ANN UAL REPORT ON THE STATISTICS AND SANITARY CONDITION RELATING TO THE CITY OF WESTMINSTER FOR THE YEAR 1914 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. -V~- " ■ ANNUAL REPORT ON THE STATISTICS AND SANITARY CONDITION RELATING TO THE CITY OF WESTMINSTER FOR THE YEAR 1914 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 Births 1 Notification of Births Act 2 Mother Craft and Child Welfare 3-8 Deaths 8 Infantile Mortality 9 Statistics of Block Dwellings 10 Common Lodging Houses 11 Tables 12-24 B. Communicable Diseases. Smallpox 25 Vaccination 25 Scarlet Fever 26 Diphtheria 26 Typhoid Fever 26 Ophthalmia Neonatorum 27 Plague 27 Tables 28-29 Tuberculosis 30 Cases Notified 30 Deaths 33 Diagnosis and Detection of New Cases 34 Changes of Address 34 Nationality 36 Treatment—Insured and Uninsured Persons 36 Dispensary Scheme 39 After-care 39 Diarrhœal Diseases 40 Measles 41 Whooping Cough 41 Schools and Infectious Disease 42 Bacteriological Laboratory 43 Disinfection 44 Cleansing of Persons 44 Verminous School Children 45 Verminous Houses 45 Verminous Children and Second- Hand Clothing 46 PAGE Disinfection— Motor Van 46 Mortuaries 48 PART II. C. House Inspection, &c.. Defects Remedied 49 Legal Proceedings 50 Drainage, &c., Plans 51 Removal of House Refuse 51 „ Offensive Refuse 52 Housing Conditions— Sanitary Survey of Houses 52 Underground Rooms 53 Houses Let in Lodgings 53 Water Supply 53 Revenue Act 54 Smoke Prevention 54 Offensive Smells 55 Removal of Human Remains 55 D. Workshops. Number on Register 56 Defects 57 Outworkers 58 Infectious Disease 61 Laundries 61 E. Food Supply. Restaurants, &c. 62-63 Ice Cream Premises 63 Bakehouses 63 Certification of Food for Export 64 Infectious Disease 64 Milkshops 64 Food Poisoning 64 Food and Market Inspection 66 Food Condemned 66 Sale of Food and Drugs Acts— Samples Taken, Result of Analysis and Proceedings 67 Milk and Cream Regulations 71 Details of Prosecutions 74 Annual Report on the Health and Sanitary Condition of the City of Westminster. 1914- 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 1914. Returns required by the Local Government Board, and particulars relating to Factories and Workshops required by the Home Office, are incorporated therein. The outbreak of war naturally overshadowed all else. The importance of maintaining the health of our soldiers and of guarding them against needless risks of preventable disease is now well recognised. In view of the fact that the ordinary Sanitary Advisors of the Army Medical Service in London, would be transferred to active service, I wrote to the War Office suggesting that it would be an advantage to utilise the services of the civil sanitary officials in their respective districts, and offered to co-operate in any way. I was requested to see the Deputy Director of Medical Services for the London District, at the Horse Guards, and he thereafter wrote on the 7th August, that he would be glad to avail himself of my services, and that of the sanitary staff, if the Council concurred. The Council, at their meeting on the 13th August, gave the necessary authority, and I was appointed to act as "Sanitary Supervisor" for Westminster, and was later gazetted as Captain in the Royal Army Medical Corps (Sanitary Officers available on mobilisation).* *This particular service was established in 1909 for emergencies of this kind by Sir Alfred Keogh, then Director-General of the Army Medical Service. A2 iv The War Office adopted my suggestion, and the Medical Officer of Health of each Metropolitan City and Borough consented to co-operate in his own district. Lt.-Col. Sir Shirley Murphy, late Medical Officer of Health to the London County Council, was appointed to assist the Deputy Director of Medical Services for London with regard to sanitary matters. The duties to be performed by Medical Officers are:— (1) To inspect, not less than once a week, all billets and ments, and to report once a week on a form to headquarters. The Army Council issued an Order to Home commands directing that Medical Officers of Health shall be informed of any proposed billeting in their districts with a view to obtaining their expert advice and co-operation in billeting the incoming troops under the best sanitary conditions available. Medical Officers of Health are also to be consulted and their visits encouraged wherever camps are formed and maintained. (2) To bring to the knowledge of the Commanding Officers at once, in writing, any serious defects found. (3) To advise Commanding Officer on all sanitary matters when a medical officer of the Royal Army Medical Corps is not attached to him. (4) To inform the Deputy Director of Medical Services of all places found to be occupied by troops. (5) To inspect the food supplied to the troops, and to report any supply found to be unsatisfactory. The Local Government Board subsequently issued a letter asking local authorities to co-operate in any way possible. The Board also pointed out the importance of keeping the medical officer in charge of any local troops informed of any cases of infectious disease within his area, and it is desirable to ask this officer to give him information similarly, of cases of these diseases among the troops. A constant outlook is being kept for typhus fever, enteric fever and smallpox and cerebro-spinal meningitis. The War Office arranged for each Medical Officer of Health to have notified to him any soldiers convalescent from enteric fever coming into a sanitary area, so that they might be kept specially under supervision. The Home Office wrote at the request of the War Office drawing the attention of Local Authorities to the great importance of enforcing strictly the provisions of the Factory Act as to homework in connection with the manufacture of clothing for the Army. Orders for Army clothing are being widely spread, and many comparatively small employers hold contracts ; and in view of this fact and of the enormous V quantities of clothing now being made a great deal of work is being given out to be done by out-workers at their homes. It becomes therefore more than ever necessary, in view of the possible danger of infection to the troops, that great care should be taken to see that the work is not done in premises where there is infectious disease. These various duties have thrown a considerable amount of work upon the Department which has been met by the willing co-operation of the whole staff—sanitary inspector's, food inspectors, clerks, health visitors and disinfectors. The headquarters of seven regiments are in Westminster (Electrical Engineers, Westminster Dragoons, Queen Victoria Ritles, London Scottish, Queen's Westminsters, Civil Service, and the City of London Fusiliers), and extra quarters had to be utilised from time to time for sleeping, drilling, and for stabling horses. In addition, the Army Service Corps had a camp in Kensington Gardens for Transport and Artificers, the Guards had encampments in Green Park and in Prince Consort Road, and there are a number of guardrooms at railway stations and elsewhere. A number of sanitary defects have been discovered and remedied and improvements effected in various directions. All recommendations made have been accepted and acted upon by the military authorities, with whom there has been cordial co-operation. Inspection has been made of food supplied by caterers, and in one instance the attention of the War Office was drawn to the danger of storing acid fruit in zinc receptacles, as a number of men were poisoned in this way. Contractors for the supply of food for the Army have also been regularly visited, two of these also prepare rations and the quality of the meat, vegetables, &c., used and the methods employed have been kept under supervision. Several Volunteer Defence Corps have been formed, and the premises where they meet for drill and firing have been looked after in the same way as those of the regular forces. A number of private houses, nursing homes and hospitals have been utilised for wounded soldiers. This has entailed additions and alterations to make them suitable, and arrangements have also been made for the daily collection and destruction of soiled dressings, and for the disinfection of bedding and clothing. Disinfection has been carried out for verminous conditions of blankets and clothing among the troops, of horse rugs, &c., for ringworm and glanders affecting horses. Fortunately there has been very little infectious disease among the soldiers. It might have been expected that with the congregating of large numbers of young men, illness of this sort might readily occur, especially as scarlet fever was so prevalent in London. In view of the possible importation of smallpox vi from the Continent, rooms were prepared for persons who, having been exposed to infection, might be housed temporarily for observation, but so far they have not been required. The Council made arrangements whereby soldiers in uniform could have free use of public conveniences, and of the swimming and slipper baths at the various Public Baths. Naval Stations.—A number of guard rooms for men employed in connection with searchlights, &c,, exist in Westminster. These have also been looked after and the Admiralty have acted any any suggestions which have been made for improvements in connection therewith. Refugees.—Westminster has been the centre for dealing with large numbers of refugees. The old skating rink in Aldwych has been utilised as a clearing house. They are registered there, and in many instances provided with food and clothing. It has been visited daily by one of the sanitary inspectors. Poland Street Workhouse, which had been unoccupied for some time, was acquired to house refugees who were Jews. As this place had been dismantled, the water supply and sanitary fittings had to be re-instated and the rooms disinfected and cleansed under the supervision of the Department. The number of people in residence fluctuates as accommodation is found elsewhere for the refugees, but as many as 1,200 men, women and children have been there at one time. They were chiefly Polish Jews who had been living in Belgium, and a great deal of sanitary supervision has been found necessary. A medical man attends daily and a hospital has been fitted up with a matron and a staff of nurses. Twelve refugees who came over in one party developed typhoid fever, but otherwise the amount of infectious disease which has occurred has not been great. The chief trouble has been the verminous condition of many of the refugees. Baths for the children were put in, and the Council granted the free use of slipper baths at the Public Baths adjoining. Other premises near Victoria Station, capable of accommodating 200 persons, were in use for a time until the Asylums Board made arrangements for refugees at Alexandra Palace, Earl's Court and elsewhere. The number of refugees received in this country up to the end of the year totalled 59,695. Various premises have been utilised for the reception and distribution of clothing. These have been regularly visited, and when necessary the rooms and clothing have been fumigated. During the first few months work in the tailoring and dress making trades was slack, but a number of distress workrooms have been opened to provide work for women thrown out of employment and these have been visited and assistance rendered by the women sanitary inspectors in connection therewith. Tailors found work sooner by making clothing for officers and men. vii Outworkers' premises, especially where army work was being carried out, have received special attention. The Council arranged that the families of their employees on Active Service should be visited by the Health Visitor, and this has proved helpful in many ways. The great loss of life which a war of such magnitude entails, brings forcibly to the front the urgent necessity for special service and redoubled energy to save infant life, and promote the physical development of the children in order to compensate for the wastage now occurring. Local authorities will have to restrict schemes for new works and buildings except such as are of pressing necessity either for reasons of public health or on account of war requirements, but it is to be hoped that Parliament will not curtail the financial assistance promised, in carrying out maternity and child welfare schemes. The Local Government Board issued on 30th July, a circular in which they expressed the hope that a grant of assistance from the Exchequer would stimulate those local authorities who had not yet taken action, to do so, and would encourage those already engaged in the work to develop it still further. Accompanying the Board's letter was a memorandum which set forth in outline the matters needing consideration in the preparation of a comprehensive scheme. In Westminster, the Health Society, in co-operation with the City Council has been engaged for a number of years in carrying out this kind of work, which has now reached a stage of development which fulfils most of the requirements laid down by the Board in their suggested scheme. Details are given in the body of the report. The Board of Education is also directly interested in this work, and in fact anticipated the Local Government Board by making substantial grants towards schools for mothers, in which the Westminster Health Society participated last year. Sir George Newman, in his sixth annual report, points out that the diseases of the school child are the result in too many cases of neglected infantile conditions and those again are the result of maternal neglect or of ignorance in the young mother. The education of the mother must be recognised as a factor of primary importance and "mothercraft" should be regarded as one of the chief— if indeed it be not the chief—industry of the State. Difficulty is sometimes experienced in finding out exactly the respective responsibilty of the various Government Departments in this connection. It appears that beside local sanitary authorities, county councils, care committees, &c., there are six central Government authorities concerned in the care of infant life. Sir George Newman thus differentiates their spheres of activity:— " Speaking generally, questions of sanitation, public health and viii infectious diseases come under the supervision of the Local Government Board; the control of the industrial employment of pregnant women comes under the Home Office; the midwives are supervised by the Central Midwives Board under the Privy Council; the domiciliary medical treatment of working women and the maternity benefit are under the National Insurance Commission; the instruction and training of women and girls in the care and management of infancy, in home nursing, and in hygiene, comes under the Board of Education." The suggestion has frequently been made that Government Departments concerned with questions of health and hygiene should be consolidated, and the above description provides an additional argument in its favour. Tuberculosis.—The decrease in the frequency of this disease which has taken place in the last twenty years in Westminster was continued in 1914 Details of the work carried out are submitted. The scheme, which was prepared in 1913 in connection with local hospitals for the provision of a tuberculosis dispensary, has been the subject of much discussion during the year, and has now been formally presented to the Local Government Board for their sanction. The general work of the Public Health Department has been continued throughout the year. Staff.—Four members of the disinfecting staff (Bridger, Powell, West and Atkins) and the mortuary assistant (Watling) were called up for service in the army, and Miss Dick, inspector of workshops, &c., acted for a month a,s an hospital orderly in Antwerp up to the time of its fall. During the year the Council extended the maximum of the salary attached to the position of female sanitary inspector from £160 to £175 per annum. Miss A. E. Smith, one of the sanitary inspectors, was appointed one of H.M. Inspectors of Factories and left the Council's service on the 30th September. She had been chiefly occupied in tuberculosis work, visiting outworkers' premises, houses let in lodgings, and children suffering from measles, whooping cough, &c. Pending the sanction of the Council's scheme for a tuberculosis dispensary the position has been filled by a temporary appointment. I have the honour to be, Mr. Mayor, my Lords, Lady and Gentlemen, Your obedient servant, FRANCIS J. ALLAN, Medical Officer of Health. March, 1915. PART I A. STATISTICS. Population. The population of Westminster as estimated to the middle of the year 1914, is 152,346, made up according to the proportion found at the last census of 69,821 males and 82,525 females. This proportion was probably altered in the latter half of the year by the withdrawal of men to serve in the Army and by the importation of refugees from Belgium. 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 1,021 53 632 561 1911 2,110 60 311 2,361 1,562 1,507 55 578 483 1912 2,131 49 264 2,349 1,501 1.469 34 564 451 1913 1,99 2 35 276 2,233 1,162 1,424 38 474 570 1914 1,860 15 312 2,157 1,386 1,347 39 484 477 The following table shows the distribution of births (including infants born in institutions outside the City) according to wards:— 1914. 1913. 1914. 1913. Conduit 28 7 St. Anne 146 158 Grosvenor 86 116 Regent 71 84 Knightsbridge St. George 135 158 Pall Mall 6 10 Victoria 685 723 Great Marlborough 52 71 St. Margaret 101 93 Charing Cross 19 25 St. John 660 623 Covent Garden 92 87 Knightsbridge Hamlet 71 73 Strand 5 5 2 The birth-rate, uncorrected, was 12.2, corrected 14.1 per 1,000 persons. The birth-rate for the County of London for 1914 was 243, and for England and Wales, 23.6. The birth-rates calculated on the number of married (15,097), and unmarried (35,310) women, between the ages of 15 and 45 in Westminster, show more exact rates Westminster. 1907. 1908. 1909. 1910. 1911. 1912. 1918 1914. Legitimate Births (net) 2,764 2,739 2,548 2,399 2,195 2,194 2,057 1,995 16.4 16.4 15.5 14.7 13.7 13.8 13.0 13.2 Illegitimate Births (net) 163 174 203 193 166 155 176 162 0.42 0.46 0.53 0.51 0.44 0.42 0.48 0.45 There were 39 stillborn children, whose births are not subsequently registered; 17 other stillbirths were known but not notified, making 56 in all. The proportion of live births notified to births registered was 72.4 per cent. The proportion notified in previous years was 64.8 per cent. in 1909, 68 in 1910, 70.9 in 1911, 71.1 in 1912 and 71.2 in 1913. 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 also supplies a more complete list of births in outlying institutions and of those which have to be excluded. 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. Of the 2,157 births, 1,879 (87.1 percent.) were visited besides the 56 cases of stillbirths; 47 appeared to be above the standard and were only once visited ; 19 did not desire to be visited, 30 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). A certain number of children born in the Infirmary or in Lying-in-Hospitals from Rescue Homes do not return to Westminster and so therefore cannot be visited. There were 1,110 infants who were under one year of age at the end of 1913, and these also have been visited in 1914. After making allowance for removals and deaths there were 1,535 infants on the visiting list at the end of the year. 3 The visitors endeavour to keep in touch with the children up to school age. In this way 7,006 children have been visited during 1914 Making allowance for removals, deaths, and infants found who had been born elsewhere, there were at the end of the year 5,974 children on the visiting list. Maternity and Child Welfare.