ANNUAL REPORT on the STATISTICS and SANITARY CONDITION relating to THE CITY OF WESTMINSTER FOR THE YEAR 1913. 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 1913. 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. ii TABLE OF CONTENTS. page Introductory Remarks iii PART I. A. Statistics. Population 1 Census Statistics 1-5 Births 6 Notification or Births Act 7 Medical Inspection of Children under School Age 8 Schools for Mothers 9 Deaths 10 Infantile Mortality 11 Statistics of Block Dwellings 12 Common Lodging Houses 13 Tables 14-26 B. Communicable Diseases. Smallpox 27 Vaccination 27 Scarlet Fever 28 Diphtheria 28 Typhoid Fever 29 Ophthalmia Neonatorum 29 Plague 29 Tables 30-31 Tuberculosis 32 Insurance Act 43 Diarrhœal Diseases 51 Measles 52 Whooping Cough 52 Schools and Infectious Disease 53 Bacteriological Laboratory 54 Disinfection 55 Cleansing of Persons 55 Verminous School Children 55 Verminous Houses 56 Mortuaries 56 page PART II. C. House Inspection, &c. Defects Remedied 57 Legal Proceedings 58 Drainage, &c., Plans 59 Removal of Offensive Refuse 59 Housing Conditions— Sanitary Survey of Houses 59 Converting Condemned Houses to other uses 60 Underground Rooms 61 Houses Let in Lodgings 62 Water Supply 63 Revenue Act 63 Smoke Prevention 64 Offensive Smells 64 D. Workshops. Number on Register 65 Defects 66 Outworkers 67 Infectious Disease 70 Laundries 70 E. Food Supply. Restaurants, &c. 71 Ice Cream Premises 72 Bakehouses 72 Certification of Food for Export 72 Infectious Disease 73 Milkshops 73 Contamination of Food—Proposed Legislation 73 Food Poisoning 74 Food and Market Inspection 74 Food Condemned 74 Sale of Food and Drugs Acts— Samples Taken, Result of Analysis and Proceedings 75 Milk and Cream Regulations 78 Details of Prosecutions 83 iii Annual Report on the Health and Sanitary Condition of the City of Westminster, 1913. 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 1913. Returns required by the Local Government Board, and particulars relating to Factories and Workshops required by the Home Office, are incorporated therein. The subject of Tuberculosis has been somewhat fully dealt with in view of the extension of notification to all forms of the disease, and of the operation of the Insurance Act. A scheme has been prepared in connection with local hospitals for the provision of a Tuberculosis Dispensary, but it has not yet received the sanction of the Local Government Board. I have the honour to be, Mr. Mayor, my Lords, Lady and Gentlemen, Your obedient servant, FRANCIS J. ALLAN, Medical Officer of Health. March, 1914. A 2 PART I. A. STATISTICS. Population. The Census of 1911.—After the census had been taken on former occasions the Registrar General published the facts relating to each county in one volume which was of considerable convenience, but on this occasion each volume deals with a separate subject. Thus information relating to Westminster is as yet attainable for certain particulars only. Reference to some of these was made in my Report for 1912. Since that was issued volumes have been published giving information on housing, occupations, birthplaces, ages and condition as to marriage. As these are dealt with in considerable detail I have summarised certain of the facts and have inserted the corresponding figures for previous census periods so that comparisons may be made. Families or Separate Occupiers (Private or other).—There were 35,984 of these (34,741 being " Private Families " as distinguished from institutions, barracks, &c.), compared with 41,344 in 1901 and 46.247 in 1891. The number of persons in private families was 128,818, giving an average of 3'7 persons to a family, approximately the same as in 1901. The number of tenements with less than five rooms was 25,236 against 26,668 in 1901 and 32,121 in 1891; the number of persons living in such tenements was 74,617 in 1911, 83,304 in 1901, and 100,877 in 1891. While the reduction of the population as a whole amounts to 22,750 between 1901 and 1911, the reduction in the number of persons occupying less than five rooms has only been 8,687. Apparently, therefore, 14,063 persons who previously rented whole houses have left the City. 2 Details of the number of families and persons occupying one, two, three, and four-roomed tenements are given below:— 1891. 1901. 1911. Total number of private families occupying tenements of less than five rooms 32,121 26,668 25,236 Population of above 100,877 83,304 74,617 Number of one-roomed tenements 10,846 7,546 6,188 Population 21,078 14,008 10,120 Number of two-roomed tenements 11,583 9,635 8,792 Population 37,898 30,048 24,966 Number of three-roomed tenements 6,557 6,279 6,735 Population 27,076 24,809 24,880 Number of four-roomed tenements 3,135 3,208 3,521 Population 14,825 14,439 14,651 This shows a reduction in the one or two-roomed tenements, and an increase in those of three and four rooms. That this implies an improvement in housing conditions in Westminster may be deduced from the fact that while in 1901, 4,346 tenements of less than five rooms each had more than two occupants per room, in 1911 there were only 2,860 so circumstanced. For each class of room the figures are:— 1901. 1911. One-roomed tenement 1,599 869 Two-roomed tenement 1,846 1,262 Three-roomed tenement 729 575 Four-roomed tenement 172 154 4,346 2,860 which show an improvement in each class, but particularly in the oneroom tenement. There were in addition 27 five-roomed tenements and 6 six-roomed tenements containing more than two persons per room. It has been assumed, for the purpose of instituting a comparison between various districts, that overcrowding exists if there are more than two persons per room, but obviously this is not a very reliable test, as no regard is paid to the size of the rooms. The position occupied by Westminster with 16,596 persons (5,987 being children under 10 years of age) living more than two in a room, equal to 12.9 per cent. of the total population in private families, is ninth lowest among the 29 Metropolitan Cities and Boroughs. In 1901 Westminster occupied the fifteenth place. 3 Average Number of Occupants per Room.—The following table shows an improvement in the average number of persons occupying tenements in Westminster of less than four rooms:— 1891. 1901. 1911. Tenements— One room 2.9 1.8 1.6 Two rooms 1.6 1.5 1.4 Three rooms 1.3 1.3 1.2 Four rooms 1.1 1.1 1.0 Ages and Condition as to Marriage.—A comparison of the proportion of males and females in the population of the County of London and the City of Westminster shows that males are fewer in Westminster than in the County and females are more. There are also considerable differences at various age periods, which have an appreciable effect when comparisons are made of birth and death rates and with respect to the incidence of infectious disease. Proportion per 100,000 of Population. County of London. City of Westminster. Males. Females. Males. Females. All ages 47,025 52,975 45,831- 54,169 + Under 5 5,187 5,150 3,041- 3,046- 5-10 4,774 4,815 2,706- 2,784- 10-15 4,401 4,489 2,634- 2.684- 15-20 4,274 4,697 4,112- 4,614- 20-25 4,225 5,261 6,018 + 7,221 + 25-30 4,194 5,111 5,168 + 6,897 + 30-35 3,848 4,452 4,235 + 5,563 + 35-40 3,493 3,964 3,910 + 4,878 + 40-45 3,008 3,403 3,416 + 4,038 + 45-50 2,589 2,919 2,996 + 3,443 + 50-55 2,144 2,408 2,475 + 2,699 + 55-60 1,636 1,882 1,880 + 2,009 + 60-65 1,275 1,514 1,355 + 1,543 + 65-70 934 1,192 907- 1,193 70-75 575 856 542- 797- 75-80 293 497 288- 438- 80-85 125 243 104- 215- 85-90 40 94 35- 85- 90 and upwards 10 28 9- 22- Up to the age of 20 the proportion of both males and females is less than in London, but from that age on to 70 years it is greater; over that age it is again less, but this may be in part due to the fact that a number of elderly people who are in the Infirmaries are not reckoned, as these institutions are situated outside the City. There is evidently 4 a large influx of both males and females into the City after the age of 20. In the St. George, Hanover Square, and the Strand Registration area, the increase begins at the age of 17, especially among females, in the Westminster (St. James and Soho) district the increase begins at the same age, and is chiefly in the males, who predominate in this part of the City. There is a marked deficiency in children under the age of 15 in the City as compared with London, and greater still when compared with the whole of England and Wales, which, taken at 100, shows London several points below and Westminster between 50 and 60. On looking at the status of the population of Westminster as regards marriage, it appears that 37,225 of the female population between the ages of 15 and 45 are unmarried or widowed and 15,999 are married. Comparing these figures with those of England and Wales, the proportion per 1,000 at this age period is :— Unmarried and widowed—England and Wales, 494; Westminster, 700; Married „ „ 506; „ 300; which accounts to some extent for the deficiency in the number of children in the population, and for the apparently low birth-rate when calculated on the population as a whole; but, of course, the excess of persons over 20 years of age in the population unduly depresses the figures given as the proportion of children :— Condition as to Marriage. Registration District. Males, all ages. Females, all ages. Between ages of 15 and 45 years. Unmarried. Married. Widowed. Unmarried. Married. Widowed. Unmarried. Married. Widowed. St. George, Hanover Square 32,074 18,093 1,662 41,851 18,145 6,132 27,044 11,709 1,186 Westminster 8,627 4,087 418 7,382 3,823 1,108 4,697 2,712 261 Strand 5,224 2,908 356 5,297 2,372 702 3,861 1,578 176 City 45,925 25,088 2,436 54,530 24,340 7,942 35,602 15,999 1,623 Birthplaces of Persons Enumerated at the Census.—»London.—The proportion of London-born persons in the total population has increased from 62,096 persons per 100,000 population in 1861 to 68,228 in 1911; the proportion of persons born in other parts of England, Scotland, and Ireland has decreased. The proportion of foreigners has increased from 1,459 in 1861 to 3,384 per 100,000 in 1911; the proportion at the previous Census (1901) being 2,984. Westminster ranks as fourth of the Metropolitan Boroughs which have the largest proportion of British subjects by parentage. It also 5 contains a fairly high proportion of naturalised British subjects. The population has been allocated in following table so as to show the distribution according to country of birth:— Males. Females. Total. England 58,623 72,009 130,632 Wales 912 1,208 2,120 Scotland 1,962 2,598 4,560 Ireland 2,149 2,194 4,343 Isle of Man and Channel Islands 125 159 284 Colonies 1,158 1,407 2,565 British Subjects born abroad 315 497 812 Naturalised British Subjects 331 132 463 Foreigners 7,943 5,102 13,043 Not stated 731 1,506 2,237 Foreigners, including naturalised British subjects, have increased in Westminster from 11,831 in 1901 to 13.508 in 1911. Of the metropolitan boroughs Westminster has the largest number of natives of France, Italy, Switzerland, and the United States. From the figures appended a comparison may be made between the numbers of each nationality enumerated in 1901 and in 1911 :— 1901. 1911. 1901. 1911. Europe— I Europe contd.— Austria 392 532 Switzerland 958 937 Hungary 91 114 Turkey 35 64 Belgium 323 240 Asia— Denmark 52 82 China 1 16 France 2,249 2,510 Japan 25 40 Germany 2,031 2,166 Other 10 6 Greece 21 31 Africa 25 43 Holland 124 174 America— Italy 2,282 2,624 United States 864 1,078 Norway 28 57 Central America 13 18 Portugal 10 18 Argentine 15 70 Russia 903 739 Brazil 8 42 ,, Poland 1,015 1,508 Other S. American 18 52 Balkan States 26 61 Born abroad— Spain 102 98 Not stated 25 14 Sweden 185 171 Born at sea — 3 Occupations of Foreigners.—Nearly all the Russian and Polish and a -considerable number of the German and Austrian immigrants are tailors. Germans, Austrians, Swiss and French provide a large proportion of those in service in connection with hotels and restaurants as waiters and cooks. Germans, French and Swiss are also found as domestic indoor servants. Germans in fair proportion also act as commercial clerks. 6 The population of Westminster as estimated to the middle of the year 1913, is 155,678 made up according to the proportion stated above of 71,349 males and 84,329 females. The Registrar-General, however, makes this a 53 week year, and for the purpose of calculating rates, the population for the additional week has to be added, making 158,672. Births. Births Registered. Births Notified. In Westminster. Belong else where. Born out of Westmin ster. Net. Total. 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 1,507 53 632 561 1911 2,110 60 311 2,361 1,562 55 578 483 1912 2,134 49 264 2,349 1,501 1,469 34 564 451 1913 1,992 35 276 2,233 1,462 1,424 38 474 570 The following table shows the distribution of births (including infants born in institutions outside the City) according to wards:— Conduit 7 St. Anne 158 Grosvenor 116 Regent 84 Knight abridge St. George 158 Pall Mall 10 Victoria 723 Great Marlborough 71 St. Margaret 93 Charing Cross 25 St. John 623 Covent Garden 87 Knightsbridge Hamlet 73 Strand 5 The birth-rate, uncorrected, was 12'6, corrected 14'2 per 1,000 persons. The corrected birth-rate for the five years 1903—7 was 17'2, and for the five years 1908—12, 15-4 per 1,000. The birth-rate for the County of London for 1913 was 24-5, the rate during the preceding ten years averaged 25'8 per 1,000. The birth-rate in England and Wales was 23'9 ; the average of the preceding ten years was 27'1. The birth-rate calculated on the number of married women in Westminster, distinguishing the legitimate and illegitimate, shows more exact rates:— Westminster. 1906. 1907. 1908. 1909. 1910. 1911. 1912. 1913. Legitimate Births (net) 2,744 2,764 2,739 2,548 2,399 2,195 2,194 2,057 16.1 16.4 16.4 15.5 14.7 13.7 13.8 13.0 Illegitimate Births (net) 187 163 174 203 193 166 155 176 0.47 0.42 0.45 0.53 0.51 0.44 0.42 0.48 7 During the year notification was received of 1,462 births which took place in Westminster; of these, 38 were stillborn children, whose births are not subsequently registered; (12 other stillbirths were known but not notified). 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*2 per cent, for the City. The proportion notified in previous years was 64'8 per cent. in 1909, 68 in 1910, 70.9 in 1911 and 71.1 in 1912. In addition, information was received through the County Council of births coming to their knowledge in their work of supervising midwives, and from some of the Medical Officers of Health of boroughs in which there is a maternity hospital; births occurring in such an institution would be notified and registered in the borough in which it is situate. The Registrar-General now supplies at the end of the year, a more complete list of births in outlying institutions, but it would be preferable if these could be supplied at the end of each month, as we are unable to visit a number of the families through absence of this information. The mothers and infants were visited after the twelfth day by the Council's visitor, Mrs. Watkinson, in co-operation with the voluntary health visitors in cases where advice appeared desirable. 1,354 of the notified were visited. In addition to these 477 births registered but not notified and 258 obtained from other sources were visited, making a total of 2,089 including cases of stillbirths ; 194 appeared to be above the standard and were not visited; 17 did not desire or did not appear to require further visiting, and 41 were not found (these occur among the registered births where several weeks intervened between the birth and registration, in which time the parents had moved). There were 1,057 infants born in 1912 who were under one year of age at the end of 1912, and these also have been visited in 1913. After making allowance for removals and deaths there were 1,470 infants on the visiting list at the end of the year. The visitors endeavour to keep in touch with the children up to school age. In this way 3,798 children born in previous years, 1908-12, have been visited during 1913. Making allowance for removals and deaths, there were at the end of the year 5,156 children on the visiting list. By co-operation with the hospitals and lying-in charities the Health Society received the names of 517 women expecting to become mothers. Arrangements are made by the visitors as to suitable nurses or for reliable women to look after the homes or family if the mother is going into hospital, and instruction is given verbally and by printed 8 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. If the children are to be strong, it is essential that the mothers should be healthy. 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, under the supervision of Dr David Forsyth, assisted by a trained nurse and members of the Society. The general approval which this experiment received, induced the Society to open a second centre at the Health Office, 1, Pimlico Road, for the southern part of the city under the supervision of Dr. R. C. Jewesbury. The method adopted is to get in touch with the mothers through the home visiting. They are invited to bring their children to the Centre to have them examined, and receive such advice as may be necessary as to feeding, clothing, &c. Any defects which are discovered are noted so that suitable treatment may be obtained, and any tendency to the development of defects is pointed out, and advice given as to how they may be prevented. Mothers are advised to bring their children regularly for re-inspection, the interval depending on the state of the child's health, and in the meantime the health visitors keeping in touch with the homes, ensure that the medical advice is not forgotten. In the year 1913, the total number of children examined for the first time was 873 (45 being over 5 years of age), and 730 re-inspections were made. At the North Centre, the children attending are of many nationalities and races, while at the south they are nearly all of British extraction. A much larger proportion of the former required to have some alteration in the method of feeding than of the latter, where the percentage was 30 per cent. The combined result of the two years' inspections at the North Centre has been summarised by Dr. Forsyth in the following table, and is based on the examination of 664 children under 5 years of age:— Age of Child 0—1 1—2 2—3 3—4 4—5 Nos. examined 294 119 120 79 52 Per cent. Per cent. Per cent. Per cent. Per cent. Decayed teeth — 1.7 16.7 45.6 55.8 Enlarged tonsils — 6.7 21.7 27.8 30.8 Adenoids 3.0 8.4 20.0 39.2 48.0 Rickets 19.0 24.4 8.3 5.0 1.9 Diet modified 45.6 23.5 4.2 - - 9 Dr. Jewesbury divides those examined according to age, and gives a list of defects found, of which the following are the principal:— Age of Child 0—1 1—2 2—3 3—4 4—5 5 and over. Number inspected 226 138 64 73 7 5 Defectives* 119 91 33 54 5 5 Improperly fed 40 24 6 — — — Rickets 19 31 7 3 — — Wasting and general debility 21 10 2 4 — — Gastro-interitis 12 2 1 — — — Tonsils and adenoids — — 4 9 2 2 Enlarged glands — 3 — 4 — 1 Decayed teeth - 3 1 4 1 2 * Inclusive of children improperly fed. Attention is drawn by Dr. Forsyth to the part played by neglected decayed teeth: children with them seem unduly liable to tonsillar and adenoid affections and to bronchitis, while the septic state of the mouth also conduces to derangement of the stomach and bowels. Special attention is given to the children of tuberculous parents and to suspect cases, and 89 children were reported upon at the two centres. The information relating to children, which is obtained through the visiting of families, is supplied to the school medical inspector when he examines the " entrants" at each school, and the value of this is enhanced when the child has been under regular medical supervision previously, Housewifery and Mothercraft Classes.—In addition to the advice given at the medical inspection, classes have been instituted for the purpose of educating mothers in various ways, " which will enable them to improve the health of their children and the hygiene and comfort of their homes." To this end classes are held at which needlework and garment making is taught, after which short addresses are given on various health subjects; demonstrations and practical cookery lessons are also given, and visits for the same object are also given in the homes, where mothers are shown how to make the best of the money and appliances they possess. Sir George Newman, Medical Officer to the Board of Education, in his annual report for 1912, writes in strong terms of commendation of such work as this, and suggests how schools for mothers might be further developed so as to include a treatment clinic and a day nursery, carried on largely by voluntary effort, but aided and supervised by the central and local authority. The Board of Education is now prepared to make 10 grants in aid for regular class instruction to schools for mothers which conform to regulations laid down by the Board. Deaths. 