WES 24 ANNUAL REPORT ON THE STATISTICS AND SANITARY CONDITION RELATING TO THE CITY OF WESTMINSTER FOE THE YEAR 1910. BY FRANCIS J. ALLAN, M.D., C.M., D.P.H. (JAMB., F.R.S. ED. MEDICAL OFFICER OF HEALTH. Printed by Order of the Council. LONDON: HARRISON AND SONS, PRINTERS IN ORDINARY TO HIS MAJESTY, ST. MARTIN'S LANE, W.C. 111 TABLE OF CONTENTS. PAGE PAGE Introductory Remarks 1 JLegal Proceedings 73 Drainage, &c., Plans 73 PART I. Public Conveniences for Women 74 A. Statistics. Daily Removal House Refuse 75 Population 5 Removal of Offensive Refuse 75 Births 8 Housing and Town Planning Act 76 Notification of Births Act" 10 Houses Let in Lodgings 79 Report of Health Visitor 11 Water Supply 80 Artesian Wells 81 Deaths 17 Infantile Mortality 18 Common Lodging-Houses 81 Statistics of Block Dwellings 21 Revenue Act 82 Tables 22-35 Smoke Prevention 83 B. Communicable Diseases. D. Workshops. Smallpox Vaccination 36 6 Number on Register 85 Defect 86 Ventilation, Unventilated Stoves 87 Diphtheria Diptheria 38 Outworkers 88 Supply of Antitoxin 39 Infectious Disease 90 Typhoid Fever 42 Laundries 91 Puerperal Fever 40 Cholera, Plague 45 Glanders and Anthrax 46 E. Food Supply. Statistical Tables 47-48 Inspection 92 Tuberculosis 49 Ice Cream Premises 92 Scheme for Helping Patients 51 Bakehouses 92 Sanatorium, Training in 54 Certification of Food for Export 92 Diarrhœal Diseases 58 Infectious Disease 92 Measles 58 Milkshop 93 Whooping Cough 59 Food and Market Inspection 93 Hospital Accommodation 60 Batchers'Meat on Stalls 91 Schools and Infectious Disease 61 Bread 94 Care Committee Work 62 Sale of Food and Drugs Acts- Bacteriological Laboratory 63 Samples Taken, Result of Analysis Disinfection and Proceedings 96 New Disinfecting Station 63 Milk 97 Cleansing of Persons 70 Cream 99 "Verminous Houses 70 Cheese 99 Mortuaries Sausages and Meat Pies, &c. 100 Tinned Foods 101 PART II. Fish 101 C. Souse Inspection, &c. Drugs 101 Defects Remedied 72 Details of Prosecutions 102-9 A 2 Annual Report on the Health and Sanitary Condition of the City of Westminster. 1910. 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 1910. 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. The death rate of London is estimated at 12.7 per thousand persons living, as compared with 16.4 the average of the previous ten years, and 14.5 for the last five years. For Westminster the rate was 11.0 per thousand, the average being 14.1 for the ten years, 12.8 for the last five years. Deaths from the principal infectious diseases were equal to a rate of 1.14 per 1,000 for London, which is lower than preceding years, the average of the ten preceding years being 1.8. 2 Measles became prevalent in London during the last three months and proved extremely fatal, the number of deaths recorded being 526 in excess of the corrected averages number in the corresponding period of the five preceding years. The disease was also prevalent in Westminster, but the mortality was not great, which may be ascribed to the attention given to each case. The method adopted is described in the Report. More could be done were information as to children suffering to reach the Council sooner from the schools. There is at present no means of learning of the existence of measles unless some member of the family attends school. It has been suggested that compulsory notification should be instituted, but as only a small proportion of the children are attended by medical men before the visit of the Council's Inspectors it would not be of much value. Parents cannot be relied upon to notify. The Local Government Board has issued an order enabling the Metropolitan Asylums Board to utilise spare accommodation in the hospitals of the Asylums Board for the reception and treatment of additional classes of poor persons. Under the authority thus conferred upon them, the Asylums Board will be enabled to receive from any of the Poor Law Authorities of the Metropolis children suffering from measles or whooping cough into any of their hospitals where there is vacant accommodation. It is understood that some 1,000 beds will be available for these cases. Special attention has continued to be given to the subject of tuberculosis, and the schemes mentioned in my last Report has been brought into active working. The medical staff and the almoners of the various hospitals has been freely co-operated, a special (paid) Phthisis Visitor has been appointed by the Health Society, and at the end of the year 406 persons suffering from pulmonary or other form of tuberculosis, together with persons who were regarded as doubtful or suspicious cases, were on the Visitor's list. These do not include persons having no settled abode, who move from one casual ward or shelter to another. The beds taken by the City Council at a sanatorium have proved to be a valuable adjunct. On the whole the "Westminster Scheme" has shown itself to be a distinct success. 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 London rate has regularly decreased year by year, until it now stands at 103. For the first five years of the decade, beginning with 1901, the rate was 138; for the last five years, 118. 3 It must, however, be kept in mind that during the last four 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 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. 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 the rate has fallen in the year 1910 to 82 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, Miss M. Horn, should be appointed the Council's Honorary Health Visitor. The Council provided an office at the St. George's Baths, Buckingham Palace Road, 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 have been collected, together with much 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 has been assisted in visiting by 25 ladies, and is in close touch with the various agencies, philanthropic and otherwise, working in the City, most of which send representatives to the committees of the Society. It is with regret that I have to add that owing to ill-health Miss Horn is unable to continue the double duty, but her valuable experience, together with the assistance of the other Visitors, will still be available. 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. 4 The Council has taken action under the new Housing and Town Planning Act in regard to a number of houses in St. John's Ward, and underground dwellings in various parts, and has also had special reports on several streets in Westminster. 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, 1911. 5 PART I. A. Population. At the census in 1901 the resident population of the City of Westminster was 183,011; for the year 1910 it is taken by the RegistrarGeneral at 167,233. 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; it is obvious that the risk of error may be considerable. The Registrar-General has to estimate the population under the Equalisation of Rates Act, and for this purpose adopts a different method, which, so far as Westminster is concerned, yields a different result. According to one method the population of Westminster has declined, as stated above, by 15,778 in the ten 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 174,491, which is 7,258 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 171,790, as estimated by me, lies between the Registrar-General's two estimates, and it is on this that the various rates in this report are calculated. The Census will be taken in 1911, and when the figures are available the rates for the years which have elapsed since the previous Census can be recalculated. A point to be noticed is the increase (shown in column two) in houses comprising two or more tenements; these have increased from 231 in 1902 to 421 in 1910, and the number of separate occupiers in them from 8,926 to 11,818. 6  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 Itatcs Act. 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 1,605 4,444 19,159 20,200 The City 22,201 231 8,926 30,896 178,489 181,889 1903. St. George Hanover Square 9,848 50 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 11,163 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 8,032 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 1905. St. George Hanover Square 9,786 61 2,405 12,130 75,522 74,800 St. Margaret and St. John 5,357 91 5,082 10,348 48,160 51,256 St. James 2,792 11 239 3,020 20,585 19,400 St. Anne 1,121 46 833 1,908 11,031 11,000 St. Martin and Strand 2,447 79 1,991 4,359 17,762 19,150 The City 21,503 283 10,550 31,765 173,060 175,606 7  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 Hated Occupiers. Estimated Population Equalisation of Rati s Act. Estimated Population RegistrarGeneral's 1st Method. 1906. St, Greorge Hanover Square 9,730 63 2,413 12,086 75,130 74,355 St. Margaret and St. John 5,354 96 5,002 10,260 48,133 50,420 St. James 2,727 13 250 2,970 20,100 19,250 St. Anne 1,104 48 859 1,915 10,863 10,900 St. Martin and Strand 2,450 86 2,041 4,411 17,847 18,980 The City 21,377 306 10,571 31,612 172,085 173,905 1907. St. Greorge Hanover Square 9,749 69 2,495 12,175 75,236 74,050 St. Margaret and St. John . 5,313 104 5,210 10,449 48,034 49,320 St. James 2,728 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 18,8S9 The City 21,373 327 11,101 32,147 172,041 172,219 1908. St. Greorge Hanover Square 9,779 69 2,495 12,205 75,408 73,598 St. Margaret and St. John 5,470 115 5,342 10,697 49,177 48.500 St. James 2,897 33 588 3,449 21,359 19,020 St. Anne 1,114 48 890 1,956 10,902 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 1909. St. Greorge 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 4,535 18,101 17,891 The City 21,752 372 11,591 32,971 175,100 108,883 8  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. 1910 St. George Hanover Square 9,793 78 2,541 12,256 75,504 73,170 St. Margaret and St. John 5,390 137 5,417 10,670 48,708 47,080 St. James 2,879 48 677 3,508 21,226 18,820 St. Anne 1,104 51 920 1,973 10,863 10,612 St. Martin and Strand 2,498 107 2,263 4,654 18,190 17,551 The City 21,664 421 11,818 33,061 174,491 167,233 According to the proportion existing at the last census, there are 79,711 males and 92,079 females in the estimated population of 171,790. Births. 2,365 births were registered in the City in the 52 weeks ending 1st January, 1911. On examination, 49 births were found to he 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 276 children were born in outlying institutions, the home address of whose mothers was in Westminster. The net number of births was, therefore, 2,592 as compared with 2,751 in 1909; the birth-rate, uncorrected, was 13.1, corrected 15 0 per 1,000 persons. The birth-rate for the County of London for 1910 was 23.6, the rate during the preceding ten years averaged 25.8 per 1,000. The birth-rate in England and Wales was 24.8, the average of the preceding ten years being 27.5. The birth-rate was again lower than any rate recorded since registration was established. 9 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. Conduit 47 46 43 27 30 Grosyenor 153 157 151 148 133 Knights bridge St. George 163 162 125 164 160 Victoria 836 886 884 862 890 St. Margaret 197 160 162 165 156 St. John 869 953 877 828 908 Knights bridge Hamlet 68 97 79 77 67 St. Anne 289 278 240 232 212 Regent 213 226 184 143 163 Pall Mall 32 23 22 17 20 Great Marlborough 208 180 162 151 149 Charing Cross 41 26 34 42 38 Covent Garden 163 163 151 156 147 Strand 153 104 71 42 17 The City 3,432 3,461 3,185 3,054 3,120 1906. 1907. 1908. 1909. 1910. Conduit 25 27 25 19 22 Grosvenor 131 145 143 121 128 Knights bridge St. George 150 150 152 169 169 Victoria 864 846 870 847 753 St. Margaret 141 152 153 163 124 St. John 860 873 854 765 787 Knights bridge Hamlet 72 66 80 80 77 St. Anne 217 205 184 173 185 Regent 141 129 135 104 110 Pall Mall 18 18 12 21 9 Great Marlborough 137 132 124 125 83 Charing Cross 26 34 31 24 16 Covent Garden 129 135 122 131 117 Strand 20 15 28 9 12 The City 2,931 2,927 2,913 2,751 2,592 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 tables following this part of the Report. It will be noted that, the total number of births is again less than in previous years. The birth-rate calculated on the number of married women in Westminster, distinguishing the legitimate and illegitimate, shows more exact rates. The number of married women between the ages of 15 and 45 in Westminster is estimated to be 17,865, and the unmarried and widows at the same age-period 38,119. 10 Westminster. 1904. 1905. 1906. 1907. 1908. 1909. 1910. Legitimate Births (net) 2,920 2,971 2,744 2,764 2,739 2,548 2,399 Per 100 Married 15.6 16.1 15.0 15.1 14.8 14.2 13.4 Illegitimate Births (net) 134 149 187 163 174 203 193 Per 100 Unmarried 0.34 0.37 0.48 0.42 0.41 0.53 0.50 London.—Legitimate per 100 Married 21.8 21.2 20.9 20.2 19.8 19.0 18.6 Illegitimate per 100 Unmarried 0.65 0.61 0.61 0.57 0.59 0.55 0.54 There were 128 illegitimate births registered in Westminster, but in 19 of these the mother's home was elsewhere; there were, however, 84 births in outlying institutions, the addresses of the mothers being given in the City. In a certain proportion these mothers were sent into the lying-in hospitals from rescue homes in Westminster whither they had been brought from other districts. Probably these might number about 50, which would reduce the illegitimate births to 143, and the total births to 2,544. I have, however, included them in order that comparison may be made with the figures in previous years, and because when the infant has died the death is put down to Westminster. The Notification of Births Act was adopted in 1908, and came into operation on January 18th, 1909. The number of names of infants notified and registered is in excess of the actual number of infants born, as it is not at all infrequent to find, especially among foreigners, that different surnames are given, the proper surname being given on registration, but the first name or some name more easily pronounced than the proper surname is given to the doctor or midwife. Foreign names in Westminster undergo a gradual change in this way. This leads to much extra work on the part of the Health Visitors. During the year notification was received of 1,674 births which took place in Westminster; of these, 53 were stillborn children. By comparing all the births which were registered as having occurred after the 1st January with those notified, it is found that the proportion of births notified was 68.0 per cent. for the City. The percentages in the several registration areas were as follows:— 11 Registration District. Births Registered. Births Notified. Percentage. 1909. 1910. 1909. 1910. 1909. 1910. May fair 167 212 35 75 20.9 35.3 Bel grave 802 843 500 585 60.2 69.3 St. John 709 775 586 615 82.7 79.3 St. James 331 355 183 219 55.2 61.6 Strand 131 131 84 83 64.1 64.0 The City 2,140 2,316 1,388 1,577 64.8 68.0 The difference between 1,674, the total notified, and 1,577 in the above table, is due to the omission of notified births in the latter months of the year which had not been registered by the 31st December. Still births, which are not registrable, are also excluded from this calculation. The notifications were made by parents in 296 instances, 632 by doctors, 561 by midwives, 185 by other persons. In addition, information is received through the County Council of births coming 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 276 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 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 in suitable cases 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 * 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 diarrhœa; (7) Care of the teeth; (8) Simple cookery. 12 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 2,263 families in which births occurred in 1910 have been visited; 1,576 of these were notified; the balance of the notified births (98) were considered "above the standard" and were not visited; 678 of those eventually notified or registered were being visited before the confinement took place. In addition, visiting also took place of 1,032 children born in 1909 until they were a year old; thus 3,295 infants were being regularly visited during 1910. At the end of the year 1,567 names were carried forward for future visiting, and 536 families had moved away from Westminster. An analysis on the same lines as that printed in last year's report, but restricted to children born in 1909, who have been visited throughout 1909 and 1910 has been made. Infants who hare moved from the district, or who have not attained the age of twelve months, have been excluded from the analysis. Subjoined are tables relating to the City, which for this purpose is divided into a north and south portion. They deal with 1,262 children and are taken from the Report of the City of Westminster Health Society. Tables A and C show the influence of housing, poverty, the mother's work, health, and the mode of feeding, and the rate of infant mortality and ill-health. Tables B and D show the influence of the mother's work on her health, confinement, mode of feeding of the child, and care of home. 13 Table A.—South (Westminster, Pimlico, Knightsbridge). Number of Cases. Infants. Healthy. Delicate. Dead. Number. Per Cent. Number. Per Cent. Number. Per Cent. 923 (13 cases twins) 689 74.7 42 4.5 *192 (42) 20.8 (4.5)* a. Housing (type of house) — 266 Block 219 81.4 9 3.4 41 (8) 15.2 (2.9) 592 Tenement 431 71.6 32 5.3 139 (32) 23.1(5.3) 52 Cottage 39 75.0 1 1.9 12 (2) 23.1 (3.8) b. Sousing (sanitary conditions)— 707 Good 549 76.8 27 3.8 139 (28) 19.4 (3.9) 137 Indifferent 93 655 8 5.6 41(11) 28.9(7.7) 66 Bad 47 712 7 10.6 12 (3) 18.2 (4.5) 81 (Basement) 57 70.4 5 6.2 19 (2) 23.4 (2.5) c. Poverty — 665 Comfortable (over 25s.) 519 77.2 21 3 1 132(26) 19.7(3.8) 212 Poor (21s. to 25s. inclusive) 146 67.9 18 8.4 51(13) 23.7 (6.0) 35 Very poor (under 21s,) 24 66.7 3 8.3 9 (3) 25.0 (8.3) d. Mother's Work— 765 No occupation 583 75.4 35 4.5 155(34) 20.1 (4.4) 24 Working at home 17 65.4 3 11.5 6 — 23.1 — 121 Working out 89 71.8 4 3 2 31 (8) 25.0 (6.4) e. Mother's Health— \ / 852 Strong 658 76.3 34 39 171 (41) 19.8(4.7) 58 Delicate 31 51.7 8 133 21 (1) 35.0(1.6) f'. Mode of Feeding†— 578 Breast 540 93.4 21 3.6 17 3.0 93 (a) „ (under 2 months) 34 36.6 6 6.4 53 57.0 54 (b) „ (over 2 months and under 6 months) 28 519 4 7.4 22 40.7 132 Bottle 87 659 11 8.3 34 25.8 * Figures in brackets denote the number still-born, † 66 infants—42 still-born, 24 dying within 1 week, excluded. Table B. Number of Cases. Mother's Work. Mother's Health. Confinement. Healthy. Delicate. Normal. Abnormal. 765 No occupation 709 (92.7) 56 (7.3) 715 (93.5) 50 (6.5) 24 Home work 21 (87.5) 3 (12.5) 21 (87.5) 3 (12.5) 121 Working out 111 (917) 10 (8.3) 114 (94.2) 7 (5.8) 910 The figures in brackets denote the percentage. 14 Number of Cases. Mother's Work. Mode of Feeding.* Breast. Partly Bottle. a. b. 710 No occupation 506 (71.3) 61 (8.6) 41 (5.7) 102 (14.4) 24 Home work 20 (83.3) 3 (12.5) - 1 (4.2) 111 Working out 48 (43.2) 24 (21.6) 12 (10.8) 27 (24.4) 845 Number of Cases. Mother's Work. Care of Home. Good. Indifferent. Bad. V65 No occupation 631 (82.5) 88 (11.5) 46 (6.0) 24 Home work 15 (62.5) 8 (33.3) 1 (4.2) 121 Working out 61 (50.4) 41 (33.9) 19 (15.7) 910 * 66 infants—42 still-born, 24 dying within 1 week. The figures in brackets denote the percentage. Table D (North). Number of Cases. Mother's Work. Mother's Health. Confinement. Care of Home. Healthy. Delicate. Normal. Abnormal. Good. Indifferent. Bad. 231 No occupation 79.1 20.9 92.6 7.4 73.1 18.1 8.6 68 Home work .. 75.0 25.0 86.7 13.3 60.4 26.4 13.2 40 Working out .. 80.0 20.0 87.5 12.5 47.5 42.5 10.0 339 N umber of Cases. Mother's Work. Mode of Feeding of Infant. Breast. Partly. Bottle. (a.) For less than 1 month. (b.) Between 1 and 6 months. 219 No occupation 77.1 4.1 12.3 6.3 62 Home work 64.5 4.8 14.4 16.1 36 Working out 69.5 5.5 11.1 13.8 317 Comparison may be made between the figures in these tables and similar ones published in the last two annual reports. They show some variation in the proportions but they show the same effects produced by the various factors. 15 From the above tables it is seen that 74.7 per cent. of the 923 children in South Westminster were alive and in a healthy condition when twelve months old, 4.5 per cent. were in delicate health, and 20.8 per cent. failed to reach their first birthday, 4'5 per cent. of these were still-born. The superior health and low mortality of the breast-fed infants is very marked. The percentage of children entirely breast-fed for at least six months was 62.6 of the births, which is practically the same as last year, though lower than the figures for 1908 when 75 per cent. ware so fed. There is also a markedly lower mortality amongst the bottle-fed, due, no doubt, largely to the teaching in the homes which has been carried out systematically for some years past. The percentage of deaths again shows a definite relation to the poverty of the family. The proportion of infants who fail to reach their first birthday is much greater in the Southern part where the income of the families is considerably lower than in the Northern area. Table c.—North (Mayfair, Strand and Soho). Number of Cases. Infants. Ileal lliy. Delicate. Dead. Number. Per Cent. Number. Per Cent. Number. Per Cent. a. Housing (type of house)— 143 Block 106 74.1 16 11.1 21 * 14.7 194 Tenement 120 61.8 39 201 35 18.1 2 Cottage 2 100.0 — — — — b. Sousing (sanitary conditions) — 214 Good 156 72.8 25 11.7 33 15.4 94 Indifferent 54 57.4 24 25.5 16 17.0 25 Bad 13 52.0 5 200 7 280 (12) (Basement) (8) 66.6 (2) 166 (2) 166 6 Unstated 5 81.3 1 16.0 - — c. Poverty — 206 Comfortable (over 25s.) 145 70.4 31 15.0 30 14.5 90 Poor (215. to 25s. inclusive) 56 62.2 16 17.7 18 20.0 43 Very poor (under 21s.) 27 62.7 8 18.6 8 18.6 d. Mother's Work— 231 No occupation 164 71.0 33 14.2 34 14.7 68 Working at home 43 63.3 15 22.0 10 14.7 40 Working out 21 52.5 7 17.5 12 30.0 e. Mother's Health— 266 Strong 192 72.1 32 12.2 42 10.7 73 Delicate 36 49.4 23 31.5 14 19.1 f. Mode of Feeding†— 234 Breast 184 78.6 32 13.6 18 7.7 14 Partly a (under 4 weeks) 6 42.8 3 21.4 5 33.5 41 „ b (over 1 month and not 6 months) 25 60.9 13 31.7 3 9.9 28 Bottle 14 50.0 6 21.4 8 28.6 7 Unstated — — — — 7 — * Figures in brackets denote infants dying under 1 week. † 22 infants—4 still-born, 11 dying within a week, 7 dying very young, feeding not stated, excluded. 16 The occupations (other than housework) in which the mothers were engaged were as follows:— South. At Home. Out. Dressmaking 8 Charing and office cleaning 62 Helping in shops 7 Street selling 17 Laundry 4 Laundry 14 Sewing 2 Cooking 7 Office cleaning 2 Servants 7 Lodging house 1 Waitresses 5 Dressmaking 4 Shop assistants 4 Milliner 1 24 121 North. At Home. Out. Tailoring 41 Charing 11 Caretaking 2 Tailoring 2 Care of shop 7 Flower selling 2 Lodgers 2 Cook 2 Dressmaking 5 Waitress 3 Cleaning houses 4 Market 1 Minding children 2 Dressmaking 2 Paper bag making 1 Housemaid 3 Cap making 1 Washing 3 Washing 1 Cleaning offices 6 Button hole making 2 Various 3 Unstated 2 68 40 The majority of the mothers in the South were unskilled workers, and presumably went out by the day to help the family income, when the fathers, unskilled labourers, were out of work. In the Soho area, the centre of the West End skilled tailoring outwork, the mothers in many cases were skilled hands helping their husbands at home and able to earn good money. The following Table in reference to nationality refers to the northern part of the City and summarises the figures for three years 1907-08-09 Number of Cases. Infants at the end of 12 months. Healthy. Delicate. Dead. Per cent. Per cent. Per cent. 785 British 572 72.8 102 12.9 111 14.1 383 Jewish 274 71.5 75 19.5 34 8.8 136 Italian 107 80.4 10 7.5 16 12.0 56 Various 37 66.0 12 21.5 7 12.4 17 In the southern half the majority of the inhabitants are of British nationality, and the figures relating thereto are to be found in Table A. Deaths. 2,164 deaths were registered in the City in the 52 weeks ending the 1st January, 1911. After deducting 1,023 deaths of non-citizens in public institutions in the City, and adding those of 750 citizens who died in other districts, the corrected total is 1,891, and is equivalent to an annual rate of 11.0 per 1,000 persons. The average death-rate for the years 1901-9 was 13.6. The London death-rate for 1910 was 12.75, the average for the previous five years being 145, and for England and Wales 13.4, the lowest rate on record (see Table VI), being 1.1 below the 1909 rate and 2.4 below the average rate of the previous ten years. Tables VI to XIII show the vital statistics of the City and five groups of districts from 1891 to 1910. The death-rates, according to the old districts of the City, are:— District. Average of Previous 10 Years. 