WES 25 ANNUAL REPORT on the STATISTICS and SANITARY CONDITION relating to THE CITY OF WESTMINSTER FOE THE YEAR 1911. BY FRANCIS J. ALLAN, M.I)., C.M., D.P.H. CAMB., F.R.S. ED. medical officer of health. Printed by Order of the Council. LONDON: HARRISON AND SONS, PRINTERS IN ORDINARY TO HIS MAJESTY, ST. MARTIN'S LANE, W.C. II TABLE OF CONTENTS. page page Introductory Remarks iii Drainage, Plans, &c 66 Removal of Offensive Refuse 68 PART I Public Conveniences for Women 69 Housing Acts 70 A. Statistics. Houses Let in Lodgings 70 Population 1 Water Supply 72 Births 3 Common Lodging-Houses 73 Notification of Births Act 5 Revenue Act 74 Deaths 11 Smoke Prevention 74 Infantile Mortality 6-11, 13, 23-27, 52 Statistics of Block Dwellings 15 Tables 16-28 D. Workshops. Number on Register 76 B. Communicable Diseases. Defects 77 Smallpox 29 Outworkers 79 Vaccination 33 Laundries 82 Scarlet Fever 33 Diphtheria 34 Typhoid Fever 37 E. Food Supply. Puerperal Fever 38 Inspection 83 Ophthalmia 38 Restaurants and Ice Cream Premises 83 Acute Poliomyelitis 39 Bakehouses 83 Cholera, Plague 39 Certification of Food for Export 84 Glanders 39 Milk shops 84 Tuberculosis 40 Butchers' Shops, Fish Shops 85 Diarrhœal Diseases 51 Food and Market Inspection 85 Measles 56 Butchers' Meat on Stalls 86 Whooping Cough 57 Food Poisoning 87 Schools and Infectious Disease. 58 Sale of Food and Drugs Acts— Bacteriological Laboratory 60 Samples Taken, Result of Analysis Disinfection 60 and Proceedings. 88 Cleansing of Persons 61 Milk. 89 Verminous School Children 61 Cream 94 Verminous Houses 62 Butter 95 Mortuaries 62 Sausages and Meat Pies, &c. 96 Fish 96 PART II Tinned Foods 96 Flour 96 C. Bouse Inspection, &c. Chocolate 97 Defects Remedied 64 Vinegar 97 Legal Proceedings 65 Details of Prosecutions 99-105 Annual Report on the Health and Sanitary Condition of the City of Westminster. 1911. To the Mayor, Aldermen, and Councillors of the City of Westminster. Me. Mayor, my Lord and Gentlemen, I have the honour to submit to you my Annual Report for the year 1911. Returns required by the Local Government Board, and particulars relating to Factories and Workshops required by the Home Office, are incorporated therein. Notwithstanding the prolonged spell of hot weather which occurred in 1911, the health of Westminster as shown by the mortality maintained its high position. Since the formation of the City there has been a progressive improvement in the death-rate. In the previous 10 years the death-rate averaged 18 per 1,000 inhabitants, in the last 10 years the average was 13.6, and in the last 5 years 12.8. Infantile deaths which had been for many years about 164 per 1,000 births have fallen to 115 during the last 10 years. Deaths from tuberculous disease have decreased in number from 413 to 238 (2.26 to 1.49 per 1,000). IV These figures show that the Council in the various departments of its work has been active in promoting improvement of the conditions under which the citizens live and work. Moreover, the many thousands who come into Westminster for employment or amusement must also participate in the benefits which accrue from these improved conditions. 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 Lord and Gentlemen, Your obedient servant, FRANCIS J. ALLAN, Medical Officer of Health. March, 1912. PART I. A. STATISTICS. Population. A census was taken in the Spring of 1911, when it was found that there were 160,261 persons in the City of Westminster on the particular night. Compared with the similar figure at the previous Census in 1901 there has been a net decrease of 22,750 persons, equal to 12.4 per cent. In the previous ten years the rate of decrease was 9.4 per cent.; consequently the yearly estimates of population founded on this rate of decrease continuing throughout the last ten years, have been too high. This difference does not affect the statistics calculated thereon for the first five years of the decade; but in the second half there is a slight increase. I have re-calculated the figures for the last 10 years on this new basis where these are referred to in this Report. For the purposes of the Equalisation of Rates Act, the RegistrarGeneral calculates the population by multiplying the number of inhabited tenements by the average number of persons per tenement as shown by the former Census. Accordingly, as the number of rated occupiers has increased in Westminster, he had estimated the population by this method to be about 15,000 more than is shown by the census to be the case. So far as Westminster is concerned it has not proved a reliable method; this will doubtless be found to be due to changes in the housing conditions. 2 City of Westminster.—Census Population, 1911. Registration Area. Families or Separate Occupiers. Population. Decrease. 1901. 1911. 1901. 1911. St. James and St. Anne 8,459 5,476 33,081 25,445 7,636 Strand 5,254 2,844 21,674 16,859 4,815 13,713 8,320 54,755 42,304 12,451 Mayfair and Knightsbridge 6,155 4,706 28,743 26,188 2,555 Belgrave 13,722 13,080 55,815 51,610 4,205 St. Margaret and St. John 11,273 10,031 43,698 40,159 3,539 The City 44,863 36,137 183,011 160,261 22,750 Ward. 1901. 1911. Decrease. Increase. Estimated to the Middle of 1911. Conduit 5,876 4,273 1,603 .. 4,233 Grosvenor 15,266 14,223 1,043 .. 14,200 Hamlet 7,601 7,692 .. 91 7,715 Knightsbridge 15,657 13,794 1,863 .. 13,748 Victoria 40,158 37,816 2,342 .. 37,758 St. Margaret 13,784 11,302 2,482 .. 11,240 St. John 29,914 28,857 1,057 ... 28,830 St. Anne 11,493 9,286 2,207 .. 9,231 Great Marlborough 7,908 5,277 2,631 .. 5,211 Pall Mall 4,122 3,774 348 .. 3,766 Regent 9,558 7,108 2,450 .. 7,047 Charing Cross 5,755 4,908 847 .. 4,887 Covent Garden 8,917 8,493 424 .. 8,483 Strand 7,002 3,458 3,544 .. 3,370 Totals 183,011 160,261 -22,841 +91 159,719 Total decrease .. •• 22,750 .. .. In the various wards (as shown on the next page) there has been a reduction, with the exception of the Hamlet of Knightsbridge, in which there has been an increase of 91. The greatest reduction has been in the wards comprised in the Strand Borough, the Strand Ward being reduced to less than half of its former sleeping population. The reliability of the figures is affected by the fact that the Census was taken on a Sunday. The habit of leaving London for the weekends is one which has grown considerably, and particularly affects Westminster, and especially certain wards. In the report on the 1871 Census, this was noted as a reason for the decrease in parts of St. George, Hanover Square; it now applies in many other parts of the City. 3 In addition to the persons enumerated in the City, there were 3,082 persons in our poor law institutions situate outside the City. The omission of these does not affect the mortality rates for the City as a whole, but it makes a material difference in the rates for some of the wards in which there are common lodging houses or shelters through which a large number of persons pass to the infirmaries. This is particularly marked in the Strand Ward, and also, though to a less extent, in St. John's Ward. The population in the various workhouses and infirmaries belonging to the City of Westminster, at the Census 1st April, 1911, was distributed thus:— Males. Females. Total. St. George's Workhouse 963 415 1,378 Do. Infirmary 310 315 625 Edmonton 480 210 720 Cleveland Street Infirmary 131 33 164 Hendon Sick Asylum 104 91 195 Total 1,988 1,094 3,082 There were also 434 persons in Poland Street Workhouse, which is in Great Marlborough Ward, who should be distributed among the wards comprised in the Westminster Union. At present, the Registrar-General has only issued a preliminary report, which does not give the full particulars, which will be published later, so that further comparisons must be postponed until next year. The population of London, as ascertained at the Census, is stated to be 4,522,961, a decrease of 13,306 since 1901, equal to 0.3 per cent. As statistics had been calculated on figures obtained by estimating that the previous increase (7.3 per cent.) would continue during the intermediate 10 years, there is therefore a discrepancy in the estimated population during these years; for the past year the difference amounts to 389,426. The rates calculated on these figures are therefore too low. The decrease in population is chiefly in Central London, but nearly all the boroughs except the furthest removed from the centre are similarly affected. The suburban districts show a considerable increase. Births. 2,110 births were registered in the City in the 52 weeks ending 30th December, 1911. On examination, 60 births were found to be referable to other districts. Through the courtesy of the Committees of Management of Endell Street, York Road, Queen Charlotte, and the 4 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 356 children were born in outlying institutions, the home address of whose mothers was in Westminster. Rescue Homes to which the women had been brought from other districts form a proportion of these addresses, and frequently the mother and child return to the Home. The Registrar-General now relegates these births to the districts whence they came, so that the number of outlying births placed to the credit of Westminster is 311. The net number of births was, therefore, 2,361 as compared with 2,592 in 1910. The birth-rate, uncorrected, was 13.2, corrected 14.7 per 1,000 persons. The corrected birth-rate for the five years 1901—5 was 17.1, and for the five years 1906—10, 16.9 per 1,000. The birth-rate for the County of London for 1911 was 24.8, the rate during the preceding ten years averaged 25.8 per 1,000. Westminster had the lowest rate of any Metropolitan City or Borough. In Poplar, Bethnal Green, Bermondsey, Shoreditch, Stepney, and Finsbury the birth-rate was over 30 per 1,000 population. The birth-rate in England and Wales was 24.4; the average of the preceding ten years was 27.2. The birth-rate was again lower than any rate recorded since registration was established. Table I.—'Showing the number of Births in the City of Westminster and its Wards (corrected by distributing Institution Births). Wards. Births (corrected). 1902. 1903. 1904. 1905. 1906. Conduit 46 43 27 30 25 Grosvenor 157 151 148 133 131 Knightsbridge St. George 162 125 164 160 150 Victoria 886 884 862 890 864 St. Margaret 160 162 165 156 141 St. John 953 877 828 908 860 Knightsbridge Hamlet 97 79 77 67 72 St. Anne 278 240 232 242 217 Regent 226 184 143 163 141 Pall Mall 23 22 17 20 18 Great Marlborough 180 162 151 149 137 Charing Cross 26 34 42 38 26 Covent Garden 163 151 156 147 129 Strand 104 71 42 17 20 The City 3,461 3,185 3,054 3,120 2,931 5 Table I.—continued. Wards. Births (corrected). 1907. 1908. 1909. 1910. 1911. Conduit 27 25 19 22 16 Grosvenor 145 143 121 128 123 Knightsbridge St. George 150 152 169 169 146 Victoria 846 870 817 753 748 St. Margaret 152 153 163 124 129 St. John 873 854 765 787 693 Knightsbridge Hamlet 66 80 80 77 66 St. Anne 205 184 173 185 141 Eegent 129 135 104 110 108 Pall Mall 18 12 21 9 10 Great Marlborough 132 124 125 83 60 Charing Cross 34 31 24 16 22 Covent Garden 135 122 131 117 94 Strand 15 28 9 12 5 The City 2,927 2,913 2,751 2,592 2,361 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, but the new figures for making the calculation are not yet available. The reduction is taking place in the legitimate births. Westminster. 1904. 1905. 1906. 1907. 1908. 1909. 1910. 1911. Legitimate Births (net) 2,920 2,971 2,744 2,764 2,739 2,548 2,399 2,195 Illegitimate Births (net) 134 149 187 163 174 203 193 166 During the year notification was received of 1,562 births which took place in Westminster; of these, 55 were stillborn children, whose births are not subsequently registered. 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 70.9 per cent. for the City. The proportion of notified was greater than in previous years (64.8 per cent. in 1909, 68 per cent. in 1910), but the 6 attention of a number of parents had to be called to their failure to notify. The notifications were made by parents in 283 instances, 578 by doctors, 483 by midwives, 218 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 356 births were so received. Further, the Health Society received the names of a considerable number of women expecting to become mothers. Arrangements are made by the visitors for the provision of suitable nurses or for reliable women to look after the homes and family if the mother is going into hospital. Visiting of the families was carried out by Mrs. Watkinson, the Council's Health Visitor, assisted by the staff of voluntary (qualified) workers of the Health Society. Of the 1,562 notified births, 63 were deemed to be above standard and were not visited, 1,454 families (including 4 brought forward from the previous year) were visited, and 49 were carried forward to this year. In addition, there were 461 children whose births were registered in Westminster but not notified, and 356 births, intimation of which came from outlying hospitals. Of these, 743 were visited (some of these births, as mentioned earlier, have been placed to the credit of other districts, although the mother and child have returned to Westminster from hospital. Thus 2,197 mothers (including still-birth cases) were visited during the year. Visiting also took place under the auspices of the Health Society of 1,567 children born in 1910, until they were a year old; thus 3,764 families in which there were young children were visited during 1911. At the end of the year 1,624 names of children who had not attained the age of one year were carried forward for future visiting; 503 families had moved away from Westminster before the infant reached that age. An analysis on the same lines as that printed in last year's report, restricted to children born in 1910, who have been visited throughout 1910 and 1911 has been made. Infants who have 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 two portions. They deal with 986 children and are taken from the Report of the City of Westminster Health Society. Tables A 1 and A 2 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. 7 Tables B 1 and B 2 show the influence of the mother's work on her health, confinement, mode of feeding of the child, and care of home. Table A 1.— West (Knightsbridge, Mayfair, Pimlico, Westminster). Number of Cases. Children's Health. Healthy. Delicate. Dead. Number. Per Cent. Number. Per Cent. Number. Per Cent. 986 Including 39 still-births and 19 deaths (rescue home cases) with insufficient information to include in the general table 660 66.9 122 12.4 204 20.7 947 Excluding the 39 still-births 660 69.7 122 12.9 165 17.4 928 Including 14 sets twins and 1 of triplets a. Housing (type of house)— 260 Block 206 79.3 26 10.0 28 (8) 10.7 598 Tenement 405 67.8 84 14.0 109(20) 18.2 70 Cottage 49 70.0 12 17.1 9 (3) 12.9 5. Housing (sanitary conditions)— 790 Good 597 75.6 81 10.2 112 (23) 14.2 128 Bad 60 46.9 35 27.3 33 (6) 25.8 (90) (Basement) 58 64.4 19 21.1 13 (2) 14.4 10 Unstated c. Poverty— 728 Comfortable 546 75.0 79 10.8 103 (20) 14.1 197 Poor 114 57.8 41 20.8 42 (9) 21.3 3 Unstated -(2) d. Mother's Work— 711 Domestic 533 75.0 76 10.7 102(18) 14.3 32 Working at home 25 78.1 4 12.5 3 (2) 9.4 181 Working out 98 54.2 42 23.2 41 (8) 22.6 4 Unstated -(3) e. Mother's Health— 745 Strong 582 78.1 80 10.7 83(16) 11.1 171 Delicate 78 45.6 40 23.4 53 (10) 31.0 12 Unstated (5) f. Mode of Feeding— 558 Breast 449 80.5 62 11.1 47 8.4 46 Partly a (under 6 weeks) 27 58.7 6 13.0 13 28.3 79 „ b (oyer 6 weeks and under 6 months) 52 65.8 21 26.6 6 7.6 126 Bottle 67 53.2 26 20.6 33 26.2 87 Unstated 32 Died under 1 week g. Care of Child and Home— 816 Good 607 74.4 98 12.0 111(26) 13.6 99 Bad 53 53.5 18 18.2 28 (1) 28.3 13 Unstated (4) * Figures in brackets denote the number still-born which are not reckoned in working out the percentages, 8 Table A 2.—East (Strand and Soho). Number of Cases. Children's Health. Healthy. Delicate. Dead. Number. Per Cent. Number. Per Cent. Number. Per Cent. 272 Including 8 still-births and 1 death with insufficient information to include in general table 180 62.2 49 18.1 43 15.8 264 Excluding the 8 still-births 180 68.2 49 18.6 35 13.2 263 Including 2 sets of twins a. Housing (type of house) — 104 Block 75 72.1 16 15.4 13 (3) 12.5 159 Tenement 105 66.0 33 20.7 21 (3) 13.2 b. Housing (sanitary conditions)— 222 Good 161 72.5 32 14.4 29 (6) 13.0 41 Bad 19 46.3 17 41.5 5 12.1 c. Poverty- 221 Comfortable 160 72.4 32 14.5 29 (5) 13.0 40 Poor 19 47.5 16 40.0 5 (1) 12.5 2 Unstated d. Mother's Work— 167 Domestic work 116 69.5 29 17.4 22 (3) 13.1 53 Working at home 41 77.3 7 1 3. 2 5 (1) 9.5 41 Working out 21 51.2 13 31.7 7 (2) 17.1 2 Unstated e. Mother's Health— 205 Strong 147 71.7 34 16.6 24 (4) 11.7 56 Delicate 32 57.1 15 26.8 9 (2) 16.1 2 Unstated f. Mode of Feeding— 169 Breast 123 72.8 29 17.1 17 10.0 12 Partly a (under 6 weeks) 10 83.3 2 16.7 — — 14 ,, b (oyer 6 weeks and under 6 months) 7 50.0 7 50.0 25 Bottle 16 64.0 6 24.0 3 12.0 32 Unstated 11 Died under 1 week q. Care of the Child and Home 225 Good 164 72.9 33 14.7 28 (6) 12.4 38 Bad 16 42.1 16 42.1 6 15.8 9 Table B 1.— West. Mother's Work. Mother's Health. Confinement. Mode of Feeding. Care of Child and Home. No. of Cases. Strong. Delicate. No. of Cases. Normal. Abnormal. No. of Cases. Breast. Partly a. Partly b. Bottle. No. of Cases. Good. Bad. Domestic— N o. of Cases 704 579 (11) 125 (6) 711 649 (13) 62 (4) 619 445 35 49 90 706 663(14) 43 (2) Per cent. 82.2 17.8 91.3 8.7 71.9 5.6 7.9 14.5 93.9 6.1 Working at home— No. of Cases 31 23 (2) 8.0 32 29(1) 3(1) 26 15 4 2 5 31 29 (2) 2(0) Per cent. 74.2 90.6 9.4 57.7 15.4 7.7 19.2 93.5 6.5 Working out— No. of Cases 177 140 (5) 37 (3) 181 170(5) 11(3) 164 98 7 28 31 178 124 (6) 54(2) Per cent. 79.1 20.9 93.9 6.1 59.7 4.3 17.0 18.9 69.7 30.3 Table B 2.—East. Domestic— No. of Cases 167 131(1) 36 (2) 167 147 (2) 20(1) 138 111 6 7 14 167 147 (3) 20 Per cent. 78.5 21.5 88.0 12.0 80.4 4.3 5.1 10.2 88.0 12.0 Working at home— No. of Cases 53 43 (1) 10 53 51(1) 2 44 29 4 4 7 53 47 (1) 6 Per cent. 81.1 18.9 96.2 3.8 65.9 91 9.1 15.9 88.7 11.3 Working out— No. of Cases 41 31 (2) 10 41 34(2) 7 38 29 2 3 4 41 29 12 Per cent. 75.6 24.4 82.9 17.1 76.3 5.3 7.9 10.6 70.7 29.3 10 The occupations (other than housework) in which the mothers were engaged were as follows:— West. At Home. Out. Needlework 14 Charing 101 Laundry 5 Laundry 13 Helping in shops 5 Service 13 Taking in Lodgers 4 Street Selling 10 Caretaking 3 Waiting 8 Unstated 1 Bottle Washing 5 Dressmaking 4 Book-Keeping 2 Paper Folding 1 Paper Sorting 1 Tailoring 1 Barmaid 1 Upholstering 1 Mid. Wife 1 School Teaching 1 Barber's Assistant 1 Theatre Dresser 1 Typist 1 Unstated 4 32 181 East. At Home. Out. Tailoring 25 Charing 13 Helping in shops 10 Tailoring 10 Caretaking 8 Laundry 8 Laundry 3 Waiting 3 Cigarette making 2 Street selling 3 Taking in Lodgers 2 Programme selling 2 Dressmaking 2 Service 1 Wig making 1 Bookfolding 1 53 41 The following Table in reference to nationality refers to the eastern part of the City and summarises the figures for four years 1907—10:— Number of Cases. Infants at the end of 12 months. Healthy. Delicate. Dead. Per cent. Per cent. Per cent. 932 British 673 72.2 130 13.9 129 13.8 458 Jewish 323 70.5 93 20.3 42 9.1 160 Italian 127 79.3 12 7.5 21 13.1 73 Various 50 68.5 13 17.8 10 13.7 11 In the western half the majority of the inhabitants are of British nationality, and the figures relating thereto are to be found in Table A. From these tables it will be seen that the infant mortality rate of all infants, excluding still-births, is 174 per cent. in the West and 13'2 per cent. in the East. These rates, of course, do not refer to the whole of the infants born in the City of Westminster, but only to those visited by the Society. The delicacy rate in the West is 12.9 per cent., while that in the East is 18.6 per cent. There appears to be an association between a high mortality and a low delicacy rate in the West, and a low mortality and a high delicacy rate in the East. This may be due to the delicate children in the East surviving, while in the West they are killed by the harder conditions of life. In support of this theory, one finds that in the West adverse conditions, such as bad housing, poverty, or ill-health of the mother, affect the mortality rate more and the delicacy rate less than in the East. This seems to be the case only during the early life of the child, for among children of school age the delicacy rate is certainly much higher in the West than in the East, as can be shown by the number of children found to require medical treatment by the school doctor. In schools in the middle of a very poor district in the West, the percentage of such children is found to be higher than in schools situated in the Eastern area. The superior health and low mortality rate of the breast-fed child is very marked in the West, while in the East the contrast between breast-fed and bottle-fed infants is not nearly as marked. This is thought to be probably due to the better conditions under which bottle-feeding is carried out in the East than in the West. In the former case, where the foreign element comes in, good cow's milk is more habitually used; while in the West the infant is frequently fed upon separated milk or skimmed condensed milk, the parents in many cases being unable to afford anything more nourishing. Deaths. 2,286 deaths were registered in the City in the 52 weeks ending the 30th December, 1911. After deducting 1,103 deaths of non-citizens in public institutions in the City, and adding those of 822 citizens who died in other districts, the corrected total is 2,005, and is equivalent to an annual rate of 12.5 per 1,000 persons. The average death-rate for the five years 1901-5 was 14.4, and for the five years 1906-10, 12.8 per 1,000, and for the ten years was 13.6. The London death-rate for 1911 was 15.0, the average for the previous five years being 14.9, and for England and Wales 14.6, being c 2 12 1.1 above the 1910 rate, but 08 below the average rate of the previous ten years. Table V shows the vital statistics of the City and five groups of districts from 1901 to 1911. The Registrar-General has adopted a new system, whereby deaths of inhabitants of a sanitary district, occurring anywhere in England and Wales, are allocated to the proper district. Hitherto, only deaths in and around London have been so allocated. Deaths of persons whose usual place of residence was not in England or Wales are to be taken as deaths belonging to the district in which they die. In both of these ways the number of deaths allocated to Westminster has been increased, by 42 under the former and by 21 under the latter rule, equal to nearly 0.4 per 1,000. Deducting this figure in order to compare the 1911 death-rate with previous years, brings the rate down to a little below the average of the previous five years. As usual there was a number of deaths of persons in the various poor law institutions who were homeless or whose home address was unknown; in 1911 there were 156 such. The death-rates, according to the old districts of the City, are:— District. Average of Previous 10 Years. 1911. St. George 12.1 12.0 West minster 16.5 16.1 St. James and St. .Anne 12.6 12.5 Strand and St. Martin 15.5 15.0 The City 13.9 12.5 Cause of death at all Ages.—These are set forth in Table III, and also their distribution in the various Wards of the City. Deaths in 1911 exceeded those recorded in 1910 from old age (by 39), cancer (by 30), whooping-cough (by 10), diseases of the digestive system, including diarrhoea (by 15), diseases of the kidney (by 15), various forms of tuberculosis (by 7), alcoholism (by 7), meningitis and convulsions (by 12), accidents caused 7 more deaths, but suicides were 11 less; disease of the heart and blood vessels, developmental affections of children, erysipelas, diphtheria, and enteric fever were each less; diseases of the respiratory system accounted for about the same number of deaths as in 1910, but pneumonias were 64 more, while bronchitis and other forms of lung disease were 60 less. Ages at Death.-—Deaths were more at each age period than in 1910, 13 chiefly by 29 under 1 year of age, 31 between 1 and 5, and 51 between 25 and 65. According to Wards, increases were greatest in Grosvenor, Knightsbridge St. George, St. John, and Covent Garden. Conduit, the Hamlet, Great Marlborough and the Strand Wards each showed a small decrease. The distribution of deaths under 1 and over 65 years is shown below:— 1911. Wards. Under 1 Year of Age. Over 65 Years op Age. 1st Quarter. 2nd Quarter. 3rd Quarter 4th Quarter. The Year. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. The Year. Conduit - - - - - 1 2 5 1 9 Grosvenor - 3 2 2 7 7 16 10 15 38 Hamlet of Knightsbridge - 1 2 - 3 7 6 2 5 20 Knightsbridge St. George 1 1 4 1 7 11 13 7 15 46 Victoria 16 26 31 15 88 51 42 37 45 175 St. Margaret - 3 4 5 12 6 7 7 6 26 St. John 21 11 31 19 82 46 43 33 33 155 St. Anne 1 1 2 4 8 11 3 10 7 31 Great Marlborough 3 - 1 - 4 6 8 4 7 25 Pall Mall - - 1 1 2 2 - 5 5 12 Regent 1 3 2 5 11 9 4 6 5 24 Charing Cross - 2 - - 2 2 3 4 3 12 Covent Garden 3 4 7 2 16 11 12 11 6 40 Strand 1 1 - - 1 12 8 9 6 35 The City 1911 47 55 87 54 243 182 167 150 159 658 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 68 106 67 323 193 170 119 182 664 Infantile Mortality.