visited 62 farms outside the county of London, and inspected 2,029 cows, of which 74 (or 36 per cent. of the animals examined) were found to be suffering from tuberculosis of the udder. In one case in which the examination of a sample of milk taken from a churn at a London railway station had given a positive result, the Council's Veterinary Inspector visited the farm from which the milk had been consigned, and found that the dairy farmer had obtained his milk from 18 farms other than his own in the district. Upon inspection of all the cows (254) at these farms, the Inspector found 11 cows (or 4.3 per cent.) with tuberculosis of the udder. In every case in which a tuberculosis udder had been diagnosed the dairy farmer, or his representative, had undertaken to sell no more milk from the affected animal. The County Council had been in communication with the local authorities in whose districts were situated the farms in which affected cows were found, with a view to preventing the supply of tuberculous milk from these animals, and they were informed that two of these authorities had recently appointed veterinary inspectors to deal with this work. The total number of cows inspected since the Act came into operation on July 1st, 1908, had been 3,192, of which number 84 (or 2.6 per cent.) were found to have tuberculous udders. 100 The County Council are seeking powers to deal with dirty milk as it arrives in London. Ice Cream Premises.—Inspectors Dee and Sanderson found that at 64 of the restaurants, &c., they visited ice cream was prepared ; 317 visits were paid by the Inspectors to places where this commodity is prepared, In eight instances the places so used were not in accordance with legal requirements, and in five the manufacture and sale of ice cream was prohibited until the conditions were rectified; one person gave up dealing in it. Two street sellers were cautioned for not having their name and address on their barrows. 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. (Withdrawn and Dismissed.) Fines. Costs. £ s. d. £ s. d. i Milk 860 703 (75) 82 44 28 16 53 10 0 18 4 6 2 do. Separated 9 9 3 do. Skimmed 8 8 4 ~? do. Machine Skimmed condensed. 1 1 5 Cream, fresh* 11 2 9 1 1 6 Butter 264 233 (13) 18 5 5 - 7 5 0 6 3 6 7 do. Milk Blended 3 3 8 Margarine 45 43 2 6 6 - 3 10 0 2 14 0 9 Cheese 5 4 1 10 do. Cream 60 50 (1) 9 1 1 - 2 0 0 1 3 0 11 do. Sandwich 1 1 12 Bread and Butter 8 4 4 3 3 - 6 10 0 0 12 6 13 Bread 27 27 14 Chocolate 3 2 1 1 1 - 2 0 0 0 2 0 15 do. Milk 1 — 1 1 1 - 5 0 0 10 10 0 16 do. Biscuit 1 1 17 Steak and Kidney Pie 3 2 1 18 Meat Pie 23 15 8 19 Veal and Ham Pie 5 2 3 1 1 - 0 10 0 0 12 6 20 Pork Pie 45 23 22 21 do. Stuffing 1 — 1 22 Sausage, German 6 1 5 23 do. Liver 2 — 2 24 do. Salami 4 4 25 do. Beef and Pork and Saveloys 100 70 30 2 1 1 2 0 0 7 7 0 26 Brawn 1 1 27 Pepper 54 54 28 Salt, Cerebos 4 4 * In addition, 13 prosecutions for boric acid in cream, adjourned from 1907, pending result of an appeal, were dealt with, and nominal fines were inflicted in each case amounting in all to £3 5s. with £8 2s. 6d. costs. 101 Number. Articles of Food. Number of Samples Purchased. Genuine. (Inferior in brackets.) Adulterated. Prosecutions. Convictions. Warranty or Disclosure. (Withdrawn and Dismissed.) Fines. Costs. £ s. d. £ s. d. 29 Oil, Olive 15 13 (2) 30 do. Lucca 1 1 31 Ginger, ground 27 26 (1) 32 do. crystallised 8 8 33 Pineapple, tinned 27 19 8 34 Fruit, tinned 6 6 35 Beer 40 40 36 Cider 12 10 2 37 Saffron 10 8 (1) 1 38 Quinine 18 18 39 do. Wine 12 9 3 1 — 1 40 Oxymel of Squills 15 13 2 1 1 — 2 0 0 0 12 6 41 Opium, tincture of 3 3 42 Camphorated Oil 17 17 43 Soap Liniment 15 14 (1) 44 Sulphur, precipitated 9 9 45 do. flowers of 1 1 46 Magnesia, fluid 9 7 2 I — I Totals 1,800 1,489 (94) 217 68 48 20 84 5 0 48 1 6 Milk.—860 samples of ordinary milk were taken during the year. Of these 82 (9.5 per cent.) were reported by the Analysts to be below the standard of the Board of Agriculture, and 38 samples were just on the border line, making a total of 13 9 per cent. of the samples. The percentage of adulterated (9.5 per cent.) is again below the average (11.3 per cent.) of the preceding 5 years. 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 3.3 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 official standard of 3 per cent. for fat and 8.5 for solids not fat. There is no doubt but that a considerable dilution of milk takes place, although it is apparently less than formerly. District. Total. Good Quality. Fair Quality. Poor Quality. Adulterated. No. Per cent. No. Percent. No. Per cent. No. Per cent. South 365 130 35.6 118 32.3 85 23.2 32 8.70 North 495 205 41.4 149 30.1 91 18.3 50 10.10 1908 860 335 38.9 267 31.0 176 20.4 82 9.50 1907 792 255 32.2 290 36.6 172 21.7 75 9.40 1906 803 267 33 .1 252 31.2 168 20.8 119 14.07 1905 831 305 36.7 281 33.8 153 18.4 92 11.07 102 Forty-four prosecutions were taken with regard to adulteration— 30 for fat abstracted, 13 for added water, and 1 for selling milk from a vehicle without having name and address thereon. Warranties or disclosures were proved in 15 instances. Nine 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; in none of these was it found necessary, on subsequent samples being taken, to take further proceedings; 61.8 per cent. of the samples were of good or fair quality, well above the official standard as compared with 68.8 in 1907. Details of the proceedings taken are appended. Sunday Samples.—131 of the samples of milk were taken on 13 Sundays during the year; 14 (10.6 per cent.) were found to be adulterated. In 1907 and 1906 the figures were 11 and 10.5 per cent. respectively. Samples taken in course of Delivery— (a) At Railway Stations.—75 samples of milk were taken on arrival at Victoria and Charing Cross Railway Stations. Fifty were reported of good quality, 18 fair, 6 poor, and 1 adulterated. A sample of milk taken at Victoria Station was found on analysis to consist of "Separated" milk, but there was no label on the churn to indicate this. Representations were made to the Board of Agriculture suggesting that such churns should have a label attached. (b) On Delivery at Shops.—21 samples of milk were taken as it was being delivered by wholesale firms to retail customers. Of these samples, 10 were good, 7 fair, 3 poor, and 1 adulterated (15 per cent, of fat abstracted). These samples were taken in consequence of the milk sold by the retailer having been previously sampled and found below the limit. The number of samples of milk taken in each of the last eight years are as follows:— 1901. 1902. 1903. 1904. 1905. 1906. 1907. 1908. New 492 491 608 741 831 806 792 860 Separated, condensed, sterilised or dried — 55 55 31 36 11 31 18 Total 402 546 663 772 867 817 823 878 Cream.—A further appeal from the Quarter Sessions to the High Court in the case of boracic acid in cream (McNair v. Cullen) was heard by the Divisional Court on 1st June, 1908, and was dismissed with costs. Following upon this decision, a number of cases which had been adjourned sine die were considered at the various Police Courts and 103 nominal penalties inflicted. Eleven samples of "fresh" cream (not the kind sold in pots) were taken, and 9 were found to contain boric acid, although the season of the year was March. The amounts were in grains per lb., 5, 6.3, 7, 7.5, 84, 9, 9, 11.5 and 25. Proceedings were taken in the last. It has been suggested that boric acid is only used to keep cream from Saturday to Monday. Seven of the samples were taken on a Monday and 2 were genuine, the other 4 samples were taken on Thursday and Friday, and each contained preservative. Butter.—A considerable amount of margarine is sold as butter. In a number of shops a strange customer is promptly recognised and will be supplied with the genuine article, but once the customer becomes a regular one margarine is substituted. In order to detect this unofficial samples have been purchased by agents preparatory to an official sample being taken. Margarine was served in some small eating-houses when bread and butter was asked for, and 3 prosecutions resulted. Margarine.—Four persons were summoned for exposing margarine for sale without the name being shown on it, or for serving in an unmarked wrapper, or for both offences. Cream Cheese.—60 samples were purchased. As a rule these were found to be genuine articles, but a few (7) contained boric acid to the following extent:-4 grains, 5 grains, 7 grains, 12½ grains, 13½ grains, 15 grains, 16 grains, and 30 grains per pound. One cream cheese was evidently a bondon prepared from skimmed milk, as it was reported to be deficient in fat to the extent of 90 per cent. The vendor was summoned and fined; the Magistrate characterised the label as a "deliberate fraud." On one part of the label referred to appeared the words "La Creme. Neufchatel. Bondon Fabrique par Blanchot," in large type, and on another part of the label the words "Sole Manufactory, Wilts United Dairies, Devizes," in small type. The Council called the attention of the makers to the remarks of the Magistrate, and they replied, stating that the Company sell this cheese as "skim milk cheese," and that, in order that there shall be no future discrepancy, they have now cut out the words "La Creme." Sausages and Meat Pies.—The Public Health Committee, having taken a considerable number of samples during 1907, and finding that, even during the winter months, some makers used preservatives, they decided to issue the following cautionary letter to vendors of this class of foodstuff in the City:— "The Westminster City Council have recently purchased, for analysis, a number of beef, pork, German, and other forms of sausage, 104 pork and other pies, potted meats and brawn, besides a quantity of tinned meat and fish of various kinds. "The Council are glad to find that the practice of using preservatives in canned and glass-packed foods has very much declined since they called the attention of manufacturers to the subject in 1906, and that it is only in comparatively few preparations of this class that any preservative is used at all. The fact, however, that the majority of manufacturers can put up these articles without using boric acid or other preservative, leads the Council to hope that others will discontinue the practice. The particular articles, some makes of which still contain boric acid, are pastes containing shrimps and those containing ham or tongue. "Brawn, pies, and sausages:- From the results obtained by analyses and the opinions expressed by leading makers of these goods, the Council are satisfied that the use of preservatives in brawn, pies, and sausages of various kinds is unnecessary, and that their use, even in small amounts, is a source of danger, in that they mask the presence of any putrefaction or decomposition which may have taken place in the meat, with the result that such meat when eaten would probably cause serious illness. "The Council are advised that, if these kind of foods are sold as ' fresh,' there should be no preservative in them; and, if sold as cooked, the process of cooking is of itself sufficient for their preservation for a reasonable time. "If, after the giving of this notice, any person exposes for sale in the City of Westminster articles of this description, which are found on analysis to contain preservatives, he will render himself liable to the institution of legal proceedings, and the Council, therefore, venture to hope that all manufacturers and retailers of such goods in the City will take every care to ensure the absence of preservatives from the foodstuffs they sell." Following the circulation of this letter, the Metropolitan Grocers', Provision Dealers' and Oilmen's Association wrote to the Council, stating that their Executive read with great surprise the circular, and they considered that one statement in particular contained in the letter is very remarkable, viz.:—"The use of preservatives, even in small amounts, is a source of danger, in that they mask the presence of any putrefaction or decomposition which may have taken place in the meat, with the result that such meat, when eaten, Would probably cause serious illness." They pointed out that this is not in accord with the facts, and that it would be impossible, even with the use of any amount of boracic acid, to mask the presence of putrefied or decomposed meat. They stated that they think it most remarkable that the City Council 105 should see fit to issue such an announcement, and they enclosed copy of a report by Dr. Klein, showing that 26.24 grains of boracic acid to the pound of sausages is the minimum amount that can be used for the preservation of these articles; further, they pointed out that the intimation of the Council to the traders of Westminster, that the Council would institute legal proceedings, after the issue of the circular, in cases where sausages or similar goods were found preserved with boracic acid, is calculated to be very detrimental alike to the public and the trader, and they urged that the Council will reconsider its decision in this matter. In reply, the Council called the attention of the Association to a report on the subject submitted to the Local Government Board by one of their Inspectors (Dr. McFadden), and expressed the opinion that the Council's action was justified thereby. To which the Association replied that they did not agree with Dr. McFadden's suggestion, that if any boric acid was permitted, it should not exceed 17½ grains per lb. The report of Dr. Klein had reference to experiments he had made to ascertain how much of this preservative would be required to enable a sausage to be kept in a moist chamber of an incubator at a temperature of 76 degrees Fahrenheit during the day, and in a refrigerator at night. Samples were taken during 1908 of pork, beef, liver, Salami and German sausages, saveloy, black pudding, pork, veal and ham, steak and kidney and meat pies, with the following results:— 76 Pork Sausages 54 genuine; 22 contained boric acid:—Trace, 2.8, 3 3, 3.6,5, 5, 5.5, 5.8, 5.9,7, 7, 79, 9 5, 12 4, 127, 16 1, 18.5, 22.4, 23'0, 24.7, 29.4, 34 grains per lb. 22 Beef Sausages 14 genuine; 8 contained boric acid :—3.5, 6, 7.4, 7.4, 9.1, 9.7, 12 7, 18'5 grains per lb. 5 Smoked Sausage 4 genuine; 1 with boric acid:—5.5 grains. 