1910. St. George 12.1 10.2 Westminster 16.5 13.0 St. James 12.7 8.7 St. Anne 12.5 9.2 Strand and St. Martin 15.5 12.0 The City 13.9 11.0 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. Deaths were fewer from nearly all causes than in 1909, the exceptions being diseases of the digestive system, including diarrhoea, diseases of the heart and blood vessels ; suicides were also more numerous. Ages at Death.—Deaths were fewer at every age period and in each ward except the Strand, which was increased by 6 by deaths of homeless per3ons admitted to Infirmaries through the casual wards. 18 Of the total deaths, 214 were those of children under 1 year of age, and 654 of persons over 65 years of age; these are referable to the various wards as follows:— 1910. Wards. Under 1 Year of Age. Oyeb 65 Years of Age. 1st Quarter. 2nd Quarter. 3rd Quarter 4th Quarter. The Year. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. The Year. Conduit - 1 1 - 2 1 1 1 3 6 Grosvenor 2 2 1 - 5 11 4 8 11 34 Hamlet of Knights bridge 3 2 1 2 8 5 6 5 10 26 Knights bridge St. George 7 1 1 1 10 14 12 7 5 38 Victoria 17 17 11 12 57 54 48 32 63 197 St. Margaret 6 4 5 - 15 9 11 6 10 36 St. John 16 22 16 23 77 48 81 25 42 146 St. Anne 5 2 8 7 17 5 9 4 5 23 Great Marlborough 3 — 2 1 6 13 3 5 5 26 Pall Mall - - - - - 2 3 2 6 13 Regent 2 1 — 4 7 6 4 4 5 19 Charing Cross - - - 1 1 6 3 1 3 13 Covent Garden 2 - 3 2 7 15 5 7 11 38 Strand — 1 1 — 2 15 8 7 9 39 The City 1910 63 53 45 53 214 204 148 114 188 654 1909 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 6S 106 67 323 193 170 119 182 664 The deaths of young children and of old persons were considerably less than in the previous year. 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 82, the average of the years 1901-9 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 78 per 1,000. The London rate for 1910 was 103, the average for the five years 1905-09 being 120. The infantile death-rate in England and Wales was 106, being 3 below the rate in 1910 and 26 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. I have also set out in Table VII, A and 13, the figures in Victoria Ward and St. Margaret and St. John. The births and deaths apportioned to these divisions are shown below:— 19  Legitimate. Illegitimate. Total Rate. Births. Deaths. Death rate per 1,000 births. Births. Deaths. Death rate per 1,000 births. Victoria Ward 666 49 73 87 8 92 75 St. Margaret and St. John 856 83 96 55 9 163 100 Rest of City 877 77 87 51 8 156 91 Figures for both births and deaths of infants corrected, showing the true rate in each of the last nine years:— Legitimate. Illegitimate. Total Rate. Births. Deaths. Death rate per 1,000 births. Births. Deaths. Death rate per 1,000 births. 1902 3,275 410 125 186 32 172 127 ] 903 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 2,744 285 103 187 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 1910 2,399 189 78 193 25 129 82 The following table shows the number of deaths of infants, and their relation to births in the last six 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. The ages at which reductions have taken place, and the causes of death in previous years, may be compared. The remarkable decrease in infantile mortality is due to a certain extent to the meteorological conditions which have obtained, but that this is only part of the explanation is shown by the fact that until recent years, when greater attention has been given to infant life, the mortality for 50 years previously maintained an average of 160 per 1,000 births. Table V.—Deaths of Infants under 12 months old per 1,000 born (corrected figures). Age at Death. 1905. 1906. 1907. 1908. 1909. 1910. No. Rate. 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 53 20.4 „ 1 month 131 41.9 120 41.0 126 43.1 105 38.3 99 35.9 78 30.1 „ 3 months 195 62.5 195 66.6 182 62.3 166 60.5 143 51.9 127 49.0 3 to 6 months 38 12.1 53 18.1 57 19.4 47 16.1 53 19.2 46 17.7 6 „ 9 „ 52 16.6 46 15.8 30 10.3 50 17.1 36 13.0 21 8.1 9 ,,12 „ 44 14.1 29 9.9 31 11.'5 30 10.2 26 9.5 20 7.7 Total in year 329 105.4 323 110.4 303 103.5 293 100.5 258 93.8 214 82.6 Causes of Death. No. Per cent. of total deaths. No. Per cent. of total deaths. No. Per cent. of total deaths. No. Per cent. of total deaths. No. Per cent. of total deaths. No. Per cent. of total deaths. Common infections diseases 37 11.2 12 3.7 17 5 5 17 5.8 19 7.3 16 7.4 Diarrhoeal diseases 46 13.9 76 23.5 30 9.9 35 11.9 27 10.4 27 12.6 Premature births and injury, &c., at birth 84 25.5 72 22.5 96 31.6 93 31.7 90 34.8 81 37.8 Did not thrive—wasting—want of milk—rickets 49 14.8 50 15.4 43 14.0 52 17.7 38 14.7 18 8.4 Tuberculous diseases.. 17 5.1 18 5.5 15 4.9 14 4.7 11 4.2 8 3.7 Erysipelas and other septic diseases — — 10 3.0 9 2.9 3 1.0 4 1.5 4 1.9 Syphilis .. 15 4.5 7 2.1 12 3.9 7 2.3 10 3.8 9 4.2 Meningitis, convulsions 11 3.3 13 4.0 11 3.6 8 2.7 9 3.4 5 2.3 Bronchitis and pneumonia .. 45 13.6 44 13.6 56 18.4 52 17.7 36 13.9 33 15.4 Suffocation—overlying, &c. 5 1.5 6 1.8 6 1.9 6 2.0 3 1.1 5 2.3 Other causes .. .. 20 6.0 15 4.6 4 1.3 6 2.0 11 4.2 8 3.7 329 100 323 100 303 100 293 100 258 100 214 100 20 21 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 Begency Street during the last six years is given below. Year. Population. Births. Rate. Deaths at all ages. 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 1910 1,120 37 33.0 8 7.1 108 The birth-rate for St. John's Ward, in which the Buildings are situated, is 27 0 for 1910. In the adjoining County Council Buildings at Millbank the rate is 33.2. The death-rate compares favourably with that of the Ward, which was 16.5. The rate in the Millbank Buildings is 11.8 per 1,000. Measles.—There is, I think, no doubt that there is a greater incidence in block dwellings. Certain of the differences in the death-rates given below are due to the varying proportion of children under 5 years of age. I have therefore ascertained the relative proportions at this age-period in the various sets of dwellings, and compare them with London and Westminster. The proportions for the County and City, Peabody Buildings and the Improved Industrial Buildings are those given as the result of the last Census, and are probably higher than will be found at the Census this year, as the birth-rate has markedly decreased in the decade. Those for the City's dwellings in Regency Street and the London County Council buildings at Millbank and Drury Lane are the exact figures at the present moment (these buildings were erected subsequent to 1901). The figures for the former may therefore require some amendment. Measles, 1904—1910. Population. Death-rate. Total. Under 5 years. On total population. On number under 5 years. Per cent. Per 1,000. City of Westminster Buildings 1,155 12.5 0.61 3.4 London County Council Buildings 4,043 15.0 0.46 3.0 Peabody Buildings 6,948 13.8 035 2.5 Improved Industrial Dwellings 4,846 10.7 0.11 1.1 City of Westminster — 6.9 0.15 2.0 County of London — 10.9 0.40 3.6 22 Table VII.—Infantile Mortality during the year 1910. City of Westminster. Deaths from Stated Causes in Weeks and Months under One Year of Age. CAUSE OF DEATH. Under 1 Week. 1—2 Weeks. 2—3 Weeks. 3—4 Weeks. Total under 1 Month. 1—2 Months. 2—3 Months. 3—4 Months. 4—5 Months. 5—6 Months. 6—7 Months. 7—8 Months. 8—9 Months. 9—10 Months. 10—11 Months. 11—12 Months. Total Deaths under One Year. Common infectious diseases— Small-pox - - - - - - - - - - - - - - - - - Chicken-pox - - - - - - - - - - - - - - - - - Measles - - - - - - 1 - - - - - 2 - 1 - 4 Scarlet fever - - - - - - - - - - - - - - - - - Diphtheria (including membranous croup) - - - - - - - - - - - - - - - - - Whooping cough - - — — — 2 — 3 1 — 3 — — 1 — — 10 Diarrhœal diseases— Diarrhœa, all forms — - — — — 2 1 - 1 - - - - - 1 - 5 Enteritis, muco-enteritis, gastro-enteritis - 1 - — 1 6 3 5 1 1 1 1 1 2 - - 22 Gastritis, gastro-intestinal catarrh Wasting diseases— Premature birth 31 6 1 2 43 2 1 1 - - - - - - - - 47 Congenital defects 6 — — 1 7 4 - 2 1 - - - - - 1 - 15 Injury at birth 4 — — — 4 — - - - - - - - - - - 4 Debility from birth 2 1 1 3 7 3 5 - - - - - - - - - - Atrophy, debility, marasmus 2 - - - 2 4 2 4 2 1 1 1 1 - - - 18 Tuberculous diseases— Tuberculous meningitis - - - - - - - - 2 1 - 1 - - - 1 5 23 Tuberculous peritonitis, tabes mesenterica - - - - - - - - - 2 1 - - - - - 3 Other tuberculous diseases - - - - - - - - - - - - - - - - - Other causes— Erysipelas - - - 1 1 - - - - - - - - - - - 1 Syphilis 1 1 — 3 5 2 1 1 - - - - - - - - 9 Rickets - - - - - - - - - - - - - - - - - Meningitis (not tuberculous) - - - - - - - - - - - - - - - 1 1 Convulsions — — 1 — 1 2 — — 1 - - - - - - - 4 Bronchitis — — — 1 1 1 2 2 1 2 — 1 — — 1 — 11 Laryngitis — - — — — — — — — 1 — — — — — — 1 Pneumonia — — 1 1 2 1 3 4 — 1 — 1 1 2 4 2 21 Suffocation, overlying 3 — — — 3 — — 1 — — 1 — — — — — 5 Other causes 1 — — — 1 1 — 2 1 1 3 1 — 1 2 — 13 53 9 4 12 78 30 19 25 11 10 10 6 5 6 10 4 214 Population, estimated to middle of 1910, 171,790. Births in the year—Legitimate, 2,399; illegitimate, 193—Total 2,592. Deaths in the year of legitimate infants, 189; illegitimate infants, 25—Total 214. Deaths from all causes at all ages, 1,891. The causes of death of the illegitimate children were: prematurity, 4; debility at birth, 4; congenital defects, 3; injury Dr want of attention at birth, 2; enteritis, 3; pneumonia, 1; whooping cough, 2; syphilis, 1; convulsions, 1; suffocation, 3; otitis media, 1. 24 Table VII, continued.—Infantile Mortality during the year 1910. St. John and St. Margaret Wards. Deaths from Stated causes in Weeks and Months under One Year of Age. CAUSE OF DEATH. Under 1 Week. 1—2 Weeks. 2—3 Weeks. 3—4 Weeks. Total under 1 Month. j 1—2 Months. 2—3 Months. 3—4 Months. 4—5 Months. 5—6 Months. 6—7 Months. 7—8 Months. 8—9 Months. 9—10 Months. 10—11 Months. 11—12 Months. Total Deaths under One Year. Measles — — - - - - - - - - - - 1 - 1 - 2 Whooping cough — — — — — 1 - 1 1 - 3 - - - - - 6 Diarrhoea, all forms - - - - - 1 1 - - - - - - - - - 2 Enteritis, muco - enteritis, gastro-enteritis - - - - - 1 - 2 1 1 - - - - - - 6 Premature birth 17 4 - 1 22 1 - - - - - - - - - - 23 Congenital defects 2 — — 1 3 — - - 1 - - - - - - - 4 Injury at birth 1 — — — 1 — — — - - - - - - - - 1 Debility at Birth - - 1 1 2 1 2 - - - - - - - - - 5 Atrophy, debility, marasmus 1 - - — 1 2 1 2 - 1 1 - 1 - - - 9 Tuberculous peritonitis, tabes mesenterica - - - - - - - - - 1 1 - - - - - 2 Erysipelas — — - 1 1 - - - - - - - - - - - 1 Syphilis 1 — — 1 2 1 - 1 - - - - - - - - 4 Convulsions - - 1 - 1 - - — — 1 - - - - - - 2 Bronchitis — — — — — 1 2 1 1 - - - - - - - 5 Pneumonia — — 1 1 2 - 3 3 1 1 - - - - - - 12 Suffocation, overlying — — — — - - - - 1 - - - - - - - 1 Other causes 1 - - - 1 1 - 2 - - 1 1 - 1 — — 7 23 4 3 6 36 10 9 12 6 5 6 1 2 2 2 1 92 Population, estimated to middle of 1910, 41,790. Births in the year—Legitimate, 856; illegitimate, 55. Deaths in the year of legitimate infants, 83; illegitimate infants, 9. Deaths from all causes at all ages, 585. 25 Table VII, continued.—Infantile Mortality during the year 1910. Victoria Ward. Deaths from Stated Causes in Weeks and Months under One Year of Age. CAUSE OF DEATH. Under 1 Week. 1—2 Weeks. 2—3 Weeks. 3—4 Weeks. Total under 1 Month. 1—2 Months. 2—3 Months. 3—4 Months. 4—5 Months. 5—6 Months. 6—7 Months. 7—8 Months. 8—9 Months. 9—10 Months. 10—11 Months. 11—12 Months. Total Deaths under One Year. Measles - - - - - - - - - - - - - - - - 1 Whooping Cough - - - - - - - - - - - - - - - - 3 Diarrhoea, all forms - - - - - 1 - - - - - - - - 1 - 2 Enteritis, muco-enteritis, gastro-enteritis - 1 - - 1 2 2 2 - - 1 1 - 1 - - 10 Premature birth 7 1 1 — 9 1 - - - - - - - - - - 10 Congenital defects 1 - - - 1 3 - 1 - - - - - - 1 - 6 Injury at birth 2 - - - 2 - - - - - - - - - - - 2 Debility from birth — — — 1 1 2 1 - - - - - - - - - 4 Atrophy, debility, marasmus - - - - - 1 1 1 1 — — 1 — — — — 5 Tuberculous meningitis - - - - - - - - 1 1 - - - - - - 2 Tuberculous peritonitis, tabes mesenterica.. - - - - - - - - - 1 - - - - - - 1 Syphilis — — — 1 1 — 1 — — — — - — — — — 2 Meningitis (not tuberculous) - - - - - - - - - - - - - - - 1 1 Bronchitis — - - - - - - - - - - 1 - - - - 1 Pneumonia — — — — — - - 1 - - - 1 1 1 - - 4 Suffocation, overlying 1 — — — 1 — — — — — 1 — — — — — 2 Other causes - — - - - - - — — — — — — — 1 - 1 11 2 1 2 16 11 6 7 2 2 2 4 1 2 3 1 57 Population, estimated to middle of 1910, 39,300. Births in the year—Legitimate, 666; illegitimate, 87. Deaths in the year of legitimate infants, 49; illegitimate infants, 8. Deaths from all causes at all ages, 546. Table VIII.—Causes of, and Ages at, Death during the 52 weeks ending 31st December, 1910. Causes or 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 undor 15. 15 and under 25. 25 and under 65. 65 and upwards. Conduit. Grosvenor. Hamlet of Knightsbridge. Knightsbridge St. George. Victoria. St. Margaret. St. John. St. Anne. Great Marlborough. Pall Mall. Regent. Charing Cross. Covent Garden. Strand. Smallpox - - - - - - - - - - - - - - - - - - - - - Measles 22 4 16 1 1 — - - 1 — — 8 1 7 2 1 — — — 2 — Scarlet fever 4 - 2 2 - — - - - - — 1 — 3 — — - - - - - Influenzaœ 24 2 1 — - 9 12 - 4 1 3 4 1 6 — 1 - - 1 1 2 Whooping cough 19 10 9 — - — — - — — — 6 1 10 — — - 2 — — — Diphtheria, Memb. croup 10 — 6 4 - — — - — 2 — 5 — 1 — — 2 — — — — Cerebro-spinal meningitis 1 — 1 - - - - - - - - - - - - - - - - 1 - Enteric fever 7 - — — 3 4 — - 1 - 1 1 - 3 - — — - 1 - - Epidemic diarrhoea 9 5 3 — — — 1 - — — — 3 1 4 1 - - - - - - Enteritis, other forms 32 21 4 1 1 2 3 - — 1 1 11 i 12 1 1 — 1 — 3 — Erysipelas 7 1 — — — 4 2 - — — — 2 — 2 1 1 — — 1 — — Puerperal fever 3 — — — 1 2 — - — — — — - 2 — — — 1 — — — Other septic diseases 16 3 — 1 6 4 2 — 1 1 1 5 2 1 1 1 1 — 1 1 Syphilis, &c. 11 9 — — — 2 — - — 1 1 3 2 3 1 — — — — — — Diabetes 17 — — — — 12 5 - 4 — — 4 1 2 1 - - 2 1 - 2 Gout 2 — — — — — 2 - — — — — — 1 — — — — — — 1 Rheumatic fever 7 — — 1 1 4 1 - 1 1 — 3 — 1 — — — 1 — — — 26 27 Tuberculosis of meninges 2141 5 7 5 2 2 — 1 — — 1 4 1 5 4 - - 1 - 2 2 Tuberculosis of lungs 186 — 1 4 13 149 19 4 3 5 5 58 4 49 9 4 1 11 1 12 20 Tuberculosis of peritoneum 5 3 — — — 2 — — — — 1 1 1 2 - - - - - - - Other forms of tuberculosis 19 — 6 3 2 7 1 — 2 — 1 9 2 1 1 2 - - - 1 - Alcoholism 13 — — — — 13 — 1 1 — - 4 - 1 - - - 1 2 1 2 Malignant growths 176 — 1 1 2 94 78 2 11 2 14 52 8 39 9 7 7 8 1 8 8 Premature birth 47 47 — — — — — 2 1 1 2 10 2 21 3 1 - - 1 2 1 Developmental diseases 55 52 3 — — — — — 2 2 3 18 1 18 5 3 - 2 - 1 - Old age 99 — — — — 1 98 — 3 3 3 24 4 29 5 4 1 5 3 3 12 Meningitis and convulsions 11 5 1 2 — 3 - - - - - 2 1 6 1 1 - - - - - Other diseases of nervous system 88 - 1 - 2 47 38 - - 2 7 24 5 27 4 3 2 4 - 7 3 Valvular diseases of heart 86 — — 2 2 41 41 1 7 6 4 23 6 14 5 1 4 - 1 8 6 Other circulatory diseases 232 — — - 1 97 134 5 12 4 9 77 16 50 8 10 5 10 3 13 10 Bronchitis 174 12 3 — — 61 98 1 6 6 11 51 9 47 11 4 - 4 2 13 9 Lobar (croupous) pneumonia 47 7 - - 3 28 9 1 2 3 1 12 2 7 6 3 - 3 1 3 3 Lobular (broncho-) pneumonia 51 12 7 2 1 13 16 - 1 1 3 13 3 19 1 3 - 1 1 2 3 Other respiratory diseases 53 2 3 1 1 31 15 1 3 1 2 16 1 17 5 - - 1 3 3 - Cirrhosis of liver 34 — — — — 27 7 — 3 — 2 10 1 6 2 3 - 1 3 - 3 Other digestive diseases 73 — 6 3 7 46 11 1 10 1 5 19 5 15 3 4 1 4 2 2 1 Bright's disease, &c. 93 1 1 — 1 49 41 1 7 3 6 24 4 24 5 5 - 2 - 5 7 Generative system diseases. 2 — - - - 2 - - - - 1 - 1 - - - - - - - - Accidents and diseases of parturition 7 - - - 1 6 - - - 1 - 1 1 3 - 1 - - - - - Deaths by accident or negligence 56 7 4 2 5 30 8 1 5 4 - 16 7 11 2 2 3 2 1 2 - Deaths by suicide and murder 31 1 - - 6 19 5 1 1 1 4 7 4 3 3 1 2 1 2 - 1 All other causes 41 5 2 4 4 19 7 1 4 2 1 15 3 11 1 1 - 1 - - 1 All causes 1,891 214 88 39 66 830 654 24 96 55 93 546 102 483 101 68 28 70 31 96 98 28 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 Marlhorougli Ward. Pall Mall Ward. Regent Ward. Charing Cross Ward. Co vent Garden Ward. Strand Ward. 1st Quarter 15.9 15.3 14.3 12.7 4.4 6.8 7.5 9.2 16.1 9.4 17.9 10.2 15.1 5.4 8.6 9.7 14.6 18.2 2nd Quarter 13.7 12.8 11.8 11.8 5.2 6.5 6.4 6.5 15.6 10.4 15.9 19.1 6.9 6.8 4.3 9.7 7.7 17.6 3rd Quarter 11.8 11.4 10.3 8.0 2.9 5.7 4.3 5.1 8.7 6.0 12.7 6.6 7.5 9.5 6.0 2.9 10.2 12.8 4th Quarter 14.2 13.9 14.6 12.1 5.2 7.0 11.3 4.3 14.9 6.3 19.6 11.0 9.9 16.3 11.3 7.8 14.1 13.2 the year 1910 13.9 13.4 12.7 11.0 4.4 6.5 7.4 6.3 13.8 8.0 16.5 9.2 9.8 9.5 7.6 7.5 11.7 15.4 „ 1909 14.8 14.4 14.0 12.7 4.4 8.1 9.5 8.2 14.7 10.l 19.5 11.5 12.1 10.1 11.1 8.6 13.5 14.5 1908 15.5 14.7 13.8 12.3 5.8 7.8 7.4 6.2 15.7 9.0 17.2 10.1 13.2 7.9 9.9 10.4 13.7 19.4 1907 14.7 15.0 14.6 12.9 4.2 9.7 7.9 8.1 15.7 9.4 20.2 10.4 12.8 8.8 8.5 9.8 15.3 11.9 1906 15.5 15.4 15.1 12.8 4.6 7.2 8.2 7.6 15.5 10.6 19.6 13.3 10.7 8.7 9.4 7.1 15.5 11.8 1905 15.5 15.2 15.1 13.3 6.2 8.2 9.6 7.4 15.1 10.8 21.0 11.2 12.3 9.6 12.1 10.8 16.4 12.9 1904 16.5 16.2 16.1 13.4 5.6 9.6 9.6 8.2 14.7 10.8 19.1 11.6 14.5 10.6 10.4 10.9 18.2 16.2 1903 15.6 15.4 15.2 13.5 4.8 7.5 8.4 8.2 14.2 12.6 18.8 13.6 14.4 9.1 15.7 11.8 15.2 20.0 1902 16.5 16.3 17.2 16.0 9.8 11.1 7.8 9.6 16.9 14.1 23.3 14.9 18.1 7.8 16.1 10.5 16.8 24.3 1901 — 16.9 17.1 15.6 8.4 10.3 9.4 11.2 15.4 13.7 22.6 12.7 19.8 10.6 16.0 10.3 18.5 26.3 29 Table IX.—City of Westminster.—Statistics of Births and Deaths during the 52 Weeks from 2nd January, 1910, to 31st December, 1910, giving the Corrected Figures and Rates. 1 2 3 4 5 6 7 8 9 10 11 12 Average Deathrate 1901-9. Wards, Population Estimated to Middle of the Year 1910. 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. Bate.* N umber. Rate per 1,000 Birth (Corrected). Number. Rate.* Conduit 5,350 22 4.1 2 90 23 6 7 8 24 4.4 5.9 Grosvenor 14,700 128 8.7 5 39 76 33 18 38 96 6.5 8.8 Knightsbridge St. George 14,700 169 11.4 10 59 427 39 361 27 93 6.3 8.3 V ictoria 39,300 753 19.1 57 75 306 256 23 263 546 13.8 153 St. Margaret . 12,650 124 9.8 15 120 324 28 247 25 102 8.0 11.2 St. John 29,140 787 27.0 77 97 298 282 102 287 483 16.5 20.1 Hamlet of Knightsbridge 7,400 77 10.4 8 103 42 19 7 20 55 7.4 8.6 Pall Mali 2,940 9 3.0 - - 21 13 8 15 28 9.5 9.2 Regent 9,200 110 11.9 7 63 39 46 17 48 70 76 12.1 Great Marlborough 6,870 83 12.0 6 72 42 44 16 42 68 9.8 14.2 Charing Cross 4,100 16 3.9 1 60 25 12 8 14 31 7.5 10.0 Covent Garden 8,200 117 14.2 7 59 242 55 194 48 96 11.7 15.9 Strand 6,340 12 1.8 2 166 218 81 187 67 98 15.4 17.4 St. Anne 10,900 185 16.9 17 91 81 53 35 55 101 9.2 12.1 The City 171,790 2,592 15.0 214 82 2,164 967 1,023 750 1,891 11.0 13.6 * Rates calculated per 1,000 of estimated population. The uncorrected birth-rate was 131, the uncorrected, death-rate, 12.5. 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. 30 Table X.—Deaths of Citizens during the Year ending 31st December, 1910, showing Locality at Time of Death. Wards Locality at Time of Death. Total Deaths (Nett). At Home. Workhouses and Infirmaries. General and Special Hospitals. Fever Hospitals. Lunatic Asylums. Elsewhere. Males. Females. Total. Males. Females. Total. Males. Females. Total. Males. Females. Total. Males. Females. Total. Males. Females. Total. Males. Females. Total. Conduit 7 9 16 - - - 2 2 4 - - - - 1 1 3 - 3 12 12 24 Grosvenor 30 25 55 3 8 11 11 10 21 — — — 1 - 1 5 3 8 50 46 96 Hamlet of Knightsbridge 17 18 35 6 2 8 4 5 9 — — — i 1 - - 1 1 28 27 55 Knightsbridge St. George 25 26 51 5 4 9 15 11 26 - 1 1 - 1 3 2 1 3 49 44 93 Victoria 116 156 272 71 47 118 57 38 95 4 — 4 17 22 39 13 5 18 278 268 546 St. Margaret 31 33 64 5 5 10 11 4 15 — — — 2 1 3 8 2 10 57 45 102 St. John 84 96 180 118 51 169 47 40 87 5 1 6 11 9 20 9 12 21 274 209 483 St. Anne 27 19 46 9 15 24 19 6 25 — — — 2 2 4 2 — 2 59 42 101 Great Marlborough 11 11 22 10 10 20 9 6 15 — — — 7 2 9 1 1 2 38 30 68 Pall Mall 11 2 13 1 — 1 4 7 11 — — — 1 — 1 1 1 2 18 10 28 Regent 11 11 22 10 14 24 13 7 20 — 1 1 — 1 1 2 — 2 36 34 70 Charing Cross 8 8 16 3 2 5 2 4 6 — — — — 1 1 1 2 3 14 17 31 Covent Garden 18 21 39 15 10 25 14 8 22 — — — 6 2 8 1 1 2 54 42 96 Strand 6 9 15 45 18 63 13 1 14 — - - 1 4 5 1 - 1 66 32 98 City of Westminster 402 444 846 301 186 487 221 149 370 9 3 12 51 47 98 49 29 78 1,033 858 1,891 .'31 Table XI.— Vital Statistics of Whole Districts during 1901-1910. 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 (nett). Kate per 1,000 Births Registered. Number. Rate.* Number. Rate.* 1901 182,567 3,232 17.8 435 135 2,998 16.3 1,227 1,019 921 2,900 15.8 1902 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 173,905 2,766 15.9 323 116 2,482 14.3 1,223 1,045 790 2,227 12.8 1907 172,900 2,732 15.8 303 110 2,396 13.8 1,171 992 833 2,237 12.9 1908 1172,650 2,665 15.1 293 109 2,437 13.8 1,234 1,089 829 2,177 12.3 53 weeks 1909 172,150 2,520 14.6 258 102 2,406 13.9 1,229 1,091 881 2,196 12.7 1910 171,790 2,365 13.1 214 90 2,164 12.5 1,169 1,023 750 1,891 11.0 * 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 183,0111 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 32 Table XI.—continued. I. II. II—continued. Institutions within the District receiving Sick and Infirm Persons from outside the District. (Total Number of Deaths in brackets.) Institutions outside the District receiving Sick and Infirm Persons from the District. Institutions outside the Disti ict receiving Sick and Infirm Persons from the District. St. George's Hospital (364). Westminster Hospital (236). Charing Cross Hospital (174). Ki ng's College Hospital (175). St. Peter's Hospital (25). Grosvenor Hospital (7). Heart Hospital, Sobo Square (15). Women's Hospital, Solio Square (7). Throat Hospital, Golden Square (15). Gordon Hospital (2). Queen Alexandra Military Hospital, Millbank (28). St. George's Workhouse, Wallis Yard (4). Poland Street Workhouse (20). Sheffield Street Workhouse (16). 22, George Street, Hanover Square, Nursing Home (3). Infants' Hospital (62). Lock Hospital (4). Royal Ear Hospital (6). 94-6, Belgrave Road (3). 24, Cliapel Street (2). King Edward's Hospital (1). Middlesex IIospit.il. St. Thomas's Hospital. St. Bartholomew's Hospital. St. Mary's Hospital. German Hospital. Endell Street Lying-in Hospital. Italian Hospital. Great Northern Hospital. French Hospital. Victoria Hospital. General Lying-In Hospital, York Road. West London Hospital. Queen Charlotte's Hospital. Great Ormond Street Children's Hospital. Cancer Hospital, Chelsea. University College Hospital. Brompton Hospital. Hospital of St. John and St. Elizabeth. South-Western Fever Hospital. Western Fever Hospital. Royal Chest Hospital. Royal Free Hospital. Belgrave Hospital. National Hospital, Queen's Square London Temperance Hospital Evelina Hospital. Homoeopathic Hospital. Metropolitan Hospital. St. Joseph's Hospital, Chiswick. Royal Mineral Hospital,Bath Kensington and Fulham General Hospital. South Wimbledon Cottage Hospital. County Hospital, Durham. New Hospital for Women. East London Hospital. St. George's Infirmary, Fulliam Road. Chelsea Infirmary, Wandsworth Infirmary. Children's, Carshalton. Ilampstead Workhouse. Edmonton Workhouse. St. Giles' Workhouse. St. George's Workhouse, Fulham Road. Central London Sick Asylum, Cleveland Street. Central London Sick Asylum, Hendon. .Banstead Asylum. Bethlehem Asylum. Long Grove Asylum. Cane Hill Asylum. Cater ham Asylum. CI ay bury Asylum. Colney Hatch Asylum. Darenth Asylum. Hanwell Asylum. Horton Asylum. Leavesden Asylum. Tooting Bee Asylum. Manor Asylum. Peckham House Asylum. III. 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. 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. Tailor's Institution, St. Pancras. St. Joseph's Home. 7, Mandeville Place. St. Elizabeth's Home, East Ham. Jewish Home, South Tottenham. 7, Colosseum Terrace. 5, Bentinck Street, Marylebone. Catholic Nursing Home, Lambeth. St. Peter's Home, Kilburn. Norton House, Clapham. 31, Upper Berkeley Street. 59, South Row, Kensington. 2, Nottingham Place, Marylebone. 20, Beaumont Street, Marylebone. 12, 23 and 29, Devonshire Street, Marylebone. Oakley House, Union Street, Marylebone. 14, Henrietta Street, Marylebone. 9, Burgoyne Road, Stockwell. 198, Cromwell Road. St. Joseph's Hospice, Hackney. 88, Palace Gardens Terrace. Home for Invalids, H ighbury. Montserrat Home, Bournemouth. St. Thomas's Home. British Home for Incurables, Norwood. 33 Table XII (L.G.B. Table).— Vital Statistics of Separate Localities, 1891-1910. Names of Localities 1. The City of Westminster. 