WES 23 ANNUAL REPORT ON THE STATISTICS AND SANITARY CONDITION RELATING TO THE CITY OF WESTMINSTER FOE THE YEAR 1909. BY FRANCIS J. ALLAN, M.I)., C.M., D.P.H. CAMB., F.R.S. ED. MEDICAL OFFICER OF HEALTH. Printed by Order of the Council. LONDON: HARBISON AND SONS, PRINTERS IN ORDINARY TO HIS LATE MAJESTY, ST. MARTIN'S LANE, W.C. Ill TABLE OF CONTENTS. PAGE Introductory Remarks 1 PART I. A. Statistics. Population 7 Births 10 Notification of Births Act 12 Report of Health Visitors 14 Influence of Industrial Work 17 Deaths 22 Infantile Mortality 23 Deaths in Block Dwellings 26 Tables 27-38 B. Communicable Diseases. Smallpox 39 Vaccination 40 Scarlet Fever 40 Diphtheria 43 Typhoid Fever 45 Puerperal Fever 46 Cholera, Plague 46 Glanders, Anthrax and Hydrophobia 46 Statistical Tables 47-50 Tuberculosis 50 Compulsory Notification of Poor Law Cases 51 Illustrations— Maitland Sanitorium between 52-3 Measles 61 Whooping Cough 62 Diarrhœal Diseases 63 Influenza 63 Schools and Infectious Disease 64 Bacteriological Laboratory 67 Disinfection 68 New Disinfecting Station 69 Cleansing of Persons 69 Verminous Houses 69 Mortuaries 69 Deposit of Dead Bodies on Undertaker's Premises 70 PART II. C. Souse Inspection, & c. Defects Remedied 71 Legal Proceedings 73 Housing and Town Planning Act 74 Drainage, &c., Plans 76 Hot Water Discharged into Sewers 76 Daily Removal of House Refuse 77 Removal of Offensive Refuse 77 Water Supply 78 PAGE Houses Let in Lodgings 78 St. John's Improvement 78 Accommodation for the Storage of Food. 79 Regulation of Cheap Furnished Rooms 80 Common Lodging-houses 81 Revenue Act 82 Smoke Prevention 83 D. Workshops. Number on Register 85 Defects.. 86 Unventilated Stoves 87 Ventilation 87 Underground Workrooms 88 Outworkers 89 Infectious Disease 91 Laundries 91 E. Food Supply. Restaurants, &c. 92 Ice Cream Premises 92 Bakehouses 92 Certification of Food for Export 93 Infectious Disease 93 Milkshops 93 Dirty Milk 93 Tuberculous Milk 93 Infectious Disease 94 Scarlet Fever and Milk 94 Cow-sheds 96 Food and Market Inspection 96 Food Condemned 97 Use of Formaldehyde for Preserving Meat 98 Sale of Food and Drugs Acts— Samples Taken, Result of Analysis and Proceedings 99 Milk 101 Cream. 103 Report re Boric Acid 103 Butter and Margarine 104 Sausages and Meat Pies 105 Appeal 105 Tinned Foods 108 Mineral Waters 109 Lead in Ginger Beer 109 Chocolate 109 Spirits 110 Drugs 111 Obstructing Inspectors 111 Details of Prosecutions 112-118 a 2 / Annual Report on the Health and Sanitary Condition of the City of Westminster, 1909 . 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 for the year 1909. Returns required by the Local Government Board, and particulars relating to Factories and Workshops required by the Home Office, are incorporated therein. I have again to point out that 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. 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 influenza was prevalent, and the number of deaths recorded was up to the average, but in the remaining quarters the death rates were below the average. For the whole year the death rate of London is estimated at 14 per thousand persons living, as compared with 16.3 the average of the previous ten years, and 14.9 the average rate, 1904-8. For Westminster the rate was 12.7 per thousand, the average being 14.4 for the ten years, 12.9 for the last five years. Deaths from the principal infectious diseases were equal to a rate of 1.31 per 1,000 for London, which is lower than preceding years, chiefly from the decline in deaths from Epidemic Diarrhoea, and notwith- 2 standing an increase in the deaths from Measles. Westminster ranked among the three lowest of Metropolitan districts in respect of deaths from infectious disease. An account is given in the body of the Eeport of an extensive outbreak of Scarlet Fever, transmitted by milk, which affected the south-western part of London and suburbs. Fortunately, it was restricted in Westminster by the early stoppage of the infected milk. A Memorandum, prepared by the Medical Officers of the Local Government Board and the Board of Education, has been issued, dealing with public health administration for the prevention of the spread of infectious diseases among school children, in which it is pointed out as essential that the relations between the local sanitary authority and the local education authority should be intimate and cordial. Attention was drawn by this and other Councils, before medical inspection was inaugurated, to the need for mutual co-operation; but at first the Education Committee in London rather ignored the Borough Councils; latterly, however, the former has recognised that the policy was not conducive to the best interests of the public, and during last year conferences have been held between the medical officers in order to come to an agreement on general lines of action. Special attention has been directed to the subject of Tuberculosis, especially with regard to consumption of the lungs (Phthisis). Increased interest was stimulated by the issue of an Order by the Local Government Board, making it compulsory that all poor-law cases should be notified to the local authority; and a valuable memorandum on the administrative measures which might be adopted was issued by Dr. Newsholme, the Medical Officer of the Board. Through the instrumentality of the Westminster Health Society, the National Association for the Prevention of Consumption allowed its Tuberculosis Exhibition to be held for a fortnight at Chelsea Town Hall, that being a convenient centre for Fulham, Chelsea, and Westminster. Lectures were given on various aspects of the subject. It was attended by over 9,000 persons, including 800 children, with their teachers, from twelve schools in Westminster. The Health Society has, moreover, taken further steps to bring about concerted action by the various agencies, lay and medical, in the City. In its work among the poor, the Society is constantly being confronted with problems relative to the unsatisfactory surroundings of those suffering from tuberculosis, to the fact that patients frequently come under treatment so late in the course of the disease that there is little hope of any real improvement in their condition, and to the danger in which other members of the families of patients are placed. On the 21st October, 1909, a Conference was held at the City Hall 3 between representatives of the Hospitals and Dispensaries in Westminster, the Westminster Division of the British Medical Association and the Health Society, at which various schemes were considered for securing diagnosis and proper medical treatment at the earliest possible stage of the disease; for improving, as far as possible, the home surroundings of patients; for the examination of "contacts" and the notification of cases to the Public Health authority. There was some difference of opinion at the Conference as to whether these highly desirable objects could in practice be best attained by the establishment of a special dispensary, on the lines of those existing in Edinburgh, New York, Paddington and many other places, or by the less ambitious method of simply inviting and urging the Hospitals, Dispensaries and Medical Practitioners in Westminster to co-operate more effectively than at present with the City Council and the Health Society in the detection and prevention of this disease. As the result of the Conference a Special Committee of the Health Society was appointed, consisting of Dr. Forsyth (Charing Cross Hospital), Dr. Macnamara (Westminster Hospital), Dr. A. E. Cope, Mr. Councillor G. W. Tallents, Miss M. Horn, Hon. Sec. of the Society, Mrs. Drake and the Medical Officer of Health. The Committee feel strongly that existing arrangements for dealing with consumption in Westminster are entirely inadequate and behind the times, but in view of the financial and other difficulties attending the formation of a special dispensary, they have decided that a scheme of co-operation shall be tried first. With this object the City Council was asked to remind medical men that a scheme of voluntary notification was adopted by the Council in 1903, and to invite them to avail themselves of it. It is now proposed that in cases in which the medical attendant desires it, a properly trained special visitor from the Health Society shall call upon the patient to give instructions as to measures of personal hygiene and precautions against infection; will look out for "contacts," and will endeavour, in cases requiring outside assistance, to obtain, through the agency of the various charitable societies, better food, clothing, separate bed, sanatorium or other treatment indicated by the medical attendant, and to discover and take steps to obtain the removal of insanitary conditions which may affect the patient. Such information will be supplied to the medical attendant, so that he may be the better enabled to advise in each case. The medical staffs of the various hospitals and dispensaries are also being asked to assist in regard to patients attending these institutions, and particularly whether they would afford special facilities for examining persons who had been exposed to infection. 4 In order to assist further, the City Council has taken beds at a sanatorium, more particularly for the training of consumptive patients in the methods of preventing infection. The death rate of children under one year of age in London varied but little for fifty years (1841 to 1890), except in the decade 1881-90 when meteorological conditions were favourable. The rate in the first ten years of the half century was 157 per 1,000 births, and in the last was 159. Since 1900 (which coincides with the period when the Borough Councils came into existence) the rate has regularly decreased year by year, until it now stands at 108. For the first five years of the decade, beginning with 1901, the rate was 138; for the last four years, 117. It must, however, he kept in mind that during the last three years the climatic conditions have again been favourable to infant life, and resemble those existing in 1881-90, but in that decade the infant death rate only fell to 152 per 1,000. The marked improvement which has taken place is due to the new methods which have been introduced in recent years, whereby instruction is given to mothers in the way to bring up children, by ladies specially qualified for the work. The system was begun in Westminster in 1903, and has gradually extended not only to other parts of London, but to many places throughout the country. (Manchester and Salford had for many years previously a society for the promotion of this kind of work.) The average death rate for the districts which eventually formed the City was 158 for the ten years 1891-1900, varying in the component districts from 132 in St. George's to 176 in St. Margaret and St. John, and in the Strand. The average of the last nine years (1901-9) for the City is 110, and for the year 1909, 93 per 1,000 births. In the beginning of 1909 the Notification of Births Act came into force, the Local Government Board having sanctioned the suggested arrangement that the Hon. Secretary of the Health Society should be appointed the Council's Honorary Health Visitor under the direction of the Medical Officer of Health. The Council provided an office at the St. George's Baths, Buckingham Palace Puoad, and the Society has thus become a special centre for health in the district. Detailed records are kept of individual cases, and systematically indexed for future reference. The discovery of sickness and ill-health in other members of the family arises frequently from the infant visiting, and in this way very complete family histories in disease are gradually being collected, together with an accumulated knowledge of sanitary and economic conditions. This collected information is particularly valuable in dealing with school children, with phthisis, and in many other directions. The Hon. Health Visitor is assisted in visiting by 25 ladies, and is in close touch with 5 the various agencies, philanthropic and otherwise, working in the City, most of which send representatives to the committees of the Society. The Council has continued the special attention it has given for some years to the purity of the food sold in the City and the sanitary condition of the places in which it is prepared. The inspection of workshops and workplaces occupies a large part of the time of the Inspectors, and especially of the two Lady Inspectors. Details of the defects found are set out in special tables, and particulars are also given relative to houses in which work is carried out by out-workers. The results of an enquiry on the effect of industrial employment on the health of married women and their children are mentioned. I regret to have to record the loss sustained by the Department by the death of Inspector Folland, an able and conscientious officer. His place has been filled by the appointment of Mr. H. E. Hardy, who was a sanitary inspector under the Wandsworth Borough Council. I desire to express my appreciation of the able assistance I have received from all the 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, 1910. 7 PART I. A. Population. At the census in 1901 the resident population of the City of Westminster was 183,011; for the year 1909 it is taken by the RegistrarGeneral at 168,883. 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, as stated above, by 14,128 in the nine years ; 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 there was an increase. This year the equalisation population is 175,100, a little lower than in 1908, but it is 6,217 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 too high. The figure, as estimated by me, is 172,150, and it is on this that the various rates in this report are calculated. A point to be noticed is the increase (shown in column two) in houses comprising two or more tenements; these have increased from 8 231 in 1902 to 372 in 1909, and the number of separate occupiers in them from 8,926 to 11,591. Taking the districts comprising the City separately, it will be 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 occurred, due to the erection of new dwellings by the Ecclesiastical Commissioners, Police Barracks, &c. St. James', which had been decreasing each year up to 1908, again shows an increase, due chiefly to premises being sub-divided into flats, which probablv does not mean a corresponding increase in population. St. Anne, St. Martin, and the Strand show a slight decrease as compared with 1908. l Number of Houses as defined in Local Government Board Schedule. Number of Houses comprising two or more Rateable Properties. 3 Number of Separate Occupations included in Col. 2. 4 Actual Number of Bated Occupiers. 5 Estimated Population Equalisation of Rates Act. 6 Estimated Population RegistrarGeneral'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 75,440 St. Margaret and St. John 5,420 60 4,545 9,905 48,727 51,960 St. James 2,822 9 219 3,032 20,806 19,730 St. Anne 1,128 45 829 1,912 11,099 11,250 St. Martin and Strand 2,460 64 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 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 19,150 The City 21,503 288 10,550 31,765 173,060 175,606 1906. St. George Hanover Square 9,736 63 2,413 12,086 75,136 74,355 St. Margaret and St. John 5,354 96 5,002 10,260 48,133 50,420 St. James 2,727 13 256 2,970 20,106 19,250 St. Anne 1,104 48 859 1,915 10,863 10,900 St. Martin and Strand 2,456 86 2,041 4,411 17,847 18,980 The City 21,377 306 10,571 31,612 172,085 173,905 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 Square 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 St. James 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 10  l Number of Houses as defined in Local Government Board Schedule. 2 Number of Houses comprising two or more Rateable Properties. 3 Number of Separate Occupations included in Col. 2. 4 Actual Number of Rated Occupiers. 5 Estimated Population Equalisation of Rates Act. 6 Estimated Population RegistrarGeneral's 1st Method. 1909. St. George Hanover Square 9,772 71 2,519 12,220 75,414 73,388 St. Margaret and St. John 5,473 119 5,363 10,717 49,204 47,892 St. James 2,905 40 622 3,487 21,418 18,990 St. Anne 1,108 50 904 1,962 10,903 10,722 St. Martin and Strand 2,494 92 2,183 4,585 18,161 17,891 The City 21,752 372 11,591 32,971 175,100 168,883 According to the proportion existing at the last census, there are 79,534 males and 92,616 females in the estimated population. Births. 2,520 births were registered in the City in the 52 weeks ending 1st January, 1910. On examination, 39 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 270 children were born in outlying institutions, the home address of whose mothers was in Westminster. The net number of births was, therefore, 2,751 as compared with 2,913 in 1908; the birth-rate, uncorrected, was 14.6, corrected 15.9 per 1,000 persons. The birth-rate for the County of Loudon for 1909 was 24.2, the rate during the preceding ten years averaged 26.1 per 1,000. The birth-rate in England and Wales was 25.6, the average of the preceding ten years being 27.8. In each quarter of the year the birthrate was the lowest recorded since registration was established. 11 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. 1909. Conduit 47 46 43 27 30 25 27 25 19 Grosvenor 153 157 151 148 133 131 145 143 121 Knightsbridge St. George 163 162 125 164 160 150 150 152 169 Victoria 836 886 884 862 890 864 846 870 847 St. Margaret 197 160 162 165 156 141 152 153 163 St. John 869 953 877 828 908 860 873 854 765 Knightsbridge Hamlet 68 97 79 77 67 72 66 80 80 St. Anne 289 278 240 232 242 217 205 184 173 Regent 213 226 184 143 163 141 129 135 104 Pall Mall 32 23 22 17 20 18 18 12 21 Great Marlborough 208 180 162 151 149 137 132 124 125 Charing Cross 41 26 34 42 38 26 34 31 24 Covent Garden 163 163 151 156 147 129 135 122 131 Strand 153 104 71 42 17 20 15 28 9 The City. 3,432 3,461 3,185 3,054 3,120 2,931 2,927 2,913 2,751 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 I, per 1,000 births. Uncorrected. Corrected. Uncorrected. Corrected. Uncorrected. Corrected. St. George 1,038 1,156 139 15.6 101 89 St. Margaret and St. John 930 1,008 18.7 20.3 101 93 Strand 552 587 11.2 12.0 108 102 The City 2,520 2,751 14.6 15.9 102 93 It will be noted that, although the total number of births is less than in previous years, there is a considerable increase in illegitimate births. The birth-rate calculated on the number of married women in Westminster, distinguishing the legitimate and illegitimate, shows more exact rates. 45 in Westminster is estimated to be 17,967, and the unmarried and widows at the same age-period 38,343. The number of married women between the ages of 15 and 45 in Westminster is estimated to be 17,967, and the unmarried and widows at the same age-period 38,343. 12 Westminster. 1E03. 1904. 1905. 1906. 1907. 1908. 1909. Legitimate Births (net) 3,051 2,920 2,971 2,744 2,764 2,739 2,548 Per 100 Married 15 6 15.6 10.1 15.0 15.1 14.8 14.2 Illegitimate Births (net) 150 134 149 187 163 174 203 Per 100 Unmarried 0.34 0.34 0.37 0.48 0.42 0.41 0.53 London.—Legitimate per 100 Married 22.3 21.8 21.2 20.9 20.2 19.8 19.0 Illegitimate per 100 Unmarried 0.63 0.65 0.61 0.61 0.57 0.59 0.55 The Notification of Births Act was adopted in 1908, and came into operation on January 18th, 1910. In order to acquaint the inhabitants of the City that the Act requires notification of all births to the Medical Officer of Health within 36 hours after the birth has occurred, circulars were freely distributed, placards exhibited, and advertisements inserted in the local Press. All doctors and midwives residing or practising in the City were advised, and requested to bring the provisions of the Act to the notice of parents who are the persons primarily responsible. Stamped addressed cards are supplied, on application, for the purpose of notifying. It will take some time before the public become aware of this new requirement, but in some parts of the City the returns have been very satisfactory. On comparing the list of births eventually registered with those notified it is found that more notifications have been received from the poorer districts than from those inhabited by the well-to-do. As the object of early notification is to enable advice to be given to the mother in regard to the rearing and nurture of the child, where necessary, it is of less importance that these latter have failed to notify. Letters have been addressed to a number of fathers who have not notified, asking for an explanation; ignorance was pleaded as an excuse in each instance. The operation of the Act has had other results. From the experience of previous years in which infant visiting has been carried on, it was known that irregularities occurred, especially among the foreign population, with regard to registration of births. The registrars now have access to the notification lists, and are thus enabled to check their lists, and to obtain earlier registration. Difference in the dates on which births have occurred is not at all unusual. In some instances this is due to forgetfulness, in some it appears to be due to the parent having calculated the date by the Russian calendar; but in a few cases, in which the difference of date has been considerable, there had evidently been delay in registering, so, to save the extra fee which would be charged, the date was altered to 13 • bring it within the limit. There is little doubt also that some births were never registered at all. Another result has been to secure greater accuracy in names and addresses. The names of some of the Bussiar, and Polish inhabitants are difficult to pronounce, consequently, from this or other reasons, they became modified or changed altogether, the first name being often taken as the surname; then, sometimes, the wife gives her maiden name instead of her married name, so that a family may appear in different lists under various appellations. During the year notification was received of 1,612 births which took place in Westminster; of these, 41 were stillborn children. By taking all the births which were registered as having occurred after the 18th January, and by noting which of these particular births had been notified, it is found that the proportion of births notified was 64.8 per cent, for the Citv. The percentages in the several registration areas were as follows:— May fair Registration District. Births Registered. Births Notified. Percentage. Mayfair 167 35 20.9 Belgrave 802 500 60.2 St. John 709 586 82.7 St. James 331 183 55.2 Strand 131 84 64.1 The City 2,140 1,388 64.8 The difference between 1,388 and 1,612 is due to the omission of notified births in the latter months of the year which were not registered by the 31st December. Still births, which are not registrable, are also excluded. The notifications were made by parents in 326 instances, 609 by doctors, 492 by midwives, 185 by other persons. In addition, information is received through the County Council of births coining to their knowledge in their work of supervising midwives, and from Medical Officers of Health of boroughs in which there is a maternity hospital; births occurring in such an institution would be registered in the borough in which it is situate. Notice of 200 births were so received. Further, the Health Society received 700 names of women expecting to become mothers from six hospitals and three maternity societies. Visiting'of the families was carried out by Miss Horn, the Council's Health Visitor, assisted by a staff of voluntary workers. Suitable b 14 leaflets* were widely distributed, both by the visitors and the registrars. Miss Horn reports that these, and the advice given, appear to be much appreciated, and that the mothers display more intelligent interest in the care of their own health as well as that of their children. The method followed is to begin visiting about twelve days after the birth has occurred (if the mother has been visited beforehand, visiting is suspended during these twelve days). This course is advisable for several reasons; the patient is under the supervision of a medical man or midwife, and it is not desirable to disturb the mother with visits; when the nurse has left and the patient is left to tend her child by herself she is more ready to accept the advice and instruction which the visitor may offer. Visiting is continued, if deemed necessary, throughout the year, once a month, or more frequently in the first three months, and afterwards quarterly. During the year, 1827 infants born in 1909 have been visited, and together with their families have been kept under observation; 1495 of these had been notified; the balance of the notified births were considered "above the standard" and were not visited; 700 of those eventually notified or registered were being visited before the confinement took place. In addition, visiting also took place of 823 children born in 1908. An analysis on tbe same lines as that printed in last year's report, but restricted to children born in 1908, who have been visited throughout 1908 and 1909 has been made. Families who have moved from the district, or who have not been visited during the whole twelve months following birth, have been excluded from the analysis. Subjoined are tables relating to the northern part only of the City, which includes the Soho area. They deal with 498 children born to 493 mothers. Table II shows the influence of housing, poverty, the mother's work, health, and the mode of feeding, and the rate of infant mortality and ill-health. Table III shows the influence of the mother's work on her health, confinement, mode of feeding of the child, and care of home. * The leaflets deal with (1) The care and management of infants and children; (2) Infant management (in English, Italian, and Yiddish); (3) Management of children over one year; (4) Hints to mothers; (5) Measles and whooping cough; (6) Summer diarrhoea; (7) Care of the teeth; (8) Simple cookery. 15 Table II. Number of Cases Infants. Healthy. Delicate. Dead. Number. Per Cent. Number. Per Cent. Number. Per Cent. a. Housing (type of house)— 176 Block 144 81.3 8 4.6 25 * 14.1 307 Tenement 235 75.8 36 11.6 39 12.6 10 Cottage 9 81.8 1 9.1 1 9.1 b. Housing (sanitary conditions)— 383 Good 315 81.4 28 7.2 44 11.4 71 Indifferent 52 73.3 11 15.5 8 11.2 30 Bad 16 53.3 6 20 8 26.7 (12) (Basement) (10) 83.4 (1) 8.3 (1) (8.3) 9 Unstated 5 50 — — 5 50 c. Poverty — 372 Comfortable (over 25s.) 300 80.2 32 8.6 42 11.2 59 Poor (21.?. to 25s. inclusive) 47 77.1 8 13.1 6 9.8 31 "Very poor (under 21s.) 19 59.4 2 9.4 10 31.2 31 Unstated 22 68.7 3 9.4 7 21.9 d. Mother's Work— 286 No occupation 230 79.9 28 9.6 31 10.5 130 Homework .. 100 76.3 12 9.1 19 14.6 77 "Working out 58 74.3 5 6.4 15 19.3 e. Mother's Health— 414 Stronge 342 82.1 33 7.9 42 10 79 Delicate 46 50.8 12 14.8 23 28.4 f. Mode of Feeding— 299 Breast 276 92.3 18 6.0 5 1.7 71 „ (under 4 weeks) 34 48.5 10 14.4 27 (11) 37.1 66 ,, (over 1 month and not 6 months).. 50 75.6 8 12.2 8 12.2 53 Bottle 28 52.7 9 171 16 (3) 30.2 * Figures in brackets denote infants dying under 1 month, † 23 infants—9 still-born, 14 dying within 1 week, excluded. Table III. Number of Cases. Mother's Work. (a) Mother's Health. (b.) Confinement. Healthy. Delicate. Normal. Abnormal. 286 No occupation 239 47 266 20 130 Home work 110 20 119 11 77 Working out 65 12 73 4 493 Number of Cases. Mother's Work. (c) Mode of deeding.* (d) Care of Home. Breast. Partly Bottle. Good. Indifferent. Bad. a. b. c. 286 No occupation 188 38 34 34 26 236 34 16 130 Home work 77 26 14 14 13 99 24 7 77 Working out .. 34 15 17 17 11 57 13 7 493 * 23 infants—9 still-born, 14 dying within 1 week, excluded. b 2 16 The superior health and low mortality of breast-fed infants in all classes is even more marked in this year's babies than in those of 1907, although the percentage of those so fed is less for 1908. The average (68 per cent.) of the two years is more likely to be nearer to the truth. For these two years the percentages in the northern part of the City are as follows:— Table IV. Number of Cases. Mother's Work. Mother's Health. Confinement. Care of Home. Healthy. Delicate. Normal. Abnormal. Good. Indifferent. Bad. 647 No occupation 76.6 23.4 91.8 8.2 76.2 15.3 8.5 239 Home work 77.0 23.0 90.8 9.2 71.0 20.0 9.0 144 Working out 79.8 20.0 88.9 11.1 63.3 19.0 17.6 1,030 Number of Cases. Mother's Work. Mode of Feeding of Infant. Health of Infant. Breast. Partly. Bottle. Good. Delicate. Dead. (a.) (b) 647 No occupation 69.7 11.3 10.0 9.0 83.6 11.3 5.1 23!) Home work 65.0 15.4 9.4 10.2 75.0 13.3 11.7 144 Working out 48.3 18.2 16.7 16.7 67.0 16.5 16.5 1,030 Mothers who undertake work in addition to their household duties appear to be a little stronger than others, but they have more difficult confinements. The influence of other claims on their time is shown clearly in the care bestowed on the home, in the mode of feeding adopted for the infant, and the result on its health. That so many mothers as 48 per cent, of those working out suckled their children for at least six months is due to the fact that the work of a considerable proportion, 78, of these mothers takes them out for only part of the day, such as office cleaning, charing, &c.; 17 were engaged in laundries; 15 as tailoresses. The home-work was, tailoring for 105; dressmaking, 27; laundry work, 13; caretakers, 28; helping in shop, 29; sempstresses, 5; keeping lodgings, 21; various, 11. The following Table in reference to nationality also refers to the northern part of the City for the two years 1907-08:— 17 Number of Cases. Infants at the end of 12 months. Healthy. Delicate. Dead. Percent. Percent. Percent. 