2 Liver Sausage 2 contained boric acid:—3.5, 7 grains per lb. 1 Chitling Sausage 1 genuine. 4 Salami Sausage 4 genuine. 6 G-erman Sausages 1 genuine (Strasburg); 5 contained boric acid:—5.6, 5.9, 8, 14.8, 18 grains per lb. 7 Saveloys 6 genuine; 1 contained boric acid:—9.5 grains per lb. 1 Black Pudding 1 contained boric acid:—2 grains per lb. 45 Pork Pies 23 genuine; 22 contained boric acid: —Trace, 1.5, 2.5, 2.5, 2.8, 2.8, 3.5, 3.7, 4.27, 5, 5.8, 7, 7, 7.8, 9, 9.2, 9.7, 10, 11, 11, 12'8, 156 grains per lb. (crust included). 5 Veal and Ham Pies 2 genuine; 3 contained boric acid:—3.6, 10.9, 41.36 grains per lb. (crust included). 3 Steak and Kidney Pies 2 genuine: 1 contained boric acid:—2.8 grains per lb. (crust included). 23 Meat Pies 15 genuine; 8 contained boric acid:—Trace, 2.3, 5, 7, 8, 9.7, 10, 12 grains per lb. In reporting upon the pies the analysts stated the amount of boric acid found in the pie as a whole but in certain instances particulars 106 were given showing the amount found in the pie apart from the crust, thus in a steak and kidney pie with 2.8 grains over all, there was 1239 grains per lb. in the meat part, a pork pie showing 4.27 grains had 14.87 grains per lb. apart from the crust, while a veal and ham pie had 109 grains in the meat part, the proportion, including the crust, being at the rate of 41.36 grains per lb. The attention of vendors was called to the amounts found, and cautions were given, but in three instances further proceedings were taken: (1) in the case of the veal and ham pie mentioned above which was apparently due to a mistake on the part of a servant; (2) in the case of sausages containing 34 grains of boric acid per lb. in which the defendant undertook to give up the manufacture of sausages; (3) in the case of sausages containing 22.4 grains per lb. Against the conviction in this case an appeal has been entered at Quarter Sessions. The contention of Mr. Beck, the solicitor for the defendant, being that there is no standard for the composition of sausages, and that the use of a certain amount of preservative in sausage meat is to the advantage of the public. The Magistrate (Mr. Mead) in giving judgment said:— "The defendant is charged under Section 6 of the Food and Drugs Act, 1875, with selling to the prejudice of the purchaser an article of food, to wit, pork sausages, which were not of the nature, substance and quality demanded. " The sausages contained 22.4 grains per lb. "I am of opinion that the food in this case was not of the nature substance and quality demanded. "I consider that 'pork sausage' implies one of which the wholesomeness has not been artificially preserved by such an antiseptic as boric acid. " Boric acid may have been used in pork sausages for as many as twenty years, and it is possible is largely used now, but such use is known in no large degree to the consumer, so that when the ordinary customer asks for a 'pork sausage' he expects to get one which has not been treated with a drug. "I am also of opinion that the sale in this case was to the prejudice of the purchaser. "For sentimental reasons a naturally fresh sausage is preferred to one artificially preserved, and I find as a fact, upon the evidence, that under certain conditions of the consumer, the introduction of boric acid makes a sausage more unwholesome than one that is naturally fresh. "The case is easily distinguished from Smith v. Wisdom. The presence of glucose in marmalade may be justifiable, as marmalade is, as it is called, a 'preserve.' The avowed object is to keep the fresh fruit 107 free from corruption for a considerable length of time, often many years, whereas a pork sausage is usually bought for immediate consumption or within such time as fresh pork will remain naturally sound. "If it is desirable in the public interest, as contended by the defendant, that boric acid should be freely used, it is satisfactory that Section 6 need be no obstacle to the practice, for those who sell sausages treated with boric acid have only to disclose the fact to the customer and they will be exempt from prosecution under that section. There must be a fine of 40s. and £5 5s. costs." Chocolate.—Two cases have been heard by Mr. Mead, at Marlborough Street Police Court, in which the question arose as to the composition of chocolate. Samples of a cheap sweetmeat sold retail at the rate of a halfpenny an ounce were purchased by one of the Council's Inspectors. One was called "milk chocolate," the other "broken chocolate." On analysis, it was found that the former did not contain more than 2½ per cent. of cocoa, the latter about 2¼ per cent.; whereas, genuine chocolate should contain 30 to 50 per cent. of cocoa (30 to 40 per cent. being the usual amount in chocolate for eating). The proportion of milk in the one sample was also very little. The other ingredients were similar in the two samples, viz.: sugar, cocoa-nut oil (not cocoa butter from the nib or bean), some starch, and about 8 per cent. of a powder made from the husks or shells of the cocoa nib. Evidence in support of the prosecution was given by Messrs. Ellis Richards and C. H. Cribb, two of the public analysts for the City, Mr. Alfred Bramen, agent for Messrs. Suchard, Ltd., Mr. Norman Boon, chemist and professional adviser to Messrs. Cadbury Bros., Ltd., and Mr. Ernest Bernhard, assistant manager Nestle's Anglo-Swiss Milk Company. These stated that chocolate should be made from sound cocoa beans free from shell or husk, with cane or beet sugar, with or without a slight flavouring of vanilla. In an analysis of over 30 different milk chocolates, only one came out with so little as 9 per cent. of milk solids; the highest was 24 per cent. The makers of the "milk chocolate" admitted that, to 2 cwts. of "mixture," there was added 20 lbs. of shell powder, 5 lbs. of nib cocoa, and 5 lbs. of dried separated milk, and contended that, if whole-cream milk powder were used, the "chocolate" would become rancid. The Magistrate said he must take a common-sense view of what milk chocolate should be; there must be a substantial quantity of cocoa in proportion to other ingredients. The sample sold to the Inspector was a fictitious article, and it was unjustifiable to call it milk chocolate. If there was a demand for such a sweetmeat it could be sold under some other name. He fined the defendant in this case £5 and £10 10s. costs. 108 In the second case, in which the preparation was made by another firm, Mr. Mead imposed a penalty of £2, and 2s. costs. Preserved Fruits.—27 samples of tinned pineapple were purchased, and 8 of them were found to contain tin in solution. The amounts were in two instances 2/5 grain, in two 4/5 grain, in two 9/10 grain, 1 grain, and 1.26 grain per lb., respectively. From the appearance of the internal surface of the cans the conclusion was arrived at that the pineapple must have been in them for a considerable period, but as the amount of tin found present in solution was so small, no proceedings were taken; but the attention of the vendors was called to the matter, with the result that the sale of the particular brands was given up. A report has since been published by the Local Government Board on this subject. It is recommended that any kind of canned fruits containing quantities of tin approximating in amount to 2 grains in the pound should be regarded with grave suspicion, in consequence of the risk of the irritant action of the tin; and even smaller amounts may produce minor digestive disturbances. In many instances the presence of tin may be taken as an indication of age, and it is pointed out that it may prove a useful test in cases where it is desired to ascertain whether "glass" packed foods are in reality canned foods which have been transferred to glass receptacles. The inquiry shows the desirability of canned foods having the date of canning on each tin. Cider.—Out of 12 samples of cider, 2 were found to contain salycilic acid in small amounts, viz., 0.175 grains and 0.315 grains per pint. Drugs.—Samples were taken of 10 different drugs, and, on the whole, they were found satisfactory. One sample of Saffron contained 10 per cent. of ash, the B.P. standard being not more than 7 per cent. Oxymel of Squills was found made with sugar, instead of honey, and a prosecution resulted. Quinine Wine was up to the standard in nine instances, but in two cases an article (St. Baphael wine) was sold which is not the quinine wine of the Pharmacopoea. Proceedings were taken in one case, but the case fell through, as the Magistrate was not satisfied that the vendor had not informed the buyer. He, however, commented adversely on the methods adopted by the vendor's assistants. Fluid Magnesia.—Two samples were found deficient in carbonate of magnesia, one to the extent of 15 per cent., the other to 76 per cent. This latter was evidently very old stock; proceedings were instituted, but a technical objection was taken to the certificate, in that it was not stated thereon that the sample had undergone no change which would interfere with the analysis. Particulars of each case are appended:- 109 Legal Proceedings Under the Food and Drugs Acts during 1908. No. of Sample. Date of Hearing. Court and Magistrate. Name and Address of Defendant. Offence. Result. 1 2 3 4 5 6 1908. MILK (Including- Refusal to Sell and want of Name on Can). 56 S 6th March. Westminster (Mr. Curtis Bennett.) Thomas Richards, 146, Horseferry Road 8 per cent, of fat abstracted Warranty proved. Summons dismissed 59 S. 6th March Westminster (Mr. Curtis Bennett) T. W. G-annaway, 22, Regency Street, S.W. 9 per cent, of added water Fined £2 and £1 3s. costs. 126 N 5th March Marlborough Street (Mr. Denman) David Richards, 62, New Compton Street 6 per cent, of fat abstracted Summons withdrawn, business having been assigned on the 21st January, 1908, to Thomas Richards. 123 N 4th and 11th March Bow Street (Mr. Marsham) North-Eastern Dairy Co., Ltd., 52, Durham Road, Finsbury Park, N. Selling at Little Newport Street milk with 9 per cent, of added water Warranty proved. Summons dismissed. 148 N 4th March Bow Street (Mr. Marsham) Edward Rayment, 65, Abbey Street, Bermondsey Selling milk at Russell Street, W.C., from which 15 per cent, of fat had been abstracted Fined 20s. and 12s. 6d. costs. 128 N 5th March Marlborough Street (Mr. Denman) Joseph Brandon, 13, Pollen Street, W. Selling milk at Maddox Street from which 6 per cent, of fat had been abstracted Warranty proved. Summons dismissed. 197 N 2nd April Marlborough Street (Mr. Mead) F. C. Fowler, "Metro" Restaurant, 1, Kingly Street, W. 6 per cent, of fat abstracted Fined £1 and 10s. costs. 166 S 3rd April Westminster (Mr. Curtis Bennett) Express Dairy Co., Ltd.. Tavistock Place, St. Paneras, W.C. 10 per cent, of fat abstracted.. Warranty proved. Summons dismissed. 117 S 3rd April Westminster (Mr. Curtis Bennett) Greorge Paice, 16, Causton Street 9 per cent, of added water Fined £2 and 12s. 6cl. costs. 223 S 15th May Westminster (Mr. Horace Smith) J. Lyons and Co., Ltd., Cadby Hall, Kensington Selling at 124, Victoria Street milk from which 15 per cent, of fat had been abstracted Warranty proved. Summons dismissed. H 110 No. of Sample. Date of Hearing. Court and Magistrate. Name and Address of Defendant. Offence. Result. 1 2 3 4 5 6 1908. 314 N 19th May Marlborough Street (Mr. Denman) Harris Goldstein, 4, Ganton Street, W. Selling milk at Greek Street from which 19 per cent, of fat had been abstracted Fined £2 and 12s. 6d. costs. 251 S 19th June Westminster (Mr. Horace Smith) Morgan Davis, 94, Rochester Row 9 per cent, of fat abstracted Warranty proved. Summons dismissed. 391 N 24th June Bow Street (Mr. Marsham) Aerated Bread Co., Ltd., Eastcheap House, Eastcheap, E.C. Selling at 407, Strand, milk from which 6 per cent, of fat had been abstracted Warranty proved. Summons dismissed. 334 S 26th June Westminster (Mr. Chapman) John Lilly white, 50, Ranelagh Road, S.W. 15 per cent, of added water Eined £10 and 12s. 6d. costs. (Previous convictions.) 381 S 10th July Westminster (Mr. Horace Smith) Joseph Samuel Smith, 56, Eaton Terrace 11 per cent, of fat abstracted Warranty proved. Summons dismissed. 380 S 10th July Westminster (Mr. Horace Smith) George Hardy (G. Hardy and Son), 143a, Ebury Street 36 per cent, of fat abstracted Warranty proved. Summons dismissed. 455 N 10th July Westminster (Mr. Horace Smith) Walter J. Ballard, 24, Dean Street 7 per cent, of fat abstracted Warranty set up, but no notice given to warrantor. Warranty was therefore not available. Fined £3. 