—Both the Local Government Board and the Board of Education are prepared to give grants in respect of work which is being done in connection with maternity and child welfare by local authorities and by voluntary societies. The first grant to be made by the Local Government Board was for the six months ending the 30lh September, 1914. The Board of Education has intimated that grants would be made from that body for the twelve months which ended at the 25th March last, and the City of Westminster Health Society has applied and has received a grant in respect of its share of the work. In this connection the Local Government Board issued a memolanduin in which they set forth the lines on which they consider local authorities should act. These are set out below, and in parallel columns a synopsis is given, showing what is being done in Westminster by the Council and voluntary agencies acting in co-operation. (1) Arrangements for the The County Council is responsible under local supervision of mid- the Midwives Act for the supervision wives. of midwives, but where infectious disease occurs in connection with their practice, the City Council is directly responsible under the Public Health Act. Midwives have also to notify the existence of Ophthalmia Neonatorum to the Medical Officer of Health. (2) Ante - natal arrangements:— (a) Ante-natal clinic for The following hospitals send their lists of expectant mothers. women who are to be attended from or in those institutions to the Health Society:— Middlesex Hospital. Charing Cross „ St. Thomas' „ St. George's „ Westminster „ York Road Lying-in Hospital. Other cases are notified by the women 4 themselves or are found in the course of visiting. 787 expectant mothers were dealt with in 1914. (b) Home visiting of ex- This is carried out in respect of abovepectant mothers. Reports are sent to the almoners of the hospitals. The visitors are expected to see that adequate preparations are made by the mothers, proper nursing arranged for, and suitable women engaged to look after the home and cook during period of confinement. (c) Provision of a materWomen can always receive treatment at nity hospital or beds at the above named hospitals. a hospital in which complicated cases of pregnancy can secure treatment. (3) Arrangements for confinement :— (a) At home. (a) and (b). No difficulty seems to exist (c) Hospital provision in in obtaining suitable attendance, and difficult cases. it does not appear nccessary to make special provision. Skilled nurses can be obtained through the Durham House Nurses Association, the Queen Victoria Jubilee Nurses, the Metropolitan Nursing Centres (Bessborough Gardens, Tite Street, Bloomsbury Square, &c.) (4) Post-natal:— (a) Provision in a hospital No difficulty is experienced in securing for complications arising treatment in hospital or in infirmary, alter parturition—for mother or child. (b) Provision of systematic The Health Society have instituted two advice and treatment for centres for infant consultations:— infants at a baby clinic (a) One for the north part of the or infant dispensary. City at 11, Golden Square, under Dr. David Forsyth, Physician for Outpatients, Charing Cross Hospital, and Physician to the Evelina Hospital for Children, assisted by a trained nurse and voluntary visitors. (b) One for the south part of the 5 City, at 1, Pimlico Road, under Dr. J. C. Jewesbury, Physician in charge of Children's Department, Charing Cross Hospital; Physician for Outpatients, Victoria Hospital for Children, Tite Street, Chelsea. Assisted by the Council's Health Visitor and the Society's Visitors. Advice is given to mothers about their children, and treatment is provided by referring to Charing Cross or Victoria Hospitals, where children are seen by Dr. Jewesbury. In the north some are also dealt with by the Middlesex Hospital. (c) Continuation of these The clinics are available for children up clinics up to school life. to school age. Records are kept on similar lines to those made use of by school medical inspectors, and copies are supplied to the latter when the children enter school. (d) Systematic house visiThis is carried out by the Council's tation of infants and Health Visitor, Mrs. Watkinson, in children. co-operation with the Visitors of the Health Society. She also assists in carrying out the previously mentioned arrangements of the scheme. Close co-operation exists between the Society, the School Care Committees, the Invalid Children's Care Association, and other bodies, so as to prevent over-lapping. The Health Society have arranged for the formation of a third Infant Clinic Centre, in St. John's Ward, to begin in January. In addition the Society conducts mothercraft classes at both centres, these include cookery, sewing, cutting-out garments, and health talks. Offices for the Society and the Health Visitor are provided at No. 1, Pimlico Road. Dinners for necessitous expectant and nursing mothers are provided at Napier Hall, Vincent Square, by Mrs. Methold. No part of the grant is at present available in aid of such expenditure. 6 Creches.—There were two of these—one in Kingsway, just outside the City boundary, the other in Pimlico, but this has now been discontinued. Verminous children are cleansed at the Council's Station, those attending schools being paid for by the County Council as Education Authority. Medical Inspection of Children under School Age.—The North Centre completed its third year and the South Centre its second year of existence and both have had their resources taxed by the number of children brought for advice. At the former 1,124 attendances were recorded, at the latter. 1.226. 875 attended for the first time. At the North Centre Dr. Forsyth reports that in 319 children under 5 years of age defects were found in 208, and were chiefly:— Age of Child 0—1 1—2 2—3 3—4 4—5 Nos. examined 201 47 33 20 18 Per cent. Per cent. Per cent. Per cent. Per cent. Decayed teeth — — 12.1 50.0 61.1 Enlarged tonsils — 6.4 27.3 20.0 44.4 Adenoids — 12.8 27.3 35.0 55.5 Rickets 0.5 23.4 6.0 — — Diet modified 17.9 6.4 — — — "These figures, disclosing so plainly the progressive deterioration of physique in each successive year, substantially confirm the results tabulated and commented on in previous reports. But in two respects they seem to show the first gleam of brighter conditions of health among the children of the neighbourhood. In the first place, the number of infants found to be improperly fed at the time when they came under supervision fell last year to less than one-third the figure for the previous year. Second, and in keeping with this, the prevalence of rickets among those under one year was very considerably less this year than last. Granting the unwisdom, until we have the figures for the coming year, of claiming these improvements as solely or even mainly the outcome of the educational work of the Centre, nevertheless it is under these two headings that the earliest indications of a higher standard of " mother-craft" are likely to be seen; and the figures at any rate encourage the hope that the beneficial effects of the Centre may be apparent even sooner than might be expected. "Apart from the preventive work of the Centre—and this, of course, still remains its essential function—no small account of curative hospital treatment has been obtained for its small patients. Inclusive of cases new and old, some 238 defects have been thus remedied, many of them requiring treatment by surgical operation; and here again, the 7 largest numbers were dental, nose and throat cases. The difficulty noted in the last report, of obtaining early conservative dental treatment (that is to say, stopping teeth as opposed to extracting them) grows no less, and it is still a frequent experience for children with early dental decay, remediable at the time without the loss of the tooth, to go untreated until several teeth are affected, some of them now beyond saving. No more important step in furthering the usefulness of the Centre could be taken than by improving the facilities for prompt dental treatment. It is hoped that before the new year is far advanced means will have been found to surmount this difficulty." 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 l—2 2—3 3—4 4—5 5 and over. Number inspected 253 97 79 42 27 31 Defectives 135 61 56 23 23 25 Improperly fed 26 6 — — — — Rickets 9 19 12 5 — — Wasting and general debility 5 6 9 2 2 4 Gastro-enteritis 25 15 1 — — — Tonsils and adenoids — 1 5 5 3 1 Enlarged glands 1 — 2 2 5 4 Congenital syphilis 6 — — — — — *Inclusive of children improperly fed. These figures compared with those of the previous year also show improvements similar to those indicated at the North Centre. Dr. Jewesbury notes a point of interest, that since the War, on account of the separation allowances, there appears to have been less poverty than in former years and the children in many cases have benefited by this. Special attention is given to the children of tuberculous parents and to suspect cases, and 144 children were reported upon at the two centres (116 at the South Centre, 28 at the North). 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. The Council gave instructions that periodical visits should be paid to the families of the Council's employees on active service. Some had removed to relatives in the country, but 231 families were visited and in only five instances were the circumstances found to be unsatisfactory. In four of the cases the mothers were spending their money on drink and more or less neglecting their homes and children. The 8 conditions in each instance improved under the supervision of the Health Visitor (Mrs. Watkinson) and it has not been necessary to take more serious measures. In addition to the Army allowance, each woman is receiving half pay from the Council. The families of soldiers who had married "off the strength" have derived much benefit from the grants made by the War Office. There are a number of such in Westminster and it was a struggle to keep the home going on the small amount which a soldier could spare from his pay. Since the receipt of the weekly war allowance it has been observed that the children are better fed and clothed and generally the home conditions have materially improved. Deaths. 1,971 deaths were registered in the City in the 52 weeks ending the 2nd January, 1915. After deducting 958 deaths of non-citizens in public institutions in the City, and adding those of 933 citizens who died in other districts, the corrected total is 1,946, and is equivalent to an annual rate of 12.7 per 1,000 persons, the same as the preceding year. The average death-rate for the ten years 1904-13, was 12.8 per 1,000. The London death-rate for 1914 was 14.4, the average for the previous five years being 141. For England and Wales the rate was 13.6. Tables appended to this part of the Report show the vital statistics of the City and five groups of districts from 1892 to 1914. The death-rates, according to the old districts of the City, are:— District. Average of Previous 10 Years. 1914. St. George 11.7 11.8 Westminster 15.0 15.1 St. James and St. Anne 11.5 9.8 Strand and St. Martin 13.8 13.8 The City 12.8 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 were 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 1914 were lower than in 1913, from influenza, cancer and old age. The causes showing a marked increase were scarlet fever, 9 whooping cough, diphtheria, enteric fever, diseases of the nervous system, accidents and suicide. Ages at Death.—The distribution in age-groups for the last four years 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 65 295 586 658 1912 1,984 195 43 44 49 54 306 594 699 1913 2,030 213 46 36 41 68 328 609 689 1914 1,946 171 31 34 48 71 314 575 702 The distribution of deaths under 1 and over 65 years is shown below:— 1914. 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 i 1 — 1 3 3 1 1 — 5 Grosvenor 2 1 1 2 6 11 12 10 10 43 Hamlet of Knightsbridge 1 — 1 1 3 8 9 4 4 25 Knightsbridge St. George 5 — 3 1 9 16 9 5 9 39 Victoria 18 11 14 16 59 68 48 41 66 223 St. Margaret 5 2 1 2 10 16 6 3 10 35 St. John 15 11 18 17 61 64 41 35 50 190 St. Anne 3 2 — 2 7 7 7 3 5 22 Great Marlborough 1 1 — 1 3 6 7 — 3 16 Pall Mall — — — — — 2 3 1 2 8 Regent — 2 — 1 3 9 4 2 6 21 Charing Cross 1 — — — 1 3 4 5 1 13 Covent Garden 4 1 1 — 6 10 10 4 12 36 Strand — — — — — 11 7 4 4 26 The City 1914 56 32 39 44 171 234 168 118 182 702 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 91 deaths per 1,000 births registered in the City, against a rate of 107, the average of the previous ten years. The corrected rate works out at 79, the average of the previous five years having teen 91, and of the preceding five years 1904—8, 107. B 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 thirteen years:— 10 / Year. 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 2,057 181 89 176 29 164 95 1914 1,995 147 73 162 24 118 79 Victoria Ward 624 52 83 61 7 114 86 St. Margaret and St. John 711 61 85 50 10 200 93 Rest of City 660 34 51 51 7 137 57 For all London the rate was 104 in 1914, compared with 105 in 1913 and 91 per 1,000 in 1912; for England and Wales the rate was 105, compared with 109 in 1913, and 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, St. Margaret and St. John Wards, and in the remaining wards. There is a general decrease in deaths from all other causes, except for whooping cough and injuries and neglect at birth. In a number of instances, the infants were not born in Westminster, the families moving into the City afterwards, and thus 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 of 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 16 139 111 1907 1,163 60 516 18 15.5 116 1908 1,155 50 432 10 8.6 120 1909 1,156 44 380 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 1914 1,212 39 32.1 17 14.0 77 11 Common Lodging-houses. The total common lodging-house accommodation available during the year was 2,051 beds for men, 62 for women. Deaths.—92 deaths (90 males and 2 females) occurred in 1914 among inmates of the common lodging-houses and shelters in the City. 26 of the deaths were due to phthisis, 22 to respiratory diseases, 4 to nervous diseases, 18 to diseases of the heart and blood vessels, 9 to cancer, and 2 to kidney disease. There were 43 deaths in St. John's Ward, 8 in Covent Garden, and 39 in Strand. The following is a list of the common lodging-houses in Westminster, the number for which they were licensed, and the number of deaths which occurred during the last five years among persons alleged to have been inmates:— Comni )n Lodging Ileuses. No. of beds. Deaths. 1910. 1911. 1912. 1913. 1914. Men. Bruce House, Kemble Street (L.C.C.) 706 36 34 24 32 35 33, Great Peter Street 397 11 8 14 16 16 Ham Yard Hospice, Great Win imill Street 20 — — — — 11,12, and 13, Hanover Court 105 8 8 8 9 8 108, Regency Street. 8 — — — — 2 16, Strutton Ground 222 3 8 7 12 9 S.A. Shelter, Great Peter Street 593 1 6 8 2 10 Women. 40, Great Peter Street 62 4 4 1 5 2 In addition, 10 deaths were recorded of former inmates of common lodging-houses the use of which has been discontinued. Tuberculosis.—Information was received of 99 new cases of pulmonary tuberculosis (7 being women) from common lodging-houses or homeless. Of these 17 have died, and the deaths have been recorded of 20 notified in previous years, but probably a number have died elsewhere. There were 2 deaths from other forms of the disease. B 2 12 Table I.—Causes of, and Ages at, Death during the year ended 2nd January, 1915. 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. Coyent Garden. Strand. Smallpox — — — — — — — — — — — — — — — — — — — — — — — Measles 7 2 3 1 1 — — — — 1 — — — 1 — 1 1 — — — — — — Scarlet fever 10 — — 3 5 1 i — — — — — — 3 — 5 1 — — — — 1 — Influenza 17 1 — — — 1 4 2 9 1 1 2 4 4 — 3 — 1 — — 1 — — Whooping-cough 21 12 7 2 — — — — — — — — — 3 1 11 — 1 — 1 — 4 — Diphtheria, Memb. croup 15 1 — 8 4 1 — 1 — — 2 1 — 4 1 4 2 — — — — — — Cerebro-spinal meningitis 1 — — 1 — — — — — — — — — — — 1 — — — — — — — Enteric fever 8 — — — 2 1 4 — 1 — — — — 2 — 1 2 1 — — — — — Infective Diarrhœa 11 6 2 — — — — 2 1 — — — — 2 — 9 — — — — — — — Enteritis 24 18 3 — — — — — — — — — — — — 13 1 2 1 — — — — Erysipelas 3 — — — — — 1 2 — — — : — — 1 — 1 — — — — — — — Puerperal fever 4 — — — — — 4 — — — — — — 2 — 1 — — — — — — — Other septic diseases 19 5 — — 5 1 6 2 — 1 — — — 5 3 5 1 1 — — — 3 — Syphilis, &c. 7 3 — — — — 3 — 1 — — — — 2 1 2 1 — — — — — 1 Diabetes 16 — — — — 1 3 6 6 — 2 — 1 10 — 1 — — — — — 1 l Rheumatic fever 7 — — — 3 1 2 1 — — — — — 3 — 2 — 1 — 1 — — — Tuberculosis of meninges 8 — 1 3 4 — — — — — — — 1 2 1 I — — 1 — — — Tuberculosis of lungs 211 — 1 1 3 16 95 76 19 1 8 4 8 51 8 75 15 4 2 4 3 13 15 13 Tuberculosis of peritoneum 6 — 2 2 — 1 — 1 — — — — — 2 — 1 1 1 — 1 — — — Other forms of tuberculosis 9 2 — 1 3 1 — 1 1 — — — — — 5 — 3 1 — — — — — — Other forms of tuberculosis 172 1 — — 1 2 16 81 71 2 14 8 18 48 6 41 4 4 2 2 3 13 1 Malignant growths 36 36 — — — — — — — 1 1 1 — 16 3 7 2 1 — 2 — 2 — Premature birth 44 40 3 1 — — — — — — 3 1 3 18 5 10 2 — — — 1 1 — Developmental diseases 84 — — — — — — 1 83 1 4 1 4 28 5 28 2 1 — 4 1 3 2 Old age 10 4 1 1 — 2 1 1 — 1 — — 2 3 — 3 — 1 — — — — — Meningitis and convulsions Loc. Ataxia and general paralysis 25 — — — — — 10 14 1 1 — — 3 8 3 5 — — 1 2 — 2 — Other diseases of nervous system 55 — — — — — 5 18 31 1 4 2 2 20 3 11 2 1 1 — 2 3 3 Valvular diseases of heart 92 — — — 2 8 15 36 31 1 4 — 8 28 6 27 3 — 2 2 3 5 3 Other circulatory diseases 299 — — — — 4 15 107 173 2 9 12 21 89 16 74 13 5 4 8 6 27 13 Bronchitis 191 9 1 — 1 1 7 42 130 — 9 5 7 57 3 36 8 6 5 7 3 7 8 Broncho-pneumonia 40 12 1 2 2 — 3 9 11 — 2 — 3 9 5 13 1 1 2 5 2 6 3 Pneumonia, other forms 84 2 2 — 3 1 21 24 31 3 4 3 5 28 2 15 5 1 2 5 2 6 3 Other respiratory diseases 19 — — — — — 3 7 9 — 1 4 — 6 3 4 — — — 1 — — — Alcoholism 13 — — — — 1 7 5 — — 1 1 1 2 2 4 — — 1 1 — — — Cirrhosis of liver 35 — — — — — 6 18 11 — 4 2 2 12 3 5 1 — — 2 1 3 — Appendicitis and typhlitis 8 — — — 1 3 1 1 2 — 1 — — 3 — 1 1 — — 1 — 1 — Other digestive diseases 58 3 1 1 1 5 9 23 15 1 6 3 2 11 4 16 — 3 4 2 — 2 1 Bright's diseases, &c. 86 — — — — 2 13 37 34 1 9 3 7 18 6 30 2 2 3 1 1 2 1 Generative system diseases. 7 — — — — — 5 2 — — — 1 1 1 2 — 1 — 1 — 1 — — Accidents and diseases of parturition 9 — — — — 1 7 1 — — 1 — 1 3 2 1 — — — — — — 1 Deaths by accident or negligence 82 7 1 5 4 3 19 28 15 2 10 — 3 1 8 14 5 4 1 5 4 5 — Deaths by suicide and murder 41 2 — — — 7 19 10 3 1 2 — 2 12 6 5 2 — 2 3 3 3 — Other defined diseases 52 5 2 2 3 5 9 16 10 — 2 1 5 12 5 14 3 4 1 2 1 2 — Diseases, ill defined or unknown — — — — — — — — — — — — — — — — — — — — — — — All causes 1,916 171 31 34 48 71 314 575 702 22 104 55 114 562 114 534 84 47 34 62 37 112 65 14 Table II.— Vital Statistics of Whole Districts during 1914 and previous years. City of Westminster. i 2 3 4 5 6 7 8 9 10 11 12 13 Year. Population Estimated to Middle of each Year. Births. i Total Deaths Registered in the District. Transferable Deaths.† Nett Deaths belonging to the District. Of NonResidents Registered in the District. Of Residents not Registered in the District. Under 1 Year of Age. At all Ages. Number (Uncorrected). Nett. Number.* Rate. Number.* Rate per 1,000 Nett Births. Number.