2. St. George's, comprising Conduit, Grosvenor, Victoria, and Knightsbridge St. George Wards. 3. Westminster, comprising St. Margaret, St. John, and the Hamlet of Knightsbridge Wards. 4. St. James, comprising 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 (cor rected). Deaths under 1 year. Population estimated to middle of each year. Births registered (uncorrected). Deaths at all ages (corrected). Deaths under I year. Population estimated to middle of each year, Births registered (un- J corrected). Deaths at all ages (corrected). Deaths under 1 year. Population estimated to middle of each year. Births registered (uncorrected). Deaths at all ages (corrected). Deaths under 1 year. 1891 202,136 4,507 4,024 740 79,967 1,610 1,312 216 55,651 1,449 1,148 256 21,839 508 493 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 296,254 4,155 3,559 683 79,368 1,470 1,185 204 53,915 1,278 1,154 246 23,149 528 407 74 12,246 324 203 48 27,576 555 610 111 1896 194,866 3,968 3,277 642 80,041 1,407 1,117 211 53,481 1,222 987 209 22,955 484 396 72 12,200 292 231 58 26,189 563 546 92 1897 194,120 3,846 3,177 587 80,376 1,365 1,067 183 53,047 1,238 1,005 200 22,576 446 388 75 12,150 314 185 39 25,971 483 532 90 1898 193,304 3,715 3,324 571 80,703 1,411 1,072 172 52,613 1,088 1,093 198 22,200 434 408 73 12,150 290 205 39 25,638 492 546 89 1899 192,452 3,610 3,442 600 81,033 1,348 1,156 177 52,179 1,114 1,174 229 21,827 435 387 69 12,100 296 210 40 25,313 417 515 85 1900 191,269 3,433 3,234 509 81,364 1,295 1,140 146 51,745 1,056 1,097 208 21.457 410 341 62 12,000 273 189 36 24,703 399 467 75 1901 185,648 3,241 2,900 435 77,475 1,199 1,007 156 52,851 1,124 871 151 21,403 453 350 62 11,590 289 148 21 22,329 387 425 43 1902 (53 weeks) 180,880 3,284 2,952 442 76,424 1.204 1,074 143 52,791 1,153 1,007 163 21,060 388 327 52 11,414 256 173 35 20,200 283 371 49 1903 179,052 3,017 2,419 370 75,675 1,156 833 135 52,284 1,071 824 143 20,094 325 286 39 11,304 218 154 24 20,007 247 322 29 1904 177,321 2,897 2,376 360 75,440 1,183 886 139 51,960 985 813 150 19,730 284 235 27 11,250 205 130 16 19,827 240 312 28 1905 175,606 2,940 2,347 329 74,800 1,162 868 115 51,256 1,057 857 138 19,400 306 229 29 11,000 227 124 21 19,150 188 269 26 1906 173,905 2,766 2,227 323 74,350 1,150 868 124 50,420 973 789 124 19,250 296 189 33 10,900 217 145 25 18,985 179 236 17 1907 172,900 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 (53 weeks) 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 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 Averages of 10 years 1900 to 1909 178,138 2,989 2,506 362 75,782 1,156 930 126 51,229 1,034 849 143 19,958 320 257 38 11,215 218 141 23 20,172 246 317 32 1910 171,790 2,365 1,891 214 74,050 958 759 74 49,190 893 640 100 19,010 189 166 13 10,900 169 101 17 18,640 156 225 10 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. 34 Table XII, continued.— Vital Statistics of Separate Localities, 1891-1910.— 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 Reeistered (uncorrected). Rale 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. Rale per 1,000 Births (uncorrected). Births Registered (uncorrected). Rate per 1,000. Deaths at all Ages (corrected) Rate per 1,000. Deaths under 1 Year. Rates per 1,000 Births (uncorrected). Births Registered (uncorrected). Rate per 1,000. Deaths at all Ages (corrected). Rate per 1,000. Deaths under 1 Year. Rate per 1,000 Births (uncorrected). Births Registered (uncoirected). Rate per 1,000. Deaths at all Ages (crrected). 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 10.0 111 19.9 13.3 115 9.4 12.3 116 1907 15.8 12.9 110 14.8 12.2 86 19.9 15.5 142 13.5 10.1 116 16.4 10.4 94 10.3 13.0 96 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 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 Averages of 10 years 1900 to 1909 16.4 13.9 121 15.1 12.1 108 20.2 16.5 137 15.8 12.7 115 19.3 12.5 107 11.9 15.5 126 1910 13.1 11-0 90 12.9 10.2 77 18.1 13.0 111 9.9 8.7 68 15.5 9.2 100 8.3 12.0 64 (Corrected birth-rates and death-rates of children under 1 are shown on Table V. The corrected figures arenot available for the City until 1901. See Table VIII.) 35 Table XIII.— Vital Statistics relating to Residents in Blocks of Dwellings in the City of Westminster, 1910. 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 1,120 37 8 1 — — 1 1 — — — 1 2 2 4 St. James's Dwellings, Ingestre Place, and Marshall Street 163 1 3 - 1 1 - 1 - - - - - - - 1 Peabody 6,761 158 86 3 6 22 5 15 4 3 1 9 3 15 8 31 Westminster 187 4 4 1 - - 1 1 1 — — — — - - 2 London County Council— Millbank 3,043 101 36 3 3 4 3 5 6 1 — 2 7 2 10 7 Drury Lane 1,000 15 9 1 1 3 2 — 1 — — — — 1 1 3 Improved Industrial 6,878 100 45 2 3 6 3 10 3 1 2 7 3 5 5 15 Metropolitan Association 757 18 9 3 2 2 — 2 - - - - - - 1 2 St. George's Model Dwellings 419 8 5 — — 2 — 1 - 1 - 1 - - - 2 Clerkenwell and Soho Company 1,184 24 17 1 1 4 — 5 1 1 1 2 - l 1 2 (Newport Market) G-reencoat 119 2 - - - - - - - - - - - - - 1 Spencer 99 — 2 — - 1 1 - - - - - - - - - Chapter Chambers 175 2 1 — 1 - - - - - - - - - - 1 Alexandra and Castle — 7 2 — 1 — — 1 — — — — - - - - New Building — 2 2 — — 1 — 1 — — - - - - - - St. James's Residences — 12 2 - 2 - - - - - - - - - - - 36 B. Communicable Diseases. (1) Compulsorily Notifiable Diseases. The details respecting the 517 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 the number of cases of typhoid and puerperal fevers was above the number notified in the previous year, while scarlet fever, diphtheria and erysipelas were below. In Westminster typhoid fever cases were more numerous, but the cases of scarlet fever, diphtheria and erysipelas were much below the average. Doubtful cases, contacts, and certain patients returning from fever hospitals, &c., were visited. Smallpox.—During the year seven cases of smallpox were notified in London, one of these being in Westminster. On Sunday evening, 19th June, a lady and her child, aged 6 months, arrived at Charing Cross Station, having travelled from Tientsin, in China (which they left on the 7th), by overland route vid Siberia to Ostend. The child became ill at Moscow, but was not seen by a medical man until arrival in London, when she was taken to Charing Cross Hospital, where the nature of the illness was at once recognised. Information was given to the authorities at Dover and Hastings, a friend from the latter place, having travelled from Dover to London with them. The Railway Company and the Steamship Company were communicated with, and steps were taken to have the saloon carriage on the train and the cabin on the steamer disinfected. The child's father was suffering from smallpox when she left China. The mother was removed to hospital along with the child, who was able to be discharged on the 2nd July. Intimation was received of 87 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 1910:— 37 Vaccination Statistics. 1909. Union. Births. Died Unvaccinated. Successfully Vaccinated. Insusceptible. Vaccination Postponed. Conscientious Objectors. Removed and Vaccination Officer Informed. Not Found. Removed to Address Unknown. St. George 1,981 138 1,627 13 11 118 18 53 Westminster 388 23 313 0 2 17 2 31 Strand 168 17 115 0 7 13 8 8 The City 2,537 178 2,055 13 20 148 28 92 The following is a summary of the total primary vaccinations performed in the City during the years 1901-10, 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 lie-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 1910 1,652 326 188 43 517 * There were also 16 primary vaccinations of persons over 14 years of age. Scarlet Fever.—The striking reduction in the number of cases in 1910 is shown in the subjoined statement of each quarter of the last three years:— Scarlet Fever. London. Westminster. 1908. 1909. 1910. 1908. 1909. 1910. 1st quarter 5,943 4,227 2,701 168 113 88 2nd „ 4,462 4,404 2,548 129 218 57 3rd ,, 5,616 4,680 2,580 87 144 54 4th „ 6,038 3,940 2,683 243 115 49 22.059 17,251 10,512 627 590 248 38 The rise and fall of the disease is shown week by week on the accompanying charts. The schools attended by affected children are shown later, but no school has been much affected. In the early part of the year several families, the children of whom have been attending St. Gabriel's Day or Sunday School, wore affected. Probably this arose from a mild undetected case. In one family a child was notified on the 10th' February, and it was then reported that two other children had sore throats, but the medical attendant did not feel justified in notifying them as scarlet fever until they began to peel. One case notified followed somewhat closely the return from the fever hospital of an elder sister. There were four deaths, giving a low mortality rate, as shown below. In the whole year, 84 of the 248 cases were in Victoria Ward, 57 in St. John's; 4 were fatal, 1 being in the former and 3 in the latter Ward. The death rate for London was 0'04 per 1,000, the fiveyearly average being 0.11. In 18 instances, 2 cases occurred during the year in the same house, and in 4 instances 3 cases. There were 4 cases in one police section house and 7 in a large business establishment. In 8 instances the disease was eventually found not to be scarlet fever. Scarlet Fever. 1901. 1902. 1903. 1904. 1905. Deaths per 100 Cases— The City 1.8 3.3 2.5 2.8 4.0 The County 3.2 3.0 2.8 2.7 2.8 Scarlet Feyer. 1906. 1907. 1908. 1909. 1910. Deaths per 100 Cases— The City 2.5 2.8 1.27 3.00 1.61 The County 2.6 2.49 2.48 2.22 2.03 Diphtheria.—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 again suffered most, there being more persons at a susceptible age in these wards. 39 Notification of Diphtheria Cases Received in each Month, 1901-10. 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 h 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 1910 19 11 19 10 7 12 10 15 9 10 14 13 149 There were 10 deaths. Diphtheria. 1901. 1902. 1903. 1904. 1905. Deaths per 100 Cases— The City 10.0 11.0 8.6 3.4 4.2 The County.. 10.9 10.8 9.6 10.2 8.6 Diphtheria. 1906. 1907. 1908. 1909. 1910. Deaths per 100 Cases — The City 7.6 11.0 9.9 8.0 6.7 The County 8.8 8.9 9.0 9.0 7.8 The mortality is greatest among children at ages 1 to 5 years; at that period it amounted to 13.6 per cent. of the cases notified, and between 5 and 15 years 6.7 per cent.;there were no deaths in the 46 persons under 1 or over 15 years of age. In 5 instances 2 cases occurred in one house. Supply of Anti-toxin.—The Local Government Board, in a letter dated the 15th August, 1910, stated that they have had under consideration the question of facilitating the prompt use of diphtheria anti-toxin in the case of persons who may be attacked by diphtheria or exposed to the infection of the disease, and with that object they have made an Order under Section 77 of the Public Health (London) Act, 1891, sanctioning the provision by Councils of metropolitan boroughs of a temporary supply of diphtheria anti-toxin and of medical attendance in connection therewith. The Board pointed out that the arrangements with respect to the keeping, distribution and use of the diphtheria anti-toxin are to be made in accordance with the advice of the Medical Officer of Health, 40 and, having regard to the importance of the matter, the Board suggested that at an early date the Council should consider with the Medical Officer of Health what arrangements should be made for the provision of anti-toxin and for its use both as a prophylactic and a curative agency. They stated that in cases in which a patient is under the care of a medical practitioner the latter should, in ordinary circumstances, be the person to administer the anti-toxin. The Board suggested that the Council in considering the matter should take into special account the possible requirements of the Poor Law Medical Officers, as it appeared to the Board to be desirable where the Council avail themselves of the powers now given them, that the Poor Law Medical Officers should be able to obtain from the store of the Council the anti-toxin which they may require from time to time for use in connection with patients under their care. It was also suggested that to prevent misapprehension it should be observed that the free provision of diphtheria anti-toxin which is authorised by the Order must not be regarded as a substitute for removal to hospital of a patient suffering from diphtheria, nor as implying that the patient to whom the anti-toxin has been administered may properly be retained for treatment at home, unless means are available for his efficient isolation to the satisfaction of the Medical Officer of Health. The Board added that the prompt administration of anti-toxin before the patient is removed to hospital may, especially if delay in removal is inevitable, go far towards preventing the attack of diphtheria from being fatal; that by Article II of the Order the duties of the Medical Officer of Health are to be deemed to extend to and include all action by the Medical Officer of Health in the execution of the Order, and Article III provides for the payment by the Council to the Medical Officer of Health of reasonable compensation for such action taken by him; that the arrangements which the Council may make for the supply of diphtheria anti-toxin should be brought to the knowledge of all medical practitioners practising within their jurisdiction; and that in any circular letter which the Council send out to medical practitioners it is desirable that emphasis should be laid on the importance of prompt treatment by anti-toxin and of the saving of life which may thereby be effected. The Council resolved to avail themselves of the powers given, and the following letter was sent to medical men practising in Westminster:—- "Provision of Diphtheria Anti-Toxin. "The Local Government Board having made an Order sanctioning the provision of a temporary supply of diphtheria anti-toxin, for use in 41 cases of the disease, the City Council have made arrangements whereby a supply of anti-toxin may be available for the use of medical practitioners, in cases in which the patients (resident in Westminster) are themselves unable to pay, and I enclose particulars of these arrangements. "In this connection I may remind you that if the best results are to be obtained, anti-toxin must be administered within the first forty-eight hours. Dr. Goodall, Medical Superintendent ol Homerton Fever Hospital, in a paper read recently before the Medical Officers of Health Society, stated that he had never seen paralysis ensue if anti-toxin had been given within that period; that the earlier anti-toxin is given, the smaller is the dose required. He advised that in suspected cases, where the probability is strong, anti-toxin should be given, especially where the patient is under ten years of age. In cases in which the patient is being removed promptly to hospital, Dr. Goodall does not consider it of much advantage to administer a dose of anti-toxin before removal, but it should be used if delay in removal to hospital is inevitable. Dr. Goodall further pointed out that the use of anti-toxin is contraindicated in patients suffering from asthma or allied disorders, or if more than a week had elapsed since the previous dose was administered, as dangerous and even fatal results had followed its use under such circumstances. "The Local Government Board wish it to be understood that the free provision of diphtheria anti-toxin must not be regarded as a substitute for the removal to hospital of a patient suffering from diphtheria, or as implying that the patient to whom anti-toxin has been administered may properly be retained for treatment at home unless means are available for his efficient isolation to the satisfaction of the Medical Officer of Health. "The Westminster City Council have made arrangements that medical practitioners practising in Westminster can obtain a supply of diphtheria anti-toxin (4,000 units) for poor patients resident in Westminster, at the following places and times :— "(1) Messrs. Parke, Davis & Co., Beak Street, Kegent Street, W. (Telephone Nos. 8636 Gerrard and 9201 Central; Telegraphic Address— "Cascara,"London). Monday to Friday inclusive—9 a.m. to 8 p.m. Saturdays—9 a.m. to 1 p.m. and 6 p.m. to 7 p.m. Sundays and Bank Holidays —11 a.m. to 12 noon and 7 p.m. to 8 p.m. "(2) Messrs. Heppell & Co. Chemists, of 35, Hayniarket and 78, Strand. At any hour of the day and night, except on Sunday night between midnight and 8 a.m. on Monday. 42 "(3) The Caretaker, Coroner's Court, Horseferry Road, S.W., at any hour. "When a supply has been obtained a receipt must be given by the medical practitioner in order that it may be forwarded to the City Council, who will otherwise not hold themselves responsible for payment." 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 184 instances. In 13 instances I had a bacteriological examination made of the throats of the members of families in which a case had occurred, or when children were excluded from school in consequence, and no medical man was in attendance; the bacillus was present in one of them. In one instance examination was made on account of other cases occurring subsequent to the first patient's return from hospital—it proved negative. Typhoid Fever.—The number of cases notified, both in London and Westminster, show an increase over 1909. Of the 48 persons notified in the City, 1 was eventually declared not to be so suffering. This disease was proportionately most prevalent in Holborn, Finsbury, Shoreditch, Bethnal Green, Stepney, Poplar, and Bermondsey. According to a report issued by Dr. Hamer to the County Council, it is possible that some of the attacks may be due to the consumption of small plaice or dabs. These small fish frequent the more shallow waters, which are those which would be more liable to pollution. The Local Government Board has also issued a report by Dr. Ledingham, dealing with the subject of the enteric fever carrier. The carrier is a person, usually a woman, who, although in good health, carries the infectious material in the body and excretes the bacillus typhosus in fæces or urine. The excretion of the bacillus may continue, persistently or at intervals, during many months or years. The carrier state is not necessarily the result of a previous attack of enteric fever, or at least of any illness which can be traced or is known to the carrier. Fnteric fever patients, however, may continue after convalescence to excrete the bacillus, sometimes for a period less than three months ("temporary carrier") and sometimes for much longer periods ("chronic carriers"), and it is naturally among persons who have been attacked by enteric fever that most carriers have been detected. The average carrier does not appear to be a serious danger, but some have been proved capable of causing outbreaks wherever they go. Surveillance seems necessary in the case of carriers of proved infective ability, especially where food preparation is concerned. 43 Notifications of Infectious Diseases in each week of the year 1910. The County of London. The City of Westminster. 44 In London the increase in the number of cases occurred in the third and fourth quarters of the year; in Westminster it was in the second and third quarters:— Typhoid Fever. London. Westminster. 1909. 1910. 1909. 1910. 1 st Quarter 354 242 9 10 2nd 197 166 1 19 3rd 239 415 6 14 4th 253 460 9 5 The Year 1,043 1,283 25 43 Of the 47 eases, 17 of the patients contracted the disease out of London; of the remaining 30 no definite history was obtainable in 14 instances, 3 contracted the disease by attending persons suffering from the complaint, and 13 had a definite history of having eaten shell fish or fresh fish (from stalls or from fried fish shops). As pointed out in previous reports, a number of the cases are of persons connected with food in some way, such as hotel and restaurant employes. Seven of the cases proved fatal. Five cases occurred in one family, the patients being the mother and four daughters, the father, son and baby escaping. It has not been possible, so far, to discover how they became infected. Suspicion at first fell on winkles which had been eaten by all the family, except the baby, on the 3rd April; the officials of the Fishmongers' Company made very careful enquiries with regard to the source from which they were obtained and the processes to which they are subjected before they reach the consumer. It appears that winkles arrive at Billingsgate from several sources and on arrival are mixed. They are sold to retailers, in this instance for his Sunday trade only. The winkles are placed in brine by the retailer for 16 hours, and are then washed in fresh water to remove grit and dirt. They are then cooked, about three-quarters of a bushel at a time being plunged in a wire basket into boiling water. The water in the first instance is brought up to the boil, on the winkles being plunged in, the water is necessarily cooled, but the water is again allowed to come up to the boiling point, and the winkles are kept in it at boiling point for 2½ to 3½ minutes, being kept in the water therefore for about 5 minutes in all. After this operation the winkles are again placed in brine for about half an hour. If this operation be done thoroughly the winkles ought to be freed from any deleterious organism should such have been present. Advantage was taken to obtain the City Bacteriologist's opinion in 18 cases, in 5 the Widal reaction was reported. 45 Puerperal Fever.—Six notifications were received, and three deaths occurred. Disinfection was carried out after each case, including the clothing, &c., of those in attendance. All the patients were treated in hospital or infirmary. The illness was due to want of proper attention at birth in one case; one to abortion; two to pre-existing disease; no definite history was obtainable in two cases. The Asylums Board have decided to make arrangements for the reception of certified cases of puerperal fever in their hospitals, having been advised that such cases can be safely admitted to the same hospital with other infectious diseases, and are in some hospitals treated in the same wards as cases of enteric fever. Cholera.—This disease continued prevalent in Russia during last year. I received notification from the Port Sanitary Authorities of 121 persons coming to Westminster from affected districts, and these were kept under observation. Plague.—The recent occurrence of cases of this disease in Suffolk is cause for some apprehension, but not necessarily for alarm. It is now generally admitted that rats play an important part in the dissemination of this disease, and infected rats have been found not only in Suffolk, but also in Essex, while there is always the danger of infected rats entering the docks from vessels coming from localities where the disease is prevalent. The London Port Sanitary Authority takes active steps to prevent this, and the Local Government Board have made regulations whereby local authorities may deal with the destruction of rats in their district, but the co-operation of the householder is also necessary. Steps must be taken to keep rats from gaining access to dwellings and stores. In London the usual route by which they do so is through defects in the sewers and house drains; it is therefore incumbent upon owners of property who are troubled with rats to take steps to have all drains thoroughly examined with a view to their being made sound. If rats are kept out of houses and stores, and exterminated in waste places, &c. there need not be much fear that there will be any great outbreak such as occurred 245 years ago. Once the disease attacks human beings there is danger, especially in the pneumonic form, that infection may be given off by the breath of the patient, but isolation and disinfection will doubtless act as sufficient checks, if undertaken promptly. At present it should be the aim to prevent infection spreading to human beings from lower animals, especially rats. Circulars prepared by the Board of Agriculture on the destruction of rats have been circulated in the city. D 46 Table XIV.—Infectious Diseases Notified, 1890-1910, in London. Year. Smallpox. Scarlet Fever. Diphtheria and Croup. EntericFever. 