—The uncorrected death rate of infants for Westminster was 115 deaths per 1,000 births registered in the City, against a rate of 130, the average of the previous ten years. The corrected rate works out at 102.9, the average of the previous five years having been 98.5, and of the ten years, 1901-10, 110. On deducting the births and deaths of illegitimate children, among whom the mortality is always high, it will be seen below that the infant deathrate among legitimate infants was 125 per 1,000 births in 1902, and fell gradually to 91 in 1909; in 1910 there was a large fall to 78, but for 1911, the rate has gone up again to 91. Figures for both births and deaths of infants corrected, showing the true rate in each of the last ten years are given on the next page. 14  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 1903 3,035 345 113 150 25 166 116 1901 2,920 320 109 134 40 298 118 1905 2,971 305 102 149 24 161 105 1906 2,744 285 103 187 38 203 110 1907 2,764 269 97 163 34 208 103 1908 2,739 266 97 174 27 155 100 1909 2,548 232 91 203 26 128 93 1910 2,393 189 78 193 25 129 82 1911 2,195 210 91 166 33 198 102 1911. Legitimate. Illegitimate. Total Kate. Births. Deaths. Death rate per 1,000 births. Births. Deaths. Death rate per 1,000 births. Victoria Ward 683 78 114 65 10 153 117 St. Margaret and St. John 763 78 102 59 16 271 114 Best of City 749 54 72 42 7 166 77 Meteorological conditions were responsible to some extent for the decrease since 1902, especially in 1910, and for the rise in 1911. In view of the excessive heat and drought in the summer, a high infantile mortality was to be expected in the usual course of events, and for all London the rate went up from 102 in 1910 to 129 per 1,000, the average of the years 1906-10 being 114; for England and Wales the rate was 130, compared with 106 the rate for 1910, and 127 the ten yearly average. The climatic conditions of 1911 were a severe test of the work which has been done in past years in visiting mothers and giving advice on the rearing of infants, and the result may fairly be claimed as proof of the practical value of health visiting and of the lines on which the work has been carried out. This is especially shown in the eastern part of the City, including Soho, where health visiting has been longest in operation. Tables VI, VIa and VIb show the causes of death of infants in the City as a whole, and separately in Victoria Ward and St. Margaret and St. John Wards. Whooping cough and premature births are responsible for an increase in the number of deaths in Victoria, while digestive troubles caused an increase in St. Margaret and St. John. Table VII 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. 15 The causes of death in each year are given, together with the relative proportion each group bears to the whole of the infant deaths. Statistics of Dwellers in Block Dwellings.—These are set out in Table VIII. A comparison of the births and deaths in the Council's Buildings in Regency Street during the last seven 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 44 38.0 12 10.3 99 1910 1,120 37 33.0 8 7.1 108 1911 1,063 37 34.8 19 17.8 81 The 19 deaths included five of old people. Statistics relating to the various dwellings of the Peabody Trust in Westminster have been got out for the ten years 1901-1910. I subjoin a general summary. Years. Population. Birth rate. Death rate. Deaths under 1 per 1,000 births. Deaths from Diarrhœa, Deaths from Phthisis. Other Tuberculosis. Peabody Avenue 1901-5 2,086 33.87 13.71 141 0.67 1.34 0.38 1906-10 2,062 25.89 11.63 86 0.29 1.64 0.67 Buckingham Gate 1901-5 533 19.38 18.76 193 1.12 2.25 0.37 1906-10 517 26.26 21.66 185 1.16 1.16 0.77 Orchard Street 1901-5 1,358 22.80 14.13 107 0.14 1.32 0.44 1906-10 1,307 25.70 11.62 71 0.15 0.76 1.07 Old Pye Street 1901-5 886 37.99 16.25 108 0.90 2.25 0.22 1906-10 861 33 .44 15.09 62 0.46 2.55 0.23 Wild Street 1901-5 1,332 33.28 16.06 120 0.60 1.81 0.90 1906-10 1,30a 25.90 14.09 118 0.76 1.53 0.91 Bedfordbury 1901-5 553 13.26 14.46 91 0.00 1.08 1.08 1906-10 535 16.82 15.70 66 0.00 1.56 0.37 City of Westminster 1901-5 17.1 14.4 118 0.48 1.67 0.39 1906-10 15.6 12.8 98.5 0.31 1.30 0.32 From a consideration of these figures the Trustees have agreed to make some radical improvements in certain of their older blocks of buildings. These were not built by the Trust but were taken over by them. 16 Table II.— Vital Statistics of Whole Districts during 1911 and previous years. City of Westminster. 1 2 3 4 5 6 7 8 9 10 11 12 13 Year. Population Estimated to Middle of each Year. Births. Total Deaths Registered in the District. Transferable Deaths† Nett Deaths belonging to tbe District. Under 1 Year of Age. At all Ages. N umber (Uncorrected). Nett. Of NonResidents Registered in the District. Of Residents not Registered in the District. Number.* Rate. Number.* Rate per 1,000 Nett Births. Number.* Rate. Number. Rate. 1906 170,652 2,766 2,931 17.1 2,482 14.5 1,045 790 323 110 2,227 13.0 1907 168,396 2,732 2,927 17.3 2,396 14.2 992 833 303 103 2,237 13.3 1908 166,170 2,665 2,913 17.5 2,437 14.6 1,089 829 293 100 2,177 13.1 1909 163,974 2,520 2,751 16 .7 2,406 14.6 1,091 881 258 93 2,196 13.3 1910 161,803 2,365 2,592 16.0 2,164 13.3 1,023 750 214 82 1,891 11.6 1911 159,709 2,110 2,361 14 .7 2,286 14.3 1,103 822 243 102 2,005 12.5 * 111 Column 6 are included the whole of the deaths registered during the year as having actually occurred within the distric t. In Column 12 is entered the number in C0olumn 6, corrected by subtraction of the number in Column 8 and by addition of the number in Column 9. Deaths under 1 year of age in Column 10 are similarly corrected. Rates in Columns 5, 7, and 13 are calculated per 1,000 of estimated population corrected from the 1911 Census. † "Transferable Deaths" are deaths of persons who, having a fixed or usual residence in England or Wales, die in a district other than that in which they resided. The following special cases arise as to Transferable Deaths:— (1.) Persons dying in institutions for the sick or infirm, such as hospitals, lunatic asylums, workhouses, and nursing homes (but not almshouses), must be regarded as residents of the district in which they had a fixed or usual residence at the time of admission. If the person dying in an institution had no fixed residence at the time of admission, the death is not transferable. If the patient has been directly transferred from one such institution to another, the death is transferable to the district of residence at the time of admission to the first institution. (2.) The deaths of infants born and dying within a year of birth in an institution to which the mother was admitted for her confinement should be referred to the district of fixed or usual residence of the parent. (3.) Deaths from violence are to be referred (a) to the district of residence, under the general rule; (b) if this district is unknown, or the deceased had no fixed abode, to the district where the accident occurred, if known; (c) failing this, to the district where death occurred, if known ; and (d) failing this, to the district where the body was found. Total population at all ages 160,2611 Area of District in acres (exclusive of area covered by water) 2,502.7 Number of inhabited houses At Census of 1911. Average number of persons per house 17 Table II.—continued. I. Institutions within the District receiving Sick and Infirm Persons from outside the District. (Total Number of Deaths in brackets.) II. Institutions outside the District receiving Sick and Infirm Persons from the District. II—continued. Institutions outside the District receiving Sick and Infirm Persons from the District. St. George's Hospital (320). Middlesex Hospit al. St. Catherine's Hospital, Ramsgate. Westminster Hospital (250). St. Thomas's Hospital. Charing Cross Hospital (208). St. Bartholomew's Hospital. Battersea General Hospital. Kind's College Hospital (191). St. Mary's Hospital. Taunton Hospital. St. Peter's Hospital (25). German Hospital. General Hospital, Tunbridge Wells. Grosvenor Hospital (11). Guy's Hospital. Heart Hospital, Sobo Square (15). Freidenheim Hospital. Cottage Hospital, Paignton. Endell Street Lying-In Hospital. New Hospital for Women. Women's Hospital, Soho Square (15). East London Hospital. Italian Hospital. St. George's Infirmary, Fulham Road. Throat Hospital, Golden Square (10). Great Northern Hospital. French Hospital. Chelsea Infirmary. Gordon Hospital (6). Victoria Hospital. Marylebone Infirmary. Queen Alexandra Military Hospital, Millbank (33). General Lying-In Hospital, York Road. Marylebone Workhouse. Bermondsey Workhouse. St. George's Workhouse, Wallis Yard (3). West London Hospital. Edmonton Workhouse. Great Ormond Street Children's Hospital. St. Giles' Workhouse. Poland Street Workhouse (17). St. George's Workhouse, Fulham Road. Cancer Hospital, Chelsea. Sheffield Street Workhouse (11). University College Hospital. Staines Union Infirmary. Hospital of St. John and St. Holborn Workhouse. 22, George Street, Hanover Square, Nursing Home (4). Elizabeth. Central London Sick Asylum, Cleveland Street. South-Western Fever Hospital. Infants' Hospital (79). Central London Sick Asylum, Hendon. Lock Hospital (2). London Fever Hospital. Royal Eur Hospital (2). Brook Fever Hospital. Banstead Asylum. 42, Belgrave Road (1). Northern Fever Hospital. Bethlehem Asylum. 24, Chapel Street (2). Park Fever Hospital. Long Grove Asylum. King Edward's Hospital (2). Grove Fever Hospital. Cane Hill Asylum. 2, Caledonia Place (1) North-Western Fever Hospital. Caterham Asylum. 112, Grosvenor Road (2) Claybury Asylum. Quinton Polyclinic (27) Western Fever Hospital. Colney Hatch Asylum. Royal Free Hospital. Darenth Asylum. Home Hospital, Fitzroy Square. Hanwell Asylum. Horton Asylum. London Temperance Hospital Evelina Hospital. Leavesden Asylum. Tooting Bee Asylum. St. Joseph's Hospital, Chiswick. Manor Asylum. Dartford Heath Asylum. London Lock Hospital. Belmont Asylum. Hampstead General Hospital. Bethnal House Asylum. Sussex Hospital, Brighton. City of London Asylum, Stone Essex County Asylum. III. Other Institutions, the Deaths in which have been distributed among the several wards in the City. Ill — continued. Other Institutions, the Deaths in which have been distributed among the several wards in the City. Ill—continued. Other Institutions, the Deaths in which have been distributed among the several wards in the City. St. Luke's House, Pembridge Square. 1, Highbury Terrace. 51, Warrington Crescent. 7, Knaresboro' Place. 26, Holland Park Gardens. 7, Mandeville Place. 20, Stamford Road, Fulham. 10, Russell Square. St. Peter's Home, Kilburn. 4, Dorset Square. H.M. Prison, Brixton. St. Joseph's Hospice, Hackney. 3, Devonshire Terrace. Home for Jewish Incurables, Tottenham. 18, Langham Street. 130, Albany Street. [0, Rosslyn Hill. St. Mary's Convent, Chiswick 21,Wontner Road,Streatham. 26, Belsize Avenue. 18 Table III.—Causes of, and Ages at, Death during the 52 weeks ending 30th December, 1911. Causes of Death. Corrected Deaths in the City at subjoined Ages. Deaths in Wards (at all Ages). All ages. Under 1. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 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 24 3 10 8 1 - 1 1 - 1 5 - 3 6 1 3 1 - - 2 1 1 - Scarlet fever 4 - 1 1 2 - - - - - - - - - - 3 - 1 - - - - - Influenza 15 - - - - - 1 5 9 - 3 - 2 4 1 2 1 - - 1 1 - - Whooping cough 29 17 7 4 1 - - - - - - - - 14 - 15 - - - - - - - Diphtheria, Memb. croup 14 2 3 5 3 1 - - - - 1 - 3 1 - 2 1 2 - 1 - 1 2 Cerebro-spinal meningitis 1 - - 1 - - - - - - - - - - 1 - - - - - - - - Enteric fever 4 - - - - 3 - 1 - - - - - 2 1 - - - - - - - 1 Infective diarrhoea 47 37 4 1 - 1 - 2 2 - - 1 3 13 2 16 4 - 1 2 1 2 2 Enteritis 27 12 4 - 1 1 3 3 3 - 1 1 - 12 1 6 2 - - 2 - 2 - Erysipelas 2 - - - - - - 1 1 - - - - 1 1 - - - - - - - - Puerperal fever 4 - - - - - 4 - - - - - -- 1 - 1 1 - - 1 - - - Other septic diseases 15 - 1 1 1 2 3 6 1 - 2 - - 3 1 6 - - 1 1 - - 1 Syphilis, &c. 7 4 - - - - 1 2 - - - - - 5 - 1 - 1 - - - - - Diabetes 15 - - - - - 1 7 7 - - 1 - 3 1 3 2 - - 1 - 3 1 Rheumatic fever 10 - - - 3 - 4 3 - - 4 1 - 2 - 1 - - - - - 1 1 Tuberculosis of meninges 28 2 9 6 3 4 3 1 - - 2 - - 9 3 6 4 - - 1 1 2 - Tuberculosis of lungs 191 1 1 - 4 21 86 58 20 - 3 4 9 52 11 55 15 4 2 8 3 11 14 19 Tuberculosis of peritoneum 6 2 1 1 - — 1 1 - - - - - 2 - 4 — - — — — — - Other forms of tuberculosis 13 3 1 1 1 1 2 3 1 — - - - 4 1 6 - 1 - - - - 1 Malignant growths 206 — — — — 1 25 101 79 7 14 4 14 61 11 36 11 4 5 9 4 16 10 Premature birth 51 51 — — — - - - - - 3 - 2 19 3 11 2 1 - 4 — 6 — Developmental diseases 49 46 2 1 - - - - - - 1 1 1 17 3 21 1 - - - — 4 - Old age 140 - — — - - - 4 136 1 5 4 9 40 3 45 3 4 3 1 - 10 12 Meningitis and convulsions 23 9 4 5 — 3 — 1 1 — 2 1 3 7 - 7 1 1 - - - 1 - Loc Ataxia and general paralysis 16 — — — — — 10 6 — — — — 1 5 1 4 3 - - - - - 2 Other diseases of nervous system 61 - — — — 1 7 22 31 — 4 4 4 17 4 11 1 3 1 4 1 2 5 Valvular diseases of heart 73 — — 1 1 3 16 25 27 2 3 3 4 17 1 17 8 4 - 3 4 6 1 Other circulatory diseases 240 — — — — 2 19 94 125 2 18 9 16 64 19 50 14 11 4 12 8 12 3 Bronchitis 150 16 2 1 — — 4 44 83 1 6 - 7 43 7 37 11 11 1 6 1 8 9 Broncho-pneumonia 69 22 11 8 2 — 4 6 16 — 3 - - 13 2 34 4 1 - 4 - 5 3 Pneumonia, other forms 93 3 2 2 2 4 15 34 31 1 5 5 6 23 6 25 1 4 2 3 4 4 4 Other respiratory diseases 17 — — — 1 1 3 8 4 1 3 1 - 6 2 2 1 - - - - 1 - Alcoholism 22 — — — — — 9 13 — — 2 1 1 5 2 4 2 1 1 - - 3 - Cirrhosis of liver 33 — — — — — 7 19 7 1 2 1 3 10 2 5 2 1 2 - 1 1 2 Appendicitis and typhlitis 16 — — — 3 1 5 6 1 - 4 - - 2 3 2 1 - 2 3 - - - Other digestive diseases 52 2 — 2 — 1 15 19 13 — 2 3 3 12 4 17 - 2 2 - 1 5 1 Bright's disease, &c. 108 1 1 1 — 5 10 51 39 2 6 3 11 26 2 24 10 1 - 8 2 6 5 Generative system diseases 7 — — — — — 4 2 1 1 1 1 - 1 - 2 - 1 - - - - - Accidents and diseases of parturition 4 — — — — 1 3 - - — - 1 — — — 2 1 - - - - - - Deaths by accident or negligence 63 4 2 2 3 8 16 18 10 2 5 3 5 15 5 15 1 2 2 1 1 3 3 Deaths by suicide and murder 20 1 - - — 2 6 9 2 - 1 - 1 4 2 4 2 1 1 1 2 - 1 Other defined diseases 35 5 — 1 4 1 7 9 8 — - - 3 10 2 5 4 1 1 2 2 4 1 Diseases, ill defined or unknown 1 — — — — — — 1 — — — — - — — - — — — — 1 — - All causes 2,005 243 66 53 36 68 295 586 658 22 111 53 114 551 109 510 115 63 32 81 39 120 85 20 Table IV.—Deaths of Citizens daring the Year ending 30th December, 1911, 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 10 6 16 - - - 2 2 4 1 - 1 - 1 1 - - - 13 9 22 Grosvenor 37 31 68 9 2 11 4 11 15 — 2 2 — — — 13 2 15 63 48 111 Hamlet of Knightsbridge 15 23 38 5 2 7 2 4 6 — — — — — — 2 — 2 24 29 53 Knightsbridge St. George 29 39 68 9 5 14 16 7 23 — 1 1 2 2 4 2 2 4 58 56 114 Victoria 135 140 275 72 67 139 49 35 84 5 2 7 19 10 29 12 5 17 292 259 551 St. Margaret 28 25 53 9 8 17 9 12 21 — 1 1 3 1 4 8 5 13 57 52 109 St. John 98 91 189 107 75 182 66 35 101 9 1 10 9 4 13 10 5 15 299 211 510 St. Anne 24 23 47 14 13 27 22 8 30 — 1 1 3 2 5 3 2 5 66 49 115 Great Marlborough 6 15 21 7 11 18 3 5 8 1 2 3 6 4 10 3 — 3 26 37 63 Pall Mall 14 4 18 1 4 5 3 2 5 — — — — - — 4 — 4 22 10 32 Regent 25 14 39 11 6 17 11 7 18 — 1 1 2 2 4 2 - 2 51 30 81 Charing Cross 12 7 19 5 1 6 6 4 10 — - — 1 1 2 2 - 2 26 13 39 Covent Garden 27 26 53 19 6 25 14 12 26 — 1 1 6 7 13 1 1 2 67 53 120 Strand 7 2 9 46 15 61 3 1 4 1 1 2 4 3 7 2 — 2 63 22 85 City of Westminster 467 446 913 314 215 529 210 145 355 17 13 30 55 37 92 64 22 86 1,127 878 2,005 21 Table V (L.G.B. Table).— Vital Statistics of Separate Localities, 1901-1911. 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, Pall Mall and St. Anne's Wards. 5. Strand, comprising Covent Garden, Strand, and Charing Cross Wards. Year. ! Population estimated to middle of each year. Births registered (uncorrected). Deat hs 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 1 year. Population estimated to middle of each year. Births registered (uncorrected). Deaths at all ages (corrected). Deaths under 1 year. 1901 182,492 3,241 2,900 435 76,778 1,199 1,007 156 51,210 1,124 871 151 32,864 742 498 83 21,538 387 425 43 1902 179,981 3,284 2,952 442 76,065 1,205 1,074 143 50 855 1,153 1,007 163 32,014 644 500 87 21,004 283 371 49 1903 177,602 3,017 2,419 370 75,359 1,156 833 135 50,502 1,071 824 143 31,184 543 440 63 20,483 247 322 29 1904 175,254 2,897 2,376 360 74,660 1,183 886 139 50,152 985 813 150 30,376 489 365 43 19,975 240 312 28 1905 172,938 2,940 2,347 329 73,967 1,162 868 115 49,804 1,057 857 138 29,589 533 353 50 19 479 188 269 26 1906 170,652 2,766 2,227 323 73,280 1,150 868 124 49,459 973 789 124 28,823 513 334 58 18,996 179 236 17 1907 168,396 2,732 2,237 303 72,601 1,101 905 95 49,116 998 778 142 28,077 437 308 47 18 524 196 246 19 1908 166,170 2,665 2,177 293 71,927 1,076 878 111 48,776 993 688 117 27,349 416 323 42 18,065 180 288 23 1909 163,974 2,520 2,196 258 71,260 1,038 843 104 48,437 930 771 94 26,641 384 343 46 17,617 168 239 14 1910 161,803 2,365 1,891 214 70,598 958 759 74 48,101 893 640 100 25,951 358 267 30 17,180 156 225 10 Averages of 10 year 1901-1910 171,926 2,842 2,372 332 73,649 1,122 892 119 49,641 1,017 803 132 29,286 505 373 54 19,286 222 293 25 1911 159,709 2,110 2,005 243 69,943 924 798 102 47,768 797 672 97 25,279 268 291 25 16,753 121 244 19 22 Table V, continued.— Vital Statistics of Separate Localities, 1901-1911.—Rates. Localities 1, City of Westminster. 2. St. George's. 3. Westminster. 4. St. James. 5. Strand. Year. Births Registered (uncorrected). Rate per 1,000. Deaths at all Ages (corrected). Rate per 1,000. Deaths under 1 Year. Rate per 1,000 Births (uncorrected). Births Registered (uncorrected). Rate per 1,000. Deaths at all Ages (corrected). Rate per 1,000. Deaths under 1 Year. Rate per 1,000 Births (uncorrected). Births Registered (uncorrected). Rate per 1,000. Deaths at all Ages (corrected). Rate per 1,000. Deaths under 1 Year. Rate per 1,000 Births (uncorrected). Births Registered (uncorrected). Rate per 1,000. Deaths at all 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). 1901 17.7 14.6 134 15.6 13.1 130 21.9 17.0 134 22.5 15.1 111 17.9 19.7 72 1902 18 .2 16.4 134 15.8 14.1 119 22.6 19.7 141 20.1 15.6 135 13.4 17.6 136 1903 16.9 13.6 122 15.3 11.o 116 21.2 16.3 133 17.3 14.1 116 12.0 15.7 110 1904 16.5 13.5 124 15.8 11.8 117 19.6 16.2 152 16.1 12.0 87 12.0 15.6 69 1905 17.0 13.5 111 15.7 11.7 99 21.2 17.2 131 18.0 11.9 93 9.6 13.8 92 1906 16.2 13.0 116 15.6 11.8 100 19.6 15.5 127 17.8 11.5 113 9.4 12.4 115 1907 16.2 13.2 110 15.1 12.4 86 20.3 15.8 142 15.5 10.9 107 10.5 13.2 94 1908 16.0 13.1 109 14.9 12.2 103 20.3 14.1 117 15.2 11.8 100 9.9 15.9 104 1909 15.3 13.3 102 14.5 11.8 100 19.2 15.9 101 14.4 12.8 119 9.5 13.5 149 1910 14.6 11.6 90 13.5 10 .7 77 18.5 13.3 111 13.7 10.2 83 9.0 13.0 100 Average of 10 years 16.4 13.5 115 15.1 12.0 104 20.4 16.1 128 17.0 12.5 106 11.3 15.0 104 1901-10 1911 13.2 12.5 115 13.2 11.4 110 16.6 14.0 121 10.6 11.5 93 7.2 14.5 71 23 Table VI.— Infantile Mortality during the year 1911. 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 - - - - - - - - - - 1 - - - - - 1 Measles - - - - - - - - - - - 1 2 — — — 3 Scarlet fever - - - - - - - - - - - - - - - - - Diphtheria (including membranous croup) - - - - - - - 1 - - - - - - - 1 2 Whooping cough - - - - - 1 — 2 1 3 — 1 1 3 4 1 17 Diarrhœa diseases— Diarrhoea, all forms - - — 1 1 3 5 6 2 4 1 8 1 3 2 1 37 Enteritis, muco- enteritis, - 1 — — 1 1 2 2 — 2 1 — 2 1 — — 12 gastro-enteritis Gastritis, gastro-intestinal catarrh Wasting diseases— Premature birth 38 5 1 1 45 5 1 - - - - - - - - - 51 Congenital defects 1 1 2 — 4 3 — 1 — 1 1 — 1 — 1 — 12 Injury at birth 6 - — — 6 — — — — — - — — — — — 6 Debility from birth 6 — — 2 8 1 — 1 1 - - - - - - - 11 Atrophy, debility, marasmus0 - 1 1 2 1 3 2 2 1 — 2 — 1 — 14 Tuberculous diseases— Tuberculous meningitis - — — — — — — — — — — 1 — 1 — — 2 Tuberculous peritonitis, tabes mesenterica - - - - - - - - - - - - - - - - 2 Other tuberculous diseases — — — — — 1 — — — — — — — 1 — 2 4 24 Table VI.—continued. 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. j 1—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. Other causes— Erysipilas - - - - - - - - - - - - - - - - - Syphilis 2 1 — — 3 1 - - - - - - - - - - 4 Rickets — — — — — — — — — 1 — — — — 1 - 2 Meningitis (not tuberculous) - - - - - 1 1 - - 1 1 - 1 - - - 5 Convulsions — 1 — — 1 i 1 — — 1 — — — — — - 4 Bronchitis — 1 1 1 3 3 5 1 — - — — 1 2 - 1 16 Laryngitis — — — — - - - - - - - - - - - - - Pneumonia — — 1 — 1 5 4 2 1 3 3 2 1 — 2 1 25 Suffocation, overlying — — — — - — — — — — — — — — — — - Other causes 1 2 — — 3 — — 2 2 2 2 1 1 — — — 13 54 12 6 6 78 27 23 20 8 20 11 14 13 11 11 7 243 Population, estimated to middle of 1911, 159,709. Births in the year—Legitimate, 2,195 ; illegitimate, 166—Total 2,361. Deaths in the year of legitimate infants, 210; illegitimate infants, 33—Total 243. Deaths from all causes at all ages, 2,005. The causes of death of the illegitimate children were: prematurity, 8; debility at birth, 2; congenital defects, 1 injury or want of attention at birth, 2; diarrhoea, 6; enteritis, 2; pneumonia, 1; whooping cough, 1; syphilis, 1; otitis media, 1; measles, 1; marasmus, 3; bronchitis, 2 ; tuberculosis, 2. 25 Table VIa, continued.— Infantile Mortality during the year 1911. 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. 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 Whooping cough - - - - - - - 1 1 2 - — — 2 1 — 7 Diarrhoea, all forms - - - - - - 2 2 1 3 — 5 — 2 1 — 16 Enteritis, muco - enteritis, gastro-enteritis - - - - - 1 1 1 - 1 1 - - - - - 5 Premature birth 12 — 1 - 13 1 - - - - - - - - - - 14, Congenital defects - 1 1 — 2 2 - 1 - 1 - - - - - - 6 Injury at birth 1 - - - 1 - - - - - - - - - - - 1 Debility at Birth 4 - - 1 5 - - - - - - - - - - - 5 Atrophy, debility, marasmus - - - 2 2 - - 1 - 2 1 — 2 — 1 - 9 Tuberculous peritonitis, tabes - - - - - - 1 - - - - - - - - - 1 Meningitis — — — — - — 1 — — — 1 — — — — — 2 Syphilis - - - - - 1 - - - - - - - - - - 1 Convulsions - - - - - - - - - 1 - - - - - - 1 Bronchitis — — 1 — 1 2 2 — — — — — 1 1 — 1 8 Pneumonia — — 1 — 1 3 1 — — 2 — 1 — — — 1 9 Rickets — — — — — — — — — — — — — — — 1 1 Tubercular - - - - - - - - - - - - - - - 1 2 Other causes — 1 — — 1 — — 1 2 1 - - - - - - 5 17 2 4 3 26 10 8 7 4 13 3 8 3 5 3 4 94 Population, estimated to middle of 1911, 40,070. Births in the year— Lgitimate, 763 ; illegitimate, 59. Total 822. Deaths in the year of legitimate infants, 78; illegitimate infants, 16. Deaths from all causes at all ages, 619. 26 Table VIb, continued.—Infantile Mortality during the year 1911. 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. 1—5 Months. 5—(5 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 Whooping Cough - - - - - 1 - 1 — 1 - 1 1 1 3 1 10 Diarrhœ, all forms - - - - - - 2 2 1 - 1 1 1 1 1 1 11 Enteritis, rnuco - enteritis, gastro-enteritis - - — — — — 2 — — — — — 1 1 — — 4 Premature birth 11 3 — 1 15 3 1 - - - - - - - - - 19 Congenital defects — — 1 — 1 1 - - - - - - 1 - - - 4 Injury at birth 2 — — — 2 — — — — — — — —- - - - 2 Debility from birth 1 — — 1 2 1 — 1 1 - - - - - - - 5 Atrophy, debility, marasmus - - - - - 1 1 1 - - - - - - - - 3 Tuberculous peritonitis, tabes mesenterica - - - - - - - - 1 - - - - - - - 1 Other tuberculous disease - - - - - 1 - - - - - - - 1 — 1 3 Syphilis 1 1 - 2 - - - - - - - - - - - 2 Meningitis (not tuberculous) — — — — — 1 — — — - - - - 1 - - 2 Bronchitis — 1 — — 1 1 3 - - - - - - - - - 5 Pneumonia - - - - - - 1 1 1 — — 1 1 — 1 6 Dentition - - - - - - - - - 1 1 - - - - - 2 Convulsions — 1 — — 1 — 1 — — — — — — — — — 2 - - - - - - - - - - - - - - - - 1 Other causes — 1 — — 1 — — . 1 — — 1 1 1 — — — 5 15 7 1 2 25 10 11 7 4 3 3 4 7 5 6 3 88 Population, estimated to middle of 1911, 37,758. Births in the year—Legitimate, 683 ; illegitimate, 65, Total 748. Deaths in the year of legitimate infants, 78 ; illegitimate infants, 10. Deaths from all causes at all ages, 551. 27 Table VII.— Deaths of Infants under 12 months old per 1,000 lorn (corrected figures). Age at Death. 1906. 1907. 1908. 1909. 1910. 1911. No. Bate. No. Rate. No. Eate. No. Rate. No. Rate. No. Rate. Under 1 week 64 21.8 85 29.1 66 21.2 57 20.8 53 20.4 54 22.8 ,, 1 month 120 41.0 126 43.1 105 38.3 99 35.9 78 30.1 78 33 .0 ,, 3 months 195 66.6 182 62.3 166 60.5 143 51.9 127 49.0 128 54.2 3 to 6 months 53 18.1 57 19.4 47 16.1 53 19.2 46 17.7 48 20.3 6 „ 9 „ 46 15.8 30 10.3 50 17.1 36 13.0 21 8.1 38 16.1 9 „12 „ 29 9.9 31 11.5 30 10.2 26 9.5 20 7.7 29 12.2 Total in year 323 110.4 303 103.5 293 100 5 258 93.8 214 82.6 243 102.9 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 infectious diseases 12 3.7 17 5.5 17 5.8 19 7.3 16 7.4 23 9.4 Diarrhceal diseases 76 23.5 30 9.9 35 11.9 27 10.4 27 12.6 50 20.5 Premature births and injury, &c., at birth 72 22.5 96 31.6 93 31.7 90 34.8 81 37.8 80 32.9 Did not thrive—wasting—want of milk—rickets 50 15.4 43 14.0 52 17.7 38 14.7 18 8.4 15 6.1 Tuberculous diseases 18 5.5 15 4.9 14 4.7 11 4.2 8 3.7 8 3.3 Erysipelas and other septic diseases 10 3.0 9 2.9 3 1.0 4 1.5 4 1.9 — — Syphilis 7 2.1 12 3.9 7 2.3 10 3.8 9 4.2 4 1.6 Meningitis, convulsions 13 4.0 11 3.6 8 2.7 9 3.4 5 2.3 9 3.9 Bronchitis and pneumonia 44 13.6 56 18.4 52 17.7 36 13.9 33 15.4 41 16.8 Suffocation—overlying, &c. 6 1.8 6 1.9 6 2.0 3 1.1 5 2.3 — — Other causes 15 4.6 4 1.3 6 2.0 11 4.2 8 3.7 13 5.3 323 100.0 303 100.0 293 100.0 258 100.0 214 100.0 243 100.0 27 83 Table VIII.