583 British 438 74.5 74 12.5 76 12.9 302 Jewish 221 73.1 55 18.2 26 8.8 90 Italian 75 83.3 7 7.7 8 8.8 38 Various 28 73.5 8 21.0 2 5.2 The Industrial Employment of Married Women and Infant, Mortality.—The Home Secretary had under consideration the report of the Physical Deterioration Committee in regard to the further regulation of the industrial employment of women before and after childbirth, together with the resolutions adopted by the Conference on Infantile Mortality, held in Caxton Hall in 1906, that women should not be employed in a workshop or factory within three months after giving birth to a child, and that women advanced in pregnancy should not be employed. He found that the question of imposing further restrictions presents difficulties both from a social and administrative point of view, but, before forming a decision, he considered it necessary to have fuller information than was then available, and with that view he held a Conference of Medical Officers of Health in 1907 at which it was decided that a systematic and simultaneous inquiry on uniform lines should be made in a number of industrial centres throughout the kingdom, the inquiry in each case to be limited to homogeneous districts and to families of the same class and circumstances. It was to relate to children born in the year 1908, and, as it is to cover the whole of the first year of life, it could not be completed until the end of 1909. The two main objects of the inquiry, so far as the Home Office is concerned, are:— (1) To determine the effect of the employment of women before and after childbirth on the health of mother and child, and particularly by means of a comparison between women who have been at work in a factory or workshop and women who have been otherwise employed or engaged only in domestic duties, whether employment in a factory or workshop has any special prejudicialeffect; and, (2) so far as the Medical Officer of Health may be able to collect material bearing on the question, to gauge the social and economic effects which further restrictions on the employment of women in factories and workshops before and after confinement would entail, and in particular whether such restrictions would or would not have indirect effects prejudicial to infant life, either (a) by adding to the economic burden of child bearing and so 18 leading to a further fall in the birth-rate, or (b) by increasing the poverty of the household, and so—through worse feeding, &c.— leading, to an increase in the infant death-rate. In Westminster, part of the Strand Parliamentary Borough appeared best suited to the purpose of such an inquiry, especially the wards of Great Marlborough, Regent, St. Anne and Covent Garden. The number of children born in these wards during 1908 was 565, but a few above a certain standard were excluded, and later there were eliminated a large number who moved away from the district before twelve months had elapsed from the date of birth. In each of the 459 remaining, the families were visited regularly by the visitors of the Health Society during the twelve months. The Home Office supplied forms which had to be filled up with details relating to the infant, the family, and the dwelling. There has also been supplied a series of tables, whereby analyses and summaries may be prepared. In the area selected, it was found possible to divide the families into two groups. Group I, in which the husbands are tailors, and Group II, in which the husbands follow any other occupation. An analysis of the nationality of these groups shows that in Group I, 78.7 percent. are foreigners, nearly all Jews (Russian and Polish), and 213 percent. are British. In Group II, 27.5 percent. are foreigners (half being Italian, the others of various nationalities) and 72.5 percent. British. In Group I a total of 150 cases has been analysed. 57 percent. of the mothers were found not to be industrially employed, 40.4 percent. work at home, i.e., helping their husbands, and 2.6 percent. work in a factory or workshop. In those not employed, 97.6 percent. of the children survive the first year, 1.2 percent. died during the first year, and 12 percent. were still-born. In those working at home 86.9 percent. of the children survive the first year, 11.4 percent. died during the first year, and 1.6 percent. were still-born. The wives in many cases employ a servant to look after the baby while they work in the business, as this is much cheaper than employing another hand. These figures show a great saving of infantile life in those not industrially employed. As to the feeding in those cases where the mother was not employed, 65.5 percent. were breast-fed for six months or over. 11.8 percent. were breast-fed for two or three months, and 16'8 percent. were breastfed for under one month, 2.4 percent. partially breast-fed and 38 percent. were artificially fed entirely. In those cases where the mother works at home, 58.5 percent. were breast-fed for six months or over, 13 percent. were breast-fed for two or three months, and 20.7 percent. were breast-fed for under one month; 5.7 percent. were partially breast-fed and 19 percent. were artificially fed entirely. 19 The figures on which the statistics are based are not large, but when considered with those of the previous year for the northern part of the City (see above) it will be seen that the conclusions which may be drawn are similar. I have not reproduced the Home Office tables here, but append a short summary in tabular form. Group I. Tailors. Mothers. Children. Average Income of Family. Surviving 1st Year. Dying 1st Year. Stillborn. Percent. Percent. Percent. s. d. Not industrially employed 97.6 1.2 1.2 32 5 Industrially employed at home 86.9 11.4 1.6 43 3 Children Surviving the 1st Year. Mothers. Children Breast-fed Children Artificially Fed Entirely. 6 Months and Over. 2—3 Months. 1 Month. Partially. Percent. Percent. Percent. Percent. Percent. Not industrially employed 65.5 11.8 16.8 2.4 3.8 Industrially employed at home 58.5 13.0 20.7 5.7 1.9 Working at home in this trade, even though it brings in a larger income, is apparently detrimental to the infant's health. In Group II there are included 309 infants, and 58.9 percent. of the mothers are not industrially employed. In this sub-division 85.2 percent. of the children survive the first year. Only 5.8 percent. of the mothers are employed in a workshop, and 77.8 percent. of the children survived the first year. The balance, 35.3 percent., of the mothers cannot be said to be "industrially" employed either at home or elsewhere, as among them are included women acting as caretakers of premises, looking after lodgings, office cleaning and such like work, occupying them only a part of the day. The number actually employed in handicrafts is too small to deal with statistically. If, however, all the above are included as "industrially" employed, then the figures are as shown below:— 20 Group II. Other Occupations. Mothers. Surviving 1st Year. Children. ge Income of Family. Dying 1st Year. Stillborn. s. d. Not industrially employed 82.5 13.2 1.6 26 2 Employed in factory or workshop 77.8 22.2 — 22 7 „ at home 91.5 8.5 — 32 - „ elsewhere 82.0 16.4 1.6 24 7 Mothers. Children Breast-fed. Children Artificially Fed. Months nd Over. 2—3 Months. 1 Month. Partially. Percent. Percent. Percent. Percent. Percent. Not industrially employed 78.7 7.7 8.4 2.6 2.6 Employed in factory or shop 42.9 21.4 28.6 — 7.1 „ at home 60.4 14.0 14.0 4.6 7.0 „ elsewhere 54.9 27.4 5.9 2.0 9.8 In these figures it appears that there is some relation between the average income and the chance of the child surviving. The Health Visitor has prepared a number of diagrams showing how the visit to the infant leads to the discovery of other matters of importance and value. One of these is appended as an example Diagram showing development of health work. Case visited at birth of baby. Discovery of weak members of family. Methods of dealing with fame. 21 Baby, born March, 1905.* Father, tailor, Mother. Sister, 14. Brother, 10, Brother, 3½. Baby,* Baby, suffering from phthisis 3 years. Waistcoat hand. Scarlet fever. at school suffering from glands. Measles, bronchitis. C.C.H.F. 4 weeks. born Mar., 1905. born Dec., 1906. O.P. Middlesex Hospital 1 year. Home worker. No other illness. I.C.A.A. sent to Ramsgate for 4 months. Rheumatism and heart. Whooping cough and pneumonia. Very delicate. Health good. Helps mother at home. Tonsilitis. C.O.S. sent to Convalescent Home 3 months. I.P. Middlesex 11 weeks. Died. Age 6 months, Aug., 1905. Well cared for. Frequently visited, Adenoids removed at Middlesex Hospital. i I.C.A.A. and C.O.S. boarded out 3 months. Relapse year later. Sent to Convalescent I.C.A.A. and C.O.S. Apparently healthy. Home again. sent to Tunbridge Wells. School. Not thriving. Relapse 6 monthslater. I.P. letter obtained Royal Chest Hospital. C.C.E.P, 4 weeks. 2 year in succession under medical supervision. Too ill for admission, Admitted to Hendon Infirmary. | Disinfection. Home done up. Window made to open, &c. Died at Hendon, July, 1907. Age 42. 22 Dinners for Nursing Mothers.—The scheme of supplying these dinners, started by Mrs. Methold in 1907, has been continued during the winter months. The object is to minimise, in some degree, infant mortality by giving good meals to expectant or actual nursing mothers during the two months before and the nine months after confinement. The dinners are iutended only for such women as are in real want; one penny is charged, and the dinners must be consumed on the premises. During the winter (1908-9) 1,335 meals were given to 52 women. Deaths. 2,437 deaths were registered in the City in the 52 weeks ending the 1st January, 1910. After deducting 1,091 deaths of non-citizens in public institutions in the City, and adding those of 881 citizens who died in other districts, the corrected total is 2,196, and is equivalent to an annual rate of 12.7 per 1,000 persons. The London death-rate for the same period was 14.0, and for England and Wales 14.4, the lowest rate on record (see Table VI). Tables VI to XIII show the vital statistics of the City and five groups of districts from 1891 to 1909. The death-rates, according to the old districts of the City, are:— District. Average of Previous 10 Years. 1909. St. George 12.5 11.3 Westminster 17.2 15.6 St. James 13.5 11.4 St. Anne 13.2 11.5 Strand and St. Martin 16.5 12.9 The City 14.6 12.7 The Ward rates are shown in Table VI. Cause of death at all Ages.—These are set forth in Table VIII, and also their distribution in the various Wards of the City. Influenza again caused an excess of deaths, and was accompanied by an increase in the number of deaths from chest diseases. Phthisis deaths show an increase, those from cancer are slightly less than those recorded in 1908. There were more deaths from scarlet fever, whoopingCough, diabetes, nervous diseases and old age. Ages at Death.—Of the total deaths, 258 were those of children under 1 year of age, and 755 of persons over 65 years of age; these are referable to the various wards, as follows:— 23 1909. 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 Q,uarter. 4th Quarter. The Year. Conduit - 1 1 - 2 2 - 4 3 9 Grosvenor 1 2 2 — 5 27 15 4 7 53 Hamlet of Knightsbridge 1 3 1 2 7 14 7 3 4 28 Knightsbridge St. George 4 2 4 1 11 23 10 8 9 50 Victoria 18 21 19 28 86 72 35 22 51 180 St. Margaret 3 4 — 1 8 20 13 5 13 51 St. John 23 20 18 18 79 55 39 34 55 183 St. Anne 7 4 6 6 23 11 8 6 9 34 Great Marlborough — 3 3 6 ] 2 11 4 8 6 29 Pali Mall — — — 1 1 3 7 1 2 13 Regent 4 3 3 — 10 15 6 5 7 33 Charing Cross 3 — — — 3 5 6 — 5 16 Covent Garden 1 1 3 6 11 11 7 9 8 35 Strand — — — — — 11 7 12 11 41 The City l909 65 64 60 69 258 280 164 121 190 755 1908 82 56 74 81 293 245 168 135 208 756 1907 106 74 49 74 303 246 159 133 180 718 1906 82 68 106 67 323 193 170 119 182 664 The deaths of young children were again less; those of old persons were about the same as in the previous year. Influenza and chest affections have killed a large number of old people in each of the last three years, especially in the first quarters. Infantile Mortality.—The uncorrected rate for the City was 102 deaths per 1,000 births registered in the City, as compared with 133, the average of the previous ten years. The corrected rate was 93, the average of the years 1901-8 being 112. 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 91 per 1,000. The London rate for 1909 was 107, the average being 137. The infantile death-rate in England and Wales was 109, being 11 below the rate in 1908 and 29 below the ten yearly averages. Table VII, required by the Local Government Board, shows in detail the ages and causes of death of children under 1 year of age. Figures for both births and deaths of infants corrected, showing the true rate in each of the last eight years:— 24 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 1904 2,920 320 109 134 40 298 118 1905 2,971 305 102 149 24 161 105 1906 2,744 285 ]03 187 38 203 110 1907 2,764 269 97 163 34 208 103 1908 2,739 266 97 174 27 155 100 1909 2,548 232 91 203 26 128 93 Eight years 22,996 2,432 106 1,346 246 183 110 The following table shows the number of deaths of infants, and their relation to births in the last five years. It also shows the age periods at which they died. The causes of death in each year are given, together with the relative proportion each group bears to the whole of the infant deaths. 55 percent of the deaths under 1 year of age occurred before the infants were three months old, 38 percent before the end of the first month of life, and 22 percent soon after birth. These figures have not varied much from year to year, but this year they are less than hitherto. It is extremely difficult, even with careful inquiry, 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 inherent 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. In 1909, in addition to the deaths directly attributed to prematurity, congenital debility and injury at birth, which account for 109 deaths, there were 10 deaths from syphilis, and 42 children whose deaths were ascribed to other causes were found to have been prematurely born or to have suffered from debility or ill-health from birth, making 62 percent of the total number who died. Probably some of the remaining 97 should also have been included, but the information obtained was not sufficient to make a definite statement thereon. Table v.—Deaths of Infants under 12 months old per 1,000 horn (corrected figures). Age at Death. 1905. 1906. 1907. 1908. 1909. No. Rate. No. Rate. No. Rate. No. Rate. No. Rate. Under 1 week 66 21.1 64 21.8 85 29.1 66 21.2 57 20.8 ,, 1 month 131 41.9 120 41.0 126 43.1 105 38.3 99 35.9 ,, 3 months 195 62.5 195 66.6 182 62.3 166 60.5 143 51.9 3 to 6 months 38 12.1 53 18.1 57 19.4 47 16.1 53 19.2 6 ,, 9 „ 52 16.6 46 15.8 30 10.3 50 17.1 36 13.0 9 „12 „ 44 14.1 29 9.9 31 11.5 30 10.2 26 9.5 Total in year 329 105.4 323 110.4 303 103.5 293 100.5 258 93.8 Causes of Death. No. Percent. of total deaths. No. Percent. of total deaths. No. Percent. of total deaths. No. Percent. of total deaths. No. Percent. of total deaths. Common infectious diseases 37 11.2 12 3.7 17 5.5 17 5.8 19 7 3 Diarrhœal diseases 46 13.9 76 23.5 30 9.9 35 11.9 27 10.4 Premature births and injury, &c., at birth 84 25.5 72 22.5 96 31.6 93 31.7 90 34.8 Did not thrive—wasting—want of milk—rickets 49 14.8 50 15.4 43 14.0 52 17.7 38 14.7 Tuberculous diseases 17 5.1 18 5.5 15 4.9 14 4.7 11 4.2 Erysipelas and other septic diseases — — 10 3.0 9 2.9 3 1.0 4 1.5 Syphilis 15 4.5 7 2.1 12 3.9 7 2.3 10 3.8 Meningitis, convulsions 11 3.3 13 4.0 11 3.6 8 2.7 9 3.4 Bronchitis and pneumonia 45 13.6 44 13.6 56 18.4 52 17.7 36 13.9 Suffocation—overlying, &c. 5 1.5 6 1.8 6 1.9 6 2.0 3 1.1 Other causes 20 6.0 15 4.6 4 1.3 6 2.0 11 4.2 329 100 323 100 303 100 293 100 258 100 25 26 The question of proper feeding enters into every inquiry in connection with the death of an infant; thus, many pneumonia deaths are the result of malnutrition. Of 27 deaths from diarrhoeal complaints, 2 infants only were breast-fed entirely. 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 1907 1,163 60 51.6 18 15.5 116 1908 1,155 50 43.2 10 8.6 120 1909 1,156 41 38.0 12 10.3 99 The birth-rate for St. John's Ward, in which the Buildings are situated, is 26.2 for 1909. In the adjoining County Council Buildings at Millbank the rate is 27'9. The death-rate compares favourably with that of the Ward. The rate in the Millbank Buildings is 12.1 per 1,000. Table VI.—Quarterly and Annual Death-rates per 1,000 Inhabitants in the City of Westminster (in Various Wards), in the United Kingdom, England and Wales, and the County of London. Period. United Kingdom. England and Wales. County of London. The City. Conduit Ward. Grosvenor Ward. Hamlet of Knightsbridge Ward. Knightsbridge St. George Ward. Victoria Ward. St. Margaret Ward. St. John Ward. St. Anne Ward. Great Marlborough Ward. Pall Mall Ward. Regent Ward. Charing Cross Ward. Covent Garden Ward. Strand Ward. 1 st Quarter 18.4 18.2 19.0 17.1 4.4 14.6 15.9 14.4 19.9 13.8 23.3 15.4 14.4 9.4 16.5 10.5 17.0 15.7 2nd Quarter 14.5 14.0 12.7 12.1 4.4 9.7 9.0 7.8 13.2 10.9 19.0 10.2 11.5 12.2 12.1 8.6 9.2 13.2 3rd Quarter 11.9 11.6 10.8 9.1 5.1 2.9 4.7 5.1 10.2 5.9 16.0 9.5 9.2 9.4 7.3 3.8 10.2 11.9 4th Quarter 14.6 14.1 13.5 12.5 3.7 5.4 8.5 5.7 16.3 10.0 17.9 11.0 13.3 9.4 8.6 9.6 17.5 17.0 The Year 1909 14.8 14.4 14.0 12.7 4.4 8.1 9.5 8.2 14.7 10.1 19.5 11.5 12.1 10.1 11. 1 8.6 13.5 14.5 ,, 1908 15.5 14.7 13.8 l2.3 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 27 Table VII.—Infantile Mortality during the year 1909. Deaths from Stated Causes in Weeks and Months under One Year o] Age. CAUSE OF DEATH. Under 1 Week. 1—2 Weeks. 2—3 Weeks. 3—4 Weeks. Total under 1 Month. 1—2 Months. 2—3 Months. 3—4 Months. 4—5 Months. 5—6 Months. 6—7 Months. 7—8 Months. 8—9 Months. 9—10 Months. 10—11 Months. 11—12 Months. Deaths under One Year. Common infectious diseases— Small-pox — — — — — — — — — — — — — — — — — Chicken-pox - - - - - - - - - - - - - - - - - Measles — — — — — — — — 1 1 — 1 — — — 1 4 Scarlet fever — — 1 — 1 — — — — — — — — — — — 1 Diphtheria — — — — — 1 — — — — — — — — 1 — 2 Whooping cough — - — 1 1 — — 2 1 1 1 2 1 2 1 — 12 Diarrhoeal diseases— - - - - - - - - - - - - - - - - - Diarrhoea, all forms - - - - - - 2 1 — 1 I 1 — — 1 — 7 Enteritis, muco-enteritis, - - — — — 4 6 — 3 6 — — 1 — — — 20 gastro-enteritis Gastritis, gastro-intestinal catarrh Wasting diseases— Premature birth 40 9 4 3 56 2 3 — 1 — i — 1 — — — 64 Congenital defects 5 5 — 1 11 4 2 1 — — 2 — — — — — 20 Injury at birth 4 — 2 — 6 — — — — — — — — — — — 6 Want of breast-milk, starvation, improper food - - - - - - - - 1 1 1 - 1 - - - 4 Debility from birth 4 2 1 1 8 1 2 3 2 1 1 — — — 1 — 19 Marasmus — — — 1 1 — 6 1 1 1 3 — — — 1 1 15 Neglect - - - - - - - - - - - - - - - - - Tuberculous diseases — Tuberculous meningitis — — — — — — 1 — 1 — 2 — — 1 1 — 6 Tuberculous peritonitis, tabes mesenterica — — — — — — — 1 — — — 1 28 Population, estimated to middle of 1909,172,150. Births in the year—Legitimate, 2,548; illegitimate, 203—Total 2,751. Deaths in the year of legitimate infants, 232; illegitimate infants, 26—Total 258. Deaths from all causes at all ages, 2,196. The causes of death of the illegitimate children were: prematurity, 7; debility at birth and congenital defects, 5; injury or want of attention at birth, 4; wasting, 4; enteritis, 2; broncho-pneumonia, 2; tuberculosis, 1; whooping cough, 1. Other tuberculous diseases - - - - - - - - - - - - - - 1 1 4 Other causes- Erysipelas - - - - - - - - - - - - - - - - 1 Other Septic — 1 — 1 2 — 1 — — — — — — — — — 3 Syphilis — — 1 1 2 2 — 2 4 — — — — — — * — 10 Rickets - - - - - - - - - - - - - - - - - Meningitis (not tuberculous) - - 1 - 1 - 1 - - - - - 1 1 - - 4 Dentition - - - - - - - - - - - - 1 1 — — 2 Convulsions 1 — — - 1 — — — — — — — 1 — 1 — 3 Bronchitis - 1 - - 1 2 — — 3 2 1 — — 2 — — 11 Broncho-pneumonia — 2 2 1 5 — 1 2 1 1 3 1 4 4 — 1 23 Pneumonia - - - - - 1 - — — — — — — 1 — — 2 Suffocation, overlying - - - - - - - - - - - - - - - - - Accidents 3 — — — 3 — 1 1 2 - - - - - - - 7 Other causes - - - - - - 1 2 1 — 1 — - — 2 — 7 57 20 12 10 99 17 27 15 22 16 19 5 12 12 10 4 258 29 Table VIII.—Causes of, and Ages at, Death during the 52 weeks ending ls< January, 1910. 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 1 - - - - 1 - - - - - - - - 1 - - - - - - Measles 26 4 20 — 1 1 — 1 — — 3 2 3 4 5 3 - 2 - 3 - Scarlet fever 18 1 11 5 1 — — — — — 1 3 2 7 2 1 1 1 - - - Influenza 43 1 — 1 1 12 28 2 6 3 2 7 7 6 - - - 3 4 2 1 Whooping cough. 23 11 12 — — — — — — 2 — 9 — 7 1 - - 2 - 2 - Diphtheria, Memb. croup 18 2 12 - - - - - - - - 7 1 6 1 — 1 — — 1 - Cerebro-spinal meningitis 1 — — — — 1 — — — — — — 1 — — — - — - - - Enteric fever 9 — — — 3 6 — — — — 1 4 — 3 — 1 - - - - - Diarrhoea 6 4 — — — — 2 — — — — 3 — 1 — 2 - - - - - Epidemic enteritis 4 3 1 — — — — — — 1 — — — 1 1 - - 1 - - - Enteritis 23 20 1 — 1 — 1 — — 1 1 11 — 6 2 1 - 1 - - - Erysipelas 6 1 — — — 2 3 — — — 1 — — 2 1 - - - - 1 1 Puerperal fever 2 — — — — 2 — — 1 — 1 - — - - - - - - - Other septic diseases 17 3 1 1 3 5 4 1 — — — 2 — 5 3 1 - 3 - - 2 Syphilis, &c. 15 10 — — — 5 — — — — — 7 — 4 1 - - 1 - 1 1 Diabetes 23 — — — 1 16 6 1 2 2 2 6 2 1 2 2 - 1 - 1 1 Gout 8 — — — — 2 6 — 1 1 1 1 — 2 — — - - - 2 - Rheumatic fever 7 - 1 1 4 — — ] — — 1 — 2 1 — - 1 — 1 — 30 Tuberculosis of meninges 20 6 7 5 - 2 - - 1 1 1 4 1 7 3 — — — — 1 1 Tuberculosis of lungs 225 — 2 4 23 176 20 — 7 5 9 55 11 86 9 6 2 7 2 9 17 Tuberculosis of peritoneum 10 1 4 1 1 3 - — - — — 5 1 1 — — 1 1 — 1 — Other forms of tuberculosis 23 4 2 4 2 10 1 2 - 1 — 4 2 9 — — 1 — 1 2 1 Alcoholism 23 — — — — 23 - -_ 3 1 2 8 — 2 1 — — 2 — 2 2 Malignant growths 192 — — — 1 110 81 3 10 3 15 63 13 48 9 6 3 4 1 7 7 Premature birth 64 64 — — — — - — 2 2 5 14 4 18 7 4 — 1 2 5 — Developmental diseases 64 63 — 1 — — — — 2 1 3 20 2 22 4 3 1 3 1 2 — Old age 103 — — - — 1 102 - 5 2 8 22 8 21 8 9 1 2 1 3 10 Meningitis and convulsions 12 8 2 1 1 — — — - — 5 1 2 2 1 — 1 — — — Other diseases of nervous system 95 - 2 2 1 61 29 1 2 1 8 23 4 15 9 6 1 10 - 7 8 Yalvular diseases of heart 87 — — 1 9 46 31 - 8 4 5 20 5 22 5 4 — 2 4 5 3 Other circulatory diseases 218 — — 4 3 100 111 2 13 9 13 65 13 58 8 6 4 6 4 11 6 Bronchitis 276 11 9 — 86 170 3 19 6 8 84 7 67 13 12 3 19 4 16 15 Lobar (croupous) pneumonia 57 1 1 - 2 37 16 1 3 2 3 15 2 18 1 3 1 1 2 4 1 Lobular (broncho-) pneumonia 64 22 14 1 - 12 15 - 1 5 2 18 5 19 8 2 - - - 3 1 Other respiratory diseases 66 2 2 1 2 34 25 1 3 1 7 10 8 20 3 _ 1 8 1 3 — Cirrhosis of liver 38 — — - — 32 6 2 2 1 1 9 4 8 2 2 — 2 — 4 1 Other digestive diseases 54 3 — 3 2 31 15 1 10 4 4 12 6 10 - 2 1 2 — 2 — Bright's disease, &e. 117 — 1 - 2 56 58 1 10 5 6 27 5 24 5 5 4 6 6 7 6 Generative system diseases 5 — - - 1 4 - - - - - 2 - - - - 1 - 1 1 — Accidents and diseases of parturition 9 - - - 1 8 - - - 1 - 2 1 1 - - 1 2 1 - - Deaths by accident or negligence 62 10 5 2 7 29 9 1 4 4 2 14 6 16 6 2 1 3 - 1 2 Deaths by suicide and murder 25 - - - 2 21 2 - - 3 4 5 3 5 - - - 2 1 1 1 All other causes 37 3 1 — 1 18 14 1 3 — 2 9 2 10 2 — 1 3 — — 4 All causes 2,195 258 111 42 73 957 755 24 120 72 121 578 130 569 126 84 30 103 36 1ll 92 31 Table IX. City of Westminster—Statistics of Births and Deaths during the 52 Weeks from 3rd January, 1909, to 1st January, 1910, giving the Corrected Figures and Rates. 1 2 3 4 5 6 7 8 9 10 11 12 Average Deathrate 1901-8. 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. Number. Rate.* Number. Rate per 1,000 Birth (Corrected). dumber. Rate.* Conduit 5,400 19 3.5 2 105 19 8 5 10 24 4.4 6.1 Grosvenor 14,700 121 8.2 5 41 89 37 14 45 120 8.1 8.9 Knightsbridge St. George 14,700 169 11.4 11 65 466 41 383 38 121 8.2 8.3 Victoria 39,300 847 21.5 86 101 324 269 20 274 578 14.7 15.4 St. Margaret 12,750 163 12.7 8 49 359 46 268 39 130 10.1 11.3 St. John 29,140 765 26.2 79 103 366 329 117 320 569 19.5 20.2 Hamlet of Knightsbridge 7,520 80 10.6 7 87 54 22 8 26 72 9.5 8.5 Pall Mall 2,950 21 7.1 1 45 17 11 4 17 103 10.1 9.1 Regent 9,200 125 13.5 10 80 63 57 18 58 103 11.1 12.2 Great Marlborough 6,900 104 15.0 12 115 60 57 22 46 84 12.1 14.2 Charing Cross 4,150 24 5.7 3 125 34 13 14 16 36 8.6 10.2 Covent Garden 8,200 131 15.9 11 83 257 65 205 59 111 13.5 16.2 Strand 6,340 9 1.4 — — 218 78 190 64 92 14.5 17.8 St. Anne 10,900 173 15.8 23 132 80 74 32 78 126 11.5 12.2 The City 172,150 2,751 15.9 258 93 2,406 1,107 1,091 881 2,196 12.7 137 * Rates calculated per 1,000 of estimated population. The uncorrected birth-rate was 14 6, the uncorrected death-rate, 13 9. 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. 32 Table X.—Deaths of Citizens during the Year ending 1st January, 1910, showing Locality a,t 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. Totai. Conduit 8 6 14 2 1 3 4 1 5 - - - - - - - 2 2 14 10 24 Grosvenor 33 40 73 3 10 13 7 10 17 1 — 1 2 4 6 6 4 10 52 68 120 Hamlet of Knightsbridge 19 27 46 3 3 6 5 11 16 — — — — — — 2 2 4 29 43 72 Knightsbridge St. George 35 43 78 8 11 19 9 7 16 — 1 1 3 2 5 1 1 2 56 65 121 Victoria 140 159 299 69 65 134 42 40 82 6 2 8 19 26 45 9 1 10 285 293 578 St. Margaret 42 37 79 5 13 18 16 6 22 2 2 4 1 1 2 3 2 5 69 61 130 St. John 126 104 230 127 66 193 73 33 106 7 6 13 6 10 16 10 1 11 349 220 569 St. Anne 26 22 48 13 18 31 20 12 32 4 2 6 2 2 4 4 1 5 69 57 126 Great Marlborough 16 10 26 11 16 27 9 4 13 2 — 2 4 11 15 1 — 1 43 41 84 Pall Mall 11 2 13 1 1 2 3 4 7 — 1 1 1 — 1 6 — 6 22 8 30 Regent 22 23 45 10 15 25 13 9 22 1 — 1 8 1 9 1 — 1 55 48 103 Charing Cross 12 8 20 1 4 5 4 4 8 — — — — — — 2 1 3 19 17 36 Covent Garden 23 21 44 25 10 35 11 ]0 21 1 — 1 5 3 8 2 — 2 67 44 111 Strand 7 5 12 52 15 67 3 1 4 - - - 5 2 7 ] 1 2 68 24 92 City of Westminster 520 507 1,027 330 248 578 219 152 371 24 14 38 56 62 118 48 16 64 1,197 999 2,196 33 Table XI.— Vital Statistics of Whole Districts during 1901-1909. 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 NonResidents Registered in Public Institutions in the District, Deaths of Residents Registered in Public Institutions beyond the District. Nett Deaths at all Ages belonging to the District. Number (Uncorrected). Rate.* Number (net). Rate per 1,000 Births Registered. Number. Rate.* Number. Rate.* 1901 182,567 3,232 17.8 435 135 2,998 16.3 1,227 1,019 921 2,900 15.8 1902 1184,211 3,284 17.8 442 134 2,899 15.7 1,129 906 959 2,952 16.0 53 weeks 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 1,244 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,P05 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 1,171 992 833 2,237 12.9 1908 53 weeks 1172,650 2,665 15.1 293 109 2,437 13.8 1,234 1,089 829 2,177 12.3 1909 172,150 2,520 14.6 258 102 2,406 13.9 1,229 1,091 881 2,196 12.7 * Rates in Columns 4, 8, and 13 calculated per 1,000 of estimated population. Note.—The deaths to be included in Column 7 of this Table are the whole of those registered during the year as having actually occurred within the district or division. The deaths to be included in Column 12 are the number in Column 7, corrected by the subtraction of the number in Column 10 and the addition of the number in Column 11. By the term "Non-residents" is meant persons brought into the district on account of sickness or infirmity, and dying in public institutions there; and by the term "Residents" is meant persons who have been taken out of the district on account of sickness or infirmity, and have died in public institutions elsewhere. The "Public Institutions" to be taken into account for the purpose of these Tables are those into which persons are habitually received on account of sickness or infirmity, such as hospitals, workhouses, and lunatic asylums. A list of the institutions in respect of the deaths in which corrections have been made is given on the next pages. Total population at all ages 183,011} Area of District in acres (exclusive of area covered by water) 2502.7 Number of inhabited houses 18,366} At Census of 1901. Average number of persons per house 8.9} 34 35 Table XI.—continued. i. Institutions within the District receiving Sick and Infirm Persons from outside the District. (Total Number of Deaths in brackets.) ii. Inst itutions outside the District receiving Sick and Infirm Persons from the District. II—continued. Institutions outside the District receiving Sick and Infirm Persons from the District. St. George's Hospital (384). Middlesex Hospital. New Hospital for Women. Westminster Hospital (283). St. Thomas's Hospital. Joyce Green Hospital. Charing Cross Hospital (188). St. Bartholomew's Hospital. East London Hospital. King's College Hospital(173). St. Mary's Hospital. Home Hospital, Fitzroy St. Peter's Hospital (20). Guy's Hospital. Square. Grosvenor Hospital (8). Endell Street Lying-in Hospital. St. George's Infirmary, Fulham Road. Heart Hospital, Sobo Square (22). Italian Hospital. St. Pancras Infirmary. Women's Hospital, Soho Square (4). Great Northern Hospital. French Hospital. Wandsworth Infirmary. Children's, Carshalton. Throat Hospital, Golden Square (14). Victoria Hospital. General Lying-in Hospital, Marylebone Infirmary. Edmonton Workhouse. Gordon Hospital (3). York Road. Robinhood Court. Military Hospital, Millbank (2). Children's, Paddington. West London Hospital. St. George's Workhouse, Fulham Road. Queen Alexandra Military Hospital, Millbank (29). St. George's Workhouse, Wallis Yard (3). Queen Charlotte's Hospital. Great Ormond Street Children's Hospital. Cancer Hospital, Chelsea. Central London Sick Asylum, Cleveland Street. Central London Sick Asylum, Hendon. Poland Street Workhouse (31). University College Hospital. Brompton Hospital. Banstead Asylum. Bethlehem. Sheffield Street Workhouse (22). Hospital of St. John and St. Elizabeth. Long Grove Asylum. Camberwcll House. 