AC 4341 FIN 4 THE METROPOLITAN BOROUGH Of FINSBURY. REPORT ON THE PUBLIC HEALTH OF FINSBURY 1904. Including Annual Report on Factories and Workshops. BY GEORGE NEWMAN, M.D., Medical Officer of Health of the Metropolitan Borough of Finsbury. London: Printed by Thomas Bean & Son, Golden Lane, e.g. 1905. THE METROPOLITAN BOROUGH OF FINSBURY. REPORT ON the PUBLIC HEALTH OF FINSBURY 1904. Including Annual Report on Factories and Workshops. by GEORGE NEWMAN, M.D., Medical Officer of Health of the Metropolitan Borough of Finsbury. London: Printed by Thomas Bean & Son, Golden Lane, e.c. 1905. PUBLIC HEALTH COMMITTEE, 1904-5. Chairman: Councillor George M. Gillett. Vice-Chairman: Councillor Rev. G. H. Perry, m.a. His Worship the Mayor (Alderman William Howes, j.p.). Alderman T. Wildbore. Councillor Evan Jones, m.r.c.s., l.r.c.p., d.p.h. Councillor W. T. Page, m.r.c.s., l.r.c.p. Councillor L. Phillips. Councillor P. R. Pratt. Councillor Rev. G. Smith. Councillor Walter Smith. Councillor G. Standring. Councillor J. Thornton. Councillor J. J. Udale, m.r.c.s., l,.r.c.p. PUBLIC HEALTH DEPARTMENT STAFF. Chief Sanitary Inspector: William Green (Certificate, Sanitary Institute). Special Meat Inspector: George T. Billing (Certificate, Sanitary Institute). Sanitary Inspectors: George E. J. Davis (Certificate, Sanitary Institute). William P. Ensor (Certificate, Sanitary Institute). Robert W. hindhaugh (Certificate, Sanitary Institute). Charles M. Longden (Certificate, Sanitary Institute) Ernest A. Norman (Certificate, Sanitary Institute). Arthur E. Powell (Certificate, Sanitary Institute). Factory and Workshop Inspector: George Peverett (Certificate, Sanitary Inspectors' Board). Lady Sanitary Inspector: (Mrs.) Florence J. Greenwood (Certificate, Sanitary Inspectors' Board.) Clerks in the Department. T. G. Collins. A. A. Jackson. A. Paterson. Disinfectors and Keepers of Reception Houses and Mortuaries: W. Oliver, J. E. Oakley, T. Steggles, J. Alder, G. Vickers. Solicitor appointed to act for the Borough Council in all Public Health Prosecutions: Mr. W. T. Ricketts, 103, King's Cross Road. Medical Officer of Health: George Newman, M.D., F.R.S.Edin., D.P.H.Camb. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Finsbury. His Worship the Mayor : Alderman William Howes, J.P. Gentlemen, I have the honour to submit herewith the Annual Report on the Public Health and Sanitary conditions of the Borough of Finsbury for the year 1904. It is drawn up in accordance with the instructions of the Local Government Board, and contains a record of the work of the Department, as carried out under the Public Health Committee. A Report on Factories and Workshops, required by the Home Office, is incorporated. The Report is arranged, for convenience, in six sections, as follows :— A. Vital Statistics. B. Records of Disease. C. The Protection of the Food Supply. D. House Property and Overcrowding. E. Factories and Workshops. F. General Sanitary Administration. Appendix : Summary and Conclusions. I desire to take the opportunity of expressing my grateful appreciation of the continued support and assistance I have received from the Chairman and members of the Public Health Committee of the Council during the year. I am glad also to have the opportunity of most heartily acknowledging the excellent work and loyal co-operation of the staff of the Department. I am, Gentlemen, Your obedient Servant, GEORGE NEWMAN, Public Health Department, Medical Officer of Health. Town Hall, Rosebery Avenue, E.C. January 19th, 1905. TABLE OF CONTENTS. A VITAL STATISTICS. Page Population 11 Births 12 Deaths 13 „ in Public Institutions 16 „ in Finsbury Districts 17 „ according to age 17 „ of Infants 18 „ from Senility 20 ,, from Infectious Diseases 21 „ in relation to Tenements 22 B- RECORDS OF DISEASE. Notification of Infectious Disease 27 Small Pox 27 Chicken Pox 37 Diphtheria 37 Scarlet Fever 44 Enteric Fever 49 Discharge Notices 51 Measles 52 Whooping Cough 54 Epidemic Diarrhoea 55 Phthisis 63 „ Voluntary Notification of 63 „ Deaths from 66 Other Forms of Tuberculosis 73 Cancer 76 Alcoholism 78 Feeding and Infant Mortality 82 C-FOOD SUPPLY. Meat Supply 89 Meat Prosecutions 90 Meat Confiscated 97 Royal Commission on Tuberculosis 98 Venison 101 Slaughter-houses 103 The Milk Supply 104 Sale of Food and Drugs Acts 109 Restaurants and Eating-houses 110 Page Ice-Cream 112 Water Supply 113 Infant Milk Depot 115 D—HOUSE PROPERTY, &c. Housing 127 Insanitary Areas 128-139 Dwelling Houses Closed 139 Houses Let in Lodgings 142 House Inspection 153 Overcrowding 153 Common Lodging-Houses 157 Model Dwellings 158 Underground Rooms 158 The Housing Question 158 E-FACTORIES AND WORKSHOPS. Introduction 163 Sanitation in Workshops 167 Bakehouses 179 Home Work 180 Outworkers' Lists 183 Inspection and Registration 184 Legal Proceedings 187 Special Enquiries 191 Air Analyses 200 F—SANITARY ADMINISTRA TION, &c. The Canal and Canal Boats 213 Stables 216 Schools 219 Disinfection 221 Mortuaries 223 Reception Houses 226 Lady Sanitary Inspector 226 L.C.C. (General Powers Act, 1904) 231 Smoke Nuisances 233 Sanitary Inspection 234 Legal Proceedings 236 Tables 240-252 Summary and Conclusions 255 A.—VITAL STATISTICS. 