— Vital Statistics relating to Residents in Blocks of Dwellings in the City of Westminster, 1911. 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 1,063 37 19 1 2 3 1 1 3 2 2 1 1 2 3 St. James's Dwellings, Ingestre Place, and Marshall Street 163 - 1 - - - - - - 1 - - - - - 1 Peabody 7,025 154 82 4 18 11 — 10 2 4 2 10 5 16 8 20 Westminster 187 1 1 — — 1 — — — — — — — — — 1 London County Council— Millbank 3,043 80 36 5 5 9 2 2 4 1 1 2 1 4 1 6 Drury Lane 1,000 20 13 1 1 2 1 2 — 1 — 1 3 1 3 3 Improved Industrial.. 6,878 96 46 6 3 8 3 4 2 3 — 5 5 7 6 10 Metropolitan Association 757 15 10 1 1 1 — 1 — 1 — 1 — 4 1 3 St. George's Model Dwellings 419 12 4 — — — 1 1 — 1 — 1 — — — 3 Clerkenwell and Soho Company (Newport Market) 1,184 19 11 — 5 3 - 1 - - - - - 2 - 4 Greencoat 119 6 — - - - - - - - - - - - - - Spencer 99 - - - - - - - - - - - - - - - Chapter Chambers 175 2 1 — — 1 - - - - - - - - - 1 Alexandra and Castle — 4 5 — 1 — — 2 — — — 1 — 1 1 — St. James's Residences — 12 1 — — — — — — — — - 1 — 1 — 29 B. Communicable Diseases. (1) Compulsorily Notifiable Diseases. The details respecting the 694 notifications of infectious disease received by me are set out in the Local Government Board's Return (Table IX), 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 X, 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 smallpox, diphtheria, erysipelas and puerperal fevers was above the number notified in the previous year, while scarlet fever and typhoid fever were below. In Westminster erysipelas cases were more numerous, but the cases of scarlet fever, diphtheria and typhoid fever were much below the average. A number of doubtful cases, contacts, and certain patients returning from fever hospitals, &c., were visited during the year. Smallpox.—During the year 72 cases of smallpox were notified iu London, one of these being in Westminster. A sharp outbreak of this disease occurred in the Borough of Stepney in the early part of the year, and a few cases appeared in several boroughs in persons who had been in contact with others suffering from the complaint. An unvaccinated youth living in Westminster and employed in Stepney contracted the disease, but fortunately no others appear to have been infected by him. Those who had been in his vicinity, so far as could be traced, were kept under observation. Intimation was received during the year of 162 persons who had been in contact, or came from places abroad where smallpox existed, and these were kept under observation. 30 CITY OF WESTMINSTER TABLE IX.—LOCAL GOVERNMENT BOARD TABLE C.— Cases of infectious Disease Notified during the 52- weeks from 1st January to 30th December, 1911. 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 Ages—Years. Conduit. Grosvenor. Knightsbridge St. George. Victoria. St. Margaret. St. John. | Hamlet of Knightsbridge. Pall Mall. Regent. Great Marlborough. Charing Cross. Covent Garden. Strand. St. Anne. j Conduit. Grosvenor. Knightsbridge St. George. 1 Victoria. St. Margaret. St. John. Hamlet of Knightsbridge. Pall Mall Regent. Great Marlborough. Charing Cross. Covent Garden. Strand. St. Anne. At all Ages. 0 to 1. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 and upwards. Small-pox— Cases 1 - - - 1 - - - - - - 1 - - - - - - - - - - - - - 1 - - - - - - - - - - Deaths - - - - - - - - - - - - - - - - - - - - - - Cmeken-pox— - 8 Cases 157 8 60 81 5 3 — — — 3 5 23 8 34 5 - 7 10 1 51 2 8 - - - - - - - - - - - - - - Deaths - - - - - - - - - - - - - - - - - - - - - - Cholera- Cases - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Deaths - - - - - - - - - - - - - - - - - - - - - - Diphtheria- Cases 143 1 40 61 22 18 3 — 2 10 16 31 7 20 8 4 8 14 1 9 3 12 - 10 14 29 7 18 6 4 8 13 1 9 3 10 Deaths 14 2 8 3 1 — — — — 1 3 1 - 2 - - 1 2 - 1 2 1 Erysipelas— Cases 82 — 1 1 11 36 25 8 — 2 2 19 6 30 1 - 7 - 2 4 4 5 - - - 4 5 17 1 - 1 - - 4 3 2 Deaths 2 - - - - - 1 1 — — — 1 1 - - - - - - - - - Scarlet— Cases 252 — 61 134 43 14 — — 2 15 17 49 16 76 8 2 12 9 6 24 3 13 2 14 17 46 15 75 7 1 12 8 6 23 3 12 Deaths 4 — 2 2 - - - - - - - - - 3 - - - 1 - - - Enteric— . Cases 31 — 2 4 8 14 3 — — 3 1 9 3 5 - - 2 1 3 1 - 3 - 1 1 8 2 4 - - 1 1 3 1 - 2 Deaths 4 — — — 3 — 1 — — — — 2 1 - - - - - - - 1 - Puerperal— 2 Cases 6 - - - - 6 - - - - - 1 - 2 - - 1 - - - - 1 Deaths 4 - - - - 4 - - - - - 1 - 1 - - 1 - - - - 1 Poliomyelitis- Cases 1 - - - 1 - - - - - - - - 1 - - - - - - - - - - - - - - - - - - - - - - Deaths - - - - - - - - - - - - - - - - - - - - - - Cerebro-spinal— 1 1 Cases 3 — 1 1 1 - - - - - - 1 2 - - - - - - - - - Deaths 1 — 1 - - - - - - - - - 1 - - - - - - - - - Ophthalmia — Cases 16 16 - - - - - - - 1 1 8 - 5 - - - - - - - 1 - - - - - - - - - - - - - - Deaths - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - Total Cases 694 25 165 282 92 91 31 8 4 34 42 142 42 173 22 6 37 34 13 89 12 44 22 25 32 89 30 l16 14 5 23 22 10 37 28 9 cases notified as scarlet fever,7 as diptheria,2 as enteric fever,and I as cerebro-spinal were eventually alleged not to be suffering from the disease notified. 1 death from each of the following complaints,viz.:diptheria,enteric fever,and puerperal fever was reported,but no notification of the illness had been received previously. 31 Table X.— Infectious Diseases Notified, 1890-1911, 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 45,848 1893 2,813 36,901 13,694 3,666 22 205 397 9,700 86 4 67.485 1894 1,192 18,440 11,190 3,360 21 162 253 6,080 21 2 40,925 1895 979 19,757 11,223 3,506 14 105 236 5,660 29 3 41,512 1896 225 25,647 13,941 3,190 6 103 279 6,438 13 3 49,845 1897 104 22,848 13,199 3,103 4 65 264 5,800 38 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 - 35,747 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* J908 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* 1911 72 10,485 7,388 1,023 1 23 503 4,849 10 - 24,255* 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* 1911 1 252 145 31 — — 6 82 — — 517 * 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. „ 101 „ „ 3 „ 1911. 32 Table x— continued. Case-rates per 10,000 Living in London. Year. Smallpox. Scarlet Fever. Diphtheria. Enteric. Typhus. Other Continued Puerperal. Fevers. Ery. sipelas. 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 0.0 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 10 years 1902.11 1.90 35.9 16.1 3.5 0.01 0.04 0.5 9.8 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 1911 0 .15 23.1 16.3 2.2 0.00 0.05 0.6 10.7 In the City of Westminster. 1891 0.1 19.1 8.8 5.0 0.1 0.4 0.5 7.3 1892 0.7 43.9 17.8 5.0 - 0.4 0.4 9.6 1893 8.4 69.7 18.1 7.5 - 0.3 0.6 11.7 1894 1.1 27.4 13.7 8.5 - 0.5 0.1 6.9 1895 1.0 36.9 15.6 5.9 - 0.2 0.2 7.1 1896 0.4 43.1 16.4 6.2 - 0.3 0.4 9.1 1897 0.7 34.3 17.5 5.4 - 0'3 0.3 9.1 1898 0.1 21.5 17.7 5.9 - 0.1 0.3 6.9 1899 — 28.1 14.9 7.5 - 0.1 0.2 9.3 1900 0.1 24.0 15.2 6.2 - 0.1 0.3 6.8 1901 5.5 35.7 13.6 5.6 - 0.1 0.32 6.3 Average of 10 years 1892-1901 1.8 35.5 16.0 6.3 - 0.25 0.31 8.3 1902 12.6 25.8 15.4 7.1 - 0.05 0.32 7.8 1903 2.5 19.6 10.3 3.9 - 0.11 0.27 6.2 1904 0.3 17.6 8.2 2.9 0.05 0.11 0.28 7.1 1905 0.1 21.0 6.7 2.3 - - 0.68 7.0 1906 — 31.0 11.8 2.7 - 0.11 0.51 7 .2 Average of 10 years 1902-11 1.57 23.9 10.2 3.0 - - 0.35 6.0 1907 - 24.2 8.4 2.9 - 0.11 0.17 5.9 1908 (53 weeks) 0.05 35.6 0.6 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 3.6 1911 0.06 15.9 9.7 1.9 — — 0.37 5.1 33 Vaccination.— The Vaccination Officers have supplied me with the following particulars relating to vaccination of infants born in 1910:— Vaccination Statistics. 1910. Union. Births. Died Unvaccinated. Successfully Vaccinated. Insusceptible. Vaccination Postponed. Conscientious Objectors. Removed and Vaccination Officer Informed. Not Found. Removed to Address Unknown. St. George 1,856 106 1,524 6 19 145 15 41 Westminster 361 16 283 0 0 18 3 41 Strand 156 12 103 0 11 17 2 11 The City 2,373 134 1,910 6 30 180 20 93 The following is a summary of the total primary vaccinations performed in the City during the years 1901-11, and of re-vaccinations in so far as these were made by the Public Vaccinators:— Vaccination Returns. Primary Vaccinations under 14 years of age, in the Union District of Re-vaccinations performed by Public Vaccinators in the Union District of St. George's. Westminster. Strand. St. George's. Westminster. Strand. 1901 2,467 1,491 725 4,039 3,317 2,201 1902 2,893 715 450 7,453 6,226 3,910 1903 2,178 369 245 159 9 347 1901 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 5 517 1911 1,606 288 181 193 63 673 *There were also 16 primary vaccinations of persons over 14 years of age. Scarlet Fever.—The total number of cases in London remained low, but this was chiefly in the first half of the year. It is possible that the character of the summer affects the subsequent crop of cases, if so, we may expect a larger number in the first half of 1912. The disease became more prevalent in Loudon from September onwards. The number of cases of each quarter of the last three years is shown in the subjoined statement:- 34 Scarlet Fever. London. Westminster. 1909. 1910. 1911. 1909. 1910. 1911. 1st quarter 4,227 2,701 1,900 113 88 59 2nd „ 4,404 2,548 2,090 218 57 48 3rd ,, 4,080 2,580 2,783 144 54 68 4th 3,940 2,683 3,717 115 49 77 17,251 10,512 10,490 590 248 252 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. A number of cases occurred in Covent Garden and Strand Wards, most of the children going to schools in Holborn Borough. A. number of cases occurred in connection with three schools in Westminster but fortunately they were limited by the detection of the source of infection. There were four deaths, giving a low mortality rate, as shown below. The death rate for London was 0.04 per 1,000, the five-yearly average being 0.l0. In 19 instances, 2 cases occurred during the year in the same house, and in 6 instances 3 cases, and in 2 instances 4 cases. Two children who had been in hospital developed infection after their return home with the result that three other persons were infected. In 9 instances the disease was eventually found not to be scarlet fever. A man was fined 15s. at Great Marlborough Street Police Court for taking his child to Bethnal Green after he had been told she was suffering from Scarlet Fever. Scarlet Fever. 1902. 1903. 1904. 1905. 1906. Deaths per 100 Cases— The City 3 .3 2.5 2.8 4.0 2.5 The County 3 .0 2.8 2.7 2.8 2 .6 Scarlet Fever. 1907. 1908. 1909. 1910. 1911. Deaths per 100 Cases— The City 2.8 1 .27 3 .00 1.61 1 .58 The County 2.49 2.48 2.22 2.03 1.64 Diphtheria.—From the subjoined table it will be seen that the cases of diphtheria in Westminster were most numerous in the last three months of the year. In London the prevalence of diphtheria showed a considerable increase from September onwards. Table IX 35 Notifications of Infectious Diseases in each week of the year 1911. The County of London. 36 snows that Victoria and St. John Wards again suffered most, there being more persons at a susceptible age in these wards. Of the 145 cases notified, 7 were subsequently found not to be suffering from the malady, , but in one instance the existence of diphtheria was not discovered until after death. Notification of Diphtheria Cases Received in each Month, 1901-11. January. February. March. April. May. June. July. August. September. October. November. December. Total. 1901 13 10 16 22 19 19 34 19 27 36 21 17 253 1902 27 19 17 17 25 20 39 25 9 27 32 28 285 1903 17 13 23 8 18 14 21 9 13 17 13 20 186 1904 6 17 10 12 9 18 11 10 10 27 9 6 145 1905 7 7 7 12 11 9 6 10 8 14 15 12 118 1906 20 23 11 8 13 20 21 14 13 28 22 13 206 1907 20 21 8 11 9 12 18 1 7 18 7 13 145 1908 19 10 14 14 17 12 14 13 13 23 17 21 187 1909 20 18 27 9 11 20 13 11 32 23 7 34 225 1910 19 11 19 10 7 12 10 15 9 10 14 13 149 1911 .. 10 9 11 4 5 11 11 10 8 17 34 15 145 There were 14 deaths. Diphtheria. 1902. 1903. 1904. 1905. 1906. Deaths per 100 Cases— The City 11 .0 8 .6 3.4 4.2 7.6 The County 10.8 9.6 10.2 8.6 8.8 Diphtheria. 1907. 1908. 1909. 1910. 1911. Deaths per 100 Cases— The City 11.o 9.9 8.0 6.7 9.6 The County 8.9 9.0 9.0 7.8 8.2 In 4 instances 2 cases, in one 3, and in one 4, occurred in one house. 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 126 instances. In 16 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 not present in any of them. 37 In one instance examination was made on account of other cases occurring subsequent to the first patient's return from hospital—it proved negative. Supply of Anti-toxin.—The City Council have made arrangements, under an Order of the Local Government Board, 1910, whereby 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, Regent 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, Haymarket and 78, Strand. At any hour of the day and night, except on Sunday night between midnight and 8 a.m. on Monday. (3) The Caretaker, Coroner's Court, Horseferry Road, S.W., at any hour. There has not been much demand for it, only six tubes having been supplied, due doubtless to the promptness with which patients suffering from the illness are removed to hospital. Typhoid Fever.—The number of cases notified, both in London and Westminster, show a decline. Of the 31 persons notified in the City 2 were eventually declared not to be so suffering, and 1 case was not notified, the nature of the disease not being recognised until after death. Typhoid Fever. London. Westminster. 1909 1910 1911 1909. 1910 1911 1st Quarter 354 242 173 9 10 5 2nd 197 166 127 1 19 3 3rd 239 416 402 6 14 12 4th 253 460 323 9 5 11 The Year 1,043 1,284 1,025 25 48 31 Of the 30 actual cases, 16 of the patients contracted the disease out of London, most of them abroad; of the remaining 14 no definite history was obtainable in 12 instances, 1 contracted the disease by attending a person suffering from the complaint, and 1 was suspected to have been infected from a " carrier " case, 38 Three of the cases proved fatal, but another death occurred in an unnotified case, the nature of the illness not being recognised during life. Advantage was taken to obtain the City Bacteriologist's opinion in 16 cases, in 5 the Widal reaction was reported. Puerperal Fever.—Six notifications were received, and four deaths occurred. In one instance in which death occurred, the illness had not been previously notified and the medical man in attendance was summoned and fined 20s. and costs at Westminster Police Court. Unfortunately, a pupil midwife went straight from this case to another woman, who subsequently developed erysipelas. The County Council, who supervise midwives, dealt with this part of the affair. Disinfection was carried out after each case, including the clothing, &c., of those in attendance. Ophthalmia Neonatorum..—Notification of this affection became compulsorily notifiable on 13th March, 1911. Sixteen infants were notified as suffering from this complaint, and seven other cases were discovered by the Health Visitor in the course of her work or intimated by the inspectors of midwives. Twelve were slight cases, 7 medium and 4 severe. In 13 instances it was the first confinement, in 5 the second, in 3 the third, in 1 the fourth, and in 1 the eleventh. Four of the children were illegitimate. Twelve of the homes were in Victoria Ward (5 cases in two streets), 7 in St. John's, and 1 each in St. Anne, Regent, Grosvenor and Knightsbridge Wards. Eleven children were treated at hospitals, 2 as in-patients. Nineteen were reported to have recovered without permanent impairment of vision. One had still a slight discharge from the eye on leaving the district, and the remaining three were improving but died from other causes. Altogether five of the children died, and in two cases the mothers also died, one from puerperal fever, the other an alcoholic subject from bronchitis. In each instance the Health Visitor has visited at the house daily or less frequently as the circumstances demanded, and has taken steps to see that proper medical and nursing attention was secured for the child. Ophthalmia in new-born children is the most common cause of blindness originating in infancy, and is responsible for 36 per cent. of the children being in the County Council Schools for the Blind. The virus causing it is introduced within the eyelids at birth, and prompt treatment is necessary to prevent permanent injury to the eyes. Even when a medical man is in attendance it cannot be assumed that the treatment which necessitates very frequent bathing of the eyes will be 39 carried out by the mother, hence the need for frequent visits by the official. In a number of cases the district nurses have rendered valuable assistance. The cause of the infection is frequently gonorrhoea, especially in the severer forms, and it has been suggested, and it is now under the consideration of the Council, that facilities should be provided to enable medical men to have a bacteriological report stating the particular organism present in the purulent discharge. Acute Polio-myelitis.—This disease was made notifiable on 1st September, 1911. It is an infective disease affecting chiefly the nervous system and producing paralysis. The virus can frequently be obtained from the mucous membrane of the nose, and it is suggested that it is by that channel that it finds entrance into the body. Numerous epidemics have been recorded during the last 30 years in the United States and in most Continental countries. Small outbreaks have been recorded in this country, but in the last two years these outbreaks have assumed more serious proportions. The greatest prevalence is during the months of July, August and September, and children during the second and third years of life are most commonly affected, but adults are also liable. Infected persons as well as contacts should be isolated. The period of incubation is probably less than 6 days, and the period for isolation of the infected should not be less than 3 weeks. It is suspected that infection may be retained in the nose for a considerable time and may result in fresh outbreaks. One person suffering from this disease was notified in Westminster, infection having been contracted in the country. Cholera.—This disease was prevalent in countries bordering on the Mediterranean and Black Seas, especially Turkey and Italy. I received notification from the Port Sanitary Authorities of 27 persons coming to Westminster from affected districts, and these were kept under observation. Plague.—Seven persons came to Westminster from countries in which this disease existed. Information reached me of a woman who was suspected to be suffering from bubonic plague. She had arrived in London shortly before. She was visited by Dr. Cantlie, the expert engaged by the County Council, and bacteriological examination was made of the blood and gland contents, and in the result the diagnosis of plague was negatived. Glanders.—Two intimations of cases of glanders in horses have been received from the Veterinary Inspector of the County Council; this is done in accordance with the provisions of the Order which came 40 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. Tuberculosis. Compulsory Notification of Hospital and Dispensary Cases.— Under an Order which came into force on the 1st May, 1911, the system of notification which was made compulsory for Poor Law cases in 1909, was extended to persons attending any hospital or dispensary. The total number of certificates received in the year was 1,393 ; 488 were under the Poor Law Order, 510 under the Hospitals Order, and 395 under the Council's Voluntary Scheme, Deducting 284 referable to other districts, 1,109 certificates were received in connection with Westminster cases. The number of new cases of pulmonary disease was 356, of whom 100 were homeless persons or inmates of common lodging-houses, &c.; 102 of the persons affected were females. Poor Law Order.—Of 488 notifications received, 392 were from medical officers of poor law institutions of which the patients were inmates, 33 from out-door medical officers, and 63 were notices of discharge from infirmaries. 160 (34 females) of the poor law cases notified had not been registered previously ; and of these, 98 gave addresses of common lodging-houses, shelters, casual wards, or were homeless (28 including 2 women). 248 notifications were received in connection with 139 persons of this class, 41 of whom had been previously notified in the years 1905-10. Hospital Order.—510 certificates were received, but 284 of these related to persons living in other districts and were forwarded to the districts in which the patients lived. Of the remaining 226 certificates, 103 related to persons already registered. There remained 123 persons (38 females) who had not been previously notified; 2 of these were inmates of common lodging-houses or homeless. Voluntary.—Of the 395 intimations received 73 (30 females) related to persons suffering from pulmonary tuberculosis, and 38 (21 females) to other forms of the disease, none of them having been registered previously ; 102 suspects were registered, and in 25 instances the suspicion was confirmed, in 69 it was negatived. There were also recorded 182 changes of address, not including removal to hospital infirmary, and sanatorium, &c. On the next page is a return showing the ages, wards, &c., relating to cases not previously registered, 41 Notification of Pulmonary Tuberculosis. tinder 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 1911 392 33 63 — 488 98 62 160 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 sent by Relieving Officers. Under Hospital Order :— Year. Certificates. New cases. N umber received. Number transferred. Inmates of C.L.H., &c. Inmates of Private Houses. Total. 1911 511 284 2 121 123 Under Voluntary System:— Year Pulmonary Tuberculosis. Other Forms. New Cases. Total Certificates. New Cases. Suspects. Change of Address. 1908 148 2 8 4 162 1909 159 63 5 5 232 1910 135 100 46 17 318 1911 73 102 182 38 395 The number of persons notified voluntarily must decrease as the system of compulsory notification is extended. A form has been drafted by the Metropolitan Medical Officers of Health in conjunction with the County Council's Medical Officers, whereby statistical information may be prepared on similar lines in each city and borough. Very little information is obtainable about the casual and homeless consumptive, and full particulars are not always obtainable with respect to a number of those notified from private addresses, for various reasons, such as in the case of persons who have been in lodgings for short periods only, and do not return on discharge from hospital or infirmary. "Without the co-operation of the Health E 42 Tuberculosis. Table showing respective age, sex, d1str1but1on 1n Wards, number not1f1ed, under each scheme, and numbers treated 1n Inst1tut1ons. 1911. Pulmonary. All Age3. Under 1. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. Condu1t. Grosvenor. Hamlet of Knightsbridge. knightsbridge St. George. V1ctor1a. St. Margaret. St. John. St. Anne. Great Marlborough. Pall Mall. Regent. Charing gross Covent Garden. Strand. 1908 Poor Law Order— Common Lodging houses,&c. 98 — — — 5 38 46 9 — — — — 15 — 16 1 3 — 1 — 5 57 Other 62 — 2 4 2 24 27 3 — 1 1 3 12 4 24 3 3 1 2 - 5 3 1911 Order- Hosp1tal 123 — — 6 23 68 24 2 1 6 5 3 33 7 30 9 7 1 6 2 10 3 Voluntary 73 — 2 9 14 44 4 — 2 3 1 2 19 1 17 10 4 — 6 — 7 1 Total number of persons suffer1ng from phth1s1s 356 — 4 19 44 174 101 14 3 10 7 8 79 12 87 23 17 2 15 2 27 64 Res1dents after deducting Common Lodg1ng-house and casual cases 256 4 19 39 134 55 5 3 10 7 8 64 12 71 22 14 2 14 2 22 5 Other forms of tuberculos1s (voluntary) 38 — 12 19 3 3 1 — — 1 — 2 9 1 12 7 — — 3 — 2 1 Ages of Males and Females not1f1ed as su,jfer1ng from Pulmonary Tuberculos1s. All Ages. 0—1. 1—5. 5—15. 15—25. 25—45. 45—65. 65 upwards. Males 254 - 3 13 26 120 81 11 Females 102 — 1 6 18 54 20 3 (98 Males and 2 Females were casuals or 1nmates of Common Lodg1ng-house, Shelters, &c.) 43 Society, who appointed a special lady phthisis visitor (according to the scheme detailed in previous reports), it would have been impossible to have kept in touch with the details of each case. A card record is prepared for each person, and these cards are submitted to me daily. The following table shows the number dealt with through' the society during 1911 ; it excludes common lodging house and certain other cases where visiting was not possible, or considered necessary. In the course of visiting, a number of persons are discovered who appear to be phthisical or are in a state of health in which they might readily be infected if in contact with phthisical patients. In this way, 248 persons have been under observation during the year, 79 of these were already receiving medical care, and the remainder were brought under medical inspection, and, where necessary, continued supervision. They include many delicate children. As a result, 21 cases were definitely diagnosed as pulmonary tuberculosis, and 4 as other forms, while 150 were reported to be free from tuberculosis, but many of these were found to be suffering from other complaints requiring medical attention. The remainder are still being kept under observation. Summary relating to visiting of Tuberculous families. Cases carried forward from 1910— Definite pulmonary tuberculosis 257 406 Removals 118 Suspected tuberculosis 121 Deaths of persons already known 92 Other forms of tuberculosis 28 Persons notified during 1911— Deaths of persons not previously notified (families visited) ... 