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 45,84b 1893 2,813 36,901 13,694 3,666 22 205 397 9,700 86 4 67,485 1894 1,192 18,440 11,190 3,360 21 162 253 6,080 21 2 40,925 1895 979 19,757 11,223 3,506 14 105 236 5,660 29 3 41,512 1896 225 25,647 13,941 3,190 6 103 279 6,438 13 3 49,845 1897 104 22,848 13,199 3,103 4 65 264 5,800 38 1 45,361 1898 32 16,894 11,855 3,024 16 55 247 5,169 23 1 37,316 1899 29 18,113 13,704 4,463 14 69 330 5,615 15 1 42,353 1900 87 13,800 11,985 4,291 7 73 237 4,762 5 — 35,247 1901 1,700 18,381 12,157 3,194 20 48 253 4,604 3 — 40,360 1902 7,796 18,252 10,731 3,407 4 47 311 5,536 1 2 46,087 1903 416 12,531 7,739 2,339 22 40 233 4,372 — — 27,692 1904 489 13,439 7,219 1,896 3 29 273 4,943 1 1 28,293 1905 74 19,461 6,482 1,552 9 14 292 4,972 — 1 32,857 1906 31 20,343 8,035 1,606 7 9 297 5,026 2 — 35,356 1907 8 25,925 8,771 1,394 5 36 255 4,496 — — 40,890* 1908 1 22.059 9,998 1,350 4 13 230 4,209 — — 35,864* 1909 21 17,251 6,685 1,042 7 20 287 4,194 — — 29,507* 1910 7 10,512 5,495 1,284 3 15 292 3,981 1 1 21,706* In the City of Westminster. 1890 1 402 150 79 - 9 - 128 1 - 770 1891 2 379 174 100 - 7 9 144 1 - 817 1892 14 864 349 99 — 8 7 191 2 - 1,534 1893 165 1,366 353 148 — 5 11 230 4 - 2,284 1894 21 535 269 106 — 9 2 134 — — 1,134 1895 195 715 383 114 — 4 4 138 — — 1,297 1896 7 846 323 121 — 5 7 178 — — 1,487 1897 13 658 336 104 — 5 6 175 1 — 1,298 1898 2 409 338 112 — 2 5 131 — — 999 1899 — 534 283 143 — 1 3 176 — — 1,140 1900 2 453 287 118 — 4 5 129 — — 998 1901 102 475 253 104 — 2 6 117 — — 1,059 1902 232 475 285 132 — 1 6 144 — — 1,275 1903 45 352 186 71 — 2 5 111 — — 772 1904 6 313 145 51 1 2 5 125 — — 648 1905 2 370 118 41 — — 12 123 — — 666 1906 — 540 206 47 — 2 9 127 — — 931 1907 — 418 145 51 — 2 3 102 — — 721* 1908 1 627 187 41 — — 6 81 — — 943* 1909 1 590 225 25 — — 5 102 — — 948* 1910 1 248 149 48 — — 6 61 — — 515* * There were also notified 132 cases of Cerebro-Spinal Meningitis in London, 4 in Westminster in 1907. „ 85 „ „ 3 „ 1908. ,, 111 ,, „ 3 „ 1909. „ 115 ,, „ 2 „ 1910. Glanders and Anthrax.—Three intimations of cases of glanders and one of anthrax 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. 47 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 16.3 2.7 0.00 0.02 0.4 8.6 1909 0.04 35.6 13.9 2.1 0.01 0.04 0.6 8.3 1910 0.01 21.5 11.2 2.6 0.00 0.03 0.6 8.1 In the City of Westminster 1891 0.1 19.1 8.8 5.0 0.1 0.4 0.5 7.3 1892 0.7 43.9 17.8 5.0 - 0.4 0.4 9.6 1893 8.4 69.7 18.1 7.5 — 0.3 0.6 11.7 1894 1.1 27.4 13.7 8.5 — 0.5 0.1 6.9 1895 1.0 36.9 15.6 5.9 — 0.2 0.2 7.1 1896 0.4 43.1 16.4 6.2 — 0.3 0.4 9.1 1897 0.7 34.3 17.5 5.4 — 0.3 0.3 9.1 1898 0.1 21.5 17.7 5.9 — 0.l 0.3 6.9 1899 — 28.1 14.9 7.5 — 0.l 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) 0.05 35.6 10.6 2.3 — — 0.34 4.6 1909 0.05 34.3 13.0 1.4 — — 0.29 5.9 1910 0.05 14.4 8.6 2.7 — — 0.34 3.5 D 2 48 City of Westminster. Table XV.—Local Government Board Table C.— Cases of Infections Disease Notified during the 52 weeks from 2nd January to 31s£ December, 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. Knightsbridge St. George. Victoria. St. Margaret. St. John. Kamlet of Knightsbridge. Tall Mall. Regent. Great Marlborough. Charing Cross. 1 Covent Garden. Strand. St. Anne. Conduit. Grosvenor. Knightsbridge St. George. Victoria. St. Margaret. St. John. Hamlet of Knightsbridge. j 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 - - - - - - - - - - - - - - - - - - - - Cases 149 3 44 59 26 17 — 2 8 11 39 16 33 9 4 6 4 2 7 4 4 2 8 10 38 13 32 7 3 6 4 2 7 3 4 139 Deaths 10 — 6 4 - - - - - - 5 — 1 2 2 - - - - - - Erysipelas— Cases 61 3 1 3 3 44 7 2 1 2 15 6 16 — — 5 6 1 1 1 5 — 1 — 7 2 10 — — 1 4 — 1 — 1 27 Deaths 7 1 — — — 4 2 — — — 2 — 2 — — — 1 1 — — 1 Fevers. Scarlet— Cases 248 1 49 126 41 31 — 6 20 18 84 13 57 6 4 4 12 1 7 4 12 5 20 18 79 13 57 6 4 4 11 1 7 4 12 241 Deaths 4 — 2 2 - - - - - - 1 - 3 - - - - - - - - Enteric— Cases 48 — 2 6 20 20 — 1 5 4 10 4 10 2 — 1 1 2 3 1 4 1 2 2 10 2 7 1 — 1 1 2 3 1 2 35 Deaths 7 — — — 3 4 — — 1 1 1 — 3 — — — — 1 — — — Cerebro-spinal— Cases 2 — 2 - - - - - - - - - - - - - - - 1 - - - - - 1 - - - - - - - 1 - - 2 Deaths 1 - - - - - - - - - - - - - - - - - 1 - - ruerperal— Cases 6 - — — — 6 — — — — 2 — 3 — — 1 — — — — — — — — 2 — 3 —- — I — — — — — 6 Deaths 3 - - - - 3 - - - - - - 2 - - 1 - - - - - Total Cases 515 8 98 194 90 118 7 11 34 35 151 39 119 17 8 17 23 6 20 10 25 8 31 30 137 30 109 14 7 13 20 5 20 8 19 451 8 cases notified as scarlet fever, 10 as diphtheria, 1 as enteric fever were eventually alleged not to be suffering from the disease notified. 49 Tuberculosis. Compulsory Notification of Poor Law Cases.—Poor Law District Medical Officers and Medical Officers of Poor Law Institutions are lequired, under an Order which came into force on the 1st January, 1909, 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 Eelieving Officers are required to notify changes of address of patients other than to an institution. Voluntary Notification.—In addition to the above requirement the Council has had in force since the beginning of 1903 a system of voluntary notification. In 1908, 148 persons were notified, 69 of these being inmates of Poor Law infirmaries. In 1909, 438 persons were notified under the combined systems, 30 having been previously known; of these, 159 persons were voluntarily notified, and 281 under the Order (two of the latter having been notified voluntarily in the first instance). Of the compulsory group, 136 were persons from common lodging-houses, casual wards, &c., so that 302 was the net number of consumptive persons notified as having regular residence in the City. In 1910, 275 persons not previously notified were certified to be suffering from pulmonary tuberculosis, of these 135 were voluntarily notified and 140 under the Order. Of the latter 90 were persons from common lodging-houses, casual wards, &c. 186 deaths from consumption were registered of persons who had resided in Westminster, inclusive of casuals, &c.; 71 of these had been notified during life; 45 more should have been notified under the Order, as the deaths occurred in Poor Law institutions, but the majority of these had no definite address other than the casual ward ; these are to be notified in future. There remain therefore 70 deaths of residents who had not been known to the Public Health Department during their illness. Details are shown on the next page. Visits to the families subsequently have led to the discovery of other persons suffering. 50 Notification of Pulmonary Tuberculosis. Under Poor Law Order:— Year. Number of Certificates Received. New Cases. A. B. C. D. Total. Inmates of C.L.H., &c. Inmates of Private Houses. Total. 1909 328 53 56 437 136 111 247 1910 .. 276 39 49 1 365 90 50 140 A is notification of a person in a Poor Law Institution. B of a person in the district. C is notice that a notified person has left a Poor Law Institution. D refers to change of address of a notified person in the district. Under Voluntary System:— Year. Pulmonary Tuberculosis. Other Forms. New Cases. Total Certificates. Number of Certificates. New Cases. Suspects. Change of Address. 1908 155 148 2 5 - 162 1909 164 159 — 5 — 169 1910 155 135 100 46 17 318 Of the 100 persons suspected to be suffering from pulmonary tuberculosis in 1910, in 24 the diagnosis was eventually confirmed, and in two the suspicion was negatived; the others were still under observation at the end of the year. Deaths in 1910, Showing Place at Time of Death. Ward. Notified. Not Notified. Home. Hospital. Infirmary. Asylum. Home. Hospital. Infirmary Asylurr. Conduit - - - - 1 3 - - Grosvenor.. - 1 - - 1 1 — - Hamlet 1 - 1 - 2 — 1 — Knightsbridge — — — - 3 - 2 - "Victoria 6 2 9 - 21 7 10 4 St. Margarets 1 — — - 2 1 — — St. John .. 11 3 10 - 4 3 18 — St. Anne 1 — 5 - — 3 — — Great Marlborough — 1 — - 2 — 1 — Pall Mall — — — - — 1 — — Regent — — 2 - 5 4 — — Charing Cross 1 — — - — — — — Covent Garden — — 4 - 2 1 2 2 Strand — — 11 1 2 1 3 2 21 7 42 1 45 25 37 8 51 Difficulty still occurs in keeping in touch with the common lodginghouse and casual type of consumptive; they are only notified when inmates of an infirmary and on leaving. It is almost impossible to find them at the addresses they give as their proposed destination, as such addresses are usually false; many of them, however, decline to give any address. I think the Superintendents of Poor Law Institutions should be required to notify the discharge in all cases whether an address is given or not. Through the courtesy of the Medical Officers, I have ascertained that at the end of the year, 127 persons suffering from consumption were inmates of the Poor Law Institutions connected with the City. During 1909 there was considerable delay in sending in accounts; but this has been got over by sending a card of reminder at the end of each quarter. Arrangements have been made with the Health Society, who have appointed a special visitor for the purpose, to keep in close touch with persons notified voluntarily or compulsorily who are living at home. At the end of 1910,251 persons suffering from pulmonary tuberculosis were under supervision, 126 suspected or doubtful cases, and 29 persons suffering from other forms, making a total of 406 persons, of whom 143 are in the North part of the City, and 263 in the South, In previous reports I have given particulars of a scheme which was being framed to carry out the essential objects and methods of the system which has been devised and gradually built up in Edinburgh by Dr. Philip. This scheme demands:— (1) A special department of public health activity devoted to the handling of tuberculosis in all its manifestations. (2) A sanatorium for selected patients—(a) for education; (b) for prolonged treatment. (3) A hospital or asylum for advanced cases. (4) Means by which suitable employment can be found for patients in whom the disease is arrested. In Edinburgh most of these objects have been attained:— A special centre has been formed and has become the uniting point of all the other agencies, besides being the office in which all information and records are kept, and where enquiries are attended to on all matters connected with Phthisis; it includes a Dispensary where patients can be examined and treated by the staff of physicians, and instructions given how to prevent or minimise the risk of infection to others. Medicines, disinfectants, and sputum bottles are supplied, and where the patient's condition warrants it food-stuffs and the like are given. Patients are subsequently visited at their own homes, by one of the 52 Assistant Physicians and a specially trained nurse, for the double purpose of treatment and investigation into the state of the dwelling, the general conditions of life, the risk of infection to others, and opportunity is taken to see the other members of the family with the view of detecting cases in the early stages, and of suggesting measures whereby any members of the family who seem predisposed to the disease may be protected and their health strengthened, so as to be able the better to resist it. Records of all these matters are prepared by the Special Visitor under the superintendence of one of the Medical Officers. There had been some difference of opinion as to whether a Special Phthisis Dispensary, with a Eesident Medical Officer and Resident Nurses, should be provided in Westminster, such as is now established in Paddington mainly by the munificence of a private donor, or whether, in view of the number of Hospitals and Dispensaries already existing in Westminster, it would be better to endeavour to secure a more complete co-operation between the City Council, the Health Society, the various Hospitals and Dispensaries, and private medical practitioners dealing with cases of Tuberculosis. In October, 1909, at the suggestion of the Health Society, a conference of representatives of Hospitals and other Charitable Institutions in Westminster was held at the City Hall, at which the matter was fully discussed. Eventually, in view of the heavy cost of establishing and maintaining a Special Dispensary, the Society resolved to try the method of co-operation between existing agencies. This scheme has now been placed on a good working basis. A special Tuberculosis Committee of the Society has been appointed, on which the City Council and the Boards of Guardians are represented. A Visitor (Miss Sanders), who thoroughly understands the system, has been appointed. She compiles the records in a methodical manner on the card system, and has prepared useful indices whereby important facts and details are available, such as the frequency of disease in various houses and streets; its association with varying insanitary conditions of dwellings; the frequency with which one or more persons share a room, or even a bed, with a consumptive patient; the varying amount of fresh air admitted into the dwelling by day and by night; the frequency with which the consumptive patient changes his house, thus multiplying the infection again and again; the frequency with which a previous family or house infection can be traced; and the effect of the disease in producing physical and financial distress in a more or less wide family circle. The information thus filed is confidential, and is used solely for the information of the Medical Officer of Health, Hospitals, Medical Men and Health-workers who require special knowledge re environment and health of particular families who are under their charge. 53 Visiting of patients at their homes is carried out by the Phthisis Visitor, who gives instructions as to measures of personal hygiene, and precautions against infection, &c., and the Hon. Secretary arranges where required for better food, Sanatorium treatment, clothing, &c., through the various Charitable Societies. Arrangements have been made whereby the Physicians at the following Hospitals will examine suspected and contact cases, viz.: Brompton, Mount Vernon, Margaret Street Consumption Hospitals, Golden Square Throat Hospital, Charing Cross, St. George's, and Westminster General Hospitals, besides treating actual cases. The members of the local profession are taking advantage of the scheme, which has received the approval of the Local Division of the British Medical Association. In cases in which the family is not under the care of any medical man, arrangements have been made with Dr. P. W. Spaull that he should visit the houses and see the other members of the family. The Health Office at St. George's Baths has become just such a centre as Dr. Philip suggests. The clerical work entailed is considerable, as reports on the homes, &c., visited are supplied to the physicians in charge of cases, and there is much correspondence between the various agencies whose help may be desired. An advantage which the Westminster Scheme possesses is that it is in close touch with the other schemes of the Society—by this means the Phthisis Visitor can at once have access to a great deal of information already acquired. Her attention can also be called to persons who may appear to require special attention from a phthisis point of view, by those visiting families in connection with the rearing of children, school work, &c. Educational training by a short stay in a sanatorium is provided by the City Council. Prolonged sanatorium treatment for patients resident or employed in the parishes of St. Anne and St. Mary, 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. Disinfection of rooms, bedding, clothing, &c., after death, on change of address or while patients are temporarily away, is provided by the City Council. Provision is also made 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 nfection, by the City Council, and for others through the Health Society 54 Provision is also made by the Council whereby bacteriological examination of sputum, &c., may be obtained by medical practitioners. During the eighteen months ending 31st December, 1910, 767 cases of tuberculosis, or of persons suspected to be suffering, have been visited by the Society, 148 of these having been brought forward from the previous period. These have been analysed as follows:— Definite pulmonary tuberculosis (Thirty-three of these cases had been " suspects.") 564 Removals 107 Deaths of cases already known to Society 74 Families visited where deaths occurred of cases not previously notified 132 Current cases still under eupervision 251 Suspected pulmonary tuberculosis 143 Removals 14 Deaths of cases already known to Society 3 Current cases still under supervision 126 Other forms of tuberculosis 60 Removals 2 Deaths of cases already known to Society 4 Families visited where death occurred of cases not previously notified 25 Current cases still under supervision 29 Sanatorium or Convalescent Home Treatment (including Boarding out of suitable cases) were arranged for by the following agencies:— Charity Organisation Society 11 Jewish Board of Guardians 20 Invalid Children's Aid Association 30 Clergy, private individuals, &c. 99 St. Henry Trust 39 Through the Guardians; in Poor Law Infirmaries 113 City Council 26 Seventy-six patients had had institutional or convalescent treatment previous to the period now under review. Twenty-six patients have been sent away by the City Council for educational training, 25 to Maitland Sanatorium and one to the Eoyal National Sanatorium, Bournemouth. 16 of these were men, 10 women, J 3 were married. Their occupations were :— Ages. Ages. 5 housewives 39, 26, 26, 1 scaffolder 38 29, 26 1 plumber 1 printer's porter 25 2 dressmakers 42, 45 17 1 tailoress 28 1 insurance agent 42 1 barmaid 23 1 labourer at stores 39 1 labeller in jam factory 35 1 butler 54 1 carman W.C.C. 34 1 lift attendant 55 1 electrician 30 1 storeliouseman. A. C. Factory 44 1 labourer at brewery 26 1 motor builder 31 1 eyelet maker 29 1 stoker 18 1 footman 19 1 boot polish maker 41 55 The special object—education—has been attained. It was clearlyexplained to the patients before they were sent that an opportunity was being afforded them to learn how to live at home with safety to themselves, their relations, and those with whom they worked. Most of them derived marked benefit from their stay at the Sanatorium— 13 returned to work, and have been able to continue at it. 2 are at home looking for light work. 2 are in the country, not able to work, trying to continue the line of treatment they have been taught. 1 obtained a situation on board ship. 4 are at home, unable to work. 2 have since died; and 2 were still at the Sanatorium at the end of the year. Bacteriological Examination of Sputum.—Sixty-five examinations were made of sputum, from 63 patients, to ascertain if the tubercle bacillus was present. It was found in 15 instances, and was doubtful in one. Disinfection.—Two hundred and fifty-three rooms in 200 houses and 2,450 articles were disinfected by the Council's staff, 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 ten years are set fortli in the following table The City op Westsiinsteb. Year. Pulmonary. Abdominal. Meningeal. Other. Total. Deaths. Hates. Deaths. Kates. 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 237 130 13 7 36 20 25 14 3J1 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 16L 1910 .. 186 108 5 3 21 12 39 11 231 135 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 56 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 Bates. 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 .. 131 116 174 141 1910 .. 114 96 — 120 I have worked out a table showing the number of deaths from tuberculosis which have taken place in the City within the last ten years, and I have divided this period into two groups of five years each. In the first five years, deaths from Pulmonary Consumption numbered 1,509, in the second period 1,088, thus showing a striking reduction. When deaths in common lodging houses are deducted, the reduction is from 1,355 to 932, or 31 per cent. 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 26.6 per cent. for males, 39.9 per cent. for females. The total number of deaths of males is just double that of females in the last 5 years; in the previous 5 years the proportion was about 5 to 3. In deaths from other forms of tuberculosis there is a reduction of 15.2 per cent. among males, and of 20.0 among females. It is encouraging to note that the number of young children who have died from pulmonary or other form of tuberculosis has considerably decreased. There has been some reduction in the deaths from other tubercular disease in London during the same period, and it will be interesting to see if the reduction is at the same age periods as in Westminster, and if so to what extent. It is to be expected that the greater freedom of milk from the tubercle bacillus during the last few years (since 1907), would have such a result, but the increased care which many patients are taking to prevent infection must also play an important part. 57 Table XVII.—Tuberculosis. Deaths in the Various Wards in the City, distinguishing those in Common Lodging Houses. Comparison of Two Periods of 5 Years each, 1901-5 and 1906-10. Corrected Deaths in the City at subjoined Ages. Deaths in Wabds (at all Ages). All Age3. 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. Kegent. Charing Cross. Covent Garden. Strand. Deaths from pulmonary consumption— 5 years, 1901-05 1,509 6 23 28 141 1,204 107 10 47 28 58 326 99 461 97 61 17 73 24 90 118 ( Common lodging-house deaths) (134) — — — (3) (123) (28) — — — — — (2) (69) 10) — — (14) — (16) (43) 5 years, 1906-10 1,088 1 11 17 96 855 108 7 40 18 31 285 47 375 40 31 8 40 11 79 66 ( Common lodging-house deaths) (156) — — — — (127) (29) — — — — — — (90) — — — (2) — (24) (40) Without common lodging-house deaths— 5 years, 1901-05 1,355 6 23 28 138 1,081 79 10 47 28 58 326 97 392 87 61 17 59 24 74 75 „ 1906-10 932 1 11 17 96 728 79 7 40 18 31 285 47 285 40 31 8 38 11 55 26 Deaths from other forms of Tuberculosis. Deaths of Males and Females. 5 years, 1901-05 352 80 1.13 48 39 66 6 Pulmonary Phthisis. Other Forms. „ 1906-10 291 65 96 44 22 57 7 Males. Females. Males. Females. 5 years, 1901-05 959 (112) 550 (32) 197 155 „ 1906-10 762 (141) 326 (15) 167 124 All forms, less common lodging-house deaths— Males. Females. Total. 1901-05 1,044 673 1,717 1906-10 788 435 1,223 (Common lodging-house deaths in brackets.) 58 Non-notifiable Diseases. Diarrhœal Diseases.—In London, deaths from the epidemic or acute form of this disease were half the corrected average, giving a rate of 0.28 per 1,000. In Westminster the number of deaths was less than any previous year. Meteorological conditions again played an important part in keeping down the rate during the autumn months. The figures for several years are shown below. Deaths from other forms of enteritis numbered 32, which is above the average; 21 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. 1903. 1901. 1905. 1906. 1907. 1908. 1909. 1910. Epidemic diarrhoea 59 80 47 75 27 24 10 9 Other forms of enteritis 14. 16 17 20 19 23 23 32 Total deaths 73 96 64 95 46 47 33 41 Number under 1 year of age 52 72 42 71 27 33 27 26 Number of births 3,185 3,054 3,120 2,931 2,927 2,913 2,751 2,592 Deaths of infants per 1,000 births 16.3 23.5 13.4 24.2 9.2 11.4 9.2 10.0 Sixteen of the deaths were in St. John's Ward, 14 in Victoria. Measles.—Twenty-two deaths were attributed to this cause in 1910 in the City. During the year 567 cases came to my knowledge, 555 having been notified by school teachers (particulars as to schools affected are given later). The deaths per 1,000 calculated on the total population were:— 1903. 3904. 1905. 1906. 1907. 1908. 1909. 1910. Westminster— Cases notified 346 181 412 362 554 566 529 567 No. of deaths 47 23 44 20 22 26 26 21 Rate per 1,000 population 0.26 0.13 0.25 0.11 0.12 0.13 0.15 0.12 London 0.44 0.49 0.37 0.41 0.38 0.31 0.48 0.41 The average death-rate for seven years being 0'40 for London, 0.15 for Westminster. As 22 of the deaths in Westminster, and the bulk of those in London, occurred in children under five years of age, it affords a better 59 comparison to calculate the deaths on the number of children estimated to be living under five years of age:— 1903. 1904. 1905. 1906. 1907. 1908. 1909. 1910. Westminster 3.7 1.8 3.5 1.4 1.7 2.0 2.1 1.9 London 4.0 4.4 3.3 3.4 3.4 2.8 4.3 3.7 The average rate being 2.0 for "Westminster and 3.6 for the County of London. Disinfection of 84 rooms in 36 houses, and of 1991 articles, was carried out by the Council's staff. Visits were paid by the women inspectors in cases notified from schools : advise is given verbally and printed instructions are left at the house. Wherever necessary, the Inspectors visit throughout the illness, see that medical attendance is obtained, and that proper attention is given to the cleanliness of the rooms, bedding, &c. It may, I think, be claimed that the low mortality in Westminster is the result of this attention. Whooping-cough.