11 VITAL STATISTICS. The Metropolitan Borough of Finsbury was created in November 1900, under the London Local Government Act, 1899. It was formed by amalgamation of the following constituent parts, namely:—The Parish of the Vestry of Clerkenwell, the Parish of the Vestry of St. Luke, Middlesex, the Liberty of Glasshouse Yard, the Liberty of the Charterhouse, and the Parish of St. Sepulchre Without. The population of the Borough is estimated at 98,958, and there are 8,500 inhabited houses. The area is 589 acres. The rateable value is £980,428, and the gross assessable value £1,201,842. The Borough is bounded upon the north by the Boroughs of Islington and Shoreditch; on the east by the Borough of Shoreditch ; on the south by the City of London ; and on the west by the Boroughs of Holborn and St. Pancras. Population—The estimated population to the middle of 1904 in the Borough of Finsbury was 98,958, comprised as follows:— North Clerkenwell 34,163 South Clerkenwell 27,968 Finsbury (St. Luke) 35,225 St. Sepulchre 1,602 98,958 The sub-registration district of Glasshouse Yard (pop. 740) is now incorporated in the sub-registration district of Finsbury, making Finsbury (St. Luke) 35,225. At the census of 1901 the population was 101,463, in 1891 it was 110,907, and in 1861 it was at its maximum of 129,031. Hence it will be seen that the district is one of those central metropolitan areas, forming an inner zone immediately around the City of London, which has shown during the last 40 years a steady decline of population. This decline was most marked between 1871 and 1881, and between 1891 and 1901. The numbers of the population, of each sex and at various ages (at the Census, 1901), was as follows:— 12 Totals at all ages. Under 5. 5-14. 15-19. 20-54. 55-75. Above 75. Males 49,910 6,158 10.371 5,182 24,467 3,477 255 Females 51.553 6,107 10,674 5,162 24,792 4,316 502 Total 101,463 12,265 21,045 10,344 49,259 7,793 757 In regard to occupation and status of the Finsbury population it may be said that in the main it is industrial. The Borough is rapidly becoming more and more a centre of commerce and manufacture. With one or two exceptions the district is not a good residential one, most of the inhabitants merely living in the Borough to be near their work. Particularly is this so in the Finsbury (or St. Luke) Sub-registration district. Large factories abound, although the main street frontages are used, in considerable measure, for small shops, which, however, carry on a considerable trade. In North Clerkenwell there are some residential neighbourhoods. The question of the relationship between the population and housing will be considered at a later stage of the present report. Births.—The total number of births registered in the district during 1904 was 3,603, as follows :— Sub-registration District. Total Births. Bate per 1,000 of the Population in 1904. North Clerkenwell 1,078 31.5 South Clerkenwell 832 29.7 Finsbury (St. Luke) 1,660 47.1 St. Sepulchre 33 20.5 The Borough 3,603 36.4 13 The birth rate for London was 27.8. Of the 3,603 births in Finsbury, 609 took place in the City of London Lying-in Hospital, and of this number only 10] rightly belonged to the Borough. Consequently, after correction, the total number of births belonging to the Borough was not 3,603, but 3,095, which gives a birth rate of 31.3 per 1,000 of the population. Of the 3,603 births in Finsbury, 1.837 were boys and 1,766 were girls. The birth rates of Finsbury (in sub-registration districts) since the Borough was formed have been as follows:- The Borough. North Clerkenwell. South Clerkenwell. Finsbury. St. Sepulchre. 1901 37.3 30.2 30.9 50.8 20.1 1902 36.0 30.1 30.4 45.6 23.1 1903 36.4 30.5 30.9 47.3 20.3 1904 36.4 31.5 29.7 47.1 20.5 These rates include the births taking place in the City of London Lying-in Hospital, only about one-sixth of which belong to the Borough of Finsbury. This is the reason why the Finsbury birth rate is frequently stated to be so high. The corrected birth rate for the past four years has been, 1901, 32.0 ; in 1902, 31.7 ; in 1903, 31.4 ; and in 1904, 31.3. Deaths.—The total number of deaths registered in the district was 2,139, but as 55 of these deaths were of persons who died in but resided outside the Borough, that number has been deducted, leaving a total of 2,084. This total includes 965 deaths of Finsbury persons who died in various institutions outside the district. The crude death rate is therefore 21.1 per 1,000 of the population, as against 19.8 last year. The death rate for the whole of London in 1904 was 16.6 per 1,000 living as compared with 15.7 in 1903, when it reached the lowest figure recorded. The difference in the London rate of 1904, as compared with 1903, is chiefly owing to a larger number of deaths of infants in the third quarter of the year. The same applies to Finsbury. 14 The intra-parochial death rate, that is, the death rate calculated on the number of Finsbury persons who actually died inside the Borough, is 11.3, as compared with 11.1 in 1903. This figure is of course of no value except for local comparative purposes. The death rates in the Borough since its formation may be stated as follows :— The Borough. North Clerkenwell. South Clerkenwell. Finsbury. St. Sepulchre. 1901 21.4 20.0 20.3 23.7 18.8 1902 22.7 22.3 20.7 24.3 20.1 1903 19.8 19.2 18.3 21.7 19.0 1904 21.1 21.7 18.9 22.0 23.0 These death rates are "crude" or uncorrected death rates, that is to say they are calculated merely on the number of deaths per 1,000 of the population in Finsbury. They do not take cognizance of the relative numbers of the sexes nor of the age distribution of the population. Yet this is necessary for purposes of comparison with other districts on account of the fact that the mortality among young children and old people is higher than amongst adults, and also higher among males than females. Therefore it is evident that a district containing many young children and old people would have a higher death rate than a district composed more largely of young adults and females. It is this characteristic which makes "correction" necessary, The Registrar-General in his annual summary gives the "factor for correction for sex and age distribution" in the seventy-six great towns of England and Wales, and the Medical Officer of Health of the Administrative County of London gives a corresponding factor for each Metropolitan Borough. For Finsbury the factor is 1.04563, and the true or "corrected" death rate for this Borough, which shows the mortality of each sex at different age-periods, is 22.0 per 1,000 living. 