* Rate. Number. Rate. 1906 170,652 2,766 2,931 17.1 2,482 14.5 1,045 790 323 110 2,227 13.0 1907 168,396 2,732 2,927 17.3 2,396 14.2 992 833 303 103 2,237 13.3 1908 166,170 2,665 2,913 17.5 2,437 14.6 1,089 829 293 100 2,177 13.1 1909 163,974 2,520 2,751 16.7 2,406 14.6 1,091 881 258 93 2,196 13.3 1910 161,803 2,365 2,592 16. 0 2,164 13.3 1,023 750 214 82 1,891 11.6 1911 159,709 2,110 2,361 14.7 2,286 14.3 1,103 822 243 102 2,005 12.5 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 1,048 870 213 95 2,030 12.7 1914 152,346 1,860 2,157 14.1 1,971 12.9 958 933 171 79 1,946 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 b, corrected by subtraction ot the number in Column 8 and by addition ot the number in Column 9. Deaths under 1 year of age in Column 10 are similarly corrected. Rates in Columns 5, 7, and 13 are calculated per 1,000 of estimated population corrected from the 1911 Census. †"Transferable Deaths" are deaths of persons who, having a fixed or usual residence in England or Wales, die in a district other than that in which they resided. The following special cases arise as to Transferable Deaths:— (1.) Persons dying in institutions for the sick or infirm, such as hospitals, lunatic asylums, workhouses, and nursing homes (but not almshouses), must be regarded as residents of the district in which they had a fixed or usual residence at the time of admission. If the person dying in an institution had no fixed residence at the time of admission, the death is not transferable. If the patient has been directly transferred from one such institution to another, the death is transferable to the district of residence at the time of admission to the first institution. (2.) The deaths of infants born and dying within a year of birth in an institution to which the mother was admitted for her confinement should be referred to the district of fixed or usual residence of the parent. (3.) Deaths from violence are to be referred (a) to the district of residence, under the general rule; (b) if this district is unknown, or the deceased had no fixed abode, to the district where the accident occurred, if known ; (c) failing this, to the district where death occurred, if known ; and (d) failing this, to the district where the body was found. Total popuiati0rL at all ages .. .. 160,2611 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 J (3.) Deaths from violence are to be referred (a) to the district of residence, under the general rule; (b) if this district is unknown, or the deceased had no fixed abode, to the district where the accident occurred, if known ; (c) failing this, to the district where death occurred, if known ; and (d) failing this, to the district where the body was found. Total population at all ages .. .. 160,261 Area of District in acres (exclusive of area covered by water) 2,502*7 Number of inhabited houses .. .. 17,540 At Census of 1911. Average number of persons per house .. 9*1 15 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 (361). Middlesex Hospital. North-Western Fever Hospital. Westminster Hospital (191). St. Thomas's Hospital. Charing Cross Hospital (219). St. Bartholomew's Hospital. Grove Fever Hospital. St. Peter's Hospital (30). St. Mary's Hospital. Maitland Sanatorium. Grosvenor Hospital (2). German Hospital. St. Michael's Home, Cheddar. Women's Hospital, Soho Square (20). French Hospital. East Anglian Sanatorium. Italian Hospital. Mount Yernon Hospital. Throat Hospital, Golden Square (4). Guy's Hospital. Middlesex Convalescent Home, Clacton. Freidenheim Hospital. Gordon Hospital (1). Brompton Hospital. Downs Sanatorium. Queen Alexandra Military Hospital (35). Northern Hospital. City of Westminster Infirmary, Fulham Road. Victoria Hospital. Infants' Hospital (164). Great Ormond Street Hospital. City of Westminster Infirmary, Hendon. Royal Ear Hospital (5). King Edward's Hospital (2). Cancer Hospital. City of Westminster Workhouse, Fulham Road. Westminster Ophthalmic Hospital (1). University College Hospital. London Hospital. Edmonton Workhouse. All Saints' Hospital (1). West London Hospital. Marylebone Infirmary. Lock Hospital (3). Evelina Hospital. llolborn Infirmary. Empire Hospital (15). Homoeopathic Hospital. Chelsea Infirmary. 24, Chapel Street (2). Queen Mary's Hospital. Lambeth Infirmary. 15, Charles Street (1). West London Hospital. Kensington Infirmary. 17, Park Lane (3). Queen Charlotte's Hospital. Cleveland Street Infirmary. 26, Park Lane (1). Metropolitan Hospital. Belmont Infirmary, Sutton. 96, St. George's Road (1). Chest Hospital,YictoriaPark. St. James' Infirmary, Battersea. 22, George Street (4). New Hospital for Womsn. 42, Bel grave Road (2). Hospital of St. John and St. Elizabeth. Wandsworth Infirmary. 96, Belgrave Road (2). St. Pancras Infirmarv. City of Westminster Workhouse, Wallis Yard (1). Poplar Hospital. City of London Infirmary, Hacknev. Putney Hospital. National Hospital, Queen's Square. Huddersfield Infirmary. Chelsea Workhouse. Home Hospital, Fitzroy Square. St. Giles' Workhouse. Greenwich Workhouse. Hospital for Epilepsy and Paralysis llolborn Workhouse. Banstead Asylum. Royal Free Hospital. Caterham Asylum. King's College Hospital. Cane Hill Asylum. Great Northern Hospital. Clajbury Asylum. Croydon General Hospital. Colney Hatch Asylum. St. Andrew's Hospital, Windsor. Camber well House Asylum. Darenth Asylum. West Ham Hospital. Han well Asylum. East Suffolk Hospital. Horton Asylum. St. Nicholas's Hospital, Thanet. Leavesden Asylum. Manor Asylum. Hampstead General Hospital. Tooting Bec Asylum. Royal Waterloo Hospital. Fisher ton House Asylum, St. Joseph's Hospital, Chiswick. Dartford Heath Asylum. Middlesex County Asylum. Addenbroke Hospital, Cambridge. Bethnal House Asylum. Northampton County Asylum. Hostel of God. Western Fever Hospital. Oxford County Asylum. Fountain Fever Hospital. South Yorkshire Asylum. London Fever Hospital. Long Grove Asylum. South-Western Fever Hospital. Somerset and Bath Asylum. Epileptic Colony, Epsom. 16 Table II—continued ill. Other Institutions, the Deaths in which have been distributed among the several wards in the City. Ill — continued. Other Institutions, the Deaths in which have been distributed among the several wards in the City. Ill—continued. Other Institutions, the Deaths in which have been distributed among the several wards in the City. 3, Upper Vernon Street, Clerkenwell. 9, King Street, Marylebone. 3, Nottingham Place, Marylebone. 13, St. Edmund's Terrace, Marylebone. 2, 20, 37, Beaumont Street. 7, Knaresborough Place, Kensington. 15, 51, Welbeck Street. 7, Mandeville Place. 3, Cambridge Lodge Villas, Hackney. 4, Dorset Square. 3, Upper Montague Street. 2, Crookham Road, Fulham. St. Elizabeth's Home. 18, Langham Street. 5, Wigmore Street. The Priory, Putney. 21, Braybourne Avenue. 50, Weymouth Street. Clapham Maternity Home. 101, Shepherd's Bush Road. 7, Queen Anne Street. St. Luke's House, Pembridge Square. 23, Devonshire Street. 64, South Side, Clapham Common. 73, Belsize Park Gardens. Thrale Hall, Mitcham Lane. 99, Cromwell Road. 17 Table III.—Deaths of Citizens during the Year ending 2nd January, 1915, showing Locality at Time of Death. Locality at Time of Death. Total Deaths (Nett). Wards. 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. 8 6 14 1 — 1 1 2 3 — — — 1 1 2 2 2 13 9 22 Grosvenor 27 28 55 7 7 14 8 10 18 — 1 1 — — — 12 4 16 54 50 104 Hamlet of Knightsbridge 17 15 32 5 3 8 6 5 11 — — — — — — 2 2 4 30 25 65 Knightsbridge St. George 35 30 71 9 5 14 10 7 17 — — — 2 2 4 5 3 8 61 53 114 Victoria 118 120 238 81 78 159 50 36 86 6 2 8 24 20 41 16 11 27 295 267 562 St. Margaret 33 22 55 9 7 16 12 13 25 1 1 2 2 2 4 10 2 12 67 47 114 St. John 80 90 176 152 72 224 47 32 79 2 6 8 18 14 32 11 4 15 310 224 534 St. Anne 13 10 23 8 10 18 17 12 29 2 3 5 2 5 7 1 1 2 43 41 84 Great. Marlborough 7 8 15 9 6 15 6 7 13 1 — 1 2 1 3 — — 25 22 47 Pall Mall 12 3 15 4 1 5 5 2 7 — 1 1 1 2 3 2 1 3 24 10 34 Regent 16 10 26 7 8 15 4 7 11 — — — 4 2 6 3 1 4 34 28 62 Charing Cross 18 8 26 — — — 4 4 8 — — — 1 — 1 2 — 2 25 12 37 Covent Garden 20 21 41 25 11 36 21 3 24 2 — 2 4 2 6 2 1 3 74 38 112 Strand 5 4 9 43 5 48 4 1 5 — — — 1 1 2 1 — 1 54 11 65 City of Westminster.. 409 387 796 360 213 573 195 141 336 14 . 14 28 62 52 114 69 30 99 1,109 837 1,946 18 Table IV (L.G.B. Table).—Vital Statistics of Separate Localities, 1904-1914. 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. Jchn, and the Hamlet of Knightsbridge Wards. 4. St. James, comprising Itegent, Marlborough, Pail 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. 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 ?5 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 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 Averages of 10 years 1904-1913 165,226 2,512 2,147 273 71,618 1,039 848 103 48,615 914 734 113 27,069 393 314 38 17,886 170 249 18 1914 152,346 1,860 1,946 171 67,413 826 802 77 46,373 709 703 74 23,160 218 227 13 15,400 107 214 7 19 Table IV, continued.— Vital Statistics of Separate Localities, 1904-1914.—Rates. Localities 1. City of Westminster. 2. St. George's. 3. Westminster. 4. St. James. 5. Strand. Year. Births Registered (uncorrected). Rate per 1,000. Deaths at all Ages (corrected). Rate per 1,000. Deaths under 1 Year. Rate per 1,000 Births (uncorrected). Births Registered (uncorrected). Rate per 1,000. Deaths at all Ages (corrected). Rate per 1,000. Deaths under 1 Year. Rate per 1,000 Births uncorrected). Births Registered (uncorrected). Rate per 1,000. ' ' | Deaths at all Ages (corrected). Rate per 1,000. Deaths under 1 Year. Rate per 1,000 Births (uncorrected). Births Registered (uncorrected). Rate per 1,000. Deaths at all Ages (corrected). Rate per 1,000. Deaths under 1 Year. Rate per 1,000 Births (uncorrected;. Births Registered (uncorrected). Rate per 1,000. Deaths at all Ages (corrected). Rate per 1,000. Deaths under 1 Year. ! Rate per 1,000 | Biiths (uncorrected). 1904 16.5 13.5 124 15.8 11.8 117 19.6 10.2 152 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 1900 16.2 13.0 no 15.0 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 80 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 14.0 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 10.6 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 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 Average of 10 years 1904-13 15.1 12.8 107 14.4 11.7 98 18.7 15.0 122 14.3 11.5 95 9.3 13.8 98 1914 12.2 12.7 91 12.2 11.8 93 15.2 15.1 104 9.4 9.8 59 6.9 13.8 65 * The rates in these years are calculated on a 53-week population. 20 Table V.—Infant Mortality, 1914. Nett deaths from stated causes at various ages under One Year of Age in the City of Westminster. CAUSES OF DEATH. Under 1 Week. 1—2 Weeks. 2—3 Weeks. 3—4 Weeks. Total under 4 Weeks. 4 Weeks and under 3 Months. 3 Months and under 6 Months. 6 Months and under 9 Months. 9 Months and under 12 Months. Total Deaths under 1 Year. Measles 1 1 2 Whooping cough — — — 1 1 1 2 4 4 12 Diphtheria and Croup — — — — — 1 1 Septic causes — 2 1 — 3 1 1 5 Other tuberculous diseases 1 1 2 Convulsions — 1 — 1 1 2 Bronchitis — — — 1 1 4 1 1 1 8 Pneumonia (all forms) — 1 1 — 2 4 4 5 2 17 Diarrhoea — 3 2 2 7 Enteritis — — 2 2 6 6 3 17 Gastritis — — — 2 1 3 Syphilis — — 1 — 1 1 1 3 Rickets — 1 1 2 Suffocation 1 1 Injury and neglect at birth 9 1 10 10 Atelectasis 2 — 2 2 Congenital Malformations 4 1 4 9 4 2 1 16 Premature birth 26 2 1 — 29 7 36 Atrophy, marasmus, and debility from birth 2 1 1 4 4 2 1 2 13 Other causes 2 — 1 — 3 3 — — 6 12 Totals 45 9 7 7 68 42 23 15 23 171 Nett Births in the year— Legitimate 1,995 Illegitimate 162 Nett Deaths in the year of— Legitimate infants 147 Illegitimate infants 24 21 Table V, continued.—Infant Mortality. 1914. Nett Deaths jrom stated causes at various ages under One Year of Age in St. John and St. Margaret Wards. CAUSES OF DEATH. Under 1 Week. 1—2 Weeks. 2—3 Weeks. 3—4 Weeks. Total under 4 Weeks. 4 Weeks and under 3 Months. 3 Months and under 6 Months. 6 Months and under 9 Months. 9 Months and under 12 Months. Total Deaths under 1 Year. Whooping cough — — — — — — 1 3 4 8 Diphtheria and Croup — — — — — 1 — — — 1 Umbilical Sepsis — 1 — — 1 1 — 1 — 3 Other tuberculous diseases — — — — — — — 1 — 1 Bronchitis — — — 1 1 2 — — 1 4 Pneumonia (all forms) — — — — — 3 1 1 1 6 Diarrhoea — — — — — 2 1 — 1 4 Enteritis — — 2 — 2 6 3 — 2 13 ■Gastritis — — — — — 1 — — — 1 Syphilis — — 1 — 1 — — — — 1 Rickets — — — — — — 1 — — 1 Injury at birth 3 — — — 3 — — — — 3 Atelectasis 1 — — — 1 — — — — 1 Congenital malformations 1 — — 1 2 2 1 — — 5 Premature birth 4 2 . — — 6 4 — — — 10 Atrophy, marasmus and debility from birth 1 — — — 1 2 — — — 3 Other causes 1 — 1 — 2 2 — — 2 6 Totals 11 3 4 2 20 26 8 6 11 71 Nett Births in the year— Legitimate 711 Illegitimate 50 Nett Deaths in the year of— Legitimate infants 61 Illegitimate infants 10 22 Table V, continued.—Infant Mortality, 1914. Net deaths from stated causes at various ages under One Year of Age in Victoria Ward. CAUSES OF DEATH. Under 1 Week. 1—2 Weeks. 2—3 Weeks. 3—4 Weeks. Total under 4 weeks. 4 Weeks and under 3 Months. 3 Months and under 6 Months. 6 Months and under 9 Months. 9 Months and under 12 Months. Total Deaths under One Year. Measles 1 1 Whooping Cough 1 1 Septicaemia — 1 1 — 2 — 2 Other tuberculous diseases 1 1 Bronchitis — — — — 1 1 2 Pneumonia (all forms) — 1 — 1 1 3 1 Diarrhoea 1 1 1 3 Enteritis 2 1 3 Syphilis — — 1 1 2 Rickets 1 1 Injury at birth 3 1 — 4 4 Congenital malformations 1 1 2 4 1 1 1 7 Premature birth 14 — — — 14 2 16 Atrophy, marasmus and debility from birth.. 1 1 2 2 1 1 7 Other causes 3 3 Totals 18 5 1 2 26 8 9 7 9 59 Nett Births in the year— Legitimate 624 Illegitimate 61 Nett Deaths in the year of— Legitimate infants 52 Illegitimate infants 7 23 Table V. continued.—Infant Mortality, 1914. Nett Deaths from stated causes at various ayes under One Year of Age in the. other Wards. CAUSE OF DEATH. Under 1 Week.. 1—2 Weeks. 2—3 Weeks. 3—4 Weeks. Total under 4 Weeks. 4 Weeks and under 3 Months. 3 Mont lis and under 6 Months. 6 Mouths and under 9 Months. Months and under 12 Months. Total Deaths under 1 Year. Measles — — — — — — — — — 1 Whooping cough — — 1 1 1 1 — — 3 Convulsions — 1 — i — — — 1 2 Bronchitis — — — — 1 1 — 2 Pneumonia (all forms) 1 i 1 2 1 — 5 Enteritis — — 1 — — 1 G-astritis — — — — — 1 1 — — 2 Suffocation, overlying 1 — — 1 Injury at birth 3 — — — 3 — — — — 3 Atelectasis 1 — — — 1 — — — — 1 Congenital Malformations 2 — — 1 3 1 — — — 4 Premature birth 8 1 — 9 1 — — 10 Atrophy, Marasmus and Debility from birth 1 — — 1 2 — — — 1 3 Other causes 1 — — 1 i — — 1 3 Totals 16 1 2 3 22 8 6 2 3 41 Nett Births in the year— Legitimate 660 Illegitimate 51 Nett Deaths in the year— Legitimate infants 34 Illegitimate infants 7 24 Table VI.— Vital Statistics relating to Residents in Blocks of Dwellings in the City of Westminster, 1914. 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 G5. Westminster City Council— Regency Street 1,212 39 17 1 3 3 1 4 — 1 — 1 — 3 3 3 St. James's Dwellings, Ingestre Place, and Marshall Street 102 2 3 — — 1 — — — — 1 1 — — — 2 Peabody 7,025 186 101 4 20 12 6 21 8 3 4 6 10 7 15 25 Westminster.. 187 5 2 — — 1 — 1 — — _ — — 2 London County Council— Millbank 3,010 70 22 1 3 4 3 5 — — — 1 2 3 5 3 Drury Lane 775 17 15 4 1 4 1 5 — — — — — 1 5 Improved Industrial 4,400 71 47 3 5 14 4 4 3 2 1 7 3 1 4 19 Metropolitan Association 546 11 10 — 1 2 — 2 1 — — 1 — 3 — 4 St. George's Model Dwellings 419 12 8 — 1 2 — 2 — — 1 1 — 1 — 6 Clerkenwell and Soho Company (Newport Market) 1,184 23 11 2 5 — — 2 — — 1 1 — — — 2 Greencoat 119 2 1 — — — — — — — — — 1 — 1 — Spencer 99 1 1 — — — — 1 — — — — Chapter Chambers 175 3 — — — — — — — — — — Alexandra and Castle — 3 4 — 1 — — 1 — — 2 — 1 St. James's Residences — 17 4 — — — 1 — — 1 — — 2 — 2 — 25 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. Smallpax.—One case of smallpox was notified in Westminster, a ship's surgeon who had treated a case on boardship on a voyage from S. America, and the symptoms appeared on his arrival at a club, but the disease aborted at an early stage and the eruption did not proceed beyond the papular stage. He rapidly recovered and no further cases developed. 122 notifications were received of persons coming to Westminster from infected places or off ships on which cases had occurred, 4 families being Belgian refugees. Vaccination.—The Vaccination Officers have supplied me with the following particulars relating to vaccination of infants born in 1913:— Vaccination Statistics. 1913. Union. Bithts. Died Unvaccinated. Successfully Vacillated. Insusceptible. Vaccination I'oHtponed. Conscientious Objectors. Removed and Vaccination Officer Informed. Not Found, Removed to Address Unknown. St. George 1,576 104 1,163 7 17 201 25 54 Westminster Strand 379 26 270 — — 50 — 33 The City 1,955 130 1,433 7 17 251 25 87 The following is a summary of the total primary vaccinations performed in the City during the years 1901-14, and of re-vaccinations in so far as these were made by the Public Vaccinators:— c 26 Vaccination Returns. Primary Vaccinations under 14 years of age, in the Union. Re-vaccinations performed by Public Vaccinators in the Union. St. George's. Westminster. Strand. St. George's. Westminster. Strand. 1901 2,467 1,491 725 4,039 3,317 2,201 1902 2,893 715 450 7,453 6,226 3,910 1903 2,178 369 245 159 9 347 1901 2,065 325 144* 72 13 398 1905 2,162 498 142 47 7 418 1906 2,110 372 145 51 5 397 1907 2,013 443 155 45 7 468 1903 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 1,340 363† 20 7 538 1914 1,271 699‡ 36 5 508 * There were also 16 primary vaccinations of persons over 14 years of age. † There were also 162 primary vaccinations of persons over 14 years of age. ‡ There were also 128 primarv vaccinations of persons over 14 years of age. Scarlet Fever.—The prevalence of this disease which began in the latter half of 1913, increased markedly in 1914, 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 848; there were 379 in the previous year. There were 10 deaths. Diphtheria.—There was also a greater prevalence of this disease in London. In Westminster there were 188 notifications against 192 in 1913. There were 15 deaths. Anti-toxin was supplied in cases treated at home. 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 256 cases. In connection with one of the diphtheria cases, it was found that previous to the illness a cat had been ill with some obstruction in its throat and had died, and its two kittens subsequently died with similar trouble. These had been nursed by the patient who eventually developed diphtheria. The bodies of the cats had been destroyed so that examination could not be made. Typhoid Fever.—Of the 50 persons notified in the City, 7 were eventually declared not to be so suffering. 27 The majority of the patients contracted the disease out of London, most of them abroad. Twelve refugees from Antwerp who came over in one party, developed typhoid fever soon after arrival. Examination was made of a number of others in the Refuge, with the view of detecting others or carrier cases but proved negative. Of two notified patients reported subsequently not to be suffering from enteric fever, one was stated to have para-typhoid, the other cystitis apparently due to an attack of fever 10 years previously. This latter was doubtless a "carrier" as his daughter was eventually notified with enteric fever. Fifty-two examinations of the blood from suspected cases were made. One patient (not notified) whose blood gave a positive reaction on two occasions, suffered from the disease 12 years ago and lie has since suffered from attacks of enteritis at times. Ophthalmia Neonatorum.