43 Definite pulmonary tuberculosis 218 358 401 Suspected tuberculosis 102 Other forms of tuberculosis 38 Current cases still under supervision 31 Dec., 1911 538 Families visited during 1911 where death occurred of persons not previously notified— 807 Definite pulmonary tuberculosis 32 43 Other forms of tuberculosis 11 807 Of the 118 patients (including suspects) who removed from Westminster in 1911, 13 emigrated and 64 went to reside in the suburbs of in the country. Sanatorium, Convalescent, Boarding-out and In-patient Hospital treatment was arranged during 1911 by the following agencies Charity Organisation Society 6 Invalid Children's Aid Association 35 St. Henry Fund 28 City Council 21 Jewish Board of Guardians 13 Clergy, School Care Committees, private individuals, etc 53 Guardians of Poor Law Infirmaries and Homes 139 Hospitals (in co-operation with the above in many cases) 93 388 E 2 44 The kind of treatment obtained is shown below. Sanatorium. Convalescent Home. Boarding Out. Consumption Hospital Home for the Dying. General Hospital. Poor Law Infirmary. Total. London. Seaside. Definite pulmonary tuberculosis 72 31 7 12 8 6 21 126 283 Suspected tuberculosis 2 27 13 5 — — 10 8 65 Other forms of tuberculosis — 21 1 1 2 — 10 . 5 40 74 79 21 18 10 6 41 139 388 The figures 388 in these two tables represent the number of persons who received treatment in this way during 1911. When two or more agencies have assisted the same case only one has been recorded to secure an accurate return of number of cases. Thus, the Charity Organisation Society and the Jewish Board of Guardians almost invariably co-operate with the Invalid Aid Association cases. Similarly with some of the St. Henry Fund cases, the families have been maintained during the absence of the breadwinner. The remaining persons were treated at home by their own doctors, or as out-patients at hospitals or dispensaries. " In the case of children where the home conditions were unsatisfactory or the child did not respond readily to home treatment, sanatorium or convalescent treatment was obtained. The Invalid Children's Aid Association, Charity Organisation Society, St. Henry Fund, Jewish Board of Guardians or the Poor Law Guardians have in several of these cases maintained the child away from home for long periods varying from three months to three years or longer. " The Skilled Employment Association has co-operated by finding suitable work for tuberculous children on leaving school. " The closer co-operation with the School Care Committees, has greatly aided the preventive side of the work. The examination of " contacts " and "suspects" has been facilitated by means of this co-operation, and in certain schools the doctor is now notified through the School Care Committees, of any tuberculous history in the family of the child to be examined, and a searching examination accorded to it. An extension of this co-operation would ensure the systematic examination of every contact between the ages of 5 and 14. These children receive special care during school hours, and cod liver oil or milk is supplied when recommended by the school doctor, and is not otherwise obtainable." Number of living rooms in patient's tenement where recorded:— 45 1 room. 2 rooms. 3 rooms. 4 rooms. Over 4 rooms. Total. Males 50 38 45 4 9 146 Females 32 24 21 5 6 88 (Servants and others not included.) Rent Under 5s. 5s. to 10s. 10s. to 15s. Over 15s. Total. Males 39 78 20 9 146 Females 22 39 13 13 87 Duration of illness before notification:— Under 1 year. 1 to 2 years. 2 to 3 years. 3 to 4 years. 4 to 5 years. 5 to 6 years. 6 to 8 years. 3 to 10 years. 10 to 15 years. 15 to 20 years. Males 81 18 16 7 9 4 1 2 1 - Females 43 19 6 7 8 3 2 2 1 1 Duration of illness up to death:— Under 1 year. 1 to 2 years. 2 to 3 years. 3 to 4 years. 4 to 6 years. 5 to 6 years. 6 to 8 years. 8 to 10 years. 10 to 15 years. 15 to 20 years. Males 9 11 13 5 2 1 - - 1 - Females 6 2 — 2 2 2 — 1 - - Period between notification and death:— Under 1 week. 1 week to 1 month. 1 to 3 months. 3 to 6 months. 6 to 9 months, Males 6 19 14 10 5 Females 3 10 2 1 1 History of phthisis in parents, grandparents, uncles, aunts:— Males. Females. Males. Females, Positive 41 23 None 76 38 Doubtful 10 9 Unknown 27 31 Males Females. Married 70 55 No family 23 17 Not known 1 13 Families with children tuberculous 8 7 Families without known tuberculous children 39 18 46 In six instances tuberculous wives had husbands also affected ; in one case the woman's first husband also was phthisical. In 33 instances patients had consumptive brothers or sisters. In 32 instances there had been opportunities of infection from relatives. Of the 507 cases of Pulmonary Tuberculosis visited by the Health Society during the year, 209 were married. The children in these families number 646, of whom 434 are reported healthy and 212 delicate. In 8 instances, there had been old standing tuberculosis affections of other parts of the body before the lungs became affected. Occupations of Persons Notified in 1911. Outdoor. Indoor. Present. Past. Present. Past. Males. Males. Motor car, cab, bus, and tram men 7 1 Baker Tailors 14 1 Army 1 Army Packers 7 1 Army 1 Merchant service 1 Out uoor porter Horse vehicle, drivers, &c 4 - Army Storekeepers 2 1 Army 1 Tobacconist Stable hands 5 Furniture remover 1 House painters 7 Building trade 2 Clerks 6 1 Choir boy General labourer 1 Caretakers 3 1 Waiter Window cleaner 1 1 Clerk Gardener 1 1 Draper Messengers 2 Housekeeper 1 Commissionaire 1 Army Hall porters 3 Soldiers 2 Club 4 1 Army Engineer's labrs 1 Valets, and other men-servants 11 Car. Co. 1 Electric lamp trimmer 1 Kitchen porter 1 Waiters 6 Engine stoker 1 Barmen and potmen 3 Brewery labrs 2 Cooper 1 Publican 1 Watchmen 2 Billiard marker 1 Costermongers (and street stall) 10 Gas Co. labourer Confectioner 1 Musician 1 Army Gas fitters 2 Selling papers on street and odd jobs 4 1 Labr. in brewery Gas-burner maker 1 1 Sailor 1 Tailor Bottle wirer 1 Postman 1 Army Boot maker 1 Telegraph messenger 1 Chiropodist 1 Railway ticket clerk 1 No occupation 7 Theatre attendant 1 | Army Turkish bath attendant 1 Porters, shop 4 47 Occupations of Persons Notified in 1911—continued. Outdoor. Indoor. Present. Past. Present. Past. Males. Shop assistants 4 Dispenser 1 Journalists 2 Bottle and rag dealer 1 Hair dresser 1 Printers 2 Book-edge gilder 1 Females. Females. Flower sellers 3 Housewives 31 1 Furrier Casual—streets 5 1 Lady's maid 1 Machinist 2 Tailoresses 1 shop assistant Housekeeper 1 Servants 20 Governess 1 Tailoresses 8 Dressmakers 6 Fur sewer 1 Shop assistants 4 Waitresses 2 1 Servant Church pew tendant 1 Office cleaning charing 5 Packer in dry 1 No occupation 7 1 Tailoress Nationality.—The majority of the persons affected were English but there were also the following:— Males. Females. Males. Females. Irish 20 2 German 5 - Scots 3 — Russian 11 8 American 2 — Italian 3 1 French 2 3 Spanish - 1 Austrian 1 - All the Kussians and 1 Englishman were Jews. Opportunities of infection.—In 12 instances there were definite opportunities for infection to have been conveyed by proximity to consumptive fellow workmen. 43 In 32 instances there had heen exposure to infection from relatives, and in 9 to infection from lodgers or other inmates of tenement houses. In both the first and last groups many of the persons affected had no history of phthisis among their relatives. Doubtless, there were many more cases especially among the common lodging-house class, but those mentioned were definitely recorded. It was at one time held that consumption was a hereditary disease, then with the discovery that tuberculosis was produced by a germ there was a tendency to regard infection as of chief importance. All are liable to be attacked by the tubercle bacillus, and statistics derived from the post-mortem examinations of persons dying from other causes show that a very large percentage have been attacked but have been able to resist, so that traces only of the damage done can be recognised. Children are not born with the disease, but various tests which can now be applied show that before they reach the age of 15 years 30 or 40 per cent., and even more, have been infected. The bacillus is of slow growth and may remain in the body for a long time without causing marked symptoms, and this probably accounts for the occurrence of consumption in adolescents and young adults, as by that time under favourable circumstances the presence of the organism begins to produce marked effects, hence the importance of measures to prevent infection of children and of raising their powers of resistance, so that they may be able to overcome and destroy the bacillus before it has time to grow. While the disease is not hereditary yet a certain amount of susceptibility to it may be transmitted so that a smaller dose of infective material may set up the disease than would be the case in persons with high powers of resistance. Even persons of the latter class may be unable to resist a very large dose or repeated small doses such as may happen when in close daily contact with a careless patient. Successful infection occurs when the power of resistance has been lowered by some other illness, by insufficient food, by intemperance, by overwork, by insanitary conditions, particularly defective ventilation and dampness, by dusty occupations, &c. Examples of all these are to be found among the cases notified during the last 12 months. In the campaign against tuberculosis it is necessary— (a) To remove such conditions as those specified. (b) To remove opportunities for infection, especially for those with low powers of resistance (natural or acquired). (c) To bring infected persons and susceptible persons under treatment at a very early stage. It is with these objects in view that a scheme has gradually been built up in Westminster, by which all the various organizations 49 (statutory and voluntary) of the City have been brought into harmonious co-operation. A summary of the means available is appended. Educational Training in Sanatorium.—In 1910 the Council resolved to engage for twelve months as on and from Lady Day four beds, two at the Maitland Sanatorium, at Peppard Common, Oxfordshire, and the remaining two, as opportunity offered, either at the Maitland Sanatorium or at some other approved Sanatorium, as might be most convenient for the use of phthisical patients from Westminster at a cost not exceeding 30s. per bed per week, and that the period of treatment be for one month, subject to extension at the discretion of the Medical Officer of Health in such cases as he may think fit. The Council further decided to continue the arrangement for a further period of twelve months, and included £350 in their financial estimates for the year 1911-12, for this purpose. Twenty-one patients were sent by the City Council for educational training during the year, 15 (10 males, 5 females) of these went to Maitland Sanatorium, at Peppard Common, Oxfordshire, and 5 (3 males, 2 females) to Fairlight Sanatorium, Hastings. The beds were occupied for a total period of 151 weeks, at a cost of about £235, inclusive of travelling expenses, sputum flasks, &c. Bacteriological Examination of Sputum.—Seventy-seven examinations were made of sputum, from 75 patients, to ascertain if the tubercle bacillus was present; it was found in 17 instances. Disinfection.—Three hundred and ten rooms in 234 houses and 3,592 articles were disinfected or destroyed by the Council's staff, after death, or on removal of patients from one house to another, or to hospital. In 37 other cases, disinfection (or thorough cleaning and re-decoration of rooms) was carried out privately. Deaths.—The deaths for 1911 and for the preceding ten years are set forth in the following table:— The City of Westminsteb. Year. Pulmonary. Abdominal. Meningeal. Other. Total. Deaths. Rates. Deaths. Rates. Deaths. Rates. Deaths. Rates. Deaths. Rates. 1901 341 187 16 10 31 16 25 12 413 226 1902 328 182 18 9 32 17 35 19 413 229 1903 309 174 9 5 23 13 19 10 360 203 1904 271 154 12 6 26 14 32 18 341 194 1905 259 149 12 6 31 17 ' 31 17 333 192 1906 237 139 13 7 36 21 25 14 311 182 1907 232 138 11 6 26 15 20 11 289 172 1908 208 125 11 6 25 15 26 15 270 162 1909 225 137 10 6 20 12 23 14 278 169 1910 186 116 5 3 21 13 19 11 231 143 1911 191 120 6 3 28 17 13 8 238 149 50 These rates are calculated per 100,000 inhabitants, and corrected by the last census. They show a considerable diminution. The pulmonary rate for 1911 was 120, the average of the preceding 5 years being 181. The London rate for 1911 was 135 ; the rate in the previous year was 114, and the five-yearly average 140. Of the 191 persons who died, 124 had been notified during life, 11 others would have been notified had they had any definite address, and 7 deaths occurred in asylums, the authorities of which are apparently not required to notify unless the asylum is a poor law institution. There remain 49 deaths of persons whose illness did not come to the knowledge of the Public Health Department. Sixty-five of the deaths occurred at home, 24 in hospitals, 95 in infirmaries, and 7 in asylums. Summary of Methods. The following is a summary of the means which have been adopted in Westminster for the prevention of consumption:— (1) Notification of all persons suffering from pulmonary tuberculosis. (2) A Central Index at the Health Office—with filed records and current reports of every notified phthisical case in the City (including deaths). 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. (3) Visiting of patients, at their homes by the Phthisis Visitor (Miss Sanders) and by the Voluntary Health Visitors—who give instruction as to measures of personal hygiene and precautions against infection, &c and deal with the " after care " of patients who have been in sanatoria; the Hon. Secretary arranging, where required, for better food, sanatorium treatment, clothing, employment, &c., through various charitable and other bodies. (4) Examination of suspected and " contact" cases in the families of patients attending Brompton Hospital for Consumption. Mount Vernon Hospital for Consumption. Margaret Street Hospital for Consumption. Golden Square Throat Hospital. Charing Cross Hospital. St. George's Hospital. Westminster Hospital. School Medical Examination. (5) Provision of means for obtaining Bacteriological examination of sputum, &c, 51 (6) Educational training by a short stay at a sanatorium, in which beds are provided for the purpose by the City Council. (7) Prolonged sanatorium treatment for patients in the Parishes of St. Anne's and St. Mary's, through the St. Henry Trust (of which the Medical Officer of health is ex officio a member); for Jewish cases, through the Jewish Board of Guardians; for children, through the Invalid Children's Aid Association; for some others, through the Charity Organisation Society, and the various general and special hospitals through their almoners. (8) Convalescent homes, boarding-out treatment, and provision of additional food for delicate children in consumptive families, and for other susceptible or delicate persons, through various charitable agencies, School Care Committees, &c. (9) Homes for Advanced and Chronic Gases.—Arrangements are made for admission of patients to suitable homes. (10) Poor Law Provision.—The Guardians of the Strand and Westminster Unions send their cases to the Central London Sick Asylum, Hendon. Open-air treatment is given. There is a Children's ward to which all children are at once transferred from Cleveland Street Infirmary. Cleveland Street Infirmary retaining the cases which would not be benefited by the Hendon treatment. The Guardians of St. George's Union send cases to the Infirmary, Fulham Eoad, where four wards are set apart for Phthisical patients. All the three unions send children suffering from tuberculosis to Rustington and to Carshalton. (11) Provision is made, where necessary, of sputum flasks and disinfectants, beds and bedding to enable the patients to sleep alone, outdoor shelters, &c. (12) Disinfection by the public health authority of rooms, bedding, clothing, &c. after death, on change of address, or while patients are temporarily away. (13) Removal of insanitary conditions of dwellings and workplaces. Diarrhiea.—The summer of 1911 was remarkable on account of the dry hot weather experienced. Not only was a high level of temperature reached, but it was maintained for a considerable period (from early in July to the middle of September the thermometer was above 80 degrees on 42 days), a circumstance which is without parallel since records have been kept. Fortunately, the nights were comparatively cool, except on a few occasions; but in Westminster they were 3 or 4 degrees warmer than at outlying stations (such as Kew and Greenwich). The maximum temperature exceeded 90 degrees on three days in each of the months of July, August and September. The amount of 52 sunshine registered was much in excess of the average. Westminster has, as a rule, less sunshine than the suburbs, but in June, July and August there was a gain of 255 hours, equal to 50 per cent. of the normal. Westminster had exceeded its usual total annual average of 1,144 hours by 103 hours at the end of August, and by the end of September this was increased to 300 hours. According to the Greenwich records, no rain fell on 26 days in July (there were small amounts on the 24th, 25th, 26th and 29th), on 23 days in August (a small amount fell on the 1st, none until the 19th, when over half an inch fell, and from then until the end of the month there were small amounts on several days, the 30th giving 32 inch— the total being 1.34 inch), and on 20 days in September, chiefly in the earlier part of the month. In Westminster, however, there was a very heavy downfall on the evening of the 28th July, which the sewers in parts of the city were unable to cope with at once, thereby leading to flooding of houses. One effect of the anomalous conditions of the summer upon health was a great increase in deaths from diarrhceal complaints. The prolonged heat caused great difficulty in the keeping of food of all kinds. Persons dealing in foodstuffs may be expected to provide proper means for preserving the food in a fresh state, but householders, as a rule, make no provision for this in the hot weather. As regards milk, the arrangements for its transport and distribution leave much to be desired. If it could be kept cool from the time it leaves the farmer until it reaches the consumer, there would be less complaint that it had become unfit for consumption soon after it was bought. The death rate of London during the third quarter rose to 15.5 (the rate in the previous ten years averaged 13.9 per 1,000); for Westminster the rate was 11.9 (the decennial average being ll'l). In the three months it was for London and Westminster as follows :—- London. Westminster. July 12.4 11.5 August 18.9 12.0 September 16.0 12.3 This rise was largely due to diarrhoeal complaints, affecting principally young children. The deaths, from all forms, of children under 2 years of age in the year amounted to 5,313; in Westminster there were 57 at the same age period. Most of these occurred in the months JulyOctober. The rise and decline is shown in the following figures. 53 Deaths from Diarrhœa in London and Westminster in children under two years of age. 1911. Week ending July 8th. 15 th. 22nd. 29th. - London— Under 2 years 23 40 56 157 - Westminster— Under 2 years — 1 1 1 — Week ending August 5th. 12th. 19th. 26th. - London— Under 2 years 318 548 C29 635 Westminster— Under 2 years 1 2 4 4 — Week ending September ... 2nd. 9 th. 16th. 23rd. 30 th. London— Under 2 years 537 439 368 335 227 Westminster— Under 2 years 10 8 9 6 1 The death-rates, calculated on the deaths under 2 years of age for each quarter, were:— 1st quarter. 2nd quarter. 3rd quarter. 4th quarter. The year. London 0.18 0.18 3.81 0.58 1.18 Westminster — 0.02 1.02 0.22 0.31 With the exception of the Borough of Hampstead, which had a rate of 0.26, no metropolitan borough had so low a death-rate from this disease at this age-period. At all ages the deaths from all forms of diarrhoea and enteritis were equal to a rate of 0.46 per 1,000 inhabitants, the average in the five years 1901-05 having been 0.48, and in the five years, 1906-10, 0'31. The deaths, under one year of age were 49, which is about doable the average of the previous 4 years, which were years of low diarrhoeal prevalence generally, but they are much less than the number recorded in many of the earlier years of the decade. The following table exhibits the particulars:— 54 Westminster. 1903. 1904. 1905. 1906. 1907. Epidemic diarrhoea 59 80 47 75 27 Other forms of enteritis 14. 16 17 20 19 Total deaths at all ages 73 96 64 95 46 Number under 1 year of age 52 72 42 71 27 Number of births 3,185 3,054 3,120 2,931 2,927 Deaths of infants per 1,000 births 16 .3 23.5 13.4 24.2 | 9.2 Westminster. 1908. 1909. 1910. 1911. Epidemic diarrhoea 24 10 | 9 47 Other forms of enteritis 23 23 32 47 Total deaths at all ages 47 33 41 74 Number under 1 year of age 33 27 26 49 Number of births 2,913 2,751 2,592 2,361 Deaths of infants per 1,000 births 11 .4 9 .2 10 .0 20 .7 I consider that the low mortality in Westminster from this form of illness may be ascribed to three causes:— (a) The frequent inspection of tenement houses, resulting in a higher standard of cleanliness, and the removal of insanitary conditions. (5) The instruction given to the parents by the health visitors, (c) The extension of the system of the daily removal of house refuse and the cleanliness of the streets. In Tables II and VI, the ages at death, and the distribution according to wards may be seen. Victoria ward had 25 at all ages, 17 being under 2 years of age. St. John's ward had 22 at all ages, 16 being under 2 years. The rate of deaths under 1 year per 1,000 births is 20'0 for Victoria, 25'5 for St. John's; the rate for the rest of the City is20 7. The Local Government Board issued a circular to the sanitary authorities of the country on the subject of the excessive mortality from diarrhoea and enteritis. They realised that some excess over that occurring in cool and wet summers is inevitable, and they suggested lines of action which, they believe, would minimise the excess. "Firstly, it is important that exact advice should be given as to the feeding and management of children, and more generally as to preventing the exposure of their food to contamination from decomposing organic matter. The distribution of clearly worded leaflets is usual in this connection: but even more important are personal visits and the offer of practical advice to the mothers of babies born within the last twelve months. Exact and simple 55 instructions are most likely to be followed if given during A, period of special danger. In districts and towns in which the Notification of Births Act has been adopted, the records obtained under that Act would give valuable information in selecting the homes to which visits are now most urgently required. " Secondly, the full value of the personal instructions indicated above cannot be realised unless vigorous efforts are made to prevent the accumulation in or in the vicinity of the house of decomposing animal and vegetable matter. It is not necessary to do more than mention the importance of efficient scavenging, of frequent and, if practicable, daily removal of house and stable refuse, of domestic cleanliness, and of keeping all food properly protected. The Council may consider it advisable during the next few weeks to divert the sanitary inspectors from less urgent work, and to instruct them to make rapid visits with a view to securing efficient sanitation, especially in and about the houses of the working classes. " Thirdly, it is important that the Council should promptly ascertain in which parts of their district diarrhoea is especially prevalent, and should devote close attention to street and court scavenging and to the removal of stable and domestic refuse in these areas. Without waiting for the weekly death returns, efforts should be made to obtain information of cases of diarrhcea from health visitors and others who make domestic visits; and to impress upon parents the importance of immediate treatment of infantile diarrhoea. Apart from the medical notification of cases of epidemic diarrhoea in children, the visits of health visitors can be utilised for impressing upon parents the seriousness of diarrhoea amongst young children and the desirability of information being given to the Medical Officer of Health should a case of diarrhoea occur. " The Board will be glad if the Medical Officer of Health, in his annual report dealing with the current year, will set out the course of action adopted in the district to prevent diarrhcea and child mortality generally, in the special circumstances of the present year." It is on the lines of these recommendations that the City Council have been working for some years. In addition to the methods described earlier in this report and in previous reports, visits are paid where practicable to every house in which a death from diarrhoea occurs. In a number of instances it has been found that the child had not been born in Westminster and so had not been previously visited by the Health Visitors. 