2,208 deaths were registered in the City in the 53 weeks ending the 3rd January, 1914. After deducting 1,048 deaths of non-citizens in public institutions in the City, and adding those of 870 citizens who died in other districts, the corrected total is 2,030, and is equivalent to an annual rate of 127 per 1,000 persons. The average death-rate for the five years 1903-7 was 13.2, and for the five years 1908-12, 12.2 per 1,000. The London death-rate for 1913 was 14.2, the average for the previous five years being 14.7. For England and Wales the rate was 13.4. . Tables appended to this part of the Report show the vital statistics of the Citv and five groups of districts from 1892 to 1913. The death-rates, according to the old districts of the City, are:— District. Average of Previous 10 Years. 1913. St. George 11.7 11.8 Westminster 15.2 13.9 St. James and St. Anne 11.7 12.1 Strand and St. Martin 14.0 14.1 The City 12.9 12.7 Distribution according to Wards and the locality at time of death are shown in Table III. There were 10 deaths in hotels of persons who came from abroad whose deaths have to be included in Westminster. Before 1911 such deaths would have been excluded. Cause of Death at all Ages.—These are set forth in Table I, and also their distribution in the various Wards of the City. Deaths in 1913 exceeded those recorded in 1912, from influenza (by 21), diseases of the lungs (by 38), pulmonary tuberculosis (by 15), cancer (by 12), diarrhoea (by 11), accidents or negligence (by 8), old age (by 23), prematurity (by 9), developmental causes (by 14); on the other hand, deaths from the following causes were fewer in 1913, measles (by 12), whooping-cough (by 10), erysipelas, puerperal fever and other septic causes (by 14), diabetes (by 8), diseases of the nervous system (by 17). 11 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 upwards. 1911 2,005 243 66 53 36 63 295 586 658 1912 1,984 195 43 44 49 54 306 594 699 1913 2,030 213 46 36 41 68 328 609 689 The distribution of deaths under 1 and over 65 years is shown below:— 1913. 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 2 2 3 9 Grosvenor 2 1 2 1 6 17 13 3 11 41 Hamlet of Knightsbridge - - 1 - 1 8 4 7 6 25 Knightsbridge St. George 1 1 4 4 10 16 12 9 12 49 Victoria 23 14 12 17 66 69 56 41 54 220 St. Margaret 3 3 1 4 11 13 10 6 4 33 St. John 17 18 17 24 76 48 29 26 30 133 St. Anne 1 5 4 3 13 10 9 4 6 29 Great Marlborough — 1 1 1 3 6 4 6 10 26 Pall Mall — — - — — 2 3 2 4 11 Regent 3 2 1 3 9 12 7 5 9 33 Charing Cross — 1 — — 1 2 2 3 5 12 Covent Garden 4 2 2 7 15 5 9 4 12 30 Strand — - 1 — 1 13 7 9 6 35 The City 1913 55 48 46 64 213 223 167 127 172 689 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 107 deaths per 1,000 births registered in the City, against a rate of 110, the average of the previous ten years. The corrected rate works out at 95, the average of the previous five years having been 92, and of the preceding five years 1903-7, 110. Below are given figures for both births and deaths of infants corrected, distinguishing legitimate and illegitimate births, showing the true rate in each of the last eleven years:— 12 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 1913 2,057 184 89 176 29 164 95 Victoria Ward 648 58 89 75 8 106 91 St. Margaret and St. John 667 72 107 49 15 306 121 Rest of City 742 54 72 52 6 115 75 For all London the rate was 105 in 1913, compared with 91 per 1,000 in 1912; for England and Wales the rate was 109, compared with 95, the rate for 1912. Table V 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. There is a slight increase in deaths from diarrhoea and enteritis (chiefly in St. John's Ward), in congenital defects, debility and atrophy, syphilis and pneumonia, while there is a decrease in deaths from bronchitis, injury and neglect at birth, whooping cough and other causes. In a number of instances, the infants were not born in Westminster, the families moving into the City afterwards, and consequently there was no information available until the death was registered. Statistics of Dwellers in Block Dwellings.—These are set out in Table VI. A comparison or the births and deaths in the Council's Buildings in Regency Street during the last nine 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 57 500 23 20.2 140 1906 1,150 63 54-7 16 13.9 111 1907 1,163 60 51-6 18 15.5 116 1908 1,155 50 43.2 10 8.6 120 1909.. 1,156 44 38.0 12 10.3 99 1910 1,120 37 33 0 8 7.1 108 1911 1,063 37 34.8 19 17.8 81 1912 1,215 43 35.3 15 12.3 69 1913 1,113 39 34.3 9 7.9 128 13 Common Lodging-houses. The total common lodging-house accommodation available during the year was 2,255 beds for men, 62 for women. At the end of the year the accommodation for men was reduced to 2,051 by the closure of the Salvation Army Shelter, Kean Street, and the lodging-house at 45-47, Tufton Street. Deaths.—90 deaths (85 males and 5 females) occurred in 1913 among inmates of the common lodging-houses and shelters in the City. 35 of the deaths were due to phthisis, 22 to respiratory diseases, 7 to nervous diseases, 7 to diseases of the heart and blood vessels, 8 to cancer, and 3 to kidney disease. There were 43 deaths from St. John's Ward, 9 from Covent Garden, and 36 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 five years among persons alleged to have been inmates:— Common Lodging Houses. No. of beds. Deaths. 1909. 1910. 1911. 1912. 1913. Men. Bruce House, Kembie Street (L.C.C.) 706 28 36 34 24 32 33, Great Peler Street 397 22 11 8 14 16 Ham Yard Hospice, Great Windmill Street 20 11,12, and 13, Hanoyer Court 105 10 8 8 8 9 108, Regency Street 8 The Schools, Kean Street (S.A. Shelter) 125 7 8 4 10 4 16, Strutton Ground. 222 10 3 8 7 12 45 and 47, Tufton Street 79 — 2 3 4 5 S.A. Shelter, Great Peter Street 593 — 1 6 8 2 Women 40, Great Peter Street 62 1 4 4 1 5 In addition, 5 deaths were recorded of former inmates of common lodging-houses the use of which has been discontinued. Tuberculosis.—87 new cases of pulmonary tuberculosis (8 being women) were notified from common lodging-houses or as being homeless. Of the 87, 17 have died since notification in 1913, and the deaths have been recorded of 26 notified in previous years, but probably a number have died elsewhere. The total number of deaths from all causes recorded in 1913 of persons with common lodging-house addresses, or as homeless, was 221, as compared with 160 in 1912. B 14 Table I.—Causes of, and Ages at, Death during the year ending 3rd January, 1914. Causes of Death. Corrected Deaths in the City at subjoined Ages. Deaths in Wards (at all Ages). All ages. Under 1. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. Conduit. Grosvenor. Hamlet of Knightsbridge. Knightsbridge St. George. Victoria. St. Margaret. St. John. St. Anne. Great Marlborough. Pall Mall. Regent. Charing Cross. Covent Garden. Strand. Smallpox — — — — — — — — — — — — — — — — — — — — — — — Measles 24 5 10 5 3 1 — — — 1 — 1 — 7 5 7 1 1 1 Scarlet fever 6 — 1 2 — 1 1 1 — — — 1 — 2 — 2 — 1 Influenza 35 2 — — — — 3 14 16 1 5 2 3 10 5 4 — — 3 1 1 Whooping-cough 7 4 2 1 — — — — — — — — — l — 6 — — 1 — Diphtheria, Memb. croup 9 2 1 3 3 — — — — — — — 1 ?, 3 1 2 — Cerebro-spinal meningitis — — — — — — — — — — — Enteric fever 4 — — — — 2 2 1 2 1 — — Diarrhoea 20 10 4 2 1 1 2 1 4 2 7 2 — — 1 2 1 Enteritis 29 23 3 — — — 1 1 1 1 10 1 15 1 — — 1 — — Erysipelas 4 1 — — — 1 1 1 1 1 1 1 — — Puerperal fever 2 — — — 1 1 — — 1 — — — — — — —1— — — — — — — Other septic diseases 15 2 1 2 6 3 1 2 1 1 1 1 3 3 1 1 — — 1 — Syphilis, &c 11 6 — — — 3 1 1 — — — 1 1 6 — — 1 2 — Diabetes 14 1 1 6 6 3 1 3 2 3 1 — — Rheumatic fever 5 2 ] 2 2 1 2 — — — — — — — Tuberculosis of meninges 19 3 1 10 5 — 1 3 1 8 4 — — — — — Tuberculosis of lungs 198 — — 1 13 92 81 11 3 6 2 6 41 11 56 11 11 1 8 2 23 17 15 Tuberculosis of peritoneum 8 1 — — 1 2 2 1 1 — 1 2 1 2 1 — — 1 — — — Other forms of tuberculosis 15 1 3 2 4 1 4 — 1 1 4 1 o 1 1 — — — 1 2 Malignant growths 229 — — — — 4 34 110 81 2 20 8 7 75 11 58 15 6 5 7 5 6 4 Premature birth 57 57 — — — — — 2 1 22 2 18 2 5 1 4 Developmental diseases 46 40 4 2 1 2 1 3 14 1 15 1 3 — — 5 Old age 131 — — — — — — — 131 — 3 3 12 40 3 32 1 5 2 5 2 5 18 Meningitis and convulsions 10 4 1 — 3 1 1 — — 1 __ 1 2 2 — — 1 1 — 1 1 Loc. Ataxia and general paralysis 23 — — — — 12 11 — — 1 — 2 9 1 6 — 1 — — 1 2 — Other diseases of nervous system 49 1 — 1 2 — 12 18 15 1 3 1 4 11 1 10 5 2 — 3 1 4 3 Valvular diseases of heart 74 — 1 — 2 12 31 28 1 6 3 5 20 6 14 4 1 1 6 1 3 3 Other circulatory diseases 256 — — — 4 2 22 85 143 6 13 8 22 81 14 50 1G 10 6 9 3 13 5 Bronchitis 164 9 2 1 1 — 8 32 111 5 7 8 54 8 43 6 8 13 7 5 Bronclio-pneumonia 68 23 4 5 1 1 5 13 16 2 2 1 4 17 5 23 4 2 2 2 2 2 Pneumonia, other forms 101 5 4 — 1 7 23 33 28 2 4 3 4 22 10 20 8 5 3 4 3 11 2 Other respiratory diseases 29 — 1 1 2 2 5 10 8 2 2 2 2 5 10 1 — 1 1 2 1 Alcoholism 21 — — 1 5 11 4 — 1 — 7 3 4 — 1 — — — 4 1 Cirrhosis of liver 31 — — — — 1 25 5 — 1 2 11 3 1 2 1 2 1 1 3 3 Appendicitis and typhlitis 12 — — 2 2 1 4 3 — 4 1 2 1 — — 1 1 2 Other digestive diseases 50 2 — — — 2 10 20 16 — 6 2 3 12 3 10 4 4 3 1 2 Bright's disease, &c. 92 1 — _ — 1 9 45 36 3 4 3 2 36 6 14 9 3 4 4 2 2 Generative system diseases 11 5 4 2 2 1 1 6 1 1 — — — — — — — Accidents and diseases of parturition 6 — — — — 1 5 — — — 1 3 — — — — 1 — — — — — Deaths by accident or negligence 74 7 1 2 2 6 26 17 13 1 5 2 8 22 5 13 5 2 2 3 2 3 2 1 Deaths by suicide and murder 28 2 1 1 3 12 7 2 1 3 8 1 6 4 — — 2 — 1 Other defined diseases 43 2 2 — 3 4 7 17 8 2 — 1 5 11 5 9 2 1 1 1 3 2 Diseases, ill defined or unknown — — — — — — — — — — — — — — — — — — — — — — — All causes 2,030 213 46 36 41 68 328 609 689 29 105 61 122 574 128 482 115 67 29 88 36 119 75 B 2 16 Table II.— Vital Statistics of Whole Districts during 1913 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 Non. Resi dents Eegistered in the District. Of Residents not Registered in the District. Under 1 Year of Age. At all Ages. Nett. Number.* Rate. N umber.* Bate per 1,000 Nett Births. Number.* Rate. Number. Rate. 1906 170,652 2,766 2,931 17.1 2,482 14.5 1,045 790 323 110 2,227 13.0 1907 168,396 2,732 2,927 17.3 2,396 14.2 992 833 303 103 2,237 13.3 1908 166,170 2,665 2,913 17.5 2,437 14.6 1,089 829 293 100 2,177 13.1 1909 163,974 2,520 2.751 16.7 2,406 14.6 1,091 881 258 93 2,196 13.3 1910 161,803 2,365 2,592 16.0 2,164 13.8 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 2,134 2,349 14.8 2,113 13.4 982 853 195 83 1,984 12.5 1913 155,678 1,992 2,233 14.1 2,208 13.1 1,018 870 213 95 2,030 12.7 * 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 patient has been directly transferred from one such institution to another, the death is transferable to the district of residence at the time of admission to the first institution. (2.) The deaths of infants born and dying within a year of birth in an institution to which the mother was admitted for her confinement should be referred to the district of fixed or usual residence of the parent. (3.) Deaths from violence are to be referred (a) to the district of residence, under the general rule; (4) if this district is unknown, or the deceased had no fixed abode, to the district where the accident occurred, if known; (e) 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 60,261 Area of District in acres (exclusive of area covered by water) 2,502 7 Number of inhabited houses 17,540 V At Census of 1911. Average number of persons per house 9.1 17 Table II—continued. I. Institutions within the District receiving Sick and Infirm Persons from outside the District. (Total Number of Deaths in brackets.) II. Institutions outside the District receiving Sick and Infirm Persons from the District. II—continued. Institutions outside the District receiving Sick and Infirm Persons from the District. St. George's Hospital (335). Middlesex Hospital. Addenbroke Hospital, Cambridge. Westminster Hospital (250) St. Thomas's Hospital. Charing Cross Hospital (208) St. Bartholomew's Hospital. St. Catherine's Hospital, Ramsgate. King's College Hospital (89). St. Mary's Hospital. St. Peter's Hospital (28). German Hospital. Passmore Edwards Hospital. Grosvenor Hospital (11). Guy's Hospital. Royal Sussex Hospital. Heart Hospital, Soho Square (17). Freidenheim Hospital. Hampstead General Hospital. Brompton Hospital. Women's Hospital, Soho Square (12). Italian Hospital. Princess Alice Hospital. Northern Hospital. Mount Vernon Hospital. Throat Hospital, Golden Square (17). French Hospital. Atkinson-Morley Hospital, Wimbledon. Victoria Hospital. Gordon Hospital (5). Great Ormond Street Children's Hospital. Downs Sanatorium. Queen Alexandra Military Hospital, Millbank (27). Hospital for Jewish Incurables. Cancer Hospital, Chelsea. Infants' Hospital (159). University College Hospital. Cottage Hospital, Dorking. Royal Ear Hospital (1). Hospital of St. John and St. Elizabeth. St. George's Infirmary, Fulham Road. King Edward's Hospital (2). Westminster Ophthalmic Hospital (1). London Hospital. Edmonton Workhouse. South-Western Fever Hospital. St. George's Workhouse, Fulham Road. All Saints' Hospital (2). Poland Street Workhouse (12). Park Fever Hospital. Central London Sick Asylum, Cleveland Street. Grove Fever Hospital. Sheffield Street Workhouse (13). North-Western Fever Hospital. Central London Sick Asylum, Hendon. 22, George Street, Hanover Square, Nursing Home (2). Western Fever Hospital. Marylebone Infirmary. South-Eastern Fever Hospital. Holborn Infirmary. 42. Belgrave Road (4). Chelsea Infirmary. 96, Belgrave Road (4). London Fever Hospital. Islington Infirmary. Brook Fever Hospital. St. Pancras Infirmary. Fountain Fever Hospital. Hackney Infirmary. Evelina Hospital. Paddington Workhouse. Bolingbroke Hospital. Fulliam Workhouse. St. Catherine's Hospital, Ramsgate. Kingston Infirmary. Banstead Asylum. Battersea General Hospital. Long Grove Asylum. Children's Hospital, Pactdington. Cater bam Asylum. Claybury Asylum. Hostel of God. Colney Hatch Asylum. Homoeopathic Hospital. Darenth Asylum. Queen Mary's Hospital, Carshalton. Hanwell Asylum. Horton Asylum. City of London Lying-in Hospital. Leavesden Asylum. Tooting Bee Asylum. General Lying-in Hospital. Manor Asylum. Samaritan Free Hospital. Camberwell House Asylum. Alexander Free Hospital. Fisherton House Asylum. Central London Throat and Ear Hospital. Cane Hill Asylum. Brighton Asylum. Royal Victoria Hospital, Folkestone. East Sussex Asylum. Earls wood Asylum. 18 Table II—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, Pembridge Square. 39, Royal Avenue, Chelsea. 46, Hendrick Avenue, Battersea. 6, Coliseum Terrace, St. Pancras. St. Joseph's Hospice, Hackney. 5, Knaresborough Place, Kensington. 4, 8 and 15, Dorset Square, Marylebone. 15, 19, 20, 33, 46, 50, 52, 57, Beaumont Street, Marylebone. 29, Wimpole Street. 7, Circus Street. 4, Holford Road, Hampstead. 75, Oxford Terrace. 14—15, Henrietta Street, Marylebone. 11, Nottingham Place. 3, Upper Montague Street. 2, Queen Downs Road, Hackney. 4, Upper Wimpole Street. 3, Devonshire Terrace, Marylebone. 33, Brixton Hill. 131, Upper Richmond Road, Putney. 3 and 9, Mandeville Place, Marylebone. 19 Table 111.—Deaths of Citizens during the Year ending 3rd January, 1914, 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 8 5 13 1 1 2 3 5 8 - - - - - - 4 2 6 16 13 29 Grosvenor 26 36 62 3 6 9 10 6 16 - — - 3 1 4 11 3 14 53 52 105 Hamlet of Knightsbridge.. 17 27 44 2 1 3 4 5 9 1 — 1 - — — 2 2 4 26 35 61 Knightsbridge St. George 29 43 72 6 9 15 8 9 17 1 - 1 4 3 7 8 2 10 56 66 122 Victoria 117 155 272 62 86 148 50 34 84 3 5 8 23 11 31 18 10 28 273 301 574 St. Margaret 35 39 74 2 10 12 17 9 26 1 1 2 3 — 3 8 3 11 66 62 128 St. John 99 78 177 96 63 159 55 38 93 6 6 12 13 10 23 11 7 18 280 202 482 St. Anne 19 21 40 17 11 28 16 21 37 1 — 1 1 2 3 3 3 6 57 58 115 Great Marlborough 5 6 11 16 10 26 7 8 15 — — — 6 7 13 — 2 2 34 33 67 Pall Mall 16 2 18 — — — 3 3 6 — — — — — — 4 1 5 23 6 29 Regent 22 14 36 8 12 20 10 10 20 - — - 5 3 8 1 3 4 46 42 88 Charing Cross 10 5 15 8 1 9 2 2 4 — — — 1 — 1 6 1 7 27 9 36 Covent Garden 27 19 46 17 7 24 20 14 34 3 1 4 3 6 9 2 — 2 72 47 119 Strand 8 3 11 41 13 54 1 1 2 — — — 6 1 7 1 - 1 57 18 75 City of Westminster 438 453 891 279 230 509 206 165 371 16 13 29 68 44 112 79 39 118 1,086 944 2,030 20 Table IV (L.G.B. Table).- - Vital Statistics of Separate Localities, 1903-1913. Names of Localities 1. The City of Westminster. 2. St. George's, comprising Conduit, Grosvenor, Victoria, and Knightsbridge St. George Wards. 3.Westminster, comprising St. Margaret, St. John, and the Hamlet of Knightsbridge Wards. 4. St. James, comprising Regent, Marlborough, Pall Mall and St. Anne's Wards. 5. Strand, comprising Covent Garden, Strand, and Charing Cross Wards. Year. Population estimated to middle of each year. Births registered'(uncorrected). Deaths at all ages (corrected). Deaths under 1 year. Population estimated to middle of each year. Births registered (uncorrected). Deaths at all ages (corrected). Deaths under 1 year. Population estimated to middle of each year. Births registered (uncorrected). Deaths at all ages (corrected). Deaths under 1 year. Population estimated to middle of each year. Births registered (uncorrected). Deaths at all ages (corrected). Deaths under 1 year. Population estimated to middle of each year. Births registered (uncorrected). Deaths at all ages (corrected). Deaths under 1 year. 1903 177,602 3,017 2,419 370 75,359 1,156 833 135 50,502 1,071 824 143 31,184 543 440 63 20,483 247 322 29 1904 175,254 2,897 2,376 360 74,660 1,183 886 139 50,152 985 813 150 30,376 489 365 43 19,975 240 312 28 1905 172,938 2,940 2,347 329 73,967 1,162 868 115 49,804 1,057 857 138 29,589 533 353 50 19,479 188 269 26 1906 170,652 2,766 2,227 323 73,280 1,150 868 124 49,459 973 789 124 28,823 513 334 58 18,996 179 236 17 1907 168,396 2,732 2,237 303 72,601 1,101 905 95 49 116 998 778 142 28 077 437 308 47 18,524 196 246 19 1908 166,170 2,665 2,177 293 71,927 1,076 878 111 48,776 993 688 117 27 349 416 323 42 18,065 180 288 23 1909 163,974 2,520 2,196 258 71,260 1,038 843 104 48,437 930 771 94 26,641 384 343 46 17,617 168 239 14 1910 161,803 2,365 1,891 214 70,598 958 759 74 48,101 893 640 100 25,951 358 267 30 17,180 156 225 10 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 1912 157,693 2,134 1,985 195 69,294 898 847 87 47,437 812 670 81 24,624 275 259 19 16,338 149 208 8 Averages of 10 years 1903-1912 167,419 2,614 2,185 288 72,288 1,064 848 108 48,955 950 750 118 27,789 421 328 42 18,341 182 258 19 1913 155,678 1,992 2,030 213 68,651 901 830 83 47,108 703 671 88 23,986 264 299 25 15,933 124 230 17 21 Table IV, continued.— Vital Statistics of Separate Localities, 1903-1913.—Rates. Localities 1. City of Westminster. 2. St. George's. 3. Westminster. 4. St. James. 5. Strand. Year. Births Registered (uncorrected). Rate per 1,000. Deaths at all Ages (corrected). Rate per 1,000. Deaths under 1 Year. Rate per 1,000 Births (uncorrected). Births Registered (uncorrected). Rate per 1,000. Deaths at all Ages (corrected). Rate per 1,000. Deaths under 1 Year. Rate per 1,000 Births (uncorrected). Births Registered (uncorrected). Rate per 1,000. Deaths at all Ages (corrected). Rate per 1,000. Deaths under 1 Year. Rate per 1,000 Births (uncorrected). Births Registered (uncorrected). Rate per 1,000. Deaths at all Aces (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). 1903 16.9 13.6 122 15.3 11.0 116 21.2 16.3 133 17.3 14.1 116 12.0 15.7 110 1904 16.5 13.5 124 15.8 11.8 117 19.6 16.2 152 16.1 12.0 87 12.0 15.6 69 1905 17.0 13.5 111 15.7 11.7 99 21.2 17.2 131 18.0 11.9 93 9.6 13.8 92 1906 16.2 13.0 116 15.6 11.8 100 19.6 15.5 127 17.8 11.5 113 9.4 12.4 115 1907 16.2 13.2 110 15.1 12.4 86 20.3 15.8 142 15.5 10.9 107 10.5 13.2 94 1908 16.0 13.1 109 14.9 12.2 103 20.3 14.1 117 15.2 11.8 100 9.9 15.9 104 1909 15.3 13.3 102 14.5 11.8 100 19.2 15.9 101 14.4 12.8 119 9.5 13.5 149 1910 14.6 11.6 90 13.5 10.7 77 18.5 13.3 111 13.7 10.2 83 9.0 13.0 100 1911 13.2 12.5 115 13.2 11.4 110 16.6 14.0 121 10.6 11.5 93 7.2 14.5 71 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 Ayerage of 10 years 1903-12 15.5 12.9 109 14.6 11.7 100 19.3 15.2 123 14.9 11.7 98 9.8 14.0 95 1913* 12.5 12.7 106 12.8 11.8 92 14.6 13.9 125 10.8 12.1 94 7.6 14.1 137 * The rates in these years are calculated on a 53-week population. 22 Table V.—Infantile Mortality during the year 1913. City of Westminster. Deaths from Stated Causes in Weeks and Months under One Year of Age. CAUSE OF DEATH. Under 1 Week. 1—2 Weeks. 2—3 Weeks. 3—4 Weeks. Total under 1 Month. 1—2 Months. 2—3 Months. 3—4 Months. 4—5 Months. 5—6 Months. 6—7 Months. 7—8 Months. 8—9 Months. 9—10 Months. 10—11 Months. 11—12 Months. Total Deaths under One Year. Common infectious diseases— Small-pox - - - - - - - - - - - - - - - - - Chicken-pox - - - - - - - - - - - - - - - - - Measles - - - - - - - - - - - - 1 - 3 1 5 Scarlet fever - - - - - - - - - - - - - - - - - Diphtheria - - - - - - - - - - - - - 1 1 —. 2 Whooping cough — — — — — 1 1 — — — — — 2 — — — 4 Diarrhœal diseases- Diarrhœa — — — — - 3 — 2 1 3 - 1 - — — — 10 Enteritis - - — — - 2 3 5 6 2 4 - 1 — - - 23 Gastritis - - - - - - - - - - - - - - - - - Wasting diseases— Premature birth 36 1 — 5 42 8 2 3 1 1 - - - - - - 57 Congenital defects 3 3 1 1 8 3 3 2 - - - - - 1 — 1 18 Injury at birth 1 2 - - 3 - - - - - - - - - - - 3 Debility from birth 2 1 - — 3 — 1 — - - — — - — — — 4 Atrophy, marasmus 1 1 3 - 5 - - 3 1 1 - 1 - — — — 11 Neglect at birth 3 - - - - - - - - - - - - - - - 3 Tuberculous diseases— Tuberculous meningitis — — — - — - - - - 1 - - 1 - 1 — 3 Tuberculosis, abdominal - - - - - - - - 1 - - - - - - - 1 Other tuberculous diseases — - 1 - 1 - - - - - - - - - - - 1 23 Table V—continued. CAUSE OF DEATH. Under 1 Week. 1-2 Weeks. 