15 It will be seen that the number of deaths of Finsbury persons in institutions has slightly increased as follows :— Total Deaths. Deaths in Public Institutions. Percentage of Deaths in Public Institutions. 1901 2,161 876 40.5 1902 2,283 908 39.8 1903 1,993 870 43.6 1904 2,084 965 46.3 16 The following is a list of the outlying institutions and other places where 965 of the residents of the Borough died during the year 1904 : — I. General Hospitals. St. Bartholomew's 176 Royal Free 37 King's College 10 Middlesex 4 University 4 Great Northern 2 London Temperance 1 London 7 St. George's 1 Charing Cross 1 Guy's 1 II. Special Hospitals. Royal Chest 12 Italian 2 National 1 Hospital for Women, Euston Road 1 German 5 Great Ormond Street (Children's) 29 French 1 Homoeopathic 2 Mildmay 4 Infants' Hospital, stead 2 Brompton 1 West London 1 Queen Charlotte 1 III. Fever Hospitals. Eastern 1 Western 2 North Western 26 Joyce Green 2 IV. Poor Law Institutions. Holborn Infirmary 306 Holborn Workhouse, City Road 203 Holborn Workhouse, Mitcham 39 Shoreditch Infirmary 1 Islington Infirmary 5 St. Pancras Infirmary 1 St. George's Infirmary 1 Lewisham Union 1 Islington Workhouse 2 V. Asylums. Caterham 4 Darenth 4 Dartford 4 Colney Hatch 5 Claybury 2 Cane Hill 2 Banstead 6 Manor Asylum, Epsom 2 Horton Asylum, Epsom 3 Bookbinders' 2 VI. Unclassifiable. Freidenheim Home 1 On way to St. Bartholomew's Hospital 10 In River Thames 3 St. Peter's House, nington 1 Day Industrial School, Goldsmith Street 1 Private Houses outside the Borough 5 In Gray's Inn Road 4 Metropolitan Railway 1 Rymill's Repository, Barbican 1 In Regent's Canal 2 Electric Generating Station, Greenwich 1 In Crowndale Road 1 Cheyne Hospital,Chelsea 1 St. Ann's House, Manor Road 1 Brook House 1 H.M. Prison, Pentonville 1 965 17 As regards their distribution, therefore, all the deaths belonging to Finsbury may be summarized briefly as follows :— Intra-Parochial— North Clerkenwell 427 South Clerkenwell 280 = 1119 Finsbury (St. Luke) 388 St. Sepulchre 18 Extra-Parochial— 1. General Hospitals 244 2. Special Hospitals 62 3. Fever Hospitals 31 =965 4. Poor Law Institutions 559 5. Asylums 34 6. Elsewhere (unclassifiable) 35 Total 2,084 The following Table records the deaths from all causes at subjoined ages, with the census population at each age period:— Deaths from All Causes at Subjoined Ages, 1901-1904 At all Ages. Under 1 Year. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. Total Death Rate. Census, 1901 101,463 2,792 9,473 21,054 20,410 44.582 3.161 Deaths 1901 2,161 553 290 82 94 764 398 21.3 1902 2,283 558 339 81 82 805 418 22.7 1903 1.993 503 268 53 78 716 375 19.8 1904 2,084 522 257 56 68 755 426 21.1 18 INFANTILE MORTALITY. The infantile mortality of a district is the annual number of deaths of children under one year of age to every thousand births during the same year. Such a return is of considerable value, as it is one of the most reliable tests of the health of a community and of the sanitary condition of a district. It has a characteristic value for two reasons—migration does not greatly affect the distribution of deaths at this early age, and life is very susceptible to its surroundings. Hence such a record of deaths affords a delicate index as to the prevalence of disease and the external circumstances of life affecting it. During 1904, as we have seen, there were 3,604 births in Finsburv. This includes the births in the City Road Lying-in Hospital. The total deaths of infants under one year was 522, out of the whole total of deaths of 2,084. The infantile mortality rate is therefore 168.6. The infant mortality percentage on total deaths is 25.0. The infant mortality rate is calculated on the total births, excluding the births in the City of London Lying-in Hospital which do not belong to Finsbury. In the whole of London during 1904 there were deaths of infants (18,901) equal to a rate of 146.1 per thousand births. The mean rate for the last 10 years in London is 153.3. The distribution in the Borough of the deaths of infants may be set out as follows :— Districts. Deaths of Infants under 1 year of age. Infant mortality rates per 1,000 births. North Clerkenwell 191 177.2 South Clerkenwell 123 147.8 Finsbury (St. Luke) 206 178.7 St. Sepulchre 2 60.6 The Borough 522 168.6 The infant mortality rates for each division of the Borough and also for the Borough itself, since its formation may therefore, be set forth as follows : — The Borough. North Clerkenwell. South Clerkenwell. Finsbury (St. Luke). St. Sepulchre. No. of Infant Deaths Infant Mortality No. of Infant Deaths Infant Mortality No. of Infant Deaths Infant Mortality No of Infant Deaths Infant Mortality No. of Infant Deaths Infant Mortality 1901 461 141.7 158 149.2 124 139.6 172 137.0 6 162.1 1902 558 174.9 183 173.3 152 172.7 217 178.4 6 157.9 1903 503 159.1 163 153.8 125 142.2 210 176.5 5 151.5 1904 522 168.6 191 177.2 123 1478. 206 178.7 2 60.6 The returns for 1901 are those of intra-parochial deaths of infants only, the returns for 1902-04 include all the deaths of infants. Throughout the table, births taking place in the City of London Lying-in Hospital, but not belonging to Finsbury, have been excluded. 19 As regards age distribution of infants' deaths, as a general rule it may be said that they diminish from the first month onwards to the twelfth. The following table gives the age incidence for 1904:- Months. 