392 S 17th July Westminster (Mr. Horace Smith) Express Dairy Co., Ltd., Tavistock Place, St. Pancras Selling in Emery Hill Street, milk from which 11 percent, of fat had been abstracted Warranty proved. Summons dismissed. 531 N 23rd July Marlborough Street (Mr. Mead) Reuben Kerner, 4, Edward Street, Soho 10 per cent, of fat abstracted Fined 10s. and 12s. 6d. costs. 544 N 23rd July Marlborough Street (Mr. Mead) Alfred E. Douglas, 27,Carnaby Street, Soho 8 per cent, of fat abstracted Fined £2 and 12s. Gd. costs. 53G N 23rd July Marlborough Street (Mr. Mead) Thomas J. Davies, 4, Shepherd Place, W. 9 per cent, of fat abstracted Fined £4 and 12s. 6d. costs. 399 S 24th July Westminster (Mr. Horace Smith) J. Lyons and Co., Ltd., Cadby Hall, Kensington, W. Selling milk at 92, Victoria Street, from which 6 per cent, of fat had been abstracted Warranty proved. Summons dismissed. Ill 522 N. 29th J uly Bow Street (Mr. Marsham) Mrs. Emma Williams, 1, Duke Street, Adelplii 43 per cent, of fat abstracted Fined £2 and 12s. 6d. costs. 450 S. 7th August Westminster (Mr. Francis) Henrietta Gardner, 137, Regency Street 7 per cent, of fat abstracted Fined £1 and 12s. 6d. costs. 413 S. 7th August Westminster (Mr. Francis) Giovanni Necchi (trading as Necchi and Co.), 51, Strutton Ground 24 per cent, of fat abstracted Fined £3 and 12s. 6d. costs. 452 S. 7th August Westminster (Mr. Francis) Elizabeth Reeve, 110, Regency Street 6 per cent, of fat abstracted Fined £1 and 12s. 6d. costs. 448 S. 7th August Westminster (Mr. Francis) Thomas Milrose, 35, Yauxhall Bridge Road 34 per cent, of fat abstracted The summons was marked " not served," owing to death. 443 S. 7th August Westminster (Mr. Francis) George Sailer, 38, Warwick Street 33.3 per cent, of fat abstracted Fined £2 and 12s. 6d. costs. 522 S. 28th August Westminster (Mr. Francis) Salvator Janin, 9a, Earl Street 13 per cent, of fat abstracted Fined 10s. and 12s. 6d. costs. 520 S. 28th August Westminster (Mr. Francis) Fredk. W. Smetliurst, 15, Regency Street 5 per cent, of added water Fined £1 and 12s. 6d. costs. 514 S. 28th August Westminster (Mr. Francis) James Burley, 13, Regent's Place 20 per cent, of added water Fined £2 and 12s. 6d. costs. 535 S. 18th September Westminster (Mr. J. de Grey) Ellen Badcock, 40, Graham Street 7 per cent, of fat abstracted Fined £1 10s. and 12s. 6d. costs. 735 N. 22nd October Marlborough Street (Mr. Plowden) Samuel Levy, 33, Greek Street 6 per cent, of added water Fined £1 and 12s. 6d. costs. 714 N 22nd October Marlborough Street (Mr. Plowden) Alphonse Crockhart, 34, Greek Street 6 per cent, of fat abstracted Fined £5 and 12s. 6d. costs (previous conviction). 741 N. 22nd October Marlborough Street (Mr. Plowden) John Timothy, 45, Greek Street Selling at 85, Berwick Street milk with 6 per cent, of added water Fined £1 and 12s. 6d. costs. 754 N 23rd October Bow Street (Mr. Curtis Bennett) Francis Esposito, 36, Exeter Street, Strand 10 per cent, of fat abstracted Fined £2 and 12s. 6d. costs. 586 S 30th October Westminster (Mr. Horace Smith) John Adams, 9, Moreton Street 5 per cent, of added water Warranty proved. Summons dismissed. 613 S 27th November Westminster (Mr. Horace Smith) John Goddard (Goddard and Son), 63, Tachbrook Street 5 per cent, of added water Warranty proved. Summons dismissed. 628 S 1st December Bow Street (Mr. Marsham) J. Lyons and Co., Ltd., Cadby Hall, Kensington, W. Selling at Bridge Street milk with 5 per cent, of fat abstracted Warranty proved. Summons dismissed. ♦ 916 N 15th December Bow Street (Mr. Marsham) John Hughes, 13, Bedfordbury 7 per cent, of added water Warranty proved. Summons dismissed. H 2 112 No. of Sample. Date of Hearing. Court and Magistrate. Name and Address of Defendant. Offence. Result. 1 2 3 4 5 6 795 N. 1908. 17th December Marlborough Street (Mr. Mead) Percy Harris, 62, Old Compton Street, Solio 10 per cent, of added water Fined £2 and £1 3s. costs. 898 N. 17th December Marlborough Street (Mr. Mead) John Bonner, 15, Sherwood Street. W. 30 per cent, of fat abstracted Warranty proved. Summons dismissed. 712 S. 18th December W estminster (Mr. Horace Smith) J. Cridlan and Son, Ltd., 14, Bishops Road, Paddington, W. Selling at 60, Lower Sloane Street, milk from which 5 per cent, of fat had been abstracted £1 Is. costs. * 18th December Westminster (Mr. Horace Smith) London Pure Milk Association, Ltd., 4, Eccleston Street, Eaton Square, W. Selling milk from vehicle without having name and address thereon 2s. costs (see note below). * The defendants' solicitors raised two points in this case, one that the milk was sold from sealed bottles and not from the vehicle, and the other, that there was no evidence that the defendants were selling milk at all, as there had been no purchase by the Inspector or analysis made, The Magistrate, under the circumstances, dismissed the summons on the payment of 2s. costs. 957 N 31st December Marlborough Street (Mr. Mead) John Brooker, 24, Peter Street, Soho, W. 13 per cent, of added water Fined £1 10s, and £1 3s. costs. 787 S 1909. 22nd January Westminster (Mr. Horace Smith) Mrs. Maria Brooman, 2, Carey Street 5 per cent, of added water Fined 10s. and 12s. 6(2. costs. 160 S 1908. Westminster (Mr. Curtis Bennett) BUTTER. Selling as butter a substance containing 86 per cent, of foreign fat Fined £2 and £1 3s, costs. 3rd April William G-iessler (trading as G-iessler and Son), 5, Westmoreland Street 267 S 19th June Westminster (Mr. Horace Smith) John Adams, 9, More ton Street, S.W. Selling as butter a substance containing 82 per cent, of foreign fat Fined £1 and £3 3s. costs. As the City Solicitors gathered from a letter of the defendant to the inspector that he was going to plead that the margarine had been gold by a mistake, they thought it well to have the analyst present who had analysed three unofficial samples, 304 S., 305 S, and 330 S.} purchased at the same shop. 113 426 N. 24th June Bow Street ». (Mr. Marsh am) Mary Jane Robson, 71, Charing Cross Road Selling as butter a substance containing 75 per cent, of margarine Fined £3 and 12s. 6d. costs. 644 S. 27th November Westminster (Mr. Horace Smith) John Bromley, 5, Caledonia Street Selling as butter a substance containing 88 per cent, of foreign fat Fined 5s. and 12s. 6d. costs. 701 S. 18th December Westminster (Mr. Horace Smith) Henry Bulbeck, 22, Sussex Street Selling margarine as butter Fined £1 and 12.s. 6d. costs. (See also under " Margarine.") MARGARINE. 63 S. 6th March Westminster (Mr. Curtis Bennett) Ellen Rowlands, 24, Chapter Street, S.W. Selling in a wrapper not marked " margarine " Exposing for sale in a parcel not marked " margarine " Fined £1 and 2s. cost'. 125. 6d. costs. 216 S. 15th May Westminster (Mr. Horace Smith) Alfred Howell, 7, Aylesford Street, S.W. Selling without a label Fined 10s. and 12s. 6d. costs. 649 S. 27 th Not ember Westminster (Mr. Horace Smith) Elizabeth Johnson, 38, Marsham Street Selling without a paper wrapper marked as required Exposing for sale without a label Fined 10s. and 12s. 6d. cost?. Fined 10s. and 2s. costs. 705 S. 18th December Westminster (Mr. Horace Smith) Henry Bulbeck, 22, Sussex Street Exposing for sale without a label Fined £1 and 12s. 6d. costs. (See also No. 701 under " Butter.") CREAM. The subjoined prosecutions with reference to boracic acid in cream, with the exception of No. 232 N, were cases adjourned from 1907 pending the appeals in the case of McNair v. Cullen, which were heard at Quarter Sessions, 31st October, 8th and 18th November, 1907, and by the Divisional Court, 1st June, 1908. 440 S. 10th July Westminster (Mr. Horace Smith) Edwin Smith, 50, Moreton Street, Westminster Selling cream containing 31*85 grains of boracic acid per lb. Fined 5s. and 12s. 6d. costs. 441 S. 10th July Westminster (Mr. Horace Smith) S. Frost and Co., Ltd., 202, Kennington Park Road, S.E. Selling at 105, Lupus Street, cream containing 42-35 grains of boracic acid per lb. Fined 5s. and 12s. §d. costs. 431 S. 10th July Westminster (Mr. Horace Smith) Hy. Wm. Coppen, 42, Marsham Street Selling cream containing 32'2 grains of boracic acid per lb. Fined 5s. and 12s. Qd. costs. 458 S. 10th July Westminster . (Mr. Horace Smith) Pearks, Ltd., 6, Bayer Street, E.C. Selling at 8, Lower Belgrave Street, cream containing 23'87 grains of boracic acid per lb. Fined 5s. and 12s. 6d. costs. 114 No. of Sample. Date of Hearing. Court aud Magistrate. Name and Address of Defendant. Offence. Result. 1 2 3 4 5 6 1908. 457 S. 10 th July Westminster (Mr. Horace Smith) Hudson Bros. (London), Ltd., 50 and 52, Ludgate Hill Selling at 2, Wilton Road, cream containing 32.48 grains of boracic acid per lb. Fined 5s. and 12s. 6d. costs. 655 S. 10th July Westminster (Mr. Horace Smith) Herbert Lockhart Cope, 67, Buckingham Grate Selling cream containing 24.78 grains of boracic acid per lb. Fined 5s. and 12.?. 6d. costs. 650 S. 10th July Westminster (Mr. Horace Smith) Elizabeth Day, 11, Artillery Row Selling cream containing 26.25 grains of boracic acid per lb. Fined 5s. and 12s. 6d. costs. 639 S. 10th July Westminster (Mr. Horace Smith) Elizabeth Johnson, 58, Marsh am Street Selling cream containing 26.6 grains of boracic acid per lb. Fined 5s. and 12s. 6d. costs. 649 S. 10th July Westminster (Mr. Horace Smith) The Express Dairy Co., Ltd., Tavistock Place Selling at 119, Victoria Street, cream containing 22.05 grains of boracic acid per lb. Fined 5s. and 12s. 6d. costs. 455 N. 14th July Bow Street (Sir A. de Rutzen) Civil Service Supply Association, Ltd., 136, Queen "Victoria Street, E.C. Selling cream in Bedford Street which contained 0.42 per cent, of boric acid Fined 5s. and 12s. 6d. costs. 609 N. 14th July Bow Street (Sir A. de Rutzen) John Driscoll (trading as J. Driscoll and Son), 6, Garrick Street Selling cream which contained 23.1 grains of boric acid per lb. Fined 5s. and 12s. 6d. costs. 232 N. 14th J uly Bow Street (Sir A. de Rutzen) J. Lyons and Co., Ltd., Cadby Hall, Kensington Selling at 35, Strand, cream which contained 25 grains of boric acid per lb. Summons dismissed. Defendants raised the defence, under Section 5, tliat they had no knowledge that the preservative was used, and as evidence of this produced a warranty. The Magistrate expressed himself satisfied that they had no knowledge, and that their defence was made out. 570 N. 30th July Marlborough Street (Mr. Mead) West End Grocery, Wine and Provision Stores, 397, Oxford Street Selling cream which contained 0.33 per cent, of boric acid Fined 5s. and 12s. 6d. costs. 573 N. 30th July Marlborough Street (Mr. Mead) Dennis Wheatley (trading as Wheatley and Co.), 65, South Audley Street Selling cream which contained 0'32 per cent, of boric acid Fined 5s. and 12s. 6d. costs. 115 326 N. 21st May Marlborough Street (Mr. Chester Jones) CREAM CHEESE. Selling cream cheese that had been deprived of 90 per cent, of fat Fined £2 and 23s. costs, or 21 days' hard labour Abraham Cohen, 54, Broad Street, E.C. In this case the Magistrate described the label in which the cheese was wrapped as a " deliberate fraud." The Council called the attention of the Wilts United Dairies to their label and the observations of the Magistrate. 206 N. 2nd April Marlborough Street (Mr. Mead) BREAD AND BUTTER. Selling bread and margarine as bread and butter Fined £2. Arthur Thomas Yince, 16, Portland Street 2001ST. 2nd April Marlborough Street (Mr. Mead) Bartholomew Borzone, 59, Old Compton Street Selling bread and margarine as bread and butter Fined £2 10s. and 12s. 6d. costs. 191 N. 2nd April Marlborough Street (Mr. Mead) Joseph Dauphin, 25, Little Pulteney Street Selling bread and margarine as bread and butter Fined £2. 372 N. 15th June Marlborough Street (Mr. Denman) PORK SAUSAGES. Selling pork sausage containing 34 grains of boric acid per pound Summons withdrawn. £2 2s. costs paid. John Cridlan (Cridlan and Son), 3, Foubert's Place The Defendant stated that he had ceased the manufacture of sausages, and did not propose to make them any more. 845 N. 28th November, and 5th and 11th December Marlborough Street (Mr. Mead) George William Hayward, 5, Market Street, Shepherd's Market Selling pork sausage containing 22.4 grains of boric acid per pound Fined £2 and £5 5s. costs. (Appeal entered at the London Quarter Sessions.) 349 S. 17th July Westminster (Mr. Horace Smith) VEAL AND HAM PIE. Selling a yeal and ham pie which contained 41.36 grains of boracic acid per lb. Fined 10s. and 12s. 6d. costs. Army and Navy Co-operative Society, Ltd., 105, Victoria Street, S.W. The Defendants, through their Counsel, stated that they had given their servants instructions not to use any preservative of this character, and that the amount found in this sample was due to a mistake on the part of one of their servants. 534 N. 23rd July and 31st July Marlborough Street (Mr. Mead) CHOCOLATE. Selling milk chocolate containing foreign starch, foreign fat, and cocoa husks Fined £5 and £10 10s. costs. Jas. D. Sullivan, 36, Rupert Street, W. 533 N. 23rd July and 31st July Marlborough Street (Mr. Mead) E. L. Bean, 5a, Walker's Court, W. Selling broken chocolate containing foreign starch, foreign fat, and cocoa husks Fined £2 and 2s. costs. 116 No. of Sample. Date of Hearing. Court and Magistrate. Name and Address of Defendant. Offence. Result. 1 2 3 4 5 6 373 N. 1908. 5th May Marlborough Street (Mr. Denman) DRUGS. Foreign Chemists, Ltd. (Wilcox, Jozeau and Co.), 49, Haymarket, S.W. Selling oxymel of squills in which sugar had been substituted for honey Fined £2 and 125. Gd. costs. 