AC 4344 WES 26 ANNUAL REPORT on the STATISTICS AND SANITARY CONDITION relating to THE CITY OF WESTMINSTER FOR THE YEAR 1912. By FRANCIS J. ALLAN, M.D., 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. ANNUAL REPORT on the STATISTICS and SANITARY CONDITION relating to THE CITY OF WESTMINSTER FOR THE YEAR 1912. By FRANCIS J. ALLAN, M.D., 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. TABLE OF CONTENTS. page Introductory Remarks v PART I. A. Statistics. Population 1 Births 5 Notification of Births Act 6 Medical Inspection of Children under School Age 7 Deaths 9 Infantile Mortality 10 Statistics of Block Dwellings 11 Common Lodging Houses 12 Tables 14-26 B. Communicable Diseases. Tables 27 Smallpox 30 Vaccination 30 Scarlet Fever 31 Diphtheria 31 Typhoid Fever 32 Puerperal Fever 32 Ophthalmia Neonatorum 32 Cholera, Plague 33 Tuberculosis 33 Schemes for Helping Patients 34 Sanatorium Treatment 33 Diarrhoeal Diseases 46 Measles 47 Whooping Cough 47 Schools and Infectious Disease 48 Bacteriological Laboratory 49 Disinfection 50 Cleansing of Persons 50 Verminous School Children 50 Verminous Houses 51 Rag Flock Act 51 Mortuaries 52 PART II. C. House Inspection, Sfc. Defects Remedied 53 Legal Proceedings 54 Drainage, &c., Plans 55 PAGE Deep Basements., 55 Intercepting Traps 56 Removal of Offensive Refuse 57 Housing Conditions — Sanitary Survey of Houses 57 Underground Rooms 53 Houses Let in Lodgings 58 Water Supply 59 Artesian Wells 59 Revenue Act 60 Smoke Prevention 60 Offensive Smells 61 D. Workshops. Number on Register 63 Defects 64 Outworkers 65 Infectious Disease 68 Laundries 68 Underground Workplaces 69 E. Food Supply. Restaurants, &c. 71 Cleanliness of Public House Bars 71 Ice Cream Premises 71 Bakehouses 72 Certification of Food for Export 72 Infectious Disease 72 Milkshops 72 Fried Fish Shops, Proposed By-laws 73 Food and Market Inspection 75 Food Condemned 75 Tuberculous Meat 76 Sale of Food and Drugs Acts— Samples Taken, Result of Analysis and Proceedings 77 Milk 78 Cream 82 Butter and Margarine 83 Sausages and Meat Pies 83 Fish 84 Tinned Foods 84 Vinegar 85 Ginger Beer 85 Details of Prosecutions 85-87 Annual Report on the Health and Sanitary Condition of the City of Westminster. 1912. To the. Mayor, Aldermen, and Councillors of the City of Westminster. Mr. Mayor, my Lords, Lady and Gentlemen, I have the honour to submit to you my Annual Report for the year 1912. Returns required by the Local Government Board, and particulars relating to Factories and Workshops required by the Home Office, are incorporated therein. The Report shows that the Council has maintained the activity which has always characterised it in promoting whatever is likely to improve the health of the citizens. It is impossible, however, to do more than indicate the amount of consideration which has been given by the Public Health Committee, or the increasing mass of detail work which has been undertaken by the department. New duties are continually being placed upon local authorities by Parliament, and methods have to be devised in order to deal with the new problems arising therefrom. For many years the Council has devoted considerable vi attention to Tuberculosis, and has gradually evolved schemes for dealing with this disease which resemble so closely those recommended by the Special Committee appointed to report on the subject in connection with the Insurance Act, that little alteration is necessary. Additional facilities will be afforded for the treatment of all forms of this disease, and if persons suffering can be sent away in an early stage good may result. Experience, however, shows that it is more satisfactory to prevent the occurrence of this disease by improving the conditions under which people live than to attempt to cure those attacked by it. Hence the Council has sought not only to improve the sanitary conditions of dwellings and workplaces, but also to raise the standard of personal hygiene of the inhabitants. It is now being generally recognised that the conditions under which the first few years of life are spent have a lasting effect on the subsequent health of the individual, and during the last year the visiting and teaching which have been carried out by health visitors has been supplemented not only by medical examination of children in schools, but also of children under school age, particulars of which are given in this Report. If the contention be correct that the seeds of tuberculosis are implanted in childhood to develop in later years into pulmonary disease, the increased attention to the health of the children should be rewarded by a reduction in Phthisis cases in the future. The Council has continued the special attention it has given for some years to the purity of the food sold in the City and the sanitary condition of the places in which it is prepared. I desire to express my appreciation of the able assistance I have received from all the staff in the work of the Department. I have the honour to be, Mr. Mayor, my Lords, Lady and Gentlemen, Your obedient servant, FRANCIS J. ALLAN, Medical Officer of Health. March, 1913. PART I. A. STATISTICS. Population. During 1912, some further results of the 1911 Census have been published. These show the number of males and females in each ward, and the kind of building used as dwellings with the population therein. These particulars are shown in the two tables following. 35,185 persons were recorded as living in 10,802 flats; 10,246 in hotels and public houses; 11,449 in institutions, barracks, Ac. There were 2,489 persons in hospitals and poor law institutions in the City, viz.:— Inmates. Officials and their families Total. In hospitals 1,154 591 1,745 In poor law institutions 691 53 744 1,845 644 2,489 The majority of the indoor paupers of Westminster are in institutions outside the City, at Edmonton, Fulham Road, Cleveland Street, Hendon and Ashford. There were 3,464 persons recorded as residing in Military Barracks Hospitals, &c., in the City. These are given as 2,812 officers and men, and 652 other inmates, of whom 215 were males and 437 females. Twenty-four persons were recorded on board 14 vessels. Ninety-three persons (14 of whom were women) were found in barns, sheds, &c., or in the open air. B 2 Census, 1911.—City of Westminster. Wards. Families or Separate Occupiers, Population. Institutions, Large Establishments, &c., 1911 (included in Columns 2 and 4). 1901. 1911. No. 7 Population. 8 1 1911. 2 Persons. 3 Persons. 4 Males. 5 Females. 6 The City 35,984 183,011 160,261 73,449 86,812 544 27,987 Charing Cross 733 5,755 4,908 2,489 2,419 32 2,335 (a) Conduit 742 5,876 4,273 1,894 2,379 38 1,623 (b) Covent Garden 1,802 8,917 8,493 4,090 4,403 32 2,097 (a) Gt. Marlborough 1,026 7,908 5,277 2,588 2,689 14 1,049 (c) Grosvenor 2,684 15,266 14,223 5,525 8,698 84 2,347 Hamlet of Knightsbridge 1,243 7,601 7,692 2,779 4,913 34 1,376 (d) Knigbtsbridge St. George 2,743 15,657 13,794 4,968 8,826 52 1,595 (e) Pall Mall 663 4,122 3,774 2,071 1,703 49 1,598 Regent 1,586 9,558 7,108 3,560 3,548 33 959(f) St. Anne 2,143 11,493 9,286 4,913 4,373 34 1,066 (g) St. John 7,602 29,914 28,857 14,490 14,367 33 2,930 (h) St. Margaret 2,417 13,784 11,302 5,187 6,115 52 3,223 (i) Strand 308 7,002 3,458 1,909 1,549 18 2,500 (j) Victoria 10,292 40,158 37,816 16,986 20,830 39 3,289 (k) (а) 206 persons enumerated in Chaiing Cross Hospital, 47 in the Royal Westminster Ophthalmic Hospital, 46 in St. George's Barracks, 52 in St. Peter's Hospital, and 1,592 in the following hotels: Metropolo, Victoria, Grand, Charing Cross, Strand Palace; 301 in Hotel Cecil. (b) 414 persons in Salvation Army Hall for the one night. (c) 454 persons in Poland Street Workhouse. (d) 488 persons in Hyde Park Barracks. (e) 481 in St. George's Hospital. (f) 56 in the Throat Hospital, Golden Square. (g) 110 persons in Hospital for Women, and 86 in other hospitals. (h) 983 persons in Salvation Army C.L.H. Great Peter Street, 136 in Queen Aleiandra Military Hospital, 264 in R.A.M.C. Barracks, 313 in other Army Institutions, and 137 in other hospitals. (i) 976 persons in Wellington Barracks, 259 in Westminster Hospital. (j) 249 persons in Waldorf Hotel, 138 in Strand Union Workhouse, 311 in King's College Hospital, 301 in Hotel Savoy, 714 in Bruce House C.L.H. and 124 in S.A. Shelter, Kean Street. (k) 1,241 pe rsons in Chelsea Barracks, 152 persons in Wallis's Yard Workhouse. 3 Table I. Cols, 1 1911. 1901. Total. 2 Buildings used as Dwellings. Buildings not used as Dwellings. Total. (Cols. 4—11.) 3 Ordinary Dwellinghouses. 4 Blocks of Flats. 5 Shops. 6 Hotels, Inns, and Public Houses. 7 Offices, Warehouses, Workshops, Factories. 8 Institutions. 9 Others. 10 Vessels, Sheds, Vagrants, &c. 11 Separate Flats. (Included in Col. 5.) 12 Kind of Building. 13 No. 14 Number in habited 18,336 17,540 11,522 1,146 2,203 518 695 154 1,302 10,631 Places of worship 81 Separate occupiers 41,344 35,984 18,543 10,802 3,510 531 811 280 1,462 45 10,802 Government and municipal buildings 25 Population 183,011 160,261 76,536 35,185 14,327 10,246 2,773 11,449 9,628 117 35,185 Shops 3,285 Offices 685 Uninhabited 3,463 1,116 374 25 186 6 37 - 488 - 1,568 Warehouses, workshops, factories 1,017 Being built 157 105 42 2 35 4 17 — 5 — 80 Theatres and other places of amusement 42 The classification of the kinds of buildings is based on descriptions furnished by the local enumerators; in some cases, especially as regards the B2 distinction between a flat and an ordinary dwelling-house occupied by more than one family, differences in practice are almost inevitable, the numbers under the several headings must therefore be regarded as approximate. 4 The proportion of males and females in the population of the county is practically the same as at the 1901 census, but in Westminster the proportion of females to 100 males has increased from 115 to 118. The relative proportions in the several wards are shown below:— Males. Females. Proportion. 1901. 1911. Males. Females. Females. County of London 47.0 53.0 100 112 112 City of Westminster 45.8 54.2 100 118 115 Wards— Charing Cross 50.7 49.3 100 97 92 Conduit 44.3 55.7 100 125 146 Covent Garden 48.2 51.8 100 107 103 Great Marlborough 49.0 51.0 100 104 108 Grosvenor 38.9 61.1 100 157 148 Hamlet of Knightsbridge 36.1 63.9 100 177 159 Knightsbridge St. George 36.0 64.0 100 178 166 Pall Mall 54.9 45.1 100 82 83 Regent 50.0 50.0 100 100 105 St. Anne 52.9 47.1 100 89 91 St. John 50.2 49.8 100 99 98 St. Margaret 45.9 54.1 100 118 110 Slrand 55.2 44.8 100 81 97 Victoria 44.9 55.1 100 122 118 The proportion of males is greater than in 1901 in Conduit, Great Marlborough, Pall Mall, Regent, St. Anne and Strand Wards. The increase in the population of females is most marked in Grosvenor, Hamlet and Knightsbridge St. George and St. Margaret Wards. The population of Westminster, as estimated to the middle of 1912 is 157,693, of whom, according to the percentages given above, 72,223 were males and 85,470 females. The number of inhabited houses has been reduced in the 10 years from 18,366 to 17,540, reckoning a block of flats as one house. The average number of persons per house was 9.14 (without institutions the number is 8.5); in 1901 the average number was 9.96. In London the numbers were 7.89 in 1911, 7.93 in 1901. 5 Births. Births Registered. Births Notified. Gross. Out. Added. Net. Gross. Alive. Stillborn. Notified by Doctor. Midwife. 1909 2,520 39 270 2,751 1,612 1,571 41 609 492 1910 2,365 49 276 2,592 1,674 1,621 53 632 561 1911 2,110 60 311 2,361 1,562 1,507 55 578 483 1912 2,131 49 264 2,349 1,501 1,469 34 564 451 The following table shows the distribution of births (including infants born in institutions outside the City) according to wards :— Conduit 21 Grosvenor 109 Knightsbridge St. George 131 Victoria 709 St. Margaret 114 St. John 712 Knightsbridge Hamlet 75 St. Anne 156 Regent 91 Pall Mall 18 Great Marlborough 66 Charing Cross 22 Covent Garden 121 Strand 4 The birth-rate, uncorrected, was 13.5, corrected 14.8 per 1,000 persons. The corrected birth-rate for the five years 1902—6 was 17.6, and for the five years 1907—11, 15.8 per 1,000. The birth-rate for the County of London for 1912 was 24.5, the rate during the preceding ten years averaged 25.8 per 1,000. Westminster had the lowest rate of any Metropolitan City or Borough. The birth-rate in England and Wales was 23.8; the average of the preceding ten years was 27.2. 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. In the following wards: St. John, Hamlet, Conduit, St. Anne, Pall Mall, Great Marlborough and Covent Garden, there was an increase in the number of births. This, however, is counterbalanced by a decrease in all the other wards except Charing Cross, which was the same as in 1911. Fiom the figures given below it will be seen that the decrease in 1912 is in the illegitimate birth. The birth-rate calculated on the number of married women in Westminster, distinguishing the legitimate and illegitimate, shows more 6 exact rates, but the new figures for making the calculation are not yet available:— Westminster. 1905. 1906. 1907. 1908. 1909. 1910. 1911. 1912. Legitimate Births (net) 2,971 2,744 2,764 2,739 2,548 2,399 2,195 2,194 Illegitimate Births (net) 149 187 163 174 203 193 166 155 During the year notification was received of 1,469 births which took place in Westminster; of these, 34 were stillborn children, whose births are not subsequently registered. By comparing 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 71.1 per cent, for the City. The proportion of notified was greater than in previous years (64.8 per cent, in 1909, 68 in 1910, 70.9 in 1911). The attention of a number of parents was called to their failure to notify. In addition, information was 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. There are, further, those infants whose births were not notified, but were eventually registered. Those mothers and infants are visited after the twelfth day by the Council's visitor, Mrs. Watkinson, in co-operation witli the voluntary health visitors in cases where advice appears desirable. 1,926 were visited, besides 31 of the cases in which there were stillborn children; 93 did not desire or did not appear to require further visiting, and 52 were not found (these occur among the registered births where several weeks intervene between the birth and registration, in which time the parents have moved). The visitors endeavour to keep in touch with the children up to school age, in this way. 3,734 children born in previous years, 1908-11 have been visited during 1912. After the first visit to those born in 1912, the visitors have kept up the visiting of 1,600 babies. After making allowance for removals and deaths, there were at the end of the year 4,435 children on the visiting list. By co-operation with the hospitals and lying-in charities the Health Society received the names of a considerable number of women expecting to become mothers. Arrangements are made by the visitors as to 7 suitable nurses or for reliable women to look after the homes and family if the mother is going into hospital, and instruction is given verbally and by printed directions. Steps are also taken to obtain additional food for mothers, both before and after birth, where it appears to be required. Pre-natal visiting, it is hoped, will have the effect of reducing the number of stillbirths, and of infants who are born in a feeble state of health. Medical Inspection of Children under School Age—Under the auspices of the Health Society, a scheme was inaugurated in January, 1912, to provide for the periodic medical inspection of children in the northern (Soho) half of the City. Helving in the fiist instance on the information received by the Medical Officer of Health under the Notification of Births Act, a health visitor gets into contact with every family where a child is newly born. As soon as possible after the mother is up and about, she is invited to come with her baby to the Centre. Here the child, after being undressed, and weighed, is medically examined. In most instances it is found to be healthy, but if any defect is discovered arrangements are made for appropriate treatment before any serious or permanent harm can follow. In all cases, the details as to feeding, clothing, &c., are gone into closely, and all shortcomings attended to. Finally the mother is advised to bring her child again for re-inspection, the interval depending on the case, but being shorter the younger the child, and in the meantime the health visitors, keeping in touch with the home, ensure that the medical advice is not forgotten. In addition to these new-born infants, older children of one, two, three and four years attend and are dealt with on similar lines, medical or convalescent treatment being arranged for in all cases needing it. Lastly, with the oldest children, now about to enter the schools, their medical records are sent to the respective school for the information of the school doctors. The Centre is under the medical supervision of Dr. David Forsyth, who examines the children, assisted by a trained nurse and members of the Society. Dr. Forsyth states in his report on the first year's working that 374 children have been examined, excluding re-inspections. Of these, 131 were under 1 year ; 77 under 2 years; 83, 50, and 33 under 3, 4, and 5 years respectively. The outstanding feature of an analysis of the medical record cards is the rapid rise in the tide of disease every year. While the large majority of the children in the first period are found to be healthy, only a small minority come through to their fifth year without at least one physical defect of some kind or another. This is most strikingly seen with that condition which is, probably, 8 responsible for more ill-health among children than any other, namely, dental caries. The percentage of these cases in the year works out at 0, 2-6, 18'1, 34 0, and 63 6 respectively.* It may farther be added that, as a rule, the later the age the more extensive was the disease. A veiy similar rise is seen both with enlarged tonsils and with adenoids, while the proportion of these cases in urgent need of surgical treatment increases yearly, indicating, of course, the aggravation of the condition when left untreated. With rickets, on the other hand, the incidence reaches a maximum in the second year, thereafter rapidly declining. Altogether the 374 children presented 332 defects. In addition, the feeding in a large proportion of the cases in the earliest years needed some modification, great or small, almost exactly one-half the cases under one year's standing in need of some revision in this connection. The following table summarises the incidence of the more important delects. Table showing the Incidence of the Commoner defects in each of the first five years. 0 Year. 1 Year. 2 Years. 3 Years. 4 Years. Per cent. Per cent. Per cent . Per cent. Per cent. Teeth — 2.6 18.1 34.0 63.6 Tonsils — 7.8 16.9 24.0 26.9 Adenoids 1.5 10.4 22.9 38.0 33.3 Rickets 13.0 25.9 9.6 8.0 3.0 Diet modified 40.6 22.8 6.0 — — The practical conclusion from the point of view of preventive and curative treatment is too obvious to need stating. Suffice it to say that there is no reason to suppose that the children examined at the Centre differ materially from other children of their class, at any rate in urban areas, and it is highly probable that, as similar Inspection Centres are organised elsewhere, the results will be, in the main, similar to those in Westminster. In other words, large numbers of children, healthy in every respect at birth, become, within five years, the physically defective entrants whom the Education Authorities are required, at no small cost, to restore, as far as possible, to their original state of health. Yet most of these cases are preventable, if taken in time, and can be remedied more speedily and therefore more cheaply than if left until school age. by which time not a few will have received permanent damage, physical or mental. The problem of the defective child, therefore, resolves itself, in most instances, into the problem of the under-school-age child, and is * These figures lead up very well to the statement of the Chief Medical Officer to the Board of Education (Annual Report, 1910, p. 166) that "not more than a few children out of every hundred .... fail to bear evidence of present or past dental disease." 9 hardly likely to be solved by any scheme short of a national one ensuring all children regular medical supervision from birth to school age. A second Inspection Centre is to be opened in Roehampton Street, Vauxhall Bridge Koad, to serve the Pinilico and St. John's district. Deaths. 