0— 1— 2— 3— 4— 5— 6— 7— 8— 9— 10— 11— Totals North Clerkenwell 42 17 12 15 13 14 6 17 13 9 10 23 191 South Clerkenwell 36 7 10 7 10 14 7 10 2 5 2 13 123 Finsbury (St. Luke) 44 22 26 16 14 13 12 12 10 11 9 17 206 St. Sepulchre 1 1 2 Totals 122 46 49 38 37 41 26 39 25 25 21 53 522 20 Turning now to the causes of death in these infants, we find the record is as follows:— Causes of Death. Diarrhœa. Prematurity. Marasmus. Bronchitis. Pneumonia. Convulsions. Suffocated in Bed. Measles Whooping Cough. Accidents. Tuberculosis. Diphtheria, Erysipelas. Croup Miscellaneous. Totals. North Clerkenwell 38 21 24 17 18 7 1O 6 7 ... 14 ... 29 191 South Clerkenwell 34 17 8 11 10 3 6 5 3 2 5 2 17 123 Finsbury (St. Luke) 44 25 23 17 25 9 15 5 5 ... 6 I 31 206 St. Sepulchre ... ... 1 ... ... ... ... ... ... ... 1 ... ... 2 Totals, 1904 116 63 56 45 53 19 31 16 15 2 26 3 77 522 The chief increase during the year occurred in the number of infant deaths due to Epidemic Diarrhoea. Further reference is made to this subject, and the whole question of infant mortality, on a later page in the present report. Here it may be noted that one quarter of all the deaths in Finsbury, in 1904, was of infants under one year of age. SENILE MORTALITY. The deaths of persons aged (55 years and over were as follows:— Intra-Parochial— North Clerkenwell 81 189 South Clerkenwell 43 Finsbury (St. Luke) 55 St. Sepulchre 10 Extra-Parochial (Hospitals, Poor Law Institutions, etc.) 237 Total 426 Out of the total of 426, 114 were between 65-70 years of age ; 212 were between 70-80 ; 94 were between 80-90 ; 6 were between 90-100. 21 The claims of death at the two extremes of life, and the effect of season, are shown in the following table of total deaths, intra-parochial and extra-parochial: — Jan-March April-June July-Sept Oct-Dec Total Infants under I year 115 101 180 126 522 Persons of 65 years and upwards I20 98 88 120 426 DEATHS FROM ZYMOTIC OR INFECTIOUS DISEASES. The deaths from Zymotic Disease occurring in the Borough intra-parochial and extra-parochial) during the year numbered 282 and were caused as follows:— Small-pox Scarlet Fever Diphtheria and Membranous Croup Enteric Fever Puerperal Fever Erysipelas Measles Whooping Cough Diarrhœa TOTAL I901 8 19 36 11 4 4 49 37 95 263 1902 32 15 37 9 6 5 83 68 84 339 1903 — 12 12 11 4 2 69 52 100 262 1904 3 17 14 8 5 4 60 26 145 282 These returns yield a zymotic death rate of 2.82 per 1,000. The amount paid to medical practitioners for furnishing notification certificates was £80 7s. 6d. as against £57 7s. 6d. last year and £175 in 1903. The Local Authority is recouped for this expenditure by the Metropolitan Asylums Board. The fees paid for Voluntary Notification of Phthisis amounted to £13 6s. 22 DEATHS IN RELATION TO TENEMENTS. This year we have again classified the deaths in relation to the number of rooms in the tenements occupied by the persons who have died, and the causes of death have been divided into (a) all causes, (b) zymotic disease (including the notifiable diseases, influenza, and zymotic enteritis), (c) phthisis, and (d) respiratory diseases other than phthisis. This Table, which is one of the most instructive in the whole report, is as follows :— Finsbury, 1903 and 1904. Death Rates from all and Certain Causes in Houses or Tenements of several sizes. Size of Tenements. Census Population, 1901. All Causes. Zymotics. Phthisis. Respiratory Disease (excluding Phthisis). Death rate per 1000. 1903. Death rate per 1000. 1904. Death rate per 1000. 1903. Death rate per 1000. 1904. Death rate per 1000. 1903. Death rate per 1000. 1904. Death rate per 1000. 1903. Death rate per 1000. 1904. One-room tenement 14,516 38.9 40.6 5.6 5.1 4.5 4.5 9-3 9-8 Two-room tenement 31,482 22.6 21.9 3.8 4.1 2.8 2.2 5-3 4-9 Three-room tenement 21,280 11.7 14.7 1.8 2.1 1.2 2.3 2-4 3-4 Four-room tenement and upwards of four rooms 33,185 5.6 7.5 0.54 0.1 0.63 1.2 0.84 1.4 Institutions* 1,000 16.0 28.0 — — 7.0 5.0 4.0 8.0 Deaths not traced† — 273 216 12 11 13 25 10 62 The Borough 101,463 19.6 21.1 2.6 2.8 2.2 2.5 3.9 4.8 * Institutions include Common Lodging Houses, Houseless Poor Asylum, House of Retreat, and other similar Institutions (excluding of course, Hospitals, Infirmaries, &c.). The population is stated approximately only. † These are deaths (not death-rates) returned as belonging to Finsbury, in which no address was furnished or the deaths were not traceable at the addresses furnished. 23 24 The population upon which these death rates have been tabulated is that of the census, which provides the only available figures. The population in each class of accommodation has declined since 1901, so that, in fact, all the rates are probably, if anything, a little below the accurate figures. A study of the Table will show the effect of the one-room system upon the death rates. It will be seen that in each of the four classes selected, the death rate falls in proportion as the number of rooms occupied rises. In the next place, it will be seen that the number of deaths occurring in tenements of two rooms or less furnish the majority of all the deaths in the Borough, though only 46 per cent. of the population actually live in such tenements. Then, again, under each of the stated causes, of infectious disease, phthisis, and other respiratory diseases, it will be seen that the same broad result holds good. Many deductions might be drawn from this Table, but it is perhaps undesirable to burden the report with them. The main lesson is an obvious one. The conditions of life obtaining in one-room tenements are such as tend towards poor physique, disease, and death. The density of population is higher, the physical restrictions are greater, and there is less fresh air and more uncleanliness. B.