941 S. 31st December Marlborough Street (Mr. Mead) John Parker Ellerington (trading as Crowe and Co.), 19, Air Street, W. Selling fluid magnesia deficient in carbonate of magnesia to the extent of 76 per cent. Dismissed on a technical objection to form of certificate. 930 N. 1909. Bow Street (Sir A. de Rutzen) Cornelius Francis Serjeant, 17 and 18, Rupert Street Selling quininewine containing not more than one-tenth of a grain of quinine per pint of wine Summons dismissed, the Magistrate being of opinion that the inspector's assistant had been told by the defendant's assistants that they had no quinine wine, but that they had tonic wine. 1st and 8th January 117 Report on the Sanitary Condition of St. John's Ward, To the Public Health Committee. Mr. Chairman and Gentlemen, The condition of St. John's Ward has engaged the attention of the Public Health Committee on many occasions during the last seven years. Questions have arisen in connection with its high death-rate, the insanitary condition of the property in certain parts, the dilatory carrying into execution of schemes of improvement, the demolition of dwellings and the displacement of population dependent thereon, and the remaining vacant of considerable areas cleared of their inhabitants, compensated to some extent by the blocks of buildings erected by the City Council, and lately by the Ecclesiastical Commissioners. In 1904, in a report on the distribution of consumption in the City, attention was given to this Ward in particular, and there was included in my annual report for 1905 an abstract of a special report on St. John's, based on a careful examination of each street, and an analysis of the statistics of the years 1901-04 It was shown that the death-rate during these four years had fallen from 23.3 to 191, giving an average of 211 per 1,000 inhabitants, while the average rate for the whole City during the same period was 14.6. Certain facts having an important bearing on the cause of this high rate were disclosed: (1) that there were a number of common lodginghouses in the Ward which contributed very largely to the number of deaths; (2) that an equally large number of deaths were assigned to St. John's Ward without any definite address being recorded ; these are deaths of persons who were inmates of the workhouse and infirmary (44 out of 60 in 1907 were of persons over 65 years of age), and were doubtless admitted from the poorest districts, from the common lodging-houses and the casual ward; these two classes contribute together about 4 per 1,000 to the Ward rate; (3) that when figures 118 were got out for certain (twenty) sub-divisions of the Ward, for each of which the population was separately taken at the last census, it appeared that in the years 1901-04 four of these smaller areas, viz., Nos. 12, 4, 3 and 5, had rates equivalent to 21.1, 23.1, 23 7 and 39.5 respectively, notwithstanding that common lodging-house and unknown deaths were excluded. In 1901 few of these small areas had less than 21 per 1,000, Nos. 11, 17, 20 and 5 having death-rates of 26.4, 29.4, 30.3 and 44.3 per 1,000 respectively. The deaths assigned to each of the twenty areas in 1901 and each subsequent year are shown below:— St. John's Ward. Number of Enumeration District. Population at Census, Deaths from all causes. Death Kate in 1901. 1902. 1903. 1904. 1905. 1906. 1907. 1901. 1901. 1 642 14 8 2 4 3 4 2 21.8 2 2,173 48 47 21 19 16 12 7 22.0 3 2,750 63 71 63 64 51 36 37 22.9 4 735 16 21 14 17 6 11 22 21.7 5 1,918 85 72 82 47 69 56 65 44.3 6 1,992 31 39 28 32 32 26 28 15.4 7 1,123 16 19 18 15 13 7 15 17.0 8 1,904 35 36 34 40 32 34 31 18.3 9 2,801 21 45 33 34 40 41 50 10.0 10 2,321 47 45 37 46 46 39 33 20.2 11 605 16 14 12 18 32 23 20 26 4 12 2,202 44 55 44 43 40 29 35 19 9 13 1,386 22 33 24 19 27 18 24 15 8 14 2,935 40 44 41 38 61 42 57 13.6 15 1,014 16 20 11 18 15 15 13 15.7 16 853 18 15 12 9 2 5 8 21 1 17 814 24 16 9 14 14 12 12 29.4 18 632 9 4 4 4 10 8 5 142 19 539 10 7 5 2 5 5 5 18.5 20 198 6 2 3 4 10 7 7 30.3 Deaths in common lodging houses and the military hospitals are not included, and the population of these premises lias also been excluded. Where no address is given, such deaths have also been excluded. No. 9 includes the L.C.C. Buildings, Millbank. It is not practicable to work out the rates for the years subsequent to 1901 in all the areas with any degree of accuracy as the demolition or closure of property in some of the areas has altered the number of persons living thereon. However, having the figures and the rates for the census year, it is easy to see in the subsequent years if the deaths have varied up or down, or if they have remained stationary. Thus No. 2 district, which had 48 deaths in 1901, had only 7 in 1907 ; No. 3 kept fairly even until 1905 when its numbers declined ; No. 6 has not 119 St. John's Ward. fluctuated much one way or another; while Nos. 9, 11 and 14 have gone up. In order to help to understand the reasons for these variations I have prepared a map of the Ward showing the twenty districts; a plan of the area included in the Westminster Improvement Scheme is given and also an enlarged map of an area including the Chadvvick Street neighbourhood. 120 It is, however, convenient to consider the Ward in detail on the lines adopted in previous Reports. District No. 1.—The population was estimated in 1901 at 642, but has been reduced by demolition of premises in Millbank, Wood Street, Great College Street, Little College Street and the north end of Tufton Street. The existing property adjoining the Abbey consists chiefly of good-class private residences in Great College, Barton and Cowley Streets, a part of Westminster Mansions and large public buildings and offices. District No. 7 adjoins No. 1 on the other side of Great Smith Street. The larger part of the population of this and District No. 6 are housed in the Peabody Buildings in Orchard Street and Old Pye Street, part of Westminster Mansions, Parliament Mansions, and Dacre Chambers, Strutton Ground. There are very few other dwellings remaining in Districts 6 and 7, and they consist of small houses in St. Matthew Street, St. Aim's Lane, and the piece of Great Peter Street, between Great Smith Street and Strutton Ground. The population of the two districts was 3,115, of which 2,400 were housed in the dwellings belonging to the Peabody Trustees. The following deaths have been assigned to these buildings from 1901-7. 1901. 1902. 1903. 1904. 1905. 1906. 1907. Peabody Buildings 34. 47 37 36 30 25 32 Rate per 1,000 14.5 20.0 15.8 15.3 12.8 10.2 13.6 This gives an average death rate of 14 7 per 1,000 for the seven years on an average population of 2,342. The rate for the whole City being 13'9. With the exception of Rochester Buildings, which are of an older date and were acquired by the Peabody Trust in 1876, the Buildings occupy the site of a number of small courts and narrow streets, the whole of which were the subject of official representations made by Dr. Barnard Holt, the Medical Officer of Health, under the Artizans' Dwellings Act, 1875, in the years 1876 and 1878. The houses occupying the site were old and in bad condition, the rooms small and ill-ventilated, the courts were confined and deficient in air space. There were eighteen common lodging-houses in the area. After an inquiry schemes were approved, and the ground was cleared by the Metropolitan Board of Works by 1880. The ground was acquired by the Peabody Trust, who erected these Buildings, giving accommodation for 2,232 persons. Those displaced numbered 1,512, of whom 459 occupied common lodging-houses. Several streets were widened throughout or in parts, viz., Orchard Street, Old Pye Street, St. Ann's Street, New Pye Street, Perkins' Bents, and St. Matthew Street. 121 Districts 2, 3, and 5.—These districts form a distinct block of property extending from the-river, with Horseferry Eoad on one side, Wood Street and Great Peter Street on the other. No. 2 is the section nearest the river, and extended as far as the west side of Smith Square, and the small streets (St. John Street, Church Passage, and Carpenter Street) running north and south from it. This line and Marsham Street mark the extent of No. 3 district. The whole of these two districts and a little hit of No. 5 (viz., the west side of Marsham Street, and Laundry Yard) are undergoing a transformation authorised by two Acts of Parliament. The scheme was initiated by the County Council, under the powers of the London County Council (Improvements) Act, 1900, for the purpose of the Thames Embankment Extension, and dealt chiefly with Millbank and the adjacent land round Smith Square—that is to say, all No. 2 and part of No. 3 districts. There was then a population of 2,173 persons in No. 2 area, and, with the exception of the dwellers in the houses on the three sides of Smith Square, which is in this area, they consisted of poorer working-class people, and much of the property inhabited by them was old and worn out. The tenants were turned out from these and most of the houses pidled down ; but the houses in North Street, which were in a much better condition, after standing empty for several years, are now being adapted and re-let for periods of seven years to good-class tenants. The deaths in this sub-district were 48 in 1901, giving a rate of 22 per 1,000. The progress of the displacement of the population is shown by the fall in number of deaths to 21 in 1903, and then gradually down to 7 only in 1907. Some difficulty has been experienced by the County Council in dealing with certain business properties, with the result that any scheme for re-housing the persons displaced, or dealing with thevacant land, has been delayed. It was estimated that 2,242 persons of the working classes were displaced under the County Council's part of the scheme, but as there was room for 4,430 persons on the Millbank Estate the County Council were held to have provided house room for those displaced. The remainder of the "Improvement" is to be carried out by a Syndicate under the St. John's (Westminster) Improvement Act, 1906. In this part 1,846 persons of the working class will bedisplaced, and no suggestion has yet been made as to the housing accommodation to be provided for them. The Housing Act, 1903„ requires such accommodation to ba provided where as many as 30 persons are displaced. The power to purchase land compulsorily ceases at the end of August, 1911. Under Section 8 (3) of the London County Council (Improvements) Act, 1900, that Council is required to clear and lay out as a 122 Area included in the L.C.C. Improvement and Syndicate Extension. The solid lines indicate the streets" as widened. garden the land between the new street in continuation of Grosvenor Road and the new embankment wall extending from Lambeth Bridge to the Victoria Tower Gardens. Several properties on this land have been demolished, and the Council have resolved meanwhile to level up and use a portion of the vacant ground as a playground for children under 14 years of age. District No. 3.—The census population of this district was 2,841, which, after deduction of the inhabitants of common lodging-houses, becomes 2,750. Closure of houses in the County Council's area did not begin until the end of 1904, when the number of deaths dropped from an average (1901-4) of 65 a year, 24.6 per 1,000, to 51 in 1905, 36 in 1906, 37 in 1907. Probably the high rate of these earlier years 123 would be higher still if it were possible to ascertain the addresses of all the persons going from this area to institutions where their deaths occurred. Two blocks of buildings contributed to a large extent to the high death rate, one of these, known as St. John's Chambers, occupied the west side of Smith Square and accommodated some 400 persons. The two blocks in which the chambers were arranged, formed a strange contrast to the " old-world red-brick houses with beautiful doorways, quaint windows, and sloping roofs" on the other side of the Square. At one time, these chambers were fairly well looked after, but as is usual when improvement schemes are, on foot, less money was spent in keeping the place in repair, and the character of the inhabitants also deteriorated, until the City Council were forced to threaten to close the premises as unfit for habitation, when some steps were taken by the owners, but very shortly after the County Council acquired the buildings, and shut them up. Lyon's Buildings, in Tufton Street, was a particularly bad feature of this street, it was a badly constructed block of dwellings, with a population of about 200 persons; there was considerable overcrowding, which was abated, and the worst parts of the building were also closed, the County Council on acquiring it still further restricted its use, until eventually it was pulled down. The death rate, calculated on known deaths, was 55'8 per 1,000 in 1901-2, this was reduced to 30 in 1903-4. The death rate from consumption in 1901-2 was six times greater than that for the whole City. Worked out in tabular form, the rest of Tufton Street also shows a high death rate in the years 1901-4:— Deaths per annum per 100 Houses. Deaths per annum per 1,000 Population. Sub-District No. 3 31 23.7 Tufton-street excluding Lyon's Buildings 41 31.6 Tufton Street, including Lyon's Buildings 53 40.9 Half of the houses in Tufton Street on the east side have been demolished. Several of the houses remaining require continual supervision by the Sanitary Inspectors. Most of them in this street and in the rest of this district can only be kept habitable by constant care and attention on the part of the owners. On the plan showing the area of the Improvement Scheme it will be observed that a new street is to be cut from Smith Square to Marsham Street, through the middle of this district, while Marsham Street and Tufton Street will be widened to 50 ft. 124 There are a number of small courts between Tufton and Marsham Streets, and running out from Wood Street. In several instances these are very confined, the ground floor rooms are damp and often dark, but the houses are fairly well maintained and some of the worst ground floor rooms are not used for habitation. The tenants appear to take greater care of these cottages, even when more than one family occupy them, than do the dwellers of the larger houses in the main street. These courts do not appear to contribute disproportionately to the mortality. Marsham Street is half in No. 3 and half in No. 5 District. The houses as a rule are of three floors, the ground floor being generally used for business purposes. Some of the houses which were old and structurally defective have been closed by the owners rather than carry out works required by the Council. The deaths which were somewhat high in 1901-4 in the houses on the east side of the street have been reduced to a half in 1905-7. There is no difference in the west side. The exact population of the street is not known, but the rate per house is not so large as it is in Tufton Street. Under the scheme Marsham Street, which is a very narrow thoroughfare, is to be widened. The powers of the syndicate for the compulsory purchase of lands for the purposes of the improvement cease after the expiration of five years from the date of commencement, which was 1st September, 1906, so that this street will doubtless be dealt with at an early date. District No. 5.