2—3 Weeks. 3—4 Weeks. Total under 1 Month. 1—2 Months. 2—3 Months. 3—4 Months. 4—5 Months. 5—8 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 2 — 1 — 1 — — — - - — 2 6 Rickets - - - - - - - - - - - - - - 1 2 3 Meningitis (not tuberculous) - - - 1 1 - - - - - - - - 2 - - 3 Convulsions - - 1 - 1 - - - - - - - - - - - 1 Bronchitis — 2 — 1 3 2 — 1 — 1 — — 1 1 — — 9 Laryngitis — — — — — — — — — — — — - - — — — Pneumonia (all forms) — 2 1 — 3 1 4 1 1 3 — 3 2 5 2 3 28 Suffocation, overlaying 1 — — — 1 — 1 1 — — — — - - — — 3 Other causes 2 — 1 — 3 4 3 — — 2 — — 1 - — 1 14 50 12 8 9 79 24 20 18 12 14 4 5 9 10 8 10 213 Nett Births in the year—Legitimate, 2,057; illegitimate, 176—Total 2,233. Nett Deaths in the year of legitimate infants, 184; illegitimate infants, 29—Total 213. The causes of death of the illegitimate children were: prematurity, 6; debility at birth, 1; want of attention at birth, 3; diarrhoea, 2; enteritis, 6; pneumonia, 1; syphilis, 2; suffocation, 2: marasmus, 2; bronchitis, 1; whooping cougli, 1; murder, 1; congenital defects, 1 24 Table V, continued.—Infantile Mortality during the year 1913. 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 — 2 3 Whooping cough — — — — — 1 1 — — — — — — — — — 4 Diarrhœa — — — — — i — i — 1 — 1 — — — — 4 Enteritis — — — — — 2 — 5 3 2 2 — — — — — 14 Premature birth 14 1 — 1 16 1 2 1 — — — — — — — — 20 Congenital defects — — — — — 1 — — — — — — — 1 — — 2 Injury at birth 1 — — — 1 — - — — — — — — — — — 1 Debility at Birth — 1 1 — 1 — 1 — — — — — — — — — 2 Atrophy, debility, marasmus 1 1 1 — 3 — — 2 — — — 1 — — — 1 7 Tuberculous meningitis — — — — — — — — — — — — 1 — 1 — 2 Abdominal tuberculosis — — — — — — — — — — — — — — — — — Other tuberculous diseases — — — — — — — — — — — — — — — — — Erysipelas — — — — — — — — — — — — — — — — — Syphilis — — — — — — 1 — 1 — — — — — — 2 4 Convulsions — — — — — — — — — — — — — — — — — Bronchitis — 1 — — 1 1 — — — 1 — — 1 — — — 4 Pneumonia, all forms — — 1 — 1 1 3 1 — 1 — 1 1 3 1 1 14 Suffocation, overlaying 1 — — — 1 — — 1 — — — — — — — — 2 Other causes — — — — — 2 1 — — 1 — — - — - — 4 17 4 2 1 24 10 9 11 4 6 2 3 6 4 4 4 87 Nett Births in the year—Legitimate, 667; illegitimate, 49. Total 716. Nett Deaths in the year of legitimate infants, 72 ; illegitimate infants, 15. 25 Table V, continued.—Infantile Mortality during the year 1913. Victoria Ward. Deaths from Stated Causes in Weeks and Months under One Year of Age. CAUSE OF DEATH. Under I 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 Wliooping Cough .. — — — — — — — — — — — — — — — — — Diarrhoea — — — — — — — — — 1 — — — — — — 1 Enteritis .. .. k. — — — — — — 3 — 2 — — — 1 — — — 8 .Premature birth .. ». 11 i — 2 14 4 — 2 1 1 — — — — — — 22 Congenital defects — 2 — — 2 1 1 1 — — — — — — — — 5 Injury at birth — 1 — — 1 — — — — — — — — — — — 1 Debility from birth 1 — — — 1 — — — — — — — — — — — 1 Atrophy, debility, marasmus — — 1 — 1 — — 1 1 1 — — — — — — — Tuberculous meningitis — — — — — — — — — — — — — — — — — Tuberculosis, abdominal — — — — — — — — 1 — — — — — — — 1 Other tuberculous disease .. — — — — — — — — — — — — — — — — — Bronchitis — 1 — 1 2 — — 1 — — — — — 1 — — 4 Pneumonia, all forms — 2 — — 2 — 1 — — 1 — 1 1 1 — 1 8 Dentition — — — — — — — — — — — — 1 — — — 1 Convulsions — — — — — — — — — — — — — — — — — Other causes .. 2 — — . — 2 2 2 — — — — — — 1 — — 7 14 7 1 3 25 7 7 5 5 4 2 1 3 3 2 2 66 Nett Births in the year—Legitimate, 648; illegitimate, 75, Total 723. Nett Deaths in the year of legitimate infants, 58; illegitimate infants, 8. 26 Table VI.— Vital Statistics relating to Residents in Blocks of Dwellings in the City of Westminster, 1913. 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 1,113 39 9 1 4 — 1 1 — — — 1 1 — 5 1 St. James's Dwellings, Ingestre Place, and Marshall Street 108 2 4 — — — 1 — 2 — — 1 — — — 1 Peabody 7,025 159 88 2 13 27 4 12 4 2 5 10 6 3 16 21 Westminster 187 4 4 — 1 — — 1 — — — — 1 1 2 1 London County Council— Millbank 3.010 67 39 — 6 7 3 6 4 1 1 7 1 3 5 5 Drury Lane 775 17 17 — 5 3 1 4 1 — — 2 1 5 4 Improved Industrial 4,400 102 43 — 3 4 4 7 5 1 4 6 2 1 5 16 Metropolitan Association 546 10 4 2 — — — 1 — — — 1 — — 1 2 St. George's Model Dwellings 419 9 2 — — 1 — — — — — 1 — — — 1 Clerkenwell and Soho Company (Newport Market) 1,184 18 13 1 2 3 2 1 — 2 — 2 — — — 5 Greencoat 119 6 2 1 — v 1 — — — — — — — — — Spencer 99 1 — — — — — — — — — — — — — — Chapter Chambers 175 5 — — — — — — — — — — — — — — Alexandra and Castle — 1 4 1 — — 2 — — — — — — 1 1 — St. James's Residences — 12 3 — — — — — — — 1 — 1 1 2 — 27 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 VII), 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 VIII, 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, diphtheria, and enteric fever was above the number notified in the previous year. The same applies to Westminster. A number of doubtful cases, contacts, and certain patients returning from fever hospitals, &c., were visited during the year. In August and September, when a large number of children are sent to the country by various agencies, it is not infrequent to find that some of them return with various diseases of an infectious character. It has been mentioned in the papers that several local authorities in the country complain that insufficient care is taken in sending children to holiday homes, and that infectious disease is thus introduced into their districts. So far as Westminster is concerned, I know that the various agencies regularly make careful enquiries, and no child is sent away from a house from which any case of infectious disease has been notified. It may, of course, happen that a child is apparently well on leaving London, but may have been unknowingly infected just before, and consequently does not develop any symptoms until arrival in the country. It would be an advantage if the cottages to which the children are sent were examined by the local authority as to their fitness for the purpose, and certified as to the number of children who may be accommodated. This would necessitate a visit when each fresh batch of children arrived, to see that overcrowding did not occur, and the existence of any suspicious illness might be detected at the same time. Smallpox.—There were no cases of smallpox notified in Westminster, but 51 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 1912:- 28 Vaccination Statistics. 1912. Union. Births. Died Unvaccinated. Successfully Vaccinated. Insusceptible. Vaccination Postponed. Conscientious Objectors. Removed and Vaccination Officer Informed. Not Found. Removed to Address Unknown. St. George 1,722 110 1,327 3 9 195 16 62 Westminster Strand 433 20 310 2 — 56 5 40 The City 2,155 130 1,637 5 9 251 21 102 The number of "conscientious objectors " has increased from 14 in 1905 to 251 in 1912. The following is a summary of the total primary vaccinations performed in the City during the years 1901-13, and of re-vaccinations in so far as these were made by the Public Vaccinators:— Vaccination Returns. Primary Vaccinations under 14 years of age, in the Union District of Re-vaccinations performed by Public Vaccinators in the Union District of St. George's. Westminster. Strand. St. George's. Westminster. Strand. 1901 2,467 1,491 725 4,039 3,317 2,201 1902 2,893 715 450 7,453 6,226 3,910 1903 2,178 369 245 159 9 347 1901 2,065 325 144* 72 13 398 1905 2,162 498 142 47 7 418 1900 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 10 18 493 1913 1,340 20 7 538 363† * There were also 16 primary vaccinations of persons over 14 years of age. t There were also 162 primary vaccinations of persons over 14 years of age. Scarlet Fever.—This disease was extremely prevalent in the latter part of the year throughout London, but was of a very mild type, and many cases were so slight that the nature of the disease was not recognised unless a well-marked case occurred in the house. The notifications were 379, an excess of 141 over the previous year. Diphtheria.—There was also a greater prevalence of this disease. In Westminster there were 192 notifications against 160 in 1912. Anti-toxin was supplied in three cases treated at home. 29 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 187 cases. In 4 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.—Of the 29 persons notified in the City 8 were eventually declared not to be so suffering. Of the 21 actual cases, 6 of the patients contracted the disease out of London, most of them abroad ; 4 persons were infected from previous cases, 2 being in one family, 3 were ill after eating shell fish, and 2 after eating watercress ; no history as to the possible source of infection was available in the remaining 6 cases. Advantage was taken to obtain the City Bacteriologist's opinion in 6 cases. Ophthalmia Neonatorum.—Twenty-four infants were notified as suffering from this complaint. In 6 instances it was the first confinement. Three of the children were illegitimate. Ten children were treated at hospitals, 4 as in-patients. Twenty-one were reported to have recovered without permanent impairment of vision, no information could be obtained about 3 of the cases as the families left Westminster before the eyes were better. 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. 1'lague.—Notifications were received from Port Sanitary Authorities of 29 persons coming to Westminster from districts affected with plague. They were kept under observation. c 30 City of Westminster. Table YII.—Local Government Board Table C.— Cases of Infectious Disease Notified during the 53 weeks from 29th December, 1912, to 3rd January, 1914. Notifiable Diseases. Cases Notified in the City of Westminster. Total Cases Notified in each Ward. Number of Cases Removed to Hospital from each Ward. At all Ages. At Ages—Years. Conduit. Grosvenor. Knightsbridge St. George. Victoria. St Margaret. St. John. Kamlet of Knightsbridge. Pall Mall. Regent. Great Marlborough. Charing Cross. Co vent Garden. Strand. St. Anne. Conduit. Grosvenor. Knightsbridge St. George. Victoria. St. Margaret. St. John. Hamlet of Knightsbridge. Pall Mall. Regent. Great Marlborough. Charing Cross. Co vent Garden. Strand. St. Anne. 0 to 1. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 and upwards. Small-pox— Cases - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - Deaths - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - chicken pox- cases - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - Deaths - - - - - - - - - - - - - - - - - - - - - - Cholera- Cases - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Deaths - - - - - - - - - - - - - - - - - - - - - - Diphtheria— Cases 192 *» 5 3 si 33 1h 2 1 3 4 11 41 20 b3 1 b i — 18 4 15 2 4 8 4ti 20 53 2 1 6 7 1 h 4 15 Deaths 9 2 4 3 — — — — 1 2 — 3 — — — — — 2 — 1 Erysipelas— Cases 75 1 3 6 6 23 26 10 j 3 3 lb b 25 1 2 — 3 8 — i 1 o 2 7 1 14 2 2 2 — 1 Deaths 4 1 — — — 1 1 1 1 1 — — — — — — 1 1 — — — — Fevers— Scarlet— Cases 379 1 64 209 74 29 2 — 5 22 8 119 23 98 6 4 12 9 17 29 b 22 b 18 7 lib 21 96 6 4 12 f) 16 28 b 22 Deaths 6 — 3 — 1 1 1 — — — — 2 — 2 1 — — — 1 — — — Typhus- Cases - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Deaths - - - - - - - - - - - - - - - - - - - - - - Enteric— cases 29 - 2 - 4 14 3 - - 2 10 2 5 4 - 1 - - 2 - 3 - 2 - 10 2 5 1 - 1 - 2 - 3 Deaths 4 — - - 2 2 — — — 1 — 2 1 — - — — — — — — — - - - - - - - - - - - - - - Poliomyelitis— cases 4 - - 2 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Deaths - - - - - - - - - - - - - - - - - - - - - - Ophthalmia Neon — Cases 24 24 - - - - - - - - 1 3 16 — 3 — - — — — — — 1 - 1 - 3 - 1 - - - - - - - - Deaths — — - - - - - - - - - - - - - - - - - - - - Puerperal— Cases 6 — — — 2 4 — — — 2 — 1 — 2 — — — — — — — 1 1 — I — 1 — 1 — — — — — — — 1 Deaths 2 - - - - - - - - - - - - - - - - - - - - Totals 709 32 124 .304 119 86 33 11 9 34 26 208 50 186 14 7 21 17 20 58 9 50 8 28 18 1»2 44 170 9 5 21 17 18 51 9 42 12 cases notified as scarlet fever, 22 as diphtheria, and 3 as enteric fever were eventually alleged not to be suffering from the disease notified. 2 deaths from the following complaints, viz.: erysipelas and puerperal fever were reported, but no notification of the illnesses had been received previously. 31 Table viii.—Infectious Diseases Notified, 1890-1913, in London. Year. Smallpox. Scarlet Fever. Diphtheria and Croup. Enteric Fever. Typhus Fever. Other Continued Fevers. Puerperal Fever. Erysipelas. Cholera. Relapsing Fever. Totals. 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.C99 24,563* 1913 4 17,550 7,649 762 4 14 349 4,152 — 1 31,363* In the City of Westminster. 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* 1913 — 379 192 29 — — 6 75 — — 709* * 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 ,, ,, ,, 134 ,, Poliomyelitis „ 6 ,, ,, ,, 93 ,, Cere bo-Spinal Meningitis ,, — ,, 1913. „ 641 ,, Ophthalmia ,, 24 ,, ,, „ 145 „ Poliomyelitis „ 4 ,, ,, Case-rates per 10,000 Living in London. Year. Smallpox. Scarlet Fever. Diphtheria. Enteric. Typhus. Other Continued Fevers. Puerperal Erysipelas. 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 54.4 18.4 2.9 0.01 0.05 0.5 9.4 1908 (53 weeks) 0.00 45.1 16.3 2.7 0.00 0.02 0.4 8.6 1909 0.04 35.6 13.9 2.1 0.01 0.04 0.6 8.3 1910 0.01 21.5 11.2 2.6 0.00 0.03 0.6 8.1 1911 0.15 23.1 16.3 2.2 0.00 0.05 0.6 10.7 Average of 10 years 1902-11 1.90 35.9 16.1 3.5 0.01 0.04 0.5 9.8 1912 0.01 25.0 15.7 1.5 0.00 0.01 0.8 9.0 1913 0.00 38.9 17.0 1.7 0.00 0.01 0.8 9.2 In the City of Westminster. 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 1904 2.5 0.3 19.6 17.6 10.3 8.2 3.9 2.9 0.05 0.11 0.11 0.27 0.28 6.2 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 1913 — 23 .9 12.1 1.8 — — 0.38 4.5 c 2 32 Tuberculosis. In 1913, all forms of Tuberculosis became compulsorily notifiable, superseding entirely the voluntary system which had been in existence in Westminster since June, 1903. There was a considerable rush of notifications in the first quarter of the year, especially of old standing cases of disease of the spine, hip-joint and bones, but the numbers rapidly decreased in succeeding quarters. The total number of pulmonary cases was lower than in 1912. The total number of certificates received was 1,203, including 189 notices of admission and 168 notices of discharge from infirmary or sanatorium; 440 notifications related to cases already notified. The number of new cases of pulmonary tuberculosis was 443, and included 87 homeless persons or inmates of common lodging houses. The number of new cases of other forms of the disease was 152, of whom 8 were casuals. The following table shows the number of new cases in each of the last 5 years :— Pulmonary. Other Forms. General. Casuals. Total. 1909 270 136 406 5 1910 165 110 275 17 1911 256 100 356 38 1912 368 125 473 27 1913 356 87 443 152 The notifications of new cases calculated as rates per 1,000 of population were as follows:— Pulmonary. Other Forms. 1912. 1913. 1913. London 7.39 5.01 1 .55 England (excluding London) ... 2.44 2.32 1.11 Westminster 3.10 2.80 0.96 The figures for England and London are taken from the Local Government Board Report. Deaths from pulmonary disease of persons whose illness had not been notified during life were, 67 in 1911, 39 in 1912, and 32 in 1913, making the total number of cases in these years 423, 512 and 475. In 1913 there were 25 deaths from other forms in unnotified persons, making the total number of cases 177. Details as to age, sex, ward and institutional treatment are shown in the following tables:— 33 Public Health (Tuberculosis) Regulations, 1912. 1913. Number of notifications on Form A. Primary notifications. Total notifications, including cases previously notified. Age periods. Otol. 1 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 and up. Total new case; Pulmonary— Casuals— Males — — — — — 4 9 32 21 10 3 79 j Males, 536 ' Females, 288 Females — — — 1 — — 1 2 1 1 2 8 General— Males — 2 4 10 10 23 51 31 41 17 4 193 Females — — 3 5 8 20 44 39 29 10 4 162 Other forms— Males — 11 21 12 T 7 8 5 2 2 1 76 94 Females 8 9 11 9 7 9 8 11 5 1 — 73 86 Total 3 22 39 37 32 63 121 120 99 41 14 591 1,004 Number of notifications on Form B. (School medical inspection.) Number on Form C. Admissions to. Primary notifications. Total notifications, Including cases previously notified. Poor Law institutions. Sanatoria. Under 5. 5 to 10. 10 to 15. Total. Pulmonary— Males — — 1 1 2 124 30 Females — — — — 24 6 Non-pulmonary— Males — 1 1 2 4 1 1 Females 1 1 1 3 — Total — 1 3 4 7 152 37 34 Tuberculosis. Table showing distribution in Wards, and numbers of persons who have been treated in Institutions. All Ages. Conduit. Grosvenor. Knight&bridge St. George. Victoria. St. Margaret. St. John. Hamlet of Knightsbridge. Pall Mall. Regent. Great Marlborough. Charing Cross. Covent Garden. Strand. St. Anne. Received Institutional Treatment. Pulmonary— Common Lodging-houses, &c.— Males 79 — — — 10 I 18 — — — 1 — 6 43 — 79 Females 8 — — — 3 — 2 — 2 1 8 G-eneral— Males Females 193 162 1 2 6 8 8 8 54 53 13 7 52 35 i 7 i 3 12 8 13 8 3 2 15 8 3 2 11 11 113 75 Other forms— Males 78 2 1 7 30 4 12 2 2 1 1 — 3 9 4 52 Females 74 2 5 6 23 1 18 5 2 1 2 2 2 5 44 7 of the males and 1 of the females notified, with other forms of Tuberculosis were homeless or had been inmates of common lodging houses, &c. 35 Deaths from Tuberculosis in the Only of Westminster. Year. Pulmonary. Abdominal. Meningeal. Other. Total. Deaths, i Bates. Deaths. Kates. Deaths. Bates. Deaths. Bates. Deaths. Bates. 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 1913 198 124 8 5 19 12 15 9 240 151 The rates are calculated per 100,000 inhabitants. Seventy-three of the deaths from pulmonary disease occurred at home, 31 in hospitals and sanatoriums, 81 in infirmaries, and 13 in asylums. Deaths from other forms occurred at home 11, in hospitals 23, in infirmaries 5, and in asylums 2. In consequence of the increase in the work, it was necessary to appoint a second tuberculosis visitor, and the city was divided into two parts, Miss Sanders taking the southern part and Miss Smith, one of the sanitary inspectors, the northern. Their duties are. acting under the Medical Officer of Health, to make such enquiries 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 tuberculous patients under constant observation. Members of families, or others who are suspected of being infected, or who have been exposed to the danger, have also to be kept under observation, and brought under medical examination and treatment where necessary. The visitors also arrange for hospital, sanatorium, or convalescent treatment, and endeavour in suitable cases to see that additional food, &c., is supplied through School Care Committees, the Insurance Committee, the Guardians, and various charitable agencies. Yery 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. 36 Soldiers admitted to the Military Hospital from the various barracks are not visited ; there were 16 of these in 1913. When the death of an un-notified person occurs the family is visited, if still in the district. The number of consumptive patients visited during the year was 761, and patients suffering from other forms, 238. At the end of the year there were 449 consumptives and 169 other patients remaining on the visiting list. , Analysis of cases visited in 1913:— Pulmonary. Other Forms. North. South. Total. North. South. Total. N umber visited ... 263 498 761 64 174 238 Dead or removed 105 207 312 10 59 69 Remaining at end of year ... 158 291 449 54 115 169 The illness of many of these patients dates back for several years, and in a number of instances has been arrested. The dates when the cases were first brought under observation were:— 1903 3 1907 17 1910 123 1904 9 1908 28 1911 154 1905 4 1909 56 1912 274 1906 10 Making allowance for those not notified, soldiers and others, the actual number of persons in the City suffering from pulmonary tuberculosis at any one time may be taken to be about 510, but in addition to which there are casuals, who probably number about 100. Irrespective of casuals and soldiers, the illness of 86 consumptive persons (43 male, 43 female) notified in 1913 began previous to taking up residence in Westminster, 9 others had been resident for long periods in asylums or workhouses and developed the disease there. Of persons suffering from other forms of tuberculosis, 43 were ill previous to coming into Westminster. Changes of address are frequent for various reasons, such as inability to pay rent, through irregular work or incapacity to earn so much as formerly, to persons in lodgings not returning to the same after institutional treatment, and to servants leaving situations. Information is now received from infirmaries and sanatoriums when patients leave, but not from hospitals, and some patients change houses without informing the visitors of the new address, consequently a certain number are lost sight of for a time. When the new address is in another sanitary area, and is known, information is sent to the medical officer, and similar notice is received by me of patients moving into Westminster, 37 but from time to time persons are discovered of whom no advice has been received. If they are under medical treatment-, the medical man is not required to notify me if he believes that the case has been notified previously to some medical officer of health. Exclusive of transference to hospital, infirmary, sanatorium or temporary change of address due to visits to the country or seaside, and exclusive of the movements of casuals, 237 changes of address have been noted among pulmonary patients; 106 have moved out of Westminster, 90 have changed houses in the City, and the addresses of 41 are not at present known. Of patients suffering from other forms, 27 left Westminster, 29 changed houses in the City, and 8 have been lost sight of—64 in all. Suspects to the number of 114 have changed addresses, 29 left the City, 62 remain, and of 23 the new addresses are unknown. Disinfection was carried out in 355 houses by the Council's staff after death, or on removal of patients from one house to another or to hospital. In 44 cases, disinfection (or thorough cleaning and re-decoration of rooms) was carried out privately. Occupations.