22, .George Street, Hanover Square, Nursing Home (3). South-Western Fever Hospital. Cane Hill Asylum. Caterham Asylum. Infants' Hospital (78). Western Fever Hospital. Clay bury Asylum. Lock Hospital (3). London Fever Hospital. Coluey Hatch Asylum. Royal Western Ophthalmic Hospital (1). Grove Fever Hospital. Roval Hospital, Waterloo Dartford Heath, City of London, Home. 94-6, Belgrave Road (1). Road. Hanwell Asylum. 87, Belgrave Road (1). Royal Chest Hospital. Horton Asylum. 24, Chapel Street (1). Royal Free Hospital. Leavesden Asjlum. 42, Belgrave Road (1). Freidenheim. Belgrave Hospital. National Hospital, Queen's Square London Temperance Hospital Tooting Bee Asylum. Manor Asylum. Metropolitan Benefit Society 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. Ill—continued. Other Institutions, the Deaths in which have been distributed among the several localities in the District. Hostel of God. St. Luke's House, Pembridge Square. 8, 51 and 55, Welbeck Street. St. Ann's House, Stoke Newington. 3, Bentinck Street, Marylebone. 31, Broomwood Road, Battersea. Crossways, Sutton. 19 and 57, Beaumont Street. 12, Holies Street. St. Peter's House, Lambeth. St. Elizabeth's Home, East Ham. 5, Burwood Place, Paddington. 53, Ritherdon Road, Streatham Jewish Home, South Tottenham. 182, Hercules Road, Lambeth 39, Royal Avenue, Chelsea. Catholic Nursing Home, Lambeth. David Lewis Colony,Marthall Tailor's Institution, St. Pancras. 1, Brixton Road. 30, Poruhester Square. 7, Colosseum Terrace. 68, Hereford Road, Paddington. St. Joseph's Home. All Saint's Home, Margaret Street. 7, Mandeville Place. Ockley Sanatorium. 18, Manchester Street. Cottswold Sanatorium. 11, Duchess Street, Marylebone. 19, Manchester Street. Table XII (L.G.B. Table).— Vital Statistics of Separate Localities, 1891-1909. Names of Localities J 1. The City of Westminster. 2. St. George's, comprising Conduit, Grosvenor, Victoria, and Knightsbridge St. George Wards. 3. Westminster, comprising St. Margaret, St. John, and the Hamlet of Knightsbridge Wards. 4. St. James, comprising Regent, Marlborough, and Pall Mall Wards. 5. St. Anne Ward. 6. Strand, comprising Covent Garden, Strand, and Charing Cross Wards. Year. Population estimated to middle of each year. Births registered (uncorrected). Deaths at all ages (corrected). Deaths under 1 year. Population estimated to middle of each year. Births registered (uncorrected). Deaths at all ages (corrected). Deaths under 1 year. Population estimated to middle of each year. Births registered (uncorrected). Deaths at all ages (corrected). Deaths under 1 year. Population estimated to middle of each year. Births registered (uncorrected). Deaths at all ages (corrected). ! Deaths under 1 year. Population estimated to middle of each year. Births registered (uncorrected). Deaths at all ages (corrected). Deaths under 1 year Population estimated to middle of each year. Births registered (uncorrected). Deaths at all ages (corrected). Deaths under 1 year. 1891 202,136 4,507 4,024 740 79,967 1,610 1,312 216 55,651 1,449 1,148 256 24,839 508 493 84 12,422 334 293 65 29,257 606 778 119 1892 199,382 4,377 4,070 710 78,649 1,519 1,334 220 55.217 1,418 1,297 246 24,368 524 446 76 12,378 310 261 67 28,770 606 732 101 1893 198,249 4,255 3,970 699 78,883 1,496 1,217 204 54,783 1,350 1,290 255 23,873 520 470 71 12,334 330 278 58 28,376 559 715 111 1894 197,283 4,017 3,277 587 79,123 1,499 1,096 177 54,349 1,219 1,006 180 23,571 456 390 80 12,290 288 202 41 27,950 555 583 109 1895 196,254 4,155 3,559 683 79,368 1,470 1,185 204 53,915 1,278 1,154 246 23,149 528 407 74 12,246 324 203 48 27,576 555 610 111 1896 194,866 3,968 3,277 642 80,041 1,407 1,117 211 53,481 1,222 987 209 22,955 484 396 72 12,200 292 231 58 26.189 563 546 92 1897 194,120 3,846 3,177 587 80,376 1,365 1.067 183 53,047 1,238 1,005 200 22,576 446 388 75 12,150 314 185 39 25,971 483 532 90 1898 193,304 3,715 3,324 571 80,703 1,411 1,072 172 52,613 1,088 1,093 198 22,200 434 408 73 12,150 290 205 39 25,638 492 546 89 1899 192,452 3,610 3,442 600 81,033 1,348 1,1.56 177 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 l,097 208 21.457 410 341 62 12,000 273 189 36 24,703 399 467 75 1901 185,648 3,241 2.900 435 77,475 1,199 1,007 156 52,851 1,124 871 151 21,403 453 350 62 11,590 289 148 21 22,329 387 425 43 1902(53weeks) 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 I906 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 172,900 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 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 Averages of 10 years 1899 to 1908 180,168 3,058 2,631 396 76,476 1,187 961 134 51,506 1,052 889 156 20,236 340 274 42 11,335 232 150 25 20,834 271 345 39 1909 172,150 2,520 2,196 258 74,100 1,038 843 104 49,410 930 771 94 19,050 230 217 23 10,900 154 126 23 18,690 168 239 14 The figures for the several districts previous to the formation of the City in November, 1900, relate to the areas as then existing, except as regards No. 6, in which case the figures relating to the added part were obtainable from the reports of the late Medical Officer of Health for St. Giles. 36 37 Table XII, continued.— Vital Statistics of Separate Localities, 1891.1909.— Rates. 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 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. 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. Rate per 1,000 Births (uncorrected). Births Registered (uncorrected). Rate per 1,000. Deaths at all Aces (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 (uncorrected). Rate per 1,000. Deaths at all Ages (corrected). Rate per 1,000. Deaths under 1 Year. Rate per 1,000 Births (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 14.9 138 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 16.9 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 17.1 153 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 20.3 203 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 1903 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 l0.0 111 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 1908 15.4 12.3 109 14.2 11.6 103 19.6 13.8 117 13.0 10.1 98 14 .7 10.1 104 9.4 14.9 127 Averages of 10 years 1899 to 1908 16.9 14.6 129 15.5 12.5 1.3 20.4 17.2 148 16.8 13.5 123 20.5 13.2 107 13.0 16.5 143 1909 14.6 12.7 102 14.0 11.3 100 18.8 15.6 101 12.1 11.4 100 14.1 11.5 149 9.0 12.9 83 (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. See Table VIII.) 38 Table XIII.— Vital Statistics relating to Residents in Blocks of Dwellings in the City of Westminster, 1909. Buildings. Population. Births. Total Deaths. Infectious Deaths. Tubercular Deaths. Respiratory. Digestive. Circulatory Diseases. Nervous Diseases. Kidney Diseases. Violence. Cancer. Developmental Diseases. Other Deaths. Deaths Under 1. Deaths Over 65. Westminster City Council— Regency Street 1,155 44 12 2 i 4 2 2 — — — — 1 — 4 — St. James's Dwellings, Ingestre Place, and Marshall Street 163 2 7 - - 4 - 1 - - 1 - - 1 1 5 Peabody 6,761 162 113 13 19 29 2 13 8 4 2 3 10 10 23 32 West minster 187 3 9 — 1 1 1 1 — 1 — — — 4 1 3 London County Council— Mill bank 3,043 85 37 4 6 8 1 2 1 1 — 3 9 2 14 4 Drury Lane 1,000 25 9 2 1 1 1 3 — — 1 — — — — 1 Improved Industrial 6,878 126 59 3 5 11 5 8 5 3 3 3 4 9 9 19 Metropolitan Association 757 20 12 2 1 2 1 1 — — 2 2 — 1 1 4 St. Greorge's Model Dwellings 419 6 14 1 — 6 2 1 — — 1 1 — 2 — 9 Clerken well and Soho Company (Newport Market) 1,184 35 9 1 2 1 — 1 — — — 3 1 — 1 1 Green coat 119 6 — — — — — — — — — — — — — — Spencer 99 1 1 - - - - - - - - - - 1 — 1 Chapter Chambers 175 4 — — - - - - - - - - - - - - Alexandra and Castle — 6 3 — — 1 — 1 — — — 1 — — — 1 New Buildings — 1 — — — — — — — — — — — — — — St. James's Residences - 19 4 - - 1 - 1 - - - - 1 1 1 - 39 B. Communicable Diseases. (1) Compulsorily Notifiable Diseases. The details respecting the 951 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. 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 charts indicate the number of notifications of scarlet fever, diphtheria, enteric fever, and erysipelas in each week. In London as a whole smallpox, puerperal, typhus and other continued fevers were above the number of cases notified in recent years, while scarlet fever, diphtheria, enteric fever and erysipelas were below. In Westminster diphtheria and erysipelas showed an increase. 183 visits were paid in connection with doubtful cases, contacts, patients returning from fever hospitals, &c. Smallpox.—A man suffering from this disease was notified in Camberwell. He had come from Cairo, and arrived in London on the 21st January. His mother and three sisters were employed in Westminster, two of them being hands in tailors' establishments. Steps were at once taken to disinfect the work-places and all articles of clothing therein, as well as some articles which had already been delivered to the shops. Fortunately, most of those employed in the various places had been re-vaccinated fairly recently, so that the risk of the disease spreading amongst them was reduced to a minimum, and no cases have occurred from this source in Westminster. On the 2nd March, however, an Italian employed in a hotel kitchen as a scullery man took ill, and was eventually found to be suffering from smallpox. The origin of his illness could not be traced, but he must have received the infection on the 18th or 19th February. There had been a number of cases in Bristol, but no connection could be traced between them. The man died. He had been unsuccessfully vaccinated in infancy. Between 30 and 40 persons had been exposed to infection in the house; 15 of these were engaged in hotels and restaurants, 1 as a milliner and 1 as an upholsterer. Most of these people had been re-vaccinated within recent years; those who had not were re-vaccinated at once. Three adults and 3 children (including the patient's wife and child) were taken into the Shelter for two days. No spread of the disease occurred. There were a few cases at the same 40 time in other parts of London, a circumstance which suggests that there may have been some unrecognised mild case, possibly a visitor or some one passing through London with whom these people came in contact. During the year 21 cases of this disease were notified in London, 8 of them being in Stepney; the others were spread over 10 boroughs. Intimation was received of 65 persons who had been in contact, or came from places where smallpox existed, and these were kept under observation. Vaccination.—The Vaccination Officers have supplied me with the following particulars relating to vaccination of infants born in 1909:— Vaccination Statistics. 1908. Union. Births. Died Unvaccin ated. Successfully Vaccinated. Insusceptible. Vaccination Postponed. Conscientious Objectors. Removed and Vaccination Officer Informed. Not Found. Removed to Address Unknown. St. George 2,038 147 1,714 5 14 92 23 43 Westminster 400 25 323 2 2 7 2 39 Strand 177 18 115 0 7 7 9 20 The City 2,615 190 2,152 7 23 106 34 102 The following is a summary of the total primary vaccinations performed in the City during the years 1901-09, and of re-vaccinations, in so far as these were made by the Public Vaccinators:— 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 1909 1,902 370 148 39 35 399 * There were also 16 primary vaccinations of persons over 14 years of age. Scarlet Fever.—An increase in the number of cases began in Westminster in the last quarter of 1908, but the first quarter of 1909 41 42 showed a considerable decrease; the second and third quarters, however, had a considerable increase, while the last quarter declined to about the average. The number of cases in London and Westminster are shown for 1908 and 1909:— London. Westminster. 1908. 1909. 1908. 1909. 1st quarter 5,943 4,227 168 113 2nd „ 4,462 4,404 129 218 3rd „ 5,616 4,680 87 144 4th „ 6,038 3,940 243 115 22,059 17,251 627 590 The rise and fall of the disease is shown week by week on the accompanying charts. The increased number of cases reported in June was due chiefly to infected milk, which affected the St. John, Victoria, and Knights bridge St. George Wards; 43 cases were directly traceable to it, and 3 others were probably due to the same cause. The illness was of a mild type (1 child died), and there may have been other cases which escaped detection on this account. There were 2 cases in each of 5 families 3 in 3 families; no secondary cases have been notified, even in houses where the nature of the malady was not immediately recognised, but in the majority of cases the patients were removed to hospital in the earliest stage when there had not been much opportunity to infect others. In the whole of London there were 333 more notifications in June than there were in that month last year. (Further particulars of this outbreak are given below under the heading "Milk.") A good deal of illness of a suspicious character was reported later in the year from certain streets (Victoria Ward), and a number of children attending St. Gabriel's School we.re examined, but the majority were suffering from complaints not recognisable as scarlet fever, although possibly some of them may have been so. In 7 cases there were more than one person affected in the same house, accounting for 15 notifications. It is suspected that some of the cases may have been due to a child who had still some infection in his nose and throat on his return from hospital, while others were possibly due to mild unrecognisable cases. A number of children suspected to be suffering from scarlet fever in Victoria Ward were examined in connection with a slight outbreak which occurred on the re-assembling of the schools after the summer 43 holiday, and one child was found who had been ill for some weeks, and probably was the source of infection; the nature of her illness, which was slight, had not been recognised. Ten cases of scarlet fever were notified among children attending St. George's Row School, and eventually the particular class in which they were was discontinued shortly before Christmas. The children were ascertained to be attending various Sunday schools, and in this way infection may be introduced into day schools. Sometimes, too, other members of an infected family, and frequently other children in the house, attend other day schools to that attended by the patient. Intimation is always sent to the teachers, and the children excluded, but, of course, infection may have already been taken to the school. In the whole year, 177 of the 590 cases were in Victoria Ward, 174 in St. John's. In 57 instances, 2 cases occurred during the year in the same house; in 10 instances, 3 cases; in 5 instances, 4 cases; and in one, 5 cases. Scarlet Fever. 1901. 1902. 1903. 1904. 1905. 1906. 1907. 1908. 1909. Deaths per 100 Cases— The City 1.8 3.3 2.5 2.8 4.0 2.5 2.8 1.27 3.00 The County 3.2 3.0 2.8 2.7 2.8 2.6 2.49 2.48 2.22 Diphtheria.—More cases of this disease were notified in Westminster than in any year since 1902, although in London, as a whole, there was a decrease. The increase in Westminster is not so serious as it at first sight appears. The explanation of this is given below. 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 most, there being more persons at a susceptible age in these wards. Notification of Diphtheria Cases Received in each Month, 1901-09. 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 1909 20 18 27 9 11 20 13 11 32 23 7 34 225 44 Nine cases were eventually decided not to be diphtheria; on the other hand, probably some were not discovered. There were 18 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. 1909. Deaths per 100 Oases— The City 10.o 11.o 8.6 3.4 4.2 7.6 11.o 9.9 8.0 The County 10.9 10.8 9.6 10.2 8.6 8.8 8.9 9.0 9.0 The mortality is greatest among children at ages 1 to 5 years; at that period it amounted to 15.8 per cent. of the cases notified; under 1 year of age it is only 3 per cent., and between 5 and 15 years, 3.9 per cent.; there were no deaths in the 42 persons whose ages were over 15 years. The mortality in St. John and Victoria Wards was 8.8 per cent. of the cases notified. In one or two instances, cases of suspicious sore throat were discovered at certain schools, and, in co-operation with the Medical Officer of the Education Committee, the throats of the children in the classes affected were examined, as well as those of other members of their families, and bacteriological reports were obtained in respect thereof Thus in connection with one school 18 persons proved to have the specific organism in their throats, and 2 of them had been ill some weeks previously, and were probably acting as sources of infection in the school; after they were excluded, no further cases were detected. The teachers had instructions to exclude from school any child with a sore throat until a certificate (based upon bacteriological examination) was produced stating the child to be free from infection. These 18 persons had no signs of diphtheria which could be seen by the naked eye, and it is considered by some to be unlikely that they would cause infection to others. It is also doubtful whether persons who are carrying an infectious organism without showing any effects from it can, strictly speaking, be said to be suffering from diphtheria. Without attempting to clear up these disputed points, I think that it is in the public interest to regard such cases as diphtheria, and to take precautions accordingly; and this action appears to be justified by the result in the case of the school mentioned above. The importance of having an examination made of persons in contact with diphtheria patients was exemplified in a family in which a baby was taken suddenly ill. There were five other members of the family and a servant, none of whom at the time showed definite symptoms of diphtheria, although one had a slight sore throat and the 45 servant was said to suffer always from a bad throat. Bacteriological examination proved that four, including the servant, had the organism in their throats, and the probability is that the complaint had been introduced into the family by the servant. Four cases of diphtheria, in three families not acquainted with one another, occurred in a large block of flats, but the source could not be traced. Careful enquiries were made into the source of the milk and cream which was supplied from the same source to each family, but no evidence was forthcoming to incriminate them. In twelve instances 2 cases occurred in one house, and,, in two instances 3 cases, in one 4 cases, and in one 5 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 145 instances. In 28 instances I had a bacteriological examination made of the throats of the members of families in which a case has occurred, or when children were excluded from school in consequence, and no medical man was in attendance; the bacillus was present in nine of them. In 2 instances examination was made on account of other cases occurring subsequent to the first patient's return from hospital—both were negative. Bacteriological examination of a membrane found at the post-mortem of a child who had died suddenly proved to be diphtheritic. Typhoid Fevee.—The number of cases notified, both in London and Westminster, show a continuous decrease. Of the 25 persons notified in the City, 1 was eventually declared not to be so suffering. As usual, a number of these cases resulted from infection contracted out of London, often abroad, 14 of those whose history could be obtained came under this class; infection was attributed to eating oysters by 3, mussels by 1, and drinking polluted water by 4. Three persons apparently contracted the disease by personal contact, one as a nurse, one child from her mother, and one through visiting at a house in which the disease already existed. In connection with this last case, the Medical Officer for the Borough of Finsbury, in whose district the house is situated, gave me the following information:— Two cases of typhoid fever having occurred in a block of flats, one in October, the other in December, inquiry was made, and revealed the fact that a child, the son of one of the above, had been taken to hospital about the 28th September suffering from diarrhoea, but was only detained one day. At intervals attacks of diarrhoea occurred, and on examining a drop of his blood a positive Widal reaction was obtained. This boy was removed d 46 to hospital, but not before he had succeeded in infecting his 2 sisters and this visitor from Westminster. No history was obtainable in 7 instances. Two of the deaths recorded were those of persons nan Epileptic Colony in Cheshire, and had been sent there from Westminster. Advantage was taken to obtain the City Bacteriologist's opinion in 5 cases, in 2 the Widal reaction was reported (in one of the cases the report was negative in the early stage of the disease). Puerperal Fever.—Five notifications were received, and two deaths occurred. Disinfection was carried out after each case, including the clothing, &c., of those in attendance. Four patients were treated in hospital or infirmary. The illness was due to want of proper attention at birth in one case (illegitimate); to abortion at an early stage, brought on by fright, the house being on fire; to pre-existing abscess of kidney; no definite history was obtainable in two cases, one of which proved fatal, and an inquest was held in respect thereof. Cholera.—This disease continued prevalent in St. Petersburg and neighbourhood during last year, and cases appeared in Holland. I received notification from the Port Sanitary Authorities of 301 persons coming to Westminster from affected districts, and these were kept under observation. Plague.—Nine persons coming from plague-infected districts were also notified. An isolation shelter for use in the event of plague breaking out in London has been arranged for by the County Council in the neighbourhood of the docks. Glanders.—Four 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 the 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 stables are undertaken by the officers of the County Council. Two rooms were disinfected by the City staff. An Order has been made making Glanders, Anthrax, and Hydrophobia in man notifiable diseases throughout the County of London. 47 Table XIV.—Infectious Diseases Notified, 1890-1909, in London. Year. Smallpox. Scarlet Fever. Diphtheria and Croup. Enteric Fever. Typhus Fever. Other Continued Fevers. Puerperal Fever. Erysipelas. Cholera. Relapsing Fever. Totals. 1890 60 15,330 5,870 2,877 35 237 206 4,598 25 7 30,245 1891 114 11,398 6,412 3,372 27 152 221 4,764 23 39 26,552 1892 423 27,095 8,356 2,465 20 147 347 6,934 54 7 45,848 1893 2,813 36,901 13,694 3,666 22 205 397 9,700 86 4 67,485 1894 1,192 18,440 11,190 3,360 21 162 253 6,080 21 2 40,925 1895 979 19,757 11,223 3,506 14 105 236 5,660 29 3 41,512 1896 225 25,647 13,941 3,190 6 103 279 6,438 13 3 49,845 1897 104 22,848 13,199 3,103 4 65 264 5,800 38 1 45,361 1898 32 16,894 11,855 3,024 16 55 247 5,169 23 1 37,316 1899 29 18,113 13,704 4,463 14 69 330 5,615 15 1 42,353 1900 87 13,800 11,985 4,291 7 73 237 4,762 5 — 35,247 1901 1,700 18,381 12,167 3,194 20 48 253 4,604 3 — 40,360 1902 7,796 18,252 10,731 3,407 4 47 311 5,536 1 2 46,087 1903 416 12,531 7,739 2,339 22 40 233 4,372 — — 27,692 1904 489 13,439 7,219 1,896 3 29 273 4,943 1 1 28,293 1905 74 19,461 6,482 1,552 9 14 292 4,972 — 1 32,857 1906 31 20,343 8,035 1,606 7 9 297 5,026 2 — 35,356 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* 1909 21 17,251 6,685 1,042 7 20 287 4,194 — — 29,507* In the City of Westminster. 1890 1 402 150 79 - 9 - 128 1 - 770 1891 2 379 174 100 - 7 9 144 1 - 817 1892 14 864 349 99 — 8 7 191 2 — 1,534 1893 165 1,366 353 148 - 5 11 230 4 — 2,284 1894 21 535 269 106 - 9 - 134 - - 1,134 1895 195 715 383 114 — 4 4 138 — — 1,297 1896 7 846 323 121 - 5 7 178 — — 1,487 1897 13 658 336 104 — 5 6 175 1 — 1,298 1898 2 409 338 112 — 2 5 131 — — 999 1899 - 534 283 143 — 1 3 176 — — 1,140 1900 2 453 287 118 — 4 5 129 — — 998 1901 102 475 253 104 — 2 6 117 — — 1,059 1902 232 475 285 132 — 1 6 144 — — 1,275 1903 45 352 186 71 — 2 5 111 — — 772 1904 6 313 145 51 1 2 5 125 — — 648 1905 2 370 118 41 — — 12 123 — — 666 1906 — 540 206 47 — 2 9 127 — — 931 1907 - 418 145 51 - 2 3 102 - - 721* 1908 1 627 187 41 — - 6 81 — — 943* 1909 1 590 225 25 - - 5 102 - - 948* * There were also notified 132 cases of Cerebro- Spinal Meningitis in London, 4 in Westminster in 1907. „ 85 „ M 3 „ 1908. „ 111 „ „ 3 „ 1909. 48 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 54.4 18.4 2.9 0.01 0.05 0.5 9.4 1908 (53 weeks) 0.00 45.1 163 2.7 0.00 0.02 0.4 8.6 1909 0.04 35.6 13.9 21 0.01 0.04 0.6 8.3 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 85 — 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 1909 0.00 34.3 13.0 1.4 — — 0.29 5.9 49 City of Westminster. Table XY.—Local Government Board Table C.— Cases of Infectious Disease Notified during the 52 weeks from 3rd January, 1909, to 1st January, 1910. Notifiable Diseases. Cases Notified in the City of Westminster. Total Cases Notified in each Ward. Number of Cases Removed to Hospital from each Ward. At all Ages. At Ages—Years. Conduit. Grosvenor. Knights bridge St. George. Victoria. St. Margaret. St. John. Kamlet of Knights bridge. Pall Mall. Regent. Great Marlborough. Charing Cross. Covent Garden. Strand. St. Anne. Conduit. Grosvenor. Knights bridge St. George. Victoria. St. Margaret. St. John. Hamlet of Knights bridge. 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 Deaths 1 - - - - 1 - - - - - - - - - - - - - - 1 Diphtheria— Cases 225 6 76 101 20 22 — 5 12 7 76 20 G9 4 6 2 4 4 4 3 9 4 11 7 73 15 67 3 6 2 4 4 4 3 9 212 Deaths 18 2 12 4 — — — — 1 — 7 1 6 - 1 - - - 1 - 1 Erysipelas- Cases 102 2 6 7 7 67 13 - 4 6 24 3 22 3 - 4 18 3 5 5 5 - - 2 8 2 10 2 - - 8 - 2 5 3 42 Deaths 6 1 — — — 2 3 — — 1 — — 2 — — — 1 1 1 Fevers. Scarlet— Cases 590 5 154 310 76 45 — 2 35 41 177 24 174 13 7 24 97 5 14 1 46 2 31 37 169 24 170 12 7 23 26 5 14 1 44 565 Deaths 18 1 11 5 1 - — - - - 3 2 7 - 1 1 1 - - - 2 Enteric— Cases 25 — — 6 7 12 — — - 4 6 - 4 1 2 2 1 - 1 1 3 - - 2 4 - 4 - 2 - 1 — 1 1 3 18 Deaths 9 — — 3 6 — - - 1 4 - 3 - - - 1 - - - - Cerebrospinal— Cases 3 — — 1 1 1 — — — — 2 1 — — — — — — — — — — - — 2 1 — - — - — — — — — 3 Deaths 1 - - - - 1 - - - - - 1 - - - - - - - - - Puerperal— Cases 5 — — — 2 3 — — 1 1 1 - 1 - - - - 1 - - - - 1 - 1 - 1 - - - - 1 - - - 4 Deaths 2 - - - - 2 - - 1 1 - - - - - - - - - - - Total Cases 951 13 236 425 113 151 13 7 52 59 286 48 270 21 15 32 50 13 24 10 64 6 43 48 257 42 252 17 15 25 39 10 21 10 60 845 21 cases notified as scarlet fever, 9 as diphtheria, 1 as enteric fever were eventually alleged not to be suffering from the disease notified. 50 Table XVI.—London and the Metropolitan Boroughs..Notified Cases of Infectious Disease in 1909. Cities and Boroughs. Estimated population in the middle of 1909. 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 4,833,938 21 17,251 6,685 7 1,042 20 287 4,194 1ll 29,618 6.1 West Districts. Paddington 151,955 — 630 184 - 29 — 3 106 4 956 6.3 Kensington 183,683 — 420 177 — 48 — 7 135 4 791 4.3 Hammersmith 125,704 — 389 192 - 16 — 14 76 1 688 5.5 Fulham 176,406 — 511 322 - 41 1 34 115 3 1,027 5.8 Chelsea 75,249 — 307 98 - 12 2 1 40 — 460 6.1 City of Westminster 172,150 1 590 225 — 25 — 5 102 3 951 5.5 North Districts. St. Marylebone 126,027 - 458 113 - 21 — 3 134 6 735 5.8 Hampstead 94,185 — 259 47 — 16 — 5 30 4 361 3.8 St. Pancras 237,422 1 771 320 — 50 — 15 155 6 1,318 5.6 Islington 351,202 3 1,284 432 1 94 — 14 221 11 2,060 5.9 Stoke Newington 54,423 — 110 28 - 11 — 4 27 — 180 3.3 Hackney 237,601 1 784 264 — 59 1 15 271 6 1,401 5.9 Central Districts. Holborn 53,802 1 97 47 - 16 1 3 41 — 206 3.8 Finsbury 95,289 — 240 167 1 13 — 5 132 3 561 5.9 City of London 18,193 1 38 19 — 4 - 1 10 — 73 4.0 East Districts. Shoreditch 114,802 - 341 186 - 50 - 14 144 2 737 6.4 Bethnal Green 131,316 1 566 184 - 33 — 7 164 5 960 7.3 Stepney 312,525 8 1,038 583 2 71 2 13 487 4 2,208 7.1 Poplar 171,965 — 733 213 — 54 — 13 177 8 1,198 7.0 South Districts. Southwark 211,125 2 590 256 - 35 1 6 224 5 1,119 5.3 Bermondsey 127,569 — 458 198 3 30 — 7 143 4 843 6.6 Lambeth 324.188 — 1,182 378 — 50 1 16 191 14 1,832 5.7 Battersea 186,036 — 723 288 54 — 14 156 4 1,239 6.7 Wandsworth 297,646 — 997 371 66 2 26 193 4 1,659 5.6 Camber well 283,022 1 1,017 379 — 47 — 14 234 4 1,696 6.0 Deptford 118,583 — 374 195 — 33 6 7 181 2 798 6.7 Greenwich 111,014 — 390 163 — 30 1 8 95 4 691 6.2 Lewisham 160,749 1 927 388 - 18 1 4 105 — 1,444 9.0 Woolwich 133,374 — 1,027 267 — 12 9 101 — 1,416 10.6 Port of London - — — 1 — 4 1 - 4 - 10 - Tuberculosis. Compulsory Notification of Poor Law Cases.