—This district includes one side of Great Peter Street, Chadwick Street, Monek Street, 36 to 68 Marsham Street, Medway Street, Arneway Street, Laundry Yard, Blue Anchor Court, and part of Horsef'erry Eoad (74 to 162). It contains a large common lodginghouse for men. By deducting its inmates (461) from the census estimate of 2,379 a population of 1,918 is arrived at. Probably the census figures are less than the true number of residents, for in the same year (1901) a house-to-house inquiry was made by the City Council in this sub-district to ascertain the class of persons living therein for whom house accommodation might be required, and the inquiry agent reported that-there was an admitted population of 2,934 persons in 655 tenements, 664 being men, 781 women, and 789 children. Doubtless there was then a considerable amount of overcrowding, for even now when constant inspection takes place instances of it are frequently detected. Whichever basis be taken the deaths give an extremely high rate. On the assumption that the population, less common lodging-houses, has been maintained at about 3,000, the average death rate of the seven years would be 23'3. There have, however, been some alterations, due to stricter sanitary supervision, pulling down of part of Laundry Yard and Great Peter Street, and the 125 conversion of a common lodging-house in Monck Street into tenement dwellings. Possibly also allowance should be made for a number of former residents of the district who are now in the workhouse or infirmary (the majority of the deaths take place in the infirmary or in hospital), so that the figure 23 3 is without doubt considerably below the real rate. (See Table, p. 118.) It is desirable to consider the streets of this district more closely than is necessary with most of the other areas. Laundry Yard is a long narrow passage. Up to recently it contained 19 houses, with 58 rooms and a population of about 120, 7H being adults and 47 children; from 1901-4 the death rate was about 37 per 1,000. Eight of the 22 deaths were of infants under 1 year, and were due chiefly to diarrhoea; 7 deaths of older persons were due to bronchitis and pneumonia and 4 to phthisis. In 1906 there were no deaths and in 1907 only 2. Seven houses, accommodating 36 persons, were closed in 1906 and have now been pulled down; they contributed 10 of the 22 deaths. They were small cottage property. The remaining houses are frequently inspected and are now kept in much better condition than formerly; they will, however, be cleared away as part of the Improvement Scheme. Arneway and Medway Streets consist of small houses which are maintained in good sanitary condition, but the remainder of the district constitutes an area the condition of which requires serious consideration ; it consists of one side of Great Peten Street, Blue Anchor Court and Chadwick Street, and unfortunately does not form part of the Improvement Scheme. I have reproduced this neighbourhood on a larger scale so that the relationship of this piece of St. John's may be seen. Great Peter Street was at one time part of an area which had come to be recognised as '' The Rookery," which lay between Great Smith Street and Strutton Ground, and extended over part of the site now occupied by Victoria Street. Originally it was the " Sanctuary" adjoining the Abbey, and had afforded refuge to debtors, thieves and lawbreakers generally for many hundreds of years (the privilege of sanctuary within the precincts of the Abbey was first granted by the Saxon King Sebert, was extended by Edgar and confirmed by Edward the Confessor). The districts in which asylums of this kind were located naturally became centres of a pauper and criminal population. The formation of Victoria Street in 1845 swept away a large part of this rookery, and the schemes of 1876, already alluded to, removed a further portion. There still remains one side of Great Peter Street with Chadwick Street behind it, and between them Blue Anchor Court. Old inhabitants of Chadwick Street fand some have lived I 126 there all their lives) declare that its general tone has deteriorated since the above clearances were effected. Probably many of those turned out of the courts and alleys on the other side of Great Peter Street crowded into the nearest houses, for, as a rule, few of those dishoused find accommodation in the new buildings erected. The inhabitants of this particular area may be divided into three classes, the first consisting of shopkeepers in Great Peter Street and house-farmers who hold one or several houses directly from the freeholders, generally on a quarterly tenancy. Nearly all these live in Chadwick Street or near by, and thus ought to be able to exercise supervision over the occupiers of the houses. The second group contains the majority of the inhabitants. It consists of the poorer working class—labourers, general dealers, costers, carmen, porters, woodchoppers, newsvendois, &c., some being in regular employment, but for a considerable proportion the means of obtaining a living must be frequently precarious, and probably the border line, between this and the third class is sometimes over-stepped; many of the women, as well as the men, have to go out to work, consequently the children do not always receive the care and attention they require. The third class consists of those who " still bear the brand of sanctuary." Some are regular residents, women who call themselves charwomen, sempstresses, dressmakers or laundry workers, but from their appearance it is evident that they are too intemperate to do any regular work (arrests of these women for being drunk and disorderly are frequent). Phthisis is a common cause of death among them. There is in addition to these a floating population—people without any settled mode of life who stay for a week or two, or, perhaps, for only a few days. They are enabled to do this, as a number of the rooms are let " furnished,'' the furniture generally consisting of a bedstead with some scanty bedding, a chair, a table, a strip of carpet, a few pots and pans and some odd bits of crockery, all being more or less dilapidated. Were this class of letting discontinued, and the common lodging houses (especially one for 71 women on the opposite side of Great Peter Street) near by done away with the whole tone of these streets would be considerably improved, for so long as this class of person is allowed to frequent the neighbourhood it must be difficult to get decent people to take up residence especially when they have families to bring up. The comparative lowness of the rents charged doubtless attracts those of the second class to the neighbourhood, although if their means allowed it some at least, would prefer to live elsewhere. The houses themselves have plenty of yard space, and by incessant visits of the Sanitary Inspectors are kept in fairly good condition, so 127 that if the moral atmosphere of the district could he purified there would be no difficulty in letting the houses unfurnished to respectable working people. There is further to be considered, as a reason for action, that there is in close proximity to this area, several schools (the Grey Coat Hosnital Girls' School, the Weslevan Training College and Schools, the I 2 128 Cathedral B.C. School, and St. Matthew's School) attended by many hundred boys and girls, and also that the windows of the Peabody Buildings overlook Great Peter Street and Chadwick Streets. Chadwick Street for some time was made a place for the storage of barrows, thereby bringing into the street many loafers who created disturbances both by day and by night. As the result of a representation made by me to the Commissioner of Police, a stop has been put to this practice. The houses in Chadwick Street are mostly two and three-storeyed buildings without cellars, one or two are larger buildings, one evidently .having been a good class house, while another consists of two houses which have been made into one. Six are small cottages placed in the back yards of other houses. The houses 1 to 19 are old, and probably will have to be re-built in whole or in part, the ground floors of some of these are below the street level. In 1901 about 600 persons lived in the 48 houses in this street, an average of 12.5 per house, nearly double the average of the rest of this sub-district. There are about 220 separate tenements, of which 197 are single rooms, indeed with but one exception, the whole of the lettings contain less than 5 rooms as compared with 64.6 per cent, for the City, and the one-roomed tenements actually amount to 916 of the total lettings. To put it in another way, of a total of 592 persons, 495, i.e., 83.6 per cent., live in single-roomed tenements, of these, approximately 170 are men, 200 women, and 130 children under 15 years of age. Of the remainder there are 12 sets of 2 rooms (67 persons), 3 of 3 rooms (15 persons), 2 of 4 rooms (11 persons), and 1 of 6 rooms (4 persons), but this varies continually. Rents.—Four small cottages in the yards at the back of others are assessed at £10 gross, £8 rateable. The other houses vary from £17 to £65 gross, £13 to £55 rateable; Nos. 21 to 31 are assessed at the lower figure, Nos. 14 and 16 at £20 (£16 rateable), Nos. 4 to 12 at £25, Nos. 1 to 19 at £30, except No. 13, which is £35; Nos. 24, 26, 38, 40 at £32; No. 46 at £34, No. 44 at £35, Nos. 48, 50 and 52 at £38, No. 32 at £40, No. 37 at £60, and No. 39 at £65, No. 41 being £30. Nearly all are let out as single rooms, the weekly rents varying from 2s. 6d. and 3s. to 7s. a week; there are only a few at the lower figures, the majority of the rooms fetching 4s., 5s., and 6s. per week. The usual charge for one of the "furnished" rooms is 5s. a week, but if the tenants cannot pay in one sum, Is. a day is charged. The rents paid vary in a peculiar manner, some houses assessed at the same figure bring in several shillings a week more than others. One reason for this is that some (17 or 18) of the tenants have been there for many years (several for 10, 12, 20 years, two families have lived 40 years in the street, 129 and one 50 years), and their rents are lower; possibly the variation is dependent to some extent on the existence of the "furnished" rooms, but apparently the profit on a £30 house may vary from £15 to £50 without allowing for repairs. This item must be heavy, if the premises are to be kept in proper repair, and probably at least 20 per cent. of the income might be allowed for this purpose in houses with the worst class of tenant. 