56 Eight of the deaths of infants under 1 were of illegitimate children; 10 children had been delicate from birth; only 3 infants had been entirely breast fed; 21 had been suckled at first for a week or two and 17 of these were subsequently fed on cow's milk (3 of the 17 were fed on tinned milk after cow's milk had been tried), 3 on tinned milk, and 1 on special diet; 8 had been put on to cow's milk at birth and two of these eventually had tinned milk instead; 3 were put on tinned milk from the first. Several mothers gave their children tinned milk instead of cow's milk as the latter would not keep sweet; the quality of the tinned milk was often unfit for the purpose of feeding an infant being condensed separated milk, generally the tin was reserved for the baby until finished so that it was liable to contamination by flies. In 3 instances the child had been taken with its parents on their holiday and the parents who in each case had been careful in preparing the milk at home, were unable to take similar precautions while away. In 5 instances the mother was out at work during the day and the children did not get the necessary care. In many instances personal infection is an important factor, and results from want of sufficient care in attending to the cleanliness of those suffering from the complaint. In 7 instances the general cleanliness of the home was found to be poor. Of those dying between 1 and 3 years of age, 1 was born and died in the infirmary, 1 was neglected by its mother, 4 had been delicate from birth. The presence of flies often in large numbers was noted by the Visitors and Sanitary Inspectors towards the end of August, especially in parts of Pimlico, in nearly every house in which there was diarrhoea. Of the 5 adult persons who died from acute diarrhoea, 4 were inmates of asylums or workhouses. Deaths from other forms of enteritis were below the average; 12 were of infants; cold, improper feeding and defective powers of digestion were the usual causes, whereas, in the form of diarrhcea which appears in hot weather, it is the result of an infection. Measles.—This disease was extremely prevalent in London from November, 1910 to April, 1911. As a result of a conference between the Medical Officer of the Local Government Board and the Metropolitan Medical Officers of Health, the Board issued a memorandum in which they stated that it had been arranged that early notification shall be given by School Attendance Officers of all cases coming under their notice. They point out that the information obtained must be followed up. Probably many cases may prove not to be measles, and arrangements should be made for obtaining a proper diagnosis, for securing proper isolation and for urging on the parents the need of obtaining medical 57 aid where such is required. Advice should be given by the official visiting the houses as to the care and nursing of the patients. The Metropolitan Asylums Board agreed to receive cases of measles on the recommendation of the Medical Officer of Health, subject to their limited accommodation being available, after pauper cases have been provided for. In the first three months of 1911, 1,581 deaths were registered in London from this disease, the highest number being in the month of March. The death-rate for London was, in the 1st quarter, 1-40 per thousand, for Westminster 027. It fell in the 2nd quarter to 061 and 022 respectively. There were 24 deaths in Westminster in the year. For the 12 months the rates were 0.57 for London and 014 for Westminster per 1,000 of population. The average deatli-rates for the preceding 5 years being 0.42 and 0.13, respectively. During the year 596 cases came to my knowledge, 478 having been notified by school teachers (particulars as to the schools are given later in this report). The group of schools in St. John's and St. Margaret's Wards furnished 177 cases, Millbank school alone having 74; there were 76 in the Pimlico schools, 91 in the Mayfair group, of which St. Anselm supplied 77 ; 85 cases occurred in the Soho schools, and 40 in the Strand and St. Martin's area. Visits were paid by the women inspectors in cases notified: advice 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. Disinfection of 227 rooms and of 2,739 articles was carried out by the Council's staff in 133 houses Fifteen children were removed to the Metropolitan Asylums Board's hospitals for treatment. In 19 schools unprotected children under five year of age were excluded for varying periods. Whooping-Cough.—This complaint was responsible for 29 deaths, all but one of children being under five years of age; 279 cases were notified to me (for particulars as to schools affected see list below). In London, the fatal cases were slightly less than the corrected average number for the previous five years. In Westminster they were a little above. The death rates in each quarter were:— 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. The Year. Westminster 012 0.45 0.15 0.18 London 037 031 0.15 0.07 0.23 F 58 Children suffering from whooping-cough are also visited by the women inspectors. Nine children were removed to Metropolitan Asylums Board's hospitals. Disinfection of nine rooms was carried out. Schools and Infectious Disease. School teachers are required to notify the Medical Officer of Health when they exclude children on account of infectious disease. when they exclude children on account of infectious disease. The following list shows how far this was carried out and the nature of the cases notified:— School. Actual Cases. Infection in House. Other Causes. Chickenpox. Measles. Mumps. Whoopingcough. | Chickenpox. Measles. Mumps. Whoopingcough. Buckingham Gate 2 19 1 6 2 10 1 5 ringworm. Charing Cross Road 3 2 14 1 1 1 — — Horseferry Road 1 15 16 13 - 27 1 6 3 ringworm. 4 ophthalmia. Millbank 16 74 11 52 2 20 1 7 28 ringworm. Pulteney 27 12 5 — 13 18 2 — St. George's Row 20 5 26 30 8 1 — 9 7 ringworm. Wild Street 17 10 7 — 5 8 — 2 ringworm. Brompton Higher Grade 25 5 — 17 1 — — 1 1 ringworm. Burdetc Coutts 3 18 21 18 2 3 — — 7 ringworm. Cathedral, Great Peter Street — 1 14 — — 3 — — Christ Church 2 3 — — 3 1 — — Holy Trinity 24 18 8 3 13 23 2 4 7 ringworm. 1 German measles. St. Anne's 2 20 21 19 — 10 1 1 1 ringworm. St. Anselm's 30 14 1 9 9 6 — 2 2 ringworm. St. Barnabas 1 18 66 2 1 11 — — 14 ringworm. St. Clement Danes 12 1 13 — 7 — 1 — 5 ringworm. St. Edward's, Dufour's Place 1 20 — — — 7 — — 1 scabies. St. Gabriel's 10 6 51 29 7 10 - 31 16 ringworm. 16 scabies. St. George's, South Street — 77 3 4 — 12 — — 6 ringworm. St. James the Less 9 4 12 15 5 10 - 1 5 ringworm. 1 German measles. St. James' and St. Peter's 5 33 — — — 1 — — St. Margaret's — 5 - - - - - - St. Martin's, Adelaide Place 25 29 — 14 2 7 — 1 St. Martin's, Castle Street — — — — — — — St. Mary's, Hide Place 13 23 20 12 3 16 — — 6 ringworm. St. Matthew's 2 11 3 15 4 7 1 1 2 ringworm. 1 German measles. St. Michael's 3 23 2 - 2 2 — — 5 ringworm. 1 German measles. St. Paul's — 7 31 9 5 St. Peter's, Lower Belgrave Place 4 2 2 - - - - - Wesleyan Training 5 3 3 — 1 9 — — 262 478 351 267 91 223 14 65 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 346 notifications were sent out during 1911 to school teachers as follows;— 59 School. Small Pox. Scarlet Fever. Diphthoria. Enteric Fever. Buckingham Gate,. - 3 Charing Cross Road — — — 1 Horseferry Road — 1 1 — Millbank — 19 2 — — 4 6 — St. George's Row — 3 1 1 Wild Street — 17 1 — Brompton Higher Grade — 3 1 — Burdett Coutts — 6 2 — Cathedral, 48, Great Peter Street — 4 1 — Christ Church — 2 — — Curzon — — — — French Protestant — 6 2 — Grey Coat — 4 — — Holy Trinity — 2 — — St. Anne's — 1 3 — St. Anselm's — 1 1 — St. Barnabas — — 1 — St. Clement Danes — 1 1 — St. Edward's, Dufour's Place — — 1 — St. Gabriel's — 5 3 — St. George's, South Street — 3 3 — St. James's and St. Peter's — 5 2 — St. James the Less.. — 4 3 — St. Margaret's — — — — St. Martin's, Adelaide Place — 3 — — St. Martin's, Castle Street — — — — St. Mary's, Hide Place — 2 2 — St. Matthew's — 5 — — St. Michael's — 8 1 — St. Patrick's — 1 — — St. Paul's, Caroline Street — — — — St. Paul's, Wilton Place — — 3 — St. Peter's, Lower Belgrave Street — 11 8 — St. Vincent's — 3 — — Weslevan Training College — 2 1 - In several instances the continuance of cases of scarlet fever has been due to the presence of a child who has had the complaint in a mild form and the nature of the disease has not been recognised. It is sometimes a matter of difficulty to discover the source of infection, and entails an examination not only of those attending the school but of others who may be temporarily absent, and an inquiry as to any illness in their homes. The attendance of various members of a family at different schools promotes the diffusion of infection among the schools. 16 rooms in five schools were disinfected, together with 90 books and other articles. As to the arrangements for dealing with children affected with vermiu, see below under " disinfection." 517 school children suffering from various non-infectious complaints were visited for the Care Committees and Hospital Almoners, by the Health Visitors. F 2 60 Bacteriological Laboratory. During the year 240 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; 1910, 270. Disease. Persons. Examinations. Results. Positive. Negative. Doubtful. Diphtheria— Suspected cases 118 126 18 104 4 Contacts or school children 16 16 — 16 — Returned from hospital 1 1 — 1 — 135 143 18 121 4 Typhoid Feter 16 20 5 8 7 Tuberculosis 75 77 17 60 More advantage has been taken to obtain information as to the presence of the tubercle bacillus than in previous years. In addition to those mentioned above, many medical men and hospitals obtain reports on their cases from private or hospital laboratories. Disinfection. Below is shown the number of rooms and articles disinfected by the Staff of the Department. The premises included 16 rooms in 5 schools ; 11 vehicles were also disinfected. In 23 cases of infectious disease treated at home, the laundry linen was collected weekly and disinfected. Disinfection was carried out after all cases of the notifiable diseases, except as regards erysipelas (in which disinfection was performed in 24 instances, when the circumstances of the case required it), and also after 133 cases of measles, 6 chicken-pox, 26 cancer, 5 influenza, 7 whooping cough, and 234 phthisis. In 44 instances the premises, &c., were disinfected privately (35 of these being cases of phthisis). Shelters.—One person was admitted to the temporary shelter at Horseferry Boad while disinfection was being carried out. The following table gives a comparative statement of the above work during the past seven years:— 61  1904. 1905. 1906. 1907. 1908. 1909. 1910. 1911. Premises 581 667 961 840 1,067 1,287 841 979 Booms 935 1,177 1,627 1,455 1,568 1,865 1,284 ] ,449 Articles disinfected 29,107 34,703 47,865 36,115 31,915 49,843 26,850 26,264 Articles washed - - - - - - 514 782 Articles destroyed 52 151 195 1,660 233 186 1,651 496 Books disinfected 10 52 363 136 557 281 595 266 Number admitted to shelters 39 6 1 5 5 6 1 1 Cleansing of Persons.—The Guardians deal with the frequenters of their casual wards, who are the persons most troubled with vermin, at their own establishments, and the Education Committee had in use an apparatus at Pultenev School. The names of children treated at this school were to be forwarded to me, so that the homes, bedding, &c., might be examined and, if necessary, cleansed, but no names were received from school authorities during the year. 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. Nineteen persons have been treated at the cleansing station and their clothing fumigated (161 articles). Verminous School Children.—The City Council has entered into an agreement with the County Council, as an experiment for one year, for the cleansing of school children. The proposed agreement provides inter alia for the use by the County Council of the Cleansing Station, Grosvenor Eoad, for the purpose of cleansing the persons and clothing of verminous children who may be in attendance at public elementary schools provided or maintained by the County Council, they to pay the Council in respect to each child cleansed under the agreement the .sum of 2s., such payment of 2s. in respect of each child to cover any number of attendances by such child at the Cleansing Station for the purpose of such cleansing within the period of one calendar month calculated from the attendance at which the child is first cleansed and to be irrespective of the number of baths required before the child can reasonably be regarded as cleansed. The place of treatment of children shall be entirely distinct from any establishment used for the isolation of suspected cases of infectious disease contacts. The exclusive use of the baths for the cleansing of children shall be allowed on Tuesdays and Thursdays between 9 a.m. and 4 p.m. The City Council shall not be required to cleanse more than 10 children in 62 any one day. The children must be efficiently supervised, with female attendants for the treatment of girls. (A female attendant has been appointed for this purpose.) The City Council agreed to allow School Nurses to be present. The County Council will pay the Council a minimum sum of 5s. for every day on which the Cleansing Station is placed at the disposal of the County Council, whether any children are sent on every one of such days or not, unless the County Council give the City Council 24 hours' previous notice that they do not require the use of the Cleansing Station. In the case of children living in Westminster, the City Council agree to take concurrently with the cleansing of any child, such steps as they are legally empowered to take in order to effect the cleansing of the home of such child in all cases where the cleansing of the house is, in the opinion of the Medical Officer of Health for the City of Westminster, reasonably necessary for the health and cleanliness of the child. A woman was sentenced to three months' hard labour, at the instance of the Society for the Prevention of Cruelty to Children, for neglecting her two children and allowing them to become dirty and verminous. Verminous Houses.—244 notices with reference to vermin in rooms were issued on the reports of the Sanitary Inspectors; 58 of these were fumigated with sulphur by the Council's staff, the remainder by the owners. In all 1,185 articles were treated at the disinfecting station on account of their verminous condition, and a number were destroyed. Mortuaries. The number of bodies removed to the Council's mortuaries under order of the Coroner, or to await burial, was 373; in 2 instances death was the result of infectious disease. Three hundred and thirty-four inquests were held at Horseferry Road where the Coroner's Court is situated; 4 adjourned inquests were held. Post-mortem examinations were made in 177 instances at Horseferry Iioad. The number of inquests has not been so large since 1903. 63 The number of dead bodies taken to the mortuaries for purposes of inquest and to await burial during the last eleven years are:— Total. For Inquest. To await Burial. Total. For Inquest. To await Burial. 1901 438 370 66 1907 358 281 77 1902 389 345 44 1908 364 298 66 1903 393 341 55 1909 291 258 33 1904 388 322 59 1910 333 281 52 1905 370 307 61 1911 373 334 49 1906 345 283 61 Of the 49 bodies admitted to await burial, 36 were taken to Horseferry Eoad, 8 to Dufour's Place, 5 to Drury Lane, and none 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 1911 360 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:— 1911. 1911. Complaints received and dealt with 858 Sanitary Work completed:— Drains:— Premises inspected on complaint, &c. 872 Tested by smoke 221 ,, chemical 373 House to house inspection 5,937 „ water 569 Subsequent visits 26,142 „ air 64 Premises (registered), visits to 7,559 Fresh air inlets fixed or repaired 323 Overcrowding found 115 Other infringements 1,182 Soil Pipes:— Fixed 372 Sanitary Work completed:— Houses:— Cleansed throughout 457 Yentilated 340 Repaired 199 „ partially 1,375 Tested by smoke 163 Overcrowding abated—rooms 107 „ chemical 142 Light or ventilation improved 369 ,, air 49 Water-closets:— Constructed 1,565 Roofs repaired 507 Floors and staircases repaired 534 Repaired 1,323 Underground rooms— Illegal use 49 Ventilated and light improved 421 Closed 49 Cleansed or limewashed 1,024 Yards, areas, paved or repaired 671 Y entilated lobbies provided 399 Damp walls remedied 241 Unstopped 166 Offensive refuse removed 300 Traps ventilated 709 Keeping of animals discontinued 19 Flushing cisterns fixed 1,365 „ ,, repaired 438 Drains:— Constructed 336 Waste Pipes:— 1,197 Constructed Amended and repaired 342 Repaired 265 Y entilated 268 Unstopped 79 Unstopped and cleansed 240 Trapped 1,361 Interceptor traps fixed 188 Y entilated 720 Cleansed and sealed off from sewer 96 Disconnected 324 Rainwater Pipes:— Fixed or repaired 448 Gully traps fixed 1,038 Defective traps abolished 240 Disconnected from drains 108 Manholes built 600 Urinals:— Constructed 206 ,, repaired and cleansed 239 Repaired or improved 58 „ covers fixed or repaired 725 Cleansed 68 * In addition to the above, supervision was given to the provision of earth closets (151), urinals (86), and cabinets (11), in connection with stands erected for viewing the Coronation processions. 65  1911. 1911. Sanitary Work completed:— Water Supply:— Provided 628 Sanitary Work completed:— Dust Bins:— Movable, provided 216 „ additional in tenement houses 143 ,, repaired 20 Fixed, abolished 38 87 Stables:— Drained 32 Reinstated 30 Cisterns fixed 140 Paved 34 ,, cleansed 231 Cleansed 33 „ covered 268 Dung receptacles provided 7 Cisterns defective, abolished 97 Dung accumulations removed 81 Taps off main provided 600 Pipes repaired 201 3,368 intimations of nuisances, &c., and 233 statutory notices (including 7 for smoke nuisances) were issued; 2,240 letters were written, and 1,548 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. 21, Ryder Street (dwellings) Absence of sufficient supply of water Order to abate nuisance within 7 days and to pay 6s. costs. 10, Little Newport Street (restaurant) Failure to cause w.c. to be kept in a cleanly condition. (By-law) Fined 40s. and 12s. 6d. costs. 14, Livonia Street (tenements) Dirty condition of walls and ceilings of rooms, walls of yard, w.c. and basement, accumulation of refuse and absence of water supply to upper part of house Summons withdrawn, the work being completed immediately after summons was issued. Defendant paid 10s. 6d. costs. 2, Lexington Street (tenements and outworker premises) Dirty and verminous condition of house Order to abate within 21 days and to pay 40s. cost. 83 and 87, Eccleston Square (private hotel) Defective lead soil pipe Ordered to abate nuisance within 7 days and to pay 21s. costs. 4, St. Anne's Court (tenements) The dirty state of yard; the leaky gutter in front of premises and the dirty condition of ceiling of top back room; gully obstructed, overflowing into basement; absence of refuse bin and a leaky tap in yard As the work was done the Magistrate made a Prohibition Order with 6s. costs. 31, Lillington street (tenements) Dirty and defective condition of walls and ceiling of staircase; dirty condition of walls of front basement; insufficient flush to w.c. Ordered to abate nuisance within 14 days and to pay 16s. 6d. costs. 48, St. George's Road (boarding house) Walls and ceilings of rooms, passages, staircases, w.cs. and area walls dirty; w.c. in vault foul and defective ; waste-pipe from lavatory on ground floor defective and roof over anteroom on ground floor defective Ordered to abate within one month and to pay 27s. costs. 66 Plans.—588 sets of plans were examined during 1911. 462 of these resulted from notices served by the Public Health Department, and 126 were plans of new buildings or reconstructions, 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 34 instances. Infringement of the By-laws in connection with the erection of buildings occurred in 26 instances. Proceedings against one firm offending were taken with the following result:— Premises. Offence. Result. 28, Victoria Street Erecting apparatus to w.c. without notice Order to pay £1 1s. costs. 28, Victoria Street Partly reconstructing drains without notice Order to pay £1 1s. costs. Twenty-five persons were cautioned by the Public Health Committee. In six instances the work was not being carried out satisfactorily, but was altered so as to comply witli the By-laws. Drain-testing.—In the list given above is shown the number of drains and soil pipes 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 458 instances the services of the two drain-testers attached to the Department were requisitioned. Supervision of House Drainage.—For a considerable time it has been evident that the system adopted by the Council, whereby part of this work was under the control of the City Engineer and part under the Medical Officer of Health, was too complicated. During 1911 the matter was specially considered by a joint sub-committee of the Public Health and Works Committees of the Council, and as a result the Council amended the arrangement in accordance with a report submitted. The Sub-committee said:— "We would point out that the reference to the Public Health Committee includes the construction of all water closets, soil pipes and other apparatus which are the subject of the provisions of the Public Health (London) Act and the By daws made thereunder. This necessitates inspection and supervision by the Officers of the Public 67 Health Department of the construction of water closets in the case of drainage work within the jurisdiction of the Works Department, as well as in the case of drainage work executed pursuant to a Nuisance Notice or Order. Thus, the cases of drainage work are comparatively few in number in which it is not necessary for the Officer of the Public Health Department to inspect and supervise work which is subject to the provisions of the Public Health (London) Act and the By-laws made thereunder. " It appears that under existing arrangements the amount of drainage work supervised by the Public Health Department is far greater than that falling within the scope of the Works Department. " We have consulted the City Engineer and the Medical Officer of Health upon the subject. In his report of the 8th April, 1911, the City Engineer states that the duties of the staff of the Works Department in connection with drains, sewers and other sanitary works are of such a ' multifarious and extensive nature, that the relegation to them of the supervision of all construction work of every class in connection with buildings and their sanitary schemes would be but little felt.' The Medical Officer of Health informs us that if the duty of supervising drainage works which are not executed pursuant to a Nuisance Notice or Order were transferred to the Public Health Committee and their Department, the work could be undertaken without any additional cost to the Council, except that the Council would not obtain from the London County Council a moiety of such part of each Sanitary Officer's salary as may be allocated as payment for the supervision of the additional drainage work above mentioned. " Having carefully considered the subject in all its bearings, we have come to the conclusion that the control of the work under the existing system is unsatisfactory, and that it would be advantageous to the Council and more convenient to the owners of property and builders if the supervision of all drainage works (except that part of the drain which lies between the intercepting trap and the sewer), and the construction of all water closets, soil pipes, and other apparatus, and the approval of all plans relating thereto, were referred to the Public Health Committee and Public Health Department, and if the supervision of the construction of so much of each drain as lies between the intercepting trap and the sewer were referred to the Works Committee and Works Department. "We think, however, that the Public Health Committee should have the benefit of the engineering and constructural knowledge of the Works Department, and that all drainage plans deposited should be examined by the Works Department, and that it should be an instruction to the City Engineer to report to the Public Health Committee on any plan which he may consider to be unsatisfactory from an engineering and constructional point of view." Effluvia from Sewers.—During the dry weather numerous complaints were received with reference to the offensive smells emanating from the openings into the sewers at street level. These were referred to the City Engineer to be dealt with. Flooding of Basements.