2,113 deaths were registered in the City in the 52 weeks ending the 28th December, 1912. After deducting 982 deaths of non-citizens in public institutions in the City, and adding those of 853 citizens who died in other districts, the corrected total is 1,984, and is equivalent to an annual rate of 12.5 per 1,000 persons, the same as in 1911. The average death-rate for the five years 1902-6 was 13.8, and for the five years 1907-11, 12.7 per 1,000, and for the ten years was 13.3. The London death-rate for 1912 was 13.6, the average for the previous five years being 14.7. Tables appended to this part of the Iteport show the vital statistics of the City and five groups of districts from 1892 to 1912. The death-rates, according to the old districts of the City, are:— District. Average of Previous 10 Years. 1912. St. George 11.8 12.2 Westminster 15.8 14.1 St. James and St. Anne 12.2 10.5 Strand and St. Martin 14.5 12.7 The City 13.3 12.5 The Ward rates are shown in Table V. Cause of death at all Ages.—These are set forth in Table II, and also their distribution in the various Wards of the City. Deaths in 1912 exceeded those recorded in 1911 from diseases of blood vessels (by 26), of the lungs (by 21), from measles (by 12), erysipelas (by 7), other septic diseases (by 10), diabetes (by 7), cancer (by 11), locomotor ataxia and general paralysis of the insane (by 13); on the other hand, deaths from the following causes were fewer in 1912, whooping-cough (by 12), diarrhoea and enteritis (by 37), rheumatic fever (by 5), tuberculosis (by 16), premature birth and developmental causes (by 20), old age (by 32), meningitis (by 9), and kidney diseases (by 23). 10 Ages at Death.—The differences in the ages of persons who died is shown below:— All ages. Under 1. 1—2. 2—5. 5—15. 15—25. 25—45. 45—65 65 and upward's. 1911 2,005 243 66 53 36 63 295 586 658 1912 1,981 195 43 44 49 54 306 594 699 According to Wards, there was an increase in all the St. George's group and in St. Margaret's, while there was a decrease in all the ethers. The distribution of deaths under 1 and over 65 years is shown below:— 1912. Wards. Under 1 Year of Age. Over 65 Years of Age 1st Quarter. 2nd Quarter. 3rd Quarter 4th Quarter. The Year. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. The Year. Conduit - - - 1 1 2 3 2 3 10 Grosvenor 3 4 - 2 9 17 6 10 17 50 Hamlet of Knightsbridge 2 3 1 1 7 9 11 3 6 29 Knightsbridge St. George 1 3 2 4 10 14 11 13 11 49 Victoria 25 10 14 18 67 63 48 45 68 224 St. Margaret 4 3 1 - 8 15 7 3 7 32 St. John 14 16 6 30 66 48 34 26 41 152 St. Anne 6 5 1 1 13 11 4 3 7 25 Great Marlborough 2 - - 1 3 8 4 4 7 23 Pall Mall — — — - — 2 1 1 6 10 Regent 2 1 - - 3 11 7 1 3 22 Charing Cross 2 - - — 2 1 2 5 1 9 Covent Garden 2 2 — 2 6 7 7 7 9 30 Strand — — — — — 6 8 11 9 34 The City 1912 63 47 25 60 195 214 153 134 198 699 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 91 deaths per 1,000 births registered in the City, against a rate of 114, the average of the previous ten years. The corrected rate works out at 83, the average of the previous live years having been 90, and of the preceding five years 1902-6, 115. Below are given figures for both births and deaths of infants 11 corrected, distinguishing legitimate and illegitimate births, showing the true rate in each of the last eleven years:— Legitimate. Illegitimate. Total Rate. Births. Deaths. Death rate per 1,000 births. Births. Deaths. Death rate per 1,000 births. 1902 3,275 410 125 186 32 172 127 1903 3,035 345 113 150 25 166 116 1904 2,920 320 109 134 40 298 118 1905 2,971 305 102 149 24 161 105 1906 2,744 285 103 187 38 203 110 1907 2,764 269 97 163 34 208 103 1908 2,739 266 97 174 27 155 100 1909 2,548 232 91 203 26 128 93 1910 2,399 189 78 193 25 129 82 1911 2,195 210 95 166 33 198 102 1912 2,194 168 76 155 27 174 83 Victoria Ward 650 58 89 59 11 186 97 St. Margaret and St. John 762 63 82 64 11 171 89 Rest of City 782 47 62 32 5 156 63 Meteorological conditions were responsible to some extent for the decrease since 1902, especially in 1910, for the rise in 1911, and again for the fall in 1912. The low temperature in July and August kept down attacks of acute diarrhoea, so that the deaths were 30 less than in 1911. For all London the rate was 91 in 1912, compared with 128 per 1,000 in 1911; for England and Wales the rate was 95, compared with 130, the rate for 1911. Table VI shows the causes of death of infants in the City as a whole, and separately in Victoria Ward and St. Margaret and St. John Wards. Digestive troubles caused an increase in both the latter groups, measles and premature births in Victoria, and syphilis in St. Margaret and St. John; whooping cough and diarrhoea a decrease in both groups. 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 eight years is given below. Year. Population. Births. Rate. Deaths at all ages. Rate. Deaths of Infants under one per 1,000 births. 1905 1,138 57 50.0 23 20.2 140 1906 1,150 63 54.7 16 13.9 111 1907 1,163 60 51.6 18 15.5 116 1908 1,155 50 43.2 10 8.6 120 1909 1,156 41 38.0 12 10.3 99 1910 1,120 37 33.0 8 7.1 108 1911 1,063 37 34.8 19 17.8 81 1912 1,215 43 35.3 15 12.3 69 12 Common Lodging houses. The total common lodging-house accommodation available is now 2,255 beds for men, 62 for women. Deaths.—77 deaths (76 males and 1 female) occurred in 1912 among inmates of the common lodging-houses and shelters in the City. 30 of the deaths were due to phthisis, 15 to respiratory diseases, 10 to nervous diseases, 7 to diseases of the heart and blood vessels, 3 to cancer, and 2 to kidney disease. There were 35 deaths from St. John's Ward. 8 from Covent Garden, and 34 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:— Deaths. Common Lodging Houses. Men. 1909. 1910. 1911. 1912. Bruce House, Kemble Street (L.C.C.) 706 28 36 34 24 33, Great Peter Street 397 22 11 8 14 Ham Yard Hospice, Great Windmill Street 20 — — 11, 12, and 13, Hanover Court 105 10 8 8 8 108, Regency Street 8 — — — — The Schools, Kean Street (S.A Shelter) 125 7 8 4 10 16, Strutton Ground 222 10 3 8 7 45 and 47, Tufton Street 79 — 2 3 4 S.A. Shelter, Great Peter Street 593 — 1 6 8 Women. 40, Great Peter Street 62 1 4 4 1 In addition, 1 death was recorded of a former inmate of the common lodging-house—107, Wardour Street, the use of which as a common lodging-house has been discontinued. Tuberculosis.—105 new cases of pulmonary tuberculosis (9 being women) were notified from common lodging-houses or as being homeless:— Bruce House 24 S.A. Shelter, Kean Street 13 33, Great Peter Street 9 S.A. Shelter, Great Peter Street 4 12, Hanover Court 7 47, Tufton Street 4 10, Strutton Ground 7 40, Great Peter Street 1 Besides, 44 inmates of common lodging-houses who had been notified in previous years (1905-1911), were re-notified in 1912. Homeless :— St. George's Union District 29 Westminster 5 Strand 2 13 Of the 105, 23 have died since notification in 1912: the deaths have been recorded of 17 notified in previous years, but probably a number have died elsewhere. The number of homeless persons in the streets has been materially reduced by the Local Government Board Scheme for issuing lodginghouse tickets to homeless persons found on the Embankment and its neighbourhood. At the end of October a central office was opened by the Metropolitan Asylums Board at Waterloo Bridge, where tickets distributed by the police are presented. Every man and woman who receives a ticket is assured of food and shelter, while opportunity is afforded through the charitable agencies co-operating in the work, of helping any case that seems at all likely to respond to remedial treatment. The total number of deaths recorded in 1912 of persons with common lodging-house addresses, or as homeless, was 160. There were 27 deaths in hotels of persons who came from abroad whose deaths have to be included in Westminster Before 1911 these were excluded. 14 Table II.—Causes of, and Ages at, Death during the year ending 28th December, 1912 :— Corrected Deaths in the City at subjoined Ages. Deaths in Wards (at all Ages). Causes of Death. All ages. Under 1. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 15. 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 36 5 15 13 3 — — — — — — — — 8 2 24 1 — - 1 Scarlet fever 4 — 1 — 3 — 1 3 — — Influenza 14 — — — — 1 2 3 8 1 1 1 6 1 2 2 — — — — — — Whooping cough 17 10 4 3 — — — — — — 2 — 3 4 — 6 — — — 1 — 1 — Diphtheria, Memb. croup 12 — 2 3 6 1 — — 1 — — 3 — 3 2 2 — 1 — — — Cerebro-spinal meningitis 2 1 — — — — — 1 — — — — — — — 1 — — — — — — — Enteric fever 5 — — — — 1 4 — 1 3 1 Infective diarrhoea 9 5 3 — — — 1 — 1 2 3 2 Enteritis 28 22 — 1 1 — — 2 2 1 1 1 3 9 3 8 1 1 — — — — — Erysipelas. 9 1 — — — — 3 3 2 — 1 — — 1 5 1 1 — — — Puerperal fever 6 — — — — — — — — — — — 1 — 2 2 — — — — — 1 — Other septic diseases 25 1 — 1 2 3 9 5 4 1 2 1 2 8 1 7 — — — 1 —: 2 — S yphilis, &c 9 4 — — — — 3 2 — — — 3 4 1 — 1 Diabetes 22 — — — 1 1 — 13 7 5 7 2 4 1 1 1 1 Rheumatic fever 5 — — — 1 2 1 1 1 1 1 1 — 1 — Tuberculosis of meninges 17 5 4 4 3 — 1 — — — — — 1 5 — 9 1 — — 1 — — — Tuberculosis of lungs 183 — — 1 8 17 86 55 16 2 2 4 7 43 12 54 14 5 3 11 3 10 13 15 Tuberculosis of peritoneum 8 2 1 — 1 1 2 1 — — — — 1 2 — 2 1 — — — — — 2 Other forms of tuberculosis 14 3 — 1 3 2 2 — 3 — 1 1 — 3 — 4 3 — — — — — 2 Malignant growths 217 — — — — — 19 107 91 9 19 7 14 71 16 40 8 6 4 6 4 9 4 Premature birth 48 48 — — — — — — — — 1 1 3 24 1 12 4 — — 1 — 1 — Developmental diseases 32 31 1 — — — — 1 107 — 2 3 3 8 — 10 2 2 — 1 — 2 — Old age 108 — — . — — — — 1 107 1 6 2 4 37 2 Meningitis and convulsions 14 7 — 3 2 — 1 1 — — 1 — 1 5 — 4 1 l — — — 1 — Loc. Ataxia and general paralysis 29 — — — — 1 10 18 — 1 1 — 1 9 1 5 2 1 1 3 2 1 1 Other diseases of nervous 19 9 system 60 — — 3 2 2 5 20 28 — 6 4 3 3 3 6 — 4 — 1 2 Valvular diseases of heart 73 — 1 — — 4 12 34 22 — 5 3 2 23 7 15 4 1 — 2 4 1 6 Other circulatory diseases 266 — — 1 3 1 23 87 151 5 16 13 23 79 23 49 6 9 6 10 2 18 7 Bronchitis 184 11 2 2 — — 11 47 111 1 11 5 12 52 9 46 7 8 3 12 3 10 5 Broncho-pneumonia 62 19 5 1 1 — 4 12 20 1 4 1 1 22 — 20 4 — 2 3 2 1 1 Pneumonia, other forms 82 3 1 1 — 2 23 31 21 4 6 3 4 22 4 20 6 2 1 1 1 5 3 Other respiratory diseases 22 — — — — — 4 8 10 — 1 1 — 8 1 7 1 2 — — — 1 — Alcoholism 14 — — — — — 2 10 2 — — — — 8 1 2 1 1 — — — — 1 Cirrhosis of liver 38 — — — — — 4 26 8 2 3 — 2 9 2 6 2 1 2 1 2 6 — Appendicitis and typhlitis 18 — — 1 1 — 5 10 1 — 3 2 2 4 2 2 — 1 1 — 1 — 2 Other digestive diseases 54 4 — 1 — 1 9 21 18 2 3 1 9 13 1 10 3 2 2 2 4 5 2 Bright's disease. &c. 85 1 — — — 2 14 31 37 — 11 5 3 l6 4 23 8 1 1 5 1 1 — Generative system diseases. 9 — — — — 1 4 2 2 — — — — 3 — 1 l I 2 1 — Accidents and diseases of parturition 4 — — — — — 3 1 — — — — — — 1 2 1 — — — — — — Deaths by accident or 13 negligence 66 9 2 4 6 6 15 14 10 5 6 4 3 15 5 3 2 3 — 2 3 2 Deaths by suicide and murder 2 24 — — — — 2 9 12 1 1 — 2 1 4 2 4 1 1 — 3 2 1 Other defined diseases 48 3 1 — 2 4 8 15 15 — 2 3 2 14 3 18 1 — 1 1 1 1 1 Diseases, ill defined or unknown 2 — — — — — — 1 1 — — — — 1 — 1 — — — — — — — All causes 1,984 195 43 44 49 54 306 594 699 36 121 69 118 572 117 484 98 59 32 70 40 96 72 16 Table III.— Vital Statistics of Whole Districts during 1912 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. Number (Uncorrected ). Births. Total Deaths Registered in the District. Transferable Deaths† Nett Deaths belonging to the District. Of NonResidents Registered in the District. of Residents not Registered in the District. Under 1 Year of Age. At all Ages. Nett. Number* Rate. Number.* Rate per 1,000 Nett Births. Number.* Rate. Number Rate. 1906 170,652 2,766 2,9331 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 1912 157,693 2,314 2,349 14. 8 2,113 13. 4 982 853 195 83 1,984 12.5 * In Column 6 are included the whole of the deaths registered during the year as having actually occurred within the district. In Column 12 is entered the number in Column 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 paticnt 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 160,261] Area of Distript in acres (exclusive of area covered by water) 2,502.7 Number of inhabited houses 17,540 At Census of 1911. Average number of persons per house 9.1 17 Table III.—continued. I. II. II—continued. Institutions within the District receiving Sick and Infirm Persons from outside the District. (Total Number of Deaths in brackets.) Institutions outside the District receiving Sick and Infirm Persons from the District. Institutions outside the District receiving Sick and Infirm Persons from the District. St. George's Hospital (320). Middlesex Hospital. Royal Naval Hospital, Gillingham. Westminster Hospital (224). St. Thomas's Hospital. Charing Cross Hospital (169) St. Bartholomew's Hospital. Cottage Hospital, Chad well St. Mary. King's College Hospital(178). St. Mary's Hospital. St. Peter's Hospital (20). German Hospital. All Saints Hospital, Eastbourne. Grosvenor Hospital (6). Guy's Hospital. Heart Hospital, Soho Square (15). Freidenheim Hospital. Epping Isolation Hospital. Brompton Hospital. Whippingham Isolation Hospital. Women's Hospital, Soho Square (19). Italian Hospital. Great Northern Hospital. Weymouth Isolation Hospital. Throat Hospital, Golden Square (10). French Hospital. Victoria Hospital. Worthing Hospital. Gordon Hospital (3). West London Hospital. St. George's Infirmary, Fulham Road. Queen Alexandra Military Hospital, Millbank (17). Great Ormond Street Children's Hospital. Marylebone Infirmary. Infants' Hospital (66). Cancer Hospital, Chelsea. Edmonton Workhouse. Royal Kar Hospital (2). University College Hospital. St. George's Workhouse, Fulham Road. King Edward's Hospital (2). Hospital of St. John and St. Elizabeth. Westminster Ophthalmic Hospital (2). Holborn Workhouse. South-Western Fever Hospital. Central London Sick Asylum, Cleveland Street. Poland Street Workhouse (17). London Hospital. Central London Sick Asylum, Hendon. Sheffield Street Workhouse (14). Park Fever Hospital. Grove Fever Hospital. Lambeth Infirmary. 22, George Street, Hanover Square, Nursing Home (2). North-Western Fever Hospit al. Camberwell Infirmarv. St. James' Infirmary, Battersea. 42, Belgrave Road (2). Western Fever Hospital. 96, Belgrave Road (6). Home Hospital, Fitzroy Square. Royal Infirmary, Gloucester. Banstead Asylum. Evelina Hospital. Long Grove Asylum. St. Joseph's Hospital, Cliiswick. Cater ham Asylum. Clay bury Asylum. Bolingbroke Hospital. Colney Hatch Asylum. St. Catherine's Hospital, Ramsgate. Darenth Asylum. Han well Asylum. Battersea General Hospital. Horton Asylum. Children's Hospital, Paddington. Leavesden Asylum. Tooting Bee Asylum. Mildmay Memorial Hospital. Manor Asylum. Hostel of God. Belmont Asylum. Homoeopathic Hospital. Camberwell House Asylum. Queen Mary's Hospital, Carshalton. Fislierton House Asylum. Thorpe Lunatic Asylum. National Hospital, Queen's Square. County Asylum, Exminster. Kent County Asylum. Royal Waterloo Hospital. Middlesex County Asylum. Royal Chest Hospital. City Asylum, Birmingham. Atkinson-Morley Hospital, Wimbledon. c 18 Table III—continued. III. Other Institutions, the Deaths in which have been distributed among the several wards in the City. III—continued. Other Institutions, the Deaths in which have been distributed among the several wards in the City. III—continued. Other Institutions, the Deaths in which have been distributed among the several wards in the City. St. Luke's House, Peinbridge Square. 13, Bulstrode Street, Marylebone. 3, Bennett Street, St. Pancas. St. Peter's Home, Kilburn. 14—15, Henrietta Street, Marylebone. 41, Royal Avenue, Chelsea. Northumberland House, Green Lanes. St. Joseph's Hospice, Hackney. 3, Deronshire Terrace, lebone. 1, Drayton Terrace, Kensington. 12, Hinde Street,Marylebone. 4, Cambridge Villas Hackney. 50, Salford Road, Streat ham. 51, Welbeck Street, Marylebone. 7, Coliseum Terrace, St. Pancas. 30, Grosswell Street, Fulham. 1, Letterstone Road, Fulham. 55, Welbeck Street, Marylebone. S.A. Home, Hackney. 18, Langham Street, Marylebone. H.M. Prison, Brixton. 7, Mandeville Place, bone. St. Michael's Home, Cheddar. 7, Queen Anne Street, Marylebone. 75, Barcombe Avenue, Streatham. French Convalescent Home, Brighton. 20, Beaumont Street, Marylebone. 15, Cantlay Avenue, Clapham. Ringwood Sanatorium. 19 o Table IV.—Deatlhs of Citizens during the Year ending 28th December, 1912, 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 12 7 19 – 2 2 6 5 11 – – – 1 – 1 3 – 3 22 14 36 Grosvenor 31 41 72 4 4 8 11 15 26 1 — 1 1 2 3 2 9 11 50 71 121 Hamlet of Knightsbridge 14 24 38 5 8 13 3 6 9 — — — 1 1 2 4 3 7 27 42 69 Knightsbridge St. George 28 36 64 9 4 13 18 12 30 — — — 1 — 1 7 3 10 63 55 118 Victoria 138 150 288 66 75 141 38 39 77 1 3 4 17 14 31 17 14 31 277 295 572 St. Margaret 33 37 70 4 11 15 15 7 22 1 — 1 1 1 2 6 1 7 60 57 117 St. John 79 104 183 122 57 179 44 31 75 8 5 13 7 10 17 10 7 17 270 214 484 St.Anhn 20 15 35 12 14 26 16 15 31 — 1 1 3 1 4 1 1 51 47 98 Great Marlborough 9 9 18 5 11 16 8 6 14 1 1 6 3 – 1 1 28 31 59 Pall Mall 9 6 15 1 1 2 2 4 6 — 1 1 8 8 20 12 32 Regent 18 15 33 12 10 22 7 6 13 1 — 1 1 1 - 39 31 70 Charing Cross 9 6 15 1 4 5 5 3 8 — 5 5 6 1 7 26 14 40 Covent Garden 19 21 40 19 11 30 14 5 19 1 3 4 3 3 56 40 96 Strand 7 1 8 35 14 49 7 – 7 — — — 4 1 5 2 1 3 55 17 72 City of Westminster 426 472 898 295 226 521 194 154 348 12 10 22 49 37 86 68 41 109 1,044 940 1,984 4 20 Table V (L.G.B. Table).— Vital Statistics of Separate Localities, 1902-1912. 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 Hamletof Knightsbridge Wards. 4. St. James, comprising Regent, Marlborough, Pall Mall and St. Anne's Wards. 5. Strand,comprisingCovent Garden, Strand, and Charing Cross Wards. Year Population estimated to middle of each year. Births registered (uncorrected). Deathss at all ages (corrected). Deaths under 1 year. Population estimated to middle of each year. Births registered (uncorrected). Deaths at all ages (corrected). Deaths under 1 year. Population estimated to middle of each year. Births registered (uncorrected). Deaths at all ages (corrected). Deaths under 1 year. Population estimated to middle of each year. Births registered (uncorrected). Deaths at all ages (corrected). Deaths under 1 year. Population estimated to middle of each year. Births registered (uncorrected). Deaths at all ages (corrected). Deaths under 1 year. 1902 179,981 3,284 2,952 442 76,065 1.205 1,074 143 50,855 1,153 1,007 163 32,014 611 500 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 30,3 / 6 489 365 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 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 Averages of 10 years 1902-1911 169,647 2,729 2,282 313 72,966 1,095 871 114 49,279 985 783 126 28,528 458 352 49 18,807 195 275 23 1912 157,693 2,134 1,984 195 69,294 898 847 87 47,437 812 670 81 24,624 275 259 19 16,338 149 208 8 21 Table V, continued.—Vital Statistics of Separate Localities, 1902-1912.—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. Death's 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 (corrced. Rate per 1,000. Deaths under 1 Year. Rate per 1,000 Births (uncorrected) 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 l5.3 11.0 116 21.2 16.2 133 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 146 11.6 90 13.5 10.7 77 18 '5 13.3 111 13.7 10.2 93 7.2 14.5 71 1911 13.2 12.5 115 13.2 11. 4 110 16.6 14.0 121 10.6 11.5 10.2 1405 104 Average of 10 years 1902-11 16.0 13.3 113 14. 9 11. 8 102 19. 9 15.8 127 15.8 12.2 104 10.2 14.5 104 1912 13.5 12.5 91 12.9 12.2 96 17.1 14.1 99 11.1 10.5 69 9.1 12 .7 53 22 Table VI.—Infantile Mortality during the year 1912. 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 Month?. 7—8 Months. 8—9 Months. 9—10 Months. 10—11 Months. 11—12 Months. Total Deaths underOne Year. Common infectious diseases— Small-pox – – – – – – – – – – – – – – – – – Measles 1 1 – – 1 – 1 – – – 2 – 5 Scarlet fever – – – – – – – – – – – – – – – Diphtheria – – – – – – – – – – – – – – – – – Whooping cough — — — — — 2 — — 1 — 1 1 3 2 — 10 Diarrhoeal diseases— Diarrhoea — – — 2 2 — — 1 1 — 1 1 1 — — — 7 Enteritis — i — — 1 4 1 5 1 4 — 2 1 1 — — 20 Gastritis — — — — — — — 1 — — — – – — — — 1 Wasting diseases— Premature birth 30 2 3 3 38 5 4 1 – – – – – – – – 48 Congenital defects 5 1 1 1 8 2 – – – – – – – – – – 10 Injury at birth 6 1 – – – – – – – – – – – – – – 7 Debility from birth 2 — 1 1 4 – – 2 – – – – – – – – 6 Atrophy, marasmus 2 1 — — 3 — — 2 — — — — — — — 1 6 Neglect at birth 5 – – – – – – – – – – – – – – – 5 Tuberculous diseases— Tuberculous meningitis 1 1 1 – – 1 4 Tuberculosis, abdominal – – – – – – – – – – – – – – – – 2 Other tuberculous diseases – – – – – – – – 1 – – 1 – – 1 — 3 23 Table VI—continued. CAUSE OF DEATH. Under 1 Week. 1—2 Weeks. 2—3 Weeks. 