—The number of persons resident in Westminster employed in various occupations, as found at the last census, has not been published yet, so that it is not possible to gauge whether any occupation is specially affected by this disease. The appended list, showing the occupations of persons notified in the last three years, shows that tailors, clerks, waiters and indoor servants, shop assistants, general labourers and costermongers contribute a large proportion of the cases among men; servants, charwomen, and others employed in various forms of dressmaking among women. As a large number of persons employed in Westminster live elsewhere, these figures do not show the actual number of infecting centres which may exist, nor would the numbers of these living in Westminster engaged in business show the actual number at risk. The number of soldiers afleoted, either while in the Army or subsequently, seems to be high. 38 Pulmonary. Occupations of Persons Notified in 1911-13. Outdoor. Indoor. Present. Past. Present. Past. Males. Males. 1 Navy Tailors 49 Motor drivers, Conductors, &c. 17 1 Baker Packers 8 1 Army 1 Army 1 Out door porter 1 Merchant service Storekeepers 6 1 Army Carmen, horse 18 1 Army 1 Tobacconist Stable hands 14 1 'Bus driver Furniture removers 2 1 Army House painters 15 1 Prof, cricketer Clerks 33 Choir boy 1 Navy 1 Waiter Building trade 14 1 Army 1 Clerk General labourers 30 1 Army Caretakers and housekeeper 16 1 Draper 1 G. L. and Coke Co Window cleaner 2 Gardener 1 1 Army Messengers 3 1 Navy Commissionaires 2 2 Army Engineers' labrs. 2 Hall porters 6 1 Army Electric lamp trimmer 1 Club do. 5 1 Barman 1 Army Brewery labr 1 Valets, and other men-servants 29 Cooper 1 2 Army Watchmen 5 Cooks 6 Costermongers,&c .23 1 Gas Co. labourer Kitchen porters 3 Milkman 1 Waiters 26 Ice cream vendor 1 Barmen and potmen 16 f 1 Butler 1 Labr. in brewery 11 Carman Selling papers, &c. 12 1 Sailor Publicans 2 [l Tailor Billiard marker 1 Telegraph messenger 1 Restaurant keeper 1 Postman 1 Army Bakers and confectioners 7 Travellers 5 f 1 tin printer 1 Footman 1 1 clerk Musician 1 1 Army School attendance officer 1 Plumbers and gas fitters Relieving officer 1 Gas-burner maker 1 Porters (market) 4 „ (coal). 2 Bottle wirer 1 Goldminer 1 Carpenter Farmer 1 Paperhanger 1 Shoeblack 1 Greengrocer 1 Errand boys 3 Silversmiths Sweepers, roadmen 6 f 1 Navy Photographer 1 Ll Army Verger 1 Draper Policemen 5 Watchmaker 1 Salvage Corps 1 Navy Fishmonger 1 Soldiers 37 Picture frame maker 1 Sailor 1 Railwayman 1 Coach painter... 1 Brush maker ... 1 Bootmaker Chiropodist 1 Railway ticket clerk 1 Cinema operator 1 Actor 1 39 Ocmpations of Persons Notified in 1911-13—contimied. Outdoor. Indoor. Present. Past. Present. Past. Males. Theatre attendants and stage bands 5 1 Army Turkish bath attendant 1 Porters, shop ... 17 f 1 Caretaker <{ 1 Army [ 1 Butler Shop assistants 28 1 Clerk Polishers 2 Farriers 2 Library attendant 1 Instrument makers 2 Laundry man ... 1 Male nurse 1 Army Telephone operator 1 Lavatory attendant 1 Painter Printers 5 Stokers 3 1 Army Engravers and die sinkers ... 2 Cigarette maker 1 Glass blower ... 1 Hop merchant... 1 Dispenser 1 Journalists 2 Bottle and rag dealer 1 Hairdressers ... 3 Book-edge gilder 1 Ticket writer ... 1 Bailiff 1 Females. Females. Flower sellers ... 10 f 1 Kelief stamper Casual—streets 10 ! 1 Factory worker Market women... 2 2 Cooks Housewives and no occupation | 1 Barmaid L78 ■J. 1 Furrier 2 Ladies' maids 1 Machinist 3 Tailoresses 1^1 Shop assistant Housekeepers ... 3 Servants 81 Governesses 5 Tailoresses 16 Lace maker 1 1 Cap maker 1 1 Dressmakers ... 22 40 Occupations of Persons Notified in 1911-13—continued. Outdoor. Indoor. Present. Past. Present. Past. Females. Fur sewers 3 Shop assistants 11 Barmaid 1 Waitresses 4 1 Servant Church pew attendant 1 Office cleaning, charing 33 Laundry workers 3 Monthly nurses 3 Hospital nurses 3 Typist 5 Drapers' assistants 3 Actress and other artistes 2 Theatre dresser 1 Secretary 1 Relief stamper 1 Upholsterer 1 Second-hand furniture 2 Cashiers 2 French polisher 1 Caretakiug of houses which are unlet or temporarily unoccupied appears to be an occupation which is taken up by consumptives either solely or while still working at another occupation, though to a reduced extent. In empty houses this has a two-fold advantage in that the income is maintained and better housing accommodation is obtained while there is probably no risk to the incoming tenant who has the place re-decorated before entry; but in furnished houses the case is different, and it would be well that care should be exercised in selecting persons to be left in charge, especially as it is the servants' quarters which are occupied by the caretaker. The occupation of a monthly nurse does not appear to be a suitable one for a consumptive person, and may be a danger both to the mothers and infants attended. An instance occurred last year in which the probability is that a baby was infected in this way. The nurse, who lives in another borough, suffers from " asthma," and had a bad cough. She slept with the mother and child. The family is a healthy one, and the mother was attended by a doctor from the hospital; no neighbours or friends had visited the house after the confinement. When the child was 14 days old she developed broncho-pneumonia, and was taken into 41 hospital, where she died a few days after. Post-mortem tubercle bacilli were found in the lungs. The parents were subsequently carefully examined and found to be in good health. The nurse refused to be examined or to submit a sample of sputum for examination, so that it is not possible to say definitely that she was the infecting agent. For the various reasons stated, it is difficult to ascertain the possibility of infection from contact with fellow workers, and in only 10 instances among those notified in 1913 was there definite positive information. In 16 instances both husband and wife were affected, and 26 patients had brothers or sisters suffering from the same complaint. In 9 cases there was a previous history of tuberculous affection of some other part of the body, viz., knee 3, foot 1, spine 1, glands 1, skin 1, fistula 2. 7 patients were alcoholics. Some further information is given below in tabular form:— Males. Females. Married 89 82 No family 16 17 Not known 8 7 Families with children tuberculous 6 13 Families without known tuberculous children 59 45 Family history of phthisis in parents, grandparents, uncles, aunts:— Pulmonary Tuberculosis. Males. Females. Males. Females. Positive 46 40 None 104 99 Doubtful 4 3 Unknown 41 22 41 hospital, where she died a few days after. Post-mortem tubercle bacilli were found in the lungs. The parents were subsequently carefully examined and found to be in good health. The nurse refused to be examined or to submit a sample of sputum for examination, so that it is not possible to say definitely that she was the infecting agent. For the various reasons stated, it is difficult to ascertain the possibility of infection from contact with fellow workers, and in only 10 instances among those notified in 1913 was there definite positive information. In 16 instances both husband and wife were affected, and 26 patients had brothers or sisters suffering from the same complaint. In 9 cases there was a previous history of tuberculous affection of some other part of the body, viz., knee 3, foot 1, spine 1, glands 1, skin 1, fistula 2. 7 patients were alcoholics. Some further information is given below in tabular form:— Males. Females. Married 89 82 No family 16 17 Not known 8 7 Families with children tuberculous 6 13 Families without known tuberculous children 59 45 Family history of phthisis in parents, grandparents, uncles, aunts:— Pulmonary Tuberculosis. Males. Females. Males. Females. Positive 46 40 None 104 99 Doubtful 4 3 Unknown 41 22 41 hospital, where she died a few days after. Post-mortem tubercle bacilli were found in the lungs. The parents were subsequently carefully examined and found to be in good health. The nurse refused to be examined or to submit a sample of sputum for examination, so that it is not possible to say definitely that she was the infecting agent. For the various reasons stated, it is difficult to ascertain the possibility of infection from contact with fellow workers, and in only 10 instances among those notified in 1913 was there definite positive information. In 16 instances both husband and wife were affected, and 26 patients had brothers or sisters suffering from the same complaint. In 9 cases there was a previous history of tuberculous affection of some other part of the body, viz., knee 3, foot 1, spine 1, glands 1, skin 1, fistula 2. 7 patients were alcoholics. Some further information is given below in tabular form:— Males. Females. Married 89 82 No family 16 17 Not known 8 7 Families with children tuberculous 6 13 Families without known tuberculous children 59 45 Family history of phthisis in parents, grandparents, uncles, aunts:— Pulmonary Tuberculosis. Males. Females. Males. Females. Positive 46 40 None 104 99 Doubtful 4 3 Unknown 41 22 Duration of illness before notification of pulmonary cases :— Pulmonary Tubercules. Under 1 year. 1 to 2 years. 2 to 8 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 (147) 60 21 21 11 8 7 6 5 6 2 Females (130) 50 17 22 11 5 9 6 4 5 1 Duration of illness before notification of "other forms":— 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 (53) 20 9 5 4 3 3 2 2 2 3 Females (63) 24 6 12 2 5 ¯ 2 1 5 6 42 Nationality.—The majority of the patients were English, but there were also the following:— Males. Females. Males. Females. Irish 18 4 Russian 7 3 Scots 5 1 Italian 5 2 Welsh 3 — Swiss 4 2 French 2 2 Dutch 1 — Austrian 1 1 Indian 1 — German 3 1 All the Russians and 3 English were Jews. Other Forms of Tuberculosis.—Many of the patients had been ill for some years, and 43, were suffering previous to taking up residence in Westminster. The parts of the body effected were:— Spine 25 Pleura 2 Bones and joints 46 Bladder 2 Glands 46 Skin 9 Abdomen 10 General 3 Meninges of brain 9 There were 8 deaths from abdominal tuberculosis, 19 from meningeal (all recent cases), and 15 from affections of other parts ; and 27 of these had not been notified during life, making a total of 179 cases. There will probably always be a proportion of these eases not notified, as there is greater difficulty in deciding that the illness is due to tubercle. Two of the lupus patients were temporarily resident in Westminster, undergoing treatment. Children under school age notified numbered 38; between 5 and 15, 55. In 31 instances the parents, and in 7 other, relatives, were suffering from tuberculosis. In one case the wife became tuberculous, the husband having suffered from pulmonary trouble for some time previously. Suspects and Contacts.—In visiting patients, it is of importance to ascertain the names of all persons who have been exposed to infection and to have these medically examined, but the Health Society visitors frequently come across persons in bad health in families in which no case has been notified, and if not already under medical supervision steps are taken to have them examined. In this way 377 persons were specially examined, and 30 were found to be suffering from pulmonary tuberculosis and 7 from other forms, 88 have moved from Westminster or died, while 116 are still under observation. These persons were examined:— At hospitals, dispensaries, or by private doctors 144 At school medical inspections 72 At the Pimlico Infant Medical Inspection Centre 89 At the Soho Infant Medical Inspection Centre 72 43 In addition, 204 bacteriological examinations of sputum were made at the Council's expense for medical men who had 202 suspicious cases under observation, and in 55 instances the bacillus was found. In some instances medical men had this examination made by other than the Council's Bacteriologist. Treatment.—All the patients notified from common lodging-houses or as homeless received institutional treatment of varying duration; some of them did not go into the infirmary until within a short time of their death, but many go in and out several times in the year, while others are fairly permanent residents. Probably few of this class of patient have any treatment while out of the infirmary. Of the others, 212 of the 394 notified in 1913, or who died unnotified, had institutional treatment of one kind or another. Of other forms, 116 of the 179 cases which came under notice had institutional treatment. 351 patients notified in previous years also had institutional treatment during 1913, In addition, 68 of the suspects had the benefit of a stay in convalescent homes or in hospital. Institutional treatment was provided by the Insurance Committee for 78, the City Council for 14, the St. Henry Fund for 20, Invalid Children's Aid Association for 60, Charity Organisation Society for 7, the Jewish Board of Guardians for 13, the Guardians and Metropolitan Asylums Board for 184, employers, clergy, clubs, and friends for 138, and by hospitals for 147. An analysis has been made as to the treatment of persons over 15 years of age, with special reference to the effect of the Insurance Act in relation to tuberculous patients, and certain tables have been prepared dealing with 727 persons, of whom 324 are insured and 403 are not insured. In the latter group are included only persons with incomes within the limit of the Insurance standard. Soldiers (who are insured) and inmates of common lodging-houses, shelters and homeless persons are excluded. Table IX.—Adults. Men. Women. Total. (1) Insured persons 218 106 324 (2) Uninsured persons — Persons not insured through illness 102 59 161 Persons not insured through 41 14 55 Persons not being wage earners 30 19 49 Dependents (of insured and uninsured persons) — 138 138 173 230 403 (3) Insured and uninsured 391 336 727 44 No residents in common lodging-houses were notified by panel doctors, though probably some of the more permanent residents are insured persons. As there are estimated to be 44,000 insured persons in Westminster, the proportion of tuberculous persons among them works out at 0.74 per cent. During the first year's working of the Insurance Act many unforeseen difficulties presented themselves. The majority of consumptive patients expected to be forthwith sent away for institutional treatment while provision had still to be made for it. Pressure of various kinds was brought to bear to send away patients, and doubtless some cases unsuitable for sanatorium were sent away. Notwithstanding, however, the imperfect working which was bound to occur, it may be useful to examine how the tuburculous patients in Westminster have fared under it. Particulars are given of the institutional treatment given during the year, and of the condition of the patients at the end of 1913, also of the kind of treatment which they had while at home. Examination of Table IX brings out the important fact that there is a large proportion of adult persons who, for various reasons, fall either altogether outside the scope of the Insurance Act, or through illness or other cause have failed to become insured, or, although partially insured, have been unable to receive benefits. The present figures are not, however, an accurate forecast of those of subsequent years. The large class of persons who, owing to illness, had been unable to work at the time of the coming into operation of the Act will naturally decrease each year. Post-office contributors (of whom only two received institutional treatment) will, in all probability, also decrease to some extent. Nevertheless, the number of persons excluded through illness or from the casual nature of their work from the benefits of the Act, will not entirely disappear. The more or less chronic ill-health of many tuberculous persons is a constant handicap in the struggle to secure and retain regular positions, so that a number of patients drift into a state of semi-employment, and will always be liable to drop out of a certain amount of benefit. Young persons of 16 or 17 years of age will, owing to poor health, postpone entrance into industrial employment, or be employed only by their parents. The great majority of patients who are recorded as not insured through unemployment are casual workers, semi-employment in this case being not immediately attributed to ill-health. Hawkers, street-traders, cobblers, lodging-house keepers, small independent tailors and dressmakers, and other tradesmen make up the greater part of the class of persons who are noted as not being wageearners. 45 The large class of " dependents" is almost entirely composed of married women ; those who are engaged in certain trades, e.g., tailoring, being the employees of their husbands, are not insured. In regard to insured women, it appears that more than one-third are domestic servants—an occupation which is responsible for no less than one-ninth of the total number of adult patients. So far as a future estimate is possible from the present figures, it would seem to be probable that even when the Act comes into full effect, the proportion of uninsured adult patients will still be considerable. Hence the provision for their treatment is a no less, if not a more, important factor in dealing with tuberculosis than that for insured persons under the Insurance Act. Consideration of Table X (a), (b) and (c) suggests several points of interest. In the first place it will be seen that more than one-half of the total number of adult patients received during the year no institutional treatment (some, however, may have received it in previous years); secondly that of those patients who received such treatment more than one-third were away for less than one month (these included many advanced or chronic cases—some sent merely for educational training— Poor-law cases and acute or hospital cases; also some patients sent in for observation only, in order to determine the best treatment), and nearly two-thirds for no more than two months; and, thirdly, in spite of the 78 patients who were sent away through the Insurance Committee, the proportion of patients receiving institutional treatment is very little more among the insured than among uninsured patients, and in the case of patients in the early stage of the disease is actually less. The transference of insured patients has enabled the City Council and various charitable agencies to devote the funds at their disposal for the benefit of the uninsured, but a more important factor would appear to be the large number of married men in regular employment who, although recommended by their medical attendants to apply for institutional treatment, refuse to do so, if they are able to continue at work, on account of the difficulty of supporting the family in the absence of the breadwinner. Even where a patient is able to draw sickness benefit 10s. a week is not an adequate substitute for his own wages of 25s. or 30s., and after payment of a rent of 6s. 6d. or 7s. little is left for the sustenance of a family. The regular worker has the fear that if he goes away for any length of time he will lose his place of employment. It is a significant fact that of the 65 early patients among insured persons who were sent away, 10 only, or less than one-sixth, were married men, although the proportion of married men to other persons in this class is more than one-third (54 out of 150), and two of these were away for no longer than one week and three weeks respectively. Probably more d 46 could be sent away, at least for educational purposes, if arrangements could be made to do so in the slack season which obtains in such seasonal trades as tailoring. Table X.—Institutional Treatment. (a) Insured Persons. Public Authorities. Voluntary agencies. Insurance Committee. Westminster City Council. Poor Law. Sanatoria (including seaside (hospitals. Hospitals. Convalescent homes. Homes for dying. Nil. Total. Early 44 2 — 4 14 1 85* 150 Chronic 9 — 4 — 3 5 — 51 72 Advanced 23 1 14 — 8 — 2 14 62 Others 2 — — — 12 4 — 22 40 78 3 18 4 37 10 2 172 324 (b) Uninsured Persons. Early — 8 12 12 8 2 — 37† 79 Chronic — 3 33 2 5 4 — 84 131 Advanced — — 79 4 11 — 3 59 156 Others — — 1 2 9 1 — 24 37 — 11 125 20 33 7 3 201 403 * Including 37 apparently arrested cases, † Iucluding 18 apparently arrested cases. Table X (contd.)