—On at least two occasions heavy local storms led to the sewers being filled to such an extent that in the lower lying parts of Westminster either there was an inflow from the sewers into the basements of premises, or the house drains filled up and overflowed in consequence of the contents not being able to escape into the sewer. Flooding does not always result when there is heavy rain as the outlets for storm water into the Thames are generally sufficient unless at the same time the tide is up or is unusually high. The increase in imperviously paved streets, and in the use of tar macadam or other material necessitates the removal by the sewers of a larger amount of the rainfall which formerly would have soaked into the ground. Rats.—In a fairly large number of instances complaints were received that rats had invaded premises. The house drains are examined and the City Engineer is also communicated with in order that he may see if there is any defect in the sewer adjoining. In some cases it is extremely difficult to discover whence the rats come. The pulling down of old property occasionally disturbs a number of rats who invade the houses in the neighbourhood. From the reports of the Engineer it appears that a large number of dead eyes in the sewers have been bricked up during the year, and in addition various repairs of the brickwork of the sewers have been carried out. Removal of Offensive Refuse.—Complaints were made of offensive smells in a number of instances occurring during the removal of kitchen refuse from hotels, &c. One person was cautioned for removing refuse during prohibited hours and five prosecutions were taken as follows:— 69 Name and Address of Defendant. Offence. Result. F. N. Squire, The Rosary, Ashford, Middlesex Removal of refuse during prohibited hours Fined 20s. and 2s. costs. J. S. Cornwall, Westfield Farm, Weston Road, Mitcham Removal of refuse during prohibited hours Fined 20s. and 2s. costs. Charles Lever, Riverside," The Osier, Wandsworth Removal of refuse in improper receptacles, allowing contents to leak on to road; no covering to receptacle Fined 20s. and 2s. costs. The Sheppey Glue and Chemical Works, Ltd., 34, Mark Lane, London, E.C. Causing to be removed offensive refuse in faulty receptacles Fined £5 and 2s. costs. Thomas Garlick, 2, Bognor Street, New Road, Battersea Removing refuse during prohibited hours Fined 10s. and 2s. costs. A summons is not taken out unless the person offending has been previously cautioned. In giving judgment in one of the cases, the Magistrate (Mr. Francis) observed that the by-law was constantly infringed by offensive matter being taken in improper receptacles and in an improper way. It was thrown down anywhere, and tipped up in insufficient carts. Only the other day he saw two small children sitting in a cart containing this stuff for a ten-miles ride, and he thought that ought to be proscribed. Public Conveniences for Women—Free Water-Closets.—The Public Health Committee, at the end of 1910, recommended that some free accommodation should be provided in connection with each of the women's conveniences belonging to the Council, and 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, notices to be exhibited outside the conveniences that free w.c. accommodation is available on application to the Attendant. As a result of this experiment it has been agreed to extend the system to other conveniences in the City. Victoria Embankment Gardens—Absence of Conveniences.—In June, 1910, complaints were received by the Council of a nuisance caused by the absence of urinal and other accommodation in the neighbourhood of the Villiers Street end of the Victoria Embankment Gardens. Large numbers of people congregate in the Gardens, especially in the evening, attracted by the London County Council band, and in consequence of there being no sanitary convenience in the Gardens or in the vicinity, nuisances were committed in doorways and in the public street; the 70 Council resolved to draw the County Council's attention to the matter seeing that the Gardens as well as the Victoria Embankment are controlled by the County Council. After consideration of the matter the County Council, on the 14th November, 1911, agreed to construct suitable convenience accommodation for men and women on a site within the Gardens adjoining Hungerford House. Housing Conditions. Sanitary Survey of Houses.—Special reports have been made of the condition of houses in the following streets and courts:—Commercial Place, Allington Place, St. Leonard Street and Place, Eaton Mews South and West, Royal Oak Place, Middle Street, Wellington Mews, Alfred Street, Roberts Street and Place, Lillington Street, Dorset Place and Upper Garden Street. A number of defects were discovered and remedied, notice being served under the Public Health, London, Act. In view of the willingness in most cases of owners to carry out required works, it has not appeared necessary to the Public Health Committee to resort to the somewhat complicated procedure of the Housing and Town Planning Act. Three cottages were found to be unfit for habitation, and the owners agreed not to let them again for such purpose unless they were made habitable to the Council's satisfaction. Demolition. — The houses, 48 and 50, Tufton Street, were demolished in compliance with orders made by the Council in 1911. On account of certain legal formalities not having been complied with in respect of five other houses, the Council had to start proceedings de novo. Underground Rooms.—49 rooms were found to be illegally occupied and their use given up. Eight of these infringed the Housing Act by being less than 7 ft. high and used for sleeping purposes, notices under that Act being served in four instances. The following is a summary:— Houses specially inspected under Section 17 21 Representations made as to unfitness 8 Closing Orders made under Housing Act 0 Orders complied with 0 Number of houses since put into habitable state 6 Underground rooms represented under Section 17 8 Closing Orders made „ „ 4 Dealt with under Public Health Act 4 Houses Let in Lodgings.—The number of houses in 1911 was reduced by 55 through closure, and as none were added in that year, the number 71 on the register at the end of the year was 1,392; to this class of house 7,559 visits are recorded as having been paid. Overcrowding was found in 115 instances, and 1,182 other defects were found and remedied. Particulars are included in the general list given at the beginning of this part of the Report. The Local Government Board (5th October, 1911), confirmed the additional By-law made by the City Council with respect to houses let as lodgings or occupied by members of more than one family:— "Subject to the provisions of these By-laws, the landlord of a lodging-house in which the rent or charge payable by each lodger inclusive of any charge for the use by such lodger of any furniture is at the rate of 7s. per week or less, shall cause the bedding in such rooms to be at all times maintained in a clean and wholesome condition." Displacement of Persons of the Working Class.—In connection with the proposed erection of blocks of buildings by the Peabody Trust in Vauxhall Bridge Road, referred to in a precediug report, a number of houses have been closed in that road, Willow Street, St. Andrew's Terrace, Gloucester Terrace and Bloomburg Street. Williams Place, Tufton Street, was closed voluntarily by the owners. New Buildings and Tripp's Buildings, with 87, 89 and 91, Tufton Street, 2, 4 and 6, St. Ann's Place, and 28 and 30, Great Peter Street have been closed to enable other buildings to be erected on the site. The County Council fixed on a site for a new school in place of the one in Horseferry Road. It is to be in Johnson's Place (Nos. 1a—,15a) and Ranelagh Road (Nos. 2 and 6—28 even numbers), and will displace 265 persons of the " working class." The County Council made enquiries as to the amount of accommodation in the neighbourhood of the site available for occupation by the persons to be displaced. The number of unoccupied tenements has been ascertained within a radius of half a mile on the north side of the river. The results of the enquiry are that there are 198 rooms to be demolished and that there are 486 rooms to be let in the neighbourhood, all of them in good or fair condition (none were found in bad condition). The approximate proportion of empties is 24 per cent., which is considered as a moderate amount. The Council think this is a sufficient margin of vacant accommodation, and that they should be released from the obligation to re-house. In reporting on the matter the Housing Committee say:— "This area (half mile radius), which include.s the district on both sides of Vauxhall Bridge Road, is one in which little change in regard to housing has taken place in recent years, the only important scheme being a reconstruction of a few streets on the 72 east side of Vauxhall Bridge Road by the Ecclesiastical Commissioners. Since 1902 there has been a net decrease of about 150 working-class rooms in this district. The rents in Westminster are much higher than in other parts of London, and sub-letting necessarily prevails in working-class houses. The average rents range from 4s. 5d. for one room to 28s. for a house of ten rooms. It may perhaps be contended that, in view of these facts, the Council should in this case make specific provision for the accommodation of the persons now residing in the premises proposed to be demolished, but it should be borne in mind that, owing mainly to the general movement of the residents in the central districts towards the suburbs, the population of the County now shows a tendency to decline, and that this movement is likely to continue. This tendency of the community to spread itself, encouraged by the provision of improved means of transit at low rates, we regard as a healthy one, and we are strongly of opinion that it would be unwise for the Council to undertake at the present time the erection of working class dwellings in the central districts unless there are very special reasons to the contrary. Any such accommodation must necessarily be of the block dwelling type, and we feel that the housing operations of the Council are better directed towards the development of its suburban cottage estates than in the erection of tenement dwellings, the demand for which, we fear, may in the future fall short of the supply. We shall, as we have always done, keep close observation upon the need for housing accommodation in this and other parts of London, and, should the necessity arise, it will always be open for the Council to carry out building operations under Part III of the Housing of the Working Classes Act, 1890." Westminster (Millbank) Improvement.—This improvement, which is being carried on by the County Council, proceeds slowly. Most of the buildings in Millbank have been pulled down, and the main line low level sewer has been diverted, and a considerable part of the land in the neighbourhood of Smith's Square has been re-let for good class buildings, but other parts of the scheme have been delayed while consideration is given to the question of rebuilding Lambeth Bridge. Water Supply. Applications were received for certificates that the water supply of seven new buildings (15 dwellings) was sufficient, and were granted in each instance. 87 notices of withdrawal of water supply were received from the Metropolitan Water Board, and in 30 instances it was reinstated, on notice. Additional sources of water supply on the upper floors of tenement houses were provided in 143 instances. Legal proceedings in 73 connection with water supply were taken in one instance. 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. Notwithstanding the small rainfall last summer, the Water Board, by reason of the large storage reservoirs which have been erected and the system of inter-communication between districts, were able to maintain a satisfactory supply during the whole period. Common Lodging-houses. The total common lodging-house accommodation available is now 2,269 beds for men, 75 for women. The County Council report that there is a steady demand at Bruce House for accommodation of a slightly better class than that afforded by the ordinary cubicles, and a number of cubicles which have been specially fitted up by increasing the height of the partitions and providing a few small articles of furniture have readily let. They have therefore fitted up a room in Kean Street, previously let for commercial purposes, with seven of these special cubicles, for which a charge of 1s. a night or 6s. a week is made. Deaths.—80 deaths (76 males and 4 females) occurred in 1911 among inmates of the common lodging-houses and shelters in the City. 26 of the deaths were due to phthisis, 15 to respiratory diseases, 8 to nervous diseases, 6 to diseases of the heart and blood vessels, 9 to cancer, and 4 to kidney disease. There were 31 deaths from St. John's Ward, 2 from Begent, 1 from St. Anne's, 8 from Covent Garden, and 38 from 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 four years among persons alleged to have been inmates:— Common Lodging Houses. Men. Deaths. 1908. 1909. 1910. 1911. Bruce House, Kemble Street (L.C.C.) 706 32 28 36 34 33, Great Peter Street 397 14 22 11 8 Ham Yard Hospice, Great Windmill Street 20 — — — — 11, 12, and 13, Hanover Court 105 14 10 8 8 108, Regency Street 8 — — — — The Schools, Kean Street (S. A. Shelter) 125 2 7 8 4 16, Strutton Ground 217 12 10 3 8 45 and 47, Tufton Street 91 4 — 2 3 S.A. Shelter, Great Peter Street 600 — — 1 6 40, Great Peter Street Women. 75 3 1 4 4 G 74 In addition, 5 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, 26, Lichfield Street, and 6, Great Smith Street. Besides these, deaths were recorded of 156 persons with no fixed address who had been admitted to the hospitals and infirmaries of Westminster. Tuberculosis.—New cases of pulmonary tuberculosis in men were notified from the following premises:— Bruce House, 39 S. A. Shelter, Kean Street, 15 33, Great Peter Street, 5 S. A. Shelter, Great Peter Street, 7 12, Hanover Court, 5 Besides, 41 inmates of common lodging-houses who had been notified in previous years (1905-1910), were re-notitied in 1911. In addition there were 19 casuals or homeless persons in St. George's Union district, 5 in the Strand, and 5 in the Westminster Union districts, making 100 in all, two of these were women. With two exceptions all were reported by Poor Law Medical Officers. Revenue Act. Certificates under this Act relieve the recipient from the payment of Inhabited House Duty. Applications were received by me in 6 instances comprising 40 tenements. Certificates were refused for five tenements. The premises in which are situated the tenements for which certificates were granted are:— Ashley Mansions. Crediton Mansions. St. George's Mansions. Garrick Mansions. Two applications were also made for common lodging-houses and were granted, viz., for the Salvation Army Shelters in Kean Street and Great Peter Street. 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:— 1911. North District. South District. Total. Complaints received 50 13 63 Observations taken 1,788 832 2,620 Notices issued— Preliminary 60 39 99 Statutory 5 2 7 Summonses — — — 75 A comparison with previous years is given below:— 1902 1903 1904 1905 1906 1907 1908 1909 1910 Complaints 81 52 55 52 37 48 35 44 27 Observations 2,728 2,731 3,191 2,715 2,722 2,417 2,362 2,605 3,009 Notices issued:— Preliminary 58 68 142 121 93 106 116 93 86 Statutory 18 18 26 26 25 15 12 6 6 Summonses 6 3 5 11 8 2 — — 3 As iu previous years much of the smoke nuisance 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 premises causing this class of nuisance included:— Hotels and restaurants 24 Bakers 4 Motor works 2 Government buildings 3 Clubs 3 Breweries 3 Private houses 7 Hospitals 2 Various 15 Serious nuisance was caused by the use of two destructors for burning refuse elected by a railway company in a position which allowed the smoke, which was of an offensive character, to blow into an important thoroughfare. 76 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 work premises at the end of 1911:— Workshop. Total Number. N umber in which Women are Employed. Tailors, outfitters, shirt makers, hat, cap, and helmet makers 1,281 1,039 Dressmakers, milliners, embroiderers, lace makers, blouse makers, costumiers, lingerie makers, children's outfit makers, feather dyeing, corset makers, furriers, &c. 828 828 Leather workers, boot and shoe makers, harness makers, &c. 31 27 Carpentry, upholstery, carvers, gilders, &c. 20 19 Surgical and dental instrument makers 12 9 Tobacco manufacturers 18 18 Wig makers and hair workers 44 44 Printing, bookbinding, lithographers, envelope making, stationers, publishers, &c. 30 12 Jewellers, silversmiths and burnishers, diamond cutters and polishers, engravers, &c. 174 37 Metal workers 145 — Miscellaneous—Basket making, fancy work, shoe ornaments, hat pins, stamp sorters, postcard tinters, fan makers, artificial 116 73 Florists 30 30 Luandries 34 34 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 197 registered workshops was discontinued, and 260 additions were made to the register during the year; 64 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 seventy-six complaints were received, including 100 from the Home Office and were duly investigated ; 19 matters were referred to the Home Office relating to insufficient warming of rooms, working overtime, &c., and in addition, notice was sent of 91 workshops in which Abstracts were not affixed. 77 Statutory notices were issued in 35 instances; four prosecutions took place in connection with premises in which work was carried on two being workplaces as shown above, under the heading of " House Inspection." Inspection. Premises. Number of Inspections. Defects Found. Intimation Notices. Statutory Notices. Prosecutions. Factories (Including factory laundries) 237 78 20 — — Workshops (Including workshop laundries) 4,246 1,055 588 35 2 Workplaces (Including restaurant kitchens, &c.) 4,304 396 380 24 2 Total 8,787 2,429 988 59 4 In addition, 68 re-inspection visits were paid to factories and 3,346 to workshops and to other workplaces. Defects found.—1911. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. * Nuisances under the Public Health Acts:— Want of cleanliness 807 807 2 Want of ventilation 176 176 — Want of ventilation of gas stoves 81 81 — Overcrowding 44 44 — Want of drainage of floors 31 31 — Other defects 754 754 1 Sanitary accommodation— Insufficient 89 89 — Unsuitable 72 72 — Defective 338 338 1 Not separate for sexes 37 37 — 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 2,429 2,429 4 * Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act as remediable under the Public Health Acts. The prosecutions covered a number of defects. 78 Other Matters. Class. Number. Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (Sec. 133) 91 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 100 Reports (of action taken) sent to H.M. Inspectors 100 Other 9 Workrooms measured 272 Underground bakehouses (Sec. 101):— Certificates granted during the year — ,, refused „ 1 In use at the end of the year 69 Printers Factories and Workshops.—During the year Inspector Dee made a special examination of the premises belonging to the printing firms in the neighbourhood of Chancery Lane and the Strand. There are 23 firms, and half of these employ large numbers of persons, two of the largest employing about 600 each. The total number actually at work at the time of the Inspector's visit was 3,236, but night work and other extra work lead to the employment of an additional number. The number of workrooms is 186. As these premises are factories they are also under the supervision of the Home Office Inspectors; it was therefore not expected that any very serious defects would be discovered. In several factories, however, w.cs. were found opening directly from workrooms without the provision of a ventilated lobby. In a few cases the sanitary accommodation was not kept separate for men and women workers. Some of the w.cs. and urinals were not well looked after. No instances of overcrowding were observed. Complaint was received of offensive smells proceeding from one building, and they were found to be due to the type-melting pots. Covent Garden Market.— Women Worlcers.—Arising out of a complaint, Miss Carey (Sanitary Inspector) made an inquiry into the conditions under which women are employed in pea-shelling and walnut-shelling. Some of this is done in the open market when the weather permits, but two or three firms were found using their basements in the market for this purpose, which is contrary to the regulations, and besides they are not suitable for the purpose. In one of these cellars 20 women were found, and they stated they were occasionally employed from 3 a.m. to 5 p.m. In another basement where fruit sorting was being performed 79 by four women, there was a disused w.c. in a very objectionable condition. In the neighbourhood of the market certain fruit and vegetable firms nave premises in some of which women are employed. In one of these, in a space which on the Factory Act scale would allow 40 persons, 90 women were found sitting as close together as possible, the seating accommodation occupying about two-thirds of the floor space. It was admitted that in wet weather 20 women who usually work in the open were also sent to this room. It is a fairly well ventilated room when not overcrowded. Work is carried on from 3 a.m. to mid-day during three or four months of the year. It is evidently necessary to make inspections during these special seasons to ensure that better arrangements are maintained. 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 34 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 1911. 603 lists were sent in by employers ; 3,357 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; 550 addresses were received of persons in Westminster taking in work from other boroughs. They were distributed thus:— 80 Council. Sent from Westminster. Received by Westminster. Council. Sent from Westminster. Received by Westminster. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Acton 6 12 – – Kingston-on-Thames 1 – – Barnes — 3 – — Lambeth 44 82 2 – Battersea 57 73 1 — Lewisham 3 11 2 2 Beckenham — 2 – — Leyton 2 6 1 1 Bedfont — 1 – — London, City 8 18 25 31 Bedford – 1 – — Luton – 1 — – Bermondsey 2 4 1 – Merton — 1 — – Bethnal Green 8 18 – — Newbury — 1 — – Billingshurst — 1 – — Northampton — 6 — – Camberwell 22 54 – 1 Paddington. 50 85 20 14 Cambridge – 1 – — Perth – 1 — – Charlton Kings – 1 – — Ponder's End — 1 — – Chelsea 10 12 33 33 Poplar — 1 — – Chiswick 3 3 – — Sr. Leonards – 1 — – Croydon 5 6 – — St. Marylebone 507 733 56 51 Deptford – 4 – — St. Pancras 94 324 6 4 Ealing 4 6 – — Shoreditch 6 11 — 1 East Ham 1 1 – — Southend – 1 — – Edmonton 1 3 – — Soutliwark 20 43 — – Farnborough 1 2 – — Stepney 60 101 — – Finchley – 1 – — Stoke Newington – 2 — – Finsbury 4 12 6 2 Tottenham 3 5 — – Fulham 15 39 – — Walthamstow — 1 — – Hackney 10 13 1 2 Wandsworth 40 60 9 1 Hammersmith 25 53 – — Wantage — 1 — – Hampstead 7 8 1 4 Wealdstone — 2 — – Hanwell – 2 – — Wembley — 1 — – Harrow - on - the Hill – 1 – – West Ham 4 7 — – Willesden 53 75 1 – Hendon – 1 – — Wimbledon 1 3 — – Holborn 80 103 29 28 Woolwich — 1 — – Hornsey – 4 1 2 Yeovil — 1 — – Ilford – 1 – — – Islington. 30 49 2 2 Kensington 30 58 36 41 1,216 2,141 233 220 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 1,825, being 47 more 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 975. Notices were served in respect of 657 defects discovered in 323 houses. They may be summarised thus:— 1910 1911 1910 1911 Sanitary accommodation— Walls and ceilings dirty 250 248 Rooms verminous 17 22 Insufficient 4 3 Rooms overcrowded 4 5 Not kept separate 10 12 Rooms badly ventilated 15 24 Improper position. – 5 Gas stoves and heaters unventilated 9 11 Apparatus defective 87 72 Requiring cleansing 42 27 Other defects (dampness, defective roofs, floors, water supply, dust 112 103 Ventilation defective 8 5 Drains, &c., defective 33 20 81 City of Westminster. Outworkers. 1911. FEBRUARY lists. august lists. Trade. Number of Lists. Number of Outworkers. Received from other Authorities. Sent to other Authorities. Addresses in City. Number of Lists. Number of Outworkers. Received from other Authorities. Sent to other Authorities. Addresses in City. Tailoring 227 3,083 131 1,023 2,060 255 3,649 191 1,561 2,279 -Dressmaking 18 126 84 50 76 7 50 2 45 7 Theatrical costumiers – – — – – 1 20 — 15 5 Waterproofing 1 6 — 2 4 1 5 — 3 2 Shirt making and hosiers 4 41 4 1 40 23 120 10 71 59 Boot making 16 144 5 105 39 35 460 5 378 87 Veil Spotting 1 2 – 2 – — — – – – Corset making – — – 3 4 – 4 – Embroidery 1 26 – 25 1 6 64 2 61 5 Glove making — — – — – 1 3 – 3 — Lace making 2 9 1 8 1 – – – — — Eur pulling – – 3 – 3 – – 3 — 3 Ironmongery – – – – – – – 1 — 1 Umbrella making – – 1 – 1 1 3 1 — 4 Paper bag and box making – – 1 – 1 – – 1 — 1 Stuffed toy making – – 1 – 1 – – 1 — 1 Artificial flowers – – 1 – 1 – – – — – Dyers and cleaners – – 1 – 1 – – 1 — 1 Brush maker – – 1 – 1 – – – — — Belt making – – – – – – – 1 — 1 Wig making – – – – – – – 1 — 1 270 3,437 233 1,216 2,229 333 4,378 220 2,141 2,457 264 firms sent in lists on both occasions, giving a total of 6,708 addresses; 75 firms sent in once in the year, the number on their lists being 1,107. 