3—1 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. Other causes— Erysipelas — — — — 1 — — — — — 1 Syphilis 1 — — — 1 — — 1 1 — — — 1 4 Rickets — — — — — — — — — — — — 1 — 1 — 2 Meningitis (not tuberculous) — — — — — — 1 — — — — — 1 — — — 2 Convulsions 2 — — 2 — 1 2 1 1 7 Bronchitis — — 1 1 2 4 2 — 1 1 1 11 Laryngitis — — — — Pneumonia (all forms) — — 2 — 2 1 — 1 1 1 3 4 2 1 2 22 Suffocation, overlaying — — — — — — — 1 1 — — — — — 2 Other causes — 1 — 1 2 1 2 — 1 1 — — 1 — 1 1 10 53 7 9 9 78 18 16 16 9 9 7 13 9 7 9 4 195 Nett Births in the year—Legitimate, 2,194; illegitimate, 155—Total 2,349. Nett Deaths in the year of legitimate infants, 168 ; illegitimate infants, 27—Total 195. The causes of death of the illegitimate children were: prematurity, 9; debility at birth, 2; want of attention at birth, 2 ; diarrhoea, 1; enteritis, 2; pneumonia, 2; syphilis, 1; measles. 1, marasmus, 3; bronchitis, 2 ; tuberculosis, 2 intussusception 1. 24 Table VI, continued.—Infantile Mortality during the year 1912. 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 – – – – – 1 – – – – – 2 Whooping cough – – – – – – – – – – – 1 1 1 1 4 Diarrhoea – – – – – – – 1 1 — — 1 — – – – 3 Enteritis — 1 — — 1 1 1 2 — 2 — — 1 – – 8 Premature birth 9 2 — — 11 1 1 – – – – – – – – – 13 Congenital defects 3 1 – – 4 – – – – – – – – – – – 4 Injury at birth — 1 – – 1 – – – – – – – – – – 1 Debility at Birth — — — 1 1 — — 1 — — — — — — - 2 Atrophy, debility, marasmus 1 1 – – 2 – – 1 – – – – – – – – 3 Tuberculous meningitis – – – – – – – – – 1 – 1 – – – 1 3 Abdominal tuberculosis – – – – – – – – – – – – – – – – 1 Other tuberculous diseases – – – – – – – – – – – – – – 1 – 1 Erysipelas — — — — — 1 — — — — — — — — — 1 Syphilis 1 — — — 1 — — 1 1 — — — — 1 4 Convulsions 1 — — — 1 – – — — – – – – 1 – 2 Bronchitis – – – – – 2 2 – – – – – – – – – 4 Pneumonia, all forms — — 1 — 1 — 2 — 1 1 1 1 1 – 1 – 9 Suffocation, overlaying — — — — — — — 1 — — — — — — — — 1 Other causes. 2 1 — 1 4 1 2 — — 1 — — — — – — 8 17 7 2 2 28 6 8 8 3 5 2 4 3 3 3 i 74 Nett Births in the year—Legitimate, 762; illegitimate, 64. Total 826. Nett Deaths in the year of legitimate infants, 63 ; illegitimate infants, 11. 25 Table VI, continued.—Infantile Mortality during the year 1912. Victoria Ward. Deaths from Stated Causes in Weeks and Months under One Year of Age. cause OF DEATH. Under 1 Week. 1—2 Weeks. 2—3 Weeks. 3—4 Weeks. Total under 1 Month. 1 —2 Months. 2—3 Months. 3—4 Months. 4—5 Months. 5—45 Months. , (5—7 Months. 7—8 Months. 8—9 Months. 9—10 Months. 10—11 Months 11—12 Months Total Deaths under One Year. Measles – – – – – – – – – – – – – – 2 — 3 Whooping Cough – – – 2 – – – – – – – – – 1 – – 2 Diarrhoea — — — – — — — — — – – – – – – 4 Enteritis — — — — — 1 — 1 1 – — 1 — 1 – – 7 Premature birth 14 — 2 1 17 4 2 1 – – – – – – – – 24 Congenital defects 1 — — 1 2 – – – – – – – – – – – 2 Injury at birth 1 – – – 1 – – – – – – – – – – – 1 Debility from birth 2 — 1 — 3 – – – – – – – – – – – 4 Atrophy, debility, marasmus – – – – – – – – – – – – – – – – 1 Tuberculous meningitis — — — — — — — — 1 – – – – – – – 1 Tuberculosis, abdominal – – – – – – – – – – – – – – – – 1 Other tuberculous disease – – – – – – – – – – – – – – – – 1 Bronchitis — — 1 1 2 1 – – – – – 1 – – – 1 4 Pneumonia, all forms — — — — — — 1 1 — — 2 1 – 1 – 7 Dentition – – – – – – – – – 1 1 – – – – – 2 Convulsions – – – – – – – – – – 1 2 1 – – 1 2 Other causes — — — — — — — — — – – – – – 18 — 4 5 27 6 4 5 4 4 5 4 3 2 3 2 69 Nett Births in the year—Legitimate, 650 ; illegitimate, 59, Total 709. Nett Deaths in the year of legitimate infants, 58; illegitimate infants, 11. 26 Table VII.— Vital Statistics relating to Residents in Blocks of Dwellings in the City of Westminster, 1912. 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 1,215 43 15 2 1 3 1 2 — — — — 2 4 3 3 St. James's Dwellings, Ingestre Place, and Marshall Street. 115 3 3 — — — 1 — 1 — — 1 — — — 2 Peabody 7,025 159 78 9 10 15 6 11 6 2 2 7 4 6 12 21 Westminster 187 3 2 — — — — 2 — — — — — — 2 London County Council— Millbank 3,010 83 26 4 4 2 — 1 1 — 3 4 3 4 5 6 Drury Lane 775 15 11 — 1 3 — 3 2 1 — — 1 — 2 2 Improved Industrial 4,400 90 47 3 3 5 3 9 4 1 2 9 3 5 4 20 Metropolitan Association 757 15 13 — 4 1 — 3 2 1 — 1 — 1 — 6 St. George's Model Dwellings 419 9 9 1 1 — — 2 2 — — 3 — — — 5 Clerkenwell and Soho Company 1,184 25 15 — 2 3 1 1 2 1 2 1 — 2 2 4 (Newport Market) Greencoat 119 5 — — — — — — — — — — — — — — Spencer 99 1 — — — — — — — — — — — — — — Chapter Chambers 175 4 — — — — — — — — — — — — — — Alexandra and Castle — 4 3 — — 1 — 2 — — — — — 2 St. James's Residences — 13 1 — — — — 1 — — — — — — — — City of Westminster. Table VIII.—Local Government Board Table C.— Cases of Infectious Disease Notified during the 52 weeks from lst January to 28th December, 1912. Cases Notified in the City of Westminster. Total Cases Notified in each Ward. Number of Cases Removed to Hospital from each Ward. Notifiable Diseases. At all Ages. 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. 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. 0 to 1. I to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 and upwards. Small-pox— Cases — — — — — — — — — — — — — — —— — — — — — — — — — — — — —— — — — — — — — Deaths — —— — — —— — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Chicken-pox- Cases — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Cholera— Cases — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Deaths — — — —— — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Diphtheria— Cases 160 2 43 65 24 24 2 — — 13 5 33 5 20 14 2 17 14 4 16 — 17 — 11 4 27 4 20 14 2 15 14 4 16 — 17 Deaths 12 — 5 6 — 1 — — — 1 — 3 — — — — — — — — Erysipelas— Cases 91 1 3 3 9 27 33 15 — — 2 26 7 24 — 7 2 — 7 5 7 7 — — 1 9 3 13 2 — 5 1 — 1 4 2 Deaths 9 1 — — 1 3 3 1 — — — — 1 5 1 — — 1 — — 1 — Scarlet— 0 Cases 91 1 64 121 36 15 — — 1 10 7 40 17 84 9 4 16 12 4 1 15 1 9 6 6 37 14 84 8 4 16 12 4 17 1 14 Deaths 1 — 1 — — — — — — — — — — — — — — — — — — Poliomyelitis— . Cases 6 — 4 1 1 — — — — — — 1 1 1 — — 1 1 — — — — — — 1 — — — — — — — — — Deaths 1 — 1 — — — — — — — — — — — — — —— — — Enteric— Cases 17 — 1 — 6 10 — — — 3 — 7 — 1 — — — — 3 — 4 — — — — — — — 1 3 1 — Deaths 5 1 4 — — — 1 — 3 — 1 — — — — — — — — Cerebrospinal— Cases 3 1 — — — 1 1 — — — 1 1 — — —— —— — — — — — 1 — — 1 1 — — — — — — — — Deaths 12 1 — — — — 1 — — — 1 — — — — — — — — — — — — — — — — — — Ophthalmia — Cases 18 18 — — — — — — — — — 10 1 5 — — — — — — 2 — 1 — — — — — — — — — — — — Deaths Puerperal— Cases 19 — — — 2 17 — — — 2 2 4 2 4 — — — — — 3 — 1 2 4 — — — — 1 — — 1 — 3 Deaths 6 — — — — 6 — — — — 1 — 2 2 — — — — — 1 — Total Cases 552 24 115 190 78 94 36 15 1 31 17 121 33 140 26 6 43 29 9 47 42 1 25 13 83 24 124 25 6 38 27 9 38 6 36 27 6 cases notified as scarlet fever, 6 as diphtheria, and 2 as enteric fever were eventually alleged not to be suffering from the disease notified. 4 deaths from the following complaints, viz.: diphtheria, enteric fever, scarlet, and erysipelas, were reported, but no notification of the illnesses bad been received previously. 28 Table IX.—Infectious Diseases Notified, 1890-1912, in London. Year. Smallpox. Scarlet Fever. Diphtheria and Croup. Enteric Fever. Typhus Fever. Other Continued Fevers. Puerperal Fever. Erysipelas. Cholera. Relaps- ins Fever. Totals. 1890 60 15,330 5,870 2,877 35 237 206 4,598 25 7 30,245 1891 114 11,398 6,412 3,372 27 152 221 4,764 23 39 26,552 1892 423 27,095 8,353 2,465 20 147 347 6,931 54 7 45,848 1893 2,813 36,901 13,694 3,666 22 205 397 9,700 86 4 67,485 1894 1,192 18,440 11,190 3,360 21 162 253 6,080 21 2 40,925 1895 979 19,757 11,223 3,506 14 105 236 5,660 29 3 41,512 1896 225 25,647 13,941 3,190 6 103 279 6,438 13 3 49,845 1897 104 22,848 13,199 3,103 4 65 264 5,800 38 1 45,361 1898 32 16,894 11,855 3,024 16 55 247 5,169 23 1 37,316 1899 29 18,113 13,704 4,463 14 69 330 5,615 15 1 42,353 1900 87 13,800 11,985 4,291 7 73 237 4,762 5 — 35,747 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* 1908 1 22,059 9,998 1,350 4 13 230 4,209 — — 35,864* 1909 21 17,251 6,685 1,042 7 20 287 4,194 — — 29,507* 1910 7 10,512 5,495 1,284 3 15 292 3.981 1 1 21,706* 1911 72 10,485 7,388 1,023 1 23 303 4,849 10 24,255* 1912 6 11,319 7 104 705 3 8 381 4.099 — — 25,222 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 — 4 3 176 — — 1,140 1900 2 453 287 118 — 2 5 129 — — 998 1901 102 475 253 104 — 1 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* 1912 — 238 160 17 — — 19 91 — — 552* * 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, ,, 105 ,, 3 ,, 1912. ,, 699 Ophthalmia ,, 18 ,, 1912. ,, 134 Poliomyelitis ,, 6 ,, 1912. 29 Table IX—continued. Case-rates per 10,000 Living in London. Year. Smallpox. Scarlet Fever. Diphtheria. Enteric. Typhus. Other Continued Puerperal. Fevers. Erysipelas. 1891 0.3 27.1 15.2 8.0 0.1 0.5 0.5 11.3 1892 1.o 63.8 19.6 5.8 – 0.3 0.8 16.3 1893 6.5 86.1 32.0 8.5 0.1 0.5 0.9 22.6 1894 2.7 42.5 25.9 7.7 0.0 0.4 0.6 14.0 1895 2.2 45.2 25.7 8.0 0.0 0.2 0.5 12.9 1896 0.5 57.0 30.7 7.1 0.0 0.2 0.6 14.3 1897 0.2 51.2 29.6 7.0 0. 0 0.1 0.6 13.0 1898 0.1 37.6 26.3 6.7 0.0 0.1 0.5 11.5 1899 0.1 39.9 30.1 9.8 0.0 0.2 0.7 12.3 1900 0.2 30.1 26.1 9.3 0.0 0.2 0.6 10. 3 1901 3.7 40.1 26.7 7.0 0.04 0.1 0.5 10.1 Average of 10 years 1892-1901 1.7 49.4 27.2 7.7 0.02 0.2 0.6 13.5 1902 16.7 39.1 23.0 7. 3 0.00 0.1 0.6 11.8 1903 0.9 27.1 16.7 5.0 0.04 0 .08 0.5 9.4 1904 1. 0 28.9 15 .5 4.0 0.00 0.06 0.59 10.6 1905 0.15 41.5 13. 5 3.3 0. 02 0.03 0.6 10.6 1906 0.06 43.0 17.0 3.3 0.-01 0.01 0.6 10.6 1907 0.01 54.1 18.4 2.9 0.01 o.o5 0.5 9.4 1908 (53 weeks) 0.00 45.1 16. 3 2.7 o.oo 0.02 0.4 8.6 1909 00.4 35.6 13.9 2.1 o.o1 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 Average of 10 years 1902-11 1.90 35.9 161 3.5 0.01 0.04 0.5 9.8 1912 0.01 25.0 15.7 1.5 0. 0 0.01 0.8 9.0 In the City of Westminster. 1891 01 19.1 8.8 5. 0 0.0 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 o.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 04 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 1907 24.2 8.4 2.9 — 0.11 0.17 5.9 1908 (53 weeks) 0.05 35.6 10.6 2.3 — — 0.34 4.6 1909 0.05 34.3 13.0 1.4 — — 0.29 5. 9 1910 0.05 14.4 8.6 2.7 — — 0.34 3. 5 1911 0.06 15.9 9.7 1.9 — — 0.37 5.1 Average of 10 years 1902-11 1.57 23.9 10.2 3.0 — — 0.35 6.0 1912 — 15.1 10.1 1.1 — — 1.20 5. 8 30 B Communicable Diseases. The details respecting the notifications of infectious disease received by me are set out in the Local Government Board's Return (Table VIII), 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 IX, 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. In London, as a whole, the number of cases of scarlet fever and puerperal fever was above the number notified in the previous year, while smallpox, diphtheria, erysipelas and typhoid fever were below. In Westminster diphtheria, puerperal fever and erysipelas cases were more numerous, but the cases of scarlet fever and typhoid fever were below the average. A number of doubtful cases, contacts, and certain patients returning from fever hospitals, &c., were visited during the year. There were no cases of smallpox notified in Westminster, but 67 notifications were received of persons coming to Westminster from infected places or off ships on which cases had occurred. Vaccination.—The Vaccination Officers have supplied me with the following particulars relating to vaccination of infants born in 1911 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 1,721 121 1,364 9 4 121 17 51 Westminster 267 15 207 1 0 23 0 21 Strand 122 12 75 0 1 15 11 7 The City 2,110 148 1,646 10 5 159 28 79 31 The following is a summary of the total primary vaccinations performed in the City during the years 1901-12, and of re-vaccinations in so far as these were made by the Public Vaccinators:— Vaccination Returns. Primary Vaccinations under 14 years of age, in the Union District of Re-vaccinations performed by Public Vaccinators in the Union District of St. George's. Westminster. Strand. St. George's. Westminster. Strand. 1901 2,467 1,491 725 4,039 3,317 2,201 1902 2,893 715 450 7,453 6,226 3,910 1903 2,178 369 245 159 9 347 1904 2,065 325 *144 72 13 398 1905 2,162 498 142 47 7 418 1906 2,110 372 145 51 5 397 1907 2,013 443 155 45 7 468 1908 1,898 284 138 37 8 413 1909 1,902 370 148 39 35 399 1910 1,652 326 188 43 5 517 1911 1,606 288 181 193 63 673 1912 1,486 187 220 — 18 493 * There were also 16 primary vaccinations of persons over 14 years of age. Scarlet Fever.—I said in my last report that "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 London from September onwards." From the tables appended it will be seen that there were more cases in each quarter of 1912. In Westminster it was only in the second quarter that they exceeded the cases in 1911. The death rate continued low. In 17 instances, 2 cases occurred during the year in the same house, and in 4 instances 3 cases, and in 1 instance 4 cases. In 6 instances the disease was eventually found not to be scarlet fever. A foreign woman called in a medical practitioner to see her child, who was unwell, and was informed by him that the child was suffering from scarlet fever; not being satisfied, however, she carried the child to the Middlesex Hospital, where the diagnosis was confirmed, and the child sent to a fever hospital. She was prosecuted for exposing her child while suffering from an infectious disease, and fined 7s. 6d., the magistrate taking into account the fact that the woman was a foreigner and perhaps did not fully understand her position. Diphtheria.—Cases of diphtheria in Westminster were most numerous in the first three quarters of the year. Of the 160 cases 32 notified, 6 were subsequently found not to be suffering from the malady. The mortality was low, being 63 per 100 cases for London, 75 for Westminster. Anti-toxin was supplied in 2 cases. In 3 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 146 cases. In 10 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. In one instance examination was made on account of other cases occurring subsequent to the first patient's return from hospital—it proved negative. Typhoid Fever.—The number of cases notified, both in London and Westminster, show a great decrease, although in the beginning of the year the complaint was more prevalent than usual. Of the 17 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. Of the 16 actual cases, 4 of the patients contracted the disease out of London, most of them abroad; of the remaining 12 no definite history was obtainable in 8 instances, 4 were ill after eating shell fish. Five deaths occurred. Advantage was taken to obtain the City Bacteriologist's opinion in 11 cases, in 2 the Widal reaction was"reported. Puerpekal Fever.—Nineteen cases were notified with 6 deaths, the average number of cases is 6. In London there were 381 cases, the average number in the last five years having been 271. Enquiry was made in each case. Seven cases occurred in the first quarter, 4 of which were attended by the same medical man during two days. As soon as the first case showed symptoms of septicaemia, he discontinued attending confinements for a month. Three cases were connected with miscarriages. Disinfection was carried out after each case, and included the clothing, obstetric bags, &c., of doctors, nurses, and others in attendance. Ophthalmia Neonatorum.—Eighteen infants were notified as suffering from this complaint. In 5 instances it was the first confinement. Three of the children were illegitimate. Eleven of the homes 33 were in Victoria Ward, 3 in St. John's, 2 in Covent Garden, and 1 in St. Margaret Wards. Nine children were treated at hospitals, 5 as in-patients. Both eyes were affected in 15 instances. Thirteen were reported to have recovered without permanent impairment of vision. Two prematurely-born children died ; the sight was entirely lost in one eye in two cases, and much impaired in one eye in one case. 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. The Inspectors of the County Council under the Midwives' Act have co-operated by calling attention to cases which come under their observation. The cause of the infection is usually gonorrhoea, especially in the severer forms, and it had been suggested that facilities should be provided to enable medical men to have a bacteriological report stating the particular organism present in the purulent discharge. The Local Government Board, in reply to an enquiry, stated that if in any case the City Council find it necessary to take swabs from the eyes of persons suspected to be suffering from Ophthalmia Neonatorum to ascertain whether they should deal with the case under their powers relating to infectious disease, the Board consider that the City Council can legally incur expenditure for that purpose. Bacteriological examination was made in two instances, the gonococcus was not found in either ease, but the bacillus xerosis was present in one. The attention of the County Council was called to a midwife who attended a case (in 1911), and the matter was eventually laid before the Midwives' Board, who ordered her name to be removed from the register of midwives for failing to take steps to have a medical practitioner to attend the case and for treating the child's eyes with chloride of mercury and silver nitrate without making a record in her register. The mother died, the child lost its sight, and another woman was infected (see under Puerperal Fever in Annual Report for 1911). Cholera, &c.—Notifications were received from Port Sanitary Authorities of persons coming to Westminster from districts affected with cholera, plague and yellow fever. The numbers were 13, 24 and (i, respectively. They were kept under observation. Tuberculosis. Tuberculosis has occupied much attention during the last year owing to two causes; first, the development which has taken place through the Local Government Board extending the Orders so that by the end of the year all forms of the disease are required to be notified; and, secondly, to the coming into force on July 15th of provisions of the Insurance D 34 Act whereby insured persons became entitled to "sanatorium" benefits. These included treatment at home and treatment in hospitals and sanatoriums. To meet immediate requirements, the Local Government Board, whose approval to plans of "sanatorium benefit" is necessary, issued an Order on July 26th prescribing the manner in which domiciliary treatment of insured persons suffering from tuberculosis might be undertaken, at the charge of insurance funds, by any registered medical practitioner, and provisionally requiring the Medical Officers of Health of counties and county boroughs to act as consulting officers for the purpose of the Order. A (temporary) local committee was formed in Westminster, but practically the whole of the arrangements for dealing with the subject fell upon the Medical Officer of Health, working in conjunction with the Central Insurance Committee for London. Meetings with the members of the medical profession were held, and a scheme drawn up for domiciliary treatment. It was never officially sanctioned, but arrangements made by me with individual medical men on the terms of the scheme were agreed to by the Central Committee in each case. This arrangement existed to the middle of January, when a fee of 6d. per head was fixed to be paid on account of the home treatment of all tuberculous insured persons. A Departmental Committee was appointed in February " to report upon the considerations of general policy in respect of the problem of tuberculosis in the United Kingdom, in its preventive, curative, and other aspects which should guide the Government and local bodies in making or aiding provision for the treatment of tuberculosis in sanatoria or other institutions or otherwise." The Committee presented an interim report in May in which they outlined a general scheme of co-ordinated effort for the prevention, detection, and treatment of tuberculosis. They advised the establishment throughout the country of organisations termed for convenience "dispensaries," together with the provision of sanatoriums, hospitals, and other institutions, including open-air schools. In London, the borough councils are to be responsible for the outdoor or dispensary treatment, and the County Council for in-door or hospital treatment. Several memoranda have been issued by the Insurance Commission and by the Local Government Board indicating the methods which may be adopted in carrying out the policy recommended by the Departmental Committee. The Local Government Board have indicated that they expect that all schemes for the treatment of tuberculous patients should include both insured and uninsured. No general scheme for London has yet been evolved, but in the boroughs considerable progress has been made with regard to the " dispensary " side. 35 Conferences have taken place between the various metropolitan councils and the County Council, with the view of ascertaining how co-operation may be best attained. One difficulty which has not yet been solved is as to the manner in which payment should be made for the use of the sanatoriums. There are two alternative methods, one by which each borough pays for the number of non-insured patients sent in, the other, that the cost should be paid by a general rate. In the final Report of the Departmental Committee on Tuberculosis it is pointed out that there is much need for research work in connection with the social and economic causes of tuberculosis, and they specially emphasize the importance of early diagnosis of the disease in children, and the urgent need for a wide application of the principle of open-air treatment and education in open-air schools. They also deem it of importance that every effort should be made to secure that the food of the country should be free from tubercle bacilli. They submit a number of recommendations on methods of prevention, similar to those in force in Westminster for some years. While in no way desiring to minimise the importance of education and supervision of consumptive patients, they are of opinion that in certain cases it would be well to have compulsory isolation, particularly where the patient's surroundings are such as to increase the risk of other persons being infected. Notification.