-RECORDS OF DISEASE. 27 THE INFECTIOUS DISEASES. The principal Infectious Diseases are seven in number, namely:— Small-pox, Scarlet Fever, Diphtheria, Fever (including typhus, typhoid or enteric, and simple or continued), Diarrhoea, Measles, and Whooping Cough. The notification clauses of the Public Health (London) Act, 1891 (Sections 55-57), deal with smallpox, cholera, diphtheria and membranous croup, erysipelas, scarlet fever, typhus, typhoid, relapsing, continued, and puerperal fevers. During 1904 there were 806 notifications, as compared with 586 in 1903 and 1026 in 1902. The returns according to the Metropolitan Asylums Board Reports are as follows:— First Qtr. Second Qtr. Third Qtr. Fourth Qtr. Total for 1904 Small-pox I 6 6 — 13 Scarlet Fever 60 88 95 80 323 Diphtheria (including Membranous Croup) 24 36 37 26 123 Fevers- Enteric 8 6 9 17 40 Typhus — — — — — Continued — — — — — Erysipelas 12 23 37 33 105 Puerperal Fever 1 2 1 1 5 Chicken-Pox (Temporary Notification) — 98 77 22 197 Totals 106 259 262 179 806 SMALL-POX. From January 3rd to March 13th there were in the Metropolis 47 cases of Small-pox. We received in those nine weeks intimation of eleven persons, resident in the Borough, who had been in direct 28 contact with Small-pox infection; but up to March 14th we had no cases. On that date, however, we had our first case, which was followed by 12 others. The cases of Small-pox in Finsbury during the last decade have been as follows:— Years. No. of Cases. No. of Deaths. 1895-1900 18 0 1901 88 8 1902 187 32 1903 1 0 1904 13 3 Total 307 43 The incidence of Small-pox, since the Borough's formation, is shown in the following table :— No. of Cases per 10,000 of population.. No. of Deaths per 10,000 of population. Case-mortality. No.. of Deaths per 100 cases notified. 1901 8.6 0.98 11.4 1902 18.6 3.2 17.1 1903 0.1 0 0 1904 1.3 0.3 23.1 The particulars respecting the thirteen cases which occurred in residents of the Borough, and three other cases which were detected by us in the Borough but which belonged to other districts, are as follows :— Case 1.—On March 14th I received a notification of a case of small-pox occurring in the Borough, in the person of G. C., of 56, 29 Rawstorne Street, male, aged 30. His occupation was that of a lithographer, and he worked in Southwark Bridge Road, S.E. His illness commenced on Wednesday, March 8th, and the characteristic rash appeared on Saturday, March 12th. He was notified to me on the following Monday, and at once removed to the small-pox hospital at Dartford. He had been vaccinated in infancy (4 marks), but not re-vaccinated. The case was one of discrete small-pox. It appears to be clear that G. C. contracted his infection from a married sister living in Bethnal Green, who fell ill on February 25th, and whose rash appeared 011 February 28th. But owing to some delay which apparently occurred, she was not notified to the Bethnal Green Authorities and removed to hospital till March 8th. She had contracted infection from surrounding cases in that district. G. C. had visited his sister in Bethnal Green on February 28th (during her illness), and again on March 6th (also during her illness), and on March 8th at the time of her removal to hospital. So that he had come into direct contact with small-pox at its acute and most infectious stage on three different occasions. He had not, however, taken the precaution of being re-vaccinated, as he " does not believe in vaccination." He was, therefore, the means of his own infection, and he introduced the disease again into Finsbury. Case 2.—on April 5th I received a notification of a case of small-pox in the person of A. W. (female, aged 26), residing at 177, Goswell Road. Her occupation was that of a kitchen-maid at an eating-house in Barbican, City, where she was found at work on April 5th by the City Authorities and removed to hospital by them. Her illness commenced on March 21st and the characteristicrash appeared on April 3rd. She had been vaccinated (three marks) in infancy, but had not been re-vaccinated. The proprietor, W. P., who has another establishment in Moor Lane (in this Borough), was removed with small-pox from his home at Clapham on Saturday, April 2nd. Two other young women from the Barbican shop had been away from work, one since March 15th with, so it was stated, chicken-pox, and the other eight or nine days later, with the same complaint. 30 Case 3.- On May 10th, at 9.30 p.m., I received a notification of a case of small-pox in the person of F. B. (male, aged 34), residing in Pollard Houses, Pentonville, N. His occupation was that of a coffin-plate engraver, and he was employed in Euston Road, in the Borough of St. Pancras, where he was last at work on May 7th. His illness commenced on that day and the characteristic rash appeared on May 10th. He had been vaccinated in infancy (three marks), but had never been re-vaccinated. About twenty men were employed at F. B.'s workplace, and one man (F. C., 24, Peabody Buildings, Drury Lane, W.C.), was removed with small-pox some live weeks earlier than F.B.'s illness. It is therefore probable that F. B. did not contract infection from him. But, on May 8th, Mrs. J. N. was removed from 46, Huntingdon Street, Barnsbury, N., suffering from small-pox, and her husband was also employed at this same workplace. It appears that, about a fortnight before her removal, her husband was taken ill with " influenza." He suffered from headache, fever, and a rash. He was unable to continue his employment for two or three days. These symptoms, history, and the dates suggest that J. N. had small-pox, and was the common source of infection in his wife and in F. B., and was also the intermediate case between F. C. and F. B., the case removed by us. Case 4.