1 reported in 1905 that about two-thirds of the time of two inspectors (a man and a woman) was occupied in dealing with the insanitary conditions of the districts 3, 4, and 5, and that 350 notices had been served with respect to property therein, 46 having reference to Chadwick Street. In 1907, no less than 186 notices were served affecting every house but one in this street, and three prosecutions took place for failure to keep w.c.'s supplied with water. Owners are now much more careful to keep their houses in good condition than was formerly the case; yards, passages and staircases are often found extremely clean where formerly the reverse was the rule, but it is only by constant supervision that the improvement is maintained. A comparison of the mortality rates for the four years 190.1-4 gave the following results:— All Causes. Phthisis. Other Respiratory. Diarrhœa. Chadwick Street 43.9 14.3 8.0 1.6 Rest of District 3 32.7 3.9 5.7 1.9 St. John's Ward 18.3 2.4 3.7 1.0 City 14.6 1.7 3.0 0.5 The figures for the last three years show no improvement. Probably the figure (600) taken as the population of this street may be understated, and allowance should also be made for inmates* of hospitals, infirmaries, &c., but even if thereby the population were doubled the rates would still be excessive. There is, unfortunately, no doubt as to the heavy mortality among infants, as the figures there are known, and births in institutions are credited. In 1904-7 there were 65 births with 12 deaths under 1 equal to 184 per 1,000; 3 of the infants who died were illegitimate. In the seven years 29 infants under 1 died, 16 between 1 and 2 years of age, 7 between 2 and 5, and 3 between 5—15. Of these 11 deaths resulted * Mr. Worlock, Clerk to the Guardians for St. George's Union, has been good enough to look up the records of persons admitted into the workhouse and infirmary from Chadwick Street, and it appears that 158 persons (110 cases) were admitted during 1907. During the same time outdoor relief was granted to 66 persons and 84 medical orders were issued. 130 from diarrhoea, 9 from measles, 3 from improper feeding, 10 from pulmonary or other forms of tuberculosis, and 11 from bronchitis or broncho-pneumonia, all these being excessive when compared with the rest of the city. Blue Anchor Court lies between Great Peter Street and Chadwick Street, the entrance being from the former through a narrow passage about 44 ft. long, 20 ft. of which is covered. The court is 104 ft. long, and there is an open space of 22 ft. between the cottages in it and the back of the Great Peter Street houses. There are six cottages, consisting of ground and first floor, the houses are old, but kept fairly clean. Several of the ground floor rooms have been lined with match boarding on account of damp. Some of the houses have windows off the staircases, opening into the yards of Chadwick Street, and air-bricks have been put in to give some through ventilation. There is no w.a, water-tap or sink inside the houses, but there are two water-taps and also w.c.'s in the open court. There is a large gully in the court to which the waste water of the houses finds its way. Four houses consist of 2 rooms only, one above the other, 2 are four-roomed. The inhabitants are respectable persons, chiefly costermongers, and some of them have lived in the court many years; one family claims to have been in continuous occupation for upwards of 70 years, another over 30 years. There are 11 families, averaging 40 persons, half of whom are under 15 years of age. Bents vary from 3s. 6d. and 4s. for one room, 6s. 6d. for two rooms. The six cottages are assessed at £69 gross, £52 rateable. Ten deaths have occurred in the last 7 years equal to an average annual rate of 35 per 1,000, the causes being bronchitis, 3; diarrhœa, 2; kidney disease, 2; consumption, heart disease and insanity, 1 each. The ages were 3 months, 4 months, 47, 47, 49, 61, 66, 68, 68 and 73, so that the liigh rate is partly due to the age constitution of the inhabitants. A number of cottages known as Ann's Place, adjoining this Court, were closed under the Housing Act in 1894. They were approached by Bull's Head Court running from Great Peter Street to Chadwick Street, in which were also a number of small cottages. The ground is now lying vacant. Great Peter Street, on this side, consists of some 24 houses of varying sizes, with shops on the ground floor. The rooms in the houses are let out singly, as a rule, at much the same rents as in Chadwick Street. The population is about 360, of whom 100 are children. Mortality rates are a little less than in Chadwick Street, but still excessive. Nos. 7-19 have recently been demolished and offices and flats erected in their place. The excessive death-rate in this particular area is particularly striking when compared with that of the Peabody Buildings, or of the 131 Westminster Buildings close by. In the latter the rents of the rooms are no higher—in many instances less than in Chadwick and Great Peter Streets, yet the death-rate averages only 14.7 for the last seven years. The fact rather indicates that if the houses were properly let and efficient control exercised, these streets might show equally good results. I have been informed that ultimately the whole of this block may be replaced by better-class dwellings by private enterprise, but if this is not likely to occur at an early date, the Council might consider the desirability of dealing with the area under Part 3 of the Housing of the Working Classes Act, either by building thereon, or by altering and improving existing buildings (Sec. 59). District No. 4 embraces the block of property between the south side of Horseferry Road and the north side of Page Street from the River to Regency Street. At the census in 1901 there were 735 inhabitants. With the exception of Regency and Vincent Houses, the dwellinghouses in this district are mostly of two and three storeys, old, but apparently in fair condition. There are also a few shops, some works and offices. The social status of the inhabitants appears to be that of the respectable working classes, aud there is some letting of apartments. The mortality rates in the four years 1901-4 were as follows:—21.7, 28.5, 19, and 23.1, giving an average of 231. Presuming that the population has been maintained, the rates for 1905-6-7 show a reduction to 20.7. Johnson Street and Horseferry Road contribute chiefly to the number of deaths. There has not been much infectious disease in these streets, but deaths from consumption are rather high in Johnson Street. Of 41 deaths in this street 9 were from consumption, 5 from alcoholism, and 9 were children under 1 year of age. The high proportion of deaths from drink indicates pretty clearly what kind of houses there must be in this street, and why the deaths are numerous. District No. 8 adjoins No. 4 and lies on the south side of Page Street, between it and the Millbank Estate, but does not extend as far as Regency Street. The population at the census was 1,904 and there does not appear to have been any change. There are no block dwellings within this district, and with the exception of some good houses in Grosvenor Road the whole of the property consists of two and threestorey dwellings occupied by artisans of a respectable type. Some of the houses are rather old, as in Earl Street and Hudson's Terrace. There are no courts or alleys. The average death rate for the seven years is 18 per 1,000, but there is a tendency to improve; the first four years had an average of 19, the last three of 16 6. 132 The phthisis rate was 3.4 in the first four years and was double that of the City. During the last three years, however, it has fallen so that the average for the seven years is 2 per 1,000. Kensington Place has had a good many phthisis and infant deaths (some of the latter being illegitimate). The sanitary condition of the houses has been examined during the last few years, and a number of improvements effected. District No. 9.—This is the site of the Millbank Prison, and is now occupied by the County Council Buildings, the Tate Gallery, and by the Army Hospital and Medical School. These last have just recently been occupied. The Buildings began to be occupied in 1899, and were completed in 1902. The inhabitants now number about 3,190; making allowance for the variation in population in the earlier years, the death-rate for the last five years works out at an average of 13'5 per year; the phthisis rate 0.25, deaths from respiratory disease at 0.19, and from diarrhoea at 0.6 per 1,000, all of which may be regarded as satisfactory. The rents of the rooms vary from 7s. to 8s. 6d. for two rooms, 9s. 6d. to 10s. 6d. for three rooms, and 12s. 6d. to 13s. for four rooms. District No. 10 lies south-west of the Millbank Estate, and abuts on the Vauxhall Bridge Road from the River to Begency Street. The census population was 2,321. The district, speaking generally, comprises two classes of property—a small proportion of two-storey dwellings built for working class occupation and a much greater proportion of three and four-storey houses built for a better class. Of the latter a small number, e.g., Bessborough Gardens (east side), are still so occupied, but the great majority, notably Ponsonby Place and Terrace, now accommodate an artizan population not improbably displaced from adjacent demolished areas. Each of these houses now contains several tenements, without having the conveniences which are now to be found in buildings such as the Council's Dwellings. Steps have been taken to lay on extra water and make other provisions. Overcrowding existed in the earlier part of the seven years, and such an influence would help to account for the death-rate from all causes averaging 4.2 per 1,000 above that of the City generally in the first four years. There is, however, a tendency to improve, but the diarrhoea rate, l.l per 1,000, is too high. District No. 11 adjoins Nos. 8, 9 and 10, and includes the east side of Chapter Street, Regency Street up to the junction with Chapter Street, and the east side of Regency Street up to Page Street, and includes the City Dwellings. This district has seen considerable changes during the last ten years. Much property was demolished notably in Regency Street, Chapter Street, Douglas Street, Frederick 133 Street, Clark's Cottages, &c. Most of it was old and in bad condition, as the death-rate of 26.4 in 1901 hears evidence. In addition to the City Dwellings (statistics relating to which are given in the Annual Report for 1907, p. 19), the Ecclesiastical Commissioners are erecting dwellings and large police barracks have recently been constructed. The only part of 'this district to which exception might be taken is Douglas Place. It is practically a narrow alley, affording poor access for light and air. It consists now of 14 cottages, containing 4 rooms each, inhabited by 20 families, consisting of 53 persons. There have been 11 deaths there in seven years, 3 being from consumption and 2 from diarrhoea. Districts 15, 16, 17, 18 and 19 are grouped round Vincent Square, and the first three adjoin No. 11. District No. 15.—The census population was 1,014. This district does not contain any of the poorest class. It includes St. Augustine's Mansions and some good working-class tenements over shops in Chapter Street. There are good-class dwelling houses in Vincent Square (south-west side), some of which are let in apartments. There are shops and apartments in Vauxhall Bridge Eoad, and the better artisan class are housed in the streets running from Vincent Square and the latter road. The existing property here consists of houses of three and four storeys, old, but in fair condition. Some demolition, however, has occurred in Edward and Alfred Streets, and there are no old houses now standing in Douglas Street. Some business premises are being built on part of the cleared sites, and a large new block (Brabazon House, 140 residents and servants) has been erected in Douglas and Edward Streets. The mortality rates have been satisfactory during the seven years, and the substitution of better class dwellings for those in Yauxhall Bridge Boad and the adjoining streets will tend still further to reduce it. District No. 16.—The census population was 853, but it must have fluctuated considerably in the last seven years owing to demolition having been carried out to a fair extent in Chapter, Douglas, and Frederick Streets and in Hide Place. Some new business premises have been constructed on part of the cleared area, and the Ecclesiastical Commissioners have built dwellings accommodating 148 persons, opened in 1907, in continuation of their dwellings in Begency Street; there are good private houses, some let in apartments, in Vincent Square, and some older working class dwellings (Chapter Chambers), a two-storeyed block housing 175 people of the artisan class. This block does not appear to have specially influenced the mortality rates. The district, like No. 15, enjoys the advantage of abutting on the large open space of Vincent Square, and its general healthiness appears to be satisfactory. 134 District No. 17 lies on the N.E. side of Vincent Square. The census population was 814, of a mixed character. The district contains Carey Mansions, a four-storey block of flats, and a new block has been erected in Vincent Square and Bell Street. There are some good houses in Vincent Square, and the rest of the population is of the artisan type, living in two and three-storey dwellings, some of them over shops, and generally in fair condition. Demolition has been carried out on a large scale in Ship Court, Elverton Street, Bell Street, and Bell Place. So far as can be gauged this district is fairly healthy. A good deal of sanitary work, re-drainage, &c., has been carried out in New Street, and the condition of the dwellings considerably improved with beneficial results. Some old property facing Regency Street will probably have to be cleared away at an early date. Districts Nos. 18 and 19.