—The total number of certificates received in the year was 1,364; 511 were under the Poor Law Older, 637 under the Hospitals Order, 170 under the General Order, and 46 under the Council's Voluntary Scheme. Deducting 351 referable to other districts, 1,113 certificates were received in connection with Westminster cases. The number of new cases of pulmonary disease was 473, of whom 105 were homeless persons or inmates of common lodging-houses, &c., and there were 27 new cases of other forms of tuberculosis. Three notifications were received from school medical officers. Notification of Pulmonary Tuberculosis. Under Poor Law Order :— Number of Certificates Received. New Cases. Year. 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 1912 404 26 81 511 97 61 158 d 2 36 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. Number received. Number transferred. Inmates of C.L.H., &c. Inmates of Private Houses. Total. 1911 511 284 2 121 123 1912 637 351 6 145 151 Under General Order:— 1912 170 — 2 143 145 Under Voluntary System;— Pulmonary Tuberculosis. Year. Other Forms New Cases. Suspects. New Cases. 1908 148 2 4 1909 159 63 5 1910 135 100 17 1911 73 102 38 1912 19 233 27 The number of persons notified voluntarily has decreased as the system of compulsory notification has been extended. With the beginning of 1913, all forms of tuberculosis became notifiable, consequently the voluntary system, which has been in existence for twelve years, will be entirely superseded. The total number of new cases of pulmonary tuberculosis notified in each of the last four years was:— Total. Less Casuals. 1909 406 270 1910 275 165 1911 356 256 1912 473 368 Details as to age, sex and ward are shown on the next page. 37 Tuberculosis. Table showing respective age, sex, distribution in Wards, number notified under each scheme, and numbers treated in Institutions. 1912. Pulmonary. All Ages. 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. 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. Institutions. Poor Law Order 88 - - - 2 26 46 14 - - - 11 - 32 - - - 4 1 7 33 - 88 Common Lodging-houses, &c. 9 — —.. 2 6 1 — — 2 — 6 — — — — — — — 1 9 35 — 1 2 3 17 9 3 — 1 2 6 2 11 — — 3 2 — 2 — 6 35 Other 26 — — 3 2 13 7 1 — — — 5 1 13 1 — 2 1 1 — 2 — 25 Hospital 95 — 1 4 19 47 23 1 1 2 5 18 8 26 7 2 9 — 4 4 9 52 56 — - 4 12 26 12 1 1 2 8 17 1 14 — — 1 2 — 4 — 6 29 General 82 — — 3 17 39 19 4 4 5 3 17 12 11 6 4 3 4 — 2 — 11 32 63 — — 2 18 30 12 1 — 6 2 32 4 10 5 — — — 2 2 — — 24 V oluntary 10 — — 2 4 3 1 — — — — 3 1 3 — - 1 1 — — — 1 7 9 — — 2 3 4 — — — — — 2 1 1 — — 2 1 — — - 2 5 Other 14 — 5 5 2 1 1 — 1 6 1 2 — — 1 — 1 1 — 1 5 13 — 2 9 2 — — — — — - 2 1 8 — — 1 — — 1 — — 7 Males 324 7 16 47 133 99 22 5 9 8 61 24 85 13 4 10 20 2 14 37 24 Females 176 — 3 20 37 75 37 4 1 8 10 60 8 52 6 — 6 4 3 9 2 14 - 38 The special Phthisis Visitor keeps in close touch with the patients and their families, with the exception of casuals and certain cases in which the medical man in charge supplies the requisite information and undertakes to give the necessary advice and assistance. 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, and persons notified from hotels where the stay was temporary. From the records which are kept of each case, the following information lias been abstracted:— 324 persons notified were males, 176 females, without casuals 236 males and 167 females; with the exception of 14 males and 13 females, these suffered from pulmonary tuberculosis. Duration of illness before notification:— Pulmonary Tuberculosis. 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. 9 to 10 years. 10 to 15 years. 15 to 20 years. Males(184) 73 35 26 22 17 4 4 2 1 - Females(140) 72 30 13 12 4 1 2 2 3 1 Duration of illness up to death:- Pulmonary Tuberculosis. 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. 8 to 10 years. 10 to 15 years. 15 to 20 years. Males 18 15 6 7 10 1 1 - 1 - Females 5 9 5 3 2 1 — I 1 - Period between notification and death:— Pulmonary Tuberculosis. Under 1 month. 1 to 3 months. 3 to 6 months. 6 to 12 months. Males 28 14 13 5 Females 7 8 8 4 History of phthisis in parents, grandparents, uncles, aunts:— Pulmonary Tuberculosis. Males. Females. Males. Females. Positive 27 45 None 104 66 Doubtful 13 18 Unknown 71 24 39  Mates. Females. Single (including 25 children) 94 72 Married 92 69 Widowed 4 14 Unknown 33 — No family 22 12 Not known 12 11 Families with children tuberculous 17 14 Families without known tuberculous children 45 46 Males. Females. Males. Females. Husbands or wives Brothers and sisters tuberculous 5 10 tuberculous 17 12 Occupations of Persons Notified in 1911-12. Outdoor. Indoor. Present. Past. Present. Past. Males. Males. Motor drivers, Conductors, &c. 12 1 Baker Tailors 28 1 Army Packers 8 1 Army 1 Merchant service 1 Out door porter Carmen, horse 8 1 Army 1 Army Stable hands 10 1 'Bus driver Storekeepers 2 1 Tobacconist House painters 9 1 Prof, crioketer Furniture Building trade 9 1 Army movers 2 General labourers 9 Clerks 17 1 Choir boy Window cleaner 1 1 Waiter Gardener 1 1 Clerk Messengers 2 Caretakers 7 1 Draper Commissionaires 2 2 Army L1G. L. and Coke Co. Soldiers 18 Housekeeper 1 Engineer's labrs. 2 Hall porters 5 1 Army Electric lamp 1 Barman trimmer 1 Club do. 5 1Army Engine stoker 1 Valets, and other Brewery labr 1 men-servants 19 1 Army Cooper 1 Kitchen porters 3 Watchmen 3 Waiters 14 Costermongers,&c.l3 1 Gas Co. labourer Barmen and potmen 11 1 Butler Milkman 1 1 Carman 1 Labr. in brewery Publicans 2 Selling papers, &c. 8 1 Sailor Billiard marker 1 Tailor Billiard table Telegraph messenger 1 marker 1 Bakers and Postman 1 Army fectioners 4 1 Footman Travellers 2 1 tin printer Musician 1 1 Army School attendance Gas fitters 2 officer 1 Covent Garden Gas-burner maker 1 porter 1 Bottle wirer 1 40 Occupations of Persons Notified in 1911-12-continued. Outdoor. Indoor. Present. Past. Present. Past. Males. Males. Sweepers 4 1 Navy Boot and shoemaker 3 Policemen 2 Salvage Corps 1 Navy Chiropodist 1 Railway ticket clerk 1 Theatre attendants 3 1 Army Turkish bath attendant 1 Porters, shop 14 1 Caretaker Shop assistants 21 1 Clerk Errand boys 3 Coach polisher 1 Farriers 2 Attendant, public library 1 Surgical instrument maker 1 Laundryman 1 Male nurse 1 Army Telephone operator 1 No occupation 22 Chef 3 Lavatory attendant 1 Painter Printers 4 Stoker 1 Army Die sinker 1 Cigarette maker 1 Glass blower 1 Hop merchant 1 Restaurant keeper 1 Dispenser 1 Journalists 2 Bottle and rag dealer 1 Hair dresser 1 Book-edge gilder 1 Females. Females. Flower sellers 7 1 Factory worker Casual—streets 8 2 Cooks Market woman 1 1 Barmaid Housewives 83 1 Furrier 2 Ladies' maids 1 Machinist 2 Tailoresses 1 Shop assistant Housekeepers 3 Servants 49 Governesses 2 Tailoresses 3 41 Occupations of Persons Notified in 1911-12—continued. Outdoor. Indoor. Present. Past. Present. Past. Females. Dressmakers 12 Fur sewers 2 Shop assistants 0 Waitresses 4 1 Servant Church pew attendant 1 Office cleaning charing 16 Laundry workers 3 Monthly nurse 1 Hospital nurses 2 Typist 1 Drapers' assistants 3 Actress andother artistes 2 Secretary 1 Relief stamper 1 Upholsterer 1 Second-hand furniture 2 No occupation 14 1 Tailoress Opportunities of Infection.— There were definite opportunities for infection to have been conveyed by proximity to consumptive persons other than relatives. Among males, 3 with fellow workers; among females, 3 had lived with consumptive fellow servants, 4 had worked with consumptive persons, 1 had nursed a friend while ill, and 1 was engaged to a man suffering from the complaint. In view of the number of tailors who are consumptive, and of many tailors having their workshop as part of their dwelling, there is a possibility that infection is spread not only to fellow workers but also to the children of the employer. In 2 cases among the males, and 7 among the females, there was a previous history of tuberculous affections of other parts of the body, viz., spine 3, glands 4, abdomen 2. Alcohol was a predisposing cause in 5 males and 6 females. Other ontributory causes were delicacy from childhood 8, chorea and heart flections 4, influenza 6, kidney disease 1 privation 7, diabetes 2. Nationality.—The majority of the persons affected were English but there were also the following:— 42  Males. Females. Males. Females. Irish 10 2 German 6 3 Scots 4 Russian 8 7 Welsh 2 1 Italian 7 2 French 7 1 Danish 1 — Austrian 1 1 Greek 1 — Swede 1 1 Swiss — 1 There were 21 Jews, most of them born in Russia. There were 27 persons found by the Health Visitors to be suffering from other forms of tuberculosis; joints were affected in 9, bones 2, spine 3, glands 7, skin (lupus) 1, abdomen 5. Seven had parents, brothers or sisters, suffering from pulmonary disease, and 11 others had uncles or aunts affected: the family history was indefinite in 3 instances, and there was no history of tubercle in the families of 13. Visiting of Tuberculovs Patients.—The Local Government Board require that the Medical Officer of Health or an officer acting under his instructions shall make such inquiries and take such steps as are necessary or desirable for investigating the source of infection, for preventing the spread of infection, and for removing conditions favourable thereto. It is necessary, therefore, to keep all consumptive persons under regular supervision. Members of families or others who are suspected of being consumptive are also'supervised and brought under medical examination and treatment. During 1912, 733 tuberculous persons have been visited, and, in addition, 17 families where death occurred without the disease having been previously notified; 109 "contacts" and 124 "suspects" have been medically examined in 1912, and 29 of these were found to be suffering from pulmonary tuberculosis, and 4 from other forms, 171 were declared to be free from tuberculosis or found to be suffering from other complaints. The examination of the above cases was effected by means of the following: Hospitals, Dispensaries, and Private Doctors, 145; Soho Infant Medical Inspection Centre, 52; School Medical Inspections, 36. At the end of the year there remained 425 cases of pulmonary tuberculosis and 76 of other forms of the disease, besides casuals, who probably number at least 100. There are also 235 persons under observation, in addition to a number in whose families no case has been notified, but who are suspected to be suffering from tuberculosis by their medical attendants (see under Bacteriological report). 43 Institutional treatment has been given during 1912 as follows:— Sanatorium. Convalescent Home. Boarding Out. Consumption Hospitals Home for the Dying. G eneral Hospital. Poor Law Infirmary. Total. London. Seaside. Definite pulmonary tuberculosis 73 26 11 16 18 7 31 149 331 Suspected tuberculosis 3 35 10 2 — — 2 10 62 Other forms of culosis — 23 3 3 4 - 8 11 52 74 84 21 21 22 7 41 170 445 This was arranged by:— Charity Organisation Society 8 Invalid Children's Aid Association 29 St. Henry Fund 21 City Council 24 National Insurance Committee 7 Jewish Board of Guardians 14 Clergy, School Care Committees, Employers, Clubs, and privately 136 Poor Law Guardians 170 Hospitals (in co-operation with the above in many cases) 36 445 Sixty-five persons (36 males and 29 females) suffering from pulmonary disease, and 3 from other forms, were ill when they came to Westminster. A number came to London to attend hospitals (1 came from Russia for this reason); one man came in order to live over a stable, as he had been told stable air was beneficial. Many of the females were domestic servants. Changes of address.—224 changes of address were recorded of consumptives, 44 of suspects, and 8 of other tuberculous patients. This does not include transference to hospital or sanatorium nor movements of casuals; 56 of the consumptives and 11 of the suspects left Westminster. Sanatorium Treatment.—The Council sent away 22 patients: 2 to Fail-light and 20 to Maitland ; 2 others were occupying beds at Maitland at the beginning of 1912, 2 wore in residence at the end of the year. Eighteen of the patients were males and 6 females. The average period of stay was eight weeks; the cost was £225, inclusive of travelling expenses, thermometers, sputum flasks, &c. Ten persons suffering from pulmonary tuberculosis and 4 from other 44 forms of the disease were sent away by the St. Henry Fund from St. Anne's Ward. Treatment in a sanatorium was to be given to suitable cases after the 15th July, under the Insurance Act, but the London Committee was able to give this benefit in only a small number of instances as little accommodation was available at first. Arrangements were eventually made through the County Council and the Asylums Board, whereby accommodation for 300 males was provided at the Downs School, Sutton, and for 100 female patients and 100 observation and educational cases at the Northern Hospital, Winchmore Hill. At present the Council are retaining their beds at Maitland for uninsured persons, any vacancies which cannot be filled up being placed at the disposal of the Insurance Committee. Schemes are under consideration by the County Council whereby treatment in institutions may be available for uninsured as well as insured persons, but no decision has yet been arrived at. "Dispensary" Treatment.—This name has been given to the scheme whereby out-patient treatment is afforded to consumptives, together with opportunities for the examination of contacts, &c. It includes the regular visiting of patients, after care on return from hospital and sanatorium, the distribution of information, the keeping of records, &c. These methods have been carried out in Westminster for some years with the voluntary assistance of the local hospitals and the Health Society. The Council has under consideration a scheme for continuing the arrangement, bringing it into line with new requirements, and for strengthening the staff by the appointment of an additional visitor for tuberculous patients. Bacteriological Examination of Sputum.—One hundred and thirty-two examinations were made of sputum, from 129 patients, to ascertain if the tubercle bacillus was present; it was found in 39 instances. Disinfection.—Three hundred and fifty-seven rooms in 271 housis and 6,602 articles were disinfected or destroyed by the Council's staif, after death, or on removal of patients from one house to another or to hospital. In 37 cases, disinfection (or thorough cleaning and re-decoration of rooms) was carried out privately. Deaths.—The deaths for 1912 and for the preceding eleven yea s are set forth in the following table:— 45 The City of Westminster. Year. Pulmonary. Abdominal. Meningeal. Other. Total. Deaths. Rates. Deaths. Rates. Deaths. Rates. Deaths. Rates. Deaths. Rates. 1901 341 187 16 10 31 16 25 12 413 226 1902 328 182 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 1912 183 116 8 5 17 10 14 8 222 140 These rates are calculated per 100,000 inhabitants, and corrected by the last census. Of the 183 persons who died, 144 had been notified during life. There remain 39 deaths of persons whose illness did not come to the knowledge of the Public Health Department. The deaths of 40 homeless or common lodging-house inmates are included. Sixty of the deaths occurred at home, 31 in hospitals, 84 in infirmaries, 5 in asylums, 2 in sanatoriums, and 1 in prison. There has been a decrease in recent years in the number of deaths from tuberculosis affecting other parts of the body than the lungs, probably due to the steps which have been taken to prevent tuberculous milk coming into London, but without bacteriological examination in each case it is impossible to say how much tuberculosis is due to bovine and how much to human infection. Recent investigations* have shown that about 80 per cent. of the tuberculosis of bones and joints in children under 3 is due to infection by the bovine bacillus, between that age and 12 years the proportion is less—about 50 per cent. In 21 instances in 70 investigated there was a definite history of pulmonary tuberculosis having occurred in some member of the family in which they lived, and in 50 per cent, of these cases the child was actually living in contact with a consumptive. Out of these 21 cases, 15 were due to the bacillus of human tuberculosis, whereas in 52 cases in which it was definitely stated that there was no family history of tubercle, 43 were bovine in origin. Investigations on similar lines are required to decide the relative degree of infection in forms of the disease other than that of bones and joints. With the notification of all manifestations of tubercle, opportunity will be afforded of ascertaining the extent to which tubercle infection occurs especially in those forms—such as * Royal College of Physicians' Laboratory, Edinburgh, Dr. John Fraser. 46 spinal disease—which do not contribute to the death-rate to such an extent as lung affection, but which entail longer suffering and disablement. Diarrhœa.—There were 1,371 deaths from diarrhoea and enteritis in children under 2 yeai-s of age in London. In 1911, the deaths from these causes were 5,313. In Westminster, the number was 37, 30 being under 2 years of age (57 at this age in 1911). Comparison with former years is made below:— Westminster. 1903. 1904. 1905. 1906. 1907. Epidemic diarrhœa 59 80 47 75 27 Other forms of enteritis 14 16 17 20 19 Total deaths 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. 1912. Epidemic diarrhœa 24 10 9 47 9 Other forms of enteritis 23 23 32 47 28 Total deaths 47 33 41 74 37 N umber under 1 year of age 33 27 26 49 27 Number of births 2,913 2,751 2,592 2,361 2,349 Deaths of infants per 1,000 births 11.4 9.2 10.0 20.7 11.4 The decrease was in the acute or infective form, which occurs in the hot weather, but the dates of the cases this year bear little relation thereto, as the deaths of 8 of the children under 5 occurred in the spring and winter months. Enquiry was made with regard to the infant deaths. Three were of illegitimate children, 8 had been delicate from birth, 3 being premature. Only 2 infants had been entirely breast-fed, and 7 had been suckled at first for a week or two. In 8 instances the mothers were out at work during the day, 1 mother died, 1 became insane, 1 is an habitual drunkard, and 1 was homeless; consequently, the children did not receive the necessary care. Nine died in hospital and 4 in the infirmary, 2 having been born and remained there all the time. In 4 instances, the general cleanliness of the home was found to be poor. Had greater care been taken in certifying the actual cause of death, the illness would probably have been attributed to tuberculosis in 5 cases, to syphilis in 2, and to rickets in 3. Cold and dampness, 47 improper feeding, and defective powers of digestion accounted for the remainder. Measles.—This complaint was below the average in London until the last quarter of the year. In Westminster, the number of cases notified was 488, 150 and 165 being in the first and last quarters. The greatest mortality was in the second quarter. There were 36 deaths, all but 3 being of children under 5 years of age; 24 of the deaths occurred in St. John's Ward. The death rate for the County was 0.40 per 1,000 of population, and for the City 0.22, the average rates for the preceding five years beiug 0.45 and 0.14 respectively. The schools affected are shown below: Millbank, with 92; St. Mary, Hide Place, with 51 cases, being the most seriously invaded. An outbreak in one school appeared to be due to infection being communicated to children attending the out-patient department of a hospital. Fifty-five children were removed to the Metropolitan Asylums Board's Hospitals for treatment Seven hundred 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 138 rooms in 133 houses, and of 1,093 articles, was carried out by the Council's staff. Whooping-Cough.