—The Local Government Board having had under consideration the desirability of affording facilities for the extension of administrative action for the prevention of tuberculosis, issued an Order in pursuance of Section 130 of the Public Health Act, 1875, as amended and extended by the Public Health (London) Act, 1891, and the Public Health Act, 1896, to provide for the notification to the Medical Officer of Health of Sanitary Authorities of cases of the infectious disease known as pulmonary tuberculosis occurring amongst the inmates of Poor Law Institutions, or 51 amongst persons under the care of District Medical Officers, and for the taking of certain measures in such cases. The Order came in force on the 1st January, 1909. Poor Law District Medical Officers and Medical Officers of Poor Law Institutions are required to send a notification to the Medical Officer of Health of the district in which a consumptive patient is (or was before admission to an institution) resident, within 48 hours after recognition of the symptoms. The Superintending Officer of an institution is required to send a notification of the actual or intended place of destination and address at that place of any consumptive person leaving such institution, and Relieving Officers are required to notify changes of address of patients other than to an institution. Four sets of forms have been prepared for the above purpose. Form A is for the notification of a person in a Poor Law Institution. Form B. of a person in a district. Form C is the notice that a notified person has left a Poor Law Institution. Form D, of the change of address of a notified person in a district. As some of the provisions of the Public Health (London) Act, 1891 relative to infectious disease are not usually appropriate in cases of pulmonary tuberculosis, the Board have provided by Article IX (1) that nothing in the regulations shall have effect so as to apply or to authorise anyone, directly or indirectly, to put in force with respect to a person in relation to whom a notification has been made any enactment which renders him or any other person liable to a penalty or subjects him to any restriction, prohibition, or disability affecting him or his employment, occupation, means of livelihood, or residence on the ground of his suffering from pulmonary tuberculosis. Subject to what is stated in the preceding paragraph, a Council, on the advice of their Medical Officer of Health, in the case of a poor person in relation to whom a notification in pursuance of these regulations has been posted to the Medical Officer of Health, may, for the purpose of preventing the spread of infection from pulmonary tuberculosis:— (i) Take all such measures or do all such things as are authorised, in any case of infectious disease, or of dangerous infectious disease, by any enactment relating to public health, and as have reference to the destruction and disinfection of infected articles, or the cleansing or disinfecting of premises; (ii) Take all such measures or do all such things as are appropriate and necessary for the safe disposal or destruction of infectious material, produced and discharged, as a result of pulmonary tuberculosis; and otherwise for the prevention of the spread of infection from any such material; 52 (iii) afford or supply all such assistance, facilities, or articles as, within such reasonable limits as the circumstances of the case require and allow, will obviate, or remove, or diminish the risk of infection arising from the conditions affecting the use or occupation of any room, when used or occupied by the poor person as a sleeping apartment; and (iv) furnish, for the use of the poor person, on loan, or otherwise, any appliance, apparatus or utensil which will be of assistance for the purpose of any precaution against the spread of infection. A Council, on the advice of their Medical Officer of Health, may provide and publish or distribute in the form of placards, handbills, or leaflets, suitable summaries of information and instruction respecting pulmonary tuberculosis, and the precautions to be taken against the spread of infection from that disease. At the end of the Order the following appears:— "Notice.—The Public Health Act, 1896, provides, by Subsection 3 of Section 1, that, if any person wilfully neglects or refuses to obey or carry out, or obstructs the execution of, any regulation made under any of the enactments mentioned in that Act, he shall be liable to a penalty not exceeding £100; and, in the case of a continuing offence, to a further penalty not exceeding £50 for every day during which the offence continues." The Board subsequently issued a valuable memorandum by their medical officer, setting out the appropriate action that can be taken under these powers. A system of voluntary notification of pulmonary tuberculosis was instituted in Westminster by the Council in the early part of 1903, and up to the end of 1908 information had been received of 700 cases. During 1907-8 the several medical officers of Poor Law Institutions co-operated. Many of the recommendations as to administrative action had already been adopted, and in previous reports I have detailed the action which has been taken. The promulgation of the Order, and the increased interest which has been taken in the subject, has resulted in a greater number of private cases of the disease being brought to the notice of the Medical Officer of Health, and to further measures being taken by the Council. One of these arose from a representation made by the City of Westminster Health Society, when the Council agreed to set aside a sum of £350 per annum to enable consumptive patients to be sent to a sanatorium for a stay of limited duration, chiefly for educational purposes. The advantages of such a scheme are thus described by Dr. Newsholme in the memorandum:— maitland sanatorium. maitland from the meadows. 53 "In actual experience a large proportion of poor patients cannot be cured at the stage at which their disease is first recognised without treatment which is so protracted and so large in amount when attempted for a number of patients as to be outside the range of present practical administration. Many such patients, however, either recover, or without complete recovery continue to be able to work indefinitely, even when protracted sanatorium treatment cannot be secured. Their working life can be extended, and their capacity to spread infection can be stopped, by an occasional stay in a sanatorium, of limited duration, say, for a month. It is on sanatorium treatment of this type for patients still able to work that stress may be laid. The patient usually does not lose his place by the short absence from work contemplated; he is willing to come into a sanatorium for such a short stay, when he would not accept more protracted treatment, and the improvement experienced during such a short stay in a sanatorium is often most remarkable. This, however, is not the only gain. When the patient enters the sanatorium his dwelling is disinfected; his relatives are releived temporarily from a source of anxiety; and the patient while in the sanatorium is trained in the methods of disposal of sputum, and in the general hygenic regulation of his life in a practical manner that is scarcely possible at home. On his return home he is, therefore, no longer likely to be a source of infection, and the general hygiene of his home is almost certain to reflect the good influence of his stay in the sanatorium. From the standpoint of the sanitary authority a much larger number of patients can, in this way, be treated and prevented from becoming a source of infection than if permanent cure of the individual patient were made the only consideration." Temporary arrangements have been made with the Maitland Sanatorium at Peppard Common, Oxfordshire, and 6 patients have been able to take advantage of residence there for a month at a time. Steps are also being taken to endeavour to secure an earlier recognition of the disease, and the co-operation of the medical staffs of the hospitals and dispensaries, and of members of the profession practising in Westminster. Arrangements are being made that in all Poor Law cases, and in such private cases in which the Medical Attendant desires it, a properly trained Special Visitor from the Health Society shall call upon the patient to give instructions as to measures of personal hygiene and precautions against infection; to obtain information as to "contacts"; to endeavour, in cases requiring outside assistance, to obtain, through the agency of the various charitable societies, better food, clothing, separate bed, sanatorium or other treatment indicated by the Medical Attendant, and to discover and take steps to obtain the 54 removal of insanitary conditions which may affect the patient. The information thus obtained is placed at the disposal of the medical man who is willing to co-operate. The following is a summary of the means which are now available in Westminster:— (1) Voluntary notification. (2) Compulsory notification of Poor Law cases. (3) Provision of means for obtaining bacteriological examination of sputum, &c. (4) Examination of suspected cases in the families of patients attending Brompton and Margaret Street Hospitals. (5) Visiting of patients at their homes by a Health Visitor, who endeavours to obtain, where required, better food, sanatorium treatment, clothing, &c., through various charitable societies; gives instructions as to measures of personal hygiene and precautions against infection, &c.; and prepares and keeps records of all material matters relating to the patient and the family. (6) Educational training by a short stay in a sanatorium provided by the City Council. (7) Prolonged sanatorium treatment for patients resident or employed in the parish of St. Anne, Soho, through the St. Henry Trust; for Jewish cases, through the Jewish Board of Guardians; for children, through the Invalid Children's Aid Association and the Metropolitan Asylums Board; for some others, through the Charity Organisation Society; and the various general and special hospitals through their Almoners; and by the Poor Law Guardians of two Unions at their special infirmary at Hendon. (8) Disinfection of rooms, bedding, clothing, &c., after death, on change of address or while patients are temporarily away, by the Public Health Authority. (9) Provision for the use of poor persons certified under the Tuberculosis Regulations, on loan or otherwise, of any appliance, apparatus, or utensil (such as special flasks for spitting into) which will be of assistance for the purpose of any precaution against the spread of infection. Notification.—In 1908, 155 notifications were received, 69 of these being inmates of Poor Law Infirmaries. In 1909, 601 notifications were received. 437 being sent by Poor Law officers. There were a considerable number of duplicate notifications, especially among the Poor Law cases. The actual number of persons was 438, of whom 109 were females; of these, 159 were heard of first through voluntary notification, and 279 were notified under the Order (30 of whom had been voluntarily certified in previous years). 55 The number of certificates received in connection with each class was:— 159 patients living at home notified voluntarily 164 certificates. 145 patients living at home notified under the Order 193 „ 136 patients living in common lodging-houses, &c., notified under the Order 244 „ Eighty-one of the last-named group had one certificate each, 24 were twice notified, 10 three times, 8 four, 1 five, 2 six, 3 seven and 1 sixteen times. That means that the patients had been in and out of the infirmary on a good many occasions. In connection with these only 31 notices were received that they were leaving to come to Westminster, whereas at least 51 ought to have been received. Probably, an address in some other borough was given as the intended destination. Information was received of 13 persons who said they were coming to addresses in Westminster, but who went to common lodging-houses in other boroughs. The danger in consumptive persons frequenting common lodging-houses is considerable, but as they can seldom be traced when not in the infirmary, it is almost impossible to ensure that any precautions are taken by them against infection of others. The Poor Law Commissioners discussed the practicability of detention of consumptive patients, and in their report express the opinion that the suggestion is beset with administrative difficulties, on the grounds that it may be a moot point at what period of its development phthisis becomes infectious; further, that the detention would often have to be for a considerable time, and that the knowledge that detention might be enforced would probably lead to concealment of the disease, or at least make it less possible to attract patients for treatment at the earlier and curable stages, and that public opinion is not likely to sanction such drastic powers of detention as would be involved in detaining all infectious cases. The majority of the Commissioners, therefore, think that:— "Meantime the spread of phthisis must be checked mainly by a wider diffusion of the knowledge of its dangers and of the means of its prevention, and by a stimulation of the efforts of the authorities concerned with its prevention and cure. If, however, anything is to be done in the direction of detention of phthisis, a beginning might be made, perhaps, with advanced cases, in which, first, the medical officer pronounced the patient in such a condition as to be likely to communicate the disease, and, secondly, the home conditions of the patient are such as to lead with practical certainty to the spread of the disease." About a dozen men of those notified might have been detained in the infirmary with considerable advantage to the community. The 56 Poor Law Amendment Act, 1867, Section 22, provides that persons suffering from infectious disease may be detained where removal would be dangerous to themselves or others. I understand that the Local Government Board has advised that phthisis would be included under this description. Certificates received under the Order are divisible as follows: Form A 328, Form B 53, Form C 56, Form D 0. Nine persons notified under the voluntary system eventually came under the Poor Law, and a few Poor Law patients were re-notified from hospitals or other institutions. The machinery is a little complicated. In St. George's Union patients may be notified first by the out-door Medical Officer, and then, if admitted to the infirmary, by the Superintendent; or the first notification may come from the latter, the nature of the illness being discovered in the infirmary (perhaps the person has been an inmate of the workhouse or admitted through the casual ward). In Westminster Union a person may be notified first by the out-door Medical Officer, then by the Medical Superintendent at Cleveland Street Infirmary, then if transferred to Hendon by the Medical Officer there. In the Strand Union the first notification comes from an out-door Medical Officer, or from the Medical Officer of the Strand Receiving Ward; the patient may then be sent to Cleveland Street or to the Strand Workhouse at Edmonton, from which further notifications are supplied. Notifications may also be received from other Union institutions or from asylums to which patients have been sent. No information is given on the certificates as to the date of admission to institutions, so that it is found in a number of cases to have been years ago, the disease having developed in the workhouse or asylum. In some cases the residence given as the home address no longer existed. The 56 intimations that patients were leaving institutions related to 52 persons; 18 of these were not previously or subsequently notified, and in only 5 instances were the addresses correct. Of the remaining 34 who had been or were subsequently notified, 12 only were found at the addresses given, but with the exception of 4 persons the others found their way back to the infirmaries, 21 of them having given addresses in Westminster to which they were not entitled. The co-operation of the Health Society in dealing with phthisis cases has been very valuable. All the cases treated at home for any time have been visited. The Society reports that many of the Poor Law group are advanced cases, and although something can be done to alleviate suffering and to prevent the further spread of infection— either by arrangements in the home or by inducing the patient to enter or re-enter the infirmary—yet it is too late to hope for any arrest 57 of the disease, and in all probability others are already infected. The extreme poverty of Poor Law patients adds again to the ordinary risks of infection. A "family history in phthisis,'' recorded on 45 per cent. of the cases visited, suggests a serious amount of domestic infection. "In addition to the compulsory notification of Poor Law cases, voluntary notification obtains in Westminster from Brompton and Margaret Street Hospitals for Consumption, from the almoners of the great general hospitals, and to some extent from the local dispensaries. It also obtains from some private practitioners; but the class of patient dealt with by the Society is seldom attended by a private doctor except in an emergency, during an acute attack of the disease. The number of patients in actual receipt of institutional treatment at any one time is insignificant. It would therefore appear from the discrepancy between the number of patients known to the Society and the number of patients (850 exclusive of those from common lodging houses and casuals) inferred on the lowest estimate by the Medical Officer of Health from the number of deaths, that there are in Westminster a considerable number of poor persons suffering from phthisis in their own homes, presumably without medical treatment, certainly without any special supervision from the public health authority, and without instructions as to precautionary measures in the home. And as the more advanced cases are those most likely to come to light, a considerable proportion of those 'missed' patients are in all probability early cases—cases it is most important not to miss !" " Among these patients were a certain number of early cases, and here the work of the Society has, on the whole, met with excellent results. Patients first visited 1904-'05-'06, and since kept under observation, are now reported ' keeping well,' 'at work'; and no further development of the disease has been reported in the home. Many patients received institutional treatment for periods ranging from a few weeks to a year, obtained in co-operation with the Invalid Children's Aid Association, the Charity Organisation Society, the Jewish Board of Guardians, and local convalescent funds. It is interesting to note in this respect, that for children (31 cases)—the majority early cases—and for young persons 15 to 20 years (39 cases), institutional treatment extending over many months was almost invariably arranged for. Poverty is less extreme here than in the Poor Law class; but, where needed, maintenance of the family during the institutional treatment of the wage-earners, rent, extra nourishment, clothing, spit-bottles, an extra bed, &c., were arranged for, in co-operation with the Charity Organisation Society and other charitable agencies." "Brompton and Margaret Street Hospitals, the only agencies offering special facilities for the examination of 'suspects,' are both outside the 58 City and beyond the reach of many persons; both require 'letters' to continue treatment; and the demands on Brompton are already far in excess of its accommodation. But in addition to insufficient facilities for obtaining the medical examination of 'suspects,' there would seem to be other difficulties in the way. Where the suspected case is in apparently fair health, the patient—or in the case of a child, the parent—is unwilling to afford the time for the journey and lengthy attendances at a hospital. And if the time spent means the loss of a day's work, the visitor hesitates to weaken her authority by urging what may prove to be a tiresome and unnecessary visit. Thus the patient remains without treatment until very definite symptoms declare themselves. The work of the visitor loses in this way and in others by the absence in the home of the medical man. She has, and can have, little real authority without medical advice and support. Again, on other points the existing system would seem to be at fault. Medical treatment is irregular and discontinuous. Patients move quickly from one medical agency to another—in one case seven different medical agencies were attended within a few years ! This is no doubt often due to the patient's anxiety to find a speedy' cure,' and sometimes to rapid changes of address as the patient, if a wage-earner, descends into cheaper quarters; but it is also to some extent encouraged by the existing hospital system. An out-patient becomes too ill to continue his attendance at a hospital. Failing admission as an in-patient, he is obliged either to forego medical treatment, or to have recourse to a private doctor, the Poor Law doctor, or to some general dispensary from which bedridden patients are visited in their own homes by the physician. On recovery—or partial recovery—from his acute attack, he will again, in all probability, seek a chest hospital, or a great general hospital, where he believes he is more likely to receive specialist treatment; or he may do without any medical assistance until weakness or another acute attack supervenes. He may, or may not, return to the hospital he previously attended, but in any case the continuity of treatment is broken." Bacteriological Examination of Sputum.—Sixty examinations were made of sputum, one of pleural effusia, to ascertain if the tubercle bacillus was present. It was found in 22 instances. Disinfection.—Two hundred and fifty-three rooms in 190 houses and 2,069 articles were disinfected by the Council's staff, 35 articles were destroyed, and general cleansing of the premises was carried out after each death, or on removal from one house to another, entailing 385 visits. Deaths.—The deaths for the last nine years are set forth in the following table:— 59 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 1904 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 1909 225 131 10 6 20 12 23 13 278 161 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 132 105 179 137 1909 131 116 — 141 Of the 225 deaths from pulmonary tuberculosis, only 82(58 male, 24 female) bad been previously notified during life. Seven bad been under observation for some years, 3 for about five years, 1 for nearly six years. 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; 136 persons of this class were notified as suffering from consumption, and 31 deaths were recorded. There were moreover 20 deaths from this cause of persons for whom no definite address could be assigned. In Table XIV a comparison is instituted between the number of deaths in the City and the various wards thereof in two groups 60 Table XVII.— Tuberculosis. Deaths in the Various Wards in the City, distinguishing those in Common Lodging Houses. Comparison of Two Periods of 4 Years each, 1901-4 and 1905-8. 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 l5. 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. Deaths from pulmonary consumption— 4 years, 1901-4 1,249 4 22 25 125 996 77 6 38 19 46 271 85 362 88 56 15 62 22 73 106 (Common lodginq-house deaths) (120) — — — (3) (93) (24) — — — — — (2) (52) (9) — — (10) — (12) (35) 4 years, 1905-8 937 3 9 12 777 74 87 7 39 17 29 227 46 339 41 26 7 33 10 75 41 (Common lodging-house deaths) Without common lodging-house deaths— (131) - - - (3) (100) (28) - - - - - - (83) - - - (1) - (26) (21) 4 years, 1901-4 1,129 4 22 25 122 903 53 6 38 19 46 271 83 310 79 56 15 52 22 61 71 „ 1905-8 806 3 9 12 74 649 59 7 39 17 29 227 46 256 41 26 7 32 10 49 20 Deaths from other forms of Tuberculosis, Deaths of Males and Females. 4 years, 1901-4 278 65 92 34 33 52 2 Pulmonary Phthisis. Other Forms. Males. Females. Males. Females. „ 1905-8 267 61 89 40 23 45 9 4 years, 1901-4 784 (90) 465 (30) 158 120 1905-8 650 (115) 287 (16) 148 119 All forms, less common lodging-house deaths— Males. Females. Total. 852 555 1,407 1901-4 1905-8 683 390 1,073 (Common lodging-house deaths in brackets.) 61 of 4 years each, 1901-4 and 1905-8. It will be noted that common lodging-house deaths among men have increased in the second group. Deducting these deaths, the reduction in the number of deaths is 22.9 per cent. for males, 37.7 per cent. for females. The phthisis death-rates in London Boroughs ranged from 61 in Hampstead, 80 in Lewisham, 83 in Stoke Newington, 93 in Wandsworth, 96 in Kensington, and 99 in Greenwich, to 175 in Shoreditch 178 in Bermondsey, 179 in Southwark, 205 in Holborn, 215 in the City of London, and 222 in Finsbury. In the three last-named boroughs, which constitute the central group, the mean death-rate from phthisis was 216 per 100,000, while among the other groups the rates were 157 in the eastern, 125 in the northern and in the southern, and 116 in the western group. Non-notifiable Diseases. Measles.— Twenty-six deaths were attributed to this cause in 1909 in the City. During the year 529 cases came to my knowledge, 527 having been notified by school teachers (particulars as to schools affected are given later). The bulk of the cases were in the early part of the year. The deaths per 1,000 calculated on the total population were:— 1803. 1904. 1905. 1906. 1907. 1908. 1909. Westminster— Cases notified 346 181 412 362 554 566 529 No. of deaths 47 23 44 20 22 26 26 Rate per 1,000 population 0.26 0.13 0.25 0.11 0.12 0.13 0.15 London 0.44 0.49 0.37 0.41 0.38 0.31 0.48 The five-yearly average death-rate being 0.39 for London, 0.15 for Westminster. As 24 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 3.7 1.8 3 .5 1.4 1.7 2.0 2.1 London 4.0 4.4 3.3 3.4 3.4 2.8 4.3 The death-rates per 1,000 persons in each of the four quarters were:— 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Westminster 0.37 0.16 0.09 - London 0.95 0.69 0.16 0.11 e 62 Disinfection of 108 rooms in 50 houses, and of 678 articles, was carried out by the Council's staff. Visits were paid by the lady inspectors in cases notified from schools. Sudden and extensive outbreaks of measles occurred at St. Michael's Ebury Street, and St. Peter's, Lower Belgrave Street, Schools, in the infant departments, necessitating closure in the former. On visiting at the homes, it was found that 24 children supposed to have measles were absent from colds only, but there were 50 cases of measles, and, in addition, 5 were found to be suffering from chickenpox and 12 from mumps. There were at the same time 49 cases in children attending St. Peter's and 29 at Horseferry Road Schools. Whooping Cough.—This complaint was responsible for 23 deaths, all of them of children under five years of age; 228 cases were notified to me, all from schools (for particulars as to schools affected see list below). Disinfection was carried out in 3 rooms. The death-rates per 1,000 persons in each of the four quarters were:— 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Westminster 0.25 0.16 0.11 0.09 London 0.30 0.34 0.18 0.19 Particulars relative to this disease for the years 1903-9 are:— 1903. 1904. 1905. 1906. 1907. 1908. 1909. W estminster— Cases notified 83 56 210 92 251 62 228 Deaths 33 17 35 23 27 10 23 Deaths per 1,000 population 0.18 0.09 0.19 0.13 0.15 0.05 0.13 London 0.35 0.33 0.32 0.26 0.38 0.20 0.25 The five-yearly average death-rate being 0.30 for London, 0.12 for Westminster. All the children who died were under five years of age. Calculated on the number of children at that age, the death-rates per 1,000 were:— Westminster 2.63 1.37 2.8 1.6 2.2 0.8 1.9 London .. 3.22 2.9 2.9 2.3 3.4 1.8 2.3 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. 63 Diarrhceal Diseases.— In London, deaths from the epidemic or infective form of this disease were less than half the corrected average. In Westminster the number of deaths was less than any previous year. The figures for several years are shown below. Deaths from other forms of enteritis numbered 23, which is above the average; 20 were of infants. Probably this form was due to cold, improper feeding, defective powers of digestion, and in some instances this condition may have resulted from a previous attack of the epidemic form. The following table exhibits the particulars:— Westminster. 1902. 1903. 1904. 1905. 1906. 1907. 1908. 1909. Epidemic diarrhoea 61 59 80 47 75 27 24 10 Other forms of enteritis 27 14 16 17 20 19 23 23 Total deaths 88 73 96 64 95 46 47 33 Number under 1 year of age 63 52 72 42 71 27 33 27 Number of births 3,461 3,185 3,054 3,120 2,931 2,927 2,913 2,751 Deaths of infants per 1,000 births 18.2 16.3 23.5 13.4 24.2 9.2 11.4 9.2 Eight of the deaths were in St. John's Ward, 14 in Victoria. The rates per 1,000 persons for each quarter for epidemic diarrhoea and enteritis were as follows:— 1908. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. The Year. Westminster — — 0.20 0.02 0.05 London 0.14 0.12 0.79 0.25 0.32 Meteorological conditions again played an important part in keepingdown the rate. Influenza.— This complaint prevailed during the first half of the year, but especially in the first three months. In Loudon the deaths recorded from this complaint began to rise in February. During that month they averaged about 22 a week; they rose rapidly to a maximum of 138 deaths in March, 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 43 deaths were ascribed to this cause, 24 of them being in the first quarter of the year, 13 in the second and 5 in the fourth. e 2 64 Schools and Infectious Disease. School Teachers are required to notify the Medical Officer of Health 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 1 15 2 4 - 4 - 2 2 ringworm. Horseferry Road — 38 1 16 — 24 — — 2 eczema, 5 blight Buckingham Gate 1 42 — 1 1 15 — — 7 ringworm. Pulteney — 30 — 7 — 30 - 3 1 blight. St. George's Row 4 7 3 6 1 1 1 16 ringworm. 3 German measles. Millbank 39 13 - 40 4 8 - - 41 ringworm. German measles. Tower Street — 1 — — — 4 — — Wild Street 8 15 1 1 1 9 — — 2 ringworm. Brompton Higher Grade — 1 1 2 — — 2 — 1 German measles. Christ Church 1 1 1 2 — 2 — — 1 ringworm. Holy Trinity 12 4 4 24 8 2 3 5 5 ringworm. St. Anne's 6 14 — 4 1 16 — — 3 ringworm. St. Anselm's 14 1 11 7 10 1 10 — 4 ringworm. St. Barnabas 10 17 6 23 3 10 6 2 7 ringworm. 2 German measles. St. Clement Danes 7 39 1 — 3 2 — — 2 ringworm. St. Edward's, Dufour's Place — 13 — — — 8 — — St. Gabriel's 13 28 6 19 11 24 4 16 5 ringworm. 1 German measles. St. George's, South Street 13 1 10 2 1 — 10 — 12 ringworm. St. James the Less 33 2 1 12 10 3 — — 4 ringworm. St. Margaret's — — — 3 — — — 1 St. Martin's, Adelaide Place 2 53 1 12 1 11 — — 2 ringworm. St. Martin's, Castle Street 3 1 - - - - - - 1 ringworm. St. Mary's, 48, Great Peter Street - - - - - - - - St. Mary's, Hide Place — 1 22 14 — 2 11 — 6 ringworm. St. Matthew's 11 7 11 4 7 9 7 - 17 ringworm. 5 ophthalmia. St. Michael's 4 76 18 — — 10 5 — 8 ringworm. St. Paul's 2 1 3 17 — 1 2 2 3 ringworm. St. Peters, Lower Bel grave Place 4 49 11 3 1 6 3 - 1 ringworm. 1 German measles. St. Peter's and St. James1 2 51 4 1 2 9 — — 1 German measles. St. Stephen's 1 6 — 4 1 6 1 1 9 ringworm. Wesleyan Training 3 — — — 3 2 — 1 1 ringworm. Westminster Jews' Free - - - - - 1 — 1 189 527 118 228 69 220 64 35 In dealing with measles, the following procedure suggested by Dr. Kerr has been adopted in London generally, with the . approval of the Local Government Board. The head teacher makes inquiry as to the measles history of every infant on admission to school. If a child has already had measles the fact is recorded in the register; if the child is not known to have suffered that fact likewise is recorded. The record thus established shows the proportion of children protected by previous attack to those unprotected, and it is upon this knowledge that all action is based. Immediately on the occurrence of a case of measles in a school a card is distributed to each of the unprotected children in the room, warning the parents of the danger of infection, and pointing out the serious character of measles. The case is then reported to the medical officer, 65 who determines the precautionary measures desirable in view of the proportion of susceptible children in the room. School closure in outbreaks of measles is undertaken solely as a preventive measure, since it has been proved to be futile to take this step when once measles is established in a school; it is therefore carried out only 011 the first appearance of the disease in a class-room. Even when carried out successfully, closure in London only postpones an attack for a few months, and is of little value, except when applied to babies' rooms. The adoption of this method has resulted in a great saving in school attendance. The Infant Departments of St. Michael's, Ebury Street, St. Peter's, Lower Belgrave Street, St. Martin's, Adelaide Place, and Pulteney Schools were closed for short periods on account of measles. A copy of each notification of fever, diphtheria, &c., received from 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 727 notifications were sent out during 1909 to school teachers as follows:— School. Small Pox. Scarlet Fever. Diphtheria. Enteric Fever. Charing Cross Road - 3 - - Horseferry Road — 9 5 — Buckingham Grate — 5 — — Pulteney — 12 2 — St. Greorge's Row — 26 1 — Millbank - 37 11 — Wild Street — 5 — — Brompton Higher Grrade — 1 — — Christ Church — 2 4 — Curzon — 2 — — French Protestant.. — — — — Holy Trinity — 7 21 — St. Anne's — 11 2 — St. Anselms — 11 2 — St. Barnabas — 7 — — St. Clement Danes — 1 1 — St. Edward's, Dufour's Place — 1 1 — St. Gabriel's — 22 8 — St. Greorge's, South Street — 4 2 — St. James the Less — 5 7 1 St. Margaret's — 5 2 — St. Martin's, Adelaide Place — 3 2 1 St. Martin's, Castle Street — — 2 — St. Mary's, 48, Great Peter Street — 7 5 — St. Mary's, Hide Place — 9 — — St. Matthew's — 9 — — St. Michael's — 4 7 — St. Paul s, Caroline Street — — — — St. Paul's, Wilton Place — 6 2 1 St. Peter's, Lower Belgrave Street — 9 5 — St. Peter's and St. James's — 10 1 — St. Stephen's — 20 2 — Wesleyan Training College - 6 1 - 66 In scarlet fever outbreaks occurring in London closure is now seldom applied, individual inspection and exclusion of suspicious cases being found to be of much greater utility in controlling the disease. Diphtheria is controlled by means of bacteriological investigation, and the exclusion and notification of children found to be harbouring bacilli. School closure for diphtheria, except in unusual circumstances, may mean loss of control of dangerous cases. Thus, in connection with Holy Trinity School, 44 children were excluded on account of suspicious throats. As a result of examination, some of these proved to be welldefined cases of diphtheria; others showed no distinctive signs, but had the specific organism in their throats. Two of the children had evidently been ill some weeks previously, and were probably acting as sources of infection in the school. Exclusion from School of Children returned home from Hospital after Isolation on account of Infectious Disease.—At a conference of Metropolitan Medical Officers it was resolved : " That in future the periods of exclusion from school for children returned home after isolation in hospital should be those laid down in the memorandum 011 Closure of and Exclusion from School, viz., for Scarlet Fever, two weeks for returned patients and contacts; for Diphtheria, four weeks (sometimes two weeks) for returned patients, and for contacts two weeks." Sixty-four rooms in 11 schools were disinfected, together with books and other articles. The Health Society has co-operated with the various School Care Committees, and 276 children were specially visited, among these being 65 suffering from ringworm. The care of children after measles and whooping cough is a matter of special importance where there is known to be a family history of phthisis. A conference was held between the Medical Officer for Education 1 and the Metropolitan Medical Officers of Health in order to endeavour to secure co-operation on definite lines. It is evidently now being recognised that it would have been more satisfactory had the machinery of the Borough Councils been utilised from the first in dealing with school inspection and supervision. There are 15,548 children on the rolls of primary schools in Westminster. Regulations made by the County Council prescribing the action to be taken in cases of infectious diseases occurring in a house in which a O teacher is living:— 67  Married Women. Diphtheria, membranous croup Teacher must cease work, and not resume until a certificate is produced stating that she may do so without fear of conveying infection to the children. Mumps, whooping cough, measles If disease is in same family, same procedure as in diphtheria. If not in same family, but in same house on another floor, may be disregarded. Chickenpox If disease is in same family, same procedure as in diphtheria. If not in same family, but in same house on another floor, same procedure as in column (3). Male Teachers and Unmarried Women. (3) Diphtheria, membranous croup Teacher must cease work, take lodgings, and not return to school until a certificate is produced stating that there is no fear of conveying infection. Teacher must not return home until a disinfection certificate has been issued by the local Medical Officer of Health. Mumps, whooping cough, measles May be disregarded, provided the teacher uses common sense in not handling or nursing the patient. Chickenpox Must cease work for two days, as there is risk of confusion with smallpox. If vaccinated since childhood may be disregarded. Bacteriological Laboratory. During the year 245 examinations have been made at the Lister Institute at a cost of £32 13s. 8d.. with the subjoined results. The number of examinations in previous years were : 1902, 251 ; 1903, 181 ; 1904, 75; 1905, 132 ; 1906, 180; 1907, 155 ; 1908, 175. Disease. Persons. Examinations. Results. Positive. Negative. Diphtheria— Suspected cases 140 145 37 108 Contacts 24 28 8 20 Returned from hospital 2 3 — 3 Deceased person 1 1 1 — 167 177 46 131 Typhoid Fever 6 7 2 5 Tuberculosis 58 61 22 39 68 Hoffman's pseudo-diphtheria bacillus was found in 10 instances of suspected diphtheria, being associated with the Kleb's Loffler bacillus 3 times. Four of the cases in which negative reports were given were notified as being clinically diphtheria, and eventually this was verified in hospital. One typhoid fever patient was examined twice; the reaction was negative at first, but developed at a later stage in the disease. Much more advantage has been taken to obtain information as to the presence of the tubercle bacillus than in previous years. 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 64 rooms in 11 schools, 43 workrooms, and 4 sets of offices; 8 vehicles were also disinfected. In 30 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 30 instances, when the circumstances of the case required it), and also after 80 cases of measles, 14 chicken-pox, 22 cancer, 9 influenza, 2 glanders, 3 whooping cough, and 190 phthisis. In 13 cases the premises, &c., were disinfected privately, certificates being produced to that effect. Shelters.—Six persons were admitted to the temporary shelters at Horseferry Boad 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 seven years:— 1903. 1904. 1905. 1906. 1907. 1908. 1909. Premises 709 581 667 961 840 1,067 1,287 Rooms 1,039 935 1,177 1,627 1,455 1,568 1,865 Articles disinfected 27,766 29,107 34,703 47,865 36,115 31,915 49,843 Articles destroyed 126 52 151 195 1,660 233 186 Books disinfected 16 10 52 363 136 557 281 Number admitted to shelters 19 39 6 1 5 5 6 69 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, and the Education Committee have erected an apparatus as an experiment at Pulteney School. The names of children treated at this school are forwarded, so that the homes, bedding, &c., may be examined and, if necessary, cleansed. Names -of 21 children were received, and the home conditions were found to be unsatisfactory in 12 instances, and steps were taken to rectify them. Six persons were specially treated at Horseferry Eoad; 150 visits in connection with verminous conditions were paid to the houses by the Chief Disinfector. Verminous Houses.—Sixteen rooms were fumigated with sulphur; in addition 191 premises were purified by the owners for like conditions after notice by the Council ; 2,358 articles were passed through the disinfecting apparatus on account of their verminous condition, and 57 were destroyed; these articles were removed from 47 houses. New Disinfecting Station.—In the year 1904 the County Council acquired the site of the Denzell Street and Clare Street Disinfecting Station, Mortuary and Depot, &c., for the Holborn to Strand Improvement, conveying to the City Council, by way of compensation, a site in Kean Street, and paying a sum of £5,000. The Council subsequently directed that the Kean Street site be let. For some time past the question of finding a suitable site for a Disinfecting Station for the Public Health Department, in lieu of the station at Denzell Street, has been considered by the Council, and eventually a suitable site was found on the land on the Grosvenor Canal property, on the west side of the lock. The Council have accepted plans prepared by Mr. John Murray, F.E.I.B.A. These show two separate blocks of buildings, one containing the Disinfecting Station, the other residences, offices, &c., for the staff. The sum received from the County Council, together with the rent which will be received for the Kean Street site, will practically meet the cost of the proposed new building. The Station is expected to be ready for occupation in 1910. Mortuaries. The number of bodies removed to the Council's mortuaries under order of the Coroner, or to await burial, was 291; in 6 instances death was the result of infectious disease. Two hundred and fifty-nine inquests were held at Horseferry Eoad, where the Coroner's Court is situated; 10 adjourned inquests were 70 held. Post-mortem examinations were made in 160 instances at Horseferry Road. The number of dead bodies taken to the mortuaries for purposes of inquest and to await burial during the last nine years are:— Total. For Inquest. To await Burial. Total. For Inquest. To await Burial. 1901 438 370 66 1906 345 283 61 1902 389 345 44 1907 358 281 77 1903 393 341 55 1908 364 298 66 1904 388 322 59 1909 291 258 33 1905 370 307 61 Of the 33 bodies admitted to await burial, 27 were taken toHorseferry Road, 4 to Dufour's Place, 2 to Drury Lane, and 0 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 1902 371 1907 341 1898 165 1903 371 1908 348 1899 273 1904 365 1909 285 1900 309 1905 344 1901 391 1906 332 Deposit of Dead Bodies on Undertakers' Premises.— The County Council has been asked to seek powers for the prohibition of the practice pursued by some undertakers of taking into their premises bodies pending burial. The Council have instituted inquiries throughout London in order to ascertain to what extent tbe practice prevails. Each of the undertaker's premises in "Westminster was inspected, and with two exceptions they appeared to be satisfactory for the purpose. In most instances it is only occasionally that undertakers are asked to take bodies to their premises, but in 3 instances the numbers averaged 75, 30 and 20 in the year. The Public Health Committee considered the matter, and expressed the opinion that it is probably a convenience in a number of cases that undertakers should temporarily give accommodation of this kind, but they consider:— (1) That no undertaker should be allowed to do so unless he has a suitable place in which the bodies can remain; 71 (2) That a register should be kept showing the date of death, and the length of time the body remained on the premises. The register to be open to inspection of the Sanitary Authority, or, alternatively, that the undertaker should notify the Sanitary Authority at once on the reception of each body. In 1905 the City Council drew the attention of undertakers and others to the fact that the Council had provided special mortuaries in various parts of the City for the reception of dead bodies. The practice appears to be decreasing, as several undertakers state that they do not now get paid for this service, as was at one time the custom. 72 PART II. C. House Inspection, &c. Below is a list of details of the work done in connection with insanitai-y conditions. In many cases some of the work specified was in premises part of which was occupied as workshops:— 1909. 1909. Complaints received and dealt with 838 Sanitary Work completed :— Drains :— Premises inspected on complaint, &c. 964 Manholes built ,, repaired and 615 House to house inspection 5,003 cleansed 203 Subsequent visits 21,971 „ covers fixed or repaired 670 Premises (registered), visits to 2,112 Overcrowding found 32 Tested by smoke 225 Other infringements 770 ,, chemical 327 Sanitary Work completed:— Houses:— „ water 385 air 27 Closed under H.W. Classes Act - Fresh air inlets fixed or repaired 292 Closed under P.H. (London) Act 4 Petrol traps provided 5 Cleansed throughout 404 Soil Pipes:— „ partially 1,113 Fixed 352 Overcrowding abated 72 Ventilated 285 Light or ventilation improved 292 Repaired 192 Tested by smoke 165 Roofs repaired 389 „ chemical 235 Floors and staircases repaired 402 „ air 17 Underground rooms vacated 42 Yards, areas, paved or repaired 604 Water-closets:— Constructed 950 Damp walls remedied 208 Repaired 1,013 Offensive refuse removed 330 Ventilated and light improved 317 Keeping of animals discontinued 23 Cleansed or limewashed 1,024 Verminous premises cleansed 191 Ventilated lobbies provided 260 Verminous and filthy bedding and other articles 2,358 Unstopped 125 Traps ventilated 514 Drains:— Flushing cisterns fixed 996 Constructed 339 „ „ repaired 385 Amended and repaired 349 Ventilated 277 Waste Pipes:— Unstopped and cleansed 218 Constructed 822 Interceptor traps fixed 233 Repaired 229 Cleansed and sealed off from sewer 99 Unstopped 76 Trapped 731 Gully traps fixed 1,141 V entilated 382 Defective traps abolished 193 Disconnected 154 73  1909. 1909. Sanitary Work completed:— Sanitary Work completed:— .Rainwater Pipes:— Water Supply:— Fixed or repaired 428 Cisterns defective, abolished 89 Disconnected from drains 96 Taps off main provided 343 Urinals:— Pipes repaired 193 Constructed 81 Dust Bins:— Repaired or improved 45 Provided 315 Cleansed 81 Repaired 15 Water Supply:— Fixed, abolished 62 Provided 147 Stables:— „ additional in tenement houses 399 Drained 26 Paved 23 Reinstated 15 Cleansed 25 Cisterns fixed 81 Dung receptacles provided 2 ,, cleansed 247 Dung accumulations removed 44 „ covered 213 3,316 intimations of nuisances, &c., and 173 statutory notices were issued ; 2,379 letters were written, and 686 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. 26, Carnaby Street (tenement house and workshops) Failure to maintain w.c. in repair- Fined 40s. and 2s. costs. Do Absence of proper and sufficient dustbins 3 s. costs. Order complied with before hearing. 53, South Molton Street (business premises and workshops) Untrapped sink wastes discharging into trap of w.c.; defective w.c.'s; w.c. supplied direct from drinking water cistern; defective brick drain. Order made by magistrate, 8th December, 1908 This summons was for failure to comply with magistrate's order. Fined 42s. and 23s. costs. 4, Upper Rupert Street (restaurant and tenements) W.C. stopped and without water; dirty and dilapidated condition of basement premises used as kitchen Adjourned sine die on an undertaking to close premises. 91, Page Street (tenements) Defective condition of roof, &c Order to abate in 14 days. 10s. costs. 5, Berwick Street (tenement and workshops) Defective condition of roof; dirty walls, &c. Order to abate in 14 days. 3s. costs. Do Non-compliance with order Fined 40s. and 23s. costs. 30, Broad Street (tenement and diningrooms) W.C. defective Work done before hearing. 12s. 6d. costs. 28, Dean Street Dirty condition of basement, &c. Ordered to abate in 14 days. 5s. costs. 41, Tufton Street (tenement) W.C. defective; dirty condition of rooms; defective yard paving, &c. Work done before hearing. 2s. costs. 9, Lewisham Street (tenements) Failure to maintain w.c. in proper condition Fined 40s. 74 In three of the above, the complaint was dealt with as an offence under the by-laws relating to water-closets. Housing and Town Planning Act.—In future, if action be taken under the powers conferred by this Act, police-court proceedings may be fewer except for the purpose of recovering costs. Houses to be Fit for Habitation.— Section 75 of the Act of 1890 enacts that in any contract for the letting of houses for the working classes it is to be an implied condition that the house is at the beginning of the holding in all respects reasonably fit for human habitation, but this Section only applies where the rent does not exceed £20 per annum. Section 14 of the new Act extends the application of this provision to houses at a rent not exceeding £40. Under Section 15, the implied condition as to fitness is to take effect so as to include an undertaking not merely that the house was fit for human habitation at the beginning of the tenancy, but that it shall be kept so throughout the tenancy. This undertaking is made enforceable by enabling the authority, if necessary, to do the work of rendering the house fit for habitation and to recover the cost from the landlord, or, as an alternative, to make a Closing Order under Sections 17 and 18. Under Section 17, any dwelling-house which is in a state so dangerous or injurious to health as to be unfit for habitation may be closed by the Council. Premises. Offence. Result. 41, Warwick Street (business premises) Defective drain, ventilating pipe, &c. Ordered to abate in 14 days. 6s. costs. 39, Warwick Street (business premises) Ceiling, walls, &c., dirty and dilapidated, &c. Do. 21a, Wellington Mews (stables, and livingrooms over) Dirty and dilapidated condition of walls and ceilings ; defective ventilation, &c. Work done before hearing. 3s. costs. 15, Monck Street (tenements) Dirty and verminous condition of rooms; dirty walls of w.c., staircase, &c. Order to abate in 7 days. 6s. costs. 24, Medway Street (tenements) Dirty walls and ceilings of rooms and staircases; defective yard surface Do. 14, Broad Street (tenement house and workshops) Dirty and defective condition of walls and ceilings; foul and choked guttering, defective woodwork and window frames on 2nd floor dirty and broken w.c.'s Order to abate in 14 days. 6s. costs. 24, Lillington Street (tenement house) Absence of water supply to upper part of house Work done before hearing. 3s. costs. 53. Romney Street (tenement house) Do Order to provide within 14 days. 6s. costs. 75 Closing and Demolition Orders.— Under the existing law, recourse must be had to a Court of Summary Jurisdiction, and there is an appeal to Quarter Sessions; under the new Act the local authority may themselves make the Order, and the appeal lies to the Local Government Board within fourteen days after the notice has been -served on the owner. The new Act does not in any way prescribe the procedure to be adopted by the Council before making a Closing Order, but the Board recommend that in each case due notice should be given to all persons interested in the house, and afford them an opportunity of being heard on the subject. Tenants may be awarded a reasonable allowance on account of removal expenses. Underground Rooms.—Under the Public Health (London) Act, Section 96, an underground room may not be used as a dwelling unless it complies with certain requirements, but if used in conjunction with another room in the same house which is not underground, it escapes from the control of the Section. Section 17 of this Act prohibits any underground room being used habitually as a sleeping place, unless it is seven feet high or complies with regulations which may be made by each local authority; it apparently includes basement rooms used by servants in good class houses as well as the kitchens of tenement dwellings. This particular part of the Act does not come into force until the 1st July, 1910. House Records.—Section 17 further states that the Local Government Board may make regulations and prescribe the records which have to be kept relating to the dwelling-houses in each district, and the Board attach much importance to this provision. The regulations have not yet been issued, but probably it is intended that complete records -of the sanitary and health conditions of each house should be kept, so as to form a continuous history, as has been done in Paris since 1894. The system adopted there was described by me in reports in 1898 and 1900, and so far as clerical assistance would permit some attempt has been made on the same lines in Westminster. By-laws with respect to Tenement Houses.—Section 16 imposes on the owner, as defined by the Public Health (London) Act, the duty of complying with the By-laws made by the Council under Section 94 of the Public Health Act, where work is involved, and the Council may execute the work and recover the cost if the owner fails to do it after having had at least three weeks notice. Apparently the existing by-laws may have to be amended. Back-to-bach Houses.— Section 43 prohibits for the future the erection of any back-to-back dwellings intended to be used as working class 76 dwellings. This also applies to a house containing several tenements, in which the tenements are placed back-to-back unless the Medical Officer of Health certifies that they are so constructed and arranged as to secure effective ventilation of all habitable rooms in every tenement. Under Scction 49 (1) the definition of the term " dwelling-house" in Section 29 of the principal Act, is amended by the omission of the words " means any inhabited building" and consequently a house would not cease to be a dwelling-house within the definition because it ceased to he inhabited. Drainage, &c. Plans.—Five hundred and eighteen sets of plans were examined during 1909. 407 of these resulted from notices served by the Public Health Department, and 111 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 eighteen instances. Infringement of the by-laws in connection with the erection of buildings occurred in six instances. Proceedings against two persons offending were taken with the following results:— Premises. Offence. Result. 31, Dean Street Constructing a water-closet without giving notice Fined £3 and 4s. costs. Do. Constructing a water-closet contrary to By-laws Fined £2 and. 4s. costs. 11 A, Regent Street Constructing a water-closet without previously giving notice Fined £2 and £1 3s. costs The other offenders were cautioned. Hot- Water discharged into Sewers.— The Princes Skating Club, Knightsbridge, were summoned by the County Council under their General Powers Act, 1894, for allowing steam or hot-water of a temperature greater than 110® Fahr., to be discharged into the sewers. The temperature ranged from 115° to 165°. Besides the danger to the men employed in the sewers the raising of the temperature is conducive -to the growth of organisms and to the discharge of obnoxious fumes into the streets and up house drains which are not protected by an interceptor, and even into the interior of dwellings. A fine of £10' and 10 guineas costs was imposed. 77 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. Seven persons were cautioned for removing refuse during prohibited hours and five prosecutions were taken as follows:— Name and Address of Defendant. Offence. Result. Michael Hanlon, Rose Cottage Lonesome, Streatham Removing on the 8th April during prohibited hours Fined 5s. and 2s. costs. Richard Turner, Hope Cottage, Lonesome, Streatham Do Fined 5s. and 2s. costs. Joseph Whiting (F. Squire and Son), 59, Tobin Street, Notting Hill Do Fined 20s. and 2s. costs. J. Vincent, Bland's Farm, Isle worth Receptacles without proper covers Fined 5s. and 2s. costs. R. Attarresi, Horsendon Wood Farm, Harrow Middlesex Do Fined 30s. and 23s. costs. Daily Removal of House Refuse.— The Council resolved on the 19th March, 1908, to establish a daily collection of dust, and since that date the system has gradually been extended from the eastern part of Soho where it had been put in operation by the Strand Board, throughout Mayfair, St. James', Belgravia, Knightsbridge and Pimlico. Part of this has been done by contractors and part by direct labour, and by degrees the latter method is being substituted for the former. Direct labour is probably more expensive for this particular kind of work than is the employment of a contractor, but the greater efficiency and thoroughness with which the work is done are more than equivalent. Mr. Yentris, the Assistant City Engineer, in a report to the Highways Committee on the subject, stated:—"The collection in most places where there were fixed receptacles took place, as a rule, once a week, the dustmen shovelling the contents of the dust-holes out into baskets and carrying them up to the carts. During the busiest part of the year, which was naturally the height of the Season, dust carts might be seen at work in the best parts of Mayfair up to six or seven o'clock in the evening. The result of retaining the refuse for so long was that decomposition took place, and the dustbin became the breeding place of flies, which are now recognised as one of the most active propagators of infectious germs. It was almost impossible to check the work of the dustmen, and the only control arose through the complaints made by ratepayers of not having their dust collected." f 78 Now, complaints are few, and the daily collection is finished by 10 o'clock in the morning. The difficulties in arranging this were enormous as the circumstances of each establishment had to be considered, but considerably more assistance was received from the residents than might have been expected. The only part of the City where the daily collection has not yet been effected is part of St. Margaret and St John district where there are still six carts working on the weekly system. Watek Supply. Applications were received for certificates that the water supply of five new buildings was sufficient, and were granted in each instance. 