—This complaint was responsible for 19 deaths, all of them of children under five years of age; 163 cases were notified to me (for particulars as to schools affected see list below). Disinfection of 8 rooms was carried out. In London, the fatal cases were slightly less than the corrected average number. Particulars relative to this disease for the years 1903-10 are:— 1903. 1904. 1905. 1906. 1907. 1908. 1909. 1910. Westminster— Cases notified 83 56 210 92 251 62 228 163 Deaths 33 17 35 23 27 10 23 19 Deaths per 1,000 population 0.18 0.09 0.19 0.13 0.15 0.05 0.13 0.11 London 0.35 0.33 0.32 0.26 0.38 0.20 0.25 0.28 Calculated on the number of children under five years of age, the death-rates per 1,000 were:— Westminster 2.63 1.37 2.8 1.6 2.2 0.8 1.9 1.6 London 3.22 2.9 2.9 2.3 3.4 1.8 2.3 2.6 Children suffering from whooping-cough are also visited by the women inspectors. 60 Hospital Accommodation for Measles and Whooping-cough.—The Metropolitan Asylums Board, at their meeting on 16 of July, adopted recommendations in regard to a change of their hospital system, brought forward as the result of a report made by Sir Arthur Downes for the Local Government Board. The matter under consideration was whether the large margin of unoccupied beds which frequently exists in the fever and small-pox hospitals could be beneficially used for providing for additional classes of patients, and for meeting the growing demands on other departments, such as those for children and imbeciles. It was decided to arrange for the reception, tentatively, of measles and other approved diseases in their fever hospitals, provided the Local Government Board can empower them to admit selected cases from the poorer classes for which no accommodation is now available. This last part of the recommendation was due to the report of Dr. Cuff, the Medical Officer for General Purposes, who states that there is adequate accommodation in the Metropolitan Workhouse Infirmaries for pau-per cases of measles; what is wanted is accommodation for cases from the poorer classes, not necessarily paupers. As to the feasibility of treating measles and whooping-cough in the same hospital with other infectious fevers, Dr. Cuff states that in his opinion this can be done without any risk of interchange of infection between the different wards. He reports : " The danger to diphtheria patients is at least as great now from scarlet fever as it would be from measles or whooping-cough. Such, at any rate, is the experience of those fever hospitals in the provinces and in Scotland which admit all these diseases. Dr. Ker, of the City Hospital, Edinburgh, where over 1,000 cases of Measles were treated last year, writes : ' Measles is never carried by the staff' Dr. Bundle, of the City Hospital, Liverpool, says: 'We have had under treatment here probably a thousand cases of measles, and I have never known the disease to be carried to other wards. I am convinced that measles is almost entirely a personal infection, and that the third factor does not exist.' With whooping-cough there is no risk at all." The balance of evidence is that the hospital treatment of measles and whooping-cough resulted in a saving of life among the poor. The arrangement which has been come to is that suitable cases are sent to the Board's Hospitals through the Believing Officer. 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:— 61 Actual Cases. Infection in House. School. Chickenpox. Measles. Mumps. Whoopingcough. Chickenpox. Measles. Mumps. Whoopingcough. Other Causes. Buckingham Gate - 2 - - - - - — 7 ringworm. 1 eczema. 1 German measles. Charing Cross Read 4 2 - 1 - — - - 1 German measles. Horseferry Road 8 28 - - 1 13 - - 6 ringworm. 11 scabies. Millbank 42 28 79 15 9 7 9 1 21 ringworm. 2 ophthalmia. 1 German measleg. Pulteney 6 5 - 1 3 5 - - 3 ringworm. 2 scabies. St. George's Row 3 75 6 2 1 10 - - 2 ringworm. 1 scabies. Wild Street 2 2 — 19 — 2 — 2 Brompton Higher Grade — 17 — 2 — 4 — 1 Burdets Coutts 15 36 1 24 6 12 — 1 5 ringworm. Cathedral, Great Peter Street 6 5 - 1 - - - - 6 ringworm. 1 scabies. Christ Church — 20 — 6 — 11 — 1 Holy Trinity 12 18 - 3 4 28 - 4 9 ringworm. 1 scabies. St. Anne's 2 39 1 7 - 16 - 1 11 ringworm. 1 scabies, l German measles. St. Anselm's 7 2 - - 3 1 - - 4 ringworm. 1 German measles. St. Barnabas 9 43 — 8 1 32 — 1 14 ringworm. St. Clement Danes — 29 — 24 — 10 — - 3 ringworm. St. Edward's, Dufour's Place — 2 — — — — — — St. Gabriel's 2 54 1 12 8 42 - 7 5 ringworm. 3 scabies. St. George's, South Street 2 8 2 11 — 2 — 4 3 ringworm. St. James the Less 2 45 16 8 - 22 2 - 8 ringworm. 3 German measles St. James' and St. Peter's 31 7 — 9 6 4 — 1 1 scabies. St. Margaret's — 8 — — — 3 — — St. Martin's, Adelaide Place 1 — 3 — — — 1 - 1 ringworm. St. Martin's, Castle Street - - - - - - - - St. Mary's, Hide Place 14 13 5 2 7 20 — - 12 ringworm. St. Matthew's 1 18 - - 1 21 - - 11 ringworm. 1 ophthalmia. 5 scabies. St. Michael's 9 30 — 1 3 13 - — 3 ringworm. St. Paul's 3 3 — 2 — 1 - — 8 ringworm. 3 blight. St. Peter's, Lower Belgrave Place - 1 - - - 2 - - Wesleyan Training — 14 5 1 — 10 — — 5 ringworm. Westminster Jews' Free 1 1 - - - - - - 1 ringworm. 4 scabies. 182 555 119 159 53 281 12 24 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 341 notifications were sent out during 1910 to school teachers as follows:— E 62 School. Small Pox. Scarlet Fever. Diphtheria. Enteric Fever. Buckingham Grate. - 1 - - Charing Cross Road - — - - Horseferry Road — — — - Millbank — 4 4 3 Pulteney — 2 1 - St. George's Row — 10 2 1 Wild Street — — — — Brompton Higher Grade — 2 3 — Burdett Coutts — 7 4 — Cathedral, 48, Great Peter Street Christ Church — 1 1 — — 1 1 — Curzon — 3 — French Protestant — 1 — — Grey Coat — 1 1 — Holy Trinity St. Anne's — 4 1 — — 4 — — St. Anselm's — 3 1 - St. Barnabas — 1 3 — St. Clement Danes — 3 1 — St. Edward's, Dufour's Place — 1 - — St. Gabriel's — 7 2 — St. George's, South Street St. James's and St. Peter's — 6 - — — 2 1 — St. James the Less — 1 2 — St. Margaret's — 1 - — St. Martin's, Adelaide Place — 3 1 — St. Martin's, Castle Street — — - — St. Marj's, Hide Place — 2 1 — St. Matthew's — 3 1 — St. Michael's — 6 9 — St.. Patrick's — — 1 - St. Paul's, Caroline Street — — — _ St. Paul's, Wilton Place — 1 1 — St. Peter's, Lower Belgrave Street — 7 4 — St. "Vincent's — 2 1 — Wesleyan Training College — 8 2 — 29 rooms in five schools were disinfected, together with books and other articles. Between 500 and 600 children, varying from one and five years of age, suffering from rickets, marasmus, chorea, eye affections and debility, etc., were referred by the Health Visitors for special treatment to Hospitals and Dispensaries. The fact that so many were found to require special treatment shows the real need of continuing to watch over them. By means of continuation sheets attached to the infant cards a complete record of the life-history of each child will be available. As the significance of this step becomes more widely appreciated a more intimate and mutually advantageous association between the Health Society and the Education Authority may be established. 370 school children (over 5 years of age) were visited for the Care Committees and Hospital Almoners, the same Visitor being the Health Visitor and the Care Committee Visitor in most cases. Reports were 63 sent to the Care Committee Secretaries. The system of comparing the School Medical lists with the Health index before further action was taken by the Care Committee Visitor has been proved to be a good one. Overlapping of Visitors is prevented and the visit for the baby and the school child has been successfully combined. Bacteriological Laboratory. During the year 270 examinations have been made by Dr. J. M. Bernstein, at the Westminster Hospital Medical School, at a cost of £36 4s. 9d., 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; 1909, 245. Disease. Persons. Examinations. Results. Positive. Negative. Doubtful. Diphtheria— Suspected cases 158 170 50 117 3 Contacts 13 13 1 12 — Returned from hospital 1 1 — 1 — Typhoid Fever 172 184 51 130 3 18 21 5 12 4 Tuberculosis 63 65 15 49 1 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. New Disinfecting Station and Staff Dwellings.—When the City was incorporated, four of the constituent authorities possessed disinfecting stations, while one did the work through a contractor. Considerable inconvenience was experienced in carrying on the work of disinfecting under such circumstances, and the Council in their first year of office had under consideration the erection of a central station. As the bulk of the work was found to come from the southern part of the City, it was evident that a site should be selected there. Several schemes have been considered in connection with the various properties belonging to the City, but none of them were deemed satisfactory. In 1904 the County Council acquired the Deuzell Street e 2 64 VERMINOUS PEPSONS' ENTRANCE. CITY OF WESTMINSTER DISINFECTING STATION ground . FLOOR. PLAN 65 CITY OF WESTMINSTER.. DWELLINGS FOR STAEF 66 Disinfecting Station, Mortuary, and Depôt belonging to the late Strand Board of Works, in connection with the Holboru to Strand Improvement, paying a sum of £5,000 and handing over a piece of land in Kean Street in exchange for that taken by them. It was, however, decided that it would be more advantageous, both from an administrative and a financial point of view, not to erect the disinfecting station here, and, consequently, this site has been let. In this way the cost of the new building is met without any additional charge upon the rates. Eventually, on the acquisition of the Grosvenor Canal property, the land on the west side of the lock was selected. The site is in an open position, well away from dwellings, and is approached both from the Chelsea Embankment and Gatliff Eoad. Mr. John Murray, F.R.I.B.A., was instructed to prepare drawings and specifications for the erection of two blocks of buildings, one containing the Disinfecting Station, the other residences for the lockmaster, some of the disinfecting staff, and other employees, and an office for the Highways Department. Tenders for the erection of the buildings were invited from fifteen firms of builders, and the lowest, that of Mr. C. F. Ivearley, of 4, Great Marlborough Street, amounting to £9,921, was accepted. The offer of Messrs. Goddard, Massey and Warner, was accepted for the erection of the necessary fittings in the disinfecting chamber, boilers and other apparatus in the possession of the Council being utilised as far as possible. The amount of the tender, the lowest of four, was £506 14s. 8d. The Disinfecting Station.-Externally the plinth of the building is faced with red pressed bricks, the upper part with Crowborough and red brick facings, red gauged arches and Portland stone dressings. The interior is faced to a height of four feet with white glazed bricks, the walls above of all the rooms, and the ceilings of the Infected and Disinfected Chambers, being lined with white tiles. The following accommodation is provided in the building:— An "Infected" Van Shed, for unloading infected articles. An "Infected Chamber," 36 ft. by 20 ft., for the reception of infected articles which will be placed directly into the disinfecting apparatus. A "Disinfected Chamber, 36 ft. by 20 ft., into which the goods which have been disinfected are discharged from the disinfecting apparatus, A Loading Store and "Disinfected" Van Shed, from which the disinfected articles are despatched. A Formalin Chamber, accessible from the "Infected" and "Disinfected " Chambers, 12 ft. by 6 ft. 3 ins., for the disinfecting of furniture 67 and such articles as cannot be submitted to the action of steam; it is provided with a Ligner's apparatus for the generation of formaldehyde gas. A Drying Boom, 23 ft. 6 ins. by 16 ft. 6 ins., containing drying horses and a mangle. A Bottle Washing Boom, fitted with sinks, washing machine and special shelving. Separate Bath Boom, Lavatory and Mess Boom accommodation is provided for the Staff. Store Rooms in Basement. A special and separate department is provided for the reception and cleansing of verminous persons. The verminous clothing is placed in air-tight receptacles between the two Bath Booms and the "Infected" Chamber, and from thence placed in the Disinfectors and returned from the "Disinfected" side to the Bath Booms, the departments being connected by a basement passage. Apparatus and Machinery.—The Steam Disinfecting Apparatus is that know as the "Alliot and Baton," made by Manlove, Alliot and Co. Two are provided, both having been removed from the Council's other stations. The apparatus has an oval chamber, 7 ft. long, 6 ft. high, and 3 ft. 7 ins. wide internally, with double walls forming a jacket round, and steel framed doors at each end. The object of the jacket is to heat the contents of the disinfecting cylinder before the steam is turned in to prevent condensation and to assist in drying the contents after the steam has been withdrawn. Articles to be disinfected pre placed inside the apparatus, and the air is extracted. This is to facilitate the penetration of the steam which is subsequently admitted under a pressure of 20 lbs. and at a temperature of 259° Fahr. After the articles have been subjected to this for a sufficient period, the steam is allowed to escape and a second vacuum obtained, this being broken in its turn by hot pure air. Articles which are partially or wholly made with leather or furs, silks, letters, &c., cannot be subjected to steam without damage. These may be treated in the same machine either with dry heat alone or with formaldehyde gas. A special appliance is provided for the introduction of this gas, which may also be used in conjunction with steam. To each apparatus is attached a Recording Fressure Gauge, fitted with a chart on which a diagram of every operation is automatically registered. These charts are preserved, and afford a means of ascertaining the treatment to which the articles have been subjected. Articles of clothing, bed liuen, or which have been soiled with discharges, require to be soaked in cold water and washed before exposure to steam, which would fix any stain. A washing machine has 68 therefore been added. In many cases treatment therein will he sufficient disinfection, and on removal the washed articles will he placed in a hydro-extractor and afterwards in a drying closet. For furniture and large articles a special room has been provided in which formaldehyde, sulphurous acid gas or other disinfectant may be applied. The Incinerator Furnace is new, and was provided by Messrs. Goddard, Massey and Co. It is for the destruction of mattresses, clothing, &c., which are worn out or too filthy to clean. It is constructed of steel plates covering side and top, the interior being built up of fire brick lining. It consists of a fire-grate, ash pit, baffle wall and flue. The smoke and fumes from articles burnt are destroyed by being passed through the fire-grate. Power for driving the various machinery and plant is obtained by means of a Horizontal Steam Engine, driving by belt on to a main shaft extending the length of the building. Any machine may be started or stopped independently. Dwellings for Staff and Highways Office.—The materials used externally are similar to those in the Disinfecting Station. The Mansard roof is covered with green slates, and the elevations are of a Georgian character. The block contains an office for the Highways Department, and seven dwellings with a central area, four of the dwellings being for Disinfectors, two for Highways employees, and one for the Lockmaster. There are four separate entrances: the West one for the Disinfectors gives access to four flats, two being on the ground floor and two on the first floor over, connected by an artificial stone staircase, from the landings of which the four flats are entered. Each flat contains Living Koom, 13 ft. by 12 ft., fitted with range and gas stove ; Scullery, 9 ft. 6 ins. by 7 ft. 9 ins., with sink and coal box, and the Larder adjoins; three Bed Rooms, the sizes of which are 16 ft. by 11 ft., 12 ft. by 10 ft. 6 ins., 12 ft. by 9 ft.; Bath Room and W.C. On the flat asphalted roof over there are two common Washhouses, each fitted with a copper. The entrance at the opposite or East side, facing the Lock, gives access to the Lockmaster's dwelling, containing on the ground floor, Sitting Room, 20 ft. by 11 ft. 6 ins.; Kitchen, 12 ft. 6 ins. by 10 ft. 6 ins. fitted with range and gas stove; Scullery, 7 ft. 3 ins. by 6 ft. 9 ins., with copper and sink; Coal Cellar and Larder. An artificial stone staircase leads to the first floor, which contains four Bed Rooms, two being 20 ft. 3 ins. by 12 ft., one 16 ft. 3 ins. by 11 ft. 6 ins., and one 12 ft. 6 ins. by 11 ft. 6 ins.; Bath Room and W.C. 69 The entrance on the North side gives access to another artificial stone staircase, which leads up to two flats situated on the second floor over the Lockmaster's rooms, each containing Living Room, 16 ft. by 11 ft. 3 ins., fitted with range and gas stove; Scullery, 6 ft. 9 ins. by 10 ft. 9 ins., with sink and coal box; three Bed Rooms, 14 ft. 9 ins. by 12 ft., 13 ft. by 12 ft., and 12 ft. by 6 ft. 9 ins.; Bath Room and W.C. The entrance on the Soutli side give access to the Highways Office, 12 ft. by 10 ft. 6 ins., and Committee Room, 20 ft. by 11 ft. 6 ins., with Lavatory and Coal Cellar adjoining. The central area is divided into four parts with a coal box in each. The floors throughout are steel and concrete, the Sculleries, Bath Rooms, W.C.'s and Corridors being finished with cement, and the floors of all other rooms are covered with deal boarding, bedded solidly in pitch and tar on the concrete. The walls internally are plastered; there are cement dadoes in the Passages and Living Rooms, and all the walls are finished in duresco. Hot water is laid on from the range to the bath and sink in each dwelling; gas is laid on throughout, and slot meters are provided. The dwellings are in telephonic connection with the City Hall, and there is an extension from the Foreman Disinfector's Room to the Disinfecting Station. A better approach from the Chelsea Embankment has been constructed under the supervision of the City Engineer. The new buildings were opened by the Mayoress on the 6th July, 1910, and the disinfecting work carried on at Horseferry Road and Commercial Road stations was shortly afterwards transferred to the new station. From the experience already gained, I am satisfied that it is in every way a success. The disinfecting staff has been re-arranged, and consists of one foreman disinfector, one man in charge of the station, boilers, &c., two drivers, and four disinfectors. Formerly the disinfectors assisted in drain testing, but now two men have been taken from the disinfecting staff and have been allocated to this work. Below is shown the number of rooms and articles disinfected by the Staff of the Department. The premises included 29 rooms in 5 schools, 6 workrooms, and 2 sets of offices; 19 vehicles were also disinfected. In 23 cases of infectious disease treated at home the laundry linen was collected weekly and disinfected (190 articles from scarlet fever cases, 240 from diphtheria, and 563 from enteric fever). Disinfection was carried out after all cases of the notifiable diseases, except as regards erysipelas (in which disinfection was performed in 70 27 instances, when the circumstances of the case required it), and also after 36 cases of measles, 2 chicken-pox, 27 cancer, 2 influenza, 3 mumps, 2 whooping cough, and 200 phthisis. In 56 instances the premises, &c., were disinfected privately (28 of these being cases of phthisis). Consequent upon the fewer cases of infectious disease in 1910 the number of rooms and articles disinfected is much lower than in previous years. The owner of a house was reprimanded for sending away linen after an infectious case without disclosing the fact; fortunately, it was discovered before it had reached its destination. Shelters.—One person was admitted to the temporary shelters at Horseferry Itoad while disinfection was being carried out. The following table gives a comparative statement of the above work during the past seven years:— 1903. 1904. 1905. 1906. 1907. 1908. 1909. 1910. Premises 709 581 667 961 840 1,067 1,287 841 Rooms 1,039 935 1,177 1,627 1,155 1,568 1,865 1,284 Articles disinfected 27,766 29,107 34,703 47,865 36,115 31,915 49,843 26,850 Articles destroyed 126 52 151 195 1,660 233 186 1,651 Books disinfected 16 10 52 363 136 557 281 595 Number admitted to shelters 19 39 6 1 5 5 6 1 The provision at the new station of an apparatus for washing dirty and stained articles has been found of great service; it has been utilised for 514 articles since the opening. 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 has in use an apparatus at Pulteney School. The names of children treated at this school are forwarded to me, so that the homes, bedding, &c. may be examined and, if necessary, cleansed. Names of 22 children, inmates of 19 houses, were received; the home conditions were found to be unsatisfactory in 6 instances, and steps were taken to rectify them Two children were reported to be in a verminous condition, and were visited at their homes until the parents had cleansed them. Eight rooms and 595 articles were fumigated on this account. Six adult persons were given a bath and their clothing fumigated (76 articles). Verminous Houses.—249 notices with reference to vermin in rooms were issued on the reports of the Sanitary Inspectors; 18 of these were fumigated with sulphur by the Council's staff, the remainder by the 71 owners. In all 1,991 articles were passed through the disinfecting apparatus on account of their verminous condition, and a number were destroyed; these articles were removed from 36 houses. Mortuaries. The number of bodies removed to the Council's mortuaries under order of the Coroner, or to await burial, was 333; in 5 instances death was the result of infectious disease. Two hundred and eighty-one inquests were held at Horseferry Eoad where the Coroner's Court is situated; G adjourned inquests were held. Post-mortem examinations were made in 141 instances at Horseferry Eoad. The number of fatal accidents due to vehicular traffic continues to increase; in 1910, 45 inquests resulted therefrom. 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 1910 333 281 52 Of the 52 bodies admitted to await burial, 41 were taken to Horseferry Eoad, 4 to Dufour's Place, 7 to Drury Lane, and 0 to Ebury Bridge resting places. The number of bodies taken in at Horseferry Eoad 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 1910 322 1901 391 1906 332 72 PART II. C. House Inspection, &c. Below is a list of details of the work done in connection with insanitary conditions. In many cases some of the work specified was in premises part of which was occupied as workshops:— 1910. 1910. Complaints received and dealt with 679 Sanitary Work completed:— Drains:— Premises inspected on complaint, &c. 683 Manholes built ,, repaired and 694 House to house inspection 5,107 cleansed 253 Subsequent visits 20,917 „ covers fixed or Premises (registered), visits to 7,507 repaired 780 Overcrowding found 63 Tested by smoke 201 Other infringements 1,292 ,, chemical 259 Sanitary Work completed:— „ water 487 Houses:— „ air 59 Closed under Housing Acts 9 Fresh air inlets fixed or repaired 337 Closed under P.H. (London) Act Soil Pipes:— Cleansed throughout 433 Fixed . 386 „ partially Overcrowding abated—rooms 1,412 Ventilated 427 93 Repaired 197 Light or ventilation improved Tested by smoke 179 203 ,, chemical 135 Roofs repaired 375 „ air 56 Floors and staircases repaired Underground rooms— 443 Water.closets:— Illegal use 50 Constructed 1,348 Closed (P.H. Act) 37 Repaired 1,018 „ (H. and T.P. Act) . Yards, areas, paved or repaired 11 Ventilated and light improved 278 539 Cleansed or limewashed 1,052 Damp walls remedied 222 Ventilated lobbies provided 348 Offensive refuse removed 368 Keeping of animals discontinued 26 Unstopped 143 Traps ventilated 679 Drains:— Flushing cisterns fixed 1,390 Constructed 352 „ ,, repaired 398 Amended and repaired 371 V entilated 310 Waste Pipes:— Unstopped and cleansed 210 Constructed 1,410 Interceptor traps fixed 206 Repaired 216 Cleansed and sealed off from sewer 116 Unstopped 69 Trapped 1,192 Grully traps fixed 1,258 Ventilated 794 Defective traps abolished 245 Disconnected 337 73 1910. 