—(c) Length of Treatment (Insured and Uninsured).* Less than 1 month. 1 month. 2 months. 3 months. 3—6 months. 6—12 months. More than 12 months. Total. Insurance Committee Westminster City 12 (6)† 10 (3) 21 (1) 22 12 (4) 1 78 Council 1 1 7 (1) 1 4(1) — — 14 Poor Law 63 (8) 11 (3) 8 7(2) 19 (4) 17 (7) 18 (15) 143 Sanatoria 2(1) 4(2) 3 7 4(2) 3(2) 1 (1) 24 Hospitals 42 (7) 14(3) 7 (2) 4 1 — 70 Convalescent homes 12 (1) 3 1 — 1 — — 17 Homes for dying 4(2) — — — 1 — — 5 138 43 47 41 42 21 19 351 The figures in brackets represent those still away at end of year. * In the case of patients receiving institutional treatment more than once during the year, the longest period only recorded, except that hospital treatment immediately preceding sanatorium treatment is recorded together as sanatorium treatment, and convalescent treatment immediately following hospital treatment is recorded together as hospital treatment. Sixteen insured persons and thirteen uninsured persons received short additional periods of Poor Law, hospital, or other treatment. Many Poor Law patients received treatment in the infirmary two, three, or more times. † Of the six patients who had less than one month of treatment, three returned of their own accord, two were sent back as being too ill for treatment, and one died. 47 Table X (contd.)—(d) Condition at End of Year, After Institutional Treatment. Able to work. I11 at home. Doubtful. Moved. Died. Still away. Total. Insurance Committee 28 15 3 6 7 19* 78 Westminster City Council 6 1 1 3 1 2 14 Poor Law 12 35 3 11 43 39 143 Sanatoria 7 4 — 3 2 8 24 Hospitals 20 12 2 8 14 14† 70 Convalescent Homes. 11 2 3 — — 1 17 Home for Dying — — — — 3 2 5 84 59 12 31 70 85 351 * Including five patients who returned form sanatorium or hospital treatment, and were subsequently removed to the infirmary. † Including two patients who returned from hospital treatment and were subsequently removed to the infirmary. The waiting period for patients sent away through the Insurance Committee was anything from nil—i.e., responsibility being taken over for patients already in institutions*—to fourteen weeks; the usual period was live weeks. At first sight the comparatively large proportion of advanced patients who received institutional treatment appears to be a gain, but of the large proportion who were treated in the infirmary many did not avail themselves of it until a late stage, while of the 23 patients who were sent away through the Insurance Committee, nearly onethird (7) returned to be subsequently removed to the infirmary, one-third are dead, and the others are at home in little or no better condition than before. So that the short stay in the hospital or sanatorium for many patients was of no benefit to themselves, and only to a slight extent a means of protection to others. For the insured, no less than the uninsured, a more adequate provision for advanced and dying cases is urgently required. The reluctance of respectable working-class people to apply to the Poor Law is well known; nevertheless, for the great majority of advanced cases there is no other provision, and is seldom taken advantage of until the family is reduced to the last extremity thus a number of advanced cases remain at home under conditions which render proper care impossible. In some 20 per cent. (41) of the 218 advanced cases the need for the removal to an institution was urgent, as well from the point of view of prevention as from that of ordinary humanity. The efforts to obtain admittance into a " home for the dying" is evidence that provision outside the Poor Law would be acceptable. Compulsory removal or detention in most cases would be unnecessary if the place * The Insurance Committee now decline to take over such cases. D 2 48 provided were made attractive. Small local homes would probably be the form of institution to be preferred by the patient and his friends who could visit without the need of taking a long journey for the purpose. Similar provision is also required for the chronic type of patient, who, although too ill to work, is yet able to keep about. To patients of this type (a grandparent or other elderly relative) the infection of a young family is not infrequently to be traced. In addition to the treatment provided through public authorities, a considerable number of patients were treated in the voluntary hospitals, the majority being cases presenting acute manifestations of the disease or cases requiring operative treatment; but the need for treatment of this kind would not appear to be altogether supplied, as 13 cases were noted of patients who could not suitably be nursed at home, and apparently had failed to gain admission into hospitals, five being subsequently removed to the infirmary and three dying at home. In seven instances among insured cases the patient was recommended by his medical attendant to apply for sanatorium treatment, and was refused as " doubtful." The view taken by the Insurance Committee would appear to be that, although clinical symptoms are present, the patient is not entitled to be sent to a sanatorium unless or until the tubercle bacillus is discovered in the sputum, by which time the disease may have passed from that early stage when treatment is most successful. In one case of two or three years standing the Insurance Committee refused institutional treatment on what appeared to be good grounds; the patient was, however, eventually sent away by the City Council for a month's training, but although the medical officer of the sanatorium reported that a great improvement had occurred, and that a six months stay would probably result in arresting the disease, the Insurance Committee refused to reconsider their decision and give the patient the opportunity. Two only of the 22 insured persons suffering from forms of tuberculosis other than phthisis received institutional treatment through the Insurance Committee. The after-care of patients who are discharged from institutions is undertaken by the tuberculosis Visitors, assisted by the Health Society, and forms one of the most important parts of their work. They are at once visited, and are advised and encouraged to continue the treatment and habits in which they were instructed in the sanatorium. Sometimes young patients are assisted to change their trade from an indoor to an outdoor occupation. But, in the case of older patients, the view is generally taken that the uncertainty of employment and the fall in wages, which are inevitable in starting again, more than counterbalance the evils of the indoor trade to which they already belong. 49 There is no doubt that, even from the short period of three months in a sanatorium, a certain amount of benefit has resulted to many patients, but to arrest the disease a much longer stay is generally requisite. The habits which are learned are practised afterwards in the home and in the workshop, and thus the benefit is sometimes extended to the whole family. From the returns of past years it is satisfactory to be able to record that a number of old patients, among whom are included many indoor workers, who were treated three, four, five, six years ago or longer, are at present apparently well and at work. These patients are included in the returns as '* arrested early cases." It should be noted, however, that as a rule these patients were away for much longer periods than three months. For the majority of cases, whatever may be the value of the institutional treatment given, the importance of home treatment is even more. On the early recognition of the nature of the illness will depend much of the effectiveness of the treatment in a sanatorium; but besides, even with insured persons, a large proportion do not apply to go away, and are thus dependent upon the treatment given by their ordinary medical attendant, or by the medical officers of hospitals and dispensaries. From Table XI it will be seen that insured persons are availing themselves of the services of the panel doctors instead of attending hospitals, thus effecting a saving of their time and strength. It is desirable, how ever, that patients should be able to secure the opinion of specialists, where such is necessary, or where special treatment is required. Table XI.—Domiciliary Treatment (Adults).* Insured. Uninsured. Total. Panel doctors 173 _ 173 Private doctors 7 48 55 Special hospitals 29 100 129 General „ 39 67 106 Special dispensaries 4 3 7 General „ 4 34 38 6 52 58 Nil† 62 99 161 324 403 727 * The main sources of domiciliary treatment are alone recorded in the above table. Many insured persons attended the out-patient departments of hospitals in the intervals of treatment by the panel doctor, and in the same way many hospital patients called in private practitioners, the dispensary physician or the Poor Law doctor at times of emergency. † Includes 55 arrested cases and 45 persons who were away or in institutions for the whole or a greater part of the year, also old patients who left the district early in the year and some who died suddenly without having had treatment. 50 This will be met when sanction is given to the scheme which the City Council has framed for a " dispensary " in conjunction with the hospitals, and non-insured patients also will be able to avail themselves of the advice and treatment of the staff. It is necessary, however, that there should be an officer to link up the domiciliary and the dispensary treatment, and in my opinion that this could best be effected by the appointment as Tuberculosis Officer of an Assistant Medical Officer of Health, who would be able to give medical supervision in the homes, besides examining suspects and contacts unable to be otherwise examined. The number of patients who do not obtain medical treatment of some kind is comparatively few, but in the case of Poor Law cases the parish doctor is often only called in when removal to the infirmary is desired. A number of persons seem to look upon their failing health as an unavoidable condition, and struggle along almost to the last without medical attention, partly because they cannot afford the time or the fee to consult a doctor, and in some instances because they are afraid they will be ordered to give up work. Extra Nourishment.—In the case of three patients only is there any record of medical accessories in the way of food being supplied through the Insurance Committee, and inquiry among medical men on the panel reveals the fact that they were unaware of the fact that they could order extra nourishment. It is to be deprecated that persons who, on the ground of their own contributions, have a statutory right to it, should be compelled to apply for relief to the charitable agencies or to the Poor Law, or else go without. Additional beds and bedding have been supplied by the Council where separate beds were required, and air cushions have been lent in a number of advanced cases. Additional clothing has also been provided from various sources, especially for patients going to a sanatorium. Another problem which is of equal importance to proper nourishment is that of the sufficiency of house room. About 7 per cent. (52 out of 727) of adult patients were noted as living three or more persons to a room. The first economy of the patient as his means of livelihood fail is invariably an economy in rent. The facts, as regards children, are even more significant—31 out of 197 children, i.e., about 16 per cent., were living three or more persons to a room, several members of the same family being sometimes infected, although in only three of the cases was the tenement legally overcrowded. Yet under conditions such 0as these it is clearly impossible either to treat the patient or to preserve the family from infection. The simplest and least expensive method of dealing with a patient so placed would be to supplement his rent by a small sum each week, on condition that he moved to new and approved 51 quarters. The ordinary objections to a " grant in aid of wages " do not apply in a case like this when the breadwinner is either partially disabled, or owing to special circumstances his needs are greater than those of the normal workman of his class. It would appear that, under the Tuberculosis Order, a local authority has power to make such expenditure, and I understand it is done in some parts of the country. The Council has authorised the provision of outside shelters, but for obvious reasons they are unsuitable in central districts. Diarrhoea.—In Westminster, the total deaths were 49, 40 being under 2 years of age (30 at this age in 1912). Comparison with former years is made below:— Westminster. 1904. 1905. 1906. 1907. 1908. Epidemic diarrhoea . 80 47 75 27 24 Other forms of enteritis 16 17 20 19 23 Total deaths 96 64 95 46 47 Number under 1 year of age 72 42 71 27 33 Number of births 3,054 3,120 2,931 2,927 2,913 Deaths of infants per 1,000 births 23.5 13.4 24.2 9.2 11. 4 Westminster. 1909. 1910. 1011. 1912. 1913. Epidemic diarrhoea 10 9 47 9 20 Other forms of enteritis 23 32 47 28 29 Total deaths 33 41 74 37 49 Number under 1 year of age 27 26 49 27 33 Number of births 2,751 2,592 2,361 2,349 2,233 Deaths of infants per 1,000 births 9.2 10.0 20.7 11.4 14.7 There was a slight increase in the acute or infective form, which occurs in the hot weather. Other forms, which depend on a variety of causes, keep fairly constant. Enquiry made with regard to these deaths, shows that there were 7 illegitimate children, 29 had been delicate from birth, 2 being premature, 1 child was one of triplets, and 1 a twin. Only 1 infant had been entirely breast-fed, and 4 had been suckled at first for a week or two. In 9 instances the mothers were out at work during the day, consequently the children did not receive necessary care and the children were nursed out or by neighbours; 4 mothers were seriously ill, 1 mother drank. Four infants were born and died in the infirmary. Cold and dampness, improper feeding, want of proper care, defective power of digestion, syphilis and tuberculosis account for many of the cases in which diarrhoea was merely one of the accompaniments of the 52 illness. The Registrar-General includes all forms of diarrhoea together in making a comparison between different districts. From one point of view this is useful, but it is desirable to discriminate between the acute form and deaths due to these various causes. Although 20 deaths were ascribed to the epidemic diarrhoea, only a few of them were rightly so described. Measles.—The number of cases notified was 350, 197 and 129 being in the first and last quarters. There were 24 deaths, all but 5 being of children under 5 years of age. The death rate for the County was 0.34 per 1,000 of population, and for the City 0.14, the average rates for the preceding five years beiug 0.45 and 0.14 respectively. The schools affected are shown below, Burdett Coutts', St. George's, South Street, and St. Anne's being the most seriously invaded. Fifty-four children were removed to the Metropolitan Asylums Board's Hospitals for treatment. Four hundred and fifty-three 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 was carried out by the Council's staff in 132 houses. Whooping-Cough.—Forty-eight cases only were notified (for particulars as to schools see list below). There were 7 deaths in the City, all of children under five years of age. The death rate was less than the average both in the County and Westminster. Six 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:— 53 School. Actual Cases. Infection in House. Chickenpox. Measles. Mumps. Whoopingcough. Chickenpox. Measles. Mumps. Whoopingcough. Other Causes. Buckingham Gate 2 4 1 15 — 1 — 2 13 ringworm. Charing Cross Read — — — — — 2 — — Horseferry Road — 13 2 1 2 6 2 — — 4 ringworm. Millbank 5 13 1 1 2 11 — — 1 ringworm. Pulteney — 10 1 — — 8 — — 3 ringworm. St. George's Row 2 23 12 — — 13 3 — Wild Street 6 — 2 — 3 — — 3 ringworm. Brompton Higher Grade . — 10 — — — — — — Burdett Coutts 12 46 1 1 1 8 — 1 10 ringworm. Cathedral, Great Peter Street — 3 — — — — — — 1 ringworm. Christ Church 1 — 1 — — 3 — — Holy Trinity 1 11 1 10 — 7 — 4 6 ringworm. St. Anne's 1 35 7 1 — 19 — 1 10 ringworm. St. Anselm's — 1 — — — 1 — — 1 ringworm. St. Barnabas 11 1 — 3 6 4 — — St. Clement Danes 10 1 1 4 5 — — — 2ophtbhalmia. St. Edward's, Dufour's Place — 1 — — — — — — St. Gabriel's 1 14 6 2 3 14 — — 7 ringworm. St. George's, South Street — 45 — — — 5 — — 2 ringworm. St. James the Less — 26 — 1 — 32 — — 1 German measles. St. James'and St. Peter's 17 22 12 — 3 9 2 — St. Margaret's 1 5 1 — — 1 — — St. Martin's, Adelaide Place 27 8 — 4 3 3 — — 3 ringworm. St. Martin's, Castle Street — — — — — — — — St. Mary's, Hide Place 2 6 4 1 6 1 — 1 3ophthakmia.. St. Matthew's — 14 44 — — 11 — —- 9 ophthalmia. St. Michael's 1 1 — — 2 — — 1 3 ringworm. St. Paul's 1 19 1 1 — 16 — — 5 itch St. Peter's, Lower Belgrave Place 4 8 — — 1 5 — — Wesleyan Training — 15 — — — 18 — — 1 ringworm. 112 350 95 48 38 203 5 10 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 487 notifications were sent out during 1913 to school teachers as follows School. Small Pox. Scarlet Fever. Diphtheria. Enteric Fever. Buckingham Gate — 7 4 — Charing Cross Road — — — — Horseferry0 Road — 3 1 Millbank — 17 12 — Pulteney — 5 4 1 St.Georges’Row — 24 1 Wild Street — 5 7 1 Brompton Hight Grade — — — — Burdett Coutts — 11 3 2 Cathedral, 48, Great Peter Street 6 2 Christ Church 2 2 ’ Curzou ¯ ¯ French Protestant 1 Grey Coat — 2 — Holy Trinity — 11 3 — 7 5 St. Anselm's — 6 1 —, 54  School. Small Pox. Scarlet Fever. Diphtheria. Enteric Fever. St.Barnabas — 5 2 — St. Clement Danes — 5 — — St. Edward's, Dufour's Place — — 1 — St. Gabriel's — 9 6 — St. George's, South Street — 5 2 — St. James's and St. Peter's — 1 2 — St. James the Less — 6 — — St. Margaret's — 3 4 — St. Martin's, Adelaide Place 16 — — St. Martin's, Castle Street — — — St. Mary's, Hide Place — 3 5 — St. Matthew's — 3 1 — — 18 6 — St. Patrick's — — — — St. Paul's, Caroline Street — — — — St. Paul's, Wilton Place — — — — St. Peter's, Lower Belgrave Street — 1 3 — St. Vincent's — 9 — — Wesleyan Training College — 8 3 — Twenty-nine rooms in seven schools were disinfected, together with books and other articles. As to the arrangements for dealing with children affected with vermin, see below under "disinfection." Nine hundred and forty-four 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 406 examinations have been made by Dr. J. M. Bernstein, at the Westminster Hospital Medical School, at a cost of £53 1s. 8d., with the subjoined results. The number of examinations in previous years were : 1902, 251 ; 1903, 181; 1904, 75; 1905, 132; 1906, 180; 1907, 155; 1908, 175; 1909, 245; 1910, 270; 1911, 240; 1912, 306. Disease. Persons. Examinations. Results. Positive. Negative. Doubtful. Diphtheria— Suspected cases 187 190 45 145 — Contacts or school children 4 4 — 4 — Returned from hospital 1 1 — 1 — 192 195 45 150 Typhoid Fever 6 7 6 1 Tuberculosis 202 204 55 149 — Ophthalmia Neonatorum — — — — — In addition to those mentioned above, many medical men and hospitals obtain reports on their cases from private or hospital laboratories. 55 Disinfection. Below is shown the number of rooms and articles disinfected by the Staff of the Department. The premises included 29 rooms in 7 schools, 23 shops and 25 offices; 5 vehicles were also disinfected. In 23 cases of infectious disease treated at home the laundry linen was collected weekly and disinfected. Disinfection was carried out after all cases of the notifiable diseases, except as regards erysipelas (in which disinfection was performed in 37 instances, when the circumstances of the case required it), and also 132 houses after measles, 7 chicken-pox, 27 cancer, 8 influenza, 3 whooping-cough, and 355 phthisis. In 55 instances the premises, &c., were disinfected privately (44 of these being cases of phthisis). The following table gives a comparative statement of the above work during the past seven years:— 1907. 1908. 1909. 1910. 1911. 1912. 1913. Premises 840 1,067 1,287 841 979 1,020 1,410 Rooms 1,455 1,568 1,865 1,284 1,449 1,346 1,796 Articles disinfected 36,115 31,915 49,843 26,850 26,264 34,478 53,567 Articles washed — — — 514 782 4,999 8,210 Articles destroyed 1,660 233 186 1,651 496 699 1,567 Books disinfected 136 557 281 595 266 315 1,810 Number of persons admitted to shelters 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; 46 adults had baths at the station, and 749 articles of clothing were cleansed of vermin. An arrangement with the County Council for the cleansing of school children came into force in 1912, and 368 children attended for the first time in 1913 for this purpose. The children attend from other Boroughs as well as from Westminster; the numbers were:— No. of Children. Articles of Clothing 1st Attendances. No. of Attendances. Disinfecteil or Washed. Westminster 112 393 Chelsea ... ... ... 27 106 Lambeth ... ... ... 67 28£ Battersea ... .., ... 151 595 Wandsworth ...... 11 40 368 1,418 14,421 It is essential that at the same time the children are treated at the station, their bedding should also be stoved, so as to destroy any vermin in it, and for this purpose the homes of those resident in Westminster were visited. It happens in a proportion of the cases that other members No. of Children. 