208 notices of withdrawal of water supply were received from the Metropolitan Water Board, and in 15 instances it was reinstated, on notice. Additional sources of water supply on the upper floors of tenement houses were provided in 399 instances. Legal proceedings to enforce this were taken in only two instances. Owners are recommended in all cases to fit a proper sink in connection with the new supply on upper floors and so prevent risk of walls and ceilings being spoiled. Two large owners of property, having received notice in respect of some of their houses, decided to lay on additional supply of water to all their tenement houses. As a rule, the Council has not asked for more than one tap and sink between the first and second floors, but in some instances owners have laid on water to each floor. Houses Let in Lodgings. The number of houses in 1909 was reduced by 67 through closure, and as none were added in that year, the number on the register at the end of the year was 1,481. 2,963 visits were recorded as having been paid to this class of house, but many more were actually paid. Overcrowding was found in 32 instances, and 770 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). Deaths in Districts No. 3 and No. 5 in St. John's Ward, on which a special report was made in 1908, number 57 and 46 respectively, Chad wick Street in the latter area accounting for 21 of the deaths. Parts of these districts form the area which may be acquired by the St. John's Westminster Improvement Company under their Act of 1906. In consequence of an inquiry held by the Local Government Board, apparently with the view to discover what steps the Company were prepared to take to comply with the provisions of the Housing of 79 the Working Glasses Act, 1903, in respect of the re-housing of persons displaced, it became necessary to ascertain the number of persons living in the area. At the time of the passing of the Act the number of persons belonging to the working class who would have to be re-housed was about 1,800. The result of a census is that 2,002 persons were found, including the inmates of a common lodging-house but excluding those in the Church Army Shelter. About 220 of the. inhabitants would not come under the definition of "Working Class" laid down in the Schedule 12 (e) of the Housing Act, 1903. Having now a definite population it is possible to ascertain the death rate of the area in question. It works out at 27.5 per 1,000 for 1909, phthisis deaths at 3'5 per 1,000, other forms of tuberculosis at 2.0 per 1,000, and respiratory diseases at 4 per 1,000. There were no deaths connected with the common lodging house or the shelter. In many instances no addresses were obtainable for persons who died in institutions, except that they belonged to St. John's; none of these have been included. Several cases of overcrowding were discovered, a proportion of the people displaced by the pulling down of houses in Parker Street and Lewisham Street have moved into this area. There were 80 families in Parker Street and in Lewisham Street. There has also been some recent displacement in the area by the closure of houses in Laundry Yard. In 1902 there were 120 persons in 19 houses, now there are 62 persons in eight houses. This neighbourhood requires the constant attention of an inspector; 221. notices to remedy defective conditions were served during 1909. Houses occupied as tenements have also been demolished in Mercer Street, Long Acre, and in Eaton Lane, near Victoria Station. The former are being rebuilt; the site of the latter is being utilised for the erection of a new hotel. There were 29 houses in Eaton Court and Eaton Lane containing 116 rooms and 130 persons were displaced. There is, however, plenty of available accommodation in the streets off Lupus Street, although not so centrally situated as Eaton Lane. Accommodation for the Storage of Food.—In the London County Council (General Powers) Act, 1909, provision is made whereby suitable arrangements must be made for the storage of food in tenement dwellings. The Section is:— "16. If at any time it appears to any Sanitary Authority that in any tenement house within their district sufficient and suitable accommodation for the storage of food is not provided for the use of each family occupying such house on the storey or one of the storeys in which are situate the room or lodgings in the separate accommodation of such family, the Sanitary Authority may, if the provision of such accommoda- f2 80 tion is practicable, cause notice to be served on the owner of such house requiring him, within such reasonable time as may be specified in the notice, to provide sufficient and suitable accommodation for the purpose aforesaid, and any owner failing to comply with such requirements within the period prescribed in the notice shall be liable on summary conviction to a penalty not exceeding forty shillings and to a daily penalty not exceeding twenty shillings. " Provided that this Section shall not apply to any tenement house used or occupied as such before the passing of this Act." Regulation of Cheap Furnished Rooms.—The London County Council have under consideration the question of the necessity for the exercise of increased control over a certain type of furnished room, the practice of letting such rooms for short periods, at a rate not exceeding 10s. a week, having recently become more general in various parts of the County of London, that this class of room appears to be occupied by persons who are, if anything, of a more degraded character than those frequenting common lodging-houses; that the rent is paid daily and the appointment of the rooms are mostly of a very scanty and dilapidated nature, the beds being, in many instances, verminous, and that the ease with which such rooms can be hired is, moreover, a great incentive to immorality. The By-laws which have been made by the councils of the several metropolitan boroughs under the provisions of Section 94 of the Public Health (London) Act, 1891, do not confer upon sanitary authorities adequate power for dealing with rooms of the above description. Probably considerable difficulty is experienced in putting into operation the provisions of the General Powers Act, 1904, as to the destruction of filthy or unwholesome articles, owing to the frequency with which disputes as to the amount of compensation for articles destroyed arise. The existence of these circumstances has led the County Council to consider whether, in the interests of public health, further legislation should be sought in respect of furnished rooms so let, to ensure that they should be maintained with due regard to sanitation, and it appears to them to be most desirable that greater supervision and control than exists at present should be exercised over this class of house, which is nearly related in character to the common lodging-house, both in respect of the class of house and the social condition of the inmates—in fact, the demand for lodgings of this character exists in the main in localities where common lodging-houses are situated, the lodging-house and the furnished rooms not infrequently being owned by the same person. The County Council are of opinion that more effective control would be ensured if persons letting such rooms were required to obtain an 81 annual licence, to be granted after consideration of the fitness of the applicant and the structure and cleanliness of ths premises, such licences to be granted by the County Council in the same manner as is done with regard to common lodging-houses. They suggest as an alternative means of securing adequate supervision that the local sanitary authority should be invested with full power to inspect and enforce a certain standard of requirements, authority being given to the Council, with the consent of the Local Government Board in each case, to act in default of action by the local sanitary authority. The County Council invited the metropolitan borough councils to assist them with their views as to the means, by licensing or otherwise, by which the sanitary and moral conditions of the inmates of these houses could be improved. There are a certain number of houses let out in the manner described in the City. The City Council agreed that further legislation is desirable, that it should be on the lines set forth in the alternative suggestion contained in the County Council's letter, and that if it is thought necessary to make provision in the Bill giving power to the County Council to act in the case of a defaulting local sanitary authority, such provision should be similar to that contained in Section 101 of the Public Health (London) Act, 1891. Common Lodgtng-iiouses. Complaint was made to the Council of the improper inspection and supervision and the insanitary condition, &c., of the common lodginghouses in Great Peter Street and Great Smith Street. The supervision of common lodging-houses in the metropolis being the duty of the London County Council, the Council resolved to transmit a copy of the complaint to the County Couucil. The condition of one of the houses was receiving consideration in the matter of the sale of milk there, prior to the receipt of the complaint, but a special inspection of the premises was made. The premises No. 40, Great Peter Street, and No. 6, Great Smith Street, were both found to be conducted in accordance with the legal requirements for such houses. With regard to the premises No. 33, Great Peter Street, the conditions of that part of the premises where milk and other provisions are stored and sold, and the caretaker's apartments, and the ventilation of the common kitchen on to the adjoining footway, were not considered satisfactory. The condition of the place where milk and other provisions are stored and of the caretaker's apartments was improved, and a copy of 82 the Medical Officer of Health's report was transmitted to the London County Council, with information of the action taken by the City Council. Deaths.—96 deaths occurred in 1909 among inmates of the common lodging-houses and shelters in the City (95 males and 1 female). 31 of the deaths were due to phthisis, and 20 to respiratory diseases. There were 45 deaths in St. John's Ward, 4 in Eegent, 10 in Covent Garden, and 37 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 1909 among persons alleged to have be'en inmates:— Men. Deaths. 1908. 1909. Bruce House, Kemble Street (L.C.C.) 699 32 28 33, Great Peter Street 397 14 22 6, 6a, 6b, and 60, Great Smith Street 201 1 9 Ham Yard. Hospice, Great Windmill Street 20 — — 11, 12, and 13, Hanover Court 105 14 10 23 and 25, Millbank Street (S.A. Shelter) 449 3 3 108, Regency Street 8 — — The Schools, Kean Street (S.A. Shelter) 125 2 7 16, Strutton Ground 217 12 10 45 and 47, Tufton Street 91 4 — Women. 40, Great Peter Street 75 3 1 In addition, 5 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, and 10, Stanhope Street. Revenue Act. Certificates under this Act relieve the recipient from the payment of Inhabited House Duty. Applications were received by me in 11 instances comprising 99 tenements, and 1 application for 4 tenements was outstanding at the end of the year pending structural alterations. Certificates were granted in respect of 95 of the tenements. The premises in which are situated the tenements for which certificates were granted are:— 120, Wardour Street. 48, Regency Street. 42, Frith Street. 31. Frederick Street. Wellington Mansions. 1, Chapter Street. Suffield Chambers. 117, Victoria Street. 229, Piccadilly. 2 and 48, Greycoat Gardens, Ann's Place, Kinnerton Street. 46, Farm Street. 83 Such certificates were originally intended as a stimulus to property owners to improve the condition of tenement houses, but in some of the above the accommodation for which application was made was intended for servants and caretakers in blocks of high-class mansions. By the Housing and Town Planning Act a further extension has been made by exempting from Inhabited House Duty any house occupied for the sole purpose of letting' lodgings to persons of the working class at a charge of not exceeding 6d. a night for each person, if certified by the Medical Officer of Health to be solely constructed and used to afford suitable accommodation for the lodgers and due provision made for their sanitary requirements. 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:— 1908. North District. South District. Total. Complaints received 25 19 44 Observations taken 1,604 1,001 2,605 Notices issued— Preliminary 77 16 93 Statutory 5 1 6 Summonses - - - Two of the statutory notices were for the same premises. A comparison with previous years is given below:— 1902 1903 1904 1905 1906 1907 1908 Complaints 81 52 55 52 37 48 35 Observations 2,728 2,731 3,191 2,715 2,722 2,417 2,362 Notices Issued:— Preliminary 58 68 142 121 93 106 116 Statutory 18 18 26 26 25 15 12 Summonses 6 3 5 11 8 2 A conference took place between the Public Control Committee of the County Council and representatives of the Borough Councils to consider the lines on which amendment of the existing law should be sought. The following proposals were considered and adopted:— "(a) That Section 24 (b) of the Public Health (London) Act, 1891, which provides that 'any chimney (not being the chimney of a private dwelling house) sending forth black smoke in such quantity as to be a 84 nuisance' shall be a nuisance liable to be dealt with summarily under the Act, should be amended by the deletion of the word ' black.' "(b) That the word 'chimney' in Section 24 (b) of the Act should be deemed to iuclude— "(i.) Openings through which smoke is emitted from buildings or places in which processes of trade or manufacture are carried on and the chimneys of any building or place where furnaces are used in operations carried on under statutory powers. "(ii.) The chimneys of Government workshops and factories. "(c) That, in special eases of nuisance arising under Sections 23 and 24 of the Act, the proceedings in respect of any nuisance may, at the request of and by agreement with the sanitary authority, be taken by the London County Council in such special cases." The following proposal was amended but finally rejected by a small majority of the borough delegates:— "That the power of the Council to take proceedings in respect of nuisance created by sanitary authorities under Section 22 of the Act should be extended to apply to smoke nuisance from electricity or other industrial works, or from premises used for the treatment or disposal of refuse, or for disinfecting purposes, or from baths or washhouses or other buildings or wharves owned by sanitary authorities in which furnaces are used; and that, as regards such proceedings, the Council should be relieved of the restriction imposed by Section 117 of the Act, that a proceeding under the Act should not be taken by the London County Council against a sanitary authority, save with the sanction of the Local Government Board, unless such proceeding is for the recovery of expenses or of money due from the sanitary authority to the Council" I dealt with this subject in the Annual Report for 1908. 85 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 l-equired. 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 1909 Workshop. Total Number. Number in which Women are Employed. Tailors, outfitters, shirt makers, hat, cap, and helmet makers 1,580 1,042 Dressmakers, milliners, embroiderers, lace makers, blouse makers, costumiers, lingerie makers, children's outfit makers, feather dyeing, corset makers, furriers, &c. 728 760 Leather workers, boot and shoe makers, harness makers, &c. 66 10 Carpentry, upholstery, carvers, gilders, &c. 25 — Surgical and dental instrument makers 5 7 Tobacco manufacturers 34 12 Wig makers and hair workers 39 37 Printing, bookbinding, lithographers, envelope making, stationers, publishers, &c. 56 34 Jewellers, silversmiths and burnishers, diamond cutters and polishers, engravers, &c. 74 32 Metal workers 45 5 Miscellaneous—Basket making, fancy work, shoe ornaments, hat pins, stamp sorters, postcard tinters, fan makers, artificial flower makers, &c. 33 75 Florists 26 31 Laundries 49 47 Bakehouses 84 — New workshops are always being discovered, at the same time the occupation of premises 011 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; 119 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. Two hundred and eight complaints were received, including 125 from the Home Office and were duly investigated ; 15 matters were referred to the Home Office relating to insufficient warming of rooms, working overtime, &c. In addition, notice was sent of 160 workshops in which Abstracts were not affixed. 86 Statutory notices were issued in 44 instances, and eight prosecutions took place in connection with premises in which work was carried on. The particulars are given in the list of police court proceedings under the heading of " House Inspection." Inspection. Premises. Number of Inspections. Defects Found. Intimation Nonces. Statutory Notices. Prosecutions. Factories 30 7 2 1 - (Including factory laundries) Workshops 2,975 2,537 816 36 5 (Including workshop laundries) Workplaces 1,460 311 101 6 3 (Including restaurant kitchens, &c.) Total 4,465 2,855 919 43 8 In addition, 16 re-inspection visits were paid to factories and 3,805 to workshops and other workplaces. Defects found,.—1909. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Nuisances under the Public Health Acts:— Want of cleanliness 958 950 3 Want of ventilation 139 139 — Want of ventilation of gas stoves 138 137 — Overcrowding 44 44 — Want of drainage of floors 61 61 — Other defects 719 712 3 Sanitary accommodation— Insufficient 44 42 — Unsuitable 84 84 — Defective 583 583 4 Not separate for sexes 85 83 — Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouses (Sec. 101) — — — Breach of special sanitary requirements for bakehouses (Sees. 97 to 100). — — — Other offences — — — Total 2,855 2,835 8 * Including those specified in Sections 2, 3, 7 and 8 of tbe Factory and Workshop Act as remediable under the Public Health Acts. The prosecutions covered a number of defects. 87 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)— 160 Notified by H.M. Inspector 125 Reports (of action taken) sent to H.M. Inspectors 125 Other — Workrooms measured 534 Underground bakehouses (Sec. 101):— Certificates granted during the year — In use at the end of the year 71 Unventilated Stoves.— The danger of using stoves which are not provided with a proper means of ventilation to which I alluded in my last Annual Report, has been emphasised by the deaths of three persons— one in Westminster—due to poisoning from the fumes. A recent analysis made by the Home Office of the air of three large workrooms in Westminster, in which a particular form of stove was being used without any special means of ventilation being provided, showed that the amount of carbonic acid (C02) in the air immediately over the stove was 34 parts per 10,000 in one case, 565 in the second and 87'5 in the third, while the more poisonous carbon monoxide (CO) varied from 0-5 to 0'8. The Home Office Inspectors (who are concerned with the warming of workshops) held that the use of such stoves is an infringement of Section G of the Factory and Workshop Act and requested that the stoves be replaced by a better system of heating or be efficiently ventilated as to prevent them interfering with the purity of the air. There are now good forms of gas stove available with proper means for carrying off the products of combustion. If properly fitted so as to ensure a sufficient flue draught no vitiation of the air of the room need ensue. Ventilation.—It is not uncommon to see in restaurants and places of business electric fans at work having no communication with the outside air. They do not act as ventilators but merely agitate the air—probably already heated and vitiated. Experiments have been carried out by two French doctors (Sartory and Filassier) proving that these fans cause draughts, stir up the dust and distribute it through the 88 rooms so that, after running for one or two hours, the number of organisms and dust particles in the air is enormously increased. They therefore recommend that fans should not be used in this way. Shafts and tubes for the purpose of bringing or taking off air should be frequently cleansed, otherwise they may become receptacles for dirt, which may be eventually carried into the air of the rooms. Underground Workrooms.—In many instances underground rooms now being used as workplaces were not constructed to be used for this purpose. They were in some instances the cellars or the kitchens of an ordinary dwelling-house, in others the storage cellars of shops to which perhaps the vaults under the pavement may have been added to give additional space and to obtain extra light through the glazed-over intervening area. Under such circumstances it is often difficult to procure structural alterations which shall bring them up to a reasonable standard of healthiness. The difficulties which are encountered relate to ventilation, warmth, lighting, dampness, entrance of impure air from ground contaminated by drains, coal-gas, &c., or from the direct connection of sanitary conveniences therewith. With the exception of lighting, there is a certain amount of legal power to assist in improving these conditions. With two notable exceptions there are no provisions requiring efficient lighting in the Factory and Workshop or Public Health Acts relating to ordinary dwellings, workshops and factories ; and even in the most recent Act — the Housing and Town Planning Act, where stricter regulations are made for underground places where people sleep, it is provided that a closing order shall not prevent a room unfit for sleeping being used for other purposes. The exceptions, it should be noted, are both in connection with underground rooms. Section 101 in the former dealing with bakehouses, and Section 96, London Health Act, dealing with dwellings. In regard to dwellings, there is no doubt but that day-light is demanded, as the size of the windows is specified. All workrooms, in my opinion, should be efficiently lighted by daylight, or some legal provision should be made for securing this. There are many workrooms, work places and offices where artificial light is used continuously, and in winter a person who spends the day in such a place is practically cut off from sunlight, except on Sundays, for a considerable portion of the year. In the Factory and Workshops Act, 1901, it was thought desirable for various reasons to legislate specially for one class of business carried on underground, viz., bakehouses, and to require that no underground bakehouse should after a certain date be used, unless certified by the 80 District Council to be suitable as regards construction, light, ventilation and in all other respects. This had the effect of bringing all underground bakehouses into line at once, with beneficial results. I think it is desirable to extend the principle to all underground workshops. I find no provision was made in the Factory Act for the withdrawal of a certificate from a bakehouse if at any time the premises are found not to comply with the requirements; I think power should be given to a Magistrate to clo=,e an underground bakehouse or workshop on being shown that it had become unsuitable for use at any time after certification. 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. Thirty-five 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 1909. 678 lists were sent in by employers, as compared with 665 in 1908, 654 in 1907 and 318 in 1906 ; 3,402 addresses were sent to other local authorities in whose jurisdiction lived persons to whom work, chiefly tailoring, is sent from Westminster to be done in other boroughs; 511 addresses were received of persons in Westminster taking in work from other boroughs. taking in work from other boroughs. They were distributed thus Council. Sent from Westminster. licceivod. Council. Sent from Westminster. Received. Feb. Aug Feb. Aug. Feb. Aug. Feb. Aug. Acton 2 2 - - Isle of Wight - 1 - - Battersea 65 54 — 2 Islington 21 48 1 - Bermondsey 1 — — — Kensington 52 26 32 30 Beth.nal Green — 6 — 1 Lambeth 41 67 — 8 Camberwell 25 32 — — Lewisham 1 1 2 2 Chelsea 14 7 49 36 Leyton 2 2 2 2 Chiswiek 3 — — — Norwood 3 — — — City of London 10 13 41 30 Paddington 27 30 15 31 Croydon 5 2 — — St. Marylebone 767 770 57 58 Deptford 2 4 — — St. Pancrns 206 181 3 9 Ealing 4 4 — — Shoreditch 9 6 2 — East Ham 2 — — — Southwark 8 22 3 2 Edmonton — 1 — — Stepney 201 113 1 1 Fmsbury 8 11 7 6 Stoke Newington — 4 — — Fulham 45 35 — — Tottenham 5 7 — — Hackney 4 4 2 1 Walthamstow 2 3 — — Hammersmith 27 30 1 — Wandsworth 55 44 3 9 Hampstead 5 9 — — West Ham 7 3 — — Harrow — 2 — — Weymouth — — — 1 Holborn 94 45 26 34 Willesden — 5 1 — Hornsey — 2 — 1 Wimbledon — — — — 90 City of Westminster. Outworkers. 1909. Trade. FEBRUARY LISTS. AUGUST LISTS. Number of Lists, Number of Outworkers. Received from other Authorities. Sent to other Authorities. Addresses in City. Number of Lists. Number of Outworkers. Ueceivei from other Authorities. Sent to other Authorities. Addresses in City. A. Tailoring 272 3,482 199 1,184 2,497 257 3,358 227 1,095 2,490 A. Dressmaking 16 188 23 151 60 15 223 17 175 65 A. Theatrical costumiers 1 22 1 15 8 1 24 — 14 10 A. Waterproofing 2 59 — 14 45 2 63 — 15 48 A. Shirt making and hosiers 25 119 12 61 70 26 111 5 55 61 A. Boot making 20 349 9 237 121 22 346 10 262 94 A. Veil Spotting 1 2 — 2 — 1 2 — 2 — A. Corset making 1 2 — 2 — 1 2 — 2 — A. Hat making 1 4 — 4 — 1 6 — 6 - A. Gold lace making — — — — — 1 50 — 28 22 A. Embroidery 2 48 1 44 5 22 1 14 9 A. Glove making 1 3 — 3 — 1 2 - 2 — B, Lace making 1 7 1 4 4 1 8 — 3 5 F. Eur pulling — — — — — 1 1 — 1 — J. Ironmongery 1 2 — 2 — 1 2 - 2 - K. Umbrella making — — — — — - — 1 - 1 L. Paper bag and box making — — 1 — 1 1 3 1 3 1 W. Stuffed toy making — — 1 — 1 — — 1 — 1 341 4,287 248 1,723 2,812 334 4,223 263 1,679 2,807 328 firms sent in lists on both occasions giving a total of 8,361 addresses, 20 firms engaged in making wearing apparel, 1 furrier and 1 paper bag maker sent in once in the year, the number on their lists being 146. 91 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. During the past year the card index method has been extended to this department, and the actual number of persons resident in the City is found to be 1,789. 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 1,039. 437 notices were served in respect of 903 defects discovered in 392 houses. were served in respect of 903 defects discovered in 392 houses. They may be summarised thus:— Sanitary accommodation— Walls and ceilings dirty 340 Insufficient — Rooms verminous 48 Not kept separate 25 Rooms overcrowded 13 Improper position 1 Rooms badly ventilated 23 Apparatus defective 130 Q-as stoves and heaters unventilated 31 Requiring cleansing 56 Other defects (dampness, defective roofs, floors, water supply, dust bins, &c.) 167 Ventilation defective 6 Drains, &c., defective 73 In 23 instances statutory notices had to be served and 2 summonses to be taken out before the work required was done. In several instances where the rooms were dirty or verminous the outworker was seriously warned, and in one instance work was stopped until the conditions were improved. 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. apparel, are given below. It was unnecessary to stop their work except temporarily during the time disinfection was being carried out:— Smallpox. Scarlet Fever. Diphtheria. Typhoid Fever. Erysipelas. Total. Clothing trades:— (a) Business in family affected - 33 4 1 7 45 (5) Business in other parts of house - 53 15 - 8 76 (c) Persons from infected houses employed in clothing business elsewhere 3 91 14 4 6 118 Other home workers trades:— 3 177 33 5 21 239 (a) Business in family — — — — — — (A) Business in other part of house - 1 - - - 1 (c) Elsewhere 1 2 — — — 3 In connection with Laundries there were cases in two of the above three classes:— (a) (b) (c) In Receiving Shops — — — Mangling only — — — Washing, Ironing, &c. Scarlet Fever, 1 — Scarlet Fever, 2; Diphtheria, 1. 92 F.— Food Supply. Restaurants, t&c.—During the years 1907 and 1908 the Council set aside an Inspector to make a special examination of hotels, restaurants, eating houses and other places where food is prepared. This examination was completed at the end of March, 1909, and the duty of regularly supervising these places devolved upon the various District Inspectors, the Food Inspectors. A very considerable improvement has been effected, not only in the structural condition of these places, but also in the general cleanliness and conduct of the business; 1,063 premises in which food is cooked and served (exclusive of licensed houses where food is not prepared and milkshops not serving light refreshments) have been thoroughly examined, and 1,627 defects (474 relating to cleansing of walls, &c.), which were found in 879 of them, have been remedied. Altogether 6,538 visits have been paid in connection with this special inspection. During 1909 visits have been paid to the various classes of business as follows:— Dairies and Milksliops 690 Bakehouses 238 Hotels, Restaurants and Eating bouses 2,149 Ice cream makers 182 Food preserving works 19 Fishmongers 438 Greengrocers and Fruiterers 451 Meat shops (various) 889 Confectioners 7 Provision shops 290 Aerated water makers 2 Five statutory notices were served and police court proceedings in two instances (see list ante); one place was closed as a result. One person was cautioned for depositing meat in an improper place, and warned that he would be prosecuted in the event of his continuing to contravene the regulations of the General Powers Act, 1908. Ice -cream Premises.