1910. Sanitary Work completed:— Sanitary Work completed:— Rainwater Pipes:— Water Supply:— Fixed or repaired 578 Cisterns defective,abolished 101 Disconnected from drains 128 Taps off main provided 454 Urinals:— Pipes repaired 160 Constructed 192 Dust Bins :— Repaired or improved 68 Movable, provided 309 Cleansed 106 ,, repaired 4 Water Supply:— Fixed, abolished 7 Provided 422 Stables:— „ additional in tenement houses 1,049 Drained 28 Paved 36 Reinstated 38 Cleansed 23 Cisterns fixed 164 Dung receptacles provide 12 „ cleansed 236 Dung accumulations removed 191 ,, covered 236 3,295 intimations of nuisances, &c., and 161 statutory notices were issued; 2,168 letters were written, and 694 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. 44, Vauxhall Bridge Road (tenements) Defective water fittings, the water supply being cut off from upper part of house Order made to abate nuisance within 14 days. 6s. costs. 11, Eccleston Place (tenements) Absence of water supply to upper part of house. Absence of external ventilation to w.c. Withdrawn, on undertaking to close the premises and payment of 21s. costs. 12, Eccleston Place (tenements) Do 13, Eccleston Place (tenements) Do 14, Eccleston Place (tenements) Do 11, Horseferry Road (tenements) Absence of water supply to upper floors Adjourned sine die on the undertaking of owner to do the necessary work and payment of costs 5s. Summons against occupier withdrawn. 5, Diadem Court (restaurant and dwelling) Failure to maintain w.c. in proper condition Two landlords, each fined 10s. 6d. Refusal to admit Inspector.—A magistrate's warrant had to be obtained before the occupier of rooms in Dufour's Place would admit the Inspector. The conditions found justified the application. Drainage, &c. Plans.—570 sets of plans were examined during 1910. 430 of these resulted from notices served by the Public Health Department, and 74 140 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 occurred in 30 instances. Infringement of the by.laws in connection with the erection of buildings occurred in 37 instances. Proceedings against one person offending were taken with the following result:— Premises. Offence. Eesult. W. E. Sharpe, 44, How. land Street, W. Carrying out certain drainage works in an improper manner at No. 7, Archer Street Fined 10.9. and 23s. costs. Twenty.one persons were cautioned by the Public Health Committee. Drain.testing.—In the list given above is shown the number of drains and soilpipes which have been tested under the superintendence of the sanitary inspectors. The chemical test is applied by them, but the other forms of test require assistance, this is frequently given by the builders employed in the work, but in 301 instances the services of the two drain.testers attached to the Department were requisitioned. Public Conveniences for Women—Free Water.Closets.—The Public Health Committee, on consideration of a letter from the Women's National Health Association of Great Britain, on the subject of the provision of free public lavatory accommodation for women, represented to the Works Committee that it is desirable that some free accommodation should be provided in connection with each of the women's conveniences belonging to the Council. The Works Committee objected to this on the ground that when such free accommodation was provided by the Yestries and the Council in the past it was misused and abused to such an extent as to render its continuance impossible; but the Public Health Committee suggested that this difficulty was due to the use of a special form of urinette and might be surmounted by using an ordinary water.closet with a wooden rim, and with proper supervision. Eventually it was agreed to give the scheme a trial for three months at each of the women's conveniences at Broad Street and Parliament Street for free use; that notices be exhibited outside the conveniences that free w.c. accommodation is available on application to the Attendant. 75 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. Three persons were cautioned for removing refuse during prohibited hours and one prosecution was taken as follows :— ]Name and Address of Defendant. Offence. Result. John Cornwell, Westfield Farm, Weston Road, Mitcham Removing offensive matter during prohibited hours Fined 20s. and 2s. costs. A summons is not taken out unless the person offending has been previously cautioned. A contractor engaged in dust removal was cautioned against removal of bones and other offensive matter from one of the Council's wharves in improper receptacles. Daily Removal of House Refuse.—In my last report I mentioned that daily removal of house refuse was in force in the City with the exception of one locality. I am glad to be able to say that during 1910 that part has been brought into line. Inquiry having been made as to the existence of any statistics bearing upon health conditions before and after the institution of a daily collection, I have compared the mortality returns for two periods of nine years each of a block of Peabodv Buildings, dailv collections having been instituted in 1901. The average annual population is 1,391, of which 242 are under five years of age, and is fairly constant in each period. 1891.99. Before. 1901.09. After. Total deaths 220 184 Rate per 1,000 15.8 13.2 Deaths under 5 105 73 Rate per 1,000 43.0 301 Deaths over 5 115 111 Rate per 1,000 100 9.7 Deaths from the principal zymotic diseases:— Small.pox 3 Scarlet fever 3 1 Diphtheria 10 3 Typhoid fever — — Measles 19 2 Whooping.cough 4 5 Diarrhoea 10 4 Total 46 18 = 3.3 per 1,000 = 1.3 per 1,000 76 The diarrhoea death-rate was equal to 0 71 per 1,000 in the first, and 028 in the second period; for all London during the same periods it was 0 79 and 0'67 respectively. Housing and Town Planning Act.—The Council on February 17th, 1910, determined that as certain of the provisions of this Act are so closely related to those contained in the Public Health (London) Act, it is desirable that the execution of the Act, together with such sections of the principal and amending Acts, in so far as they relate to the remedying, closing, or demolition of insanitary houses, should be made a reference to the Public Health Committee of the Council instead of to the Housing Committee. The Local Government Board on September 2nd, 1910, issued a series of regulations with reference to the systematic inspection of dwelling.houses and the keeping of records in respect thereof. It is required that there shall be submitted to the local authority special lists of dwelling.houses, early inspection of which is desirable, and that information and particulars in tabular form shall be included in the Annual Report of the Medical Officer of Health in regard to the number of dwelling.houses inspected under and for the purposes of Section 17, the number of which on inspection were considered unfit for habitation, the number of representations made to the local authority, and the subsequent action taken thereon. I have therefore to report as follows:— Houses inspected under Section 17 21 Representations made as to unfitness 9 Closing Orders made 9 Orders complied with 9 Number of houses since put into habitable state 0 Undergroimd rooms represented under Section 17 12 Closing Orders made 11 Still under consideration 1 The dwelling.houses with regard to which representations were made by the Medical Officer of Health were Nos. 48, 50, 58, 62, 64, 68 and 70, Tufton Street, and Nos. 41 and 43, Wood Street. The houses in Tufton Street had been unoccupied for some time, and had become dilapidated and a danger to the neighbourhood, being receptacles for refuse. Internal connections with the drains were not cut off, so that rats and effluvia could escape. Two of the houses were very old, the date of their erection being stated to be 1679.* * Tufton Street is named after Sir Richard Tufton, who is said to have built the first houses in this street. He died in 1631. 71 The houses in Wood Street *.each consisted of a basement and two floors above; the lighting and ventilation of one room were bad; the w.c. accommodation for both houses was situated in a yard a considerable distance away from the premises and approached by descending a dark staircase into a dark cellar in which, until recently, was the only source of water supply; from the cellar a long winding tunnel led to a yard at the back of some other houses. The result of such construction being that the cellars and passages became a receptacle for filth and refuse. The houses were occupied. The Public Health Committee inspected the nine premises, meeting the owners or their representatives, and subsequently made closing orders which have been complied with. The properties in Tufton and Wood Streets were part of those scheduled under the St. John (Westminster) Improvement Act, 3 906. The period within which compulsory power of acquirement could be exercised would have expired in September, 1911, but on December 7th, 1910, the Council received information from the Local Government Board that the Company found it impossible to exercise the powers conferred by the Act and had therefore passed a resolution for voluntary winding up. Systematic Inspection.—The Act requires this to be done and the Board has laid down the Order that a record shall be prepared and kept of the result of such inspection. House to house inspection has always been carried out in the City and special inspections of certain localities and streets have from time to time been ordered by the Public Health Committee. The Board recommend that records be kept in one of three ways, in a book, on separate sheets or on cards. The advantage of the card system is that the space occupied by the records is not great, but it necessitates reference to notice books, files of letters, plans, &c., which have to be kept separately. It was therefore resolved that it would be best to have the records on sheets rather than cards, so that all the information relating to a house (not only the facts found on present inspection, but plans correspondence, sanitary notices, &c.) should be kept together so that in future anyone may at once obtain the sanitary history of the house without having to hunt through minute books, notice books, plan registers, &c. The method suggested is that a large envelope be prepared for each house, into which will be placed all documents relating thereto. The various envelopes will be grouped in streets, so that reference will be easy. * Wood Street was described in 1720 as "very narrow, with old boarded hovels ready to fall." 78 This system has been in use to a certain extent for some years, so far as clerical assistance would permit. It is on the model of that in use in Paris which was begun in 1894 and recommended for adoption by me in reports made in 1898 and 1900. 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. It may, however, be dealt with under the general nuisance sections of that Act. Section 17 of the Housing and Town Planning Act prohibits any underground room being used habitually as a sleeping place, unless it is seven feet high or complies with regulations to be made by each local authority. This 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 did not come into force until the 1st July, 1910. Orders were made by the Council requiring the closure of 11 underground rooms which were not seven feet high in eleven houses. The Council has not made regulations under this section, as it does not seem clear from the wording of the section that it would be possible to enforce such regulations with regard to rooms seven feet or over in height. Back.to.baclc Houses.—Section 43 prohibits for the future the erection of any back.to.back dwellings intended to be used as working class 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 I have objected to one plan submitted for proposed dwellings under this section. Inhabited House Duty.—Section 35 exempts any house occupied for the sole purpose of letting lodgings to persons of the working class, at a charge of not exceeding sixpence 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. I have certified one house under this section and have not certified two others (see below "Inhabited House Duty.") Alteration of By.laws.—In view of the terms of the By.laws for houses let in lodgings in force in the City, it was not deemed necessary to make any alteration under the power given in this Act. Displacement of Persons of the Working Class.—Eight premises in 73 Houghton Street and Stanhope Street, in connection with the Kingsway scheme, have been closed, displacing 71 persons. About 100 persons have been displaced by the demolition of houses in Eccleston Place, and 34 by the closure of a house in St. Anne's Court. The imminent closure of certain houses in St. John's Ward will displace about 80 persons. It is proposed by the County Council to build a new school in place of that in Horseferry Road on a site not yet settled in Victoria Ward. A plot of ground with some 50 houses on it has been acquired by the Peabody Trustees between Vauxhall Bridge Road and Willow Street, and building operations are expected to be proceeded with during 1911, when seven blocks of buildings will be erected. Houses Let in Lodgings. The number of houses in 1910 was reduced by 34 through closure, and as none were added in that year, the number on the register at the end of the year was 1,447; to this class of house 7,507 visits were recorded as having been paid, but more were actually paid. Overcrowding was found in 63 instances, and 1,292 other defects were found and remedied. Particulars are included in the general list given at the beginning of this part of the Report. Regulation of Cheap Furnished Rooms.—In 1909 the London County Council addressed a letter to the City Council on the above subject, and asked their opinion as to the manner they considered best for dealing with the difficulties which had been found to exist. The City Council were of opinion that the local Sanitary Authority should be invested with power to inspect and enforce a certain standard of requirements in such cases. (A statement embodying the County Council's letter and this Council's action is given on pp. 80.81 of my Annual Report for 1909.) The Council of the Borough of Kensington have incorporated a clause in their By.laws for houses let in lodgings, which has been sanctioned by the Local Government Board, requiring that:— " Subject to the provisions of these By.laws, a keeper of a lodging house in which rooms are let in furnished lodgings shall cause the bedding and other articles in such rooms to be at all times maintained in a clean and wholesome condition." I suggested that if a similar provision were added to the City of Westminster By.laws it would provide, to a certain extent, the increased control which the Council thought it desirable to have. The Council adopted the suggestion, and have submitted to the Local Government Board a similar By.law, altering the word " keeper" to " landlord," to F2 80 be in conformity with the By.laws already in force in the City, and limiting the application of the proposed By.law to furnished lodgings let at not more than seven shillings a week. Water Supply. Applications were received for certificates that the water supply of six new buildings was sufficient, and were granted in each instance. 164 notices of withdrawal of water supply were received from the Metropolitan Water Board, and in 38 instances it was reinstated, on notice. Additional sources of water supply on the upper floors of tenement houses were provided in 1,049 instances. Legal proceedings in connection with water supply were taken in six 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. 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. Complaints were made in the early part of the year that the water supplied by the Water Board to the Council's swimming baths was objectionable from the large amount of colour, due to the presence of vegetable matter; representations were made to the Board on the subject. The cause appears to be due to imperfect filtration during times when the river is in flood, and to the want of sufficient storage. Dr. Houston, the Director of Water Examination to the Water Board, has shown that if water is stored for a sufficient period in reservoirs it can be rendered quite "safe," provided that no accident happens in course of delivery. In recent years considerable provision has been made for such storage, but the reservoirs have been chiefly used merely to cover periods of emergency. In order to obviate this, the Board is constructing more reservoirs, so that no water shall be supplied to London until it has been purified by storage. As a result of the alteration in the method of charging for water, several owners of property have been sinking wells, in order to tap the supply of water contained in the chalk below the London clay. Analyses of the water obtained have been made, and are appended. Curious variations in the contents may be noted in the water raised from the different localities. Water which is extremely soft has a tendency at first to act upon lead pipes, but after a time they become coated with a protective " skin." Analyses taken some time after the wells had been in use showed that the waters contained no lead. 81 Analyses of Water from Beep Wells. Parts per 100,000. Regent Street. Ashley Gardens. Knights. bridge. Oxford Street. Strand. Free ammonia 0.065 0076 0.004 0.052 0.07 Albumenoid ammonia o.oo1 0 003 0001 0 001 0002 Oxygen absorbed at 27°— In 15 mins. — — 0.007 — 0.0027 „ 4 hours 0013 — 0.028 0.025 0.0081 Chlorine 16.4 16.3 20.0 16.0 15'8 Nitrogen as— Nitrites Nil Nil Nil Nil Nil Nitrates Nil Traces Traces Traces Traces Total hardness 7.3 9.5 22.4 7.1 7.4 Temporary 42 — 13.2 63 21 Permanent 31 — 9.2 0.7 5.5 Lead Nil Nil Nil Nil Nil Total solids residue 82.46 87.6 89.0 80.0 80.3 Complaint has occasionally been made by consumers of the white deposit of the salts contained in the water, which sometimes occurs. These salts, which form the "solid residue," are found to consist of sodium chloride, 33.7 per cent.; sodium sulphate, 35 per cent.; sodium carbonate, 23'3 per cent.; calcium carbonate, 5 per cent.; and magnesium carbonate, 3 per cent. In the water supplied by the Water Board the total hardness varies from 22 to 26, of which from 6 to 9 parts are permanent. The great increase of these deep wells in recent years must have a marked effect upon the underground water in the chalk under London, and as the level sinks such wells will have to be sunk deeper. The rate at which the level is falling has been estimated at from 2 to 3 feet a year, and eventually it may not pay to sink wells to the depth necessary to obtain a supply, possibly, moreover, the quantity of water in this underground reservoir is not inexhaustible. The excavations in connection with the new St. Anne's Parish Hall, in Dean Street, led to the discovery under the pavement of a well 73 feet deep containing 57 feet of water. This was the source of supply of the old Parish Pump, which stood in front of the Vestry Hall. Its use was discontinued in 1866 at the time of the cholera visitation, as it was found that many of these shallow wells were contaminated by soakage from cesspools, and thus became a means of spreading the disease. Common Lodging.houses. The use of the premises 6, 6a, 6b, and 6c, Great Smith Street, and the Salvation Army Shelter at 23 and 25, Millbank Street, as common lodging.houses, was given up during the year, and a new Salvation Army Shelter has been opened in Great Peter Street. 82 The premises at 16, Strutton Ground have been reconstructed. The total common lodging-house accommodation available is now 2,162 beds for men, 75 for women. Deaths.—91 deaths occurred in 1910 among inmates of the common lodging-houses and shelters in the City (87 males and 4 females). 28 of the deaths were due to phthisis, 19 to respiratory diseases, 19 to diseases of the heart and bloodvessels, 8 to cancer, and 6 to kidney disease. There were 36 deaths in St. John's Ward, 1 in Regent, 8 in Covent Garden, and 46 in Strand. The following is a list of the common lodging-houses in Westminster, the number for which they were licensed, and the number of deaths which occurred during the last three years among persons alleged to have been inmates:— Common Lodging Houses. Men. Deaths. 1908. 1909. 1910. Bruce House, Kemble Street (L.C.C.) 699 32 28 36 33, Great Peter Street 397 14 22 11 6, 6a, 6b, and 6c, Great Smith Street 201 1 9 7 Ham Yard Hospice, Great Windmill Street 20 ' — — 11, 12, and 13, Hanover Court 105 14 10 8 23 and 25, Millbank Street (S.A. Shelter) 449 3 3 8 108, Regency Street 8 — — — The Schools, Kean Street (S.A. Shelter) 125 2 7 8 16, Strutton Ground 217 12 10 3 45 and 47, Tufton Street 91 4 — 2 S.A. Shelter, Great Peter Street 600 — — 1 Women. 40, Great Peter Street 75 3 1 4 In addition, 3 deaths were recorded among former inmates of the following premises, the use of which as common lodging-houses has now been given up:—107, Wardour Street, 10, Stanhope Street, and 11, Monck Street. Revenue Act. Certificates under this Act relieve the recipient from the payment of Inhabited House Duty. Applications were received by me in 12 instances comprising 46 tenements. Certiiicates were granted in respect of all of the tenements. The premises in which are situated the tenements for which certificates were granted are:— Bessborougli Mansions, Regency Street. Ashley Mansions,Vauxhall Bridge Road. St. Augustine Mansions, Bloomburg Street. Park Mansions, Knightsbridge. Maidstone House and Tonbridge House, Mercer Street. 152, Vauxhall Bridge Road. 68, Buckingham Gate G-ardens. Whitcombe House, Orange Street. Hyde Park Chambers, Knightsbridge. Adelplii Terrace House. 37, St. James Place. 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. Three applications were made for certificates under this Act. In one case, 16, Strutton Ground, it was granted, in one refused, and in the case of the third, which was for three houses separately licensed by the County Council as common lodging.houses but assessed as one house, a certificate was offered for one of the three but was declined. 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:— 1910. North District. South District. Total. Complaints received 14 13 27 Observations taken 952 2,057 3,009 Notices issued—. Preliminary 43 43 86 Statutory 5 1 6 Summonses 3 - 3 Police court proceedings were taken on three occasions against two offenders:— St. Petersburg Hotel Fined 5s. and 2s. costs. The Empress Club Fined 20s. and 2s. costs. Ditto Fined 40s. and 2s. costs. A comparison with previous years is given below 1902 1903 1904 1905 1906 1907 1908 1909 Complaints 81 52 55 52 37 48 35 44 Observations 2,728 2,731 3,191 2,715 2,722 2,417 2,362 2,605 Notices issued:— Preliminary 58 68 142 121 93 106 116 93 Statutory 18 18 26 26 25 15 12 6 Summonses 6 3 5 11 8 2 — — 84 As in previous years much of the smoke nuisauce complained of is the result of careless stoking of the furnaces. Several notices were also served with respect to chimneys outside Westminster from which black smoke was blowing into the City. The County Council introduced a Bill into Parliament to amend the law dealing with smoke nuisance in several respects. One of the objects of the Bill was to omit the defining word "black" before the word "smoke" in the Public Health Act. A special report from the Select Committee on Local Legislation states that as the County Council were unwilling to accept any limitation on their suggested clause, the Committee, having in view the serious effect it might have on the industries of London, did not allow it. Other clauses of the Bill were passed, and the Act received the Royal Assent on August 3rd, 1910. It provides that in any special case in which a sanitary authority request them so to do, the County Council may, in lieu of such sanitary authority, enforce the provisions of Section 23 (Furnaces and Steam Vessels to consume their own smoke) and Section 24 (Summary proceedings for abatement of nuisance caused by smoke) of the Public Health (London) Act, 1891. The County Council are also empowered to enforce the provisions of those sections in their application to any building or premises belonging to or used by a sanitary authority, but in the exercise of this power the County Council are subject to the provisions of Sub.section (3) of Section 117 of the Public Health (London) Act, 1891, which provides that no proceedings shall be taken by the 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 County Council. Difficulty is sometimes experienced in dealing with smoke from chimneys ending at a lower level than the houses adjoining. The smoke is often unable to get away, being beaten down or blown about by the currents of air induced by the varying heights of the surrounding buildings. In the accompanying photographs some of these results may be noted. The remedy consists sometimes in raising the offending chimney, or in carrying the smoke to the top of the nearest house by means of a flue, or by discontinuing the use of coal. 