—On June 17th, I received a notification of a case of small-pox, F. M. L. (female, aged 18 years), residing at 53, York Road, E.C. Her occupation was that of a labeller, and she was employed in this Borough. She was last at work on Saturday, June 11th, and was removed to Hospital on Friday, June 17th, her illness having commenced on the 14th, and the characteristic rash appearing on the 17th June. She had never been vaccinated. It was found impossible to actually locate the source of infection, but she had been on occasions in an infected area, viz., Bethnal Green. Case 5.—I received a notification on June 22nd, of a case of small-pox in the person of A. M. B. (female, aged 21 years), residing at 33, Ironmonger Street. Her occupation was that of a machinist, at a skirt-makers, in this Borough, and she was last at work on 31 Saturday, the 18th June. Her illness commenced on Sunday, June 19th, the rash appeared on Tuesday, the 21st, and she was removed to Hospital on Wednesday, the 22nd. She had been vaccinated in infancy. In connection with this case it will be as well to note that on May 23rd, a girl named A. V. H., residing at Durham Row, Limehouse, sister to E. H., who was employed at the same place as A. M. B., was removed with small-pox. E. H. was then kept from work, and on the 2nd of June she obtained a medical certificate that she could return to her work, which she did on the 6th June, and remained there for three days, but on the 9th June she developed small-pox, and was removed to hospital on the 10th. She worked on the same floor as A. M. B., and therefore, this case is distinctly attributable to the fact that E. H. returned to work too soon. Case 6.—On Sunday night, June 26th, Chief Inspector Green had the body of an infant removed to the Warwick Place Mortuary as having died suddenly from some unknown cause. The body was that of a child, I. F. D., aged five months, of 41, York Road. On Monday morning I received a note from the medical man who had seen the child on Sunday before death, asking me to examine the body and see if the case was one of small-pox. Accordingly I visited the mortuary and made an examination of the body, and formed the opinion that the case was one of smallpox. Dr. Wanklyn, the Small-pox Specialist to the London County Council, also saw the body and arrived at the same opinion. I subsequently visited the house and found that this child had been sick and ailing on Saturday, that a rash had appeared on Sunday, that there had been some pain and fever, and that the child died on Sunday night. The child was unvaccinated. From enquiries I think there is little doubt that this child contracted infection from F. M. L., of 53, York Road, the case of small-pox removed on June 17th. I made arrangements for immediate burial after disinfection of the body. The Vaccination Officer visited the premises and arranged for vaccination, and more than a dozen persons submitted to re-vaccination. The usual steps as to disinfection were properly carried out. 32 The next cases came in two groups. First Group (Case 8).— On Monday, July 4th, I received a notification of a ease of small-pox in the person of S. A. P. (male, aged 26, lodging at 31, Norman's Buildings. His illness commenced on June 25th, and on June 27th he went to St. Bartholomew's Hospital, where, after examination, he was told to return next day. This he failed to do. On June 29th other symptoms occurred, and on July 2nd the rash appeared, On July 3rd (Sunday) he again went to St. Bartholomew's Hospital, and was then found to be suffering from small-pox and was accordingly notified. He had not been vaccinated since infancy. He was removed direct to the small-pox hospitals at Joyce Green, and I received the notification on Monday morning. I at once visited 31, Norman's Buildings, and made the usual enquiries and arranged for disinfection. The information which we were able to obtain (in the absence of the patient) was very meagre. But we gathered that this man was a travelling compositor, and had been living in various lodging-houses and working in various printing works. On visiting one of these printing works in Goswell Road, we learned that S. A. P. had worked there about a fortnight before, but that all the employees were well and there had been no illness. On pursuing the matter further, however, and pressing the point, six men, out of some twenty employed, were brought to me. After examination I found that the first was suffering from toothache and neuralgia ; the second and third were suffering from small-pox (B. L and S. W. B.) in the acute stage ; the fourth was recovering from small-pox (E. P.); the fifth was affected with a minor skin disease on the face; and the sixth (H. W.), a friend of S. W. B., was suffering from what might be the premonitory symptoms of sniall-pox. B. L. lived at Edmonton and S. W. B. in Stepney. I notified them both and removed them direct to the small-pox hospital at Joyce Green, informing the authorities of the two districts. Following the ordinary course, these cases will be allocated to the districts in which they reside. They were suffering from modified small-pox, having been vaccinated in infancy, were in the acute stage and very infectious, and had been at work and moving about London with the disease full out upon them. E. P 33 lived at Leyton, and had suffered from a modified attack of small-pox, the origin of which I have been unable to trace. He was well vaccinated in infancy. When I saw him he had recovered, and