—Twenty-eight infants were notified as suffering from this complaint. In 9 instances it was the first confinement. Four of the children were illegitimate. Syphilis was noted in 3 cases, and the presence of gonococci in the discharge from the eyes in 4. Twelve children were treated at hospitals, 3 as in-patients. Twentyfive were reported to have recovered without permanent impairment of vision. In one case there was some opacity in one eye. Two infants died—one from prematurity before the eyes were better, the other from syphilis, having lost the sight of both eyes. 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. Plague.—Notifications were received from Port Sanitary Authorities of 10 persons coming to Westminster from districts affected with plague. They were kept under observation. C 2 28 City of Westminster. Table VII.—Local Government Board Table C.— Cases of Infectious Disease Notified during the 52 weeks from 4th January, 1914, to 2nd January, 1915. Cases Notified in the City of Westminster. Total Cases Notified in each Ward. Number of Cases Removed to Hospital from each Ward. Notifiable Diseases. At all Ages. 0 to 1 At Ages—Years. Conduit. Grosvenor. Kniglitsbridge St. George. Victoria. St Margaret. St. John. Hamlet of Kniglitsbridge. Pall Mall. Regent. Great Marlborough. Charing Cross. Covent Garden. Strand. St. Anne. Conduit. Grosvenor. Kniglitsbridge St. George. Victoria. St. Margaret. St. John. Hamlet of Kniglitsbridge. Pall Mall. Regent. Great Marlborough. Charing Cross. Covent Garden. Strand. St. Anne. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 and upwards. Small-pox— Cases 1 — — — — 1 — — — — — — — — — 1 — — — — — — — — — — — — — 1 — — — — — — Deaths — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Chicken pox- Cases — — — — — —— — — — — — — — — — — — — — — — — —— — — — — — — — — — — — —— — Deaths Ophthalmia— 12 Cases ••• 28 28 — — — — — — — 1 9 — 2 — 1 — — — 1 — — — 2 — — — — — — — — — — Deaths — — — — — — — — — — — — — — — — — — — — —— Diphtheria— 14 Cases 188 1 51 83 30 18 2 — 2 8 9 34 13 53 2 4 13 15 5 14 — 16 2 7 9 32 12 52 I 3 13 15 6 — 16 Deaths 15 1 8 4 1 — 1 — — 2 — 4 1 4 1 — — — 1 — 2 Erysipelas— 3 Cases 112 4 3 1 12 24 50 18 2 2 — 27 5 47 3 1 3 5 4 i 3 3 — — — 12 1 32 1 — 1 3 2 5 j Deaths 3 — — — — 1 2 — — — — — — 1 — — — 1 — — — — Fevers— Scarlet— Cases 848 3 201 477 94 g9 3 1 8 23 63 186 54 287 13 7 28 33 20 50 4 72 8 21 58 181 51 275 11 5 28 33 20 49 2 72 Deaths 10 — 3 5 1 1 — — — — — 3 — 5 — — — — — 1 — 1 Polio-myelitis Cases 1 — 1 — — — — — — — — — — — — — 1 — — — — — — — — — — — — — 1 — — — — — Deaths — — — — — — — — — — — — —— — — — — — — — Enteric— Cases 50 — 1 14 16 15 3 1 1 1 2 14 4 4 2 — — 14 3 — 2 3 1 1 1 13 3 3 2 — — 14 2 — 2 3 Deaths 8 — — 2 1 4 — 1 — — — 2 — 1 — — 1 1 1 — — 2 Cerebrospinal Meningitis — Cases 1 — 1 — — — — — — — — — — 1 — — —— — — — — — — — —— — — 1 — — — — — — — — Deaths 1 — 1 — — — — — — — — — 1 — — — — — — — — Continued— Cases 1 — — 1 — — — — — — — — — — — — — 1 — — —— — Deaths — — — — — — — — — — —— — — — — — — — — — — Puerperal— 1 Cases 10 — — — 1 9 — — — 1 — 4 — 3 — — 1 — 1 — — — — 1 — 4 — 2 — — — 1 — — — Deaths 4 — — — — 4 — — — — — 2 1 — — 1 — — — — — Totals 1,240 39 258 576 153 136 58 20 13 35 75 274 76 407 22 ,3 47 68 33 73 9 95 11 30 68 244 67 365 15 9 44 68 30 68 7 92 Not as notified: 17 cases as scarlet fever, 15 as diphtheria, 7 as enteric fever, and 1 as continued fever. 4 cases notified as suffering from scarlet fever and diphtheria. 1 death from enteric, not notified, died in asylum. 29 Table VIII.—Infectious Diseases Notified, 1902-1914, in London. Year. Smallpox. Scarlet Fever. Diphtheria and croup Typhus lever. 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 i,s9«; 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 8 881 4.099 — — 24,563 1913 4 17,550 7,649 762 4 14 349 4,152 — 1 31,363 1914 3 25,046 9,154 790 17 394 4,984 — 1 41,444 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 — 640 206 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 1K0 17 — — 19 91 — — 552 1913 — 379 192 29 — — 6 75 — — 709 1914 1 848 188 50 — 1 10 112 — — 1,240 There were also notified cases of— London. Westminster. London. Westminster. Cerebro-Spinal Meningitis— Poliomyelitis— 1907 132 4 1912 134 6 1908 85 3 1913 145 4 1909 111 3 1914 93 1 1910 115 2 Ophthalmia Neonatorum— 1911 101 3 1912 105 3 1912 699 18 1913 93 — 1913 641 24 1914 73 1 1914 888 28 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 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 1914 0.00 55.3 20.2 1.7 0.00 0.2 0.6 11.0 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 Average of 10 years 1902-11 1.57 23.9 10.2 3.0 0 00 0.05 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 1914 0.06 55 .7 12.4 3.3 — 0.06 0.65 7.37 30 Tuberculosis. The total number of certificates received was 869, including 214 notices of admission and 135 notices of discharge from infirmary or sanatorium. The number of new cases of pulmonary tuberculosis was 344 (99 less than in 1913), and included 90 homeless persons or inmates of common lodging houses. The number of new cases of other forms of the disease was 59, of whom 5 were casuals. This number is 93 less than in 1913 when notification of forms of the disease other than pulmonary became compulsorily notifiable, and a large number of oldstanding cases of spine and hip diseases were notified. The following table shows the number of new cases in each of the last 6 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 1914 254 90 314 59 A number of deaths occurred from tuberculosis of persons whose illness had not been notified in Westminster during life. These occur in cases where the disease had not been diagnosed and is found on post mortem examination, a proportion being inquest cases in which there had been no medical attendance. There are also deaths of persons who have been notified in other districts and have subsequently moved into Westminster. Combining these with notified cases, the following are the totals for 1911-14:— Pulmonary. Notified. Unnotified. Total. Other Forms. Notified. Unnotified. Total. 1911 356 67 423 38 39 77 1912 473 39 512 27 32 59 1913 443 32 475 152 25 177 1914 344 46 390 59 13 72 31 Public Health (Tuberculosis) Regulations, 1912.—Notifications, 1914. Number of notifications on Form A. Primary notifications. Total notifications, including cases previously notified. Age periods. 0 to 1. 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 cases. Pulmonary— Casuals— Males — — — — — 3 8 15 31 18 8 83 102 Females — — — — — 1 1 — 2 1 2 7 8 General— Males — 1 3 3 9 9 52 43 26 12 7 165 231 Females 1 1 1 9 3 11 25 16 9 7 3 86 109 Other forms— Males 1 5 4 3 2 3 2 4 1 2 1 28 33 Females — 7 5 5 4 3 3 — 3 — 1 31 33 Total 2 14 13 20 18 30 91 78 72 40 22 400 516 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 1 109 48 Females — 1 1 2 3 25 22 Non-pulmonary— Males — — — — — 6 — Females — — — — — 1 3 Total 2 1 3 4 141 73 32 Tuberculosis. Table showing distribution in Wards, and numbers of persons who have been treated in Institutions. All Ages. Condult. Grosvenor. Kniglitsbridge St. George. Victoria. St. Margaret. St. John. Hamlet of Knightsbridge. Pall Mall. Regent. Great Marlbo rough. Charing Cross. Covent Garden. Strand. St. Anne. Homeless. Received Institutional Treatment. Pulmonary— Common Lodging-houses, &c. Notified 90* — — — — — 19 — — 1 3 — 1 22 — 44 88 Unnotified 9* — — — — — 4 — — — — — — 5 6 General— Notified 254 6 15 13 64 17 61 10 2 7 13 6 13 4 23 — 159 Unnotified 37 1 2 3 5 2 13 l 1 1 1 — 3 — 4 — 16 Other forms— Notified 59* 1 1 2 16 1 18 l 1 3 — — 2 3 6 1 41 Unnotified 13 — — 1 5 — 3 — — 1 1 — — — 2 — 9 * 49 of the pulmonary were homeless persons; 3 in Great Marlborough Ward were Polish refugees; 4 persons suffering from other forms were inmates of common lodging houses and 1 homeless.* 33 Deaths from Tuberculosis in the City of Westminster. Year Pulmonary. Abdominal. Meningeal. Other. Total. Deaths. Rates. Deaths. Rates. Deaths. Rates. Death. Rates. Deaths. Rates. 1901 341 187 16 10 31 16 25 12 413 226 1902 328 182 18 9 32 17 35 19 413 229 1903 309 174 9 5 23 13 19 10 360 203 1904 271 154 12 6 26 14 31 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 1914 211 138 6 4 8 5 9 6 234 153 Averages: — 5 years,1901-5 169.2 7.2 15.4 15.2 208.8 5„ 1909-13 122.6 4.4 12.8 10.0 150.4 The rates are calculated per 100,000 inhabitants. The rate for London was 139 from pulmonary tuberculosis. 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. Two visitors deal with tuberculous cases. They keep the patients and their surroundings under constant observation. They 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. Very little information is obtainable about the casual and homeless consumptive, and full particulars are not always obtainable with respect to a number of those notified from private addresses, for various reasons, such as in the case of persons who have been in lodgings for short periods only, and do not return on discharge from hospital or infirmary, and persons notified from hotels where the stay was temporary. Soldiers admitted to the Military Hospital from the various barracks are not visited; there were 3 of these in 1914. 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 734, and patients suffering from other forms, 235. At the end of the year there were 455 consumptives and 167 other patients remaining on the visiting list. 34 There were 6,170 visits paid by the visitors during the year (4,200 in the South, 1,970 in the North). Analysis of cases visited in 1914:— Pulmonary. Other Forms. North. South. Total. North. South. Total. Brought forward from 1913 158 291 449 54 115 169 New cases visited 108 177 285 20 46 66 Total cases 266 468 734 74 161 235 Deaths and removals 92 187 279 33 35 68 Remaining at end of 1914 174 281 455 41 126 167 The illness of many of these patients dates back for several years, and in a number of instances has been arrested. Irrespective of casuals and soldiers, the illness of 77 consumptive persons notified in 1914 began previous to taking up residence in Westminster, 7 others had been resident for long periods in asylums or workhouses and developed the disease there. Changes of address.—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, 207 changes of address have been noted among pulmonary patients; 78 have moved out of Westminster, 86 have changed houses in the City, and the addresses of 47 are not at present known. Of patients suffering from other forms, 20 left Westminster, 38 changed houses in the City, and 15 have been lost sight of—73 in all. Suspects to the number of 118 have changed addresses, 60 left the City, 59 changed houses, and of 29 the new addresses are unknown. These changes of address (428 in all) add considerably to the work of the visitors who frequently have difficulty in keeping in touch with the patients. Assistance is, however, obtained by the system of co-operation with the Health Visitors and other agencies. Disinfection was carried out in 298 houses by the Council's staff, after death, or on removal of patients from one house to another or to hospital. In 46 cases, disinfection (or thorough cleaning and re-decoration of rooms) was carried out privately. Diagnosis and Detection of new cases.—It is an important part of the work of the tuberculosis visitors to get other members of the families in which a case occurs, medically examined, as well as others who may have been exposed to infection, moreover, the Health Society Visitors 35 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 467 persons were specially examined, and 24 were found to be suffering from pulmonary tuberculosis and 9 from other forms, 73 have moved from Westminster or died, 30 have been marked off and the remainder are still under observation. These persons were examined:— At hospitals, dispensaries, or by private doctors 275 At school medical inspections 48 At the Pimlico Infant Medical Inspection Centre 116 At the Soho Infant Medical Inspection Centre 28 In addition, 185 bacteriological examinations of sputum were made at the Council's expense for medical men who had suspicious cases under observation, and in 34 instances the bacillus was found. In some instances medical men had this examination made by other than the Council's Bacteriologist, and the hospitals have this done by their own staff. Dr. Newsholme, in his report for 1913 to the Local Government Board, points out that the success of a scheme for dealing with tuberculosis depends upon the accuracy of diagnosis. If the disease is not recognised at an early stage, curative treatment is liable to fail and direct measures for preventing the spread of infection can only be taken from the date when the disease is recognised. The decision as to whether a patient is actually tuberculous or not is often difficult, there being no general agreement among physicians as to the minimal physical signs and other evidence which may be accepted as indicating the existence of tuberculosis. While some regard certain conditions as warranting a diagnosis of tuberculosis, although no tubercle bacilli have been found in the sputum, others go to the other extreme and decline to pronounce a patient tuberculous until the bacilli is demonstrable, fearing to cast a stigma on the patient. It is well known that delay often implies unfortunate consequences for the patient, and the probability of a cure being effected is very much greater if the disease is diagnosed before tubercle bacilli commence to be discharged in the sputum. The many borderland cases concerning which no definite diagnosis can be made require to be kept under regular supervision. It is, at present often the case that a proportion of the cases when notified are suffering from more or less advanced disease. This is due to two causes—generally to the patient's delay in obtaining medical advice, but in a number of cases to medical delay in recognising the disease. Recourse to examination of the sputum in such cases would probably have insured earlier and more satisfactory treatment. Too 36 often a single negative result from examination of sputum is accepted as negativing the diagnosis of tuberculosis, and the patient has continued to be treated for bronchitis or some other non-tuberculous disease. Nationality.—The majority of the patients were English, but there were also the following :— Males. Females. Males. Females. Irish 11 3 Russian 8 4 Scotch 5 1 Italian 6 2 Welsh 1 2 Swiss 2 — French 7 4 German 6 1 Belgian 1 — There were 11 Jews, 2 being English, 1 German, the remainder Russian (4 being refugees). Other Forms of Tuberculosis.—In addition to the 59 patients notified there were 13 deaths of patients who had not been notified during life. There will probably always be a proportion of these cases not notified, as there is greater difficulty in deciding that the illness is due to tubercle. Many of the patients had been ill for some years, and 14 were suffering previous to taking up residence in Westminster. The parts of the body effected were:— Spine 4 Bones and joints 22 Glands 22 Abdomen 11 Meninges of brain 7 Pleura 1 Skin 1 General 1 Other parts of body 3 There were 6 deaths from abdominal tuberculosis, 8 from meningeal and 9 from affections of other parts. In 12 instances the parents or other relatives, and in one instance a lodger were suffering from pulmonary tuberculosis. Treatment.—With 5 exceptions 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. In three of the five exceptions the nature of the illness was only found on post mortem examination. Of the others, 175 of the 291 pulmonary cases notified in 1914, or who died unnotified, and 72 notified in previous years, had institutional treatment of one kind or another during the vear. 37 Of other forms, 50 of the 73 cases which came under notice had institutional treatment. 35 patients notified in previous years also had institutional treatment during 1914. In addition, 102 of the suspects had the benefit of a stay in convalescent homes or in hospital. An analysis has been made to show the treatment of persons notified in 1914, distinguishing those coming under the Insurance Act. Inmates of common lodging-houses, shelters and homeless persons are excluded, except 2 who were insured persons. Insured.—Pulmonary males among those notified or dying unnotified in 1914 were 106 including 4 policemen and 3 soldiers. Pulmonary females, 31. Other forms.—Males, 6 ; females, 5. Of these, 82 of the male and 22 of the female pulmonary cases, and 9 of the other forms, received institutional treatment. Notwithstanding the assistance of the Insurance Act 23 eventually had to have recourse to the Poor Law. Treatment of Insured Persons. Pulmonary. Domiciliary Institutional. Primary. Hospital. Sanatorium. Infirmary. Home for Dying. Asylum. None. Males (16 years of age and over)— Panel 66 16 21* 13 - — 19 Private 4 1 2 1 - — — Poor Law 3 — — 3 - — — Dispen-ary 3 2 — — - — 1 Hospital 22 10 7 3 1 — 4 Police 4 3 — 1 - — — Army 3 3 - - - - - None 1 — — — - 1 — Females (16 years of age and over)— Panel 22 3 14 — - — 5 Private 2 — 1 — - — 1 Poor Law 2 — — 2 - — — Hospital 5 1 1 - - 1 3 Other Forms. Males— Panel 6 2 3 — - — 1 Females— Panel 4 3 — — - — 1 Hospital 1 — 1 — - — — * One went subsequently to a second sanatorium. Uninsured.—Exclusive of casuals there were 73 males and 55 females above 16 years of age and 28 below that age (8 boys and 20 girls) with 38 pulmonary tuberculosis. Of these 47 men, 36 women, and 18 children had some form of institutional treatment. Of the other forms of tuberculosis there were 54 sufferers and of these 40 had treatment in an institution. Treatment of Uninsured Persons. Domiciliary. Institutional. Primary. Hospital. Sanatorium. Infirmary. Asylum. Convalescent Home. None. Pulmonary. Males (16 years of age and over) — Private 32 3 14 3 — — 13 Poor Law 14 — — 14 — — — Hospital 17 9 4 4 — — 5 Dispensary 3 — — 1 — — 2 None 7 — — — 1 — 6 Females (16 years of age and over)— Private 19 2 4 2 — - 11 Poor Law 14 — — 11 1 — 2 Dispensary 8 2 2 2 — — 3 Hospital 6 3 1 1 — — 2 None 8 — — — 7 — 1 Children (under 16)— Private 4 — — — — 1 3 Poor Law 3 — 1 1 — — 1 Dispensary 6 1 — — — 5 1 Hospital 14 6 4 1 — 3 4 None 1 - - - - - 1 Other Forms. Males (16 years of age and over)— Private 2 1 — — — — 1 Poor Law 1 — — 1 - - - Females (16 years of age and over)— Private 1 — 1 — — — - Poor Law 1 — — 1 - — - Hospital 5 4 — — — — 1 None 1 — — 1 — - Children (under 16)— Private 15 6 1 — — 2 7 Poor Law 5 — 3 1 — - 1 Dispensary 4 — 2 — — 1 1 Hospital 18 11 1 2 — 1 3 It will be noted that in both classes some had more than one form of institutional treatment. The County Council took over institutional treatment for noninsured adults from the middle of the year relieving the City Council of that duty. Later, arrangements were made to send away children 39 also. Certain of the methods in the scheme appear somewhat cumbrous and the Local Government Board expressed a doubt whether they would prove satisfactory in actual working. It appears the Council had to adopt them as a concession in order to be able to utilise certain institutions. In time, no doubt, the objectionable parts of the scheme will be eliminated and the Board propose to review the scheme at the end of twelve months. The scheme embraces the institutional treatment of chronic and advanced cases, and provision has been made through the Metropolitan Asylums Board for the reception of such cases among women in the premises formerly used for children by the St. George, Hanover Square Guardians. The duration of stay in sanatorium allowed by the Insurance Committee is generally three months, and must be regarded as of educational rather than of curative value in most cases. Treatment is also being given in hospitals by both bodies. Dispensary Scheme.