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 required. It is, however, a matter of difficulty in Westminster to apportion work done, as workshops and dwellings are so intermingled. The following shows the state of the register of workshops at the end of 1910:— Workshop. Total N umber. Number in which Women are Employed. Tailors, outfitters, shirt makers, liat, cap, and helmet makers Dressmakers, milliners, embroiderers, lace makers, blouse makers, costumiers, lingerie makers, children's outfit makers, feather 1,612 1,195 dyeing, corset makers, furriers, &c. 789 782 Leather workers, boot and shoe makers, harness makers, &c. 64 10 Carpentry, upholstery, carvers, gilders, &c. 25 — Surgical and dental instrument makers 12 — Tobacco manufacturers 14 6 Wig makers and hair workers 42 42 Printing, bookbinding, lithographers, envelope making, stationers, publishers, &c. 64 52 Jewellers, silversmiths and burnishers, diamond cutters and polishers, engravers, &c. 74 31 Metal workers 45 6 Miscellaneous—Basket making, fancy work, shoe ornaments, hat pins, stamp sorters, postcard tinters, fan makers, artificial flower makers, &c. 116 70 Florists 32 32 Laundries 48 48 Bakehouses 85 — New workshops are always being discovered, at the same time the occupation of premises on the register is constantly changing. The use of 283 registered workshops was discontinued, and 48l additions were made to the register during the year; 107 visits of enquiry were made at places where women were likely to be employed. The number of inspections of workshops and workplaces is shown in the accompanying tables. One hundred and sixty.seven complaints were received, including 112 from the Home Office and were duly investigated ; 12 matters were referred to the Home Office relating to insufficient warming of rooms, working overtime, &c. In addition, notice was sent of 105 workshops in which Abstracts were not affixed. Statutory notices were issued in 23 instances; two prosecutions 86 took place in connection with premises in which work was carried on, as shown above, under the heading of " House Inspection." Obstructing an Inspector.—The owner (a woman) of a dressmaking business was extremely abusive to one of the women inspectors, and pushed her aside. The Public Health Committee placed the matter in the hands of the City Solicitors, and as a result of their communication an apology was tendered which the Inspector and the Committee accepted. Inspection. Premises. Number of Inspections. defects Intimation Notices. Statutory Notices. Prosecutions Factories (Including factory laundries) 111 37 12 — — Workshops (Including workshop laundries) 3,780 2,013 861 23 1 . Workplaces (Including restaurant kitchens, &c.) 1,470 411 342 11 1 Total 5,361 2,491 1,215 34 2 In addition, 45 re.inspection visits were paid to factories and 3,276 to workshops, and 1,990 to other workplaces. Defects found.—1910. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. *Nuisances under the Public Health Acts Want of cleanliness 941 942 — Want of ventilation 121 121 — Want of ventilation of gas stoves 102 100 — Overcrowding 44 44 — Want of drainage of floors 17 17 — Other defects 643 640 1 Sanitary accommodation— Insufficient 34 33 — Unsuitable 87 87 — Defective 426 426 1 Not separate for sexes 76 77 — 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 2,491 2,487 2 * Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Vet as remediable under the Public Health Acts. The prosecutions covered a number of defects. 87 Other Matters. Class. Number. Matters notified to IT.M. Inspector of Factories: — Failure to affix Abstract of the Factory and Workshop Act (Sec. 133) 105 Action taken in matters referred by H.M. Inspectors as remediable under the Public Health Acts but not under the Factory and Workshop Act (Sec. 5)— Notified by H.M. Inspector 112 Reports (of action taken) sent to H.M. Inspectors Other 112 12 Workrooms measured 321 Underground bakehouses (Sec. 101):— Certificates granted during the year — In use at the end of the year 71 Ventilation and Unventilaied Stoves.—The number of unventilated stoves has somewhat decreased, still there were found 102 instances in which attention had to be called to them. In two or three cases oil was in use to heat the stoves, and caused the air of the rooms in which they were to be distinctly offensive. The Home Office Inspectors co.operated with the Council's staff in many instances, and had chemical examination of the air made. In one case, in a long narrow underground workshop of 2,637 cubic feet capacity, the ventilation was found to be defective, especially at the back of the room. There were large windows the whole breadth of the room part of which were kept open, the door was near the windows, and there was a small electric fan in the rear wall. This, however, was badly fixed, and failed to extract the air as it was intended to do, instead of which it threw a draught down on the workers and drew in air from an area which was not kept in as cleanly a condition as it might. In addition there was a flueless gas stove, and a gas ring heater which was connected with a flue. Nine persons were employed in the room, which was fairly light, so that artificial lighting was not usually required. On analysis it was found that the amount of carbonic acid gas was 22.5 parts per 1,000 in the centre of the room and 27.3 parts at the far end. Various improvements were effected, the fan was properly fixed and more openings provided in the window, and the result of further analysis showed the carbonic to be 12.6 and 16 parts respectively. On both occasions the gas stove was not in use. The Home Office standard is not a high one, being 12 parts per 10,000, so that the above results could not be regarded as satisfactory, and led to the conclusion that regular use was not being made of the fan, which proved to be the case, the reasons given being that the tenants in the room above complained of the vibration, and the workers in the basement that there was too great a current of cold air through the room 88 there being no means of warming the air as it entered. Eventually the use of the workroom was given up. 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. Less trouble has been experienced in getting in the lists since the Council adopted the plan of sending a printed form to all known or likely employers to be filled up by them; in addition 36 visits of enquiry to ascertain if outworkers were employed were made by the women inspectors. The accompanying table gives the details of the returns made in Westminster in 1910. 671 lists were sent in by employers, as compared with 678 in 1909, 665 in 1908, 654 in 1907 and 318 in 1906; 4,269 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; 510 addresses were received of persons in Westminster taking in work from other boroughs. They were distributed thus:— Council. Sen l from YVeslminster. Received by Westminster. Council. Sent from Westminster. Received by Westminster. Feb. Auk. Feb. Aug. Feb. Aug. Feb. Aug. Acton 9 5 - Islington 52 61 1 Battersea 73 69 2 2 Kensington 58 54 30 39 Bedfont 1 1 — - Kingston.on.Thames 1 1 — Bedford 1 1 — - Lambeth 55 58 8 2 Bermondsey 2 2 1 1 Langley 1 — — — Betlmal Green 10 11 — Lewisham 7 5 2 Broadstairs 1 1 — - Leyton 4 4 2 1 Bromley 1 1 — — New Maiden 3 3 — — Camberwell 39 37 — - Northampton 5 5 — Chelsea 20 25 36 44 Paddington 138 141 31 11 Chichester 1 1 — Perth 1 1 — — Chipping Sodbury 1 1 — Richmond 1 1 — — Chiswick 3 3 — St. Leonards.on.Sea 1 1 — — City of London 20 20 28 37 St. Marylebone 757 761 57 51 Croydon 6 6 - — St. Pancras 225 229 9 1 Ealing 4 4 — — Shoreditch 10 12 — — East Ham 2 2 — — Southend 1 1 — — Edmonton 2 2 — — Southwark 36 37 2 2 Enfield 1 1 — — Stepney 121 134 1 1 Farnborough 3 3 — — Stoke Newington 6 6 — — Finchley 3 3 — — Tottenham 8 8 — Emsbury 8 8 6 13 Walthamstow 4 4 — — Fulham 58 53 — — Wandsworth. 64 6S 9 1 Hackney 15 18 1 1 Watford 1 — — — Hammersmith 64. 68 — — Wealdstone 1 1 — — Hampstead 9 10 1 1 Wembley 1 — — — Hanwell 1 1 — — West Ham 7 6 — — Harrow 3 3 — — Weymouth 1 1 1 — Holborn 122 133 34 35 Willesden 52 56 - 1 Hornsey — — — 1 Wimbledon 3 2 — — Horsham 1 1 — — Ilford 1 1 — — Isle of Wight 1 1 — — 2,110 2,159 260 250 89 City of Westminster. Outworkeks. 1910. FEBRUARY LISTS. AUGUST LISTS. Trade. Number of Lists. Number of Outworkers. Received from other Authorities. Sent to other Authorities. Addresses in City. Number of Lists. Number of Outworkers. Received from oth er Authorities. Sent to other Authorities. Addresses in City. a. Tailoring 255 3,468 220 1,362 2,326 261 3,522 216 1,380 2,358 A. Dressmaking 17 315 19 262 72 18 321 16 269 68 A. Theatrical costumiers 1 22 — 16 6 1 23 — 16 7 A. Waterproofing 1 6 — 2 4 1 6 — 2 4 A. Shirt making and hosiers 28 140 5 81 64 27 138 4 86 56 A. Boot making 24 459 12 364 107 21 442 10 373 79 A. Veil Spotting 1 2 — 2 — 1 2 — 2 — A. Corset making 2 3 — 3 — 1 3 — 3 — a. Hat making 1 6 — 6 — 1 6 — 6 — A. Embroidery 1 16 1 1 16 2 25 1 8 18 A. (Hove making 1 3 — 3 — 1 3 — 3 — B. Lace making 2 9 — 8 1 2 12 — 11 1 K. Umbrella making — — 1 — 1 — — 1 — L. Cotton bag making — — 1 — 1 — — 1 — 1 W. Stuffed toy making - - 1 - 1 - - 1 - i 334 4,449 260 2,110 2,599 337 4,503 250 2,159 2,594 329 firms sent in lists on both occasions giving a total of 8,859 addresses ; 13 firms engaged in making wearing apparel sent in once in the year, the number on their lists being 93 ; 5 of these firms sent in their list in February only, 8 in August only. 90 Comparing the above list with that of 1909, it appears that less tailoring work was sent to Stepney, and more to Paddington, Wandsworth, Fulham, Hammersmith, Islington and Holborn. There is practically no change in the number of persons living in Westminster working for firms in other districts. 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, the actual number of persons resident in the City is found to be 1,778, being 11 less than in the previous year. 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 974. 306 notices were served in resuect of 651 defects discovered in 263 houses. They may be summarised thus :— 1909 1910 1909 1910 Sanitary Walls and ceilings dirty 340 250 tion— Booms verminous 48 17 Insufficient — 4 Booms overcrowded 13 4 Not kept separate 25 10 Rooms badly ventilated 23 15 Improper position 1 — Gas stoves and heaters unventilated Apparatus defective 130 87 31 9 Requiring cleansing 56 42 Other defects (dampness, defective Ventilation defective 6 8 roofs, floors, water supply, dust Drains, &c., defective 73 33 bins, &c.) 167 112 In 21 instances statutory notices had to be served before the work required was done. In several instances where the rooms were dirty or verminous the outworker was seriously warned, and in two instances work was stopped until the conditions were improved. Infectious Disease—A list of the cases of notifiable infectious diseases which occurred in families engaged in the making, &c., of wearing apparel, are given below. It was unnecessary to stop their work except temporarily during the time disinfection was being carried out, except in one case of typhoid fever. As the patient was too ill to be moved rooms were taken elsewhere for the family and for use as a workshop:— 91 Smallpox. Scarlet lever. Diphtheria Typhoid Fever. Erysipelas. Total. Clothing trades:— (a) Business in family affected — 10 4 2 2 18 (b) Business in other parts of house 17 6 1 7 3L (c) Persons from infected houses employed in clothing business elsewhere - 41 6 6 1 54 — 68 16 9 10 103 Other home workers trades — — — — - — In connection with Laundries there were cases in each of the above three classes:— (a) (b) (c) In Receiving Shops — — — Mangling only Scarlet Fever, 1 — — Washing, Ironing, &c. — Diphtheria, 1 Scarlet Fever, 1; Diphtheria, 1. There are 48 Laundries in which washing is done, besides which there are a number of private houses in which mangling only is done. 92 E. FOOD SUPPLY. During 1910 visits have been paid to the various classes of business as follows:— Dairies and Milkshops 608 Bakehouses 210 Hotels, Restaurants and Eating houses 1,361 Ice cream makers 188 Food preserving works 20 Fishmongers 630 Greengrocers and Fruiterers 630 Meat shops (various) 715 Confectioners 14 Provision shops 368 Aerated water makers 2 Eleven statutory notices were served and police.court proceedings were taken in one instance (see above). Ice.cream Premises.—This commodity is made at 150 premises, each of which was kept under supervision. In 3 instances defects affecting this particular part of the business were remedied. The owner of certain premises which were unfit, for the purpose was called upon to discontinue making or dealing in ice.creams at the premises until they were made to comply with Section 42 General Powers Act, 1902. Bakehouses.—At the end of 1909 there were 13 above.ground and 71 underground in use. During 1910 a new above.ground bakehouse has been added. 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. Certification of Premises, &e.—As Certifying Officer for the City of Westminster for all meat foods prepared or packed for export to several foreign States, I have granted 152 certificates during 1910, 32 for the United States, 48 for the Philippine Islands, 63 for the Argentine, and 9 for Venezuela. 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 15 3 8 4 30 (b) Business in other parts of house.. - - - - - (c) Persons from infected houses employed elsewhere 15 11 2 - 28 30 14 10 4 58 93 Milkshops.—At the end of 1909, 350 names of persons selling milk were upon the register. In 1910, 19 names were removed and 42 added, leaving 372 on the register at the end of the year; 29 of these were registered in respect of new premises; 10 are street vendors having no address in the City. Eight persons selling milk were given notice to register, and complied. The Council refused to register in 2 instances Six hundred and thirty.three 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; no proceedings had to be taken against any milk seller on this account, but two were cautioned. Infectious Disease.—Two cases of diphtheria occurred on premises in which milkshops were situated, and one person from an infected house was employed elsewhere in the milk trade. Satisfactory arrangements were made in each instance, and no infection of the milk resulted. Coivsheds.—There is now only one cow.keeper, namely, at 13, Marsbam Street (licensed for 19 cows). These premises were visited 25 times during the year. Considerable improvements have been effected during the year. There are no slaughter.houses or "offensive trades" carried on in Westminster. Fried Fish Vendors, &c.—Several complaints have been dealt with relating to the smell from these shops, and improved ventilation has been brought about, in one case by the adoption of a stove whereby the fumes from the frying are drawn into the stove and burned. 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. Apples 0 2 0 Oranges 1 19 0 Bananas 2 6 0 Peaches 0 0 28 Carrots 3 14 0 Pears 2 7 0 Cherries 0 2 0 Peas 0 0 56 Chicory 0 10 0 Pineapples 0 16 44 Cucumbers 0 2 0 Plums 0 3 0 Currants 0 4 32 Potatoes 0 1 0 Dates 0 3 0 Radishes 1 18 0 Figs 0 0 26 Spinach 0 0 56 Lemons 0 5 56 Tangerines 0 1 0 Limes 0 1 0 Tomatoes 4 12 56 Lychees 0 1 0 Turnips 0 0 28 Snipes, 15; Plovers, 4; Codfish, 1 ewt. 18 lbs.; Plaice, 84 lbs.; Fish (various), 2 cwt.; 1 Churn of Sour Milk (for making cheese). G 94 The following articles were seized and condemned; appended is a note of the action taken. Article. Name and Address of Defendant. Result. Olive Oil. 1 gallon sold to restaurant in Oxford Street, unfit for food (contained 1 per cent, of turpentine) Hayward Bros., Ltd., Mont. ford Place, Kennington Summons withdrawn. [The Magistrate, after having heard the evidence, was of opinion that it was clearly an accident that the turpentine had got into the oil, and suggested that under the circumstances the summons might properil/ be withdrawn.] Apples, 12 lbs.; Pears, 7 lbs. Mutton, 4lbs. Mr. M. Fisher, 6l, Charing Cross Road Mrs. Ellen Buckingham, 4, Walker's Court Cautionary letter sent by Committee. Cautionary letter sent by Committee. Butchers' Meat on Stalls.—The street markets are regularly inspected during the week, but especially on Saturday evenings and Sunday mornings. The attention of vendors of butchers' meat has been called to the desirability of providing forks for the use of customers, to prevent the pieces of meat being handled, and in a number of instances the suggestion has been complied with. Bread.—The Council have had under consideration the question as to the need for fresh regulations dealing with places where bread is sold. This arose over certain allegations which were made in the Press and by the Association of Master Bakers, who pointed out the unreasonableness of strict regulations being made as to the places where bread is made and no regulations as to where it is sold, and that it is in many cases sold in the same shop as such articles as soap, candles, coke, coal and paraffin oil, and occasionally exposed in egg.boxes on the pavement. It was suggested that bread might be contaminated in this way, and by being handled and breathed upon by customers. Attention was also drawn to the practice which exists amongst bakers of taking back from customers loaves which they think too stale; instances were given in which bread had been sent back to the baker by customers suffering from consumption and other diseases. In a previous report I drew attention to the risk of contamination which occurred through baskets of bread being deposited on the roadway during delivery. A letter was also received from the Local Government Board, requesting information on the subject. In reply, the Council stated that " they are of opinion that the powers conferred by Section 8 of the 95 London County Council (General Powers) Act, 1908, are sufficient to ensure the cleanliness of places where bread is sold in London. No instance in Westminster has been brought to the knowledge of the Council where infection has been communicated by means of bread; but in any case in which bread from dwellings, where there were cases of infectious disease or of pulmonary consumption, was being taken back by a baker the Council think that such bread should be seized and destroyed as being unlit for human food under the provisions of Section 47 of the Public Health (London) Act, 1891, and that the baker would be liable to prosecution if he knowingly sold such bread." ."Further, the Council considered that the practice of taking back bread from customers should be discontinued, unless such bread has been sold and kept in sealed dustproof paper coverings, which would bo a means of protecting the bread in course of transit between baker and customer as well as in retail shops." The practice of taking back stale bread appears to be one which might very well be regulated by the trade associations. Samples of flour, bread and biscuits were taken for analysis, but no adulteration was proved by the Analysts. The Public Health Committee has more than once considered the question of the quality of the Hour and bread which has been sold in recent years. The demand has been for a white bread, and in order to produce this a flour was produced which is said to have been artificially bleached, but which certainly did not contain important parts of the wheat as did the flour which used to be supplied in former times. Recently attempts have been made, apparently with success, to obtain a flour which shall contain the germ of the wheat together with a certain amount of the husk. In view of the inferior nourishing qualities of the white bread commonly sold it is being urged that the Local Government Board should lay down a standard for bread, making it compulsory that all bread sold as such should, unless distinctly labelled otherwise, be made from unadulterated wheat flour containing at least 80 per cent. of the whole wheat, including the germ and semolina. Such a standard has already been enforced by law for milk. The standardisation of bread is equally important, bread and flour forming about two.fifths of the weight of the food consumed by the working classes and constituting almost the whole diet of many poor children. An enquiry is being conducted by the Local Government Board as to the bleaching of flour and the addition to it of so.called "improvers"; also as to the presence of calcium sulphate in baking.powder and self. raising flour. G 2 96 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 brackets.) Adulterated. Prosecutions. Couvictions. Withdrawn or Dismissed. Fines. Costs. £ s. d. £ s. d. Milk 947 724 (115) 108 61 33 28 47 5 0 23 11 0 2 do. separated 8 6 2 1 1 — 0 10 0 0 12 6 3 do. skimmed 5 5 4 do. and soda water 3 3 5 Cream— Adulterated, fresh 20 49 21 28 5 4 1 2 10 0 4 1 6 potted 8 6 Cream, ice, 9 9 7 Butter 218 201 (6) 11 4 4 — 9 0 0 3 0 6 8 Margarine 45 42 3 1 1 . . 0 2 0 9 Cheese, Gorgonzola 9 7 2 10 do. Dutch 1 1 11 Lard 9 9 12 do. nut 1 1 18 Bread and butter 42 40 2 1 1 . 2 0 0 0 15 0 14 Bread 1 1 15 Biscuits 1 1 16 Oatmeal 9 9 17 Arrowroot 10 10 18 Flour 10 10 19 Tea 6 6 20 Coffee 36 35 1 21 Cocoa 32 28 (3) 1 22 do. mixture 2 2 23 Meat pie 28 27 1 24 Steak pie 1 — 1 25 Pork pie 11 6 5 1 1 . 0 10 0 3 3 0 26 Veal and ham pie 1 — 1 27 Meats, potted 5 5 28 Turkey and tongue 5 3 2 29 Sausages, pork, beef, saveloys 73 57 16 5* 5 9 0 0 5 13 0 30 do. German 6 3 3 2† 2 - 1 10 0 1 5 0 31 do. liver 6 6 32 do. ham 1 1 33 do. roll 1 1 34 Lunch tongue 1 1 35 Brawn 7 5 2 36 Beef, corned 1 1 37 Chicken and ham 5 2 3 38 39 Bacon Haddock (fresh and cured) 9 8 8 6 (1) 1 1 40 Fish (cod, plaice, herrings, smoked salmon) 6 6 41 Gherkins 1 1 . Four adjourned from 1909. † one „ 1990 97 Number. Article of Food. Number of Samples Purchased. Genuine, (Inferior in brackets.) Adulterated. tProsecutions. Convictions. Withdrawn or Dismissed. Fines. Costs. £ s. d. £ s. d. 42 Vegetables, preserved 5 1 4 43 Peas, preserved 9 8 1 44 Spinach, preserved 1 — 1 45 Pepper 11 11 46 Oil, olive 41 39 (1) 1 1 — 1 47 Ginger, ground 15 15 48 Marzipan 4 4 49 Jam 23 23 50 Marmalade 1 1 51 Honey 25 25 52 Ginger beer 9 9 53 Lemonade 2 2 54 Lime juice cordial 2 - 2 55 Kaola 1 1 56 Cream soda 1 1 57 Raspberry drink 1 1 58 Cyder 2 2 59 Cod liver oil 9 9 60 Boric ointment 9 8 1 Refusal to sell — — — 1 1 — 3 0 0 0 12 6 Totals 1,800 1,469 (126) 205 83 53 30 75 5 0 42 16 0 Summary proceedings were ordered to be taken in 83 instances, but 1 of these, upon the suggestion of the Solicitor, was not proceeded with, 15 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 35 instances, and no action was taken with regard to 72 samples which did not conform (8 of these were test purchases and not samples taken officially, the others deviated only slightly from the standard). Milk.—947 samples of ordinary milk were taken during the year. Of these 108 (1140 per cent.) were reported by the Analysts to be below the standard of the Board of Agriculture, and 63 samples were just on the border line, making a total of 18.05 per cent. of the samples. The percentage of adulterated (11.40 per cent.) is rather higher, the increase being specially noticeable in the north district. 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 percent., or in which the non.fatty solids were between 8.5 and 8.6 (if the fat was also below 3.8). Adulterated are those below the official standard of 3 per cent. for fat and 8.5 for solids not fat. 98 Good Quality. Fair Quality. Poor Quality. Adulterated. District. Total. No. Percent. No. Percent. No. Per cent. No. Per cent. South 414 151 37.1 158 38.1 78 18.8 24 5.70 North 533 178 33.3 170 31.8 101 18.9 84 1570 1910 947 332 35.0 328 34.6 179 18.9 108 11.40 1909 951 285 29.9 357 37.5 223 23.4 80 9.01 1908 860 335 38.9 207 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 31.2 108 20.8 119 14.07 1905 831 305 36.7 281 33.8 153 18.4 92 11.07 At first sight the number of "adulterated" samples would appear to have increased. The explanation of this apparent increase is that special attention has been given to restaurants, coffee houses, &c., the majority of which are situate in the north part of the City. The south district gives a more fair idea of the quality of the milk sold for home consumption, as the majority of the vendors are dairymen. The amount of "good" quality milk shows an increase, while the "fair" has dropped slightly and the "poor" rather more so. 