—One hundred and ninety cases were notified, 45 in the first quarter, 91 in the second, 35 in the third, and 19 in the last (for particulars as to schools see list below). There were 17 deaths in the City of all children under five years of age. The death rate was less than the average both in the County and Westminster. Nine cases were removed for treatment by the Asylums Board. Children suffering from whooping-cough are also visited by the women inspectors. Schools and Infectious Disease. School teachers are required to notify the Medical Officer of Health when they exclude children on account of infectious disease. The following list shows how far this was carried out and the nature of the cases notified:— 48 School. Actual Cases. Infection in House. Other Causes. Chickenpox. Measles. Mumps. Whoopingcough. Chickenpox. Measles. Mumps. Whoopingcough. Buckingham Gate 4 17 6 1 1 5 2 - 6 ringworm. Charing Cross Road — 1 — 11 — — 1 3 ringworm. Horseferry Road 8 43 21 — 4 8 37 — — 6 ringworm. Millbank 92 1 18 13 35 — 2 17 ringworm. Pulteney 3 4 — 5 1 11 — 2 2 ringworm. St. George's Row 10 31 3 24 4 19 — 2 3 ringworm. Wild Street 1 6 6 2 1 3 — 2 5 ringworm. Brompton Higher Grade — — 3 1 — — — 1 Burdett Coutts 42 16 5 10 6 6 — — 8 ringworm. Cathedral, Great Peter Street — 2 — — — 1 — — Christ Church 3 3 — — 1 1 - — Holy Trinity 13 29 - - 6 28 - 1 5 ringworm. 1 eczema St. Anne's 5 14 1 4 — 5 - 1 7 ringworm. St. Anselm's 1 — 1 — 1 — — — 1 ringworm. St. Barnabas 15 48 6 5 5 11 1 — 8 ringworm. St. Clement Danes — — 1 2 — — — — 2 ringworm. St. Edward's, Dufour's Place — — — — — — — St. Gabriel's 31 23 3 15 20 13 3 10 9 ringworm. St. George's, South Street 37 — 1 8 17 10 — — 3 ringworm. St. James the Less 16 25 2 21 13 23 - 8 5 ringworm. 1 scabies. St. James' and St. Peter's 3 10 — 10 1 — — — 2 ringworm. St. Margaret's 17 22 — 2 11 5 — — St. Martin's, Adelaide Place 1 — 24 - - - - - St. Martin's, Castle Street 4 - - - - - - - 17 ringworm. St. Mary's, Hide Place 4 51 — 31 4 20 — 1 St. Matthew's 24 13 - - 17 21 1 - 8 ringworm, 1 scabies. St. Michael's 1 23 - 6 2 3 - 2 5 ringworm. 3 scabies. St. Paul's 23 — 1 7 8 — 1 — 6 ringworm. St. Peter's, Lower Belgrave Place 1 14 — — — 3 — — 4 ringworm. Wesleyan Training 8 3 - - 7 14 - 2 318 468 64 187 147 274 8 35 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 338 notifications were sent out during 1912 to school teachers as follows:— School. Small Pox. Scarlet Fever. Diphtheria. Enteric Fever. Buckingham Grate — Charing Cross Road — — — — Horseferry Road — 1 — — Millbank — 15 7 — Pulteney — 2 6 — St. George's Row — 4 2 — Wild Street — 3 4 — Brompton Higher Grade — 4 4 — Burdett Coutts — 5 — — Cathedral, 48, Great Peter Street — 1 — — Christ Church — 4 — — Curzon — 1 1 — French Protestant — — 2 — Grey Coat — 2 — — Holy Trinity — 1 2 — St. Anne's — 7 3 — St. Anselm's — 2 2 — 49 School. Small Pox. Scarlet Fever. Diphtheria. Enteric Fever. St. Barnabas - - - - St. Clement Danes 2 1 St. Edward's, Dufour's Place — 1 2 St. Gabriel's — 2 1 — St. George's, South Street St. James's and St. Peter's — 1 4 — — 3 1 — St. James the Less.. - 5 — St. Margaret's — 4 — — St. Martin's, Adelaide Place — 10 — — St. Martin's, Castle Street — 1 1 — St. Mark's, Hide Place — 4 2 — St. Matthew's — 8 1 — St. Michael's 2 2 St. Patrick's — — __ St. Paul's, Caroline Street — _ St. Paul's, Wilton Place - — — — St. Peter's, Lower Belgrave Street — 4 2 — St. Vincent's — 1 1 — Weslevan Training College — 3 — — Four rooms in two schools were disinfected, together with 151 books and other articles. As to the arrangements for dealing with children affected with vermin, see below under "disinfection." One thousand and seventy-one school children suffering from various non-infectious complaints were visited for the Care Committees and Hospital Almoners, by the Health Visitors. Bacteriological Laboratory. During the year 306 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; 1911, 240. Disease. Persons. Examinations. Results. Positive. Negative. Doubtful. Suspected cases 146 150 19 130 1 Contacts or school children 10 10 — 10 — Returned from hospital 1 1 — 1 — 157 161 19 141 1 Typhoid Fever 11 11 2 8 1 Tuberculosis 129 132 39 93 — Ophthalmia Neonatorum 2 2 2 50 In 1911, there were 126 examinations for diphtheria and 77 for tubercle. The examination in the cases of ophthalmia was for the presence of the gonococcus. The. bacillus xerosis was found in one case. 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 4 rooms in 2 schools: 7 vehicles were also disinfected. Tn 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 35 instances, when the circumstances of the case required it), and also after 124 cases of measles, 4 chicken-pox, 21 cancer, 10 influenza, 7 whooping cough, and 271 phthisis. In 46 instances the premises, &c., were disinfected privatelv (37 of these being cases of phthisis). The following table gives a comparative statement of the above work during the past seven years:— 1906. 1907. 1908. 1909. 1910. 1911. 1912. Premises 961 840 1,067 1,287 841 979 1,020 Rooms 1,627 1,455 1,568 1,865 1,284 1,449 1,346 Articles disinfected 47,865 36,115 31,915 49,843 26,850 26,264 34.178 Articles washed — — — — 514 782 4999 Articles destroyed 195 I,660 233 186 1,651 496 699 Books disinfected 363 136 557 281 595 266 315 Number of persons admitted to shelters 1 5 5 6 1 — — Cleansing of Persons.—The Guardians deal with the frequenters of their casual wards, and at certain of the common lodging houses facilities are provided for the inmates; 48 adults had baths at the station, and 635 articles of clothin" were cleansed of vermin. An arrangement with the County Council for the cleansing of school children came into force in 1912, and 464 children attended 783 times for this purpose. The children attend from other Boroughs as well as from Westminster ; the numbers were:— No. of Children. No. of Attendances. Articles of Clothing Disinfected or Washed. Westminster 151 245 2,183 Chelsea 124 180 1,629 Lambeth 39 86 711 Battersea 143 262 2,182 Wandsworth 4 10 78 464 783 6,783 51 It is essential that at the same time that the children are treated at the station that their bedding should also be stoved, so as to destroy any vermin in it, and for this purpose 2,563 articles were removed from dwellings in Westminster. A proportion of the children require attention twice or three times, but 18 had to attend four times, 1 five times, 5 six times, 2 ten times, and 1 eleven times. Thirty-three children had their head only affected, 179 the body only, and 24 had both head and body lice, 11 had fleas only, but 127 were infested with fleas as well as lice. In 50 of the Westminster houses visited on account of these conditions in the children, bugs were also found. Verminous Houses.—In addition to the school cases, 232 notices were served by the Sanitary Inspectors with reference to vermin in houses; 33 of these were fumigated with sulphur by the Council's staff, the remainder being dealt with by the owners. From these houses 1,597 articles were stoved, 290 washed, and 345 destroyed on account of their verminous condition. The total number of articles of clothing, bedding, &c., dealt with at the station on account of vermin was 14,463, of which 2,540 articles were washed and 345 destroyed. In addition, 80 articles were fumigated on account of itch and 85 on account of ringworm. In dealing with verminous conditions, 324 visits (of which 279 were in connection with school children) were paid by the Disinfecting Superintendent. Eight notices were served at the instance of the Sanitary Inspectors, with reference to bedding, &c., in a filthy condition. (General Powers Act, 1904, Section 19 (1.)). The Bug Flock Act, 1911.—The Local Government Board issued an Order prescribing under Section 1 (1) of the Bag Flock Act, 1911, a standard of cleanliness in rag flock. The Order became operative on July 1st, 1912. By this Act flock is deemed to conform to the needful standard of cleanliness when the amount of soluble chlorine removed by thorough washing with distilled water at a temperature not exceeding 25° C. from not less than 40 grammes of a well-mixed sample of flock does not exceed 30 parts of chlorine in 100,000 parts of the flock. Subsection (1) of Section 1 of the Act enacts that "it shall not be lawful for any person to sell or have in his possession for sale flock manufactured from rags, or to use for the purpose of making any article of upholstery, cushions, or bedding flock manufactured from rags, or to have in his possession flock manufactured from rags intended to be used for any such purpose, unless the flock conforms to such standard of cleanliness as may be prescribed by regulations to be made by the Local Government Board, and if any person sells or uses or has in his possession flock in contravention of the Act he shall be liable on E 2 52 summary conviction, to a fine not exceeding, in the case of a first offence, ten pounds, or, in the case of a second or subsequent offence, fifty pounds." Samples have been taken but had not been reported upon at the end of the year. Mortuaries. The number of bodies removed to the Council's mortuaries under order of the Coroner, or to await burial, was 324; in 6 instances death was the result of infectious disease. Inquests were held at Horseferry Road, where the Coroner's Court is situated, in 284 cases, and there were 2 adjourned inquests. Postmortem examinations were made in 105 instances at Horseferry lioad. Traffic accidents were the cause of 42 inquests. The number of dead bodies taken to the mortuaries for purposes of inquest and to await burial during the last twelve 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 315 283 61 1912 324 281 40 Of the 40 bodies admitted to await burial, 39 were taken to Horseferry Road, and 1 to Drury Lane resting place. The number of bodies taken in at Horseferry Road since 1901 has been:— Year. Bodies. Year. Bodies. Year. Bodies. 1901 391 1905 344 1909 285 1902 371 1906 332 1910 322 1903 371 1907 341 1911 360 1904 365 1908 348 1912 323 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:— 1912. Complaints received and dealt with 766 Premises inspected on complaint, &c 785 House to house inspection 5,165 Subsequent visits 21,678 Premises (registered), visits to 5,555 Overcrowding found 73 Other infringements 1,032 Sanitary Work completed:— Houses:— Cleansed throughout 614 „ partially 1,032 Overcrowding abated—rooms 137 Light or ventilation improved 225 Roofs repaired 430 Floors and staircases repaired 366 Underground rooms— Illegal use 38 Closed 27 Yards, areas, paved or repaired 419 Damp walls remedied 174 Offensive refuse removed 283 Keeping of animals discontinued 17 Verminous prenvses cleansed 232 Drains:— Constructed 301 Amended and repaired 294 Ventilated 230 Unstopped and cleansed 175 Interceptor traps fixed 203 Cleansed and sealed off from sewer 105 Gully traps fixed 1,044 Defective traps abolished 261 Manholes built 602 „ repaired and cleansed 265 „ covers fixed or repaired 779 1912. Sanitary Work completed :— Drains:— Tested by smoke 227 ,, chemical. 342 „ water 703 „ air 1ll Fresh air inlets fixed or repaired 321 Soil Pipes:— Fixed 365 Ventilated 310 Repaired 192 Tested by smoke 256 chemical 204 „ air 121 Water-closets:— Constructed 1,181 Repaired 928 Ventilated and light improved 401 Cleansed or limewashed 920 V entilated lobbies vided 392 Unstopped 176 Traps ventilated 898 Flushing cisterns fixed 1,091 „ „ repaired 456 Waste Pipes:— Constructed. 1,442 Repaired 358 Unstopped 152 Trapped 1,561 Ventilated 978 Disconnected 336 Rainwater Pipes:— Fixed or repaired 703 Disconnected from drains 195 Urinals:— Constructed. 151 Repaired or improved 43 Cleansed 65 54 1912. Sanitary Work completed: — Water Supply:— Provided 743 ,, additional in tenement houses 21 Cut off 58 Reinstated 26 Cisterns fixed 148 „ cleansed 252 „ covered 242 Cisterns defective,abolished 90 Taps off main provided 756 Pipes repaired 231 1912. Sanitary Work completed: — Dust Bins:— Movable, provided 237 „ repaired 20 Fixed, abolished 23 Stables: — Drained 38 Paved 34 Cleansed 78 Dung receptacles provided 24 Dung accumulations removed 73 2,784 intimations of nuisances, &c., and 114 statutory notices (including 8 for smoke nuisances) were issued; 2,314 letters were written, and 1,932 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. 36, Marshall Street Illegal occupation of underground rooms Fined 49s. and 2s. 6d. costs. 3, Lowndes Court As the defendant months later the magist Insufficient water supply n this case had apparently made rate sentenced him to 21 days hare Fined £3 including costs, no effort to pay the fine, two labour in the second division. 13, Aylesford Street Absence of proper flush to w.c.; obstructed waste pipe and sink; dirly and verminous rooms; overcrowding of three tenements Order to abate; 27s. costs. 14, Livonia Street w.c. obstructed; areas littered with garbage; walls of areas dirty; dirty walls and ceilings of rooms The work having been completed before the hearing, the defendant was ordered to pay 33s. costs. 41 and 43, Wardour Street Overcrowding workrooms Prohibition Order and £3 3s. costs. 14, New Bond Street Failing to provide suitable w.c. accommodation at workshop The work having been carried out between the service of the summons and the hearing, the summor s was withdrawn, defendant paying £2 2s. costs. 132, Wilton Road (a) Constructing w.c. without cistern Nuisance remedied; to pay 25s. costs. (6) Failing to comply with Statutory Notice requiring provision of water to w.c. 61, York Street Insufficient supply of water to house Abatement Order within 14 days; to pay 6s. costs. 7, Kinnerton Street Dirty walls and ceilings; defective freslh air inlet to drain Nuisance abated after service of summons ; to pay 24s. costs. Two persons were summoned one for refusal to admit and the other for obstructing the Sanitary Inspector at 17, Pulford Street, the former was fined 5s. and 2s. costs, the latter 10s. and 2s. costs. 55 Plans.—661 sets of plans were examined during 1912. 91 were plans of new buildings, the drainage of which came under the supervision of the Public Health Department, consequent on the re-arrangement of duties mentioned in my report for 1911. Failure to send in plans occurred in 30 instances. Infringement of the By-laws in connection with the erection of buildings occurred in 16 instances. Proceedings against one firm offending on two occasions were taken for altering or reconstructing drains without depositing plans, and fines were imposed of 20s. and 2s. costs in the first case and £2 and 23s. costs in the second. 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 604 instances the services of the two drain-testers attached to the Department were requisitioned. Deep Basements.—There is a growing tendency for owners to obtain additional accommodation by the formation of deeper basements than was formerly the case. In a number of instances such basements are lower than the level of the sewers, so that it is impossible to drain them by gravitation. Appeals to the London County Council in former years have resulted in these basements being allowed subject to the following conditions:—(a) That details of the proposed system of drainage be carried out to the satisfaction of the City Council; (b) that the whole of the site be rendered watertight with mastic asphalte to the satisfaction of the City Council; (c) that a "Shone" or other suitable ejector be provided in duplicate and that plans and details of such ejectors and of the rainwater drainage be submitted to and approved by the City Council; (d) that the owners do give a written undertaking to the City Council to close the basement wholly or in part if the drainage thereof is at any time declared by the City Council to be unsatisfactory after reasonable opportunity of remedying defects has been given to the owners; and (e) that the owners of the premises do give an undertaking to the City Council that in the event of the construction by the City Council of a sewer into which the premises could be drained by gravitation, the owners will at their own expense carry out such alterations as will enable the buildings to be so drained by gravitation into such sewer. In three instances during the past year appeals have been taken, with the result that the Appeal Committee gave decisions on the terms stated above. 56 Unless the pumping arrangement is automatic in action, nuisance is apt to arise, as in one case in which a large quantity of fluid was pumped into the sewer at a time, causing thereby a considerable escape of effluvium from the ventilating grids in the roadway. This has been remedied by— (a) Pumping at night when the sewer is practically empty, so as to avoid creating pressure of gas ; (b) Lengthening the suction pipes of the pumps so as to reach the bottom of the tank, and grading the bottom of the tank to obtain scouring action, ensuring that when the pumping ceases no liquid is left in the tank to become offensive; and (c) Adding chemicals at frequent intervals. Intercepting Traps to Drains.—A Departmental Committee was appointed by the Local Government Board in 1908, to inquire as to the usefulness or the reverse of intercepting traps to house drains. The committee has now issued a report, from which it appears that complaints which have been made, have been due in great measure to the use of unsuitable forms, and to want of supervision in securing that such traps are properly fixed, which they admit is by no means a simple proceeding. (In Westminster, the Sanitary Inspectors examine every intercepting trap when it is being put in, with the result that subsequent obstruction in the trap is of very rare occurrence.) The Committee think that under certain circumstances the use of this trap need not be insisted upon, but the requirements considered necessary to compensate for its absence would raise the cost of a drainage scheme for a house by 10 to 20 per cent. Iron drains with lead joints would be essential, and as both sewer and drain would be ventilated through the soil pipe, very great care would have to be exercised to keep the vent pipes away from windows, chimneys, &c. The Committee suggest that the intercepting trap is susceptible of improvement as to size and shape (the trap should be 1 inch less in diameter than the drain discharging into it), the open channel drain on the floor of the inspection chamber should be abolished, and a closed drain provided, with a screwed-down removable cover; the fresh air inlet may frequently be dispensed with without practical disadvantage. It had been contended by some engineers that if intercepting traps were done away with, sewers would be better ventilated by means ot the soil pipes of each house. The Committee is of opinion that the necessity for ventilation of sewers has been exaggerated, and that free ventilation is unnecessary and impracticable. It is pointed out that in all cases before men enter the sewers special precautions should be taken, and that it is dangerous to rely for safety on ventilation. The prevention of nuisance from smell renders it necessary that any openings 57 which may be deemed to be requisite for the ventilation of the sewers should not be at the ground level. The final conclusions of the Committee is that as circumstances vary in different localities, the question whether the intercepting trap is or is not required, is one which must be considered and determined by local authorities and their advisors in the light of local conditions. 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 one prosecution was ordered, but the summons was unable to be served on account of the illness of the defendant. A summons is not taken out unless the person offending has been previously cautioned. Housing Conditions. Sanitary Survey of Houses.