—The City Council after prolonged negotiations eventually settled a scheme which apparently satisfied the authorities of Charing Cross and St. George's Hospitals and the Local Government Board and has been formally submitted to the Board for sanction. Meanwhile both these hospitals have instituted tuberculosis clinics on one afternoon a week, and are working as heretofore in conjunction with the Council. 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. Patients, especially the younger ones, are assisted to change their trade from an indoor to an outdoor occupation. Some are assisted to move to more open parts of London, or to the country. Help is obtained in the way of additional food, or grants in aid, of beds and bedding and of clothing. It is satisfactory to be able to record that a number of patients, among whom are included many indoor workers, who were treated three four, five or more years ago are at present apparently well and at work. No less than 26 of the men included in the 1914 returns were accepted for service in the Army. Most of these were men who had been in good health for several years but some were more recent, and although the disease is arrested it is doubtful if they could be said to be cured. The latter will probably break down under the heavy strain to which they will be subjected, and in fact three broke down during their .training. Others were refused enlistment, of these one is a special 40 constable, one a member of a volunteer aid corps and another is engaged on coast defence work. Eleven "suspects" enlisted and are doing well. Among the notified cases were four soldiers who had enlisted in other parts of the country but had to be sent to the military hospital. There was also one German prisoner. Diarrhœa.—111 Westminster, the total deaths were 35, 29 being under 2 years of age. Comparison with former years is made below:— Westminster. 1905. 1906. 1907. 1908. 1909. Epidemic diarrhœa 47 75 27 24 10 Other forms of enteritis 17 20 19 23 23 Total deaths 64 95 46 47 33 Number under 1 year of age 42 71 27 33 27 Number of births 3,120 2,931 2,927 2,913 2,751 Deaths of infants per 1,000 births 13.4 24.2 9.2 11.4 9.2 Westminster. '1910. 1911. 1912. 1913. 1914. Epidemic diarrhœa 9 47 9 20 11 Other forms of enteritis 32 47 28 29 21 Total deaths 41 74 37 49 35 Number under 1 year of age 26 49 27 33 24 Number of births 2,592 2 361 2,349 2,233 2,157 Deaths of infants per 1,000 births 10.0 20.7 11.4 14.7 11.1 Number of deaths under 2 years of age — — 30 40 29 Enquiry made with regard to these deaths, shows that there were 4 illegitimate children, 7 had been delicate from birth, 3 being premature. Two infants had been entirely breast-fed, and 4 had been suckled at first for a week or two. In 3 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. Twelve of the children were born in other districts and had not been visited ; with regard to two, visits had been refused by the parents. 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 illness. Seven adult persons living in four houses in Lillington Street were reported to be suffering from a severe form of diarrhoea in September 41 and three died. Three of the patients lived in one house, one family at the top, the other in the basement. Enquiries failed to show any connection between the families, the drains and sewer were examined in the particular section of street affected. Some slight defects were discovered in the drains in the yards of two of the houses, but no defects of any kind were discovered in the other two. The connections with the sewer of these four houses were sound but reported by the City Engineer " to be very dirty apparently insufficient water being used to keep the drains flushed out." The sewer which was flushed out in July was in good condition but had 3 or 4 inches of offensive deposit in the bottom of the channel. The question of food was enquired into, a common source of supply being a probable explanation, but this could not be traced, and one patient had his meals away from the house except on Sundays. No infectious illness or deaths from diarrhœa have been recorded in this part of the street during the last 10 years except a case of erysipelas in one of the affected houses in the preceding July. Measles.—The number of cases notified was 164 (350 in 1913). There were 7 deaths as compared with 27 in 1913. The schools affected are shown below. Five children were removed to the Metropolitan Asylums Board's Hospitals for treatment. Owing to the great increase in the number of scarlet fever patients in the latter half of the year the Asylums Board had to give up the hospital treatment of measles and whooping cough for a time. In view of the mildness of the scarlet fever cases and the much larger fatality in measles this decision was regrettable, but eventually the Board decided to restrict hospital treatment for scarlet fever to patients whose special circumstances required it. Two hundred and four visits were paid by the women inspectors to families in which cases were 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 29 houses. Whooping-Gough.—Information was received of 213 cases (48 in 1913) (for particulars as to schools see list below). There were 21 deaths in the City (19 of children under five years of age), in the previous year the number was 7. Six cases were removed for treatment by the Asylums Board. Children suffering from whooping-cough are also visited by the women inspectors: 215 visits were paid to families affected. D 42 Schools and Infectious Disease. School teachers are required to notify the Medical Officer of Health when they exclude children on account of iufectious disease. The following list shows how far this was carried out and the nature of the cases notified:— Cases of 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Year 1914. Measles 9 23 13 23 168 Whooping-cough 46 125 34 38 243 Mumps 105 120 25 40 290 Chickenpox 84 38 21 48 191 School. Actual Cases. Infection in House. Other Causes. Chickenpox. Measles. Mumps. Whoopingcough. Chickenpox. Measles. Mumps. Whoopingcough. Buckingham Gate 1 2 5 4 — 2 — 1 2 ringworm.. Horseferry Road 2 5 9 9 1 4 1 — 2 ringworm. Millbank 7 2 6 9 7 2 1 3 4 5 ringworm. Pulteney 8 3 — 10 1 1 — 4 St. George's Row 3 8 26 11 3 3 — 7 3 ringworm. Wild Street — — — 18 — — — 2 2 ringworm. Brompton Higher Grade — — — 5 — — — — 1 ringworm. Burdett Coutts 4 — 47 23 1 — — 6 5 ringworm. Cathedral, Great Peter Street 1 — — — — — — — 2 itch. Christ Church 8 — 9 15 2 1 — 4 Holy Trinity 15 1 9 19 12 — 1 — l ringworm. St. Anne's 18 28 16 9 9 — — — 10 ringworm. St. Anselm's — — — — — — — — St. Barnabas 17 — 25 12 3 1 — — 8 ringworm. St. Clement Danes 1 33 — 4 — 15 — — St. Edward's, Dufour's Place 8 1 — 1 4 — — — St. Gabriel's 3 15 7 34 3 6 — 12 11 ringworm. St. George's, South Street 37 3 — 13 8 1 — 3 7 ringworm. St. James the Less 36 2 10 27 21 3 3 11 3 ringworm. St. James'and St. Peter's 1 11 — 1 — 5 — — St. Margaret's — 1 4 7 — — — 1 St. Martin's, Adelaide Place 2 31 — — — 4 — — St. Martin's, Castle Street — — — — — — — — St. Mary's, Hide Place 3 4 13 14 2 7 — 1 St. Matthew's 7 1 7 8 4 4 3 3 3 ringworm. St. Michael's 7 3 19 — 1 11 1 3 ringworm 2 itch St. Paul's 1 14 3 — 1 8 — — 6 ringworm. St. Peter's, Lower Belgrave Place 1 — — — 1 — — — Wesleyan Training — — 1 2 — — — 3 191 168 279 243 79 67 12 63 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 1,033 notifications were sent out during . 1914 to school teachers as follows:— 43 School. Small Pox. Scarlet Fever. Diphtheria. Enteric Fever. Buckingham Gate — 4 1 — Horseferry Road — 26 4 — Millbank — 35 5 — Pulteney — 17 11 — St. George's Row — 26 4 — Wild Street — 5 3 — Brompton Higher Grade — 2 1 — Burdett Coutts — 29 7 — Cathedral, 48, Great Peter Street — 15 1 — Christ Church — 15 — — Curzou — 3 — — French Protestant — 2 — — Grey Coat — 2 — — Holy Trinity — 24 — — St. Anne's — 34 2 — St. Anselm's — 2 — — St. Barnabas — 27 — 1 St. Clement Danes — 9 3 — St. Edward's, Dufour's Place — 5 — St. Gabriel's — 14 2 1 St. George's, South Street — 9 — — St. James's and St. Peter's — 9 2 — St. James the Less — 8 7 — St. Margaret's — 6 1 — St. Martin's, Adelaide Place — 22 5 — St. Martin's, Castle Street — 4 — — St. Mary's, Hide Place — 10 — — St. Matthew's — 24 — — St. Michael's — 31 5 — St. Patrick's — 1 — — St. Paul's, Wilton Place — — 1 — St. Peter's, Lower Belgrave Street — 6 1 — St. Vincent's — 8 3 — Wesleyan Training College — 16 2 — Forty-eight rooms in nine schools were disinfected, together with books and other articles. As to the arrangements for dealing with children affected with vermin, see below under " disinfection." Exclusive of children under 5 years of age, 1,336 children of school age have been visited by the Health Visitors in co-operation with Care Committees, Hospital Almoners, and the Invalid Children's Aid Association. Bacteriological Laboratory. During the year 499 examinations have been made by Dr. J. M. Bernstein, at the Westminster Hospital Medical School, at a cost of £65 12s. 7d., 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; 1913, 406. d 2 44 Disease. Persons. Examinations. Results. Positive. Negative. Doubtful. Diphtheria 256 262 43 218 1 Typhoid Fever 48 52 9 38 5 Tuberculosis 185 185 31 151 — Ophthalmia Neonatorum — — — — — One patient was examined both for Tubercle and Typhoid Fever. In addition to those mentioned above, many medical men and hospitals obtain reports on their cases from private or hospital laboratories. Disinfection. Below is shown the number of rooms and articles disinfected by the Staff of the Department. The premises included 48 rooms in 9 schools, 37 shops and 9 offices; 8 vehicles were also disinfected. In 7 cases of infectious disease treated at home the laundry linen (288 articles) 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 39 instances, when the circumstances of the case required it), and also 29 houses after measles, 7 chicken-pox, 18 cancer, 3 influenza, 2 whooping-cough, 298 phthisis, 2 anthrax, 3 tetanus, and 5 mumps. In 58 instances the premises, &c., were disinfected privately (46 of these being cases of phthisis). The following table gives a comparative statement of the above work during the past seven years:— 1908. 1909. 1910. 1911. 1912. 1913. 1914. Premises 1,067 1,287 841 979 1,020 1,410 1,650 Rooms 1,568 1,865 1,284 1,449 1,346 1,796 2,461 Articles disinfected 31,915 49,843 26,850 26,264 34,478 53,567 57,591 Articles washed — — 514 782 4,999 8,210 4,807 Articles destroyed 233 186 1,651 496 699 1,567 2,047 Books disinfected 557 281 595 266 315 1,810 414 Number of persons admitted to shelters 5 6 1 — — — — Cleansing of Persons.—Adults.—The Guardians deal with the frequenters of their casual wards, and at certain of the common lodging houses facilities are provided for the inmates; 65 adults (50 men, 15 women) had baths at the station, and 807 articles of clothing were cleansed of vermin. Three persons suffering from scabies had baths and clothing disinfected. 45 Children,—1,068 baths were given to children suffering from vermin, including 10 who had scabies. Under an arrangement with the County Council for the cleansing of school children, 351 were sent from various boroughs. It is essential that at the same time as 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 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. Five mothers were treated in 1914, and 17 children under school age. Borough. No. of Children. 1st Attendances. Total No. of Attendances of old and new cases. Articles of Clothing Disinfected or Washed, Westminster 75 170 1,983* Chelsea 62 178 1,502 Lambeth 84 236 1,929 Battersea 139 471 3,983 Wandsworth 7 10— Bermondsey13— 368 1,068 9,397 * Included 653 articles of bedding. A considerable amount of additional work was thrown upon the Department by the War, through the influx of troops and refugees. Disinfection was carried out for various reasons of 5,276 articles, the destruction of 1,331 and cleansing of 194. These included blankets, horse rugs, clothing, bedding, &c. Quantities of old clothing for refugees and rooms where it was stored were fumigated (rooms, 342 times in all, 3,094 articles fumigated, 1,331 destroyed, and 184 washed). Tins of dressings were removed daily from private hospitals for officers. Verminous Houses.—In addition to the school cases, 257 notices were served by the Sanitary Inspectors with reference to vermin in houses; 343 rooms were fumigated with sulphur by the Council's staff From 207 houses 8,465 articles were stoved, 577 washed, and 1,690 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 18,350, and 584 articles were washed and 1,690 destroyed. In dealing with verminous conditions, 280 visits (of which 126 were in connection with school children) were paid by the Disinfecting Superintendent. Seven 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).) 46 Motor-van for Disinfecting Work.—The Council decided to provide a van with interchangeable bodies for the two-horse vans which had hitherto been used for the purpose of conveying bedding, &c., to and from the disinfecting chamber. Tenders were obtained on a specification drawn up by the City Engineer, and that of Messrs. John I. Thornycroft was accepted for £448 10s., and was brought into use on the 17th August. The motorvan (a photograph of which is given) has a 4-cylinder engine, an E.A.C. rating of 19'6 horse-power, worm gear transmission, a maximum speed of 13.7 miles per hour at 1,000 revolutions per minute, solid tyres, a petrol tank capacity of 14 gallons with, in addition, means for carrying one tin of petrol, and an arrangement of rollers for changing bodies. It is provided with two bodies, one for clean goods, the other for infected articles, the latter being lined throughout with aluminium. The van is designed to carry a gross load of one ton. All necessary accessories were included in the price. The van is to be maintained during the first year by the builders, and during the next four years for £45 per annum. There is a guarantee for the tyres for 10,000 miles. At the end of 1914 the van had been used on 120 days, during which it ran 2,651 miles. It consumed 276 gallons of petrol (9.6 miles per gallon), and carried 60 tons 3¾ cwt. of material. The maximum amount carried on any one day was 58½ cwt. The work has been greatly facilitated and expedited by the substitution of a motor-van for the horse-drawn vans. Verminous Children and Second-hand Wearing Apparel.—The Hackney Borough Council wrote asking the support of the City Council to a resolution they had passed dealing with the question of the frequency with which children who have once been cleansed became re-infected, and recommending that the sale of wearing apparel from ragshops should be prohibited by law. It was suggested that such wearing apparel was often a source of infection. This is not the experience in Westminster, where re-infection is found to occur from other members of the family or from infected clothing which has escaped disinfection, but it is thought desirable that existing powers for dealing with secondhand wearing apparel should be obtained. The Metropolitan Borough Councils, as the Sanitary Authorities, have certain powers with regard to dealing with filthy, dangerous, or unwholesome articles, for Section 19 (1) and (2) of the London County Council (General Powers) Act, 1904, provides:— (1) Where on the certificate of the Medical Officer of Health of any Sanitary District it appears to the Sanitary Authority of that district that any articles, in any house or part there of in that 47 district are in such a filthy, dangerous or unwholesome condition that health is affected or endangered thereby or that the cleansing or purifying or destroying of any such articles is requisite to prevent risk of or to check infectious disease, the Sanitary Authority may cause any such articles to be at their own expense cleansed or purified, or they may destroy the same. (2) If any owner suffer any unnecessary damage, the Sanitary Authority shall compensate him for the same and the Sanitary Authority shall also reasonably compensate the owner for any articles destroyed. Power of entry for this purpose is given by Section 24 of the same Act. The City Council expressed the opinion that in addition to extending the law so as to prohibit the sale of articles of clothing at rag-shops or marine stores, it should also be extended to enable the Sanitary Authority to deal effectively with filthy second-hand wearing apparel exposed or deposited for sale at other premises. The officers of the Sanitary Authority should be empowered to enter such premises and to inspect and examine such wearing apparel, and if they find it to be filthy, dangerous, or unwholesome, but reasonably capable of being cleansed, or disinfected, to cause it to be cleansed or purified, and, if it is not reasonably capable of being so cleansed or purified, to seize it, convey it to a magistrate to be condemned, and an order made for its destruction. It will be observed, however, that Section 19 of the London County Council (General Powers) Act, 1904, provides for the work of cleansing or purifying to be done at the cost of the Sanitary Authority, and for compensation being paid by the Sanitary Authority, to the owner of any article unnecessarily damaged or which has been destroyed, under the provisions of that Section. In the case of filthy wearing apparel, &c., exposed or deposited for sale, the Sanitary Authority should not be required to do the work of cleansing, &c., at their own cost, nor should the owner of such apparel be entitled to recover compensation from the Sanitary Authority for articles damaged or destroyed. A communication on the above lines was addressed to the Local Government Board, and to the London County Council. Bag Flock.—Mr. Justice Phillimore decided in a case that the Bag Flock Act, 1911, did not prohibit the re-making of bedding containing filthy rag flock without such flock being efficiently cleansed and purified. The City Council is of opinion that an amendment of the Act should be obtained to get over this difficulty. 48 Mortuaries. The number of bodies removed to the Council's mortuaries under order of the Coroner, or to await burial, was 323; in no instance was death the result of infectious disease. Inquests were held at Horseferry Road, where the Coroner's Court is situated, in 295 cases, and there were 2 adjourned inquests. Postmortem examinations were made in 134 instances at Horseferry Road. Traffic accidents were the cause of 37 inquests. The number of dead bodies taken to the mortuaries tor 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. 