82 In 21 instances statutory notices had to be served before the work required was done, and in one case police court proceedings were taken. 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. Four rooms used as workrooms were unfit to be so used, and the tenant found other premises. 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:— Smallpox. Scarlet Fever. Diphtheria. Typhoid Fever. Erysipelas. Total. Clothing trades :— (a) Business in family affected – 6 9 4 1 20 (b) Business in other parts of house – 6 24 1 1 32 (c) Persons from infected houses employed in clothing business elsewhere – 49 17 – 1 67 – 61 50 5 3 119 Other home workers trades .. – 1 1 – – – In connection with Laundries there were cases in each of the above three classes:— (a) (b) (c) In Receiving Shops – — — Mangling only – — — Washing, Ironing, &c. – Diphtheria, 1; Scarlet Fever, 1 Scarlet Fever, 1 There are 33 Laundries in which washing is done, besides which there are a number of private houses in which mangling only is done. Notices were served to remedy various defects found on inspection. These comprised:— Walls dirty 6 w.c.'s and drains defective 3 Dirty cisterns 2 Defective floor 1 Absence of dust bin 1 Ventilation defective 2 Accumulation of refuse 1 Defective cover to cistern 1 ,, paving of yard 1 83 E. FOOD SUPrLY. During 1911 visits have been paid to the various classes of business as follows:— Dairies and Milksliops 899 Bakehouses 266 Hotels, Restaurants and Eating houses 1,599 Ice cream makers 209 Food preserving works 30 Fishmongers 526 Greengrocers and Fruiterers 210 Meat shops (various) 693 Confectioners 39 Provision shops 519 Aerated water makers 5 Ice merchants 5 Breweries 4 Twenty-four statutory notices were served and police-court proceedings were taken in three instances (see above). Restaurants.—Notices served dealt with—cleansing, 56 ; drainage, 11; defective cisterns, 7; w.c. defective, 7; w.c. dirty, 11; defective ventilation of w.c., 3 ; improper position of w.c., 1 ; kitchens—refuse bins uncovered, 8; defective flooring, 6; excessive heat, 3; improper storage of food, 2; defective ventilation, 8; inlet to drain in larder; unventilated gas stove?, 2 ; accumulation of refuse, 3; sleeping in kitchen, 1; bedroom in direct communication with kitchen, 2; using kitchen as a laundry and drying place. A number of boarding-houses and private hotels were inspected, and in several the sleeping accommodation for the servants was found to be unsatisfactory. Ice-cream Premises.—This commodity is made at 150 premises, each of which was kept under supervision. In 19 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. The defects found were:— Dirty walls, &c. 7 Yards requiring cleansing 1 Dampness of walls 1 Drains obstructed 1 Insufficient ventilation 4 Dirty cisterns 2 Floors defective 3 Absence of proper dust bins 2 Paving „ 2 Yard with w.c. covered ill 1 Bakehouses.—At the end of 1910 there were 14 above-ground and 71 underground in use. During 1911 two underground bakehouses have been closed, one voluntarily, the other on notice that it had become structurally defective. All the bakehouses were inspected, and cleansing carried out twice a year. One baker was warned that he was not keeping 84 the floors, &c., as clean as he ought to do. Application for certification of an old underground bakehouse was refused. Certification of Food for Export.—As Certifying Officer for the City of Westminster for all meat foods prepared or packed for export to several foreign States, I have granted 186 certificates during 1911, 86 for the United States, 19 for the Philippine Islands, 70 for the Argentine, and 11 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 6 8 3 — 17 (6) Business in other parts of house .. 3 — 7 1 11 (c) Persons from infected houses employed else- 3 5 1 — 9 12 13 11 1 37 Milkshops.—At the end of 1910, 372 names of persons selling milk were upon the register. In 1911, 28 names were removed and 38 added, leaving 382 on the register at the end of the year; 18 of these were registered in respect of new premises ; 11 are street vendors having no address in the City. Ten persons selling milk were given notice to register, 6 complied and 4 discontinued its sale except in tea or coffee. The Council refused to register in 2 instances. Eight hundred and ninety-nine 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 2 were cautioned on account of their premises not being kept clean. In 6 instances dealers were required to remove from their shop articles likely to contaminate the milk. The defects complained of were:— Dirty walls, &c. 18 Defective or dirty w.cs. 4 Defectiive floors 2 3 Dirty floors 2 „ rain-water pipes 2 Defective roof 1 Unventilated gas stove 1 Insufficient ventilation 1 Defective paving 1 Damp walls 3 Absence of proper dust bins 2 No proper coyer to milt bowls . 8 Accumulation of refuse I 85 Infectious Disease.—One case of diphtheria and 1 of erysipelas occurred on premises in which milkshops were situated, and 3 persons from an infected house were employed elsewhere in the milk trade. Satisfactory arrangements were made in each instance, and no infection of the milk resulted. Cowsheds.—There is now only one cow-keeper, namely, at 13, Marsham Street (licensed for 19 cows). These premises were visited 25 times during the year. There are no slaughter-houses or " offensive trades " carried on in Westminster. Butchers' Shops.—Complaint had to be made with reference to want of cleanliness in the conduct of the business, improper storage of meat, proximity of brine tubs to w.cs. and dustbins, and to the keeping of fowls in an improper place. Fish Shops.—Five owners were cautioned for want of care in the conduct of their business. In one instance the fish was gutted and cleaned in the front basement area and left there in pails, which became covered with dust and refuse blown through the open grating over the area. In another, fish was placed on the pavement in front of the shop grouped round blocks of ice, in such a position as to render it liable to contamination. Complaint had also to be made of a defective drain, and of defective flooring. 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 1 0 28 Pears 10 9 12 Apricots 0 0 27 Persimmons 4 9 0 Bananas 2 5 56 Pineapples 1 2 56 Brussels Sprouts 4 11 0 Plums 0 14 22 Cokernuts 0 2 0 Strawberries 0 1 86 Maderia Beans 0 18 18 Tomatoes 0 0 70 Melons 4 9 61 Walnuts 0 15 44 Lemon soles, 49 lbs.; Codfish, 1 ton 1 cwt. 7 lbs.; Herrings, 12 lbs.; Bloaters, 50; Skate, 81 lbs.; Whiting, 1 cwt. 71 lbs. ; Bacon, 1 cwt. 36 lbs.; Tomatoes, 28 tins. 86 Butchers' Meat on Stalls.—The street markets are regularly inspected during the week, but especially on Saturday evenings and Sunday mornings. Two butchers were cautioned as to the indifferent quality of the meat they were selling. The following articles were seized and condemned; appended is a note of the action taken. Name and Address of Defendant. Article. Result. Margaret Covell, 6, Westow Hill, Upper Norwood Exposing for sale 6 lbs. of unsound meat on stall in Peter Street Eined £3. Mendet Gottfried, 134, Cable Street, E. Exposing for sale 300 bad eggs Reported to have left the country, so that summons could not be served. Walker Brothers, 132, Jermyn Street Exposing for sale at 132, Jermyn Street, carcase of a pig in a tuberculous condition Fined £10 and £5 5s. costs. John Thorpe and Son, 53, Central Markets, E.C. Aiding and abetting the offence by Walker Brothers, supra Summons dismissed, with £5 5s. costs against the Council. Edmnnd Coin tat, 15, Old Compton Street Exposing for sale the carcase of a pig in a tuberculous condition Fined £20. Retail butchers occasionally state that having paid a good price for the carcases in the Central Meat Market they do not consider they need take the trouble to examine the meat themselves, being under the impression that it must have been examined by the wholesale dealer or by the Market Inspectors. It appears to be admitted that the Inspectors in the Meat Market rely to some extent upon their attention being called by the salesman to any carcase which does not appear to be right, and that a buyer has therefore no guarantee that the carcase he buys is free from disease and safe to sell to the public. It is consequently necessary that he should examine the meat himself. It is extremely difficult to take successful proceedings against the market salesman. An attempt was made in one of the cases mentioned above. At the hearing it was argued, and the Magistrate agreed, that in consequence of Sub-section 3 of Section 47 of the Public Health Act the provisions of Section 5 of the Summary Jurisdiction Act, 1848, had been practically repealed; and that under Section 47, Sub-section 3, of the Public Health Act the defendant was entitled to acquittal if he proved that at the time he sold the article he did not know and had no reason to believe that it was unfit for food, and the Magistrate thought that the prosecution were not entitled to shut out the defendant from this defence by proceeding against him for aiding and abetting. Representations have been made to the City of London authority in 87 the hope that the methods of inspection may be improved, and the attention of the Local Government Board has also been drawn to the matter. The Local Government Board have advised that when a part of a pig is affected with tuberculosis the whole carcase should be destroyed, on account of the rapidity with which the tubercle organism permeates the system, but it has been alleged by various witnesses in cases which have been tried that in some markets this advice is not acted upon. As the recommendation of the Local Government Board has the support of the highest veterinary authorities, butchers should be careful not to purchase a pig's carcase which has had the head removed. Food Poisoning.—The Local Government Board have issued a Memorandum on the investigation of outbreaks of illness suspected to be due to food poisoning. The Memorandum suggests that in any outbreak where the implicated food has been prepared in the district, it is advisable that as soon as the Medical Officer of Health has established the probability that a particular food is at fault, he should at once proceed to make detailed investigation into the conditions of its preparation and obtain materials for chemical or bacteriological examination. The difficulty in carrying out such an enquiry is that the information does not reach the Medical Officer early enough. Thus recently several members of a family were rendered seriously ill through eating cooked pressed beef covered with jelly, but no complaint was made to me until five days after, by which time it would have been useless to have made a bacteriological examination of a fragment of meat which remained. Enquiry into the circunrstances failed to discover when and where the meat became infected—possibly it occurred after it was purchased. In another ease twelve waiters were alleged to have been made ill through eating shrimps, but the information did not reach me till a month afterwards, when one of them was found to have typhoid fever. In a third instance a custard which had been kept in a warm kitchen for two days was submitted, as on tasting it it was found to be intensely bitter. Dr. Bernstein examined it, and reported that it was odorous and contained bacilli, some motile, spores and yeasts. Cultures yielded various organisms, including some indistinguishable from B. coli, B. enteritides sporogenes and a proteus organism. The importance of washing vegetables before they are eaten is generally recognised, but fruit is seldom treated in the same way. It is frequently exposed on stalls and open shop windows, and in dusty weather may easily be contaminated with germs which may cause diarrhoea and vomiting in consumers. 88 Sale of Food and Drugs Acts. Samples Purchased under the Sale of Food and Drugs Jets, showing result of Analysis and subsequent Proceedings for year 1911. Article of Food. Number of Samples Purchased. Genuine. (Inferior in brackets.) Adulterated. Prosecutions. Convictions. Withdrawn or Dismissed. Fines. Costs. £ s. d. £ s. d. Milk 911 734 (100) 77 42 19 23 28 15 0 11 15 0 do. separated 6 5 1 1 1 — 1 0 0 0 12 6 do. skimmed 6 5 1 do. and soda water 3 3 Cream, fresh 33 17 16 4 3 1 6 10 0 2 2 6 do. potted 12 1 11 do. ice 14 14 Butter 190 168 (7) 15 7 5 2 9 0 0 3 2 6 Margarine 28 28 — 7* 7 — 8 12 0 3 5 0 Cheese 17 17 do. Midget Gouda 1 1 do. Pommel cream 1 1 do. Dutch do. 2 2 do. Parmesan. 2 1 (1) do. Gruyere 3 3 do. Camembert 1 1 do. Gorgonzola 7 7 Lard 18 18 Bread and butter 38 38 Roll and butter 3 3 Bread 16 16 Oatmeal 32 32 Flour 22 21 1 do. self-raising 1 1 Tea 19 19 Coffee 29 28 1 do. and chicory 10 10 Cocoa 52 48 (1) 3 Chocolate 4 2 2 do. powder 4 3 1 Pork pies 33 30 3 Steak pies 1 1 Meat pies 2 2 Veal and ham pies 1 — 1 Veal pate 1 1 Sausages, beef and pork and smoked 48 41 7 1 1 5 0 0 3 3 0 Sausages, fish 1 1 do. German 9 4 5 2 2 — 1 0 0 1 5 0 Turkey and tongue 6 6 Tongue 3 3 Liver paste 4 4 Beef paste 1 - (1) Lobster paste 1 1 Chicken and ham 8 7 1 * Samples taken under Sections 6 and 10 of the Margarine Act, 1887. 89 Article of Food. Number of Samples Purchased. Genuine. (Inferior in brackets.) Adulterated. Prosecutions. Convictions. Withdrawn or Dismissed. Fines. Costa. £ s. d. £ s. d. Brawn 3 3 Ham, cooked and uncooked 19 18 1 Meats (various), potted:— Veal, meat, chicken and tongue,chicken, chicken, ham and tongue, lunch tongue, turkey and ham, ham and tongue, corned beef, wild duck, black pudding, bacon (one sample each) 12 12 Fish (cod, haddock, and plaice) 31 20 11 Salmon paste 1 — 1 Sardines 1 1 Beans, preserved 3 . 2 1 Peas, preserved 12 12 Mustard 1 1 Vinegar 11 7 (2) 2 1 1 — 0 10 0 0 12 6 Oil, olive 51 45 (2) 4 2 2 — 5 0 0 3 15 6 do. Lucca,. 1 1 Sugar, brown 17 15 2 do. cane 1 1 do. Demerara cane 1 1 do. Demerara 5 4 (1) do. yellow crystals 1 1 Jam 16 16 Honey 9 9 Totals 1,800 1,517 (115) 168 67 41 26 65 7 0 29 13 6 Summary proceedings were ordered to be taken in 69 instances, but 2 of these, upon the suggestion of the Solicitor, were not proceeded with ; 21 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 4 instances, and no action was taken with regard to 74 samples which did not conform (3 of these were test purchases and not samples taken officially, the others deviated only slightly from the standard). Milk.—911. samples of ordinary milk were taken during the year. Of these 77 (8'4 per cent.) were reported by the Analysts to be below the standard of the Board of Agriculture, and 35 samples were just on the border line, making a total of 12-2 per cent. of the samples. The h 90 percentage of adulterated (8.4 per cent.) is considerably lower this year than in former years. The Analysts have graded the samples submitted to them into four groups:—Good quality, in which the fat was over 3.8 per cent.; fair quality, in which the fat was between 3.3 and 3.8 per cent.; and poor or inferior quality, in which the fat was between 3 per cent. (the official standard) and 3'3 per cent., or in which the non-fatty solids were between 8.5 and 8.6 (if the fat was also below 3-8). Adulterated are those below the official standard of 3 per cent. for fat and 8.5 for solids not fat. District. Total. Good Quality. Fair Quality. Poor Quality. Adulterated. No. Percent. No. Percent. No. Per cent. No. Per cent. South 396 122 30.7 144 36.3 99 25.0 31 7.80 North 515 183 35.5 167 32.4 119 23.1 46 8.90 1911 911 305 33.3 311 34.1 218 23.9 77 8...40 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 86 9.04 1908 860 335 38.9 267 31.0 176 20.4 82 9.50 1907 792 255 32.2 290 36.6 172 21.7 75 9.40 1906 806 267 33.1 252 31.2 168 20.8 119 14.07 1905 831 305 36.7 281 33.8 153 18.4 92 11.07 Although the amount of legal adulteration is less than that of former years, the quality of the milk samples generally is not so good. The amount of "Poor" quality milk is in excess of last year; the dry summer and the difficulty of finding food for the cattle had the effect of reducing the quantity of milk (the quality remains the same). In view of the temptation to increase the quantity at the expense of its quality, the figures given above may be regarded as fairly satisfactory. Forty-two prosecutions were taken with regard to adulteration— 25 for fat abstracted, 16 for added water, and 1 for both fat abstracted and added water. Twenty cautions were given to sellers whose milk contained less than 5 per cent, of added water, or had less than 5 per cent, of fat abstracted. Warranties were set up as a defence in 20 instances, 3 cases were withdrawn, 2 on account of insufficient time allowance between service of summons and the hearing, and 1 on account of wrong name being given to inspector who issued the summons. Sunday Samples.—116 of the samples of milk were taken on 13 Sundays during the year; 14 (12 per cent.) were found to be adulterated. In the five previous years the figures were 91, 10.6, 11.0, 10'5 and 8.6 per cent. respectively. 91 Samples taken in course of Delivery— (a) At Railway Stations.—51 samples of milk were taken on arrival at Victoria and Charing Cross Railway Stations. Thirteen were reported of good quality, 17 fair, 21 poor and 0 adulterated. (b) On Delivery at Shops, cfee.—30 samples of milk were taken as it was being delivered by wholesale firms to retail customers. Of these samples, 17 were good, 7 fair, 5 poor, and 1 adulterated (3 per cent, added water). These samples were taken in consequence of the milk sold by the retailer having been previously sampled and found below the limit (including cases where a warranty defence was set up). The number of samples of milk taken in each of the last ten years are as follows:— 1902. 1903. 1904. 1905. 1906. 1907. 1908. 1909. 1910. 1911. New 491 608 741 831 806 792 860 951 947 91 Separated, condensed, sterilised or dried 55 55 31 36 11 31 18 16 13 12 Total 546 663 772 867 817 823 878 967 960 923 Infringement of Section 9, Sale of Food and Drugs Act, 1899.— Five persons were cautioned for failure to have name and address on milk can or barrow. In two cases in which the third portion of milk taken was sent to Somerset House for analysis at the request of the defendants, different results were obtained to those reported by the Council's Analyst. In one of these (No. 393 S) Somerset House reported that their portion contained 3.49 per cent. of fat, the Council's Analyst found 2.85 per cent, in his portion, while the Analyst who examined the portion left with the defendant found 3.06 per cent. Apparently in the milk in question the cream had been partially converted into butter, and in dividing it into three portions it is probable that the fat was not equally divided. The average of the three portions was 3.13, so that it was just above the minimum permissible. In the other case (No. 79s) the Public Analyst certified a sample he examined to be deficient in fat to the extent of 10.6 per cent. Somerset House found only 3 per cent, deficiency in their part. The sample was purchased on 31st January, 1911. Public Analyst's certificate received, 14th February, 1911. Committee ordered proceedings, 21st February, 1911. Summons issued, 23rd February, 1911. First hearing of summons and request for third portion of sample to be sent to Somerset House, 23rd March, 1911. h 2 92 Third portion sent to Somerset House, 23rd March, 1911. Report received from Somerset House and summons finally heard, 27th April, 1911. The Public Analyst is by statute required to state on his certificate the date of the receipt by him of a sample for analysis, and to specially report regarding milk, butter, or any article liable to decomposition, whether any change had taken place in the constitution of the article that would interfere with the analysis. The Government Analyst is under no obligation to do this. The Council are of opinion that he should be, and with this object addressed a. communication on the subject to the Local Government Board. The Local Government Board replied by letter dated the 24th July, 1911, stating that they are advised that in the case of a sample of milk which has become decomposed no difficulty exists in accurately determining the fat originally present; and that evidence on this matter, and an account of the practice of the Government Laboratory in analysing samples of milk referred there in connection with the Sale of Food and Drugs Acts will be found in Dr. Thorpe's paper to the Chemical Society, 1905, vol. 87, p. 207. The Local Government Board add that they have already considered the suggestion that the Government Chemist should be required to state on his certificate the date of the receipt by him of a sample for analysis, and to specially report regarding milk, butter, or any article liable to decomposition whether any change had taken place in the constitution of the article that would interfere with the analysis, but that they do not, however, see the necessity of taking any action in the matter. The Public Analysts for the City subsequently submitted the following joint report on the subject:— "The statement in the letter from the Local Government Board that the process adopted by the officials at the Inland Revenue Laboratory for the analysis of decomposed milk is capable of accurately determining the proportion of fat originally present in milk depends upon what interpretation is placed upon the word accurately. " Taking the figures given in Dr. Thorpe's paper (referred to in the letter) and in other published documents on the subject, it appears that there is a possible error of as much as 5 per cent, of the fat originally present in the fresh sample in attempting to determine the fat in the decomposed milk by the process in use at the Inland Revenue Laboratory. In spite of this, certificates have' been repeatedly issued by the officials of the Inland Revenue Laboratory showing results differing from those of the Public Analyst by as 93 little as 3 per cent, of the original fat, without any qualification or any intimation that such results in reality confirmed those of the Public Analyst, thus allowing the Magistrate to assume that the Public Analyst was wrong. "It must also be borne in mind that a further possible cause of discrepancy arises from the fact that the sample analysed at the Inland Revenue Laboratory is by no means necessarily identical with that analysed by the Public Analyst—a circumstance which appears to be ignored at the Inland Revenue Laboratory. "In order that the Court may be in full possession of the facts in such cases, we consider that a statement as to the condition of the sample when received should appear on the certificate issued by the officials of the Inland Revenue Laboratory as well as on the certificate issued by the Public Analyst. It is legally necessary that a statement on this point should appear in the certificate issued by the Public Analyst, but any reasons which may be put forward in favour of the insertion of such a statement apply with far greater force to the certificates issued by the officials of the Inland Revenue Laboratory. " In view of the fact that the Magistrate frequently has before him three certificates emanating from different quarters, which are based on analyses of samples purporting to be portions of the same article> and which are assumed to be of the same composition—some of these analyses having been carried out on fresh samples and some on samples when in a state of decomposition—it is obvious that full information as to the condition of the different samples when analysed should be before the Court if a proper conclusion is to be arrived at." A copy of the report was transmitted to the Local Government Board with a request that the Board would be good enough to favour the Council with their views upon it. Colouring Matter in Milk.—The Council considered the question of the artificial colouring of milk ; dye is added to conceal the inferior quality of the milk, and in some cases it is of coal tar origin. The Council are of opinion that the artificial colouring of milk should in all cases be prohibited, and they understand that this view is shared by some of the better-class firms concerned in the trade. A communication on the subject was sent to the Board of Agriculture and Fisheries. Skimmed or Separated Milk.—Suggested Amendment of No. 3 of the Sale of Milk Regulations, 1901.—The attention of the Council has been 94 drawn on several occasions to the insufficiency of No. 3 of the Sale of Milk Regulations, which provides that where a sample of skimmed or separated milk (not being condensed milk) contains less than 9 per cent, of milk-solids, it shall be presumed, until the contrary is proved, that the milk is not genuine. The Council is of opinion that there should be separate definitions for all "skimmed" and " separated" milk, and agreed with two new suggested regulations submitted by Mr. Cassal, Public Analyst, to the Kensington Borough Council. Cream.