—Special reports have been made of the condition of houses in the following streets and courts:—Montpelier Row, Rutland Street, Rutland Yard, Ann's Place, Cheval Place, Kinnerton Place North and South, Frederick Mews, Grosvenor Cottages, Chadwick Street, St. James' Residences, Goodwin's Court, Clayton's Yard. A number of defects were discovered and remedied, notices being served under the Public Health Act. Four houses unfit for habitation were closed voluntarily by the owners. Seventeen houses were inspected under Section 17 of the Housing Acts, and representations as to unfitness for habitation were made in respect of 13, 9 of which were closed and pulled down in consequence of orders made by the City Council. Eight houses with respect to which demolition orders were made in 1911 were pulled down in 1912. The housesin Wellington Mews, which were reported upon previously, have been converted into garages and workshops. Re-building is continuing in the streets around Smith's Square, in St. John's Ward, and some existing houses hitherto let as tenements are being converted to their original use as houses for one family. Thirty-seven houses (4 in Air Street, 7 in Brewer Street, 13 in Sherwood Street, and 13 in Glasshouse Street) have been demolished, and a large hotel is being erected on the site. The premises were largely used for business purposes, but there were also a number of residents. The London County Council have been making an enquiry as to the onditions under which it becomes essential for persons of the working lasses to live in proximity to their work, and have been collecting 58 statistics in four areas, one being in Westminster, and comprising the streets between Page Street, Horseferry Road, Great Peter Street, and Tufton Street. The occupations of the inhabitants in the Westminster area were found to be:— Men.—Labourers, Carmen, Porters, Costermongers and Hawkers, Shop Assistants, Clerks and Waiters. Women.—Office Cleaners, Charwomen, Dressmakers, Tailoresses and Laundresses. Locality of employment.—There were 416 wage-earners; 318 of these were employed in Westminster, 10 in other central districts, 37 in other districts, and 41 no fixed place, or not ascertained. By far the larger proportion are employed either in the immediate vicinity of where they reside or in the-neighbourhood of Charing Cros3 or Piccadilly. 164 are stated to be persons who are obliged to live in the locality or near their work. This is principally due to the large number of costermongers, office cleaners and charwomen who live in the neighbourhood. The average weekly rental is shown below, compared with a block of the County Council's Dwellings in Millbank:— Size of Tenement. Number of Tenements. Average Weekly Rent. Size of Tenement. Number of Tenements. Average Weekly Rent. Westminster area— 8. d. L.C.C. block dwellings— s. d. 1 room tenement 96 3 11 1 room tenement — 2 69 6 6½ 2 30 6 7 3 21 8 1½ 3 30 9 2 4 9 10 l¼ 5 1 11 6 6 2 13 0 Underground Booms.—38 rooms were found to be illegally occupied and their use given up. Closing orders were made under the Housing Acts in four instances, the others were dealt with under the Public Health Act. Legal proceedings were taken in one case. Houses Let in Lodgings.—The number of houses in 1912 was further reduced through closure, and as none were added in that year, the number on the register at the end of the year was 1,345; to this class of house 5,555 visits are recorded as having been paid. In addition to the Inspectors' visits, a large number of these houses are visited by the Health Visitors, who call attention to any insanitary conditions requiring amendment. The disinfectors also visit a number in the course of the year where children have been found to be suffering from vermin. Overcrowding was found in 73 instances, and 1,032 other defects wera 59 found and remedied. Particulars are included in the general list given at the beginning of this part of the Report. Sixty statutory notices had to be issued before defects were remedied, and in four instances proceedings had to be taken in the Police Court (see above). Two persons were fined for obstructing the Inspector, and preventing her inspecting certain premises. The Local Government Board (17th October, 1912), confirmed a new set of By-laws with respect to houses let as lodgings or occupied by members of more than one family. They are substantially the same as those previously in force, certain definitions being altered. A new By-law was added by the Council to the effect that persons of different sex, above the age of 12 years, not being persons living together as husband and wife, shall not occupy the same sleeping apartment. Water Supply. Fifty-eight notices of withdrawal of water supply were received from the Metropolitan Water Board, and in 26 instances it was reinstated, on notice. The reasons given for cutting off the supply were: houses empty, 21; non-payment of rates, 24; by request, 12; leakage, 1. There has been a considerable decrease in the number of cutting-off notices in 1912, as compared with previous years. Additional sources of water supply on the upper floors of tenement houses were provided in 21 instances. Legal proceedings in connection with water supply were taken in two instances. Owners are recommended in all cases to fit a proper sink in connection with the new supply on upper floors and so prevent risk of walls and ceilings being spoiled. In a large factory, Thames water is used for Hushing sanitary conveniences and for supplying lavatory basins. The ordinary supply was laid on for drinking purposes, but it was found that some of the employes, being unaware that there were two sources of supply, had been drinking the water drawn from taps over the lavatory basins. The attention of the firm was drawn to this, and they agreed to the suggestion to put up tablets over the various taps indicating which should be used to obtain water for drinking or cooking, and which should not be so used. Several new artesian wells have been sunk during the past year. An analysis of the water has been obtained in each case. The quality of the water closely resembles analyses of other wells in the City given in previous Reports. The Geological Survey have recently issued a "Record of London Wells," in which they give examples showing the great fall which has occurred in the underground water-levels. Some of these are of interest to citizens of Westminster:— The fountains at Trafalgar Square are, or were, supplied by three 60 wells, sunk close to the National Gallery. These wells once served not only the fountains, but also most of the public buildings in Whitehall, Millbank Prison, and the Houses of Parliament. They were completed in 1847, when the water-level had fallen to 78 ft. below sea-level, but the yield still amounted to 580,000 gallons a day. The water-level steadily fell. First the supply to the Government offices ceased. Millbank was demolished. Later the supply to the Houses of Parliament stopped, and now only one of the fountains carries a supply, yielding 8,000 gallons an hour, and the water-level has fallen to 195 ft. below sea-level, or more than 115 ft. in 64 years. The fountains at the head of the Serpentine are also supplied from a deep well, which was sunk in 1864. The water-level then was 45 ft. below sea-level. It has now diminished to 138 ft., and the yield is only 1,480 gallons an hour. A deep well near Piccadilly Circus, in contrast with one at Oxford Circus, indicates that at the former site the top of the chalk is 193 ft. below sea-level; at the latter 84 ft. below sea-level. There is, however, very little difference in the water-level, though there is more than 100 ft. difference in the level of the top of the chalk. Revenue Act. Certificates under this Act relieve the recipient from the payment of Inhabited House Duty. Applications were received by me in 7 instances comprising 23 tenements. Certificates were refused for twelve tenements. The premises in which are situated the tenements for which certificates were granted are:— Chertsey Chambers, Mercer Street. Park Mansions, Knightsbridge. 3 and 4, King Street, Covent Garden. 26, Orange Street. Smoke Prevention. The following is a summary of the work done in connection with smoke prevention:— 1912. Total. Complaints received 43 Observations taken 1.722 Notices issued— Preliminary 142 Statutory 8 Summonses — There was more occasion to complain of smoke in 1912 than has been the case in the last five years due probably in some measure to 61 the strike of coal miners, but as usual there was careless stoking and occasionally burning of articles like wet sawdust, rags and hospital dressings in the furnaces. The premises causing this class of nuisance included:— Hotels and restaurants 25 Bakers 4 Motor works 1 Government buildings 2 Clubs 14 Brewery 1 Private houses 6 Hospitals 3 Printer 1 Electric Light works 1 Theatre 1 Various 8 Most of these were seen offending once only, but several had more than one notice, the maximum being seven. Statutory notices were served in respect of 8 premises, in 6 of them notices were served on the stoker as well as on the occupier. In three cases complaint was made of smoke entering rooms from adjoining chimneys, due to the chimney being too low. Notices were served with reference to smoke being emitted from 3 travelling engines, 2 crane engines, a stove for boiling tar, and a pail in the street, in which paving repairers were burning material, causing offensive smoke. Two notices were also served with respect to chimneys outside Westminster from which black smoke was blowing into the City, and the attention of the Port Sanitary Authority was called to a number of vessels emitting smoke on the Thames. Offensive Smells.—Complaints were received in a number of instances of offensive smells entering premises. It is not always easy to discover the source of such smells, for example, complaints were received from residents in several streets in Mayfair of a sulphurous smell which invaded the houses ; it was only after a careful examination of the neighbourhood, extending over two weeks, that the source was discovered in a club, and that it was due to the steam exhaust being taken into the chimney shaft at a wrong point. In another case, smells were caused by the improper use of the forced draught in a patent smoke preventing apparatus. In other cases, offensive smells were due to the burning of the rubber of dental fixtures in a gold refining establishment, to the damping of clinkers, to inlet ventilators being fixed in improper positions, such as close to outlet shafts from kitchens or lavatories, to gullies taking sink waste pipes, to exhaust shafts from kitchens, poulterers' shops, &c., discharging near windows. Serious complaint was made of large quantities of grit and fine ash falling on premises in the neighbourhood of a large shaft; this was eventually remedied by building a brick baffler in the flue, and by frequent removal of the ash from the base of the chimney shaft. 62 Soot.—The Coal Smoke Abatement Society published in the Lancet for January 6th, 1912, a report of their records of the soot which fell during twelve months in London. Two of the observation stations were in Westminster, one in Buckingham Gate, the other in Horseferry Road. The total deposit on an area of 4 square feet at the former was 71.9 grammes, at the latter 60.3 grammes, compared with 27'8 grammes at a station at Sutton. If the fall of soot were at the same rate over all London as at the Westminster stations, it would equal 53,820 tons in the year. This would contain 4,000 tons of ammonia, 5,000 tons of sulphur, reckoned as sulphates, and 4.000 tons of chlorine in chlorides. These are due chiefly to the faulty combustion of coal in domestic fires. The presence of so much ammonia renders the rain neutral, or even slightly alkaline, which probably encourages rather than discourages the disintegration of building fabrics, since insoluble lime compounds—e.g., calcium carbonate — readily yield ammonium carbonate and soluble calcium sulphate, and ammonium carbonate attacks silica. Free sulphuric acid would also attack lime compounds, but would not affect the silica appreciably. The amount of insoluble deposit (soot, &c.), varies from 1/3 to ½ of the total deposit in London Fogs.—There has been a steady decrease in the number and density of fogs in London in the last 25 years. In a series of years before 1884, fog was recorded on an average of 30 days in each year; in the last ten years the average has fallen to 10 days, due to the efforts made to abate the 6moke nuisance, and to the increasing use of gas and electricity for heating. 63 D. WORKSHOPS, Ac. 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 1912:— Work Premises. Total Number. N umber in which Women are Employed. Tailors, outfitters, shirt makers, hat, cap, and helmet makers 1,291 1,179 Dressmakers, milliners, embroiderers, lace makers, blouse makers, costumiers, lingerie makers, children's outfit makers, feather dyeing, corset makers, furriers, &c. 801 801 Leather workers, boot and shoe makers, harness makers, &c. 31 24 Carpentry, upholstery, carvers, gilders, &c. . 20 16 Surgical and dental instrument makers 12 11 Tobacco manufacturers 24 24 Wiff makers and hair workers 46 46 Printing, bookbinding, lithographers, envelope making, stationers, publishers, &c. 41 32 Jewellers, silversmiths and burnishers, diamond cutters and polishers, engravers, &c. 174 34 Metalworkers 145 — Miscellaneous—Basket making, fancy work, shoe ornaments, hat pins, stamp sorters, postcard tinters, fan makers, artificial flower makers, &c. 116 61 Florists 34 34 Laundries 42 42 Bakehouses 85 — Photographers 22 22 Jewel case makers 12 10 New workshops are always being discovered, at the same time the occupation of premises on the register is constantly changing. The use of 337 registered workshops was discontinued and 430 additions were made to the register during the year; 132 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 eighty.three complaints were received, including 91 from the Home Office, and were duly investigated; three matters were referred to the Home Office relating to insufficient 64 warming of rooms, and in addition, notice was sent of 124 workshops in which Abstracts were not affixed. Statutory notices were issued in 27 instances; three prosecutions took place in connection with premises in which work was carried on, as shown above, under the heading of " House Inspection." Inspection. Premises. Number of Inspections. Re. Inspections Defects Found. Intimation Notices. Statutory Notices. Prosecutions. Factories 67 74 49 26 . . Workshops 2,784 4,086 2,210 608 23 2 Workplaces (Including restaurant kitchens, &c.) 2,491 3,231 352 330 4 1 Total 5,342 7,391 2,611 964 27 3 Defects found.—1912. Particulars. Number of Defects. Number of Prosecutions Found. Remedied. Nuisances under the Public Health Acts :— Want of cleanliness 880 880 — Want of ventilation 146 146 — Want of ventilation of gas stoves 61 61 — Overcrowding 63 63 1 Want of drainage of floors 16 16 — Sanitary accommodation— Insufficient 64 64 1 Unsuitable 98 98 — 394 394 — Not separate for sexes 114 114 1 Other defects 775 775 — Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouses — — — Breach of special sanitary requirements for 4 4 — bakehouses Other offences — — — Total 2,615 2,615 3 65 Other Matters. Class. Number. Matters notified to H.M. Inspector of Factories :— Failure to affix Abstract of the Factory and Workshop Act 124 Action taken in matters referred by H.M. Inspectors as remediable under the Public Health Acts but not under the Factory and Workshop Act— Notified by H.M. Inspector 91 Reports (of action taken) sent to H.M. Inspectors 91 Other 3 Workrooms measured 297 Underground bakehouses— Certificates granted during the year — refused ,, — In use at the end of the year 68 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. Forty notices were sent to employers for failing to send in lists, but no prosecutions were undertaken; in addition 318 visits of enquiry to ascertain if outworkers were employed were made by the women inspectors. The accompanying table gives the details ot the returns made in Westminster in 1912. 695 lists, containing 9,221 names and addresses, were sent in by employers; 4,663 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; 443 addresses were received of persons in Westminster taking in work from other boroughs. They were distributed thus:— 66 Council. Sent from Westminster. Received by Westminster. Council. Sent from Westminster. Received by Westminster. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Acton 15 15 . . Islington 68 85 2 3 Barnes 3 3 . — Kenley 1 — — — Barnet — 1 — Kensington.. 45 57 44 30 Battersea 69 79 1 — Kingston.on.Thames 1 1 . — Beckenham 2 — . — Lambeth 92 92 2 — Bedfont 1 1 . — Langley 1 1 — — Bedford 1 1 . — Lewisham 11 14 2 2 Bermondsey 7 3 . — Leyton 9 7 — — Betch worth 1 — . — London, City 18 16 32 33 Bethnal Green 14 11 . — Luton 3 2 . . Billingshurst 1 1 . — Merton 2 1 . — Brighton . — 1 . — Molesey 1 1 . — Broadstairs 1 1 . — Newbury 1 1 . — Camberwell 40 38 1 — New Maiden 1 1 . . Cambridge 1 1 . — Newquay — 1 . — Charlton Kings 1 1 . — Northampton 5 7 . — Chelsea 9 13 38 39 Northleigh .1 — . . Chichester 1 — — — Paddington.. 96 84 12 4 Chiswick 4 4 — — Penge 1 5 — — Croydon 6 10 — — Perth 1 1 — — Deptford 4 5 — — Ponder's End 1 — — — Ealing 6 8 — — Poplar 4 6 — — East Ham 1 2 — — Radlett 1 1 . . Edinburgh — 1 — — Red hill 1 1 — — Edmonton 3 3 — — St. Marylebone 728 757 51 53 Enfield 1 1 — — St. Pancras 349 402 3 3 Farnborough 2 1 — — Shoreditch 12 16 1 — Finchley.. 3 5 — — Southall 1 2 — — Finsbury 15 19 2 5 Southend 1 1 — — Frampton. Southgate 2 2 — — Catterell 1 1 — — Southwark 43 53 — — Fulham .. 50 41 — — Stepney 110 134 — — Godalming — 1 — — Stoke Newington 2 4 — — Greenwich — 1 — — Tottenham 8 11 — — Hackney 24 27 2 1 Twickenham — 1 — — Hammersmith 59 56 — — Walthamstow 3 3 1 — Hampstead 17 12 5 4 Wandsworth 70 66 1 1 Hanwell 2 2 — — Wantage 1 — — — Harpenden — 1 — — Wealdstone 2 1 — — Harrow 2 1 — — Wembley 3 1 — — Hawich — 1 — — West Ham 8 6 — . Hendon — 2 — — Wigan — — — 1 Holborn 106 112 28 29 Willesden 63 66 — — Hornsey 3 4 1 1 Wimbledon 3 2 — — Horsham 1 — — — Woodford 1 1 — — Hounslow — 1 — — Woolwich 1 2 7 . Ilford 2 1 . . Isle of Wight . 1 — — 2,253 2,410 234 209 Workers are frequently in the employ of several firms, so that the number of names (2,150) returned as resident in the City does not necessarily coincide with the actual number of workers, this is found to be 1,881, being 56 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 979, 67 City of Westminster. Outworkers. 1912. 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 274 3,627 197 1,591 2,233 271 3,755 159 1,597 2,317 Dressmaking 8 66 9 62 13 8 114 4 96 22 Theatrical costumiers 1 20 — 15 5 1 15 — 10 5 Waterproofing 1 4 — 2 2 1 4 — 2 2 Shirt making and hosiers 26 205 10 142 73 31 320 30 241 109 Boot making 21 468 5 372 101 27 486 5 414 77 Veil Spotting — — — — — 1 2 — 2 — Corset making 3 5 — 4 1 1 1 — 1 — Embroidery 5 60 1 54 7 5 42 2 36 8 Glove making 1 3 — 3 — 1 3 — 3 — Lace making 1 2 1 2 1 — — — — — Furriers . . 5 . 5 2 6 5 5 6 Hat making . . . . . 1 2 — 2 — Millinery — . 1 — 1 . — — — — Upholsterers and carpet makers 1 4 — 3 1 — — — — — Basket making — — — — — — — 1 — 1 Ironmongery — — — — — — — — — — Umbrella making 1 4 1 3 2 — . 1 — 1 Paper bag and box making — — — — — — — — — — Stuffed toy making — — 1 — 1 — — 1 — 1 Artificial flowers . . . . . . . 1 — 1 Dyers and cleaners . . 2 . 2 . . . . — F2 Brush maker — — — — — — — Belt making and leather goods .. 1 2 — — 2 1 1 — 1 — Wig making — — 1 — 1 — — — — . 344 4,470 234 2,253 2,451 351 4,751 209 2,410 2,550 328 firms sent in lists on both occasions, giving a total of 9,050 addresses; 21 firms sent in once in the year, the number on their lists being 171. 68 many houses contain a number of outworkers. Notices were served in respect of 813 defects discovered in 400 houses. They may be summarised thus:— 1911 1912 1911 1912 Sanitary accommodation— Walls and ceilings dirty 248 280 Rooms verminous 22 58 Insufficient 3 7 Rooms overcrowded 5 23 Not kept separate 12 50 Rooms badly ventilated 24 27 Unsuitable 5 4 Gas stoves and heaters unventilated 11 17 Apparatus defective 72 79 Requiring cleansing 27 82 Other defects (dampness, defective roofs, floors, water supply, dust 103 I39 Ventilation defective 5 10 Drains, sinks, &c.,. defective 20 37 In 16 instances statutory notices had to be served before the work required was done. In several instances where the rooms were dirty or verminous the outworker was seriously warned. Two 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 . 10 (7) 12 (8) . 1 (1) 23 (16) (b) Business in other parts of house . 16 (4) 12 (2) . . 28 (6) (c) Persons from infected houses employed in clothing business elsewhere . 17 6 . 1 24 Other home workers' trades — — 1 (1) — — — The figures in brackets represent outworkers' premises. Laundries.—There are 42 Laundries in which washing is done, besides which there are a number of private houses in which mangling only is done. 69 Notices were served to remedy various defects found on inspection These comprised:— Walls dirty 7 Accumulation of refuse 2 W.o.'s and drains defective 4 Room adjoining used as a bedroom 1 Defective floor , 1 ,, roof 1 Premises unsuitable 1 Ventilation defective 1 No infectious disease occurred in rooms used for any laundry purpose, but 4 cases of scarlet fever occurred in tenement houses in which laundry work was done, and 6 persons from infected houses were employed in laundry work elsewhere. Underground Work.places.