—This commodity is made at 146 premises, each of which was kept under supervision. In 8 instances defects affecting this particular part of the business were remedied. One street seller was cautioned for not having his name and address on his barrow. Bakehouses.—At the end of 1908 there were 12 above-ground and 71 underground in use. During 1909 one underground has been relinquished and a new above-ground substituted, while one underground bakehouse which was not in use during the last three years has been resumed. There are, therefore, 13 above-ground and 71 underground at present. 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. One baker was also warned that he was not keeping the floors, &c., as clean as he ought to do. 93 Certification of Premises, die.—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; 155 certificates have been granted during 1909, 59 for the United States, 2 for the Philippine Islands and 94 for the Argentine. Infectious Disease in Places where Food is Prepared or Sold, not including Milkshops. Scarlet Fever. Diphtheria. Typhoid Fever. Erysipelas. Total. (a) Illness in persons connected with the business 16 8 3 4 31 (b) Business in other parts of house 53 1 - - 54 (c) Persons from infected houses employed elsewhere 42 12 4 7 65 111 21 7 11 150 Milkshops.—At the end of 1908, 344 names of persons selling milk were upon the register, the number having been reduced during the year from 386, chiefly as a result of the additional powers under the General Powers Act of 1908. In 1909, 37 names were removed and 43 added, leaving 350 on the register at the end of the year; 9 of these are street vendors having no address in the City. Four persons selling milk were given notice to register, and one failing was summoned and fined £5 and 9s. 6d. costs. Six hundred and ninety visits were paid during the year, besides those by the two Inspectors taking samples under the Food and Drugs Act. Notices requiring improvement of existing conditions were served in a number of instances, but no proceedings had to be taken against any milk seller on this account. In one case in which a Magistrate's assistance had to be sought, a shop in which milk is sold formed part of the premises. Dirty Milk.—The County Council again sought power to obtain larger powers to deal with dirty milk as it arrives in London, but were unsuccessful, as the President of the Local Government Board again promised to bring in a Bill to deal with this matter throughout the whole country. Tuberculous Milk.—Under the General Powers Act, 1907, the County Council has power to examine milk sent to London from various parts g 94 of the country. The total number of samples taken since the Act came into operation on 1st July, 1908, is 2,531, and of 1,930 of these in which the examination has been completed, 187, or 9'6 per cent., proved to be tuberculous. The Council's Veterinary Inspector has power to visit farms outside the county and examine the cows; the total number so examined is 16,625, of which number 363, or 2.2 per cent., were found to have tuberculous udders. 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. Two instances of milk carriers suffering from phthisis came to my notice. So soon as their employers became aware of the fact they discontinued employing them. Infectious Disease.—Six cases of scarlet fever, 2 of diphtheria, and 2 of erysipelas occurred on premises in which milkshops were situated, and two persons from an infected house were employed elsewhere in the milk trade. Satisfactory arrangements were made in each instance, and no infection of the milk resulted. An outbreak of scarlet fever, however, did occur, traceable to infected milk, and Westminster was affected to some extent; fortunately we were able to stop the supply of this milk to the City within a few hours of the notification of the first cases. Probably infected milk had formed part of the consignment to local dealers on two days. The following is an account of the matter presented to the Council by the Public Health Committee:— "Scarlet Fever and Milk.—On the evening of the 17th June, the Medical Officer of Health suspected the milk supplied by a dealer in Westminster as being the probable source of infection of two families. He at once took steps to ascertain if there was any illness in the families of the dealer or his employees, and, finding none, advised him to change his supply of milk, and to throw away that which he had left over unsold, which was done. During the course of the evening a dozen notifications were received, and inquiry elicited the fact that in each instance milk had been obtained from the same source. "It was ascertained that the milk was obtained from a large wholesale firm having twelve collecting depots, chiefly in Lhe West of England, each depot receiving milk from a large number of farms. The Medical Officer, having ascertained that the customers of other retailers in Westminster, who were getting their milk from the same company, were not suffering, was lead to suspect one of the depots as being the likely source. Meanwhile he had communicated with the manager of the wholesale company, the Medical Officer of Health for the County of 95 Wilts, and one of the local medical officers, and received replies next mornins: confirming the conclusion that the milk liad come from the o o depot suspected, hut stating that no cases of scarlet fever or any illness had been notified by any of the farmers. The farms, 31 in number, are situated in two counties, Wilts and Dorset. Inquiries were at once set on foot, and eventually a farm was found with five persons suffering from scarlet fever. Apparently four had such slight symptoms that the nature of the illness was not recognised until the fifth one developed the disease in more typical form. Meanwhile, in case other purveyors in Westminster might receive any of the suspected milk, Dr. Allan, on the night of the 17th, stopped all the milk from this particular depot coming into Westminster and we are pleased to be able to report that thereafter no further cases occurred which could be attributed to milk. "The Medical Officer also communicated with the Medical Officers of other Boroughs, and found that some cases had occurred in Chelsea and Wandsworth, but that Wimbledon, Kingston, Norbiton and Worcester Park were suffering from an extensive outbreak which had evidently begun a day or two sooner. After a conference with the London and Surrey County Medical Officers at Kingston, the whole supply of the suspected depot was stopped coming to these counties. " When the source of infection was discovered, the whole of the milk supply from the farm was prohibited by Dr. Tubb Thomas, the Wilts Medical Officer, from being sold until a clean bill of health can be given, and the whole of the depot milk supply was suspended until the premises, utensils, &c., had been disinfected and certified to be free from infection. "Forty-three cases of scarlet fever attributable to this milk were notified in Westminster, all of the patients having been taken ill about the 16th and 17th of June." The Medical Officer of the London County Council rendered every possible assistance, and sent Dr. Hamer and a Veterinary Surgeon to conduct inquiries on the farms. Reporting later, he stated that no reasonable doubt can be entertained that the milk of a particular farm was responsible for the occurrence of over 400 cases of scarlet fever in London and Surrey, and interest centres in the question how milk of this farm acquired the ability to infect those who consumed it with this disease, and whether it was infected by the milker or some other person suffering from scarlet fever, or by some condition of a cow or cows. In 1885, Sir William Power demonstrated the bovine origin of scarlet fever occurring in persons who consumed milk from a Hendon farm, the cows of which were in a morbid condition, and in the present case inquiry showed that just at the time when the milk first began to show infectious property there was added to it the milk of three recently g 2 96 calved cows, the calf of one of which had died after being suckled by the cow for four or five days, and which were all three in a morbid condition suggestive of the condition of the Hendon cows in 1885. These facts render it probable that a morbid condition of the cow was responsible for the human illness which ensued in the present case. Cowsheds.—There is now only one cow-keeper at 13, Marsbam Street (licensed for 19 cows). No. 7, Arthur Street, which was licensed for 12 cows, has been given up. These premises were visited 29 times during the year. There are no slaughter-houses or "offensive trades" carried on in "Westminster. Fried Fish Vendors, &c.—Draft By-laws made under the General Powers Act, 1908, have been under discussion and various amendments suggested, but they have not yet been definitely settled. Inspection of Food. 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. Almonds 0 16 0 Mangolds 0 0 84 Apples 1 16 91 Oranges 10 4 0 Bananas 23 13 0 Peaches 0 2 0 Beans 0 0 70 Pears 1 7 23 Brussels Sprouts 0 0 56 Peas 0 1 18 Cabbage 1 5 0 Pineapples 0 3 0 Carrots 1 5 0 Plums 1 11 18 Cauliflowers 0 5 0 Potatoes 0 12 0 Cherries 0 1 98 Raspberries 0 0 28 Currants, Black 0 1 88 Sloes 0 3 56 „ Red 0 2 0 Strawberries 0 7 71 Grapes 0 4 32 Tomatoes 1 6 9 Plaice, 1 ton 6 cwts. 48 lbs.; Dabs, 50 lbs.; Haddock, 1 cwt.; Fish (various), 214 tins ; Caviare, 10 tins; Sardines, 1 cwt. 28 lbs.; Lobsters, 100; Ducts, 24 : Grouse, 7. The following articles were seized and condemned; appended is a note of the action taken. 97 Article. Name and Address of Defendant. Result. 13½ lbs. rump steak William Everett, 163, Earl's Court Road, S.W. Fined 40s. and £2 2 s. costs. 13 lbs. beef and mutton George Cooper, 69, Lupus Street, S.W. Fined 40s. and £2 2s. costs. Cherries in Berwick Street on a stall H. Thomas, 22, Tichfield Street, W. Summons not served, seller could not be found. Twelve sheep's hearts Johnson, Cole, Brier and Cordrej, Ltd., Capel House, 62, New Broad Street, E.C. Fined 10s. and £2 2s. costs. One pig's carcase affected with tuberculosis H. Willis (trading as Westmarland and Co.), 3, New Street Cautionary letter sent by Committee. It was ascertained that the retailer on whose premises the pig was found had been assured that the carcase had been examined and passed, and there was evidence that some of the glands had been cut into. However, the pig had not been seen by the Corporation Meat Inspector, but had been seen by a man employed by the vendor. As the law does not permit proceedings against the vendor unless actual knowledge of the condition can be proved, the Council resolved to caution the retailer (who had a good record) to examine the pigs in future himself. Condemnation of Unsound Fish.—The Council received a letter from the Fishmongers' Company, stating that it has come to their knowledge that a practice is now becoming common among small traders, hawkers and others, to fraudulently substitute overday's fish for fresh fish bought in the morning and take it to a Medical Officer of Health, representing to him that it was bad when received and getting him to condemn it; that the Medical Officer of Health's Certificate of unsoundness is then taken to the salesman at Billingsgate and the return of the money paid for the fish demanded; that the salesman having no redress or proof has in many instances refunded the money, although the fish supplied that morning was absolutely fresh and had passed the Inspectors of the Fishmongers' Company. As the practice is becoming too frequent the salesmen are prepared to contest each case, and the Company would be extremely obliged if the City Council would ask their Medical Officer of Health to instruct the Sanitary Inspector to report each case to him in order that it may be properly investigated and the rightful person proceeded against. The Company have their officers at Billingsgate Market and they take every care to prevent fish unfit for food from leaving the Market. The Council promised to co-opei ate with them as far as possible in 93 this matter, and, at the same time, pointed out that the Council's Officers are fully alive to the possibilities of the committal of fraud in the manner indicated by the Company in their letter and that they act with precaution in every case accordingly. Attempts on similar lines are sometimes made in connection with unsound fruit or vegetables. The Use of Formaldehyde for Preserving Meat.—The Staff of the Local Government Board are continuing their inquiries on the use of preservatives in foodstuffs with a view to regulations being drawn up by the Board, and a report has just been published dealing with Formaldehyde and Formalin in this connection. Dr. Buchanan states that it may be safely presumed that where formalin or its preparations are offered to or used by dealers in perishable foods, the intention is to employ the solution as a disinfectant or deodorant, i.e., to conceal incipient decomposition and to hide any smell of staleness or putrefaction. A trade circular advertising a preservative (which was found to contain formalin) held out the inducement that it would arrest deca}7 and was "non-poisonous and non-acid." A testimonial from a provision merchant accompanying the circular stated "It is only right that you should know- that the treatment you gave my bacon and cheese with which were previously unfit for food are now saleable articles." It is also applied to fresh meat, fish, eggs, milk, and other products to increase keeping powers in hot weather. Formaldehyde is applied in solutions, sprays, or in gaseous form in specially constructed safes. There are substantial reasons, the Inspectors of the Local Government Board think, for objecting to the presence of formaldehyde in foodstuffs, for it has been definitely shown that it may retard digestion even when present in the food in comparatively large dilution, while it is well known that it readily combines with the protein constituents of foods, forming a compound which is less digestible than the original substance. These objectionable properties were recoguised by the Departmental Committee on Preservatives and Colouring Matters in Food in 1901, which recommended that the use of formaldehyde or its preparations in foods and drinks be prohibited absolutely. Some difficulty existed in discovering the presence of formaldehyde in meat, but Dr. Schryver has devised a satisfactory method whereby he has been able to show that it was possible to recover formaldehyde not only from various parts of a forequarter of beef taken from the hold of a vessel which had been treated with formaldehyde gas, but from parts below the surface, especially where the muscular tissue was not covered by connective tissue or fat. Portions of the beef were also tested after ordinary cooking, when it was found that boiling and roasting appeared 99 to reduce or even to remove the formaldehyde, but grilling appeared merely to make the formaldehyde retreat further into the substance of the meat. It was also found in cooked sausages made from the meat in question. The results have a special significance as regards meat which is treated in a formaldehyde safe, for they indicate that articles such as minced meat, fish, kidneys, and other foods which expose a large surface in proportion to their weight cannot be subjected to this form of formaldehyde fumigation without absorbing relatively large quantities of this disinfectant. On receipt of this report the Public Health Committee ordered that several fresh fish (sole, hake, haddock, plaice, cod and herring) be examined (unofficially), but no preservative was detected. The President of the Local Government Board subsequently stated in Parliament that he had been in communication with importers of chilled meat, with the result that a marked improvement had taken place in the amount of formaldehyde employed. If it is kept within limits he did not at present propose to prohibit its use for meat in transit, but careful observation was being kept. Sale of Food and Drugs Acts. Samples Purchased under the Sale of Food and Drugs Acts, showing result of Analysis and subsequent Proceedings. Number. Article of Food. Number of Samples Purchased. Genuine. (Inferior in braekets.) Adulterated. Prosecutions. Convictions. Withdrawn or Dismissed. Fines. Costs. £ s. d. £ s. d. 1 Milt 951 755 (110) 86 47 26 21 55 0 0 18 9 6 2 do. separated 11 11 3 do. stimmed 5 5 4 do. butter 1 — 1 5 Cream 45 16 29 4 3 — 1 15 0 2 15 0 6 do. ice 9 9 7 Butter 253 227 (14) 12 1 6 — 22 0 0 3 6 6 8 Margarine 12 11 (1) 9 Lard 23 23 10 Bread and butter 32 29 3 1 — 1 11 Bread and garine 1 1 12 Arrowroot 11 11 13 Flour 19 19 14 Coffee 12 12 15 Coffee and chicory 1 1 16 Cocoa 21 20 (1) 17 Chocolate 15 11 (1) 3 3 2 1 1 0 0 2 4 0 18 do. powder 2 2 19 do. milt 3 1 2 1 — 1 20 Meat pie 36 29 7 21 Port pie 23 11 12 22 Meats, potted 17 17 100 Number. Article of Food. Number of Samples Purchased. Genuine, (Inferior in brackets.) Adulterated. Prosecutions. , Convictions. Withdrawn or Dismissed. Fines. Costs. £ s. d. £ s. d. 23 Sausage, German 8 4 4 1 — Adj. 24 do. liver 1 1 25 do. lunch 1 1 26 do. Strasburg 1 1 27 do. blood 1 1 28 do. beef, pork, saveloys 93 74 19 4 - Adj. 29 do. roll 2 2 30 Brawn 3 2 1 31 Lobster paste 1 — 1 32 Salmon, tinned 1 1 33 Sardines 1 1 34 Calves' tongue, tinned 1 1 35 Chicken and ham paste 1 1 36 Salmon and shrimp paste 1 1 37 Cod, fresh 2 2 38 Haddock, fresh 2 2 39 Herrings, fresh 2 2 40 Hake, fresh 3 3 41 Sole, fresh 1 1 42 Shrimps, fresh 1 1 43 Vegetables, tinned 7 4 3 44 Peas, preserved 14 4 10 1 1 - 1 10 0 1 3 0 45 Spinach, preserved 1 — 1 1 1 - 5 0 0 2 14 6 46 Pepper 10 10 47 Oil, olive 29 25 (3) 1 1 1 - 5 0 0 1 3 0 48 Ginger, ground 13 13 49 Brandy 10 4 (4) 2 1 1 - 2 0 0 0 12 6 50 Gin 9 7 (1) 1 51 Whisky 9 9 52 Rum 9 7 2 1 — 1 53 Litliia water 12 10 (1) 1 54 Ginger ale 1 1 55 do. beer 2 1 1 56 Lemon squash 1 1 57 Lemonade 2 2 58 Kaola 2 2 59 Cream soda 2 2 60 Quinine, tincture of 9 8 1 61 do. wine 10 10 62 Magnesia, fluid 8 8 63 Boric acid 1 1 64 do. ointment 9 7 2 False butter warranty - - - 1 1 - 20 0 0 2 2 0 False crcam warranty - - - 1 1 - 5 0 0 3 3 0 Obstructing Inspector — — — 1 1 — 2 0 0 0 2 0 Totals 1,800 1,459 (136) 205 76 44 25 120 5 0 37 15 0 101 Proceedings were ordered to be taken in 83 instances, but 7 of these for various reasons were not proceeded with, 30 cautions were issued, generally in regard to milk which was slightly below the minimum standard ; the attention of the vendors was called to the report of the analyst in 49 instances, and no action was taken with regard to 37 samples which did not conform (14 of these were test purchases and not samples taken officially, the others deviated only slightly from the standard). Milk.—951 samples of ordinary milk were taken during the year. Of these 86 (9.04 per cent.) were reported by the Analysts to be below the standard of the Board of Agriculture, and 54 samples were just on the border line, making a total of 14.8 per cent. of the samples. The percentage of adulterated (9.04 per cent.) is again below the average (11.2 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 33 per cent., or in which the non-fatty solids were between 8.5 and 8.6 (if the fat was also below 3.8). Adul- terated are those below the official standard of 3 per cent. for fat and 8.5 for solids not fat. District. Total. Good Quality. Fair Quality. Poor Quality. Adulterated. No. Per cent. No. Per cent. No. Per cent. No. Per cent. South 415 123 29.6 179 43.1 92 22.1 21 5.06 North 536 162 30.2 178 33.2 131 24.4 65 12.1 1909 951 285 29.9 357 37.5 223 23.4 86 9.04 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 806 267 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 A1 though the number of samples below the standard is less, it is evident that a considerable amount of interference with the milk takes place; the amount of "good" quality milk is considerably below the average of the previous years, while the "fair" and the "poor" are above. Separated milk is added to bring down milk of good quality to the minimum legal standard, or even lower when it is known that proceedings will not be taken unless the adulteration is in excess of a margin allowed by the local authority. Hitherto, this Council has not prosecuted when the deficiency was under 5 per cent., but successful proceedings have been taken during the year in several cases where there had been persistent adulteration within that limit. It has been 102 suggested that no firm should be allowed to keep whole milk and separated milk on the same premises. * Forty-seven prosecutions were taken with regard to adulteration— 32 for fat abstracted, 12 for added water, and 3 for both fat abstracted and added water. Sixteen 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. Warranties were set up as a defence in 21 instances, but in 3 instances defendants were unable to prove them. In one, there was a period between delivery by the wholesale man and taking in of the milk in the early morning; another admitted the addition of colouring matter. Details of the proceedings taken are appended. Sunday Samples.—186 of the samples of milk were taken on 17 Sundays during the year; 17 (9'1 per cent.) were found to be adulterated. In the three previous years the figures were 10 6, 11*0 and 10'5 per cent, respectively. Samples taken in course of Delivery— (a) At Railway Stations.—102 samples of milk were taken on arrival at Victoria and Charing Cross Railway Stations. Forty-one were reported of good quality, 37 fair, 16 poor, and 8 adulterated. (b) On Delivery at Shops, &c.—30 samples of milk were taken as it was being delivered by wholesale firms to retail customers. Of these samples, 6 were good, 16 fair, 6 poor, and 2 adulterated (12 and 21 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:— 1902. 1903. 1904. 1905. 1906. 1907. 1908. 1909. New 491 608 741 831 806 792 860 951 Separated, condensed, sterilised or dried 55 55 31 36 11 31 18 16 Total 546 663 772 867 817 823 878 967 Infringement of Scction 9 Sale of Food and Drugs Act, 1899.— Six persons were cautioned for failure to have name and address on milk can or barrow. Refusal to Sell.—A street seller refused to sell to the Inspector from a hand can, which was three parts full, until he had filled it up from the churn. The contents of the hand can previously must have been much better quality than that in the churn, as analysis from samples taken 103 subsequently from each gave the fat as slightly above the standard in the former, 16 per cent, deficient in the latter. Evidently, the vendor expected that the Inspector would take a sample from the hand can only. (See 18 N.) Buttermilk.—Complaint having been made with reference to buttermilk, a sample was procured and was found to contain 23'837 grains of boric acid per pint, 35.3 per cent. of extraneous water and artificial colouring. The attention of the seller was called to the matter as also that of the Council of an adjoining Borough from whose district the buttermilk was supplied to the Westminster vendor. Cream.—Forty-five samples were purchased, of which 16 were reported to be genuine and free from antiseptics, 29 contained the latter in proportions varying from 7 to 30 grains of boric acid per pound. Proceedings were taken in four cases, the amounts being 21.9, 24.4, 29, and 30 grains. In three, penalties were imposed, the fourth proved a warranty guaranteeing that the cream contained not more than 17½ grains, whereas there were 29. Proceedings were taken against the warrantor, and he was fined £5 and £3 3s. costs. An important point was raised as to the duration of the warranty, which was dated 15th July, 1907. It was contended that it was a good defence for the original defendant to plead, but that under the Food and Drugs Act it only remained legally effective, so far as the warrantor was concerned, for six months. The contention of the prosecution was—first, that the warranty was a continuing one; and secondly, that the label on the pot was a warranty in itself (Lindsay v. Eook, 58 J.P., p. 735, and Bacon v. Callow Park, 66 J.P., p. 804). The Magistrate held that the label on the jar, coupled with the 1907 document, constituted a warranty, and convicted the warrantor. The Local Government Board has issued a report by Dr. Hamill, one of the Board's Inspectors of Foods, on the subject of the use of preservatives in cream. The recommendations contained in the report are "(1) In the interests of the public health and of the consumer, and also with a view to removing difficulties which traders in cream are experiencing on account of present uncertainties, it appears desirable that effect should be given (subject to (2) below) to the recommendations made by the Departmental Committee on Preservatives, 1901, that the only preservative to be used in cream should be boric acid, borax, or mixtures of these boron preservatives; that a maximum limit of boron preservative calculated as boric acid (H3B03) should be prescribed; and that the presence of boron preservatives should in all cases be declared. These provisions should also apply to clotted cream. 104 "(2) An exception might, however, be made in respect of the use of hydrogen peroxide, the addition of which to cream might be permitted provided that only traces were allowed to remain in the cream. "(3) It appears desirable that the question of issuing regulations on this matter should receive the Board's consideration, and that account should be taken of the following points :— "(a) The declaration of the presence of preservative to the purchaser, whether wholesale or retail, should in all cases he adequate, and the preserved cream as an article of commerce should be differentiated from cream which contains no added preservative. "(b) In the case of boracised cream the maximum amount of boron preservative, calculated as boric acid (H3B03), should be 0.4 per cent. from May to October inclusive, and 0.25 per cent. during the remainder of the year. "(c) Cream in which boron preservatives are permitted subject to the above limits should in all cases contain at least 40 per cent. of milk fat. "(4) Having regard to the use of sweetening agents such as saccharin to conceal sourness of cream and to impart an unnatural sweetness, it appea.rs desirable that their presence should be notified to the purchaser." In view of the evidence given in the appeal case of McNair v. Cullen, and of the analyses of samples of cream which have been made, there does not appear to be any need to allow boric acid to the amount of 0.4 per cent. from May to October. The instances in which 0.25 per cent. has been exceeded have been few in number. The utmost demand of the trade, as stated in the witness box, was for 0.5 per cent, of "preservative," which worked out at about 22 grains of boric acid (0.3 per cent.) 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 or test samples have been purchased by agents preparatory to an official sample being taken. (Eighty-six samples of butter and five of margarine were so obtained.) As an example of the way this works, the following extract from the records may be given:— 105 October 16th. Unofficial sample Genuine. 22nd. „ „ „ „ 24th. „ „ „ „ 26th. „ „ „ „ 31st. „ „ Margarine. „ 31st. (Later), official samples „ In another case the vendor wrote explaining that the sale of margarine was due to a mistake, but a further series taken before the hearing produced the same result. Margarine was served in three eating-houses when bread and butter was asked for, but butter was supplied in 29. Three persons were summoned for serving margarine in an unmarked wrapper. Two hundred and fifty-three samples of butter were obtained, 14 were inferior, and 12 adulterated. For giving a false warranty a penalty of £20 was imposed; at the same time, there was a further fine of £10 for selling margarine instead of butter, and delivering it in a wrapper not properly marked. Sausages, Meat Pies, &c.