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 1908 364 298 66 1914 323 295 28 No use was made of the resting places for the dead at Drury Lane, Ebury Bridge, or Dufours Place during the year. 49 PART II. C. House Inspection, &c. Below is a list of details of the work done in connection with insanitary conditions. In many cases some of the work specified was in premises, parts of which were occupied as workshops:— 1914. Complaints received and dealt with 942 Premises inspected on complaint, &c 1,020 House to house inspection 5.405 Subsequent visits 24,158 Premises (registered), visits to 6,006 Overcrowding found 28 Other infringements 876 Sanitary Work completed :— Houses:— Cleansed throughout 283 „ partially 1,181 Overcrowding abated—rooms 52 Light or ventilation improved 266 Roofs repaired 434 Floors and staircases repaired 485 Underground rooms :— Illegal use 17 Closed 14 Yards, areas, paved or repaired 540 Damp walls remedied 195 Offensive refuse removed 328 Keeping of animals discontinued 14 Verminous premises cleansed 257 Filthy or unwholesome bedding, &c.7 Drains:— Constructed 304 Amended and repaired 328 Ventilated 285 Unstopped and cleansed 168 Interceptor traps fixed 191 Cleansed and sealed off from sewer 42 Gully traps fixed 1,280 Defective traps abolished .. 269 1914. Sanitary Work completed :— Drains :— Manholes built 650 „ repaired and cleansed 323 „ covers fixed or repaired 626 Tested by smoke 237 ,, chemical 260 „ water 593 „ air 59 Fresh air inlets fixed or repaired 311 Soil Pipes Fixed 402 Ventilated 338 Repaired 273 Tested by smoke 225 Tested by chemical 276 „ water 209 „ air 164 Water-closets:— Constructed 1,122 Repaired 978 Ventilated and light improved 485 Cleansed or limewashed 1,008 Ventilated lobbies provided 380 Unstopped 146 Traps ventilated 932 Flushing cisterns fixed 1,291 „ „ repaired 403 Waste Pipes:— Constructed 1,295 Repaired 210 Unstopped 69 Trapped 1,740 Ventilated 1,413 Disconnected 364 50 1914. Sanitary Work completed : — Rainwater Pipes :— Fixed or repaired 636 Disconnected from drains 165 Urinals :— Constructed 137 Repaired or improved 73 Cleansed 90 Water Supply:— Provided 483 „ additional in tenement houses 18 Certificates granted 6 Cut off 39 Reinstated 21 Cisterns fixed 184 „ cleansed 286 „ covered 255 1914. Sanitary Work completed :— Water Supply:— Cisterns defective,abolished 95 Taps off main provided 410 Pipes repaired 220 Dust Bins :— Movable, provided 220 „ repaired 3 Fixed, abolished 10 Stables: — Drained 17 Paved 19 Cleansed 18 Dung receptacles provided 3 Dung accumulations removed 47 Garages constructed 32 Petrol interceptors provided 6 2,388 intimations of nuisances, &c., and 87 statutory notices (including 3 for smoke nuisances) were issued; 2,234 letters were written. Police court proceedings for failure to comply with statutory notices were taken with the following results:— Premises. Offence. Result. 8, St. Anne's Court Foul w.c. basins, accumulation Remedied after service of sumtenement and work- of rubbish, dirty walls, &c. mons; 23s. costs. shops). 27, Kingly Street Failure to provide sufficient w.c. Fined 5s. and 2s. costs, (tenement and work- accommodation. shops). 1, Hopkin's Street Dirty condition of walls and ceil- Order to abate within one (tenement house). ings of staircase and rooms. month; 6s. costs. 48, Glamorgan Street Filthy condition of a room An ejectment order being made (tenement house). against the tenant; adjourned i sine die. 23, Cumberland Street Dirty and verminous condition Order to abate within 7 days; (tenement house). of rooms, w.c.'s and passages. 6s. costs. 8, Passmore street Dirty condition of walls and ceil- Remedied after service of sum(tenement house). ings of staircase and rooms. mons; 8s. costs. 41, Ponsonby Place Walls of basement habitation Adjourned sine die, owner (tenement house). damp; w.c. foul and walls having joined his regiment. damp. Part work completed, mainder promised. 7 and 9, Willow Place Dirty and verminous condition * Order to abate within 14 days; (tenement houses). of rooms. £1 fine in each case. 8, Willow Place (tene- Roof dilapidated, allowing rain to * Closing order made and £1 ment house). soak through to lower rooms. fine. Ground floor dirty; house unfit for habitation. 97, Ranelagh Road Without water supply A closing order was made. On (tenement house). the supply being re-instated, the order was rescinded on payment of 6s. costs. * For disobedience of magistrate's orders the fine was in each case increased to £2 and 2s. costs. 51 Plans.—514 sets of plans were examined during 1914. Of these 130 were plans of new buildings. Failure to send in plans or to give notice occurred in 46 instances. Infringement of the By-laws in connection with the erection of buildings occurred in 10 instances. The builders were cautioned and required to do the work properly. For failing to deposit duplicate plans of new drainage, &c., after repeated applications, a firm of builders was summoned, but as the plans were deposited before the hearing, the summons was withdrawn on payment of 23s. costs. 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 609 instances the services of the two drain-testers attached to the Department were requisitioned. House Refuse.—As there might be some difficulty in securing the daily removal of house refuse owing to many of the dustmen and drivers being called up for army service, a notice was circulated throughout the City advising householders to burn as much of their house refuse as possible in order to reduce the quantity to be removed and prevent accumulation of offensive matter likely to become dangerous to health. Regulations for Prevention of Fire.—I reported last year that the attention of the Public Health Committee had been drawn to difficulties which were experienced owing to requirements made by the County Council in respect of means of escape in case of fire from various premises. 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 asked the County Council to furnish a copy of the requirements for the prevention of fire in each case, to which a reply was received from the Building Acts Committee of the London County Council, dated the 18th May, 1914, stating that they have had under consideration the City Council's letter of the 7th 52 November, 1913, and asserting that it is the practice of the County Council to notify the Home Office and the Borough Councils concerned, in all cases in which the ventilation of workrooms might be interfered with by requirements made in connection with the provision of means of escape, and having regard to this fact and to the large amount of additional work and correspondence which would be entailed in the event of Borough Councils being notified of all the cases in which the County Council deal with the means of escape in case of fire, the Committee do not see their way to depart from the present practice. The letter adds that the plans relating to means of escape are always available for inspection by representatives of the Borough Councils. Since receipt of this letter, information has been supplied by the County Council in several instances. 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. Five 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.—This has been continued throughout the year. Special examination has been made of 6 houses in Willow Street, 5 in Greencoat Place and 3 in Marsham Street, and the attention of the owners having been called to the general conditions thereof, it was decided in the first two instances to close and demolish the premises, and in the last case an undertaking was given to remove the insanitary conditions existing. Consideration is being given to the houses in Newport Court and Little Newport Street. Since the Housing and Town Planning Act came into force, I have reported specially on 653 houses, with the result that 105 premises have been closed and 67 demolished. Demolished. Converted to other uses. Use as habitations give up voluntarily 85 47 15 Closing orders made 20 20 - Of the remainder, 21 remain closed and two have been put into satisfactory condition and re-occupied. 53 Underground Rooms.—17 rooms were found to be illegally occupied in 1914 and their use given up, 3 of these not complying with the requirements of the Housing and Town Planning Act. Houses Let in Lodgings.—The number of houses in 1914 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 1,274; to this class of house 6,006 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 28 instances, and 876 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 ten instances proceedings had to be taken in the Police Court (see above). There were three infringements of the 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. Water Supply. Thirty-nine notices of withdrawal of water supply were received from the Metropolitan Water Board, and in 21 instances it was reinstated, on notice. The reasons given for cutting off the supply were: houses empty, 16; non-payment of rates, 18 ; by request, 0; irregular fittings, 5. Legal proceedings in connection with water supply was taken in one instance. The Water Board submitted a list of 85 premises stated to have no water supply. These were found to consist of 73 shops (mostly " lock up "), 3 offices, 2 fruit warehouses, 1 smithy, 1 auction room, 1 work shop 1 studio, 2 empty premises, 1 could not be identified. In 22 instances water supply was found to be available on the premises. In 3 only was it deemed necessary to require the provision of water. Additional sources of water supply on the upper floors of tenement houses were provided in 18 instances. Owners are recommended in all cases to fit a proper sink in connection with the new supply on upper floors and so prevent risk of walls and ceilings being spoiled. Three new artesian wells have been sunk during the past year (Victoria Street, Broad Street and Waterloo Place). 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. 54 One of these was abandoned, as an insufficient supply was obtainable at a depth of 400 ft. (The other wells are about 500 ft. deep). In sinking, the following strata are stated to have been bored:—2 ft. made ground, 18 ft. ballast, 2 ft. clay and pebbles, 96 ft. blue clay, 45 ft. mottled clay, 10 ft. clay and sand, 16 ft. dead grey sand, 1 ft. green coated flint, 184 ft. chalk. Six 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. One application was received in respect of 13 tenements in St. Ann's Buildings, St. Ann Street, and a certificate was granted. Smoke Prevention. The following is a summary of the work done m connection with smoke prevention:— 1913. 1914. Complaints received 45 42 Observations taken 2,046 2,288 Notices issued Preliminary 125 104 Statutory 3 3 Summonses - - Most of these were seen offending once only, but ten had more than one notice, the maximum being seven. The Pumping Station, Orange Street, which is under the control of the Office of Works has been a persistent offender throughout the year. In four cases complaint was made of smoke entering rooms from adjoiuing chimneys, due to the chimney being too low or defective. Notices were served with reference to smoke being emitted from 1 railway engine and 1 fixed engine, 1 steam motor, 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. The President of the Local Government Board has appointed a committee to consider the present state of the law with regard to the pollution of the air by smoke and other noxious vapours. 55 Offensive Smells.—Complaints were received in a number of instances of offensive smells, and 11 notices were issued in respect thereof. These arose from burning fat and refuse, petrol fumes, defective flues, gas engines, the discharge of waste steam into fire box of a steam trolley, from defective working of a smoke-preventing apparatus whereby steam used to produce a forced draught came in contact with the hot coals. Complaints were also dealt with arising from barges laden with house refuse. Removal of Human Remains.—The clearance of the site of King's College Hospital for the erection of new premises necessitated the removal of a large quantity of human remains from the ground in front and at the back of the hospital which was formerly a part of the burial ground belonging to St. Clement Danes' Parish. The special Act of Parliament sanctioning the removal of the hospital required the owner to remove any remains interred there under the supervision and to the satisfaction of the Medical Officer of Health of the City of Westminster. The remains of about 27,000 persons have been removed and re-interred in the City of Westminster's burial ground at Brookwood. Although there has been no burial in the ground during the last 60 years, a large number of the coffins were intact through the dryness of the ground and the fact that they were packed closely together and one above the other with little or no earth between. The inscriptions on a number of the coffin plates were decipherable. 1,550 coffins were removed in a more or less intact condition. The loose bones were taken away in large boxes. The earth was in many parts much polluted with the results of decomposition. The ground for this graveyard, rather more than onethird of an acre, was purchased by the parish in 1638, and it is believed that one of the plague pits of the year 1665 was situated here. A number of persons who died in the cholera epidemics in the early part of last century were interred here. The supervision of the work of removal necessitated frequent daily visits to the site in order to ensure that the removal was being conducted satisfactorily, and that proper precautions were being taken. In 1902, in the course of making excavations for an extension of buildings at the corner of Clement's Lane and Portugal Street, a quantity of bones were disturbed, this piece of ground having evidently formed part of the old burial ground. The remains of some 6,500 persons were removed under an Order of the Home Secretary. 56 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 1914 :— Work Premises. Total Number. Number in which Women are Employed. Tailors, outfitters, shirt makers, hat, cap, and helmet makers 1,219 1,148 Dressmakers, milliners, embroiderers, lace makers, blouse makers, costumiers, lingerie makers, children's outfit makers, feather dyeing, corset makers, furriers, &c. 929 929 Leather workers, boot and shoe makers, harness makers, &c. 30 22 Carpentry, upholstery, carvers, gilders, &c. 42 36 Surgical and dental instrument makers 13 13 Tobacco manufacturers 24 24 Wig makers and hair workers 50 50 Printing, bookbinding, lithographers, envelope making, stationers, publishers, &c. 46 37 Jewellers, silversmiths and burnishers, diamond cutters and polishers, engravers, &c. 170 33 Metal workers 145 — Miscellaneous—Basket making, fancy work, shoe ornaments, hat pins, stamp sorters, postcaid tinters, fan makers, artificial 80 71 33 33 Laundries 43 43 84 — Photographers .. 20 20 Jewel case makers 11 11 There are also 13 distress workrooms employing women. New workshops are always being discovered, at the same time the occupation of premises on the register is constantly changing. The use of 308 registered workshops was discontinued, and 297 additions were made to the register during the year; 79 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 thirteen complaints were received, including 141 from the Home Office, and were duly 57 investigated; 13 matters were referred to the Home Office relating to insufficient warming of rooms, and in addition, notice was sent of 79 workshops in which Abstracts were not affixed. Statutory notices were issued in respect of 24 workshops and 4 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. Inspections. Reinspections. Number of Defects Found. Intimation Notices. Statutory Notices. Prosecutions. Factories 83 40 35 8 - - Workshops 1,343 1,496 1,351 296 24 2 Workplaces (Including restaurant kitchens, &c.) 2,175 4,661 852 445 4 - Total 3,551 6,197 2,238 749 28 2 Defects found.—1914. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Nuisances under the Public Health Acts :— Want of cleanliness 764 764 1 Want of ventilation 101 101 — Want of ventilation of gas stoves 74 74 — Overcrowding 27 27 — Want of drainage of floors 31 31 — Sanitary accommodation- Insufficient 38 38 — Unsuitable 76 76 — Defective 278 278 — Not separate for sexes 73 73 1 Other defects 776 776 — Total 2,238 2,238 2 Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouses — — — Breach of special sanitary requirements for bakehouses (included above) 12 12 - — — — Ventilation.—Samples of air taken by one of the Home Office Inspectors in certain tailors' workshops in March, disclosed, on analysis, the following amounts of carbon dioxide (carbonic acid) per 10,000 parts :—12.8, 13.1, 13.3, 13.6, 14.4, 14.8, 16.6, and 26.3. E 58 Other Matters. Class. Number. Matters notified to H.M. Inspector of Factories: — Failure to affix Abstract of the Factory and Workshop Act 79 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 bv H.M. Inspector 141 Reports (of action taken) sent to H.M. Inspectors 141 Other 13 Workrooms measured 331 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 tliein. Notices were sent to 84 employers for failing to send in lists, no second notice was sent. Those who failed to reply were visited by the Inspector and all the lists were eventally received. In addition 78 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 1914. 734 lists, containing 8,945 names and addresses, were sent in by employers; 4,712 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; 427 addresses were received of persons in Westminster taking in work from other boroughs. They were distributed thus:— Council. Sent from Westminster. Received by Westminster. Council. Sent from Westminster. Received by Westminster. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Acton 7 7 – – Broadstairs 2 2 – – Barnes 3 – – – Bromley 1 1 – 1 Barnet 1 1 – – Camberwell 30 29 – – Battersea 75 82 – – Cambridge 1 1 – – Bedfont – 1 – – Carshalton – 1 – – Bedford 2 3 – – Charlton Kings 1 – – – Bermondsey 3 2 – – Chelsea 14 10 42 43 Bethnal Green 8 7 – – Cheltenham – 1 – – Billingshurst 1 1 – – Chichester 1 1 – – 59 Council. Sent from Westminster. Received by Westminster. Council. Sent from Westminster. Received by Westminster. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Chiswick 3 7 – – Luton 2 2 – – City of London 9 9 47 44 Newbury 1 1 – – Colchester 2 1 – – New Maiden 3 1 – – Croydon 8 12 – – Northampton 9 8 – – Deptford 6 6 – – Nottingham 1 1 – – Dulverton 1 1 – – Oxford 1 1 – – Ealing 9 7 – – Paddington 90 82 12 9 East Ham 1 – – – Penge 6 1 – – East Molesey 2 4 – – Pontypool 1 1 – – Edmonton 2 3 – – Poplar 4 2 – – Enfield 2 1 – – Redhill 1 2 – – Epsom – 1 – – Romford 1 – – – Erith 2 – – – St. Marylebone 773 761 49 47 Finchley 2 1 – – St. Pancras 365 407 1 4 Fmsbury 24 20 – 2 Shoreditch 14 17 – 1 Friern Barnet 1 1 – – Southall 1 1 – – Fulham 38 33 – – Southend – 2 – – Glasgow – 1 – – Southgate 1 – – – Greenwich 1 1 – – Southwark 52 50 – – Hackney 17 10 1 2 Stepney 137 137 1 1 Hammersmith 56 55 – – Stockbridge 1 – – – Harapstead 10 12 2 1 Stoke Newington 6 7 – – Hanwell 1 2 – – Teddington – 1 – – Harpenden 1 1 – – Tottenham 13 10 – – Harrow 1 1 – – Twickenham 1 1 – – Hendon 1 4 – – Walt hams tow 4 2 – – Holborn 100 106 33 25 Wandsworth 67 68 – – Hornsey 4 4 1 1 Wanstead 1 – – – Horsham 1 1 – – Watford 1 1 – – Hounslow 1 – – – Wealdstone 3 2 – – Ilford 1 1 – – Wembley 4 4 – – Islington 60 62 – 1 West Ham 7 8 – – Kenley 1 1 – – Willesden 87 74 – – Kensington 59 61 26 24 Wimbledon 3 2 – – Lambeth 98 92 – – Woodford 2 – – – Laigley 1 1 – – Wood Green 1 1 – – Ledbury – 1 – – Woolwich – – 1 1 Leeds 1 1 – – Yeovil 1 – – – Lewisham 10 12 2 2 2,358 2,354 218 209 Leyton 6 9 – – Workers are frequently in the employ of several firms, so that the number of names (2,335) returned as resident in the City does not necessarily coincide with ther actual number of workers, which is found to be 1,725. All those living in Westminster were visited, and the sanitary condition, not only of the rooms occupied, but of the whole house, was inquired into. The actual number of houses in which outwork was being done was 974, as many houses contain a number of outworkers. These houses are mostly in Great Marlborough, Eegent and St. Anne Wards. In the latter part of the year a considerable proportion of these outworkers were not receiving work. Dressmakers and other female workers were being employed in emergency workrooms which were duly inspected. E 2 60 City of Westminster. Outworkers. 