therefore I did not notify him. But I am disposed on the whole to think that E. P., who sickened on June 17th, was the first case in the group ; that S. A. P. contracted infection from him (or both of them from a common source); and that B. L. and S. W. B. were secondary cases deriving their infection from E. P. and S. A. P. All possible steps were taken, including prompt removal, disinfection and re-vaccination (22 employees in this one printing office being vaccinated). I also visited another printing works where S. A. P. had been at work whilst infectious, and disinfection and re-vaccination were similarly carried out there. I desire to record my appreciation of the great assistance we received from the managers at these two works in the investigations, &c. I may here add that E. P.'s doctor, and he himself, did not agree with my view, and believed that he had not had small-pox. I maintained that he had, and warned him to advise his relatives, and the young woman (A. Y.) to whom he was engaged to be married, to be re-vaccinated. He did not accept my advice. Now, it is interesting to observe the subsequent history. (a) E. P. returned to work and was the only man in that printing office who declined re-vaccination, although he was returning to infected surroundings from which I re-moved another man five days later with whom he worked. I believed him to be safe because he had just had small-pox. He remained perfectly well, which is prima facie evidence that he had had small-pox. (b) But A. Y., as far as can be judged, passed through a mild attack of unrecognised small-pox, and E. P.'s sister (C. P.) also contracted the disease from him. My view, therefore, receives abundant confirmation that E. P. had small-pox in mild form, from which he was recovering when I examined him, and he introduced the disease into Finsbury from Leyton. The total number of cases taking infection from him was five. Second Group (Cases 7, 9, 10, 11).—The other cases which we have had in Finsbury are set out in the table below and call for little comment. The Pine Street group consisted of the mother and 34 three daughters. This family were "anti-vaccinationists." The first case was E. H., aged 8 (unvaccinated). She had been notified as suffering from "chicken-pox," which indeed, it appeared to be. But a week later when the medical man saw her again, he decided that the disease was a mild case of small-pox. She was at once removed, and as she had been lying in the room several days very thorough disinfection was carried out, and I urgently pressed the father to allow of revaccination of the other children and the mother, even if he would not be vaccinated himself. He declined. As there had been an error in respect to diagnosis, I determined to keep the family under my own observation. I told the mother, therefore, to let me know at once if any of the other children sickened with illness of any kind. She apparently misapprehended me, for on July 8th she took Mary, aged 9 (unvaccinated) to St. Bartholomew's Hospital. The house physician consulted me about the case and notified it as small-pox, and it went to Joyce Green. I repeated my urgent advice to the father and mother respecting revaccination, but they declined to allow of any vaccination. On Tuesday, July 12th, I found Catherine, aged 3 (unvaccinated), to be suffering from small-pox, and moved her to hospital. She died there on July 27th. On July 13th, the mother was removed with small-pox from which she also died, on July 21st. The only members of the family left were the father (vaccinated), a baby (unvaccinated), and a girl of 14 who had been thoroughly vaccinated. Thus four cases occurred in one family, two of whom died, all as the result, as far as can be judged, of neglect of vaccination. Case 12.—on Sunday, July 24th, at 9.45 p.m., I received notification of a case of small-pox in the person of W. A. (male, aged 17), residing at 63, Wynyatt Street, vaccinated in infancy. The patient was engaged at a large restaurant and eating-house in this Borough as cashier; the actual source of infection could not be traced in this case, but, having regard to the nature of his occupation, it is possible that he contracted the disease through handling money which had been previously handled by someone who was infected with small-pox, which had been more or less prevalent in the vicinity. 35 Case 13.—On Monday, July 25th, at 10.40 a.m., I received notification (by special messenger from St. Bartholomew's Hospital) of a case of small-pox in the person of R. R. (male, aged 56), residing at 6, Banner Street. This patient, who was employed by the Church Army, and had been living at the home for the Houseless Poor, went to St. Bartholomew's Hospital, and was there seen by Dr. Turner, of South Wharf (who was at the hospital at the time), and was sent by him to Joyce Green Hospital. I was unable to obtain (in the patient's absence) any direct evidence as to source of infection, but learned that he had been engaged in delivering hand-bills in the neighbourhood of Walworth and other parts of London, and sickened with small-pox on July 18th, the rash appearing on July 22nd. He had been vaccinated in infancy (four marks). The cases of small-pox we have had in 1904 in Finsbury are therefore as follows :— No. Address. Sex and Age. Date of Eruption. Date of Removal to Small-pox Hospital. Vaccinated in Infancy Vaccd. during the last 10 years Unvaccin ated. Result. 1 Eawstorne Street, 56 M 30 March 12th March 14th * ... ... Recovered. 2 Goswell Road, 177 F 26 April 3rd April 5th * ... ... ,, 3 Pollard Houses, 17 M 34 May 10th May 10th * ... ... ,, 4 YorkEoad, 53 F 18 June 16th June 17th ... ... * ,, 5 Ironmonger Street, 33 F 21 June 21st June 22nd * ... ... ,, 6 York Road, 41 F 5 mths. June 26th Died at home ... ... * Died Jan. 26th 7 Pine Street 2, F 8 June 21st June 28th ... ... * Recovered. 