—In my Annual Report for 1908 the judgment of Mr. Mead was stated in the case of McNair v. Hayward, in which a pork sausage was sold containing 224 grains of boric acid per lb. Mr. Mead in convicting under section 6 of the Food and Drugs Act held that the article was not of the nature substance and quality demanded. An appeal was entered against this conviction and was heard before Mr. Robert Wallace, K.C., at the Sessions. Mr. M'Call, K.C., and Mr. T. C. Bartley represented the Council, Mr. Bousfield, K.C. and Mr. Clarke Hall the appellant. Evidence in support of the Council was given by Prof. Kenwood, Dr. J. M. Bernstein, Dr. Lenane, Mr. Cecil Cribb and myself, to the effect— (1) Boric Acid is not a food or a constituent part of the body and cannot be converted so as to be useful for nutrition. (2) From the want of flavour the public are unable to judge how much of the drug has been added. (3) Its use is unnecessary if good and suitable materials and proper methods of manufacture are employed—54 samples out of a total of 76 pork sausages were found to contain no preservative. (4) Boric Acid is a medicinal agent and no drug can be taken without interfering more or less seriously with the chemical and physiological processes of the body. (5) The use of preservatives in sausages is a source of danger, in that they mask the presence of any putrefaction or decomposition which may have taken place in the meat. 106 This last contention was mentioned in a circular letter which the Council had issued to the trade, and its correctness was challenged by the Metropolitan Association. They were referred to the opinions expressed by Dr. McFadden in his report to the Local Government Board and by the Health Commissioners of .New York; but were not convinced, relying on certain experiments which Prof. Klein made. After incubating sausages in a moist chamber at 76 deg. Fahr. during the day for three days, transferring them to a refrigerator at night, Prof. Klein examined them with the result that when 26.24 grains of boric preservative per pound had been added, there was no difference to be noticed in the bacterial character between the sausage material and the incubated sausage; there was no offensive smell to be noticed and the sausage looked perfectly normal. In order to demonstrate that the Council were correct in their statement, a series of experiments were carried out at my suggestion by Dr. J. M. Bernstein, Lecturer in Bacteriology at the Westminster Medical School. Fresh pork was obtained and varying quantities of boric acid were added to parts of it after it had been minced, some parts having it added at once, others after a lapse of one, two or three days, and a special series of experiments were carried out with the amount of the acid in this particular case. In other experiments, certain pathogenic organisms (B. coli, B. enteritidis, &c.) were added. The deductions which may be drawn from these experiments were, shortly:— (a) That it did not prevent decomposition proceeding, but that it prevented the development of odour so that it prevented persons detecting that the meat was bad. (b) The growth of harmless organisms was checked while the harmful ones were allowed to grow and produce harmful products. (c) When boric acid was added to meat which was beginning to smell the odour was diminished and the meat might have been used without detection for making sausage meat. (d) Very large quantities of boric acid would be required to check the growth of bacilli. (Prof. Max Gruber, International Congress of Hygiene, 1907, reporting on the subject stated (Vol. II. Proceedings, p. 286) that "boric acid is an inadmissible preservative for meat because even in large amounts (2 to 5 per cent.) it is not able to inhibit the toxin producing organisms or to kill them "). (e) By the addition of (0.3 per cent.) boric acid stale meat can be used—even after some weeks—for the making of sausages and also meat which has already begun to putrefy, without the consumer being able to tell by the sense of taste or smell that the sausage was a source of danger. 107 For the defence, Professor Klein explained the experiments he had made, and Mr. L. M. Douglas and others claimed that the trade should be allowed to add up to 35 grains of boric acid according to the weather. Mr. Robert Wallace, K.C., Chairman of the Sessions, in giving judgment, said:— "I find in regard to this matter that the sausages were sold to the prejudice of the purchaser, that they contained something which was not of the nature, substance, and quality demanded by the purchaser, and with regard to the proviso in the section as to the addition of matter necessary for preservation, I also find that it was not matter or ingredient that was required for that purpose. But I am also of opinion, and I say it at once, that in the quantity found in these particular sausages it would not be injurious to health. I think it was prejudicial to the purchaser, because I think the purchaser—I am speaking of the ordinary purchaser—would not have purchased if he knew of the quantity of boric acid which was given in evidence as being found in this particular pound of sausages, because I think that he would realise, on the evidence given before me, that it creates a danger, that it may conceal something lurking which otherwise would be discovered if present, and that the purchaser would prefer to have the .opportunity of knowing for himself. Therefore, the sale, in my opinion, was prejudicial to the purchaser; but I also find as a fact, as I say,that the quantity in these particular sausages would not be prejudicial to the health of the purchaser. The result is that the appeal will be dismissed with costs. If the Appellant desires it, I will state a case for the consideration of the High Court." A case was eventually stated, but the six months within which it should have been entered for hearing by the Divisional Court was allowed to expire. Application was made on 26th January, 1910, for leave to enter the case, although it was out of time, but the Court dismissed the motion, with costs. Five other cases in which the amounts of boric acid varied from 24J grains to 46 grains have been waiting the result of the final appeal. Samples were taken during 1909 of sausages, meat pies, &c., with the following results:— 108 83 Pork Sausages 67 genuine; 15 contained boric acid:—3.0, 4.9, 6.19, 7.5, 7.9, 9.8, 10, 12.0, 12.39, 14.84,14.87, 16.1, 17.5, 29, 30.8 grains per lb.; 1 contained 2.2 grains anhydrous sodium sulphite. 8 Beef Sausages 5 genuine; 3 contained boric acid:—7.4, 24.5, 46 grains per lb. 1 Liver Sausage Genuine. 10 Grerman Sausages 6 genuine (1 Strasburg and 1 lunch); 4 contained boric acid:—4.9, 8.6, 14.8, 24.79 grains per lb. 2 Saveloys 6 genuine; 1 contained boric acid :—9.5 grains per lb. 1 Black Pudding 1 genuine. 23 Pork Pies 11 genuine; 12 contained boric acid:—0.8, 20, 2.1, 3.0, 3.4, 3.5, 3.7, 5.0, 5.0, 5.5, 6.5, 7.0 grains per lb. (crust included). 35 Meat Pies 29 genuine; 6 contained boric acid:—3.18, 5.19, 5.9, 6.0, 7.0, 7.5 grains per lb. (crust included). 3 Sausage Rolls 2 genuine; 1 contained 1.5 grains boric acid. 3 Brawn 2 genuine; 1 contained 9.17 grains boric acid. 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 were given showing the amount found in the pie apart from the crust. In 4 pork pies the amount in the meat portion was 5.95, 9.17, 13.86 and 14.87, including the crust the same pies gave only 2.0, 3.7, 3.4 and 5.5 grains; in 3 meat pies the amount without crust was 12.39, 15.9, 16.1, with crust 5.1, 5.9, 7.5 grains. In these various meat preparations there has been a decided reduction in the amount of boric acid used as compared with previous years. The season of the year does not appear to make any difference in the amount of preservative used. Tinned Fish and Meat.—Except a small quantity of preservative in a lobster paste, various potted meats and pastes were found to be unadulterated. Shrimp paste, which was at one time heavily adulterated with boric acid, is evidently now being made from fresh shrimps. Tinned Vegetables.—The use of copper sulphate as a colouring agent has been reduced by the action of the Council to small amounts—under 2 grains per lb. Proceedings had to be taken against one retailer for selling peas with 3.45 grains per lb., and against another for selling spinach with 10.21 grains per lb. This latter was seated to be the last tin of some old stock. Olive Oil.- The custom of selling some other cheaper oil as olive oil appears to have ceased for the present in Westminster, as only one such was discovered in 29 samples. 109 Mineral Waters, &c.—Samples of lithia water, ginger ale, ginger beer, lemonade, lemon squash, kaola and cream soda were examined, and with three exceptions were found satisfactory. Two of the lithia were not up to the standard strength—one having a deficit of 60 per cent. As they were taken without division into three parts, no proceedings were taken, but the attention of the manufacturer was called to the matter, and subsequent samples were found to be right. Lead in Ginger Beer.—Information was received from a medical man that a patient was suffering from lead-poisoning and that it was suspected that his condition had resulted from drinking draught ginger beer which he had been in the habit of obtaining daily from one establishment. A sample was obtained and was found to contain one fifth of a grain of lead per pint. The carbonic acid gas in the ginger beer acting on the lead of the pipes through which it was drawn from the cellar to the bar would probably account for this. The use of such pipes was at once discontinued. Attention having been called to the matter, it was found in other parts of the Metropolis that lead pipes were being used for this purpose. In Wandsworth, a case was reported in which nearly the same amount of lead was found. Chocolate.—In 1908, samples of chocolate in various forms were taken, as it came to the knowledge of the Council that certain makers were placing on the market preparations containing a very small quantity of cocoa, a powder made from the shell or husk being used instead. In two cases prosecutions took place and penalties were imposed. 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. The Magistrate (Mr. Mead) 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. Subsequently, during 1909, other samples were purchased with the view of seeing if any improvement resulted; 18 samples were taken and 5 were reported as not containing a good proportion of cocoa. In 2 samples (broken milk chocolate and plain chocolate drops) made by the maker of one of the 1908 samples it was found that the cocoa had increased to 9'5 and 8'6 per cent, respectively. Proceedings were taken h 110 and penalties again imposed. The amount of husk was 18| per cent, in one, 27 per cent, in the other. Sample 424 S., from the Analyst's return, contained genuine cocoa and cocoa fat, apparently 14'7 per cent, of the total, and proceedings were instituted, but on a third part being sent to Somerset House it was found that chocolate nonpareils have a sprinkling of sugar pellets on the top, and on this being excluded, the percentage of cocoa and cocoa fat rose to 23'5 per cent., hence the summons was withdrawn. This figure practically agrees with that of the City's Analyst, but he is required by law to state his figures as percentages of the whole. Sample 422 S., milk chocolate, had apparently 7'75 per cent, of genuine cocoa and cocoa fat. The case was heard at the same time as 424 S., and was adjourned, and eventually withdrawn. Spirits.—A few years ago considerable discussion arose as to what the article should be to which the terms in common use should be applied, and eventually a Royal Commission was appointed. The Commissioners now report that they are unable to recommend that the use of the word "whisky" should be restricted to spirit manufactured by the pot-still process, stating that they have received no evidence to show that the form of still has any necessary relation to the wholesomeness of the spirit produced. They have framed a definition of "whisky" to which the product of both the pot and patent still processes may conform. According to it whisky is a spirit obtained by distillation from a mash of cereal grains saccharified by the diastase of malt. The term "brandy" is applicable to a potable spirit manufactured from fermented grape-juice and from no other materials, but the compounded spirit recognised by the name of "British-brandy" is entitled still to be sold under that designation. "Rum" is defined as a spirit distilled direct from sugar-cane products in sugar-cane-growing countries. "Gin" should be made from cereals, juniper berries being an essential for the subsequent flavouring. The Commission suggests for consideration the formation of a Committee from which advice might be obtained by local authorities on technical questions affecting the administration of the Food and Drugs Acts. They also suggest that Magistrates, when hearing cases under these Acts, might have the assistance of assessors with practical or scientific experience. During the year 10 samples of Brandy and 9 each of Gin, Rum and "Whisky were taken. Four of the brandies were inferior and two were adulterated with other spirit than that derived from fermented grapejuice to the extent of 55 per cent. The adulteration did not appear 1ll to be altogether the fault of the retailer as he paid the price for the genuine article. The other spirits were reported to be genuine, but three of them had the quantity of spirit reduced below the standard. Drugs.—Quinine wine, tincture of quinine, fluid magnesia, boric acid, and boric ointment were sampled. Ammoniated tincture of quinine was supplied in one instance. Two of the boric ointments were not quite in compliance with the British Pharmacopoeia, which directs that there should be 10 per cent, of boric acid; one contained 17 per cent., the other 12.5 per cent., probably due to the acid not being properly mixed with the paraffin ointment which forms a base. The attention of the sellers was called to this. Obstructing Inspectors.—It reflects creditably on the way the two food inspectors (Messrs. McNair and Williams) carry out their duties that very little friction results. Occasionally a dishonest vendor may try to recover the article he has sold when he discovers that he has sold to an agent of the inspector, but generally a warning from the inspector of the risk he runs is sufficient. In one case, however, proceedings had to be taken for obstructing the inspector, and a fine of £2 and costs was imposed. The facts are that an agent purchased some milk and butter at a small shop. On the inspector entering and declaring the reason of the purchases, the vendor seized the articles and threw them to the back of the shop. Another case has already been mentioned under the heading "Milk, Refusal to Sell." 112 Legal Proceedings Under the Food and Drugs Acts during 1909. No. of Sample. Date of Hearing. Court and Magistrate. Name and Address of Defendant. Offence. Result. 1 2 3 4 5 6 1909. MILK. 4 N. 9th February Bow Street (Mr. Marsham) Bartolmeo Cattini, 56, St. Martin's Lane 15 per cent. of fat abstracted Fined 20s. and 12s. 6d. costs. 16 N. 26th February Marlborough Street (Mr. Mead) John Timothy, 45, Greek Street, Soho 6 per cent. of added water Warranty proved. Summons dismissed. (See 53 N. and 991 N.) 18 N. 19th March Marlborough Street (Mr. Mead) Timothy James Jones, 5, Bateman Street 16 per cent. of fat abstracted Fined £2 and £2 4s. costs. Failed to prove warranty; had also refused to sell from a hand-can until he had added other milk. It proved above standard. 53 N. 26th February Marlborough Street (Mr. Mead) John Timothy, 45, Greek Street, Soho Selling milk, at Charing Cross Road, which contained 6 per cent. of added water Warranty proved. Summons dismissed. (See 991 N.) 95 N. 11th March Marlborough Street (Mr. Mead) Agostino Necchi and Georgino Corsini, 37, Beak Street 10 per cent. of fat abstracted Fined £3, or 14 days' hard labour. 96 N. 11th March Marlborough Street (Mr. Mead) Mary Evans, 24, Carnaby Street 9 per cent. of added water Warranty proved. Summons dismissed. 154 N. 18th March Marlborough Street (Mr. Denman) George Harris West, 9, Carnaby Street 9 per cent. of fat abstracted Fined 20s. and 12s. 6d. costs. 153 N. 18th March Marlborough Street (Mr. Denman) Joseph Gerratt, 19, Sherwood Street 11 per cent. of added water Fined 20s. and 12s. 6d. costs. 160 N. 26th March Marlborough Street (Mr. Mead) Fredk. Chas. Walters, 12, Brewer Street 7 per cent. of added water and 19 per cent. of fat abstracted Fined £1. 181 N. 2nd April Marlborough Street (Mr. Mead) George Jones, 183, Shaftesbury Avenue 7 per cent. of added water and 12 per cent. of fat abstracted Warranty proved. Summonsdismissed. 181 S. 23rd April Westminster (Mr. Horace Smith) James Sewell, 24, Fountain Street, Wandsworth Road, S.W. In Johnson's Place, Lupus Street. 90 per cent. fat abstracted 12s. 6d. costs. The magistrate gave no reason for this leniency, but the vendor, however, promised to use the words "separated milk" on his barrow, &c., in future. 197 S. 23rd April Westminster (Mr. Horace Smith) John Arundell, 33, Great Peter Street, S.W. 29.5 per cent. added water Fined 20s. and 12s. 6d. costs. 109 S. 23rd April Westminster (Mr. Horace Smith) Moses D. Williams, 7, Regency Street, S.W. In St. Oswulf Street. 4 per cent. added water Warranty proved. Summons dismissed. 26 S. 23rd April Westminster (Mr. Horace Smith) Moses I). Williams, 7, Regency Street, S.W. At 7, Regency Street. 5 per cent. added water Warranty proved. Summons dismissed. (See 585 8.) 194 S. 23rd April Westminster (Mr. Horace Smith) Aerated Bread Co., Ltd., 24, Eastcheap, E.G. At 3, Bridge Street. 5 per cent. fat abstracted Withdrawn. Warranty. 207 N. 27th April Bow Street (Mr. Marsham) Messrs. Clewley and Co., Ltd., 3 and 4, Buckingham Street, Strand In Adam Street. 10 per cent. fat abstracted Fined 40s. and 12s. 6cl. costs. (See 987-8 N.) 224 N. 29 th April Marlborough Street (Mr. Mead) Henry Bannister, 33, Great Marlborough Street 14 per cent. fat abstracted Fined 60s. and 14s. costs. 273 N. 11.th May Bow Street (Mr. Marsham) William Merritt, 33, Villiers Street 18 per cent. fat abstracted Fined 40s. and 12s. 6c£. costs. 318 N. 27th May Marlborough Street (Mr. Plowden) James Bird, 18, Brewer Street In Wardour Street. Milk 15 per cent. added water Dismissed. The defendant's solicitor stated that the milk had been watered by one of the defendant's servants, who had absconded. The Magistrate, under the circumstances, declined to convict. It was pointed out to the Magistrate that the master was liable for the unauthorised acts of his servants, but the result was as stated above. 213 S. 28th May Westminster (Mr. Francis) Caroline Janin, 9, Earl Street, Westminster 12 per cent. added water Fined 10s. and 12s. 6d. costs. 305 N. 8th June Bow Street (Mr. Marsham) Cream Dairy Co., Ltd., 27-31, Caledonian Road, N. In Green Street. 34 per cent. fat abstracted Warranty proved. Summons dismissed. 391 N. 22nd June Bow Street (Mr. Marsham) The British Tea Table Co., Ltd., 51, Farringdon Road, E.C. At 79, Chancery Lane. 30 per cent. fat abstracted Warranty proved. Summons dismissed. 419 N. 25th June Marlborough Street (Mr. Mead) Champion's Dairy, Ltd., 31, Cannon Street, E.C. In Old Bond Street. 20 per cent. fat abstracted Warranty proved. Summons dismissed. 335 S. 9th July Westminster (Mr. Horace Smith) Arthur Handsley, 2, Stannary Street, Kennington, S.E. In Winchester Street. 8.6 per cent. fat abstracted Warranty proved. Summons dismissed. 336 S. 9 th July Westminster (Mr. Horace Smith) John Lilly white, 50, Ranelagh Road, S.W. In Lupus Street. 11 per cent. fat abstracted Warranty proved. Summons dismissed. 429 N. 16 th July .. Marlborough Street (Mr. Mead) Morris Levenstadt, 3, Edward Street, W. 19 per cent. fat abstracted Fined £2 and 12s. 6d. costs. 435 N. 16th July Marlborough Street (Mr. Mead) Thomas Harris (Pryce and Harris), Half Moon Street, Islington, N. In Silver Place. 12 per cent. fat abstracted Defendant dead. Summons withdrawn 113 No. of Sample. Date of Hearing. Court and Magistrate. Name and Address of Defendant. Offence. Result. 1 2 3 4 5 6 1909. 438 N. 16th July Marlborough Street (Mr. Mead) John Bonner, 15, Sherwood Street In street. 10 per cent. fat abstracted Warranty proved. Summons dismissed. 468 N. 23rd July Marlborough Street (Mr. Mead) Jacob Dunn, 28, St. Anne's Court 6 per cent. fat abstracted Fined 30s. and 12s. 6d. costs. 464 N. 23rd July Marlborough Street (Mr. Mead) Eugonio Nadotti. (Nadotti & Co.), 15, Swallow Street 22 per cent. fat abstracted Fined 40s. and 12s. 6d. costs. 503 N. 23rd July Marlborough Street (Mr. Mead) James Bird, 18. Brewer Street In Broad Street. 24 per cent. fat abstracted Warranty proved. Summons dismissed. 499 N. 3rd August Bow Street (Mr. Mai sham) John Smith, Wintersell Farm, Edenbridge Sample taken from churn at Charing Cross Station in course of delivery. 8 per cent. fat abstracted Fined £5 and £1 16s. 6d. costs 505 N. 3rd August Bow Street (Mr. Marsham) John Smith, Wintersell Farm, Edenbridge Sample taken from churn at Charing Cross Station in course of delivery, 3 per cent. fat abstracted Ordered to pay 15s. 6d. costs. 516 N. 13th August Marlborough Street (Mr. Mead) Peter Gricopazzi (trading as P. Gricopazzi and Co.), 46, Greek Street, W. 13 per cent. fat abstracted Fined 30s. and 12s. 6d. costs. 618 N. 17th August Bow Street (Mr. Marsham) John Smith, Wintersell Farm, Edenbridge Sample taken at Charing Cross Station in course of delivery, 4 per cent. added water Ordered to pay 13s. 6d. costs. The defendant satisfied the Magistrate that he sold the milk as it came from the cows, which account for there benig no penalty inflicted. The Magistrate seems to have been of opinion that the bad weather in July might have had something to do with the poorness of the milk.(See 499 and 505 N.) 623 N. 20th August Marlborough Street (Mr. Mead) Thomas Jones, 26, Broad Street In Edward Street, 12 per cent. fat abstracted Warranty proved. Summons dismissed. 434 S. 26th August Westminster (Mr. Francis) •• Alfred Edward King, 108, Brompton Road 16 per cent, fat abstracted ,. Fined 20s. and 12s. 6d. costs. The defendant pleaded a warranty, but failed to prove it. 114 592 N 14th September Bow Street (Mr. Marsham) Lewis Mason Jenkins, 159, Drury Lane At Peabody Buildings. 3.5 per cent. of added water and 8 per cent. fat abstracted Warranty proved. Summons dismissed. 516 S. 23rd September Westminster ,, (Mr. Hopkins) Albert Alfred Stacey, Hathersham Farm, Horley, Surrey Sample taken at Victoria Station in course of delivery. 12 per cent. fat abstracted Summons dismissed (traced from the cow). 530 S. 23rd September Westminster (Mr. Hopkins) Emily Gledhill, 17, Commercial Road, S.W. In Warwick Street. 16 per cent. fat abstracted Fined 205. and 12s. 6d. costs. 663 N. 1st October Marlborough Street Lipton, Lid., City Road, London, E.C. At; 27, Oxford Street. 15 per cent. fat abstracted Summons withdrawn. Warranty. 585 S. 11th November Westminster (Mr. Horace Smith) Moses David Williams, 7, Regency Street At Peabody Buildings. 4 per cent. added water Fined £5 and £2 2s. costs. (The defendant set up a warranty but failed to prove it satisfactorily.) See 26 S. and 109 S. 880 N. 14th December Bow Street (Mr. Marsham) The Eustace Miles Proteid Food, Ltd., Moorgate Station Chambers, Moorfields 10 per cent. of fat abstracted Warranty proved. Summons dismissed. 922 N. 31st December M.-irlborougli Street (Mr. Mead) Joseph Mussino, 10, Sherwood Street 10 per cent. of fat abstracted Fined 305. and 12s. 6d. costs. 987 N. 1910. 25th January Marlborough Street (Mr. Mead) Clewley and Co., Ltd., 3 and 4, Buckingham Street, Strand Sample procured at Charing Cross Hospital in course of delivery, 33 per cent. fat abstracted Fined £10 and 2s. costs. (See 207 N.) 986 N. 25th January Marlborough Street (Mr. Mead) Clewley and Co., Ltd., 3 and 4, Buckingham Street, Strand Sample procured at Charing Cross Hospital in course of delivery, 21 per cent. fat abstracted Fined £5 and 2s. costs. 991 N. 21st January Marlborough Street (Mr. Denman) John Timothy, 45, Greek Street, Soho 4 per cent. of added water Fined £2 and 12s. 6d. costs. (See 16 N. and 53 N.) 1909. CREAM. 352 S. 9th July Westminster (Mr. Horace Smith) Elizabeth Sarah Tyne (Hill and Tyne), 130, Brompton Road, S.W. Cream containing 21.938 grains of boric acid per 1b. Fined 10s. and 12s. 6d. costs. 351 S. 9 th July Westminster (Mr. Horace Smith) Julia Hendra, 47, Montpelier Square, S.W. Cream containing 24.416 grains of boric acid per 1b. Fined 5s. and 12s. 6d. costs. 115 No. of Sample. Date of Hearing. Court and Magistrate. Name and Address of Defendant. Offence. Result. 1 2 3 4 5 6 1909. 587 N. 14th September Bow Street (Mr. Marsham) G. B. J. Annegarn (trading as Pryce and Harris), Half Moon Crescent, Islington, N. At 38, Bow Street. Fresh cream containing 30 grains of boric acid per 1b. Fined 20s. and 30s. costs. 585 N. 14th September Bow Street (Mr. Marsbam) Civil Service Supply Association, Bedford Street Fresh cream containing 29 grains of boric acid per lb. Warranty proved. Summons dismissed (see below). 585 N. 23rd and 30th November and 14th December Bow Street (Mr. Marsham) Turner's Cheshire Dairy Co. Giving false warranty in respect of cream Fined £5 and £3 3s. costs. BUTTER AND MARGARIN E. 72 S. 5th March Westminster (Mr. Francis) David Richards (trading as Williams and Co.), 21, Sutherland Terrace Selling margarine as butter Fined £3 and 12s. 6d. costs. 72 S. 5 th March Westminster (Mr. Francis) David Richards (trading as Williams and Co), 21, Sutherland Terrace Selling margarine in a plain wrapper 2 s. costs. 64 S. 5th March Westminster (Mr. Francis) Daniel Jones, 2, Clarendon Street Selling margarine as butter Fined 40s. and 12s. 6d. costs. 64 S. 5th March Westminster (Mr. Francis) Daniel Jones, 2, Clarendon Street Selling margarine in a plain wrapper 2s. costs. 99 N. 11th March Marlborough Street (Mr. Mead) William Jenkins, 26, Carnaby Street Selling bread and margarine as bread and butter Fined £2 and 23s. costs. 161 N. 26th March Marlborough Street (Mr. Mead) Fredk. Chas. Walter, 12, Brewer Street Selling bread and margarine as bread and butter Warranty proved. Summons dismissed. 199 N. 26th March Marlborough Street (Mr. Mead) Wm. Hy. Neve, 32, Rupert Street Selling at 12, Brewer Street margarine not in a properly marked wrapper Fined £10 and 2s. costs. 199 N. 26th March Marlborough Street (Mr. Mead) Wm. Hy. Neve, 32, Rupert Street Selling to F. C. Walters margarine as butter 199 N. 26th March Marlborough Street (Mr. Mead) Wm. Hy. Neve, 32, Rupert Street Giving false warranty Fined £20 and £2 2s. costs. 116 914 N. 31st December Marlborough Street (Mr. Mead) Max Taffel, 84, Berwick Street Selling margarine as butter On the summons for selling margarine as butter, the Magistrate fined the defendant £5 and 12s. 6d. costs; and on his suggestion the other two Summonses were withdrawn. 914 N. 31st December Marlborough Street (Mr. Mead) Max Taffel, 84, Berwick Street Selling margarine the fat of which contained over 10 per cent. of butter fat 910 N. 31st December Marlborough Street (Mr. Mead) MaxTaffel, 84, Berwick Street Exposing for sale margarine without a label marked "margarine" OLIVE OIL. 386 N. 25th June Marlborough Street (Mr. Mead) John Daurel, 40, Frith Street, W. 100 per cent. of oil other than olive oil Fined £5 and 23s. costs. PEAS. 811 N. 3rd December Marlborough Street (Mr. Mead) John Brooker, 24, Peter Street 3.45 grains of copper sulphate per pound Fined 30s. and 23s. costs. SPINACH. 679 8. I7th December Westminster (Mr. Horace Smith) The International Tea Company's Stores, Ltd., 3, Mitre Square, E.C. At 96, Buckingham Palace Road, spinach which contained 10.21 grains copper sulphate per pound Fined £5 and £2 14s. 6d. costs. SAUSAGES. 845 N. June County of Loudon Sessions Appeal of G-. W. Hayward from conviction by Mr. Mead on 11th December, 1908 Appeal dismissed. 1908 1910. 845 N. 1908 26 th January Divisional Court, High Courts of Justice Motion for leave to enter an Appeal Motion dismissed with costs, the six months in which the case should have been entered having expired. Five prosecutions on account of the presence of boric acid were commenced, but held over until the decision in the above Appeal. 1909. SPIRITS. 27 N. 22nd February Bow Street Ellen Maud Bartram, The Sun, 66, Long Acre 29*5 degrees under proof instead of 25 degrees under Defendant dead. Summons withdrawn. Rum (Mr. Mar sham) 101 N. 22 March Bow Street Denby Hare, 18, Bear Street 55 per cent, of spirit other than genuine brandy Fined 40s. and 12s. 6d. costs. Brandy (Mr. Marsham) 117 No. of Sample. Date of Hearing. Court and Magistrate Name and Address of Defendant. Offence Result 1 2 3 4 5 6 294 S. Broken milk chocolate 1909. 9th July Westminster (Mr. Horace Smith) CHOCOLATE (Confectionery). Charles Dear, 125a, Lupus Street, Westminster 12 per cent. of foreign starch, 19.25 per cent. of foreign fat; the total fat-free cocoa matter contained not less than 18.5 per cent. of husk Fined 20s. and £22s. costs. 295 S. Plain chocolate drops 9th July . Westminster (Mr. Horace Smith) Charles Dear, 125a, Lupus Street, Westminster 13.5 per cent. of foreign starch, 19 5 per cent. of foreign fat, and the fat-free cocoa matter contained not less than 27 Defendant to pay 2s. costs. 422 S. Milk chocolate Westminster (Mr. Horace Smith) Clementi Bemboni, 15, Strutton Ground, S.W. 5 per cent. foreign starch; 70 per cent. of the fat present was foreign fat; 90 per cent. of the residual matter was cocoa husk or shell Adjourned sine die to await decision in case of No. 424 S. 424 S. Chocolate Nonpareil Westminster (Mr. Horace Smith) Ketskemety, 154, Horseferry Road, S.W. 12 per cent. foreign starch; 34.8 per cent. fat present was foreign fat; 73 per cent. of "residual matter" consisted of cocoa husk or shell Adjourned for third part to be sent to Somerset House. Summons withdrawn. 118 london: harrison and sons, printers in ordinary to his late majesty, st. martin's lane.