1914. 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 283 3,610 179 1,654 2,135 291 3,654 140 1,669 2,125 Dressmaking 14 135 18 125 28 12 83 41 73 51 Theatrical costumiers 1 14 – 9 5 1 12 1 8 5 Waterproofing 1 3 – 2 1 1 3 – 2 1 Shirt making and hosiers 31 251 7 183 75 27 253 14 191 76 Boot making 24 338 7 317 78 24 401 5 351 55 Corset making 1 2 – 2 – – – – – – Embroidery 5 53 3 47 9 5 54 3 50 7 Glove making 1 3 – 3 – 1 1 – – – Lace making 1 2 – 2 – 1 2 – – – Furriers 3 13 2 13 2 2 4 1 4 1 Hat making 1 1 – 1 – 2 2 – 2 – Feather curling – – – – – – – 1 – 1 Millinery – – 2 – 2 – – 1 – 1 Belt making – – – – – 1 1 – 1 – Jewellery – – – – – – – 1 – 1 Doll making – – – – – – – 1 – 1 366 4,475 218 2,358 2,335 368 4,470 209 2,354 2,325 341 firms sent in lists on both occasions, giving a total of 8,830 addresses; 18 firms sent in once in the year, the number on their lists being 115. 61 Notices were served in respect of 658 defects discovered in 268 houses. They may be summarised thus:— 1913. 1914. 1913. 1914. Sanitary accommodation :— Walls and ceilings dirty 324 292 Rooms verminous 47 39 Insufficient 3 2 Rooms overcrowded 6 9 Not kept separate 44 16 Rooms badly ventilated 16 7 Unsuitable 5 3 Gas stoves and heaters unventilated 18 8 Apparatus defective 95 77 Requiring cleansing 39 32 Other defects (dampness, defective roofs, floors, water supply, dust bins, &c.) 192 232 Ventilation defective 1 3 Drains, sinks, &c., defective 24 38 In 11 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. Three underground rooms used as workrooms were unfit to be so used, and their use discontinued. 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:— (a) Business in family affected .. — 25 (17) 13 (10) 3 (1) 41 (28) (b) Business in other parts of house — 14(13) 12 (6) — 26 (19) (c) Persons from infected houses employed in clothing business elsewhere — 42 10 — 52 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 1 Accumulation of refuse 1 Drains defective 1 Two cases of scarlet fever occurred in rooms used as a laundry. 62 E. FOOD SUPrLY. Daring 1914 visits have been paid to the various classes of business as follows:— Visits. Notices served. Visits. Notices served. Dairies and Milkshops 1,015 29 Food.preserving works 52 1 Hotels, Restaurants and Eating houses 4,412 203 Greengrocers and Fruiterers 165 1 Fishmongers 465 23 Confectioners 70 52 Meat shops (various) 550 25 Aerated water makers 2 – Provision shops 480 Breweries and Licensed Premises not included under " Hotels, &c." 154 73 Ice merchants 6 – Bakehouses 185 12 Ice cream makers 201 44 Intimations were served in respect of 432 premises, ancl 9 statutory notices. Defects have been found in places where food is sold or prepared for sale as follows:— 1914. Restaurants Hotels, Eating. Houses and Confectioners. Ice Cream Sbops. Dairies. Bakehouses. Fish Shops. Butchers, Poultry and Provisions. Fruit and Vegetables. Dirty walls and ceilings 186 32 12 8 10 8 1 Dirty floors 14 6 1 – – 2 – Defective roofs • 8 2 – – 5 1 – ,, floors 17 2 4 2 4 2 – Absence of or defective dustbins 18 3 – 1 – – – Accumulations of refuse 25 2 4 2 – 1 – Food stored or prepared in improper places 7 2 – – 3 1 – Yards dirty 9 2 3 1 – 1 – ,, paving defective 10 1 – 1 1 – – Water cisterns dirty 16 1 3 2 – – – ,, defective 20 1 1 2 1 – – Water—insufficient or none 1 1 1 – – 1 – W.Cs. defective 72 9 4 4 4 3 – „ dirty or obstructed 19 2 1 – – 3 1 „ insufficient 8 1 – – – 2 – ,, unventilated 10 – – – – – – „ without ventilated lobby 13 1 – 2 – 1 – Urinals defective 31 – – – – 1 – Sink wastes, &c., defective 54 11 5 1 4 6 1 Drainage defective 21 – 2 – 3 5 – Burning refuse in stoves 4 – – – – – – Defective ventilation 19 1 – 1 1 4 – „ „ of gas stoves 9 – 1 1 – – – 63 1914. Restaurants Hotels, Eating. Houses and Confectioners. Ice Cream Shops. Dairies. Bakehouses. Fish Shops. Butchers, Poultry and Provisions. Fruit and Vegetables. Dampness of walls, &c. 12 2 – 1 – – – Room adjoining used as a bedroom – – – 1 – 1 – Kitchens overheated 1 – – – – – – Cloak.room accommodation absent or unsuitable 4 – – – – – – Burning refuse 4 – – – – – – Animals in kitchen, &c. 2 – – – 1 – – Restaurants.—The kitchens of hotels and restaurants are inspected at least once a quarter. 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 acsompanying table, were found and rectified. One itinerant vendor had no name or address on his barrow. Butchers' Shops.—A number of notices for defects (see table) were served. In one instance the premises had become generally unfit for the purpose and were infested with rats; the shop has been closed. There are 122 retail shops selling meat in the City, including 11 selling only pork, 10 beef and pork, 5 sausages only, 1 sausage meat and potted meats, and 4 tripe. Fried Fish Vendors and Fish Curers.—By.laws have been issued by the County Council for regulating the construction of premises used for the above purposes, and for regulation of the business. Copies of the Bylaws have been distributed to persons interested (there are 27 fish vendors and 2 fish curers), and improvements on the lines indicated in the By.laws have been carried out; other defects found have also been remedied. Greengrocers' Shops.—A return was prepared for the Board of Agriculture showing that there were 180 wholesale and 98 retail premises for the sale of fruit and vegetables in the City. Bakehouses.—At the end of 1913 there were 16 above.ground and 68 underground in use. During 1914 the numbers remained the same. All the bakehouses were inspected, and cleansing carried out twice a year. Notices were served in respect of various defects. 64 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 during 1914 31 certificates for the United States, 3 for the Philippine Islands, and 10 for Venezuela. More stringent regulations dealing with the importation of meat and meat products have been issued by the Department of Agriculture of the United States and came into force on 1st January, 1915. Copies of these have been sent to the firms in Westminster who export such products. Infectious Disease in Places where Food is Prepared or Sold, not including Milkshops. Scarlet Fever. Diphtheria. Typhoid Fever. (a) Illness in premises 25 8 5 (b) Persons from infected houses employed else. where 30 11 – Milkshops.—At the end of 1913, 456 names of persons selling milk were upon the register. In 1914, 20 names were removed and 33 added, leaving 469 on the register at the end of the year; 13 of these were registered in respect of new premises; 1 is a street vendor living in the City but storing his milk at an address in Lambeth. Six persons selling milk were given notice to register, and all complied. Ten hundred and fifteen 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 12 the walls and ceilings were dirty; 4 for accumulation of refuse; 2 drainage defective; 5 sink waste defective. Objection was taken to the sale.of paraffin in 3 milkshops, and to milkpans not being covered in 4 instances. Two cases of infectious disease occurred on premises in which milkshops were situated, and 2 persons whose relatives were suffering from an infectious disease were found to be working in milkshops. Satisfactory arrangements were made in each instance and no infection of the milk resulted. Coicshed. — There is now only one cow.shed, namely, at 13, Marsham Street (licensed for 19 cows). These premises were visited 23 times during the year. Food Poisoning.—(a) Eleven waiters at an hotel were taken ill after eating a preparation of rice, and one died. 65 On Wednesday, 12tli August, a quantity of rice was cooked with butter and chicken broth for the use of the hotel customers, and some of this was sent up to the restaurant and consumed at lunch without any bad results. Between 3 and 4 p.m. what was left was taken from the kitchen and placed in cold storage. Next morning about 11 o'clock this rice was taken to the staff kitchen and a number of the staff partook of it without bad results. It appeared to be all right and no unusual taste was observed. A second batch numbering between 20.25 dined at 12.30, of these 11 took rice, each person going to the large basin and helping himself. Two persons remarked that the rice appeared yellow or brown in parts, and it tasted "a little strong." These eleven were taken ill about 3 p.m. Bacteriological examination of the mucus of the bowel of the deceased waiter revealed the presence of the bacillus coli "but not in number much above normal." The probability is that the rice was contaminated in some way while it was standing in the kitchen after it was removed from the store, and before being placed in cold storage. It was stated that any rice sent upstairs which was not used would probably be put back into the same basin. The chicken broth would form a good medium for the growth of an organism, and as it would sink to the bottom of the basin, the upper layers from which the first set of waiters helped themselves would be free from contamination. Some growth would begin before the removal to cold storage, and would re.commence when the rice was brought out next morning into the warm kitchen. The sanitary conditions of the premises were good, and the kitchens have always been found clean and well conducted. (b). Seven persons were taken ill after eating smoked sardines in oil. They were purchased at 7 p.m. and eaten at 8 p.m. by six persons, and an hour later by a seventh. At 10.30 the first set began to be ill, and the last one at 11.30. All recovered. Another member of the family for whom some had been left did not eat any and escaped. Examination of the stock in the shop at which the box was purchased did not lead to the discovery of any defective tins, and some that were opened appeared good. (c). During August, a number of men belonging to the Queen's Westminster Territorial liegiment were taken ill after their midday meal. About 150 men complained of dryness in the throat and mouth, pain in the stomach and sickness. Suspicion fell on stewed plums which had been eaten, and a sample of some remaining was analysed, with the result that they were found to contain a considerable quantity of zinc (calculated as zinc oxide, 22.4 grains per 1b. of fruit). All the men recovered after treatment. The plums had been cooked on the previous day by a contractor, and 66 had been stored in a galvanized vessel in which they were sent to the regimental depot and kept in it for 24 hours until required for dinner. Inspection of Food. The food exposed for sale in shops and on stalls in the street markets has been regularly inspected every day (including Sundays). The following list shows the quantity of food condemned and destroyed during the year. The bulk of it was submitted by the owners or purchasers for the opinion of your officers:— Articles of Food Submitted. Tons. Cwts. Lbs. Tons. Cwts. Lbs Almonds 0 0 56 Mangoes 0 2 56 Apples 0 11 56 Mushrooms 0 0 56 Bananas 15 6 0 Oranges 6 1 56 Cauliflowers 0 10 0 Passion Fruit 0 0 84 Celery 0 2 56 Peaches 0 1 0 Cherries 0 10 81 Pears 3 19 68 Chicory 0 1 0 Peas 0 2 0 Currants 0 0 56 Pineapples 0 9 28 Garlic 0 2 56 Plums 0 6 28 Gooseberries 0 6 56 Spinach 0 1 84 Greengages 0 1 0 Tomatoes 2 4 84 Grapes 0 0 28 Turnip Tops 0 16 0 Lettuce 0 17 28 Beef, 4 lbs.; Beef (Corned), 84 lbs.; Pigs Feet, 1 cwt. 84 lbs.; Fowl, 1; Rabbits, 15 lbs.; Fresh Fish (various kinds), 5 cwts. 56 lbs. The gooseberries were affected with American blight or mildew, and proceedings in respect thereof were taken by the Board of Agriculture. A quantity of apples were examined in Covent Garden in order to discover if they showed evidence of any injurious chemicals which might have been used in the form of a spray during growth. A consignment was found which had a trace of sulphate of copper round the stalks insufficient to render the apples liable to be seized. Some others had apparently been treated with a sulphur compound. It is obviously desirable that such apples should be peeled or washed before they are eaten. The following articles were seized and condemned; appended is a note of the action taken:— and Address of Defendant. Article. Result. Frederick Richards, 32, Little Pulteney Street, Solio. Exposing for sale unsound oysters Fined £4. George Robinson, 21, Tach. brook Street. Exposing for sale unsound eggs. Fined 20s. and 21. costs. 67 Sale of Food and Drugs Acts. Samples Purchased under the Sale of Food and Drugs Acts, showing result of Analysis and subsequent Proceedings for year 1914. 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 894 739 (92) 63 35 20 15 78 14 0 11 14 6 2 do. skimmed 6 5 3 do. separated 9 8 1 4 do. condensed 8 8 5 Cream, fresh 76 51 25 12 17* 2* 23 15 0 14 2 6 6 do. preserved 79 11 68 18 20* 14* 7 3 0 21 8 6 7 do. ice 10 10 8 Butter 255 237 (13) 5 3 2 1 3 10 0 1 5 0 9 Margarine 1 1 10 Bread and butter 34 33 1 1 1 – 2 0 0 0 12 6 11 do. margarine 1 1 12 Flour 37 37 13 do. self.raising 1 1 14 Bread 2 2 15 Tapioca 7 7 16 Coffee 33 32 1 17 Coffee and chicory 4 4 18 Cocoa 59 57 (1) 1 1 1 – 1 0 0 0 12 6 19 Cocoa essence 1 1 20 Chocolate powder 1 1 21 Sugar 17 17 22 Cake 1 1 23 Meats, potted (various) 35 31 4 24 Meat pies (various) 47 40 7 25 Brawn 6 4 2 26 Beef, corned 1 1 27 Sausages, cork and beef 63 58 5 28 Sausage rolls 3 3 29 do. German 11 8 3 30 do. liver 4 4 31 Fish, potted (various) 12 9 3 32 Asparagus (tinned) 1 1 33 Beans (tinned) 1 – 1 34 Peas (tinned) 21 11 10 2 1 1 0 10 0 0 12 6 35 Piccalilli 1 1 36 Vinegar 1 1 37 Peaches (tinned) 1 1 38 Apricots (tinned) 1 1 39 Cyder 8 3 40 Ginger beer 12 12 41 Lemonade 7 6 1 42 do. powder 2 2 # The 23 cnses adjourned in 1912 and 1913 in consequence of the proposed appeal to the High Court from the decision of the Kensington justices are now settled, the proposal to appeal haying been abandoned. The Court ordered the Defendants to pay the costs in each case. 68 Number. Article of Food. Number of Samples Purchased. Genuine, (Inferior in brackets.) Adulterated. Prosecutions. Convictions. Withdrawn or Dismissed. Fines. Costs. £ s. d. £ s. d. 43 Lemon squash 4 2 2 44 Cordial, raspberry 2 2 45 do. lime juice 4 2 2 46 Muscade wine 1 – 1 47 Cream soda 1 1 48 "Kaola" 1 1 49 Camphorated oil 19 16 (1) 2 2 1 I 2 0 0 1 3 0 Totals 1,800 1,485 (107) 208 74 63 34 118 12 0 51 11 0 This year 15 cases are adjourned sine die pending the enquiry into the question of preservatives in cream by the Special Committee to be appointed by the Local Grovernment Board. Summary proceedings were ordered to be taken in 78 instances, 28 cautions were issued, the attention of the vendors was called to the report of the Analyst in 20 instances, and no action was taken with regard to 74 samples which deviated slightly from the standard or were test purchases not taken officially. There were 82 non.official samples purchased during the year. Milk.—894 samples of ordinary milk were taken during the year. The Analysts have graded the samples submitted to them into four groups:—Good quality, in which the fat was over 3.8 per cent.; fair quality, in which the fat was between 3.3 and 3.8 per cent.; and poor or inferior quality, in which the fat was between 3 per cent, (the official standard) and 3.3 per cent., or in which the non.fatty solids were between 8.5 and 8.6 (if the fat was also below 3.8). Adulterated are those below the official standard of 3 per cent, for fat and 8.5 for solids not fat. District. Total. Good Quality. Fair Quality. Poor Quality. Adulterated. No. Percent. No. Per cent. No. Per cent. No. Per cent. South 400 96 j 24.0 184 46.0 101 25.2 19 4.75 North 494 154 31.1 180 364 116 23.4 44 8.90 1914 894 250 27.9 364 407 217 24.2 63 7.04 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 69 The amount of the superior quality milk is a little less than in 1913, being two points lower in the South, while in the North it was a little better. Medium quality was again higher, while poor quality milk showed a little improvement in the North. The amount of "legal adulteration" was only 7.04 per cent, and in the South was only 4.75. Thirty.four prosecutions were taken with regard to adulteration— 18 for fat abstracted, 11 for added water, 5 for both fat abstracted and added water. 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 15 instances, and were successful in 14; 2 cases were withdrawn, it being proved that employes in eacli case had tampered with the milk; both were convicted. (See 88 N. and 875 N. infra.) One vendor who is a persistent offender was fined £30 with the alternative of 60 days' imprisonment with hard labour. The fine was paid. Sunday Sam.plcs.—111 of the samples of milk were taken on Sundays during the year; 8 (7'6 per cent.) were found to be adulterated. (See lists of Prosecutions Nos. 25 N., 26 N., 517 N., 723 N., 725 N., 904 N. and 909 N.) Since Sunday sampling was instituted the number of adulterated samples has fallen to less than half what it was at first. Samples taken in course of Delivery— (a) At Railway Stations.—50 samples of milk were taken on arrival at Victoria and Charing Cross Railway Stations. Eleven were reported of good quality, 21 fair, 16 poor and 2 adulterated:—Fat abstracted, 15 and 4 per cent. Regarding the two samples, it was ascertained that the name on the churns was not the name of the consignors, and that all they did in the matter was to lend churns and labels. The consignees said this was merely an occasional purchase and that there was no contract with the senders, whose name was not disclosed. Further there was no warranty on the churns, and the consignees did not state in their letter whether they intended to purchase pure milk. The solicitors, considering the facts before them, were of opinion that proceedings could not be instituted, and no further action was taken. (b) On Delivery at Shops, &c.—65 samples of milk were taken as it was being delivered by wholesale firms to retail customers, including shops, hotels and hospitals. Of these samples, 24 were good, 27 fair, 12 poor, and 2 adulterated (10 and 5 per cent, fat abstracted). These samples were taken in consequence of previous samples being found below the limit (including cases where a warranty defence was set up). 70 Proceedings were taken against the vendor of one of the adulterated samples.—See No. 186 s. in list of prosecutions. Refusal to sell Milk.