—These two districts yield satisfactory results so far as mortality statistics are concerned. Considerable alteration is taking place in the class of property, and the tendency appears to be to erect flats or large buildings for business purposes. Some old small shops, with rooms over, on the east side of Rochester Bow, will probably be cleared away so soon as the ground can be let; meanwhile their sanitary condition is fairly well maintained. District No. 20 embraces the west side of Strutton Ground, a great part of which is in progress of being rebuilt at present (in this street is a common lodging-house with 211 inmates), Artillery Mansions, and Artillery Buildings (working class tenements), and a number of business premises. A few houses in Artillery Row are in a very worn-out condition; they are chiefly used for business purposes, and their site has been advertised for building for some time. Districts Nos. 12, 13 and 14 lie on the other side of Vauxliall Bridge Boad, between it and Tachbrook Street, the "Tachbrook'' having been the boundary of the parish on this side. District No. 13 is bounded by Bessborough Street and Gardens and the River. The population was 1,386 at the last census. The houses generally are of good construction, most of them being of four storeys. There is some letting of apartments. There are some houses inhabited over stables in two mews, those off Bessborough Place not being altogether satisfactory. There are no block dwellings. An open space exists round Trinity Church, and the district has the advantage also of being near the Biver. In 1902 the deaths from all causes were equivalent to a rate of 23.8 per 1,000 as compared with an average of 15.6 for the other three years (1901-3-4), and the average of the last three years was 16.6. It is possible that the population here was increased by demolition in adjacent areas in 1901-2, and declined on the opening of the Millbank 135 Dwellings. The majority of the deaths are confined to Bessborough Place, which also contributes the phthisis and diarrhoea deaths. District No. 12.—The census population was 2,202. The bulk of the population is of a respectable working-class type, dwelling in such typical streets as Lillington and Tachbrook Streets. In Dorset Street (now Rampayne Street) and Garden Street are two-storey cottages of a good type. In Bessborough Street and Gardens and in Vauxhall Bridge Road a better class are housed; many bouses are let in apartments. The streets are wide generally, and there are no courts except two mews of no great size, which do not contribute appreciably to the death-rates. The total mortality from 1901 to 1904 was 211 and was high as compared with rates for the ward and City, but the phthisis and respiratory rates are fairly satisfactory. The rate for all causes rose to 24.9 in 1902 as compared with an average of 19.7 for the other three years of the period, the excess of deaths occurring in Dorset Street and Lillington Street, probably due to an influx of people from adjacent areas. During the last three years the average rate has fallen still further to an average of 16.0. Lillington Street, which is partly also in No. 14 District, demands a certain amount of regular attention from the sanitary inspectors. There has been no decrease in the total number of deaths in the seven years, 35 being the average number, of which 4 each year resulted from phthisis. District 14 extends higher up the Vauxhall Bridge Road from No. 12 District. It bad a population of 2,935 as the census, and there has been practically no alteration. The property consists of threestoreyed houses with shops, and there is a block of artisans' dwellings (Cambridge Buildings) in Upper Garden Street housing 200 people. The mortality rates are better than No. 12 District. The survey which has been made shows that this Ward of the City has been slowly undergoing change for more than 50 years. The alteration began with the formation of Victoria Street; it proceeded slowly for many years, but gradually the old style of house has been displaced by dwellings constructed in fiats, and by premises to be used for business or official purposes. Much of the property belongs to the Ecclesiastical Commissioners, and as leases have fallen in the sites occupied by such houses as had become old and dilapidated have been cleared; some of these are still vacant, but the Commissioners have erected a considerable number of dwellings to accommodate families of 136 the working class and keep them under their direct supervision. This Council has also erected dwellings on another portion of this vacant land. The County Council has built extensive buildings on the Millbank site, and have cleared a considerable area of houses abutting upon Millbank. Though a large number (probably about 5,000) have had to move, yet the returns made under the Equalisation of Rates Act (printed in my Annual Reports) show the actual decrease in population since 1900 is 2,122* in the whole of St. Margaret and St. John's Wards. Experience has shown that very few of the people displaced find rooms in the dwellings erected under such schemes. Of the abovementioned 5,000 a proportion went into the workhouse, and some left the district altogether, going chiefly to Battersea and Wandsworth, but a large proportion having either work or interests in the neighbourhood moved into the streets near by, causing overcrowding and other insanitary conditions in houses which were not built to be used as one or two-room tenements. Eventually the invaded street either rapidly deteriorates or it gradually gets rid of the intruders who go further afield. In getting out the number of deaths and deathrates for the various districts these influences can be distinctly traced. In view of this result and the considerable displacement of population which has taken place and is likely to take place in the near future through the operations of the Syndicate, the Public Health Committee have hesitated to take steps which would result in the •closing of other property and the further displacement of their inhabitants, except where the owners declined to put the houses into a reasonable state of repair. It has rather been the aim by constant inspection to maintain the houses that were left in a proper sanitary condition. In certain streets in which the houses are old it is only by continual expense that their condition can be maintained. Many of the tenement houses in this ward have too many people in them although the numbers may comply with legal requirements. It is laid down in the by-laws for houses let in lodgings that 300 cubic feet of free air space is to be allowed for each person over 10 years of age and 200 for each person under, in a room used exclusively as a sleeping apartment, and for a room used both for sleeping and living the limits are -100 feet and 200 feet respectively. That assumes, however, that the houses are suitable for such a mode of usage. In the various * The population of St. John's Ward (which covers an area of 210 acres) was only 8,375 in 1801. It gradually increased up to 1871 when the inhabitants numbered 38,478. Since then each census has shown a decrease, thus in 1881 there were 3,000 less, in 1891 the population was 34,106, in 1896, 31/130, and in 1901, 29,914. Last year the resident population was estimated to be 28,100 (exclusive of persons in workhouses, &c.), but this year the returns of inhabited houses show considerable increase, so that the resident population is probably now not less than 29,100. 137 model dwellings, built purposely for such letting, more stringent rules are in force, and practically not more than two persons per room is allowed. In Glasgow the need for a higher standard in tenement houses has been recognised, as in one-room dwellings 800 to 1,200 cubic feet per person is required, and in two-room dwellings 700 cubic feet. It seems that improvement is required to a considerable extent in the mode of letting, the class of people permitted to occupy the houses and the number which should occupy a house let in tenements. If owners were as strict in looking after these matters as are those responsible for the various block buildings, there is no doubt an immediate improvement, both morally and physically, could be effected. In houses such as the Council's Dwellings, water is laid on to each tenement, ample sanitary accommodation is provided, there is a proper place for keeping food, suitable means for cooking and washing, rendering each tenement complete in itself. But in a house "made-down" from occupation by one family, to accommodate a family on every floor, perhaps in every room, there has been no power to make the owner provide such suitable and necessary requirements. The County Council have recommended on several occasions that power should be obtained to ensure better accommodation for the tenants in tenement houses, but, with the exception of improving somewhat the law as to water supply, they have not succeeded in obtaining Parliamentary sanction to their suggestions. I have expressed the opinion in various reports, and repeat it now, that no owner should be allowed to convert a one-family house into a tenement house, or to erect a building to be used as such, without obtaining the sanction of the sanitary authority, who should see that sufficient and suitable arrangements had been made as regard storage of food, cooking, water supply, w.c. accommodation, &c. For existing tenement houses, if the owner were unwilling to bring them up to the above standard, then the local authority should have power to fix the number of persons who may occupy such houses on a higher scale than that allowed by the By-laws, varying from 400 to 1,000 cubic feet per person, according to the circumstances of the case. I have referred to the number of deaths from alcoholism; these indicate to a small extent only the serious amount of harm which "drink" effects in this neighbourhood. There is no doubt that a very considerable amount of intemperance exists in certain parts of the ward, especially among women. The demolition of other property, and the growth of public opinion on the subject, has led to the reduction of the number of licensed premises, 60 licensed premises having been done away with since 1891; the present number is 94, a figure susceptible of further reduction. If a different class of persons lived in the neighbourhood of 138 some of the public houses, it would probably not be sufficiently remunerative for the owners to retain the licenses. It is quite evident that in many families the money which should provide food and clothing for the children, and ordinary comforts in the home is spent in drink, which is to a considerable extent the cause of much of the degeneracy to be found in certain parts of the district. The lines of action on which the Council might act in the present condition of St. Jolm's Ward are briefly:— (1) To continue the policy of— (a) Systematic inspection and strict enforcement of legal requirements in tenement houses. (b) The closure of insanitary houses which cannot be made habitable or which the owners decline to make so. (2) To consider the desirability of— (a) Acquiring additional sites on which buildings for working people can be erected. (b) Acquiring existing houses in which improvements could be effected so as to render them suitable for use as tenement dwellings. (3) To represent to Parliament, the Local Government Board, and the County Council the need of further powers— (a) To compel owners of houses intended to be let in ments to provide suitable accommodation for the tenants. (b) To give greater elasticity to the by-laws for houses let in lodgings or occupied by persons of more than one family, so that in existing houses of that class the standard of cubic space may be varied according to the character of the house and the provision made for the various families. (4) To urge upon the County Council and the Syndicate the need for proceeding rapidly with the reconstruction of the areas being dealt with under their Acts. In addition there is much scope in streets like Chadwick Street and Tufton Street for various agencies to effect improvements and to raise the tone of the people, but so long as parts are infested with "undesirables" efforts to do so must be rendered almost futile. The firststeps should be to get rid of the prostitutes and loafers who inhabit certain parts, and to secure a. reduction in the number of licensed premises, especially in parts where intemperance is common. I have the honour to be, Mr. Chairman and Gentlemen, Your Obedient Servant, June, 1908. FRANCIS J. ALLAN. london: harrison and sons, printers in ordinary to his majesty st. martin's lane. WES 22 No. I. City of Westminster. Report of the Medical Officer of Health for the Five Weeks ending Ist February, 1908. Mr. Mayor and Gentlemen. I beg to present my Report for the five weeks ending 1st February, 1908. I. The population for the City, calculated as at the middle of 1908, as estimated by me is 172,650; the Registrar General makes it 170,545, but from a consideration of the circumstances of the various parts of the City, and the returns of rated houses, I am of opinion that my figure is likely to be the more nearly correct. At this distance from the Census it is impossible to have accurate statistics. 2. The births registered in Westminster were 269 (146 males, 123 females), equal to an annual rate of 1&2 per 1,000. The birth-rate for London for the same period was 2yo per 1,000. The births and deaths were distributed thus:— Total. Conduit. Grosvenor. Hamlet of Knightsbridge. Knightsbridge St. George. Victoria. St. Margaret. St. John. St. Anne. Great Marlborough. Pall Mall. Regent. Charing Cross. Covent Garden. Strand. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BIRTHS (Uncorrected) 269 — 20 3 7 75 17 77 20 17 1 9 3 17 3 Deaths— Under 1 year of age 32 1 3 — 3 5 2 13 1 1 — 2 — 1 — Over 65 years 86 1 7 1 5 21 2 15 4 9 1 9 2 3 6 Total Deaths (net) 238 4 22 2 9 69 11 53 13 17 1 16 4 9 8 Death Rates per 1,000 Inhabitants 14.3 7.7 15.5 2.7 6.3 18.2 8.8 18.9 12.4 25.6 3.5 18.0 10.0 11.0 13.1 127 persons died in their homes, 53 in poor law institutions, 41 in general and special hospitals, 1 in fever hospital, 11 in lunatic asylums and 5 in rivers, lakes or streets. The total number of deaths registered was 252. After deducting the deaths of 89 non-citizens in public institutions in the City and adding those of 75 citizens who died in other districts, the corrected total is 238 (120 males, 118 females), as compared with 180 in the previous four weeks, and is equivalent to an annual death-rate of 14.3 per 1,000, the rate for the same period during the preceding 5 years being 167. The death-rate for all London during the same period averaged 18.0 per 1,000, being just about the mean rate (1903-1907). The infantile death-rate in London as a whole was 117 per 1,000 births, and in the City of Westminster 118. (When the births are corrected this figure will be reduced to about 110.) The causes of death are shown on page 2. 14 deaths were due to violence—9 of them ascribed to negligence or accident and 5 to suicide and murder. Inquests were held on the bodies of 26 citizens. 86 of the total deaths were those of elderly persons, one being recorded of a man who had reached the age of 105 years. 70 deaths are ascribed to Bronchitis and other affections of the respiratory system, 30 of them being persons over 65 years of age. 2 Causes of, and ages at, death during the five weeks ending 1st February, 1908 :— Causes of Death. Corrected Deaths in the City at subjoined Ages. Deaths in Wards at all Ages. All ages. Under 1. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. Conduit. Grosvenor. Hamlet of lvnightsbridge. Knightsbridge St. George. Victoria. St. Margaret St. John. St. Anne. Great Marlborough. Pall Mall. Regent. Charing Cross. Covent Garden. Strand. Smallpox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 2 1 1 ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Epidemic Influenza 3 ... ... ... ... 3 ... ... ... ... ... 1 1 1 ... ... ... ... ... ... ... Whooping Cough 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria, Memb. Group 2 ... 1 1 ... ... ... ... ... ... ... 1 i... ... ... ... ... .... ... ... ... Cerebro-Spinal Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 2 ... ... ... 1 1 ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa 2 1 ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... Epidemic Enteritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteritis 2 2 ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other septic diseases 1 ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... Syphilis, &c. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diabetes 3 ... ... ... ... 3 ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... Malarial Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rheumatic Fever 1 ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... Tuberculosis of Meninges 4 ... 2 1 1 ... ... ... ... ... ... 2 ... 1 ... ... ... 1 ... ... ... Tuberculosis of Lungs 19 ... ... ... 1 17 1 ... 6 ... ... 8 ... 3 1 1 ... ... ... ... ... Tuberculosis of Peritoneum 1 ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... Other forms of Tuberculosis 2 1 1 ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... Alcoholism 2 ... ... ... ... 2 ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... Malignant Growths 22 ... ... ... ... 12 10 ... ... ... 1 8 1 7 1 ... ... 3 ... ... 1 'Premature Birth 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... Developmental Diseases 12 1 1 1 ... ... ... ... ... 2 ... ... 3 1 4 ... ... ... 2 ... ... ... Old Age 15 ... ... ... ... 1 14 ... ... ... ... 2 ... 3 3 3 ... 1 ... 1 2 Meningitis and Convulsions 1 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... Other Diseases of Nervous System 6 ... ... ... ... 2 4 ... 1 ... ... 1 1 ... ... ... ... ... 1 i Valvular Diseases of Heart 3 ... ... ... ... 1 2 ... ... ... 1 2 ... ... ... ... ... ... ... ... ... Other Circulatory Diseases 20 ... ... ... 1 8 11 c 2 ... ... 7 ... 3 1 2 1 1 ... Bronchitis 41 2 2 ... 11 15 21 ... 1 1 3 11 2 10 2 4 ... 2 1 4 ... Lobar (Croupous) Pneumonia 6 ... 1 ... ... 4 ... ... 2 ... ... 1 ... 1 ... 1 ... 1 ... ... ... Lobular (Broncho-) Pneumonia 8 5 1 ... ... ... 2 ... i ... 1 ... ... 4 1 ... ... ... ... ... ... Other Respiratory Diseases 15 5 1 ... ... 3 6 1 1 ... 1 8 1 2 ... ... ... ... ... ... 1 Cirrhosis of Liver 5 ... ... ... ... 4 1 ... ... ... ... 1 1 ... ... ... ... 1 2... ... ... Other Digestive Diseases 9 ... ... ... 1 5 3 ... 3 ... ... 2 ... ... ... 1 ... ... ... 2 I Bright's Disease, &c. 8 ... ... ... ... 3 5 1 1 ... ... ... 1 3 ... 1 ... 1 ... ... ... Generative System Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Accidents and Diseases of Parturition ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Deaths by Accident or Negligence 9 ... 2 3 ... 2 2 ... ... ... ... 2 ... 2 ... 3 ... 1 ... ... 1 Deaths by Suicide and Murder 5 ... ... ... 1 4 ... ... ... ... ... 2 ... 1 2 ... ... ... ... ... ... All other Causes 5 1 1 ... ... ... 3 1 ... ... 1 2 ... ... ... ... ... 1 ... ... ... All Causes 238 32 14 7 7 92 86 4 22 2 9 69 11 53 13 17 1 16 4 9 8 3 3. Notifiable Diseases.—79 cases of infectious disease were notified in the City in January, as compared with 55 in the previous four weeks. They were distributed as follows:— Notifiable Diseases. Total. Conduit. Grosvenor. Hamlet of Knightsbridge. Knighisbridge St. George. Victoria. St. Margaret. St. John. St. Anne. Great Marlborough. Pall Mall. Regent. Charing Cross. Covent Garden. Strand. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Smallpox — — — — — — — — — — — — — — — Scarlet Fever 48 — 3 — 6 7 11 11 3 — — 1 2 3 1 Diphtheria 19 — 2 4 4 3 2 3 — 1 — — — — — Enteric Fever 2 — 1 — — — — — 1 — — — — — — Erysipelas 10 — — — 1 2 1 4 — — — — — — 2 Puerperal Fever — — — — — — — — — — — — — — — Cerebro-Spinal Fever — — — — — — — — — — — — — — — Continued Fever — — — — — — — — — — — — — — — Pulmonary Phthisis 22 — 2 — 2 4 — 12 1 — — 1 — — — Forty-six of the Scarlet Fever, 18 of the Diphtheria, all of the Enteric, and 4 of the Erysipelas cases were treated in Hospital. One case notified as Diphtheria (in Victoria Ward), was reported not to be so. The number of notifications of infectious disease in the last five weeks, and in the corresponding period of 1907, were:— Smallpox. Scarlet Fever. Diphtheria. Enteric Fever. Erysipelas. Puerperal Fever. In London 1908 1 2,309 916 1l8 472 19 ,, 1907 1 1,651 785 146 513 24 In Westminster 1908 — 48 19 2 10 150 ,, 1907 — 33 20 6 7 150 Forty-six certificates of Infectious Disease have been sent to School Teachers, and certificates of each case notified have been sent to each of the Public Libraries in the City. Intimations have been received from School Teachers and others relating to 18 cases of Measles 5 of Mumps, and 11 of Chicken-pox. One case of infectious disease was notified in a home worker's premises. Three persons from infected houses were employed elsewhere in clothing trades, and in one instance a workshop was located in another part of a house in which infectious disease occurred. An unusual case of Diphtheria occurred in a young child 17 days old, the part affected being the eye. Five intimations of cases of Glanders in horses have been received from the Veterinary Inspector of the County Council; this is done in accordance with the provisions of Article 2 of the new Order which came into force on the 1st January, 1908. The necessary steps in connection with the outbreaks together with the cleansing and disinfection of the infected premises are undertaken by the officers of the County Council. In one instance, two men employed on infected premises were away ill, their medical attendants were communicated with and apparently neither of them were suffering from Glanders. In my Annual Report for 1905 (pp. 55, 56), in commenting on the deaths of two persons in Westminster from this complaint, I drew attention to the desirability of intercommunication between the County and Borough Councils in this matter. 4. Disinfection.—126 rooms were disinfected in 87 houses during the five weeks, and 3,437 articles were disinfected; 2,789 at Commercial Road Station, and 648 at Horse ferry Road Station. 5. Mortuaries. Horseferry Road. Drury Lane. Dufours Place. Ebury Bridge. No. of bodies removed to 31 — — — No. of inquests 31 — — — 4 Statement of the principal items of the work of your Sanitary Inspectors. District Inspectors— Particulars of Matters dealt with. Insp. Aris. Insp. Dee. Insp. Folland. Insp. Martinson. Insp. Sanderson. Insp. Taylor. Insp. Ware. Insp. Whipp. Insp. Carey (South District). Insp. Dick (North District). Totals. Notices issued (preliminary) 35 33 11 21 34 10 21 45 38 67 315 Do. (statutory) 1 1 4 1 1 — 1 4 15 5 32 Complaints received and dealt with 16 1 8 1 10 7 10 18 3 — 74 Houses inspected:— (a) On complaint, etc. 16 1 8 1 10 7 10 18 3 3 77 (b) House to House inspection 99 — 42 87 75 30 30 51 70 33 517 Houses re-inspected 223 — 251 152 247 208 353 35o 108 48 1,940 Do. (registered) visited 270 — 2 — — — — 4 25 10 311 Do. do. No. of notices issued:— (a) For overcrowding 1 — 1 — — — — — 3 — 5 (b) For other conditions 18 — 1 — — — — 7 17 4 47 Visitsre Infectious Disease 32 — 4 15 9 8 8 8 — — 84 Do. Consumption,Measles &c. — — — — — — — — 25 1 26 Do. Infantile Deaths — — — — — — — — 25 4 29 Trade Sup ervision. Complaints received — — — — 1 1 — 8 — — 10 Factories inspected — — — — — — — — — 5 5 Do. re-inspected — — — — — — — 1 — 1 Defects found — — — — — — — — — 1 1 Workshops and workplaces inspected _ 98 2 5 3 11 1 46 20 145 331 Do. re-inspected — 146 1 — 28 — — 33 15 54 277 Defects found — 62 — — 5 6 4 60 7 73 217 Workrooms measured — 78 — — — — — — — 36 114 Workshops without Abstracts — — — — — — — — 6 26 32 Nature of Defects found— Want of Cleanliness — 22 — — 2 2 — 13 — 23 62 Do. Ventilation — 3 — — — 3 — — 1 7 14 Do. do. of Gas stoves 4 — — 2 — 2 3 20 32 Want of Drainage of Floors —- 2 — — — — — — — — 2 Overcrowding — — — — — — — — — 3 3 Sanitary Accommodation— Insufficient — — — — — — — — — — — Unsuitable — 8 — — — — 1 1 — — 10 Defective — 13 — — 1 — — 15 1 7 37 Not separate for sexes — — — — — 1 — — 2 10 13 Other defects — 10 — — — — 3 29 — 3 45 Visits of Enquiry re Employment of Women — — — — — — — — 5 9 14 Do. to Outworkers' premises — — — — — — — — 13 172 185 Defects found — 1 — — — 1 1 12 2 18 35 Visits of Enquiry re Outworkers — — — — — — — — 3 — 3 5 Food and Smoke Inspectors— Particulars of Work. Insp. Williams. South District. Insp. McNair. North District. Total. Smoke complaints received 1 3 4 Do. observations taken 88 91 179 Do. Notices issued (preliminary) 1 8 9 Do. Do. (statutory) — — — Food and Drugs—Samples taken 77 90 167 Visits to butcher's shops, fish shops, poulterers, cowsheds, &c. 72 83 155 Unsound Food.—The following articles condemned as unfit for food:— Bananas, 2 tons 13 cwts. Tomatoes, 17 cwts. have been submitted for inspection and Oranges, 3 cwts. Fish (wet), 4 cwts. 56 lbs. Local Government Board Reports.—The Board has adopted the excellent practice of issuing special reports on matters connected with food. Recently two have been published. One by Dr. McFadden, with regard to the wholesomeness of tripe of home and foreign origin. From what he has seen of the dressing of fresh tripe in London and Lancashire, where the demand is large, the conditions of manufacture appear to be generally wholesome and cleanly, though he met with some conditions of storage of tripe in London which called for improvement. Cooked American keg tripe, however, Dr. MacFadden places in a separate category in the matter of wholesomeness. The objections to that form of tripe, from a public health point of view, is the habitual presence of boron preservative in quantities which of themselves constitute a risk to the health of the consumer. There is the further risk, incidental to the use of preservatives, that much decomposition may at times have actually taken place and be so hidden by the preservative that the consumer is unable to detect it by ordinary means. The second report is by Dr. J. M. Hamill, on the preparation and sale of vinegar in relation to the administration of the Sale of Food and Drugs Acts. More satisfactory and accurate descriptions of vinegars are desirable in the interests of the consumer and of satisfactory trading. In present circumstances, however, comparatively little can be effected in this direction by public authorities. Still, there are certain matters in which it appears practicable for authorities under the Sale of Food and Drugs Acts in present circumstances to take action in the interests of the vinegar consumer. Vinegar is, it is pointed out, liable to take up metallic impurities, including copper, from the plant used in its preparation, and contamination by arsenic may occur under certain conditions. Any indication of the formation of Prussian biue in a vinegar or pickle which has been clarified by the use of ferrocyanide of potassium should be regarded with suspicion. February, 1908. I have the honour to be, Mr. Mayor and Gentlemen, Your obedient Servant, FRANCIS J. ALLAN, ATedical Officer of Health for the City. .