—The increasing tendency (to which I have referred under the heading of Drainage) to the formation of deep basements and sub.basements, and the utilisation of such places for work.places, restaurants, &c., brings with it greater difficulties in securing that such places are properly ventilated, warmed and lighted. In large premises, mechanical systems of ventilation are employed, whereby either fresh air is pumped in or the used air is extracted, or both methods may be employed. One difficulty is to ensure that the air pumped in is obtained from a clean source ; in more than one instance it has been found that the inlet for fresh air was in contiguity with the outlet; in one case the outlet of a shaft from the lavatories was being placed immediately below the intake for the grill.room; in others that the source of the air was a central well into which kitchens, lavatories, or other rooms were sending a varied selection of smells. Similar trouble also arises where merely inlet fans are in use. Mechanical systems of ventilation, to work successfully, require skilled persons to supervise the working according to varying atmospheric conditions. The expense of running fans in small workshops leads frequently to their not being kept working. A Bill was introduced into Parliament to give local authorities greater power over the premises underground in which persons are employed in certain trades and industries, chiefly those of a sedentary nature, including, however, restaurant kitchens. The object of the Bill was to require that such places should be certified as being suitable as regards construction, lighting, temperature, ventilation, freedom from damp, &c., on the same lines as the last Factory Act dealt with underground bakehouses. The City Council have previously expressed the opinion that premises should not be allowed to be used for the preparation or sale of food until certified as suitable, but with regard to the other classes of business mentioned in the Bill, the Council expressed the opinion that 70 the powers possessed under existing statutes are sufficient to enforce good conditions. Many places used as underground work.places were not built for the purpose, and it is very difficult, and at times impossible, to make structural alterations when they are converted into workplaces. Should the Bill become law, it would lead to proper provision being made when the premises were built. The difficulties encountered, especially with regard to proper ventilation and temperature are increased by the requirements of the department of the County Council concerned with the prevention of danger from fire. The absence of any relation between this department and the local authorities leads to conflicting orders being given, which place the owners in a very difficult position. The maintenance of the health of the workers is of at least equal importance to protection from the risk of fire. It is requisite that there should be conjoint action in order that both these essentials should be secured. Lighting.—I have referred on previous occasions to the fact that the Factory and Public Health Acts do not deal with the question of the adequate and suitable lighting of factories and workshops, having regard to the nature of the work carried on, the protection of the eyesight of the persons employed, and the various forms of illumination. The Home Secretary has now appointed a committee to inquire into the matter. 71 E. FOOD SUPFLY. During 1912 visits have been paid to the various classes of business as follows:— Dairies and Milkshops 940 Bakehouses 270 Hotels, Restaurants and EatIce cream makers 274 ing houses 1,438 Food preserving works 17 Fishmongers 458 Greengrocers and Fruiterers 348 Meat shops (various) 693 Confectioners 98 Provision shops 438 Aerated water makers 4 Ice merchants 5 Breweries 6 Restaurants.—The kitchens of hotels and restaurants are inspected at least once a quarter, and notices were served in respect of 239. The defects included—cleansing, 276; drainage, 8; defective cisterns, 4; w.c. defective 11; w.c. dirty, 10; kitchens—refuse bins uncovered, 1; defective flooring, 3; improper storage of food, 1; defective ventilation, 5; unventilated gas stoves, 2; accumulation of refuse, 8; objectionable grease traps, 3 ; insufficient cloak room accommodation for women attendants, 2; defective ventilation of staff bed.rooms, 1; illegal occupation of kitchen, 1. Cleanliness of Public.house Bars.—Complaint having been made that " the sanitary condition of the public bars is far worse than it used to " be, and that the floors of most are simply covered with expectoration," the Public Health Committee ordered that an examination of all the licensed premises be made throughout Westminster. The result of the inspection shows that the majority of these places are in a very fair condition, and that as a rule the licence.holder is desirous to prevent the indiscriminate spitting by customers, and to take steps to keep the floors in a cleanly condition. In only a few instances was the reverse found. A circular letter has been prepared, pointing out the danger, especially to public.house servants, of tuberculosis from the expectorations on the floor, and indicating precautions that should be taken. Offer has also been made of cards to hang in the bars prohibiting spitting, and these have been largely applied for. Attention has also been called that if spittoons are required, t.hey should be of a shape which can be readily cleansed. Ice.cream Premises.—This commodity was being made at 174 premises, each of which was kept under supervision. In 30 instances defects affecting this particular part of the business were remedied. The defects found were :— Dirty walls, &c. 18 Yards requiring cleansing 1 Floors defective 1 Drains obstructed 1 Shop not kept clean 1 Defeotive w.c. cisterns 2 Untrapped sinkwastes 2 Absence of proper dust bins 2 Accumulation of refuse 2 Dirty cisterns 1 72 Bakehouses.—At the end of 1911 there were 14 above.ground and 69 underground in use. During 1912 one underground bakehouse was demolished, and one new above.ground bakehouse was opened. All the bakehouses were inspected, and cleansing carried out twice a year. One baker was warned that he was not keeping the floors, &c., as clean as he ought to do, and another for storing bread in the lobby to a w.c. The ventilation of two old bakehouses was materially improved. In the middle of August I received simultaneous information from St. Pancras, Tottenham, Gloucester and Hornsey that in each of these districts a case of typhoid fever had been notified. The four men were all employed in a bakehouse in the City, and apparently all had been infected on the same day. It is difficult to ascertain by what means they became infected, but it seems probable they must have eaten something in common about the 15th July. It was suggested that they might have been infected by drinking water from a cistern on the premises, but against this theory is the fact that none of the other employes were affected, and there is nothing to show how this cistern could have been contaminated with the typhoid organism. No other person on the premises had previously any symptoms resembling typhoid fever. Although some of the men m 1st have been at work with the disease upon them, no illness has been traced among the customers who have consumed the bread and pastry made by them. 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 173 certificates during 1912, 85 for the United States, 12 for the Philippine Islands, 76 for the Argentine, and 3 for Italy. 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 8 9 1 1 19 (S) Business in other parrs of house 1 1 1 . 3 (c) Persons from infected houses employed where 19 12 1 1 33 Milkshops.—At the end of 1911, 382 names of persons selling milk were upon the register. In 1912, 16 names were removed and 33 73 added, leaving 399 on the register at the end of the year; 28 of these were registered in respect of new premises ; 1 is a street vendor having no address in the City. Fifteen persons selling milk were given notice to register, 14 complied and one discontinued its sale. The Council refused to register in one instance. Eleven registered vendors of milk gave up selling it. Nine hundred and forty visits were paid during the year, besides those by the two Inspectors taking samples under the Food and Drugs Act, to premises in which milk is sold. 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 6 were cautioned, 1 for improper storage of the milk, 1 for keeping a dog in the shop and 4 for using rooms adjoining the shop as bedrooms In 6 instances dealers were required to remove from their shop articles likely to contaminate the milk. Other defects complained of were:— Dirty walls, &c. 1.2 Defective rain.water pipes 2 Defective roofs 2 „ sink and other pipes 10 Insufficient ventilation 4 „ paving 2 Damp walls 2 Absence of proper dust bins 1 No proper cover to milk bowls 1 Accumulation of refuse 2 Defective or dirty w.cs. 15 Defective or improperly situated „ drains 2 cisterns 6 Infectious Disease.—No cases of infectious disease occurred on premises in which milkshops were situated, but 3 persons from infected houses were employed elsewhere in the milk trade. Satisfactory arrangements were made in each instance, and no infection of the milk o ' 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. Butter Factory.—Premises at 9, Moreton Street were placed upon the register under the provisions of the Butter and Margarine Act, 1907, after alterations were carried out on the requirement of the Public Health Committee. Butchers' Shops.—Two notices were served with reference to defective w.cs. Fish Shops.—Three owners were cautioned for want of care in the conduct of their business. Fried Fish Shops.—Eighteen notices were sen ed in respect of the following nuisances:—Cleansing, 4; offensive smell, 1; defective w.cs., 3 ; 74 defective roof, 1; defective floor, 2; dirty cistern, 1; defective ventilation, 1; defective gas stove, 1; and in 2 cases the business was carried on in a careless manner. Draft by.laws proposed to be made by the County Council under Section 9 of their General Powers Act, 1908, were submitted for the observations of the City Council. They deal with the businesses of fish curers, fried fish vendors, and rag and bone dealers. The City Council objected to several of the suggested provisions. It was proposed that a notice of infringement of any by.law may be given by the County Council as well as by a Borough Council, and that penalties may be enforced for failure to comply. There does not appear to be any provision in the Act for this dual control, and Section 10 specifically states that it shall be the duty of each sanitary authority to enforce this part of the Act and all by.laws made under it. In the proposed by.laws for rag and bone dealers one of the by.laws would permit a bedroom to open directly out of a room used for the storage and manipulation of rags, bones, fat, rabbit.skins and other like articles. I reported that this is a most objectionable arrangement, and one which would be condemned under the Public Health and Housing and Town Planning Acts. I suggested the substitution of the words contained in Section 8 (d) of the 1908 General Powers Act, which requires that no sleeping place shall adjoin such room or communicate therewith except through the open air, or through an intervening ventilated space. By.law 7 dealing with the periodical removal of bones and fat provided that such removal shall be in the receptacles provided by the dealer, or in ones provided by the person removing such bones and fat. The intention may be that the person who takes the stuff away may supply the receptacles for storage in the interval, but the by.law as drafted would permit the emptying of the dealers' receptacles into those of the remover, and this procedure has been found at times to be a source of nuisance, when the material is of an offensive character. The proposed by.laws had not been confirmed at the end of the year. One dealer in rags and bones was dealt with for causing a nuisance by exposing offensive fat and bones in uncovered tins. Greengrocers' Shops.—One greengrocer was cautioned with reference to the improper storage of vegetables. Pea.picking, Seed.Sorting, &c.—Inspection has been made in the early hours of the morning of the premises in and around Covent Garden Market where women are employed. The improved conditions resulting from inspection in previous years have been maintained. 75 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. Ton Cwts. Lbs. Tons. Cwts. Lbs. Apples 0 16 56 Lemons 0 18 0 Artichokes 0 0 28 Melons 0 8 74 Bananas. 0 17 0 Oranges 3 4 0 Beans (French) 0 2 84 Pears 0 15 0 Cauliflowers 0 11 0 Peas 0 15 0 Cherries 0 1 56 Peaches 0 0 7 Currants 0 3 0 Pineapples 0 7 74 Dates 0 5 0 Plums 0 9 0 Figs 0 0 74 Pomegranates 0 3 4 Garlic 0 4 0 Tomatoes. 2 16 28 Grapes 0 2 0 Turnip Tops 2 17 0 Greengages 0 2 0 Plaice, 78 lbs. ; Skate, 1 cwt; Prawns, 9 boxes; Hams, 1 ½ cwts.; Sardines, 17 boxes Two hundred boxes of dates were seized and condemned. Apparently these had been discarded by the original owners, and the trade mark defaced, but they had not been destroyed as they ought to have been. The man in whose possession they were found alleged he had bought them from an unknown person. The defendant elected to be tried by a jury, and the case was heard at the Sessions, and he was found guilty and bound over to come up for judgment. (See below.) The following articles were seized and condemned; appended is a note of the action taken. Name and Address of Defendant. Article. Result. Stephen Waterman, 16, St. inn's Buildings, Wardour Street, W. Exposing for sale unsound dates in Upper Rupert Street Defendant decided to be tried at the Sessions. Bound over on own recognizances to be of good behaviour. Nathan Cohen, 81, Berwick Street, Soho Exposing for sale unsound pears on a stall in Berwick Street Fined 40s. and 2s. costs. Thomas Palmer, 21, New Street, W.C. Selling to Mr. E. A. Harris unsound meat on the 18th October Fined 40s. and 13s. 6d. costs. Do. Exposing for sale unsound meat on the 19th October Fined £10 and 2s. costs. The defendant was fined £5 and 2s. costs for a similar offence in 1904. 76 Seven pounds of unsound beef exposed for sale in a restaurant was seized in August. After hearing the explanation of the vendor, the Committee considered it sufficient to caution him. Tuberculous Meat.—In consequence of representations made by the City Council resulting from the seizure in 1911 of pigs which had been sold in the Central Meat Market, the Corporation of the City of London issued a notice to salesmen in their market calling their attention to the necessity for the thorough examination of all meat (especially pork) before offering the same for sale, and pointing out to them that in the case of pigs the glands of the head and neck should be carefully cut into and examined. The notice also directs attention to the legal liability which rests upon salesmen. Subsequently a pork butcher in Westminster, upon whose premises a pig had been seized in November, 1911, sued the salesman in the Central Meat Market from whom he had bought the pig, in the High Court, The defendants denied that there was any condition or warranty with regard to the meat, and endeavoured to show that there was no custom in that market to sell meat with an express or implied warranty. They supported this by saying that they had the rules of an association of meat salesmen in the market which governed the procedure, but the Judge (Mr. Justice Coleridge) said that "when these rules were examined it would be seen that they were obviously drawn up for regulating the business relations between the people who sent the meat to the market to be disposed of and the people who disposed of the meat." The defendants also denied that the carcase was tuberculous. The jury found against the defendants on all these points, and awarded damages. Foot and Mouth Disease,—The Local Government Board issued a circular (10th July, 1912) asking for specially strict supervision over the meat supply with a view to the detection of meat or offal showing signs of this disease. Several outbreaks of the disease occurred at that time in various parts of the country. 77 Sale of Food and Drugs Acts. Sam.pies Purchased under the Sale of Food and Drugs Acts, showing result of Analysis and subsequent Proceedings for year 1912. Number Article of Food. Number of Samples Purchased. Genuine. (Inferior in brackets.) Adulterated. Prosecutions. Convictions. Withdrawn or Dismissed. Fines. Costs. £ s. d. £ s. d. 1 Milk 873 720 (80) 73 34 17 17 38 7 0 9 14 0 2 do. separated 5 5 3 do. skimmed 3 1 2 4 do. and soda water 1 1 5 Cream, fresh 32 31 1 1 1 — 6 0 0 1 10 0 6 do. preserved 45 — 45 12. 1 11. 1 0 0 2 3 0 7 do. ice 16 16 8 Butter 289 257 (15) 17 11 10 1 23 0 0 8 7 0 9 do. milk blended 1 1 10 Margarine 11 11 11 Lard 9 9 12 Bread and butter 10 10 13 Bread 10 10 14 Flour 9 9 15 Sago 7 7 16 Cornflour 9 9 17 Cokernut, desiccated 4 4 18 Tea 17 17 19 Coffee 20 20 20 Cocoa 21 20 (1) 21 Chocolate powder 1 . 1 22 Pork 1 1 23 do. pies 42 36 6 24 Steak pie 1 1 25 do. and tomato pie 1 . 1 26 Meat pies .. 20 14 1 6 27 Ox tail soup 1 1 28 Tomato soup 1 1 29 Sausages, beef, pork, and smoked 65 55 10 30 Sausages, German 5 5 31 do. liver 3 2 1 32 do. garlic 1 1 33 do. rolls 2 2 34 Pudding, black 2 1 1 35 Corned beef 1 1 38 Brawn 1 1 37 Ham 6 5 1 38 Meats (various), potted 38 30 8 39 Galantine du G ibier 1 1 40 Sardines in tomatoes 3 1 2 41 ardine paste 1 1 42 Herringsin tomatoes 8 5 3 . The hearing of ten of these cases has been adjourned sine die pending an appeal in a case in the Borough of Kensington. 78 Number. Article of Food. Number of Samples Purchased. Genuine. (Inferior in bracket..) Adulterated. Prosecutions. Convictions. Withdrawn or Dismissed. Fines. Costs. £ s. d. £ s. d 43 Fish paste 2 2 44 Salmon and anchovy 1 — 1 45 Fish (various) 7 3 4 46 Peas 18 9 9 47 Spinach 8 5 3 48 Beans 6 4 2 1 1 — 2 10 0 0 10 0 49 Tomatoes (tinned ) 1 1 50 Champignons 2 2 51 Vegetables (mixed) 3 2 1 52 Dates 1 . (1) 53 Fruit (tinned) 7 3 4 54 Vinegar 17 15 (1) 1 1 1 . 0 8 0 0 2 0 55 Oil, olive 37 35 (2) 56 Ginger beer 22 21 1 57 Sugar, Demerara 3 2 1 58 do. yellow crystals 2 1 1 59 Honey 29 29 60 Oil, camphorated . 28 26 (1) 1 1 — 1 — 1 1 0 61 Rhubarb, powdered 9 9 Totals 1,800 1,492 (101) 207 61 31 30 71 5 0 23 7 0 Summary proceedings were ordered to be taken in 63 instances, but 2 of these, upon the suggestion of the Solicitor, were not proceeded with and 1 summons was not served, the defendant having left the country; 40 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 15 instances, and no action was taken with regard to 90 samples which did not conform (14 of these were test purchases and not samples taken officially, the others deviated only slightly from the standard). Milk.—873 samples of ordinary milk were taken during the year. Of these 73 (8.3 per cent.) were reported by the Analysts to be below the standard of the Board of Agriculture, and 80 samples were just on the border line, making a total of 17 6 per cent, of the samples. The percentage of adulterated (8 3 per cent.) still keeps low. The Analysts have graded the samples submitted to them into four groups :—Good quality, in which the fat was over 3 8 per cent.; fair quality, in which the fat was between 33 and 3 8 per cent.; and poor or inferior quality, in which the fat was between 3 per cent, (the official standard) and 33 per cent., or in which the non.fatty solids were between 8 5 and 86 (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. 79 District. Total. Good Quality. Fair Quality. Poor Quality. Adulterated. No. Percent. No. Percent. No. Percent. No. Per cent. South 366 98 26.7 132 36.0 112 306 24 650 North 507 153 301 165 325 140 276 49 9 60 1912 873 251 287 297 34. 0 252 28.8 73 8. 30 1911 911 305 333 311 341 218 239 77 840 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 9 267 310 176 20 4 82 9 50 1907 792 255 32 2 290 36. 6 172 217 75 9.40 1906 806 267 331 252 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 low, the quality of the milk samples generally is not so good. The amount of "Poor" quality milk is in excess of last year. Thirty.four prosecutions were taken with regard to adulteration— 24 for fat abstracted, 7 for added water, and 3 for both fat abstracted and added water. Thirty.two 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 17 instances, and were successful in 16, although there is good reason to believe that several of the vendors habitually sell adulterated milk; 1 case was withdrawn on the magistrate's suggestion—the defendant's employ^ having been prosecuted for watering his master's milk and sentenced to two months' imprisonment. Sunday Samples.