—The trade has now adopted the distinction in selling cream of the terms " fresh " or " preserved." Thirty-three samples of the former were taken, 17 of them contained no preservative, and 16 had boric acid in the following proportions per pound:-3.96, 4.35, 9, 9.29, 10.5 11.27, 14, 14.87, 17, 17 59, 19.58, 20, 20, 20.82, 2268 and 32.5 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 four with the largest amounts. The preserved creams sold in pots and marked as containing not more than 35 grains per pound were found to have the following amounts per pound:—17.35, 18.59, 19, 21, 2107, 22, 24.79, 25, 25, 30 and 34 grains respectively. Preservatives in Milk and Cream—The Local Government Board have issued draft Regulations dealing with the use of preservatives. They provide that "no person shall add, or order, or permit any other person to add, any preservative substance to milk intended for sale for human consumption, and that no person shall sell, or expose, or offer for sale, or have in his possession for the purpose of sale, any milk to which any preservative substance has been added." With regard to cream, the Regulations provide that no person shall add, or order, or permit any other person to add or sell (a) any thickening substance to cream or preserved cream; (b) any preservative substance to cream containing less than 40 per cent, by weight of milk fat; (c) to cream containing 40 per cent, or more by weight of milk fat any preservative substance other than (i) boric acid, borax, or a mixture of those preservative substances; (ii) hydrogen peroxide, in amount not exceeding 0.1 per cent, by weight, in any case in which the cream is intended for human consumption. Every seller of preserved cream will be required in every invoice, bill, advertisement, trade list or other document which is used in connection with the sale of preserved cream to describe the article as (a) preserved cream (boracised), or (b) preserved cream (peroxidised), as the case may be. It is proposed that the 95 Regulation as regards milk is to come into force on June 1st, 1912, and those relating to cream on January 1st, 1913. The Regulations will also apply to imported milk and cream, and are made under the Public Health (Regulations as to Pood) Act, 1907. Butter.—A woman was summoned on two occasions for various offences, being fined £3 2s. with 18s. 6d. costs on the first occasion, and £6 with £1 costs on the second.. She went from house to house selling margarine under the guise of " country butter." Sale of Margarine Bill.—The Council petitioned in favour of this Bill becoming law. The object of this Bill is to prevent margarine from being coloured so as to resemble butter and prevent its fraudulent sale as such. The last report of the Local Government Board, Part 2, p. 102, states that:— " The fact that one sample of butter in every sixteen was condemned shows that the practice of selling margarine when butter is demanded has not been put down." The experience of the Council's officers is that there is considerable difficulty in detecting this fraudulent practice, which through the taking of " unofficial" samples has been found to exist in Westminster, and that the prosecutions which have taken place do not represent the extent of the practice. They are of opinion that further means are required to enable protection being afforded to the public. Several suggestions have been made in order to meet this need, such as the prohibition of the sale of margarine and butter in the same shop, the addition of a distinctive colouring to margarine, and, as in the present Bill, the prohibition of the addition of any colouring. The objection to the last two methods has been that they might interfere with the legitimate sale of a cheap article of diet, which would be rendered less appetising to the purchaser. This objection was, however, carefully considered by a Select Committee of the House of Commons on Food Products Adulteration, who reported as follows:— " However, your Committee cannot but feel that the adulteration of butter with margarine and the fraudulent sale of margarine for butter are greatly facilitated in many instances by the artificial use of ingredients to colour margarine. While your Committee are reluctant to interfere with the manufacture of any edible commodity, they cannot in the interests of honest trading arrive at any conclusion other than to recommend the absolute prohibition of the artificial colouring of margarine to resemble or imitate butter." 96 Sausages, Meat Pies, &C.—Samples were taken during 1911 of sausages, meat pies, &c., with the following results:— 28 Pork Sausages 23 genuine; 5 contained boric acid :—26.03, 8.67, 8.4, 7.43, 3.5 grains per lb. 20 Beef Sausages 18 genuine; 2 contained boric acid :8*67, 3'15 grains per lb. 9 German Sausages 4 genuine; 5 contained boric acid :—26.03, 21.07, 14 87, 13.63, 5.15 grains per lb. 19 Hams 18 genuine; 1 contained 13 grains boric acid per lb. 33 Pork Pies 30 genuine ; 3 contained boric acid :—1.7 and 8.5 grains per lb., and 1 a trace. 3 Meat Pies 3 genuine. 3 Brawn 3 genuine. 1 Veal and Ham Pie Contained 2 grains boric acid. 1 Veal Pate Grenuine. In these various meat preparations there has been a great reduction in the amount of boric acid used as compared with previous years. Potted Meat.—In 35 samples of potted meats 1 was found to contain preservative to the amount of 5-2 grains per pound, and 1 contained a trace of boric acid. Fish.—Thirty-four samples of fish (fresh, filletted, cured and tinned) were examined. One sample salmon paste contained 2-1 grains of boric acid. Eleven samples of filletted fish were found to have been artificially coloured; the analyst stated that the colouring was on the surface of the fish, and consisted of an organic dye applied for the purpose of imitating the colour produced by the smoking of fish. He also added that he was not in a position to state whether such artificial colouring was harmful. The Public Health Committee were of opinion that the artificial colouring of fish, if not harmful, was unnecessary and undesirable, and recommended that the Fishmongers' Company be invited to consider the matter, with a view to steps being taken to discourage the practice. Tinned Vegetables.—The general use of copper sulphate as a colouring agent would appear to have been discontinued. Out of 15 samples taken only 1 contained copper sulphate—1-932 grains per pound. Flour.—Analysis of a sample of flour showed that it contained a compound of nitrous acid equivalent to 4 parts of sodium nitrite per million parts of flour. Mr. Richards, the Analyst, pointed out that the sample had been bleached with nitrous fumes to a greater extent than is usually the case, and stated that although Dr. Hamill, in his report to the Local 97 Government Board on this subject, does not lay down any maximum limit for sodium nitrite, he (the Public Analyst) considers it desirable that a legal limit should be fixed. The Council adopted the Analyst's suggestion, and addressed communications to the Local Government Board and to the Board of Agriculture and Fisheries, calling their attention to the result of the analysis of the sample of flour in question, and urging that steps may be taken with a view to a maximum limit for sodium nitrite used in connection with the process of bleaching flour being fixed. Chocolate and Chocolate Powder.—In a number of instances a large proportion of foreign starch has been found as an ingredient. The Council have sent a letter to the Local Government Board calling attention to the matter and asking them to consider the desirability of fixing standards. Vinegar.—Samples of malt and other vinegar were taken, and in one instance a vendor was summoned for selling an article which contained a larger amount of water than is usual, the amount of acetic acid being only 2.1 per cent., so that it must have been freely diluted. The only standard for vinegar is that contained in the British Pharmacopoeia for Diluted Acetic Acid which is used in the preparation of the Vinegars of Squill and of Ipecacuanha. This should contain 4.27 parts per 100 of hydrogen acetate (acetic acid). The Local Government Board have been approached recently by the trade with a view to having a standard fixed. The Board have replied that they have not at present any power to frame definitions of vinegar or artificial vinegar but they think it may be desirable that they should state their views on the subject. In the Board's opinion the following definitions might properly be adopted, viz.:— "General Standard for Vinegar. " Vinegar is a liquid derived wholly from alcoholic and acetous fermentations; it shall contain not less than 4 grammes of acetic acid (CH3COOH) in 100 cubic centimetres of vinegar; it shall not contain arsenic in amounts exceeding 0.0143 milligrammes per 100 cubic centimetres of vinegar nor any sulphuric or other mineral acid, lead or copper; nor shall it contain any foreign substance or colouring matter except caramel. "Mali Vinegar is derived wholly from malted barley or wholly from cereals the starch of which has been saccharified by the diastase of malt. 98 "Artificial Vinegar. "Artificial Vinegar is any vinegar or substitute for vinegar containing, or derived from any preparation containing, any added acetic acid which is not wholly the product of alcoholic and subsequent acetous fermentation. It shall contain not less than 4 grammes of acetic acid (CH3COOH) in 100 cubic centimetres of the artificial vinegar. It shall not contain arsenic in amounts exceeding 0.0143 milligrammes per 100 cubic centimetres of artificial vinegar, nor any sulphuric or other mineral acid, lead or copper; nor shall it contain any foreign substance or colouring matter except caramel." Legal Proceedings Under the Food and Drugs Acts during 1911. No. of Sample. 1 Date of Hearing. 2 Court and Magistrate. 3 Name and Address of Defendant. 4 Offence. 5 Result. 6 8 S. 1911. 9th March Westminster Mr. Horace Smith) MILK. Frank Smith, Selham Farm, Petworth, Sussex Milk, taken from a churn at Victoria Station, in course of delivery, 14 per cent. of fat abstracted The defendant called evidence tracing the milk from the cows, and showing that it had not been tampered with, and the Magistrate expressed himself as satisfied that the milk had been sold as it came from the cows, and dismissed the summons. 59.S. 9th March Westminster Mr. Horace Smith) Herbert Henry Jones, 15, Brewer Street, Westminster Selling, at Ashley Place, milk, 6.7 per cent. of added water Warranty proved. Summons dismissed. 85 N. 10th March Marlborough Street (Mr. Mead) Daniel P. Evans, 8, Upper Marylebone Street Selling, at Carlisle Street, milk, 6 per cent. of added water Warranty proved. Summons dismissed. 109 N. 21st March Bow Street (Mr. Marsham) Martha Harris, 38, Bow Street, W.C. 7 per cent. of fat abstracted The Magistrate ordered the defendant to pay 12s 6d. costs, without inflicting a fine, having regard to the good management of the defendant's business by herself and predecessors for many years past. 155 N. and 179 N. 29th March Bow Street Mr. Marsham) John Timothy, 45, Greek Street Selling, in Gerrard Street and Charing Cross Road, milk, containing respectively 7 and 4 per cent. of added water Summonses withdrawn, as the police had not served them so as to leave 14 clear days between the service and the hearing, and that they were consequently bad. (See also 324 N.) 99 No. of Sample. 1 Date of Hearing. 2 Court and Magistrate. 3 Name and Address of Defendant. 4 Offence. 5 Result. 6 79 S. 1911. 27th April Westminster (Mr. Horace Smith) Ellen Rowlands, 24, Chapter Street, Westminster 10 6 per cent. of fat abstracted (The third sample was sent to Government Analyst, who found a deficiency of 3 per cent. of fat) Ordered to pay 12s. 6d. costs. 173 S. 27th April Westminster (Mr. Horace Smith) Mary Jenkins, 15, Westbourne Strefet, S.W. Selling milk at Eaton Terrace 3 per cent. of extraneous water and 2.56 per cent. of milkfat Fined 10s. and 12s. 6d. costs. The defendant endeavoured to prove a Warranty but failed 181 S. 10th May Westminster (Mr. Francis) Leopold Briand,321, Yauxhall Bridge Road 23 per cent. of fat abstracted.. Fined 20s. and 12s. 6d. costs. 194 S. 10th May Westminster (Mr Francis) James Evans, 8, Charlwood Street 18 per cent. of fat abstracted.. Fined 20s. and 12s. 6d. costs. 268 N. 11th May Marlborough Street (Mr. Mead) S. S. Dancocks, 47, South Audley Street 15 per cent. of fat abstracted.. Warranty proved. Summons dismissed. 212 S. 24th May Westminster (Mr. Hopkins) Joseph Henry Miles, 3, Pulford Terrace, Pimlico 28*6 per cent, of fat abstracted Fined 20s. and 12s. 6d. costs. 310 N. 25t.h May Marlborough Street (Mr. Mead) Elizabeth Hall, 9, Meard Street, Soho 13 per cent, of fat abstracted.. Fined 15s. and 12s. 6d. costs. 324 N. 25th May Marlborough Street (Mr. Mead) John Timothy, 45, Greek Street 8 per cent, of added water .. Fined £6 and 12s. 6d. costs. 337 N. 25th May Marlborough Street (Mr. Mead) David Lott (trading as Lott and Son), 72, Lamb's Conduit Street Selling at Wardour Street milk, 15 per cent. of fat abstracted Summons withdrawn. The person summoned was David Lott, who appeared by a Solicitor, and informed the Magistrate that the business belonged to his wife, and that, consequently, the wrong person had been summoned. The City Solicitors pointed out that the Inspector had inquired of the man in charge of the barrow who was the proprietor of the business., and had been told that it was David Lott. The Magistrate declined to allow the Defendant's Solicitor costs. 373 N. 15th June Marlborough Street (Mr. Mead) Margaret Ellen Archer (Evans and Co.), 7, Silver Place 8 per cent. of added water Warranty proved. Summons dismissed. 100 394 N. 15th June Marlborough Street (Mr. Mead) John H. Packer (Howard and Co.), 20, South Molton Street 25 per cent, of fat abstracted.. Fined 30s. and 10s. costs. 277 S. 14th June Westminster (Mr. Hopkins) Evan Jones, 83, Pimlico Road, S.W. 11 per cent. of added water .. Fined 40s. and 12s. 6d. costs. 325 N. 27th June Bow Street (Mr. Marsham) London Pure Milk Association (1911), Ltd., Westminster Chambers, 7, Victoria Street, S.W. Selling at Charing Cross Road, milk, 9 per cent. of fat abstracted Withdrawn, as Company reported to have been dissolved. 579 S. 28th June Westminster (Mr. Hopkins) Casimiro Orsi (trading as Orsi Brothers), 10, Knightsbridge Green 9 per cent. of added water Fined £5 and 12s. 6d. costs. 354 S. 19th July Westminster (Mr. Francis) Sarah Dilley, 2 and 4, Old Queen Street Milk; 12 per cent. fat abstracted Warranty proved. Summons dismissed. 367 S. 19th July Westminster (Mr. Francis) Edgar Lewis, 131, Lupus Street Milk; 11 per cent. fat abstracted Fined 20s. and 12s. 6d. costs. 391 S. 19th July Westminster (Mr. Francis) Thomas Powell, 67, Tachbrook Street Milk ; 5 per cent, water added Warranty proved. Summons dismissed. 510 N. 4th August Marlborough Street (Mr. Mead) Aerated Bread Co., Ltd., Eastcheap House, Eastcheap, E.C. Selling at 283, Oxford Street milk 5 per cent. of fat abstracted Warranty proved. Summons dismissed. 523 N. 18th August Marlborough Street (Mr. Mead) Thomas C. Edwards (trading as Faulks and Sons), 129, Jermyn Street Selling at Piccadilly, milk, 8 per cent. of fat abstracted Warranty proved. Summons dismissed. 418 S. 6th September Westminster (Mr. Francis) Moses D. Williams, 7, Regency Street, Westminster Selling at Millbank Buildings, Millbank, milk 28.6 per cent. of fat abstracted Warranty proved. Summons dismissed. (see also 611 S.) 443 S. 6th September Westminster (Mr. Francis) Adolph Mussi, 1, Buckingham Palace Road, S.W. 12.6 per cent. of fat abstracted Fined 20s. and 12s. 6d. costs. 651 'N. 22nd September ' (Marlborough Street) (Mr. Mead) J. P. Restaurants, Ltd., 5 and 6, Camomile Street, E.C. Selling at 23, Shaftesbury Avenue milk 6 per cent of fat abstracted Warranty proved. Summons dismissed. 609 N. 22nd September Marlborough Street (Mr. Mead) James Davies, 89, Shaftesbury Avenue, W. 7 per cent. of added water Warranty proved. Summons dismissed. 393 S. 19th July and 6th September Westminster (Mr. Francis) John Adams, 9, Moreton Street Selling milk at Charlwood Street, 5 per cent. of fat abstracted Magistrate dismissed the summons, and awarded the defendant four guineas costs The third sample was sent to the Government analysts, who certified the milk as containing 3.49 per cent. of milk fat, and consequently genuine. Mr. Cassal, the Council's analyst, had certified it as containing only 2 85 per cent. of milk fat. The defendant had had his own sample analysed, and it was reported to contain 3'06 per cent. 101 No. of Sample. 1 Date of Hearing. 2 Court and Magistrate. 3 Name and Address of Defendant. 4 Offence. 5 Result. 6 663 N. 1911. 26th September Bow Street Mr. Marsham) Avenue, W. 17 per cent. of fat abstracted.. Fined 10s. and 12 s. 6d. costs. 698 N. 24th October Marlborough Street (Mr. Denman) J. R. Mills (J. R. Mills and Sons), 23, Francis Street Selling, at Church Street, Soho, milk, 5 per cent. of added water Warranty proved. Summons dismissed. 695 N. 24th October Marlborough Street (Mr. Denman) George Jones, 183, Shaftesbury Avenue Selling, at Newport Court, milk, 6 per cent. of a dded water Fined 20s. and 12s. 6d. costs.* 709 N. 24th October Marlborough Street (Mr. Denman) E. Edwards, 16, Little Earl Street Selling, at Frith Street, Soho, milk, 5 per cent. of added water Fined 20s. and 12s. 6d. costs. * 710 N. 24th October Marlborough Street (Mr. Denman) Thomas Jones, 26, Broad Street Selling, at Church Street, Soho, milk, 5 per cent. of added water Fined £3 and 12s. 6d. costs.* * The defendants attempted to prove a warranty, but not 1 laving complied with the necessary statutory requirements, the City Solicitors objected, and the magistrate upheld the objection. 601 S. 8th November Westminster (Mr. Horace Smith) Sydney Augustus Bown, 141, Battersea Park Road Selling at Jessel House, Regency Street, milk, 9.6 per cent. added water Fined 10s. and 12s. 6d. costs. 611 S. 22nd November Westminster (Mr. Francis) Moses D. Williams, 7, Regency Street, S.W. 14.3 per cent. of added water Warranty proved. Summons dismissed. 670 S. 6th December Westminster (Mr. Francis) Hansleys, Ltd., 22, Ingleton Street, Brixton Selling in Warwick Street, milk, 8 per cent. of fat abstracted Warranty proved. Summons dismissed. 868 N. 8th December Marlborough Street (Mr. Mead) Pietro Corsini (trading as Necchi and Co.), 9, Crown Court, Pall Mall 14 per cent. of fat abstracted Fined £2 and 12s. 6d. costs. 696 S. 13th December Westminster (Mr. Francis) George E. Morrish, 50, Moreton Street, Westminster 8 per cent. of fat abstracted Warranty proved. Summons dismissed. 102 763 S. 1912. 3rd January Westminster (Mr. Francis) William Walter Bates, 172, Wardour Street Selling milk at Wilton Road, 10 per cent. of fat abstracted Warranty proved. Summons dismissed. 969 N. 9th January Bow Street (Sir Albert de Rutzen) Albert Gibbs (Gibbs and Son), 2, Charlotte Street, W. Selling in Charing Cross Road milk, 9 per cent. of fat abstracted Warranty proved. Summons dismissed. 703 S. 1911. 13th December Westminster (Mr. Francis) SEPARATED MILK. Frederick Walker, 5, Effingham Street, Westminster Selling at Pulford Street separated milk containing 18.6 per cent. of added water Fined 20s. and 12s. 6d. costs. 502 N. 1911. 4th August Marlborough Street (Mr. Mead) CREAM. The Devonshire Dairies, Ltd. Selling at 409, Oxford Street fresh cream containing 20 grains of boric acid per lb. Fined £4 and 17s. 6d. costs. 435 S. 6th September Westminster (Mr. Francis) David H. Lewis, 2, Commercial Road, S.W. Selling fresh cream containing 22.68 grains of boric acid per lb. Fined 10s. and 12s. 6d. costs. 432 S. 6th September Westminster (Mr. Francis) Rees Rhys Williams, 310, Vauxhall Bridge Road, S.W. Selling fresh cream containing 20.825 grains of boric acid per lb. Dismissed. The defendant gave evidence to the effect that a notice was displayed conspicuously in his shop at the time of the sale that the cream contained boric acid. The Inspector and his Agent stated that it was not there, but the magistrate expressed himself to have some doubt and gave the defendant the benefit of it. 451 N. 11th July Bow Street (Mr. Marsham) John Briggs, 15, Catherine Street, Westminster Selling fresh cream containing 32.5 grains of boric acid per lb. Fined 40s. and 12s. 6d. costs. 16 N. 1911 24th March Marlborough Street (Mr. Mead) BUTTER. H. Goldstein, 4, Ganton Street 2.5 per cent. excess of water Fined 40s. and 12s. 6d. costs. 507 N. 14th July Marlborough Street (Mr. Mead) Jemima Dimond, 519, Wharncliffe Gardens, St. John's Wood Selling margarine as butter Fined £3 and 12s. 6d. costs. (See also under "Margarine" 508 N. and 867 N.) 552 S. 18th October Westminster (Mr. Hopkins) John Price, 1, Gayfere Street, S.W. 2.55 per cent. excess of water Warranty proved. Summons dismissed The warrantors had also bought the butter under a warranty from an Irish creamery firm. 103 No. of Sample. 1 Date of Hearing. 2 Court and Magistrate. 3 Name and Address of Defendant. 4 Offence. 5 Result. 6 586 S. 1911. 8th November Westminster (Mr. Horace Smith) Clifford, Sons and Co., Ltd., 48, Pimlico Road, S.W. 81.5 per cent. of foreign fat Fined £1 and 12s. 6d. costs. (See also under " Margarine," 622 S. 6tli December Westminster Mr. Francis) Joshua Janes, 28, Ponson by Place 28 per cent. of foreign fat 586 S.) Fined £1 and 12s. 6d. costs. 684 S. 13th December Westminster (Mr. Francis) Thomas Davies, 74, Horseferry Road, Westminster 67 per cent. of foreign fat Fined £2 and 12s. 6d. costs. 722 N. 23rd November Bow Street (Mr. Curtis Bennett) Hudson Bros., Ltd., 50 and 52, Ludgate Hill, E.C. Selling at 441, Strand, butter containing 3.8 per cent. excess of water Warranty proved. This was part of a consignment of French butter purchased by their clients under a warranty that it did not contain more than 16 per cent. of moisture. The firm from which Messrs. Hudson purchased the butter stated that owing to the exceptional heat at the time of the making of the butter in question and previously thereto the manufacturers of the butter in France had found it impossible to xtract surplus moisture from the butter as supplied by the farmers, as the machines in the factory for the purpose were ineffective owing to the softness of the butter. 379 S. 19th July Westminster (Mr. Francis) MARGARINE. Thomas Davies, 74, Horseferry Road Selling margarine without printed wrapper Fined 10s. and 12s. 6d. costs. 508 N. 14th July Marlborough Street (Mr. Mead) Jemima Dimond, 519, Wharn1 clitfe Gardens, St. John's Wood Exposing margarine for sale in a packet not branded "Margarine" Fined is. and 4s. costs. 508 N. 14th July Marlborough Street (Mr. Mead) | Jemima Dimond, 519, Wharncliffe Graidens, St. John's Wood Expo>ing margarine for sale in parcel not labelled "Margarine " Fined Is. and Is. 6d. costs. (See also 867 N. below and under "Butter" 507 N.) 586 S. 8th November Westminster ( Vlr. Fraicis) Clifford, Sons and Co., Ltd., 48, Pimlico Road, S.W. Selling margarine without a wrapper marked "Margarine " 2s. costs. (See also under "utter" 586 S.) 104 661 S. 22nd November Westminster (Mr. Francis) Richard Evans, 45, Causton Street, S.W. Exposing for sale margarine to which there was not attached in such manner as to be clearly visible to the purchaser a label marked "Margarine" Fined 20s. and 12s. 6d. costs. 867 N. 1st December Marlborough Street (Mr. Mead) Jemima Dimond, 519, Wharncliffe Gardens, St. John's Wood, N.W. Being a dealer in margarine, not marking a package containing same Fined £3 and £1 costs. 867 N. 1st December Marlborough Street (Mr. Mead) Jemima Dimond, 519, Wharncliffe Gardens, St. John's Wood, N.W. Exposing for sale margarine without a label Fined £3. 648 S. 6th December Westminster (Mr. Francis) John Coppin, 33, Wood Street, Westminster Exposing for sale margarine without a label Fined £1 and 12s. 6d. costs. 313 S. Pork sausages 14th June Westminster (Mr. Hopkins) SAUSAGES. New Irish Direct Supply, Ltd., 94, Victoria Street Pork sausage containing 26.033 grains of boric acid per lb. Fined £5 and £3 3s. costs. 686 S. German sausage 13th December Westminster (Mr. Francis) Martha Ballon), 68, Horseferry Road, Westminster German sausage containing 26.03 grains of boric acid per lb. Fined 10s. and 12s. Gd. costs. 688 S. German sausage 13th December Westminster (Mr. Francis) Mrs. Annie Topham, 2, Vincent Street, Westminster German sausage containing 21.07 grains of boric acid per lb. Fined 10s. and 12s. 6d. costs. 757 N. 6th November Marlborough Street (Mr. Denman) OLIVE OIL. Ferdinand Gennari, 60, Wardour Street, Soho 20 per cent. of oil other than olive oil Fined £2 and £3 3s. costs. 815 N. 24th November Marlborough Street (Mr. Mead) Samuel Abraliamson, 143, Oxford Street, W. 85 per cent. of oil other than olive oil Fined £3 and 12s. 6d. costs. 651 S. 6th December Westminster (Mr. Francis) VINEGAR. Margaret Garrett, 56, Tufton Street, Westminster 30 per cent. extraneous water Fined 10s. and 12s. 6d. costs. 105 london: harrison and sons, printers in ordinary to his majesty, st martin's lane.