—At the beginning of the year Inspector McNair went into a shop in which confectionery and light refreshments are sold, and seeing on the counter a glazed earthenware receptacle labelled "Pure milk" demanded to purchase some. The occupier of the shop refused, saying" he did not sell glasses of milk, only soda and milk or milk with tea, coffee, &c." A summons was issued with the result that the magistrate dismissed it on the ground that he thought that a person was not bound to sell milk if he did not want to, and he declined to state a case. Having regard to the importance of the matter, there being numerous shops of the same class in the City, application was made to the High Court for a mandamus directing the magistrate to state a case for the consideration of the High Court. On the 26th November, 1914, the case stated by the magistrate was considered by the Divisional Court, with the result that the Court held that the magistrate was wrong in his decision, and allowed the appeal with costs against Terroni, the defendant, who did not appear to argue the case. Mr. Justice Eidley said that the case must go back for conviction. Though the article was only sold when mixed with something else it was nevertheless exposed for sale within the meaning of the Act. Mr. Justice Avory said that he agreed. People did not generally go into a shop to eat butter by itself, and on this reasoning butter sold with bread would be exempt from the Act. Mr. Justice Lush concurred. Another case of refusal to sell milk occurred on 25th February The Inspector approached a man with a handcart containing milk, and retailing it to the occupants of some model dwellings, and asked for some from the can which he was carrying. The man said "This is some milk I had given to me, I don't know more than the dead what it is." He then threw the contents of the can into the gully. He was fined 10s. and 2s. costs. Infringement of Section 9, Sale of Food and Drugs Act, 1899.— One person was cautioned for failure to have name and address on milk cans. Condensed Milk.—Eight samples were examined and found to be of genuine quality and properly labelled. Skim and Separated Milk.—Five samples of the former and 9 of the latter were examined. 71 Milk and Cream Regulations, 1912.—In all cases the Public Analysts examine milk and cream for preservatives. A list is appended in the form asked for by the Board:— 1. Milk and Cream not sold as Preserved Cream. Article. (a) Number of samples examined for the presence of a preservative. (b) Number in which a preservative was reported to be present. Milk 908 0 Cream 76 25 (1) Milk.—No preservatives were found in the samples of milk examined. (2) Cream.—In May last, the President of the Local Government Board announced that as the evidence at present available as to the influence on health of the addition of small quantities of preservatives to cream is to some extent contradictory, he had decided, therefore, to nominate a small expert committee to investigate afresh the question. Pending the completion of this investigation, which should not be prolonged, he expressed the opinion that it is inadvisable that local authorities should institute proceedings except in cases where the amount of boric acid in the cream exceeds the amount declared on the label or where the amount so declared is clearly excessive. The outbreak of war has apparently led to the postponement of the formation of this committee. In seventy.six samples of cream—not sold as preserved cream—25 contained preservative (boric acid), varying from 1 grain up to 50 4 grains per pound, 4 only being over 22 grains. (See Table.) Explanations were asked, and 11 cautionary letters were sent to the vendors of cream which contained small quantities of boric acid. Two samples were taken for test purposes—one contained 7 grains of boric acid, the other 17.5 grains per lb. Police Court proceedings under the Sale of Food and Drugs Acts were instituted in 11 instances, and 9 convictions obtained; one was adjourned pending the result of an inquiry promised by the Local Government Board, and in one case a warranty was proved. One prosecution was taken under the Milk and Cream Regulations, and a fine of 20s. and 2s. costs was imposed. 2. Preserved Cream.—(a) 79 samples were taken, 11 contained no preservative and 67 had less than the amount stated on the label. 48 72 contained amounts less than 22 grains of boric acid per lb., the figure fixed by the High Court as injurious, 20 contained amounts over this and prosecutions were instituted but proceedings in 14 were adjourned sine die to await the report of the Special Committee. Samples of Milk and Cream Ancdysed during the year 1914. Milk and Cream Regulations. Milk. Preserved Cream— No. with over amount stated on label (4.08, 6.5, 10.5, 12.39, 14.7, 17, 17, 21, 22.9 and 23.1 grains boric acid.) Proceedings ordered against vendors of two last; one cautioned. (1st Quarter.) (Trace, 12.2,12.7,14 15.6, 15.6, 15.0, 17, 17, 18, 19, 19,(19.8, 21, 21.3, §23, §24, and §31 grains boric acid.) (2nd Quarter.) (9, 1227, 14, 14, 14, 15.98, 19.33, 22.68, ||23.05, ||23.42, ||23.92, ||24.79,||26.03, ||31.36 and ||40.6 grains boric acid). (3rd Quarter.) (4.9, 4.9, 7, 7, 9.79, 10.28, 11.9, 12.51. 13.02, 14.37, 14.7, 18.9,19.04,19.04,19.58, 20.3, 21.07, 21.07, 22.19, 22.96, ¶23.92, ¶25.53, ¶26.77, ^¶26.88 and ¶32.97 grains boric acid). (4th Qlarter.) 1 No. of samples examined for presence of preservatives (including 9 separated and 5 skim milk) 908 No. in which preservative reported to be present 0 Cream— No. examined 76 No. containing preservative (7 06, 11.15, 12.78 and 16.10 grains boric acid.) Vendors cautioned. (1st Quarter.) (3, 8, 10, *10.4, 18.5, *19, *21 and *23 grains boric acid.) (2nd Quarter.) (2.5, 5.32, †7.22 and †50.4 grains boric acid). (3rd Quarter.) (1, 7, ‡2, 17.5, ‡21, ‡22.4, ‡22.68, ‡32, ‡33.83 grains boric acid.) (4th Quarter.) 25 Preserved Cream— No. examined 79 No. without preservative 11 No. with preservatives under amount stated on label 67 Infringement of Art. V (1) Notice on Menu card 1 * Proceedings ordered; 3 Vendors cautioned. † Proceedings ordered; 2 Vendors cautioned. ‡ Proceedings ordered; 1 Vendor cautioned. 2 unofficial samples. § Proceedings; two cautioned. || Proceedings; one cautioned. ¶ Proceedings. Determination of milk.fat in cream sold as preserved cream was not reported in any instance. The preserved creams purchased were all thick creams. No infringements of Article Y (2) (labels on receptacles in transit containing cream in bulk) have been detected. 3. Thickening 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. As I have previously pointed out, it would appear from the result of the analyses of preserved creams in this and former years, that the maximum of boric acid at one time asked for by the trade, namely, 73 O'o (35 grains), is unnecessarily high, I understand that 28 grains is now the maximum desired by the trade. Two samples of cream and one of preserved cream were taken on Sundays. Two samples of each were taken in the course of delivery to customers and were found to contain no preservative. Butter.—Of the 255 samples purchased and submitted for analysis, 5 were found to be adulterated. (See list infra.) Three prosecutions and two convictions—one of these was taken in course of delivery (No. 332 N.)—were obtained. The remaining adulterated samples, two 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 34 samples of bread and butter one was found to be adulterated—one contained 70 per cent, of margarine. The vendor was fined £2 and 12s. 6d. costs. Sausages, Meat Pies, &c.—Samples were taken during 1913 of sausages, meat pies, &c., as shown in the list printed above. Of 47 Meat Pies (Various) 7 contained boric acid:—14.7, 6.1, 5.2, 3.6, 2.6, 2.6, and 1.9 grains per lb. Of 6 Brawn 2 contained boric acid:—14.37, and 7.43 grains per lb. Of 63 Sausages (Beef and 5 contained boric acid:—14.0, 11.52, 9.41, 5.32, and Pork) 4.83 grains per lb. Of 11 German Sausages 3 contained boric acid :—23.92, 14.0, and 13.13 grains per lb. Potted Meat.—111 35 samples of potted meats 4 were found to contain preservative to the amount of 9.5, 8.7, 5.18 and 2.8 grains per pound respectively. Fish.—Twelve samples of fish (potted and tinned) were examined. Two samples of fish paste were found to contain 15.74 and 9.91 grains boric acid per lb. respectively. One sample of salmon and shrimp paste contained 14.0 grains boric acid per lb. Cocoa.—Out of 59 samples taken one was found adulterated—contained 21 per cent, starch and 28 per cent, sugar. The vendor was prosecuted and fined £1 and 12s. 6d. costs. Coffee.—Thirty.three samples were taken and one was found to contain 2 per cent, chicory. The vendor's attention was called to the adulteration. Lemonade.—Seven samples were taken and one was found to contain '112 grains of salicylic acid per pint. No action was taken. The Departmental Committee of the Local Government Board (Preservatives F 74 and Colouring Matters in Food) recommended that salicylic acid be not used in a greater proportion than 1 grain per pint in liquid. Lemon Squash.—4 samples were taken and 2 contained salicylic acid, one 7.5 grains and one 4.9 grains per pint. The vendor's attention was called to the result of the analysis. Lime juice.—4 samples were taken and 2 contained salicylic acid, one 3.67 grains and one 1.6 grains per pint. The vendor's attention was also called to the result of the analysis. Muscade Wine.—1 sample was taken, for test purposes, and found to contain 0.5 grain salicylic acid per pint. Ginger Beer.—Twelve samples were taken during the year, 3 were drawn from the cellar by means of an engine, and 9 direct from wooden barrels by means of wooden taps. All the samples were reported as genuine; no lead, salicylic acid or other injurious substance being found. Legal Proceedings Under the Food and Drugs Acts during 1914. No. of Sample. 1 Date of Hearing. 2 Offence. 3 Result. 4 1914. milk. 25 N* 17th Feb. 6 per cent, of added water Fined £20 and 12s. 6d. costs. 26 N.* 17th Feb. 11 per cent, of fat abstracted Warranty proved. Summons dismissed. 145 N. 10th Mar. 5 per cent, of added water 13 per cent, of fat. abstracted Fined 5s. and 14s. 6d. costs. 10 N.* 27th Feb. 3 per cent, of added water and 3 per cent, of fat abstracted Fined £3 and 12s. 6d. costs. 85 S* 17th Mar. 10 per cent, of added water Warranty proved. Summons dismissed. 88 S* 17th Mar. 11 per cent, of added water Ordered to pay 2s. costs. 88 s. 17th Mar. 11 per cent, of added water Fined 20s. and 12s. 6d. costs. The second Defendant admitted watering the milk, and, under the circumstances, he was fined, his master being merely ordered to pay the cost of the summons. 199 N. 8th April 5 per cent, of added water Fined 1s. and 23s. costs. 121 s* 1st April 8 per cent, of added water Ordered to pay 23s. costs. The Defendant pleaded a warranty, but having regard to the fact that she had two lots of milk, delivered by different Warrantors 011 the barrow, the magistrate ordered her to pay 23s. costs, but he did not say whether he was satisfied that the milk sold was as delivered. 186 s. 6tli May Taken at Dean's Place in course of delivery, 10 per cent. of fat abstracted Warranty proved. Summons dismissed. 278 N. 20th May 6 per cent, of fat abstracted Warranty proved. Summons dismissed. 366 N.* 10th June 21 per cent, of fat abstracted Warranty proved. Summons dismissed. 394 N.* 24th June Selling at Long Acre milk which contained 2 per cent, of added water and from which 5.4 per cent, of fat had been abstracted Warranty proved. Summons dismissed. * In these cases there have been prosecutions previously. 75 f Sample. 1 Date of Hearing. 2 Offence. 3 Result. 4 1914. 445 N. 9th July 8 per cent, of fat abstracted Fined 10s. and 12s. Gd. costs. 325 S* 15th July 14.36 per cent, of added water and 12.80 per cent, of fat abstracted Fined 20s. and 12s. 6d. costs. 3S2 S. 15th July 19 per cent, of fat abstracted Fined 40s. and 12s. 6d. costs. 326 S * 15th July 9.3 per cent, of fat abstracted Warranty proved. Summons dismissed. 363 S. 15th July 8 per cent, of fat abstracted Warranty proved. Summons dismissed. 425 N. 17th July 7 per cent, of fat abstracted Fined 30s. and 12s. 6d. costs. 517 N * 17th July 12 per cent, of fat abstracted Warranty proved. Summons dismissed. 487 N* 23rd July 14 per cent, of fat abstracted Warranty proved. Summons dismissed. 538 N. 7th Aug. 22 per cent, of fat abstracted Fined 1s. and 12s. 6d. costs. 578 N* 7th Aug. 5 per cent, of added water Warranty proved. Summons dismissed. 505 N* 7th Aug. 7 per cent, of fat abstracted Warranty proved. Summons dismissed. 425 S. 12th Aug. 31 per cent, of fat abstracted Fined 60s. and 12s. 6d. costs. 536 S* 30th Sept. 8 per cent, of fat abstracted Warranty proved. Summons dismissed. 570 S* 9th Oct. 13.41 per cent, of added water and 12.97 per cent, of fat abstracted Warranty proved. Summons dismissed. 741 N. 14th Oct. 10 per cent, of fat abstracted Fined £3 and 12s. 6d. costs. 710 N. 14th Oct. 10 per cent, of fat abstracted Fined £2 and 12s. 6d. costs. 725 N * 14th Oct. 12 per cent, of added water Warranty proved. Summons dismissed. 723 N. 14th Oct. 9 per cent, of added water Summons withdrawn on payment of 23s. costs. 875 N.* 9th Dee. 21 per cent, of added water Withdrawn. 875 N. 9th Dec. 21 per cent, of added water Employe fined £2 10s. including costs. The milk sold was some that the employe obtained and sold oil liis own account, putting the proceeds into his'own pocket. 904 N * 9th Dec. 2 per cent, of added water and 13.2 per cent, of fat abstracted Fined £30 including costs or 60 days' hard labour. 949 N. 23rd Dec. 14 per cent, of fat abstracted Fined £3 15s. including costs. 719 S. 30th Dec. 8.5 per cent, of added water Fined £3 and 12s. 6d. costs. 909 N. 11th Dec. 9 per cent, of added water Fined £2 2s. CREAM. 520 N* 10th Mar. Contained 343 grains of boric acid per lb. Ordered to pay 23s. costs. (1913 case.) 923 N.* 10th Mar. Contained 24 grains of boric acid per lb. Ordered to pay 23s. costs. (1912 case.) 515 N * 10th Mar. Contained 29 grains per lb. of boric acid Ordered to pay 23s. costs. (1913 case.) 800 S* 11th Mar. Contained 30.247 grains of boric acid per lb. Ordered to pay 23s. coats. (1912 case.) 9S* 11th Mar. Contained 41.279 grains of boric acid per lb. Ordered to pay 23s. costs. (1913 case.) 726 S. 11th Mar. Contained 26 grains of boric acid per lb. Ordered to pay 23s. costs. (1912 case.) 721 S* 11th Mar. Contained 23.548 grains of boric acid per lb. Ordered to pay 23s. costs. (1912 case.) 313 N. 22nd May Contained 19.6 grains of boric acid per lb. Fined £3, and 12s. 6(7. costs. 389 N. 26tli June Contained 21 grains of boric acid per lb. Fined £5 including costs. * In these cases there have been prosecutions previously. 76 No. of Sample. 1 Date of Hearing. 2 Offence. 3 Result. 4 1914. 368 S.* 15tli July Contained 16.485 grains of boric acid per lb. Fined 40s. and 15s. costs. 333 s* 22nd July Selling preserved cream without a label. Public Health (Milk and Cream) Regulation, 1912. Fined 20s. and 2s. costs. 574 N.* 7th Aug. Contained 50.4 grains per lb. of boric acid Fined 40s. and 12s. 6d. costs. 537 N. 7th .Aug. Contained 22.4 grains of boric acid per lb. Fined 10s. and 12s. 6d. costs. 594 S* 11th Nov. Contained 17.227 grains of boric acid per lb. Ordered to pay £2 2s. costs. 656 s* 2nd Dec. Contained 21.07 grains of boric acid per lb. Fined 10s. and 12s.6d. costs. 872 N.* 9th Dec. Contained 12.1 grains per lb. of boric acid. Warranty proved. Summons dismissed. 925 N * 23rd Dec. Contained 32 grains of boric acid per lb. Fined £7 15s. including costs. 721 8* 30th Dec. Contained 33.838 grains of boric acid per lb. Fined 40s. and 12s. 6d. costs. 690 8, 16th Dec. Contained 22.68 grains of boric acid per lb. Adjourned sine die pending report of L.Gr.B. Undertaking given to properly label the pots in accordance with the Milk and Cream Regulations. PRESERVED CREAM. 519 N * 10th Mar. Contained 50 grains of boric acid per lb. 23s. costs. (1913 case.) 926 N* 10th Mar. Contained 27 grains of boric acid per lb. 23s. costs. (1912 case.) 927 N.* 10th Mar. Contained 22 grains of boric acid per lb. 23s. costs. (1912 case.) 517 N.* 10th Mar. Contained 35 grains of boric acid per lb. 23s. costs. (1913 case.) 512 N.* 10th Mar. Contained 34.3 grains of boric acid per lb. 23i. costs. (1913 case.) 925 N.* 10th Mar. Contained 24 grains of boric acid per lb. 23s. costs. (1912 case.) 121 N.* 10th Mar. Contained 23 grains of boric acid per lb. 23s. costs. 634 s* 11th Mar. Contained 28.882 grains of boric acid per lb. 23s. costs. (1913 case.) 480 S* 11th Mar. Contained 27.27 grains of boric acid per lb. 23s. costs. (1913 ease.) 503 s* 11th Mar. Contained 28.49 grains of boric acid per lb. 23s. costs. (1913 case.) 502 S.* 11th Mar. Contained 24.794 grains of boric acid per lb. 23s. costs. (1913 case.) 438 s* 11th Mar. Contained 35.7 grains of boric acid per lb. 23s. costs. (1913 case.) 445 s.* 11th Mar. Contained 40.41 grains of boric acid per lb. 23s. costs. (1913 case.) 908 N.* 18th Mar. Contained 42 grains of boric acid per lb. Fined 42s. and 23s. costs. (1912 case.) 907 N.* 18th Mar. Contained 21 grains of boric acid per lb. 23s. costs. (1912 case.) 906 N.* 18th Mar. Contained 23 grains of boric ucic per lb. 23s. costs. (1912 case.) 911 N.* 18th Mar. Contained 23 grains of boric acic per lb. 23s. costs. (1912 case.) * In these cases there have been prosecutions previously. 77 No. of Sample. 1 Date of Hearing. 2 Offence. 3 Result. 4 179 N.* 1914. 31st Mar. Contained 23 grains of boric acid per lb. Fined 1s. and 12 s. 6d. costs. The magistrate inflicted this nominal penalty in consequence of the representation made by the Defendants' Counsel of the awkward position of the trade, who, having complied witli the Local Government Board Regulations are still liable to be attacked under the Sale of Food and Drugs Act. 259 N * 1st May Contained 31.5 grains of boric acid per lb. I Fined £4 and 12s. 6d. costs. 411 N. 17th July Contained 23.21 grains of boric acid per lb. Adjourned sine die pending report of L.G-.B. 576 N * 7th Aug. Contained 40.6 grains per lb. of boric acid. Fined 20s. and 12s 6d. costs. 694 S. 16tli Dec. Contained 25.53 grains of boric acid. Adjourned sine die, the defendant undertaking to properly label the pot in future. BUTTER AND MARGAR INE. 211 S. 21st May Selling margarine as butter Ordered to pay 12s. 6d. costs. 1 The reason no Fine was inflicted was that the Defendant stated that she had been forty-six years in business without previous Summons. 294 N. 22nd Ma)' Selling margarine as butter Fined £3 10s. and 12s. 6d. costs. 332 N. 22nd May Exposing for sale margarine without a label Dismissed. The Defendant gave evidence and called a witness to show that the small parcel on the counter in respect of which he was summoned w as a traveller's sample, and was not in. tended for sale. The traveller bore this statement out, and as the only margarine in the shop was this small packet of a pound or so weight, the Magistrate thought the explanation given was reasonable. The Defendant in this case supplied the " butter " in the No. 294 N. case. BREAD AND BUTTER. 72 N. 17tli Feb. The butter contained 70 per cent, of margarine. Fined 40s. and 12s. 6d. costs. COCOA. 438 N. 9tli July Contained 21 per cent, of added starch and 27 per cent, of sugar. Fined 20s. and 12s. 6d. costs. PEAS. 335 N. 17th July Contained 2 96 grains of copper sulphate per pound. Fined 10s. and 12s. 6d. costs. CAMPHORATED OIL. 116 N. 18th Mar. Deficient in camphor to the extent of 60 per cent. Fined 40s. and 23s. costs. 247 N. 1st May Deficient in camphor to the extent of 27 per cent. Summons dismissed. The Magistrate dismissed this summons, as, in his opinion, the Public Analyst's certificate was defective in that it did not state whether the result was arrived at by a calculation based on weight or measure. REFUSAL TO SELL. — 31st Mar. Refusing to sell milk to Inspector. Fined 10s. and 2s. costs. 8th Dec. Refusing to sell milk at 1, Catherine Street, W.C. Fined 10s. and 2s. costs. Case referred back to Magistrate by High Court to convict. * In these cases tliere have been prosecutions previously. london: harrison and sons, printers in ordinary to his majesty, st. martin's lane.