—78 of the samples of milk were taken on 9 Sundays during the year; 5 (6.4 per cent.) were found to be adulterated. One sample taken, being skimmed milk, was found to contain 37.2 grains boric acid per gallon. A cautionary letter was sent to the vendor. In the six previous years the figures were 9.1, 10 6, ll.0, 10.5, 8.6 and 12 per cent, respectively. Samples taken in course of Delivery— (a) At Railway Stations.—63 samples of milk were taken on arrival at Victoria and Charing Cross Eailway Stations. Fifteen were reported of good quality, 25 fair, 20 poor and 3 adulterated. Fat abstracted, 14 per cent. (1); 3 per cent. (2). (b) On Delivery at Shops, &c.—29 samples of milk were taken as it was being delivered by wholesale firms to retail customers. Of these samples, 6 were good, 10 fair, 12 poor, and 1 adulterated (3.6 per cent, added water). These samples were taken in consequence of the milk 80 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 eleven years are as follows:— 1902. 1903. 1904. 1905. 1906. 1907. 1908. 1909. 1910. 1911. 1912. New 491 608 741 831 806 792 860 951 947 911 873 Separated, condensed, sterilised or dried 55 55 31 36 11 31 18 16 13 12 8 Total 546 663 772 867 817 823 878 967 960 923 881 Infringement of Section 9, Sale of Food and Drugs Act, 1899.— Two persons were cautioned for failure to have name and address on milk cans. Skimmed or Separated Milk.—It will be remembered that on the 18th January, 1912, the Council expressed the opinion to the Board of Agriculture and Fisheries that the Sale of Milk Regulations, 1901, should he amended so as to treat "skimmed milk" and "separated milk" (i.e., machine skimmed milk) as dissimilar articles, and that a standard should be fixed for each. The Board replied, however, on the 12th February, 1912, that, according to the information before them, purchasers who demanded " skimmed milk " generally referred not to hand skimmed milk, but to machine skimmed milk, which was the form of " skimmed " milk most commonly offered for sale, and, so far as they were aware, there was no reason to suppose that purchasers of skimmed milk were being defrauded. They added that no complaints of unfair competition had been received from sellers of hand skimmed milk, and, in the circumstances, it did not appear that any practical advantage would be gained by the amendment of the regulations in the manner proposed. A letter has since been received from the Board of Agriculture and Fisheries, dated the 20th August, 1912, enclosing copy of the Sale of Milk Regulations, 1912, in which they state that these regulations amend the Sale of Milk Regulations, 1901, in so far as they relate to skimmed or separated milk, and replace the limit of 9 per cent, of total milk.solids on which, under Article 3 of these regulations, a presumption that the milk is not genuine is based, by a limit of 8'7 per cent, of milk solids other than milk.fat; that representations have been received from time to time from local authorities of districts where there is a trade in skimmed and separated milk that considerable practical difficulties arise in instituting proceedings in cases in which water has been added to skimmed milk, but, owing to the fact that the milk has 81 been imperfectly skimmed, the total solids have not fallen below 9 per cent., thus a sample containing 15 per cent, of fat and 7.5 per cent, of milk.solids other than milk.fat would probably contain over 12 per cent, of added water, but the total solids are up to the limit of 9 per cent. The present regulations are intended to obviate these difficulties and to facilitate the prevention of the adulteration of skimmed milk with water. The Board add that the fixing of the percentage at 8.7 may result in some hardship in cases where the milk is imperfectly skimmed, thus, if milk containing 3 per cent, of milk.fat and 8'5 per cent, of milk.solids other than milk.fat is imperfectly skimmed so that 1.5 per cent, of milk.fat remains, the proportion of milk.solids other than milk.fat will rise only to 8.63 per cent., and they suggest that this point should be taken into account by the Westminster City Council in considering the question whether they should institute proceedings on the presumption of adulteration based on the regulations in cases where the deficiency of milk.solids other than milk.fat is slight, and the skimmed milk contains a considerable proportion of milk.fat. One of the vendors of the adulterated samples of skimmed milk was cautioned ; the sample, in addition to being slightly adulterated, contained boric acid to the extent of 37.2 grains of boric acid per gallon. In the remaining case no action was taken. Milk and Dairies Bill.—The President of the Local Government Board introduced a Bill dealing with this subject, but as on several previous occasions it was not proceeded with. Several provisions appear to require amendment. The position of London boroughs under the Bill is unsatisfactory, and it is undesirable that the Local Government Board should have power to transfer by regulation the duties and powers of sanitary authorities to the County Council. The definition of the expression " dairy " is not satisfactory in view of the decision of the High Court on the 21st October, 1912, in the Appeal Case of Spiers and Pond, Ltd. versus Green. The appellants, who were tenants and occupiers of a refreshment buffet and bar at a railway station in London, sold a small quantity of milk for consumption on the premises, the amount so sold averaging three or four glasses per week. The appellants obtained their milk supply from a firm who undertook to supply it guaranteed pure and to convey it to the appellants as they might require. It was held that the appellants did not in respect of the sale of the milk at their buffet carry on the trade of purveyors of milk, and therefore that they did not require to be registered as purveyors of milk under the Dairies, Cowsheds and Milkshops Order, 1885, as amended by the Dairies, Cowsheds and Milkshops Order, 1886. This decision will remove many small milk vendors who keep G 82 general shops, from the supervision of the sanitary authorities in so far as milk regulations are concerned, and the Bill should make it clear that all such premises should be included. The procedure for dealing with milk, which appears to be the medium by which infectious disease has been caused, or is likely to be caused, might lead to delay in circumstances in which prompt action is of the greatest importance and might be simplified. Among other matters the Bill provides that a warranty or invoice shall not be available as a defence to any proceedings under the Food and Drugs Act of 1875, so far as milk is concerned. The Bill, when passed, should be of considerable value in securing a cleaner and purer milk supply, if provision is made to ensure that it will be put in force in rural districts. Cream.—Thirty.two samples of fresh cream were taken, 31 of them contained no preservative, and 1 had boric acid in the proportion of 36 grains per pound. The vendor was fined £6 and £1 10s. costs. Forty.five samples of preserved creams were taken, and were found to have the following amounts of boric acid per pound:—3.0, 3.5, 3.5, 3.5, 4.2, 5.6, 5.6, 5.95, 619, 7.0, 7.0, 8.67, 8.67, 8.67, 9.8, 14 0, 14.0, 15 0, 17.35, 17.85, 20.0, 20.4, 21.0, 214 9, 22, 22, 22 30, 22 68, 23.0, 23.0, 23.05, 23.54, 24, 24, 24.79, 2479, 26 03, 27, 28, 28, 28, 30.24, 34.70, 36 and 42 grains respectively. Most of the preserved creams were sold in jars on which were labels stating that the cream contained not more than 35 grains (.5 per cent.) of boron preservative per pound. Proceedings were taken against the vendor of the cream with 42 grains which was so labelled. A warranty was proved, and subsequent proceedings were successfully taken against the warrantor. The Public Health (Milk and Cream) Regulations, 1912, of which I gave, in my report of last year, an outline of their then proposed provisions, are now in force. The Regulations are designed to secure that no preservative shall be added to milk, or to cream containing less than 35 per cent, by weight of milk fat, at any stage from the place of production to that of delivery to the purchaser.. In the case of cream containing over 35 per cent, of niilk fat, the addition of boric acid, borax, or a mixture of these preservative substances or of hydrogen peroxide is not prohibited by the Regulations, but is subject to a system of declaration which is required to be followed by all persons dealing with such cream for the purpose of sale for human consumption. By this system (Part II of the Regulations) it is intended that preserved cream as an article of commerce shall in all stages be differentiated from cream to which no 83 preservative has been added. Further, Article IV (a) prohibits the addition of any thickening substance to cream or preserved cream. Subject as provided in sub-division (1) of Article V, the Regulations come into operation on the 1st October, 1912. Sub-division (1) of Article V provides that every seller of preserved cream shall in every advertisement, price list, or trade list which is used in connection with the sale of preserved cream for human consumption, describe that article as preserved cream, and in no such document shall any words be contained which might imply that the preserved cream is cream to which a preservative substance has not been added. The provision in this sub-division of this Article will come into operation on the 1st January, 1913. In order that sellers of milk and cream in the City be made fully acquainted with the requirements of these regulations, they have been circularised on the subject. Seven vendors of cream were eventually written to with reference to failure to properly label receptacles in conformity with the Regulations. The City Analysts raised certain questions in connection with the carrying out of the Regulations, and the Council referred the matter to the Local Government Board, and suspended further action pending a reply. Butter.—Of the 289 samples purchased and submitted for analysis, 17 were found to be adulterated. Eleven prosecutions and ten convictions were obtained. In one instance the summons was not served, as the defendant was found to have left the neighbourhood without leaving a trace of his whereabouts. The remaining adulterated samples, six in number, were unofficial or "test" samples. Boric acid was found in most of the samples, but was, in each case, under -5 per cent., which is the maximum amount permitted. Sausages, Meat Pies, &c— Samples were taken during 1912 of sausages, meat pies, &c., with the following results:— 42 Pork Pies 36 genuine; 6 contained boric acid:—12.6, 12.6, 7.43, 6.3, 2.6, 2.5 grains per lb. 1 Steak and Tomato Pie Contained 8.4 grains boric acid per lb. 20 Meat Pies 14 genuine; 6 contained boric acid :—5 6, 4 9, 3 6, 3.2, 2.2, 2 2 grains per lb. 44 Pork Sausages 39 genuine ; 5 contained boric acid 19 6, 17'35, 7.43 619, 5*82 grains per lb. 21 Beef Sausages .. .. 16 genuine; 5 contained boric acid :—13.5, 8.68, 6.19, 5'45, 3'72 grains per lb. 3 Liver Sausages 2 genuine ; 1 contained 5.6 grains boric acid per lb. 2 Black Puddings 1 genuine ; 1 contained 4 7 grains boric acid per lb. 6 Hams 5 genuine; 1 contained 2.8 grains boric acid per lb. 84 Potted Meat.—In 38 samples of potted meats 7 were found to contain preservative to the amount of 17.35, 1190, 8 54, 7, 5, 2.6, 1 grains per pound respectively, and 1 contained a trace of boric acid. Fish.—Twenty-two samples of fish (fresh, filletted,cured and tinned) were examined. Three samples of herrings in tomatoes were found to contain 1.4, and 1/6 grains tin per lb. respectively. Two samples of sardines in tomatoes contained 2/6 and 9/10 grain tin per lb. respectively. One sample salmon and anchovy paste contained 16.11 grains of boric acid per lb. Four samples of filletted fish were found to have been artificially coloured. It will be remembered that the Fishmongers Company were last year invited to consider steps being taken to discourage the practice of artificially colouring fish, and the reply was to the effect that after consideration the Company came to the conclusion that no other dye than annatto (vegetable) dye should be allowed to be used for colouring fish, and that they had accordingly placed themselves in communication with all the known curers in Hull, Grimsby and Aberdeen informing them that annatto vegetable dye was only to be used. A family were taken ill after eating sardines preserved with tomatoes. A special report was submitted embodying the results of bacteriological and chemical examination of part of the contents of the tin which had been left over. It was found to contain 2 1/5 grains of tin per lb. Seventeen other boxes in the possession of the vendor were given up and destroyed. In consequence, a number of samples of canned articles with tomatoes were taken, with the results stated above. Tinned Vegetables.—Thirty-seven samples were taken, during the year 1912, of tinned vegetables, with the results set out as follows:— 18 Peas 9 genuine; 9 contained copper sulphate :—2.7, 2 .4,1.7, 1.7, 1.6, 1.6, l.5, 1.4 and 1/3 grains per lb., respectively. 8 Spinach 5 genuine; 3 contained tin:—1.2, .7 and 35 grains per lb., respectively; the last sample also contained 10.2 grains of iron per lb. in excess of the amount of iron normally present in spinach. This last was included in some stock taken over by the vendor, and as there was a doubt that he intended it for sale, he was let off with a caution. 6 Beans 4 genuine; 2 contained copper sulphate :—3.6and 1.24 grains per lb., respectively. 2 Champignons Genuine. 3 Mixed Vegetables. 2 genuine; 1 contained f grain copper sulphate per lb. Tinned Fruit.—Of the seventeen samples taken during the year, four .contained tin to the amount of 1.6, 1.5, 8 and .5 grains per lb. respectively. 85 Vinegar.—Seventeen samples were taken, and one only was found to be adulterated. Ginger Beer.—Twenty-two samples of draught ginger beer were taken. In most cases the samples were drawn direct from a wooden barrel, through a wooden tap. Five samples were drawn through pipes by means of engines; one of these contained 0 62 grains lead per pint, to the vendor of which a letter of caution was sent. Cases have been reported in which lead poisoning has resulted from drinking ginger beer and other beverages. It would be an advantage if vendors were prohibited using any pipes, taps, &c., made of material liable to be acted upon by liquids so that deleterious compounds are formed. Cocoa.—This sample contained 25 per cent, of foreign starch; but being labelled " Chocolate Powder " no action was taken. Sugar.—Of three samples of Demerara sugar, one consisted of sugar crystals with an organic colouring; and of two samples of yellow crystals, one was artificially coloured. Legal Proceedings Under the Food and Drugs Acts during 1912. No. of Date of : offence Reault Sample. Hearing. 1 2 3 4 1912. MILK. 17 N. 8th Feb. 20 per cent, of fat abstracted .. Fined £5, including costs. Previous prosecutions. 14 N. 8th Feb. 10 per cent, of fat abstracted Warranty proved. Summons dismissed. 11 N. 8th Feb. 5 per cent, of added water Warranty proved. Summons dismissed. 13 N. 20th Feb. 11 per cent, of fat abstracted Fined £5 and £2 2s. costs. The defendant endeavoured to rely on a warranty, but did not comply with the statutory requirements with regard to the notice. 30 S. 21st Feb. 30 per cent, of added water Warranty proved. Summons dismissed. 71 S. 6th Mar. 51 per cent, of fat abstracted Fined £10 and 12s. 6d. costs. Previous convictions. 37 S. 6th Mar.13 5 per cent, of added water Fined 20s. and 12s. 6d. costs. 76 S. 13th Mar. 18 per cent, of fat abstracted Fined 40s. and 12 s. 6d. costs. 81 N. 8th Mar. 32 per cent, of added water. 9 per Summons withdrawn. cent., of fat abstracted The defendant's employe was prosecuted for watering his master's milk and sentenced to two months' imprisonment. 141 N. 19th Mar. 10 per cent, of added water Warranty proved. Summons dismissed. 181 N. 2nd April 12 per cent, of fat abstracted Warranty proved. Summons dismissed. Previous prosecution 17.5.1906. 16 per cent, fat abstracted. Warranty proved. 86 No. of Date of Sample.' Hearing. 0ffence Re8ult 1 2 3 4 1912. 169 N. 4th April 2 per cent, of added water and Warranty proved. Summons 4 per cent, of fat abstracted dismissed. Cautioned for selling milk with 4 per cent, added water, 10.2.1912. 168 S. 24th April 22 per cent, of fat abstracted Fined 10s. and 12s. 6d. costs. 284 N. 14th May 13 per cent, of added water . Fined 20s. and 12s. 6d. costs. 261 N. 16th May 6 per cent, of added water.. Fined 42s., including costs. 308 N. 30th May 8 per cent, of fat abstracted .. Warranty proved. Summons dismissed. 396 N. 11th June 25 per cent, of fat abstracted Warranty proved. Summons dismissed. 378 N. 11 th June 24 per cent, of fat abstracted Warranty proved. Summons dismissed. 216 S. 12th June 18 per cent, of fat abstracted Warranty proved. Summons dismissed. Two previous prosecutions. Warranty proved in each case. 214 S. 12th June 4.47 per cent, of added water and Warranty proved. Summons 14.1 per cent, of fat abstracted dismissed.* * Several previous prosecutions. Warranty proved in each case (see also Butter 712 S.). The Magistrate expressed the opinion that the facts were very suspicious. The City Solicitors add that it seems to be practically impossible to get a conviction where a warranty is pleaded. 297 N. 10th July Selling milk, a sample of which Fined 40s. and 14s. 6d. costs, was taken at Victoria Station in course of delivery, from which 14 per cent, of fat had been abstracted 513 N. 23rd July 13 per cent, of fat abstracted Warranty proved. Summons dismissed. Summoned 19.8.10. 26 per cent, fat abstracted. Warranty proved. 525 N. 26th July 20 per cent, of fat abstracted Warranty proved. Summons dismissed. 495 N. 26th July 1 7 per cent, of fat abstracted Warranty proved. Summons dismissed. Summoned 25.5.09. 20 per cent, fat abstracted. Warranty proved. 506 N. 26th July 116 per cent, of fat abstracted Fined 20s. and 12s. 6d. costs. 508 N. 26th July 6 per cent, of fat abstracted Fined 20s. and 12s. 6d. costs. 530 N. 2nd Aug. 11 per cent, of fat abstracted Fined 20s. and 12s. 6d. costs. 534 N. 2nd Aug. 10 per cent, of fat abstracted Fined 10s. and 12s. 6rf. costs. 426 S. 4th Sept. 12 per cent, of fat abstracted Warranty proved. Summons dismissed. 669 N. 6th Sept. 8 per cent, of fat abstracted Warranty proved. Summons dismissed. 723 N. 25th Oct. j 10 per cent, of fat abstracted .. Fined £3 and 12s. 6d. costs. Previous prosecution 11.5.1907. 50 per cent, fat abstracted. Fined 20s. and costs. 787 N. 15th Nov. 9 per cent, of added water Fined 25s., including costs. 772 N. 15th Nov. 6 per cent, of fat abstracted Fined 30s., including costs. Three previous convictions since 1905. 918 N. 20th Dec. 30 per cent, of fat abstracted Fined 10s. and 12s. 6d. costs. BUTTER. 58 S. 6th Mar. Selling margarine as butter Fined 40s. and 12s. 6d. costs. (See 376 S.). 359 N. 14th June 22 7 per cent, of water, i.e., 6 7 per Fined £3 and 12s. 6d. costs, cent, excess of water 380 S. 31st July Selling margarine as butter Fined 40s. and 12s. 6d. costs. 87 No. of Date of Offence Result. Sample. Hearing. 1 2 3 4 1912. 387 S. 31st J uly Selling margarine as butter Fined £3 and 12s. 6d. costs. Fined in 1908 for similar offence. 376 S. 31st July Selling margarine as butter Fined 40s. and 12s. 6d. costs. (See 58 S.). 375 S. — Selling margarine as butter Defendant gone away. Summons not served. 545 N. 9th Aug. Selling milk-blended butter as Fined £5 and £1 3s. costs, butter. 497 S. , llth Sept. Selling margarine as butter Fined 20s. and 12s. 6d. costs. 592 S. 13th Nov. Selling margarine as butter Fined 40s. and 12s. 6d. costs. 1913. 712 S. 1st Jan. Selling margarine as butter Fined 20s. and 33s. 6d. costs. (See Milk, 214 S.). 947 N. 21st Jan. Selling margarine as butter .. Fined 40s. and £1 3s. costs. 1912. CREAM. 928 N. 20th Dec. Selling cream containing 36 grains Fined £6 and 30s. costs, of boric acid per lb. 908 N. 7th Dec. Selling preserved cream containing Warranty proved. Summons 42 grains of boric acid per lb. dismissed. Label on jar stated that the cream contained not more than 35 grains per lb. 1913. 908 N. 4th Feb. Giving a false.warranty in respect Fined £1 and £2 3s. costs, of preserved cream 1912. FRENCH BEANS. 881 N. 13th Dec. Selling French beans containing Fined 50s. and 10s. costs. 3 .6 grains of crystallised copper sulphate per lb of beans VINEGAR. 639 S. 28th Nov. Deficient in acetic acid to the ex- Fined 8s. and 2s. costs. tent of 53 per cent. CAMPHORATED OIL. 437 N. — Deficient in camphor to the extent Withdrawn on payment of of 7 per cent. £1 ls. cost. london: harbison and sons, printers in ordinary to his majesty. st. martin's lane.