1st Attendances. No. of Attendances. Articles of Clothing Disinfected or Washed. Westminster 112 393 Chelsea 27 106 Lambeth 67 284 Battersea 151 595 Wandsworth 11 40 368 1,418 14,421 It is essential that at the same time the children are treated at the station, their bedding should also be stoved, so as to destroy any vermin in it, and for this purpose the homes of those resident in Westminster were visited. It happens in a proportion of the cases that other members 56 of a family than those at school age are affected, and parents are persuaded to allow them to be treated, otherwise re-infection is almost certain to occur. Verminous Houses.—In addition to the school cases, 228 notices were served by the Sanitary Inspectors with reference to vermin in houses; 17 of these were fumigated with sulphur by the Council's staff, the remainder being dealt with by the owners. Prom 74 houses 2,127 articles were stoved, 247 washed, and 908 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 17,252, and 292 articles were washed and 908 destroyed. In addition, 381 articles were fumigated on account of itch and ringworm. In dealing with verminous conditions, 321 visits (of which 259 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).) Bag Flock.—Three samples were taken at the end of 1912, but were not reported upon until January, 1913. One was reported not to conform to the prescribed standard of cleanliness, and the man from whom the sample was taken was prosecuted, and fined 10s. with 23s. costs. Mortuaries. The number of bodies removed to the Council's mortuaries under order of the Coroner, or to await burial, was 328; in 1 instance death was the result of infectious disease. Inquests were held at Horseferry Road, where the Coroner's Court is situated, in 286 cases, and there were 6 adjourned inquests. Postmortem examinations were made in 165 instances at Horseferry Eoad. Traffic accidents were the cause of 25 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. 1902 389 345 44 1908 364 298 66 1903 393 341 55 1909 291 258 33 1904 388 322 59 1910 333 281 52 1905 370 307 61 1911 373 334 49 1906 345 283 61 1912 324 284 40 1907 358 281 77 1913 328 286 42 Of the 42 bodies admitted to await burial, 41 were taken to Horseferry Eoad, and 1 to Drury Lane resting place. PART II. C. House Inspection, &c. Below is a list of details of the work done in connection with nsanitary conditions. In many cases some of the work specified was in premises, parts of which were occupied as workshops:— 1913. 1913. Complaints received and dealt with 876 Sanitary Work completed :— Drains :— Premises inspected on complaint, &c. 956 Manholes built 760 „ repaired and cleansed 374 House to house inspection 5,379 Subsequent visits 25,044 ,, covers fixed or repaired 1,013 Premises (registered), visits to 6,810 Overcrowding found 41 Tested by smoke 256 Other infringements 1,171 ,, chemical 360 Sanitary Work completed:— „ water 834 Houses:— Cleansed throughout 469 „ air 202 Fresh air inlets fixed or repaired 389 „ partially 1,221 Overcrowding abated—rooms 137 Soil Pipes:— Fixed 537 Light or ventilation improved 358 Ventilated 463 Roofs repaired 475 Repaired 191 Floors and staircases repaired 384 Tested by smoke 243 Tested by chemical 247 Underground rooms:— Illegal use 30 „ water .. 162 ,, air 250 Closed 35 Yards, areas, paved or repaired 574 Water-closets:— Constructed 1,715 Damp wails remedied 270 Repaired 1,111 Offensive refuse removed 364 Ventilated and light improved 427 Keeping of animals discontinued 23 Cleansed or limewashed 1,049 Verminous premises cleansed 228 Ventilated lobbies provided 380 Filthy or unwholesome bed- ding, &c. 8 Unstopped 134 Drains:— Constructed 391 Traps ventilated 1,162 Flushing cisterns fixed 1,523 Amended and repaired 318 „ „ repaired 389 V entilated 327 Waste Pipes:— Constructed 1,647 Unstopped and cleansed 164 Interceptor traps fixed 227 Repaired 280 Cleansed and sealed off from sewer 88 Unstopped 65 Trapped 2,034 Gully traps fixed 1,296 Ventilated 1,455 Defective traps abolished 309 Disconnected 554 58  1913. 1913. Sanitary Work completed :— Sanitary Work completed:— Rainwater Pipes :— Fixed or repaired 810 Water Supply:— Cisterns defective, abolished 115 Disconnected from drains 247 Taps off main provided 951 Urinals:— Constructed 234 Pipes repaired 453 Dust Bins:— Movable, provided 317 Repaired or improved 39 Cleansed 59 „ repaired 14 Water Supply:— Provided 626 Fixed, abolished 24 Stables:— Drained 31 „ additional in tenement houses 15 Paved 30 Certificates granted 10 Cleansed 41 Cut off 59 Dung receptacles provided 12 Reinstated 27 Dung accumulations removed 48 Cisterns fixed 210 „ cleansed 264 Garages constructed 35 „ covered 330 Petrol interceptors provided 11 2,554 intimations of nuisances, &c., and 69 statutory notices (including 3 for smoke nuisances) were issued; 2,157 letters were written, and 2,477 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. 31, Willow Street (dwelling). Damp walls of washhouse Remedied after service of summons; 24s. costs. 19, Lillington Street (tenement house). Dirty condition of basement room Order to abate within 14 days. 53, Ponsonby Place (tenement). Defective R.w. pipe, scullery drains, &c.; water supply in basement only. Order to abate within 14 days; 11s. costs. 1, Meard Street (tenement house) and outworkers. Dirty and defective flooring, ceilings, walls, &c. Order to abate within 14 days ; 6s. costs. 51, Conduit Street (workshop). Workshop and w.c. without sufficient ventilation. Adjourned to allow work to be put in hand, at second hearing the work was reported to be nearing completion; 45s. costs. 224, Vauxhall Bridge Road (shop and living rooms). Damp walls of basement and ground floor. Summons dismissed. In the last case, the owner alleged that the cause of the dampness was leakage from an adjacent public urinal. Evidence was given by one of the Council's Divisional Surveyors that this was not and could not be the cause; but the Magistrate said he was not satisfied, and dismissed the summons, refusing, however, costs to the defendant, who was the agent for the premises. Subsequently, when the owner became acquainted with the facts, steps were taken to protect the walls from damp. 59 Plans.—636 sets of plans were examined during 1913. Of these 129 were plans of new buildings. Failure to send in plans occurred in 29 instances. Infringement of the By-laws in connection with the erection of buildings occurred in 14 instances. The builders were cautioned, and required to do the work properly. 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 543 instances the services of the two drain-testers attached to the Department were requisitioned. Regulations for Prevention of Fire.—The attention of the Public Health Committee has been drawn to difficulties which have arisen in carrying out the requirements of the County Council in respect of the prevention of fire. No information is given to the Borough Councils by the County Council in individual cases, with the result that from time to time there is a conflict between the requirements of the County Council on the one hand and those of the Home Office and the City Council on the other, especially with regard to ventilation. Unnecessary expense is caused to property owners, which could be obviated when premises are being built or reconstructed if the County Council would give information to the City Council of their requirements. Complaints have also been received of the want of finality in the County Council's requirements. The Public Health Committee has asked the County Council to furnish a copy of the requirements for the prevention of fire in each case. 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. Four persons were cautioned for removing refuse during prohibited hours and one firm was prosecuted and fined 40s. and 2s. costs. Housing Conditions. Sanitary Survey of Houses.—Special reports have been made of the condition of houses in the following streets and courts:—Little Grosvenor Street (4), Susannah Place (3), William's Mews (38), Horseshoe Alley (17), Conduit Court (2), Catherine Street (5), Vandon Street (4). 60 A number of defects were discovered and remedied, notices being served under the Public Health Act. Pour houses unfit for habitation were closed voluntarily by the owners. Thirty-four houses were inspected under Section 17 of the Housing Acts, but no representations as to unfitness for habitation were made, as the owners either undertook to carry out the required improvements, or to pull them down ; five were demolished, and ten are included in a scheme in a Bill now before Parliament. One house with respect to which a demolition order was made was pulled down. A notice under Sec. 15 (3) Housing and Town Planning Act was served requiring premises 43, Tufton Street, to be put into habitable condition and was complied with. Converting Condemned Dwelling-Houses to Other Uses.—The question has been raised on more than one occasion whether a local authority could allow a dwelling which had been closed to be converted to other uses, but apparently they must proceed to a demolition order if it is not made habitable. In this connection the following extract from the annual report of the Local Government Board (Scotland) for 1912 is of interest, and it appears desirable that local authorities in England should have discretionary power to withhold a demolition order on being satisfied that structural alterations had been effected which would prevent the use of a building as a dwelling:— “We entered into the question of the competency of converting to other uses a dwelling-house in respect of which a closing order has become operative very fully in our last report. While the question was a difficult one and not free from doubt, it appeared to us, as advised, that if an owner determined to put a condemned building to a different use, the local authority had no power to prohibit such use of the building by demolishing it, unless it is a ‘nuisance or dangerous or injurious to the health of the public or of the inhabitants of the neighbouring dwelling-houses.’ As doubts had been expressed regarding the soundness of this view, we deemed it advisable to consult the Scottish Law Officers of the Crown on the point. As the question is an important one, we give their opinion here in full:— “We are of opinion if the owner of a building which has been occupied as a dwelling-house undertakes that it shall no longer be so occupied, but shall be put to a different use, e.g., a store, then a demolition order under Sec. 18 (2) of the Housing Town Planning, &c., Act, 1909, ought not to be pronounced. If, however, the building, although not occupied as a dwelling-house, is in such a condition as to be a nuisance, or dangerous to the health of the 61 public or of the neighbours, then a demolition order must be pronounced, even although there is no intention to use it as a dwelling-house. This appears to us to be the correct interpretation of the Act, which in Sec. 18 (1), and in the former of the two alternatives to which Sec. 18 (2) relates, speaks exclusively of dwelling-houses. It would, in our judgment, be absurd to compel the owner of, say, a store, to render it ‘fit for human habitation’ on pain of having it demolished. This would be the effect of so interpreting the Act as to force an owner whose property had once been used as a dwelling-house to continue so to use it, or have it demolished by order of a public authority.” Underground Booms.—35 rooms were found to be illegally occupied and their use given up, 3 of these not complying with the requirements of the Housing and Town Planning Act. In connection with the Westminster Improvement Scheme, the County Council closed and demolished a block of 40 flats, known as St. Stephen's Mansions, in Smith's Square. The vacant ground round this square is gradually being occupied by good class buildings. Six tenement houses in Alfred Street, Vincent Square, and eight in Arthur Street, Knightsbridge, have been pulled down, and the sites will not be used for dwellings. The Peabody Trustees have erected eleven blocks of buildings at the corner of Francis Street and Vauxhall Bridge Eoad. They contain 199 tenements, a superintendent's and two porters' lodges. Of one-roomed tenements there are 58 at 2s. 11d. and four at 3s. 1d. of two-roomed, 38 at 5s.; of three-roomed, 60 at 6s. 6d.; of fourroomed, 35 at 7s. 3d.; two at 7s. 6d.; and two at 7s. 9d.; a weekly rentroll of £52 5s. 9d. Coals are supplied to the occupants of the tenements, all the year round, at 1s. 2d. a cwt., and each set of rooms is supplied with a gas-stove, a self-filling boiler and ample cupboard room. In the basement the tenants are able to obtain a bath aud hot water free of charge; there is also the laundry, provided with coppers, wringers, washing basins and patent clothes-driers; sheds which are let out at a charge of 1d. a week have been erected for the storage of bicycles and perambulators. There was a very considerable demand for the rooms, and the Superintendent states that in his 28 years experience of managing model dwellings he never remembered such a tremendous rush. If the buildings had been six times as large he would have had no difficulty in letting the rooms. A number of the tenants in some of the older blocks belonging to the Peabody Trust in Westminster were given a preference in order e 62 that improvements might be carried out in the houses vacated. At the end of the year there were 716 inhabitants, of the following ages:— Under 5 years, 69; between 5 and 20, 241; between 20 and 40, 208; between 40 and 60, 158 ; over 60 years, 40. Six houses in Shepherd's Place and one in Chadwick Street which had been closed were put into habitable condition and re-occupied. Under the auspices of the local branch of the Charity Organisation Society, there has been formed the Pimlico and District. HouseManagement Association. The general object of this body is to apply the system of house-management, which was carried on so successfully by Miss Octavia Hill, to those areas in the district where the need of some reforming agency is apparent. If owners of houses now let in tenements would provide each tenement with suitable accommodation, proper cooking stoves, water supply, sinks, and w.c., the standard of housing would be very materially improved. In many of the large houses in Pimlico there is ample space at the rear in which an addition could be built to provide these conveniences, which would make the houses similar to those of the Peabody Trust, which are so much sought after. H.M. the King has set an example of what can be done in this way on the estate in London belonging to the Duchy of Cornwall. Houses Let in Lodgings.—The number of houses in 1913 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 1,300; to this class of house 6,810 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 41 instances, and 1,171 other defects were found and remedied. Particulars are included in the general list given at the beginning of this part of the Report. Twenty-three statutory notices had to be issued before defects were remedied, and in three instances proceedings had to be taken in the Police Court (see above). There were three infringements of the new By-law 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. While much is being done to render houses habitable, it should be recognised that many insanitary conditions which are found are not the fault of the landlord, but arise from the careless and dirty habits of the tenants. Additional powers are required by which such tenants could 63 be summarily dealt with. It would have an excellent effect if tenants of this description who refused to reform could be punished. There is another class of persons with whom it is extremely difficult to deal, and who for their own sakes require attention. These are old people living by themselves, who are unable to look after themselves or the rooms they occupy. They get into a deplorable condition from neglect, and not infrequently the Coroner has to hold an inquiry when death occurs. In one such case the Coroner remarked that “It was remarkable that in the heart of the richest city in the world there should be human beings in such a state of disgusting filth, and the authorities powerless to cleanse them or remove them to an infirmary. The Old Age Pension Act really encouraged old people to stay outside infirmaries, which were most comfortable and excellent institutions provided by the ratepayers.” WateR Supply. Fifty-nine notices of withdrawal of water supply were received from the Metropolitan Water Board, and in 27 instances it was reinstated, on notice. The reasons given for cutting off the supply were: houses empty, 30; non-payment of rates, 22; by request, 6; irregular fittings, 1. Additional sources of water supply on the upper floors of tenement houses were provided in 15 instances. Legal proceedings in connection with water supply was taken in one instance. Owners are recommended in all cases to fit a proper sink in connection with the new supply on upper floors and so prevent risk of walls and ceilings being spoiled. 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. Ten certificates were granted under Sec. 48 (1) Public Health (London) Act. Revenue Act. Certificates under this Act relieve the recipient from the payment of Inhabited House Duty. Applications were received by me in 5 instances comprising 221 tenements. Certificates were granted with one exception. The premises in which are situated the tenements for which certificates were granted are:— Wellington Mansions, York Street. 59, Pall Mall. Newport House, Great Newport Street. Chester House, Eccleston Place. Peabody Buildings, Vauxhall Bridge Road. e2 64 Smoke Prevention. The following is a summary of the work done in connection with smoke prevention:— 1913. Total. Complaints received 45 Observations taken 2.046 Notices issued— Preliminary 125 Statutory 3 Summonses — The premises causing this class of nuisance included:— Hotels and restaurants 23 Bakers 4 Motor works 3 Government buildings 2 Clubs 7 Brewery 1 Private houses 6 Hospitals 2 Printer 1 Electric Light works 1 Theatre 1 Various 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 3 premises. In three cases complaint was made of smoke entering rooms from adjoining chimneys, due to the chimney being too low or defective. Notices were served with reference to smoke being emitted from 7 railway and 1 road engine, 2 crane engines, 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. These arose from burning fat and refuse, petrol fumes, defective flues, gas engines, &c. 65 D. WORKSHOPS, &c Section 132 of the Factory and Workshops Act directs that "The Medical Officer of Health of every District Council shall in his annual report to them report specifically on the administration of this Act in workshops and workplaces, and he shall send a copy of his annual report, or so much of it as deals with this subject, to the Secretary of State," and forms have been supplied giving a summary of what is required. It is, however, a matter of difficulty in Westminster to apportion work done, as workshops and dwellings are so intermingled. The following shows the state of the register of work premises at the end of 1913 :— Work Premises. Total Number. Number in which Women are Employed. Tailors, outfitters, shirt makers, hat, cap, and helmet makers 1,366 1,349 Dressmakers, milliners, embroiderers, lace makers, blouse makers, costumiers, lingerie makers, children's outfit makers, feather dyeing, corset makers, furriers, &c. 834 834 Leather workers, boot and shoe makers, harness makers, &c. 23 21 Carpentry, upholstery, carvers, gilders, &c. 20 19 Surgical and dental instrument makers 10 10 Tobacco manufacturers 27 24 Wig makers and hair workers 52 51 Printing, bookbinding, lithographers, envelope making, stationers, publishers, &c. 46 34 Jewellers, silversmiths and burnishers, diamond cutters and polishers, engravers, &c. 174 35 Metal workers 145 — Miscellaneous—Basket making, fancy work, shoe ornaments, hat pins, stamp sorters, postcard tinters, fan makers, artificial flower makers, &c. 80 77 Florists 33 33 Laundries 43 43 Bakehouses 84 — Photographers 20 20 Jewel case makers 11 11 New workshops are always being discovered, at the same time the occupation of premises on the register is constantly changing. The use of 390 registered workshops was discontinued, and 347 additions were made to the register during the year; 93 visits of enquiry were made at places where women were likely to be employed. The number of inspections of workshops and workplaces is shown in the accompanying tables. Two hundred and twenty-seven complaints 66 were received, including 94 from the Home Office, and were duly investigated; three matters were referred to the Home Office relating to insufficient warming of rooms, and in addition, notice was sent of 135 workshops in which Abstracts were not affixed. Statutory notices were issued in respect of 20 workshops and 13 workplaces; two 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. Reinspections. Defects Found. Intimation Notices. Statutory Notices. Prosecutions Factories 73 73 50 27 — — Workshops 2,963 3,576 2,240 918 20 2 Workplaces (Including restaurant kitchens, &c.) 2,590 4,790 357 252 13 — Total 5,626 8,439 2,647 1,197 33 2 Defects found.