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. This Council has prosecuted when the deficiency was under 5 per cent., and successful proceedings have been taken in several cases where there had been persistent adulteration within that limit. Sixty-one prosecutions were taken with regard to adulteration — 41 for fat abstracted, 14 for added water, and 6 for both fat abstracted and added water. Fourteen cautions were given to sellers whose milk contained less than 5 per cent. of added water, or had less than 5 percent. of fat abstracted. Warranties were set up as a defence in 27 instances, 1 case was adjourned sine die, as the defendant was reported to be in Italy, and 1 case was withdrawn, as at the hearing it transpired that the business had been transferred. Details of the proceedings taken are appended. Sunday Samples.—150 of the samples of milk were taken on 15 Sundays during the year; 13 (8.6 per cent.) were found to be adulterated. In the four previous years the figures were 9.1, 10.6, 1T0 and 10.5 per cent. respectively. Samples taken in course of Delivery— (a) At Railway Stations.—68 samples of milk were taken on arrival at Victoria and Charing Cross Railway Stations. Thirty were reported of good quality, 23 fair, 13 poor, and 2 adulterated. 99 (b) On Delivery at Shops, &c.—47 samples of milk were taken as it was being delivered by wholesale firms to retail customers. Of these samples, 22 were good, 15 fair, 6 poor, and 4 adulterated (9 per cent. fat abstracted, 1 per cent. added water, 2 per gent, added water, 2 per added water and 4 per cent. abstracted fat). 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 nine years are as follows:— 1902. 1903 1904. 1905. 1906. 1907. 1908 1909. 1910. New 401 658 741 831 806 792 860 951 947 Separated, condensed, sterilised or dried 55 55 31 36 11 31 18 16 13 Total 546 663 772 867 817 823 878 967 960 Infringement of Section 9, Sale of Food and Drugs Act, 1899.— Several persons were cautioned for failure to have name and address on milk can or barrow. Refused to Sell.—A vendor refused to sell milk in a shop to the Inspector from a can which contained about one quart and was standing in front of the counter. A customer had been served from the can in question previous to the Inspector.s Assistant demanding some of the milk. The explanation given was that the milk was wanted for the proprietor.s wife. A fine of £3 was inflicted and 12s. 6d. costs. A sample of milk purchased on a former occasion had been found deficient and the vendor had been lined. Cream.—The trade has now adopted the distinction in selling cream of the terms "fresh" or "preserved." Forty.one samples of the former were taken, 21 of them contained no preservative, and 20 had boric acid in the following proportions per pound:—5.95, 7.7, 9, 10, 10.25, 11, 11.2, 12.39, 13.8, 13.8, 148, 16.1, 16.1, 17.3, 20.5, 21.7, 23.5, 23.5, 24.29 and 30.98 grains respectively. In most of these instances notices were displayed in the shops that the cream contained preservative, although it was sold as fresh. Proceedings were taken in respect of five with the largest amounts, and notwithstanding the notices in the shops, convictions were obtained. The preserved creams sold in pots and marked as containing not more than 35 grains were found to have the following amounts per pound:—7.7, 7.8, 10.6, 14, 16.8, 19, 20.2 and 29.4 grains respectively. Cheese.—It having come to the notice of the Public Health Com 100 mittee that Gorgonzola cheese was being sold coated with a mixture of barytes and tallow they ordered some samples to be bought, and the Analysts reported that the rind contained 70 to 80 per cent. of barytes. The attention of dealers was called to this and the sale of such coated cheese was discontinued. Sausages, Meat Pies, &c—In my Annual Eeport 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 pound. 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. The result was that the appeal was dismissed with costs. A case was stated for the. consideration of the High Court, 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 245 grains to 46 grains had been waiting the result of the final appeal. The summonses were restored to the list and lines inflicted. Samples were taken during 1910 of sausages, meat pies, &c., with the following results:— 64 Pork Sausages 53 genuine; 11 contained boric acid:—0.6, 1.3, 6.5, 7.4, 9.9, 10.78, 10.8, 161, 347 grains per lb.; and 2 contained traces. 8 Beef Sausages 3 genuine; 5 contained boric acid:—7.2, 7.5, 9.12 and 9.12 grains per lb.; 1 contained a trace. 6 Liver Sausages Genuine. 6 German Sausages 3 genuine; 3 contained boric acid:—3.5, 19.83 grains per lb.; and 1 a trace. I Saveloy Genuine. 11 Pork Pies 6 genuine; 5 contained boric acid:— 2.5, 4.4, 13.0, 14.8, 24.7 grains per lb. (crust included). 29 Meat Pies 27 genuine; 2 contained boric acid:—20 and 2.6 grains per lb. (crust included). 1 Sausage Roll Contained 1.5 grains boric acid (16 grains in meat portion). 3 Brawn 2 genuine; 1 contained 1.5 grains boric acid. 1 Veal and Ham Pie Contained 1.0 grain 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 some of these it was above 16 grains per pound of meat. 101 In these various meat preparations there has been a great reduction in the amount of boric acid used as compared with previous years. In one sample of bacon examined 9 grains boric acid per pound was found. Tinned Meat,—In 15 samples of potted meats 5 were found to contain preservatives to the amount of 1½, 9, 12.39, 1.8 and 19.8 grains per pound. Fish.—Fourteen samples of fish, fresh, filletted and cured, were examined. One "fresh" haddock (taken unofficially) was found to contain 21.07 grains of boric acid per pound. A sample of filletted cod was found to have the skin dyed with an organic dye; the analyst reported: " The proportion of the dye found is extremely small, too minute in fact for determination, and there is no reason for supposing that it is in any way injurious or that its use would serve any fraudulent purpose, so that in the absence of any further information I only regard the offence as a technical one." 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 pound. One retailer was cautioned for selling spinach with over this amount. Drugs.—Boric ointment was purchased 9 times and found to be satisfactory except in one instance; this sample contained 11 per cent. of the drug instead of 10 per cent. The ointment in question was procured by the retailer from a wholesale firm, who had another sample examined which was found to be of correct strength but a little lumpy. 102 Legal Proceedings Under the Food and Drugs Acts during 1910. No. of Sample. Date of Hearing. Court and Magistrate. Name and Address of Defendant. Offence. Result. 1 2 3 4 5 6 1910. MILK. 82 N. 16th February Bow Street (Sir Albert de Rutzen) Arthur Scrivens, 28, Great Barlow Street Selling milk in Newport Street with 4 per cent. of added water Fined 20s. and 12s. 6d. costs. 29 N. 16th February Bow Street (Sir Albert de Rutzen) G-eorge Jones, 183, Shaftesbury Avenue Selling milk in Newport Street, 21 per cent. of fat abstracted The defendant set up a warranty but failed to prove it, and was fined 20s. and 12s. 6d. costs. 2 S. 24th February Westminster (Mr. Denman) Rhys Rees Williams, 30, Vauxhall Bridge Road 9 per cent. of added water Warranty proved. Summons dismissed. 35 N. 25th February Bow Street (Mr. Curtis Bennett) Richard Baker, the Globe Restaurant, 3 and 4, Coventry Street 34 per cent. of added water Ordered to pay £2 2s. costs. 143 N. 16th March Bow Street (Sir Albert de Rutzen) Bucks Direct Dairy Supply Co., Ltd., 114, Shaftesbury Avenue, W. 8 per cent. of added water Fined 10s. and 17s. 6d. costs. 144 N. 16 th March Bow Street (Sir Albert de Rutzen) Bucks Direct Dairy Supply, Co., Ltd., 114, Shaftesbury Avenue, W. Selling in street milk with 8 per cent. of added water Fined 10s. and 17s.6d. costs. 38 N. 18th March Marlborough Street (Mr. Mead) J. Lyons and Co., Ltd., Cadby Hall, Kensington Selling at 9, Regent Street, milk, 7 per cent. of fat abstracted Warranty proved. Summons dismissed. 173 N. 18th March Marlborough Street (Mr. Mead) Frederick Joseph Staples, 24, Great Windmill Street, W. 5 per cent. of added water Fined 30s. and 12s. 6d. costs. 16S. 31st March Westminster (Mr. Francis) Arthur Handsley, 414, Kennington Road and 2, Stannary Street, S.E. . Selling at Page Street, milk, 18 per cent. of fat abstracted Warranty proved. Summons dismissed. 126 S. 31st March Westminster (Mr Francis) John Price, 27, Wood Street 9 per cent. of fat abstracted Warranty proved. Summons dismissed. 188 N. 5th April Bow Street (Mr. Marsham) Mary Ann Forster, 7, Chandos Street, W.C. 16 per cent. of added water Fined 20s. and 12s. 6d. costs. 103 167 S. 22nd April Westminster (Mr. Horace Smith) Margaret Jeffries, 2, St. Leonard Street 13 per cent. of fat abstracted Fined 10s. and 12.. 6d. costs. 231 N. 19 th March Bow Street (Mr. Marsh am) Hermann Appenrodt, 5, Strand 11 per cent. of fat abstracted Warranty proved. Summons dismissed. 261 N. 29th April Marlborough Street (Mr. Mead) Walter J. Ballard, 24, Dean Street, Soho 5 per cent. of added water Fined £3 and 12.. 6d. costs 263 N. 29th April Marlborough Street (Mr. Mead) Jacob Dunn, 28, St. Anne.s Court, Soho 6 per cent. of added water Fined £3 and 12.. 6d. costs. 257 N. 29th April Marlborough Street (Mr. Mead) Kate Camier, 11, Sherwood Street, W. 24 per cent. of fat abstracted Fined 40.. and 2.. costs. 344 X. 24th May Bow Street (Mr. Marsham) Slaters, Ltd., 18 and 20, High Street, Kensington Selling milk at 142, Strand, with 6 per cent. of added Warranty proved. Summons dismissed. 292 N. 24th May Bow Street (Mr. Marsham) The J.P. Restaurant, Ltd., 5 and 6, Camomile Street, E.C. Selling milk at 165a, Strand, 16 per cent. of fat abstracted Warranty proved. Summons dismissed. 346 N. 24tli May Bow Street (Mr. Marsham) Am and Malzy, Colonnade Restaurant, 166. Strand 16 per cent. of fat abstracted Fined 20.. and 12.. 6d. costs. 230 S. 26th May Westminster (Mr. Horace Smith) Mary Dicker. 75, Lupus Street 15 per cent. of fat abstracted Fined 5s. and 12.. 6d. costs. 219 S. 26th May Westminster (Mr. Horace Smith) Catherine Field, 66, Ranelagh Road 14 per cent. of fat abstracted Fined 10s. and 12s. 6d. costs. 313 n. 27th May Marlborough Street (Mr. Mead) Joseph Dauphin, 25, Little Pulteney Street, Soho, W. 37 per cent. of fat abstracted Fined £3 and 12.. 6d. costs. 319 n. 27th May Marlborough Street (Mr. Mead) Charles Pearce, 1, Silver Place, Soho 8 per cent. of fat abstracted Summons withdrawn. It transpired at the hearing that the business had been transferred to Bessie Marsh by Charles Pearce, and the Magistrate declined to allow her name to be substituted; as more than 28 days had elapsed since the purchase, the City Solicitors could do nothing but withdraw the summons. 445 N. 21st June Bow Street Thomas Clarke Edwards Selling at Shaftesbury Avenue, Warranty proved. Summons (Mr. Marsham) (Faulks and Sons), 129, Jermyn Street milk, with 16 percent. of fat abstracted dismissed. 405 N. 21st June Bow Street (Mr. Marsham) Thomas Gibson (Gibson Bros.), 213, New North Road, N. Selling at 165a, Strand, milk, with 4 per cent. fat abstracted and 2 per cent. of added water Warranty proved. Summons dismissed. 352 S. 30th June Westminster (Mr. Francis) Mrs. Annie Topham, 2, Vincent Street 12 per cent. of fat abstracted Fined 20s and 12s. 6d. costs. 104 No. of Sample. Date of Hearing. Court and Magistrate. Name and Address of Defendant. Offence. Result. 1 2 3 4 5 6 1910 353 S. 14th July Westminster (Mr. Francis) Gwilyn Phillips, servant of Burnards, Ltd., Vauxhall, S.E. Selling in Earl Street milk with 10 per cent. of original fat abstracted Fined 10s. and 12s. 0d. costs. A summons was also taken out against Burnards, Ltd., but was withdrawn, it being considered at the hearing that Phillips was the culprit. The word " skimmed " was on the barrow but covered over with white paper. 465 N. 15th July Marlborough Street (Mr. Mead) George Millward, 4, Saville Place, W. 6 per cent. of fat abstracted Fined 20s. and 12s. 0d. costs. 392 S., 21st July Westminster (Mr. Francis) Maurizio, De Maria, 171, Ivnightsbridge 20 per cent. of fat abstracted.. Fined 20s. and 12s. 6d. costs. 517 N. 22nd July Marlborough Street (Mr. Mead) Callard, Stewart and Watt, Ltd., 49, Old Bond Street Selling at 74, Regent Street, milk, 11 per cent. of fat abstracted Warranty proved. Summons dismissed. 535 N. 22nd July Marlborough Street (Mr. Mead) Harry Hanson, New Yard, Great Queen Street, W.C. Selling milk, a snmple ofwhich was procured in course of delivery at the Workhouse, Poland Street, 9 per cent. of fat abstracted Warranty proved. Summons dismissed. 536 N. 22nd July and 16tb September Marlborough Street (Mr. Mead) Soloman Goodman, 141, War. dour Street 48 per cent. of fat abstracted. Fined 10s. and 12s. 6d. costs. 496 N. 22nd July Marlborough Street (Mr. Mead) London Pure Milk Association, Ltd., 2, Halkin Place Selling at Mount Row, milk, 12 per cent. of fat abstracted Withdrawn. Third sample broken. 508 N. 22nd July Marlborough Street (Mr. Mead) Joseph Brandon, St. George.s Dairy, 13, Pollen Street, W. Selling at Maddox Street, milk, 15 per cent. of fat abstracted Warranty proved. Summons dismissed. 494 N. 22nd July Marlborough Street (Mr. Mead) London and Provincial Dairy Co., Ltd., 4, West Halkin Street Selling at Berkeley Square, milk, 10 per cent. of fat abstracted Warranty proved. Summons dismissed. 514 N. 22nd J uly Marlborough Street (Mr. Mead) Cabins (1901), Ltd., 46, Queen Victoria Street Selling at 214, Piccadilly, milk, 17 per cent. of fat abstracted Warranty proved. Summons dismissed. 518 N. 22nd July Marlborough Street (Mr. Mead) Adolphus Massie, 15, Air Street 12 per cent. of fat abstracted Fined 40s. and 12s. 6d. costs. 105 524 N. 22nd July Marlborough Street (Mr. Mead) Eugenio Naddoti, 15, Swallow Street 10 per cent. of fat abstracted Fined £3 and 12s. 6d. costs. 468 N. 26th July Bow Street (Mr. Marsham) John Evans, 7, New Street, W.C. Selling at St. Martin's Lane, milk, 6 per cent. of fat abstracted Warranty proved. Summons dismissed. 523 N. 26th July Bow Street (Mr. Marsham) Pietro Necchi, 5, Gerrard Street 6 per cent. of fat abstracted Fined 20s. and 12s. 6d. costs. 521 N. 26th July Bow Street (Mr. Marsham) Lewis Mason Jenkins, 159, Drury Lane Selling at NewportStreet,milk, 35 per cent. of fat abstracted Withdrawn on payment of £1 1s. costs. In this case a Warranty was pleaded. which might have succeeded. Another sample taken at the same time was genuine. 520 N. 26th July Bow Street Bucks Direct Dairy Supply Selling at 114, Shaftesbury Fined £5 and 12s. 6d. costs. (Mr. Marsham) Co., Ltd. Avenue, milk, 48 per cent. of fat abstracted 512 N. 26th July Bow Street (Mr. Marsham) Eustace Miles Proteid Foods Ltd., Moorgate Station Chambers Selling at 40, Chandos Street, milk, 10 per cent. of fat abstracted Warranty proved. Summons dismissed. 560 N. 11th August Marlborough Street (Mr. Mead) George Edward Thomas, 69, Albany Street, Regent's Park 5 per cent. added water, 8 per cent. fat abstracted Warranty proved. Summons dismissed. 556 N. 11th August Marlborough Street (Mr. Mead) James Edwin Mason, 15, Charles Street, Haymarket 13 per cent. fat abstracted Warranty proved. Summons dismissed. 559 N. 11th August Marlborough Street (Mr. Mead) Susannah Allibone, 9, Shepherd Street 29 per cent. fat abstracted Fined 20s. and 12s. 6d. costs. 584 N. 11th August Marlborough Street (Mr. Mead) John Timothy, 45, Greek Street 4 per cent. added water and 4 per cent. fat abstracted Fined £4 and 23s. costs. 632 N. 19th August Bow Street (Mr. Curtis Bennett) John 0. Morris, 35, Lisle Street Selling in the Strand, milk, 26 per cent. of fat abstracted Warranty proved. Summons dismissed. 433 S. 25th August Westminster (Mr. Hopkins) Wm. Goodson, 32, Rephidim Street, Southwark Selling in Horseferry Road, milk, 32 per cent. of fat abstracted Fined 40s. and 12s. 6d. costs. 406 S. 25th August Westminster (Mr. Hopkins) George Thatcher (Thatcher and Son), 4, Denbigh Place Selling at Belgrave Street, milk, 13 per cent. of fat abstracted Warranty proved. Summons dismissed. 106 No. of Sample. Date of Hearing. Court aud Magistrate. Name and Address of Defendant. Offence. Result. 1 2 3 4 5 6 1910. 701 N. and 6th October Westminster S. H. Merrick, "Hydehurst," Milk, in course of delivery, Summonses dismissed. 702 N. (Mr. Horace Smith) Crawley, Sussex containing respectively 7 per cent. and 1 per cent. of added water These samples were taken at Victoria Station in course of delivery from two churns consigned to Williams Creameries, Ltd., by the same farmer. Two summonses were issued, and the usual evidence was given for the prosecution. The inspector having stated that the chums arrived unsealed and with one label loose on the top of one of the churns, the defendant gave evidence and called two of his employees to prove that the churns were sealed on the morning they left him, that labels were attached to each, and that such labels could not get loose without being cut, the suggestion apparently being that the water was added by the railway officials. The City Solicitor pointed out to the Magistrate (Mr. Horace Smith) that this was no defence, but he dismissed both the summonses, stating that he did not consider the evidence for the prosecution sufficient. The Magistrate did not say in what respect the evidence was insufficient. 729 N. 27th October Bow Street (Mr. Curtis Bennett) John Hughes, 13, Bedfordbury 6 per cent. of added water Fined 40s. and 23s. costs. 739 N. 28th October Marlborough. Street (Mr. Denman) Barto Mentasti, 11, Archer Street, W. 7 per cent. of fat abstracted Fined 10s. and 12s. 6d. costs. 832 N. 30th November Bow Street (Mr. Marsham) The Coliseum Syndicate, Ltd., 29a, Charing Cross Road 13 per cent. of added water, and a deficiency of 4 per cent. of fat Warranty proved. Summons dismissed. 645 S. 8th December Westminster (Mr. Horace Smith) Herbert Henry Jones and Alice Jones (Jones. Dairies), 15, Brewer Street 9 per cent. of fat abstracted Warranty proved. Summons dismissed. 889 N. 21st December Bow Street (Mr. Marsham) Arena, Ltd., the Arena, Villiers Street. Strand, W.C. 22 per cent. of added water Fined 20s. and 12s. 6cl. costs. 833 N. 21st December Bow Street (Mr. Marsham) Bartolmeo Cattini, 56, St. Martin.s Lane, W.C. 31 per cent. of fat abstracted Adjourned sine die. The defendant was reported to be in Italy, and there seems to be some question as to whether he was really the proprietor of the business. 718 S. 29th December Westminster (Mr. Horace Smith) Thomas Jones, 52, Rochester Row Selling at Coburg Row, milk, 6 per cent. of added water Summons dismissed. Warranty proved. 107 1911. 922 N. 3rd January Bow Street (Sir Albert de Rutzen) BioscopicTea Rooms Co., Ltd., 28a, Leicester Square 7 per cent. of added water Fined 20s. and 12s. 0d. costs. 979 N. 13th January Marlborough Street (Mr. Mead) Abraham Lewis, 76, Berwick Street 14 per cent. of fat abstracted Fined 40s. and 12s. 6d. costs. 597 S. 1910. 17th November.. Westminster (Mr. Horace Smith) SEPARATED MILK. James Sewell, 24, Fountain Street, Battersea Selling at Westmoreland Place separated milk which contained 19.20 grains of boric acid per gallon Fined 10s. and 12s. 6d. costs, or 7 days. hard labour. 335 S.. 1910. 21st July Westminster (Mr. Francis) CREAM. John Adams (Adams and Co.), 9, Moreton Street, Selling cream containing 30.989 grains of boric acid Fined 20s. and 24s. costs. 355 S. 21st July Westminster (Mr. Francis) minster John Adams (Adams and Co.), 9, Moreton Street, per lb. Selling fresh cream containing 23.548 grains of boric acid Warranty proved. Summons dismissed. 45o S. 25th August Westminster (Mr. Hopkins) minster Edward Jenkins, 27, Churton Street per lb. Selling fresh cream containing 2107 grains of boric acid per lb. Selling fresh cream containing 23.52 grains of boric acid per lb. Selling fresh cream containing 24297 grains of boric acid per lb. Fined 10s. and 12s. 6d. costs. 45S 25th August Westminster (Mr. Hopkins) Wm. Morgan Davies (Davies Bros.), 95, Charlwood Street Fined 10s. and 12s. 6d. costs. 459 S. 25th August o. Westminster (Mr. Hopkins) George W. Thatcher, 40, Moreton Street, Westminster Fined 10s. and 12s. 6d. costs. 174 S. 1910 22nd April Westminster (Mr. Horace Smith) BUTTER. Samuel Gascoigne, 16, Sussex Street 85 per cent. of foreign fat Fined 40s. and 12s. 6d. costs. (See also under " Margarine," 174 S. 517 S. loth September Westminster (Mr. Francis) Arthur M. Mead, 73, Lower Marsh, Lambeth Selling at 63, Buckingham Gate, butter containing 70 per cent. of foreign fat. (Sample taken in course of delivery) Fined 20, and 21s. costs. 108 No. of Sample. Date of Hearing. Court and Magistrate. Name and Address of Defendant. Offence. Result. 1 2 3 4 5 6 1910. 892 N. 9th December 1911 Marlborough Street (Mr. Mead) Winnie Davies, 24, Little Pulteney Street Selling margarine as butter Fined £5 and 14s. 6d. costs. (See also under "Margarine," No. 983 N.) 990 N. 31st January Bow Street (Mr. Marsham) Clara Robinson, (the Coliseum Dairy), 13, Bedfordbury Selling margarine as butter Fined £1 and 12s. &d. costs. 174 S. 1910. 22nd April Westminster (Mr. Horace Smith) MARGARINE. Samuel Gascoigne, 16, Sussex Street Selling margarine without a paper wrapper marked "Margarine " Fined 2s. costs. (See also under "Butter" 174 S.) 983 N. 1911. 13 th January Marlborough Street (Mr. Mead) Winnie Davies, 24, Little Pulteney Street Selling margarine without a paper wrapper marked " Margarine " Fined £3 and 12s. 6d. costs. (See also under "Butter" 892 N.) 108 N. 1910 4th March Marlborough Street (Mr. Mead) BREAD AND BUTTER. Ernest Stevens, 22, St. James's Market, Market Street, W. Bread and butter, the "Butter" of which consisted entirely of margarine Fined 40s. and 15s. costs. | 1910 SAUSAGES. The subjoined prosecutions, Nos. 45 S., 347 N., 348 N., 836 S., 837 S. were cases adjourned in 1909 pending the final appeal re Hayward and MeNair. 45 S. German sausage 10th March ,. Westminster (Mr. Francis) Mrs. Annie Topham, 2, Vincent Street German sausage containing 24.794 grains of boric acid per lb. Fined 10s. and 12s. 6c&. costs. 348 N. Pork sausages 18th March Marlborough Street (Mr. Mead) J. E. Taylor, Ltd., 33, Little Pulteney Street Pork sausages containing 30'8 grains of boric acid per lb. Fined 40s. and 23s. costs. 109 347 N. Beef • sausages 18th March Marlborough Street (Mr. Mead) J.E. Taylor, Ltd., 33, Little Pulteney Street Beef sausages containing 24| grains of boric acid per lb. Fined 40s. and 23s. costs. 837 N. Beef sausages 18th March Marlborough Street (Mr. Mead) George Walker and Francis Walker (Walker Bros.), 47, Glasshouse Street Beef sausages containing 46 grains of boric acid per lb. Fined 40s. and 23s. costs. 836 N. Pork sausages 18th March Marlborough Street (Mr. Mead) George Walker and Francis Walker (Walker Bros.), 47, Glasshouse Street Pork sausages containing 29 grains of boric acid per lb. Fined 40s. and 23s. costs. 261 S. German sausage 26th May Westminster (Mr. Horace Smith) Henry Charles Hebard, 3, Lupus Street, S.W. German sausage containing 19.83 grains of boric acid per lb. Fined 20s. and 12s. 6d. costs. 312 S. Pork sausages 30th June Westminster (Mr. Francis) New Irish Direct Supply, Ltd., 94, Victoria Street Pork sausages containing 34.7 grains of boric acid per lb. Fined 20s. and £1 Is. costs. The defence set up was that the goods were made in Ireland, which rendered this amount of preservative necessary. This defence is not a good one, as the summons was taken out under Section 6 of the Sale of Food and Drugs Act. 124 S. 1910. 28th April Westminster (Mr. Horace Smith) PORK PIE. S. Frost and Co., Ltd., 202, Kennington Park Road, S.E. Selling at Pimlico Road pork pie containing 9.01 grains of boric acid per lb. (24 grains in the meat portion) Fined 10s. and £3 3s. costs. The third sample was referred to Somerset House to be analysed by the Government Analysts. The result practically confirmed the analysis of the Council.s Analyst. — 1911. 13tli January Marlborough Street (Mr. Mead) REFUSAL TO SELL. Jacob Dunn, 28, St. Anne.s Court, W. Refusal to sell milk to Inspector Fined £3 and 12s. 6d. costs. (See also 263 N.) H london ; haeeison and sons, peintees in oedinaey to his majesty, st. maetin.s lane.