—1913. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Nuisances under the Public Health Acts :— Want of cleanliness 859 859 1 Want of ventilation 223 223 1 Want of ventilation of gas stoves 110 105 — Overcrowding 50 50 — Want of drainage of floors 18 18 — Sanitary accommodation— — Insufficient 47 46 — Unsuitable 97 96 — Defective 364 364 — Not separate for sexes 135 135 — Other defects 742 740 — Offences under the Factory and Workshop Act:— — Illegal occupation of underground bakehouses — — — Breach of special sanitary requirements for bakehouses 2 2 — Other offences — — — Total 2,647 2,638 2 67 Other Matters. Class. Number. Matters notified to H.M. Inspector of Factories:—: Failure to affix Abstract of the Factory and Workshop Act 135 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 94 Reports (of action taken) sent to H.M. Inspectors 94 Other 4 Workrooms measured 562 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. Notices were sent to 72 employers for failing to send in lists, one prosecution was undertaken; the list was sent in before the hearing of the case, but the employer was ordered to pay 23s. costs. In addition 44 visits of enquiry to ascertain if outworkers were employed were made by the women inspectors. The accompanying table gives the details of the returns made in Westminster in 1913. 716 lists, containing 9,192 names and addresses, were sent in by employers; 4,747 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; 414 addresses were received of persons in Westminster taking in work from other boroughs. They were distributed thus:— Council. Sent from Westminster. Received by Westminster. Feb. Aug. Feb. Aug. Council. Sent from Westminster. Received by Westminster. Feb. Aug. Feb. Aug. Acton 12 10 - - Billingshurst 1 1 - - Barnes - 2 - - Broadstairs 1 1 - - Barnet 1 - - - Bromley 1 1 - - Battersea 71 68 1 - Bulverton 1 - - - Beckenham - 1 - - Camberwell 32 34 - - Bedfont 1 1 - - Charlton Kings 1 1 - - Bedford 1 2 - - Chelsea 13 10 39 48 Bermondsey 4 2 - - Chiswick 2 4 - - Bethnal Green 11 11 - 1 City of London 12 10 32 40 Council. Sent from Westminster. Received by Westminster. Feb. Aug. Feb. Aug. Council. Sent from Westminster. Received by Westminster. Feb. Aug. Fell. Aug. Colchester - 2 - - Luton 1 1 - - Croydon 9 8 - - Newbury 1 1 - - Deptford 8 8 - - New Malden 2 3 - - Dunstable 1 - - - Northampton 7 7 - - Ealing 8 7 - - Oxford 1 - - - East Ham - 1 - - Paddington 95 87 6 12 East Molesey 1 1 - - Penge 4 4 - - Edmonton 3 3 - - Perth 1 - - - Enfield 2 2 - - Pontypool - 1 - - Farnborough 1 1 - - Poplar 5 3 - - Einchley 3 4 - - Redhill 1 1 - - Pinsbury 22 23 2 1 Bomford - 1 - - Frampton-Catterell 1 - - - Salford - - 1 - St. Marylebone 776 745 40 44 Friern Barnet 1 1 - - St. Pancras 381 401 - 4 Fulham 36 39 - - Shoreditch 13 7 - - Greenwich - 1 - - Southail-Norwood 2 1 - - Hackney 19 22 - 2 Southend 1 - - - Hammersmith 57 56 - - Southgate 1 - - - Hampstead 9 12 1 3 Southwark 53 46 - - Hanwell 2 2 - - Stepney 126 136 1 2 Harpenden 1 1 - - Stoke Newington 3 4 1 - Harrow 5 - - - Teignmouth 1 - - - Hendon 1 3 - - Tottenham 6 8 - - Holborn 111 108 27 32 Twickenham 1 1 - - Hornsey 4 9 1 1 Walthamstow 2 4 - - Hounslow 1 1 - - Wandsworth 68 72 1 - Ilford 2 1 - - Watford - 1 - - Isle of Wight 1 - 1 - Wealdstone 1 6 - - Islington 75 67 - - Wembley 4 4 - - Kenley - 1 - - West Ham 10 9 - - Kensington 55 62 32 26 Willesden 82 77 - 1 Kingston-on- Wimbledon 5 7 - - Thames - 1 - - Woodford - 2 - - Lambeth 99 98 - - Wood Green 1 2 - - Langley 1 1 - - Woolwich - 2 - - Leeds 1 1 - - Yeovil - 1 - - Lewisham 3 8 5 4 Leyton 6 8 - - 2,380 2,367 193 221 Workers are frequently in the employ of several firms, so that the number of names (2,457) returned as resident in the City does not necessarily coincide with the actual number of workers, which is found to be 1,777. 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 969, as many houses contain a number of outworkers. These houses are mostly in the Soho district. Distributed according to wards they are situated as follows:— Great Marlborough 305 Regent 247 Pall Mall 6 St. Anne 172 Covent Garden 34 Charing Cross 11 Strand 2 Conduit 28 Grosvenor 47 Knightsbridge St. George 9 Victoria 60 Hamlet 9 St. Margaret 6 St. John 33 69 City of Westminster. Outworkers. 1913. 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 275 3,724 156 1,630 1,630 281 3,543 157 1,546 2,154 Dressmaking 12 132 9 119 22 12 95 11 85 21 Theatrical costumiers 1 14 — 10 4 1 14 — 9 5 Waterproofing 1 4 — 2 2 1 3 — 2 1 Shirt making and hosiers 30 262 14 197 79 29 305 12 241 76 Boot making 23 433 5 354 84 26 513 25 414 124 Corset making 2 2 — 2 — 2 3 — 3 — Embroidery 6 62 3 56 9 4 55 4 50 9 Glove making 1 3 — 3 — 1 3 — 3 — Lace making — — — — — 1 2 — 2 — Furriers 2 6 2 5 3 3 10 6 10 6 Hat making 1 2 — 2 — 1 2 2 2 2 Upholsterers and carpet makers — — — — — — — 2 — 2 Ironmongery — — — — — — — 1 1 Paper bag and box making — — 1 — 1 —- — 1 — 1 Artificial flowers — — 2 — 2 — — — — — Wig making — — 1 — 1 — — — — — 354 4,644 193 2,380 2,457 362 4,548 221 2,367 2,402 341 firms sent in lists on both occasions, giving a total of 8,919 addresses; 34 firms sent in once in the year, the number on their lists being 273. 70 Notices were served in respect of 814 defects discovered in 328 houses. They may be summarised thus :— 1913. 1912. 1913. 1912. Sanitary tion :— Walls and ceilings dirty 324 280 Rooms verminous 47 58 Insufficient 3 7 Rooms overcrowded 6 23 Not kept separate 44 50 Rooms badly ventilated 16 27 Unsuitable 5 4 Gas stoves and heaters unventilated 18 17 Apparatus defective 95 79 Requiring cleansing 39 82 Other defects (dampness, defective roofs, floors, water supply, dust bins, &c.) 192 156 Ventilation defective 1 10 Drains, sinks, &o., defective 24 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. Total. Clothing trades:— (а) Business in family affected - 6 (1) 5 (4) - 11 (5) (b) Business in other parts of house - 6(6) 7(6) - 13(12) (c) Persons from infected houses employed in clothing business elsewhere - 15 10 - 25 The figures in brackets represent outworkers' premises. Laundries.—There are 43 laundries in which washing is done, besides which there are a number of private houses in which mangling only is done. Notices were served to remedy various defects found on inspection. These comprised:— Walls dirty 3 W.c.'s and drains defective 2 Accumulation of refuse 1 Room adjoining used as a bedroom 1 Using w.c. lobby for cooking 1 Dampness 1 One case of scarlet fever occurred in rooms used as a laundry. 71 E. FOOD SUITLY. During 1913 visits have been paid to the various classes of business as follows Dairies and Milkskops 1,235 Hotels, Restaurants ancl Eating houses 4,464 Fishmongers 459 Meat shops (various) 662 Provision shops 550 Ice merchants 6 Bakehouses 236 Ice cream makers 298 Food-preserving works 10 Greengrocers and Fruiterers 188 Confectioners 287 Aerated water makers 2 Breweries 2 Restaurants.—The kitchens of hotels and restaurants are inspected at least once a quarter, and 236 notices were served. A list of the defects found is given in the accompanying table. One restaurant in which the kitchen accommodation was quite unsuitable was closed. Defects have been found in places where food is sold or prepared for sale as follows:— 1913 Restaurants Hotels, Eating Houses and Confectioners. Ice Cream Shops. Dairies. Bakehouses. Fish Shops. Butchers, Poultry and Provisions. Fruit and Vegetables. Dirty walls and ceilings 104 22 9 2 3 7 1 Vermin in rooms & — — — — — — Dirty Boors 5 1 1 — — 2 — Defective roofs 7 — — — — 1 — „ floors 3 1 — — 1 — — Absence of or defective dustbins 8 2 Accumulations of refuse .18 3 3 — — 3 2 Food stored or prepared in improper places 6 1 1 1 1 1 1 Yards dirty 5 3 3 — —r 1 — ,, paving defective 4 2 — — 1 — - Water cisterns dirty 6 — 1 — 1 — — ,, „ defective 6 4 1 — — — W.Cs. defective 75 5 — 2 3 3 — „ insufficient 3 1 „ un ventilated 6 1 1 — — — — „ without ventilated lobby 3 1 1 _ 2 Urinals defective 9 — — — — — — Sink wastes, &c., defective 22 3 1 1 1 2 1 Drainage defective 12 2 1 1 — 3 Pavement lights defective 1 Burning refuse in stoves 6 Overcrowding — — — — — 1 Defective ventilation 24 1 2 — — 1 — „ of gas stoves 6 1 1 Dampness of walls, floors, &c 8 1 1 Room adjoining used as a bedroom 2 Kitchens overheated 3 72 Ice-cream Premises.—There were during the year 180 places where this commodity was made or sold and these were kept under supervision. Defects, as shown in the accompanying table, were found and rectified. The making of ice-cream was discontinued after a warning letter was sent pointing out that the premises were unfit for the purpose. Another ice-cream maker was warned against using a room occupied by a consumptive patient wherein to make the ice-cream. Butchers' Shops.—A number of notices for defects (see table) were served. In one instance a yard had been covered in so as to enclose the w.c. and the yard was used for the storage of carcases and brine tubs. Fish Shops.—Several of these had notices on account of the defective conditions and want of proper conveniences for cleansing fish. Greengrocers' Shops.—During the year 188 visits have been made and notices have been served to remedy the following defects:— Dirtiness, accumulation of refuse, improper place for storing food, w.c. badly ventilated, defective sink wastes, &c., and overcrowding. Pea-shelling, 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. Seven premises in and adjoining Covent Garden Market were visited. Two were overcrowded, two required cleansing, in one the floor was defective, and in one there was insufficient w.c. accommodation. Bakehouses.—At the end of 19] 2 there were 15 above-ground and 68 underground in use. During 1913 one above-ground bakehouse was opened for baking pastry only. All the bakehouses were inspected, and cleansing carried out twice a year. One baker was cautioned for failing to protect cakes and tarts from flies, which were numerous in his shop, and was informed that the articles would be seized. Notices were served in respect of dirty walls and ceilings, defective w.c., and improper place for storage of food. 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 63 certificates during 1913, 56 for the United States, and 7 for the Philippine Islands. It is now no longer necessary to grant certificates for the Argentine. 73 Infectious Disease in Places where Food is Prepared or Sold, not including Milkshops. Scarlet Fever. Diphtheria. Typhoid Fever* (a) Illness in persons connected with the business 15 13 2 (b) Business in other parts of house 4 — 3 (c) Persons from infected houses employed elsewhere 15 10 4 Milkshops.—At the end of 1912, 399 names of persons selling milk were upon the register. In 1913, one name was removed and 58 added, leaving 456 on the register at the end of the year; 41 of these were registered in respect of new premises; 1 is a street vendor having no address in the City. Eighty persons selling milk were given notice to register, 59 complied and one was refused registration, the premises being unsatisfactory. One registered vendor of milk gava up selling it. Twelve hundred and thirty-five visits were paid during the year, besides those by the two Inspectors taking samples under the Food and Drugs Acts, to premises in which milk is sold. Notices requiring improvement of existing conditions were served in a number of instances; in 1 the food was stored in an unsuitable place; 1 room where the cans were washed had a boarded floor; and the discontinuance was obtained of the use of a shed as a stable in the yard of a dairy. Objection was taken to the sale of paraffin in 2 milkshops, and to milkpans not being covered in 4 instances. No cases of infectious disease occurred on premises in which milkshops were situated, but 2 persons from infected houses were employed elsewhere in the milk trade. Satisfactory arrangements were made in each instance and no infection of the milk resulted. Cowshed. — There is now only one cow-keeper, namely, at 13, Marsham Street (licensed for 19 cows). These premises were visited 26 times during the year. Contamination of Food—Proposed Legislation for Prevention. —The Public Health Committee had before them the question of the desirability of legislation being introduced for the better protection of food from dust, &c. A Code of Eegulations is in operation in New York dealing with the matter. One of the regulations provides that "No food, except fruits and vegetables that are peeled, pared or cooked before consumption, shall be kept, sold, or offered for sale, or be displayed or transported unless protected from dust, dirt, flies, or other contamination. The term ' food' as herein used shall include every article of food and every beverage used by man, and all confectionery." 74 This regulation supersedes one that was originally in use. It is more stringent than the original one, because it not only includes foods displayed outside stores, but also exposed within stores, bakeries, restaurants, factories and other places, and it is suggested that the protection of foods from infection by flies will minimise the danger of transmission of typhoid fever and other diseases by foods. Permits are now required in New York for sausage manufactories and establishments for smoking and preserving meats. As a result the Council addressed a communication to the London County Council stating that the attention of the City Council has been directed to the need for the better protection of food from contamination by dust and flies, and, on inquiry, they find that in other countries regulations have been framed dealing with this subject; that they are of opinion that if similar regulations were in force in London it would be to the public advantage, and they therefore suggest that the County Council do consider the question of inserting in their next General Powers Bill provisions dealing with the subject. Food Poisoning.—Fourteen employes were taken ill after lunch at a restaurant, and one died. The illness was due to the Gaertner bacillus, but it was impossible to determine what article of food had been contaminated. The Coroner's jury added a rider to their verdict that the Local Government Board be asked to introduce legislation, if necessary, making it compulsory that in all cases arising from food poisoning notification should be given at once to the public health authority. Inspection of Food. The food exposed for sale in shops and on stalls in the street markets has been regularly inspected every day (including Sundays). The following list shows the quantity of food condemned and destroyed during the year. The bulk of it was submitted by the owners or purchasers for the opinion of your officers :— Articles of Food Submitted. Tons. Cwts. Lbs. Apples 3 4 84 Apricots 0 4 38 Bananas 4 8 56 Beans (French) 0 10 Chestnuts 1 7 28 Cranberries 0 9 0 Currants (black) 0 6 94 Horseradish 0 12 0 Kale 0 6 0 Lettuce 0 9 56 Melons 0 5 56 Tons. Cwts. Lbs. Mushrooms 0 0 56 Oranges 3 12 0 Pears 14 1 14 Peaches 2 16 0 Plums 1 16 8 Pineapples 0 0 12 Potatoes 1 0 0 Strawberries 0 3 56 Tomatoes 2 5 0 Tomatoe Puree 0 10 0 Turnip Tops 1 3 0 Codling, 84 lbs.; Haddock, li cwt.; Fish (various), 1 ton; Lamb,8cwts.; Liver Sausage, 64 lbs.; Bullock's Liver, 14 lbs.; Turkeys, 5; Escallops, 3 dozen. 75 The following articles were seized and condemned; appended is a note of the action taken:— Name and Address of Defendant. Article. Result. Milestone and Staniforth, Ltd., 16, Stratford Road, Kensington, W. Exposing for sale at No. 44, Pimlico Road, unsound meat (mutton 4£ ibs. and beef 5 lbs.) Fined £10 and 2*. costs. Sale of Food and Drugs Acts. Samples Purchased under the Sale of Food and Drugs A cts, showing result of Analysis and subsequent Proceedings for year 1913. 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 910 737 (94) 79 43 28 15 47 5 0 25 14 o 2 do. skimmed 4 4 8 do. separated 7 5 2 1 1 0 8 0 0 12 6 4 Cream, fresh 63 46 17 6* 2 4* 2 8 0 1 5 0 5 do. preserved 61 — 61 9* — 9* 6 Butter 289 264 (13) 12 6 5 1 11 5 0 3 19 6 7 Margarine 5 5 8 Bread and butter 18 16 2 1 1 — 2 0 0 1 3 0 9 Flour 16 16 10 do. self-raising 9 9 11 Rice, ground 10 10 12 Meats (various), potted 34 28 6 1 1 13 Meat pies (various) 80 71 9 14 Oxtongue 1 1 15 Brawn 5 2 3 16 Beef, corned 3 3 17 do. spiced 1 1 18 Bacon 1 — 1 19 Sausages, pork and beef 57 49 8 1 1 5 0 0 0 12 6 20 Sausage rolls 8 5 3 1 1 — 5 0 0 0 12 6 21 do. G-erman 31 25 6 22 do. French 1 1 23 do. Italian 1 1 24 do. liver 2 2 25 do. ham 1 1 26 Lamb and Green Peas 1 - 1 27 Fish (various), potted 18 14 4 2 2 - 3 0 0 1 5 0 28 Beans (tinned) 1 1 * Proceedings adjourned sine die, in consequence of an appeal to the High Court, from a decision of the Kensington justices which was and still is pending, also 10 cases from 1912. 76 Number. Article of Food. Number of Samples Purchased. Genuine. (Inferior in brackets.) Adulterated. Prosecutions. Convictions. Withdrawn or Dismissed. Fines. Costs. £ s. d. £ s. d. 29 Peas (tinned) 5 5 30 Tomatoes do. 1 1 31 Oil, olive 28 27 (1) 32 Vinegar 13 11 2 2 2 — 0 7 6 1 5 0 33 Lemon cheese 1 1 34 Sweets (mixed) 17 15 (2) 35 Chocolates 3 3 36 Ginger beer 6 5 1 37 Lemonade 8 8 38 do. powder 2 2 39 do. home 1 1 40 made 41 Cordial, raspberry 2 2 42 do. pine apple 2 2 43 do. vanilla. 1 1 44 Cream soda 1 1 45 Borax 10 6 4 46 Linseed (crushed) 1 5 2 1 — 1 47 Epsom salts 17 17 48 Camphorated oil 18 18 49 Sulphur, flowers of 1 1 50 do. milk of 8 8 51 do. precipitated 10 10 Totals 1,890 1,466 (110) 224 74 43 31 76 13 6 36 9 0 Summary proceedings were ordered to be taken in 81 instances, but 7 of these, upon the suggestion of the Solicitor, were not proceeded with. 28 cautions were issued, the attention of the vendors was called to the report of the Analyst in 31 instances, and no action was taken with regard to 84 samples which did not conform (58 of these were test purchases and not samples taken officially, the others deviated only slightly from the standard). Milk.—910 samples of ordinary milk were taken during the year Of these 79 (8*6 per cent.) were reported by the Analysts to be below the standard of the Board of Agriculture, and 94 samples were just on the border line, making a total of 18 0 per cent, of the samples. The percentage of adulterated (8'6 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 8-6 (if the fat was also below 3*8). Adulterated are those below the official standard of 3 per cent, for fat and 8"5 for solids not fat. 77 District. Total. Good Quality. Fair Quality. Poor Quality. Adulterated. No. Per cent. No. Per cent. No. Per cent. No. Per cent. South 384 103 26.8 156 40.6 97 25.2 28 7.20 North 526 152 28.8 187 35.5 136 25.8 51 9.60 1913 910 255 28.0 343 37.6 233 25.6 79 8.60 1912 873 251 28.7 297 34.0 252 28.8 73 8.30 1911 911 305 33.3 311 34.1 218 23.9 77 8.40 1910 947 332 35.0 328 34.6 179 18.9 108 11.40 1909 951 285 29.9 357 37.5 223 23.4 86 9.04 1908 860 335 38.9 267 31.0 176 20.4 82 9.50 1907 792 255 32.2 290 36.6 172 21.7 75 9.40 1906 806 267 33.1 252 31.2 168 20.8 119 14.07 1905 831 305 36.7 281 33.8 153 18.4 92 11.07 The amount of the superior quality milk is less than in 1912, when a considerable fall was noted. Forty-three prosecutions were taken with regard to adulteration— 28 for fat abstracted, 10 for added water, 4 for both fat abstracted and added water, and 1 for having 6'13 grains of boric acid per pint. Twenty-six cautions were given to sellers whose milk contained less than 5 per cent, of added water, or had less than 5 per cent, of fat abstracted. Warranties were set up as a defence in 21 instances, and were successful in 15, although there is good reason to believe that several of the vendors habitually sell adulterated milk; 1 case was withdrawn with the magistrate's approval—the defendant attributed deficiency to natural causes, also stating that it was the first complaint in twenty-five years. Sunday Samples.—109 of the samples of milk were taken on 11 Sundays during the year; 9 (8-7 per cent.) were found to be adulterated. One sample taken, being separated milk, was found to contain 5 per cent, added water. The defendant was fined 8s. and 12s 6d. costs. Since Sunday sampling was instituted the number of adulterated samples has fallen to half what it was at first. Samples taken in course of Delivery— (a) At Railway Stations.—58 samples of milk were taken on arrival at Victoria and Charing Cross Railway Stations. Eleven were reported of good quality, 25 fair, 18 poor and 4 adulterated:—Fat abstracted, 7 and 4 per cent. (2); added water, 4 and 3"5 per cent. (2). (b) On Delivery at Shops, &c.—19 samples of milk were taken as it was being delivered by wholesale firms to retail customers. Of these samples, G were good, 8 fair, 4 poor, and 1 adulterated (17"6 per cent, added water). These samples were taken in consequence of the milk F 78 sold by the retailer having been previously sampled and found below the limit (including cases where a warranty defence was set up). Proceedings were taken against the vendor of the adulterated sample.—See No. 388 s. in list of prosecutions. Infringement of Section 9, Sale of Food ancl Drugs Act, 1899.— Four persons were cautioned for failure to have name and address on milk cans. Milk and Cream Regulations, 1912.—When these regulations were issued, the City Council took steps to bring them to the notice of all persons selling milk and cream in dairies, shops, hotels, restaurants, &c. The Council came to the conclusion that at first it was unnecessary to take samples specially under the regulations, in view of the number of samples which were taken under the Sale of Food and Drugs Acts, and also because by taking the samples under the latter Acts, they were enabled to take proceedings under either the Sale of Food and Drugs Acts or the regulations, whichever seemed the more suitable for the particular case. In all cases the Public Analysts examine milk and cream for preservatives. A list is appended in the forms asked for by the Board:— 1. Milk and Cream not sold as Preserved Cream.. — (a) Number of samples examined for the presence of a preservative. (b) Number in which a preservative was reported to be present. Milk 910 5 Cream 63 17 (1) Milk.—Preservatives were found in five samples of milk out of a total of 910 examined. Four contained traces of formaldehyde and one 6"13 grains of boric acid per pint. (2) Cream.—In the sixty-three samples of cream—net sold as preserved cream—seventeen contained preservative (boric acid), varying from 1*4 grain up to 41'279 grains per pound. Explanations were asked in eight instances. Eight vendors were cautioned for selling preserved cream as cream, without proper labels. In one case, No. 384 s, on a second omission, proceedings were taken under the regulations, but were dismissed, on the defendant showing that the omission to label was not " wilful"— Public Health Act, 1896, Section 1 (3)—as he had supplied the shop manager with a supply of labels and had given instructions that they were to be used. 79 In consequence of this decision, the Council reluctantly refrained from instituting proceedings in three further cases of infringement of the regulations, as it was considered that the Council were not in a position to prove that in either case the act of omission to label the receptacle containing the article was " wilful." Particulars of the case in which the summons was dismissed were sent to the Local Government Board, and the Board informed of the reason why the summons was dismissed, and of the fact that the Council had since, in consequence, refrained from instituting proceedings in three similar infringements, and the Board was asked to give the question consideration, particularly as to whether it is not possible to secure an amendment of the law placing the onus of proof on the defendant in any case of infringement of the regulations that his act was not wilful. The same vendor was again cautioned (640 s) later in the year for selling " Cream " with 8'6 grains of boric acid per lb. Police Court proceedings under the Sale of Food and Drugs Acts were instituted in five instances, the samples of cream containing boric acid in the following amounts per lb.: 12'39 grains (fined 8s. and 12s. 6c£ costs); 37'19 grains (fined £2 and 12s. 6d. costs); 29 grains, 34-3 grains and 41'279 grains. In the last three the proceedings were adjourned sine die, in consequence of an appeal to the High Court from a decision of the Kensington Justices, which was and is still pending. 2. Preserved Cream.—(a) In the 61 samples taken and submitted for analysis, the statements on the label as to preservatives were correct in 59, incorrect in two. Two samples were guaranteed not to contain more than 025 per cent. (17 J grains), and contained respectively 3 and 8 grains. The remainder were guaranteed not to contain more than 0'5 per cent. (35 grains)—3 approximated closely to the stated figure and two were above it, viz., 4041 grains and 50 grains. The others varied from 1 to 30 grains. An explanation as to failure to label vessel in which cream was sold was asked for in one case, and the vendor cautioned. Two others were cautioned for similar failure. In view of the High Court decision, McNair v. Cullen, 1st June, 1908, proceedings under the Sale of Food and 1 )rugs Acts were instituted in regard to nine samples, containing respectively 24.8 grains, 27.27 grains, 28.49 grains, 28.8 grains, 34.3 grains, 35 grains, 35.7 grains, 40.41 grains and 50 grains, and all were adjourned sine die pending the decision of the appeal mentioned above. Five vendors were cautioned with regard to the amount of boric acid, viz., 24.79, 26.03, 27.51, 28 and 30.49 grains per pound. 80 In nine instances the vendor's attention was called to the result of the analysis. (b) Determination of milk-fat in cream sold as preserved cream was reported in one instance only. The preserved creams purchased were all thick creams. (e) The regulations as to notice on menus have been observed. (Article Y (1).) (d) No infringements of Article Y (2) (labels on receptacles in transit containing cream in bulk) have been detected. 3. Thickcning Substances.—The analysts have not reported the presence of any foreign substances other than preservatives in any of the milks or creams examined by them. It would appear from the result of the analyses of preserved creams in this and former years, that the maximum of boric acid allowed 0-5 (35 grains) is unnecessarily high. In the evidence given on behalf of the trade in the case of McNair v. Cullen the utmost demand was for 0'5 of "preservative," by which was meant various compounds sold under fancy names, and which contain other ingredients beside boric acid. This amount of "preservative" contains only 0'3 per cent, (about 22 grains) of boric acid. In the 61 samples 45 did not exceed this amount. Butter.—Of the 289 samples purchased and submitted for analysis, 12 were found to be adulterated. Six prosecutions and five convictions were obtained. 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 0*5 per cent., which is the maximum amount permitted. Out of 18 samples of bread and butter two were found to be adulterated—one contained 70 per cent, of margarine, and the remaining sample was insufficient to allow of a complete analysis. The vendor of the adulterated sample was fined £2 and 23s. costs. From information supplied by the Board of Agriculture, visits were paid to eight dealers receiving large consignments of a butter and milk mixture which were then distributed to certain hotels and restaurants, in some instances in the original packages, in others in smaller lots. The original packages were properly labelled, but some of the divided ones were not so. Unofficial samples were taken, and found to contain an excess of moisture for butter, but subsequent official ones proved to be under the limit allowed in such mixtures. The attention of the dealers was called to the necessity for proper labelling. A woman who did a considerable business going from house to house in the West End selling what purported to be Devonshire butter was 81 sent to prison for two months. Previous convictions in Westminster, Marylebone, and Kilburn were recorded against her. The wholesale margarine merchant was called to prove the large amount of margarine purchased by defendant each week. Sausages, Meat Pies, &c.—Samples were taken during 1913 of sausages, meat pies, &c., as shown in the list printed above. Of 80 Meat Pies (Various) 9 contained boric acid :—12 39, 12, 8.6, 8, 6.3, 6.2, 61, 3.5 grains per lb. and 1 a trace. Of 5 Brawn 3 contained boric acid:—11.13, 8.05 and 5.81 grains per lb. 1 Spiced Beef Contained 6 grains boric acid per lb. 1 Bacon Contained 2.6 grains boric acid per lb. Of 57 Sausages (Beef and 8 contained boric acid:—43.4, 22.9. 17, 14, 10, 7.4, Pork) 7, and 6.1 grains per lb. Of 8 Sausage Rolls 3 contained boric acid :—28, 21 and 9.9 grains per lb. Of 31 G-erman Sausages 6 contained boric acid :—8.9, 8.6, 8, 7.4, 4.2 and 21 grains per lb. 1 Lamb and Green Peas Contained 3.5 grains boric acid per lb. Potted. Meat.—In 34 samples of potted meats 6 were found to contain preservative to the amount of 25.90, 9.91, 8.67, 7.43, 1.7 and 0"8 grains per pound respectively. Fish.—Eighteen samples of fish (potted and tinned) were examined. Two samples of salmon and anchovy paste were found to contain 99 and 14'8 grains boric acid per lb. respectively. Two samples of salmon and shrimp paste contained 26 and 20 grains boric acid per lb. respectively. Tinned Vegetables.—Seven samples were taken, during the year, of tinned vegetables (5 of peas, 1 of beans and 1 of tomatoes), and all were found free from sulphate of copper or other injurious substance. Vinegar.—Thirteen samples were taken—one bought at a small shop was found to contain an excess of water, it was purchased from an itinerant vendor, and a sample which also proved adulterated was obtained from him, and a prosecution followed. Ginger Beer.—In previous reports attention was called to the liability of contamination taking place from the use of lead pipes through which the beer was drawn. This practice is now being given up, and either glass pipes are being used or the beer is taken direct from the barrel by means of wooden taps. Sweets.—A sample of cocoa-nut gums, which were alleged to have made some children ill, was examined. No metallic impurities were F 2 82 found, but the cocoa-nut chips on the exterior of the gums were somewhat rancid, and when extracted with ether yielded a residue having a sickly odour indicating sourness. The stock of gums was given up and destroyed. Borax.—Ten samples were taken, three contained arsenic, as follows: 125, 75 and 30 parts per million of borax respectively, and one consisted of potash alum. Cautionary letters were sent to the vendors. Dr. MacFadden, of the Local Government Board, reported in 1907 on the presence of lead and arsenic in cream of tartar, and stated that satisfactory limits were fairly recognised by both the manufacturers and analysts. The limit with regard to arsenic is 1.4 parts on arsenious oxide per million (1/1000th part of a grain per lb.), this figure being based on the recommendation of the Royal Commission of Arsenical Poisoning. Martin dale and Wynn Westcott (Extra Pharmacopoeia, 15th edition, 1912) state that the present limit of contamination by arsenic in drugs is taken as xg-ths of a grain of white arsenic per lb. (about 4 parts per million). They think that for drugs given in small doses this limit might be adopted. This is looked upon as a fair standard in Southall's Laboratory Eeport for 1912, in which it is reported that 40 samples of borax had been examined and the arsenic varied from 0 to 160 parts per million. The Local Government Board, in their report for 1911-12, state that during that period 31 samples of borax had been taken by local authorities and 12 were reported against. These samples contained, respectively, as much as 20, 50 (four samples), 70 and 130 parts, while five others showed the very large proportion of 200 parts per million. Proceedings were taken in Birmingham in respect of three samples; one had been purchased from a drysalter, and the case against him was dismissed; two samples had been bought from a chemist, who had labelled them "Finest English Borax," he was fined 5s. and costs. In view of the extensive use which is made of borax and borax compounds, it seems desirable that when it is to be used as a drug for internal administration, or is likely to be added to food, the amount of arsenic should be limited to the amount suggested above. 83 Legal Proceedings Under the Food and Drugs Acts during 1913. No. of Sample. Date of Hearing. Offence. Result. 1 2 3 4 1913. MILK. 81 S. 19th Mar. 5 per cent. of fat abstracted Warranty proved. Summons dismissed. 189 N. * 15 th April 21 per cent. of fat abstracted Fined 20s. and 23s. costs. 186 N.* 15th April 2 per cent. of added water and less than 3 per cent, of milk fat "Warranty proved. Summons dismissed. 191 N. 15th April 6 per cent. of added water... Warranty proved. Summons dismissed. 185 N. 22nd April 24 per cent. of fat abstracted Fined 40s. and 23s. costs. 214 N. 24th April 5 per cent. of added water... Fined £3 and 23s. costs. 177 S. 30th April o'O per cent. of added water Warranty proved. Summons dismissed. 315 n. 23rd May 10 per cent. of fat abstracted Fined 40s. and 12s. 6d. costs. 327 N. 27th May 7 per cent. of fat abstracted Defendant pleaded a warranty, but failed to prove it, and was ordered to pay 25s. costs. 269 S.* 28th May 5 per cent. of fat abstracted Fined 5s. and 12s. 6d. costs. 297 N. 13th June 16 per cent. of fat abstracted Fined 10s. and 23s. costs, including 10s. 6d. allowed to the landlord for his attendance. 279 N.* 13th June 8 per cent. of added water... Warranty proved. Summons dismissed. 391 N .* 24th J une 25 per cent. of fat abstracted Warranty proved. Summons dismissed. 345 S.* 9th July 6 per cent. of fat abstracted Warranty proved. Summons dismissed. 334 S. * 9th July 11 per cent. of fat abstracted Fined £3 and 12s. 6d. costs. 443 N.* 18th July 10.7 per cent. of added water 18 per cent. of fat abstracted Fined £6 and 12s. 6d. costs. 436 N.* 18th July 6 per cent, of fat abstracted Fined 20s. and 12s. 6d. costs. 428 N. 22nd July 13 per cent. of fat abstracted Fined £2 and 12s. 6d. costs. 388 S. 23rd July Taken in course of delivery, 17.6 per cent, of added water Dismissed. The man to whom the milk was consigned said that he paid nothing for the milk and wa3 quite satisfied with it. It appeared that he supplied the Defendant with fish in exchange for milk, and as he did not complain of his fish, he would not complain if the milk was thin. The Magistrate thought that this was not a sale that was contemplated by the Act; it was only a matter of barter, and he felt obliged to dismiss the summons. 323 S. 9th and Taken at Victoria Station in course Summons withdrawn. 30th July of delivery, 7 per cent. of fat had been abstracted The Consignee expressed himself very satisfied with the quality of the milk hitherto supplied, and the Defendant attributed the deficiency to natural causes, stating that this was the first complaint in twenty-five years. The Magistrate expressed himself satisfied with the Defendant's version, and the summons was therefore withdrawn. 596 N. 5th Sept. 16 per cent, of fat abstracted Fined £10 and 23s. costs, or two months' hard labour. 482 N. 5th Sept. 12 per cent. of fat abstracted Ordered to pay 12s. 6d. costs. The Defendant had a warranty, but owing to the summons having been served whilst he was away on his holiday he failed to give notice in time. The Magistrate took this into account in ordering him to pay the costs only. 630 N.* 11th Sept. 23 per cent. of fat abstracted I Warranty proved. Summons I dismissed. * In these cases there have been prosecutions previously. 84 No. of Sample. Date of Hearing. Offence. Result. 1 2 3 4 612 N.* 12 th Sept. 7 per cent. of fat abstracted Fined £5 and 12s. 6d. costs. 510 N .* 12th Sept 6 per cent. of added water and 3 per cent. of fat abstracted Fined 40s. and 12s. 6d. costs. Defendant gave notice of intention to rely on a warranty, but the notice was not in accordance with the Act. 542 N. 17 th Sept. 9 per cent. of fat abstracted Warranty proved. Summons dismissed. 522 S.* 17 th Sept. 7 per cent. of fat abstracted Warranty proved. Summons dismissed. 504 S.* 17th Sept. 8 per cent. of fat abstracted Fined 20s. and 12.s 6d. costs. 490 S.* 17th Sept. Contained 613 grains of boric acid per pint Ordered to pay 42s. costs. The Defendant had a warranty but failed, to give notice. Taking this fact into account, and also the fact that she had been in business for many years without conviction, the Magistrate thought the justice of the case would be met by ordering her to pay costs. 556 S. 1st Oct. 43 per cent. of fat abstracted Fined 20.s and 12s. 6d. costs. 617 N.* 17th Oct. 7 per cent. of fat abstracted Fined 20s. and 12s. 6d. costs. The Defendant gave notice of a warranty but failed to succeed on the same owing to its not having been served within the specified time. 626 N. 10th Oct. 8 per cent. of fat abstracted Fined 30s. and 12s. 6d. costs. 540 S.* 15th Oct. 12 per cent. of fat abstracted Fined 5s. and 12s. Gd. costs. The Defendant relied on a warranty given by the Dairy Supply Co., Ltd., but the Magistrate intimated that he was not satisfied with warranties given by a company that was merely a distributing agent, and that he thought the Defendant had not discharged the onus upon him of proving that he had no reason to believe that the article was not of the nature, &c., demanded. 614 S. 12th Nov. 6'8 per cent. of added water — 613 S. 12th Nov. 12*7 per cent. of added water — The Defendants in these two cases were supplied with milk by the same vendor, and informed the Magistrate that the water had been added to the milk by one of the vendor's servants, who had admitted the offence. Under these circumstances the Magistrate thought the justice of the case would be met by ordering eacli Defendant to pay costs. 604 S. 12th Nov. Taken at Victoria Station in course of delivery, 4 per cent. of added water Taken at Victoria Station in course of delivery, 3*5 per cent. of added The Defendant, who is a farmer, traced the milk by his witnesses back to the cow, and as the added water was in neither case very great the 610 S. 12tli Nov. water Magistrate dismissed the summonses. 744 N. 14th Nov. 5 per cent. of fat abstracted Warranty proved. Summons dismissed. 784 N. 14th Nov. 16 per cent. of fat abstracted Fined 20s. and 12s. 6d. costs. The Defendant gave notice of intention to rely on a warranty, but did not send a copy of it. 653 S. 26th Nov. 26 per cent. of fat abstracted Fined 10s. and 12s. 6d. costs. 839 N. 2nd Dec. 9 per cent. of added water and 6 per cent. of fat abstracted Fined £1 and 12s. 6d. costs. 686 S * 17th Dec. 24 per cent. of fat abstracted Warranty proved. Summons dismissed. 798 S. 1914. 28th Jan. 13*3 per cent. of added water Fined 10s. and 12s. 6d. costs. 149 S. 16th April milk (Separated.) 5 per ` of added water Fined 8s. and 12s. Gd. costs. * In these cases there have been prosecutions previously. 85 No. of Sample. Date of Hearing. Offence. Result. 1 2 3 4 1913. CREAM. 9 S. 19th Feb. Contained 41.279 grains of boricacid per lb. Third sample sent to Somerset House and summons adjournsd sine die. 65 S. 9th April Contained 12.39 grains of boricacid per lb. Fined 8s. and 12s. 6d. costs. Milk and Cream Regulations:— 273 S. 11th June Selling cream containing boric acid, in a receptacle not labelled as required by the Regulations Summons dismissed, the Magistrate being of opinion that the omission to label the cream was not wilful, although Defendants had been previously cautioned. Labels had been supplied by the firm, but were not used by the manageress. 411 S. 23rd July 37.19 grains of boric acid per lb. Fined 40s. and 12s. 6d. costs. Solicitor for tlie Defendants did not dispute the facts, but contended that there was a good defence under a section of the Act, which stated that no person was liable to conviction . . . if he could show to the satisfaction of the Court that he did not know that the article sold was mixed, and that he could not, by reasonable negligence, have obtained that knowledge. The Defendants had for 18 years purchased their cream in bulk from the Belgravia Dairy Company. It was sold exactly as received and there was no notice or intimation of any preservation to the Defendants. It was described as "cream" in the dairy company's invoices. BUTTER AND MARGARINE. 280 S.* 28th May 36.5 per cent, of foreign fat Fined £3, and 12s. 6d. costs. 311 S. 25th June Exposing for sale margarine without a label Fined 5s. and 12s. 6d. costs. 370 N.* 27 th June Selling margarine as butter (taken in course of delivery) Two months' imprisonment. 371 N.* 27th June Exposing for sale margarine not labelled Withdrawn, on above sentence being passed. Package containing margarine not branded 649 S.* 26th Nov. Selling margarine as butter Fined £3 and 12s. 6d. costs. 868 N.* 2nd Dec. Selling margarine as butter Fined £5 and £2 2s. costs. BREAD AND BUTTER. 209 N.* 15th April The butter containing 70 per cent. of margarine Fined 40s. and 23s. costs. CHICKEN, HAM AND TONGUE. 158 S.* 16th April 25.907 grains of boric acid per lb. Warranty proved. Summons dismissed. SALMON AND ANCHOVY PASTE. 291 N. 23rd May 99 grains of boric acid per pound Fined 20s. and 12s. 6d. costs. SALMON, SHRIMPS AND ANCHOVIES. 525 N. 8th Aug. Containing boric acid (1.277 per cent.) Fined 40s. and 12s. 6d. costs. 1914 BEEF SAUSAGE. 912 N. 6th Jan. 43.4 grains of boric acid per lb. Fined £5 and 12s. 6d. costs. SAUSAGE ROLLS. 913 N. 6th Jan. 28 grains of boric acid per lb. of meat present Fined £5 and 12s. 6d. costs. Same Defendant as 912 N. He stated that the pork butcher's shop was under management, and the fact that an excessive amount of preservative was used, was either due to accident or to gross carelessness on the part of his assistants. * In these cases there have been prosecutions previously. 86 No. of Sample. Date of Offence. Result. 1 2 3 4 INEGAR. 217 S. 28th May 26 per cent. of extraneous water Fined 5s. and 12s. 6d. costs. 360 N. 25th J une 59 per cent, of extraneous water ... Fined 2 m. 6d. and 12s. Qd. costs. CRUSHED LINSEED. 54 N. 7th Mar. Deprived of oil to the extent 26 per cent. Summons withdrawn on account of illness of inspector.