8 Norman's Buildings, 31 M 26 July 2nd July 3rd * ... ... ,, St. Mary's Road, 148, Lower Edmonton M 17 June 29th July 4th * ... ... ,, Diggon Street, 48, Stepney M 23 June 30th July 4th * ... ... ,, 9 Pine Street, 2 F 9 July 8th July 8th ... ... * ,, Connor Street, 27, Hackney M 22 July 9th July 11th * ... ... ,, 10 Pine Street, 2 F 3 July 11th July 12th ... ... * Died July 27th 11 Pine Street, 2 F 39 July 13th July 13th * ... ... Died July 21st 12 Wynyatt Street, 63 M 17 July 22nd July 24th * ... ... Recovered. 13 Banner Street, 6 M 45 July 22nd July 25th * ... ... ,, N.B.—Three cases of small-pox occurring in persons working in Finsbury, but living elsewhere, are printed in italics. No. 1 Contracted the disease from his sister who was removed from Bethnal Green. Nos. 2, 3 and 5. Contracted the disease from their work places. No. 4. Contracted the disease from Bethnal Green Infected Area. No. 0 Contracted the disease from the same street. Nos. 7, 12, 13. The source of infection has not yet been traced in these cases No. 8 and those italicised contracted the disease from a fellow worker (unrecognised case). Nos. 9, 10, 11. Contracted the disease from a previous case in family. 36 Showing the Rise and Fall of DIPHTHERIA each week during 1904. Showing the Rise and Fall of DIPHTHERIA each week during 1904. 37 CHICKEN-POX (Varicella). On March 29th, the London Connty Council made the following Order:— "The London County Council do hereby Resolve and Order that Section 55 of the Public Health (London) Act, 1891, with respect to the notification of infectious disease shall apply in the Administrative County of London, for a period of four calendar months, to the disease known as Chicken-Pox; and the Council do hereby declare that the case is one of emergency owing to the recent increase in the number of cases of Small-pox in London and the fact that the failure in certain cases to distinguish between Chicken-pox and Small-pox has led and is likely to lead to the spread of the latter disease." The order was advertised on 31st March, 1904, and in accordance with the Statute, came into operation at the expiration of one week from that date. Subsequently the order was extended for three additional months (expiring on November 7th). We received 197 notifications as follows :— Under 1 1-5 5-15 15-20 20-30 30- Total Males 10 55 38 — 1 — 104 Females 12 54 24 2 1 — 93 Totals 22 109 62 2 2 — 197 Only one case which had been notified as Chicken-pox proved to be Small-pox. DIPHTHERIA. There have been 123 notifications of Diphtheria (including Membranous Croup) received during the year, as compared with 119 in 1903, 216 in 1902 and 289 in 1901. The age incidence of Diphtheria and its mortality for 1904 was as follows:— 38 Ages in Years Under 1 year 1-6 5-15 15-20 20-30 30-40 40- Totals No. of Notified Cases Males 1 27 17 1 2 i -- 49 Females 4 30 28 3 6 2 1 74 Totals 5 57 45 4 8 3 1 123 Deaths from Diphtheria. 3 10 — 1 — — —- '4 Percentage on Cases. 60.0 17.5 — 25.0 — — — 11.4 It will be seen that the chief incidence of the disease has fallen upon young children ; as many as 102 out of the 123 were of school age, which is almost exactly the same proportion as last year. The following table shows the seasonal occurrence of the cases of diphtheria notified to us in 1904 : — Months Jan. Feb. Mar. April May. June July. Aug. Sept Oct. Nov. Dec. Number of Cases 13 5 6 9 15 12 10 13 14 9 13 4 Totals 24 36 37 26 The cases of Diphtheria have been evenly distributed throughout the Borough, the southern portion of northern Clerkenwell, as last year, alone remaining free. In a general way it may be said that most cases have occurred in the overcrowded and poorer parts of the district. The incidence has not been exceptionally heavy in the Model Dwellings, nor in relation to any milkshops. Personal infection has been, without question, the main channel for the spread of the disease. Not a few cases have apparently arisen from contact with "ordinary sore-throats." 39 The incidence of Diphtheria, since the Borough's formation, is shown in the following table:- No. of Cases per 10,000 of Population. No. of Deaths per 10,000 of Population.. Case Mortality. No. of Deaths per 100 Cases notitied. 1901 28.4 3.5 12.5 1902 21.1 3.6 17.1 1903 11.8 1.2 10.1 1904 12.4 1.4 11.4 The following table illustrates the channels of infection and the sanitation of the houses in all those cases where infection could be at all traced, or the sanitation of the house was in any way open to criticism :— I.—Insanitation— Houses, in which Diphtheria occurred, found to be damp or dirty 15 Defective drains, sanitary conveniences, sinks, etc. 18 Defective paving in yard and accumulation of refuse in yard 9 Total 42 II.—Channels of Infection— Previous cases in the same house or family 17 Personal contact with Diphtheria in vicinity 12 Following Scarlet Fever 1 From School 3 Hospital attendant 1 Total 34 There were nine small groups of eases of personal infection among families or playmates. 40 On June 10th, I received a notification of Rose S., aged 16, a bookfolder, suffering from Diphtheria and living at 12 N. Street. On visiting the house enquiry elicited the fact that her sister Amelia, aged 10, had suffered from sore throat on May 31st, and two little sisters, Lily and Alice, were at the time of the visit suffering from sore throat. Dr. Sandilands took a swab of Alice's throat, as it seemed inflamed, and also of Amelia's whose throat appeared quite healthy. The bacteriological examination showed that Amelia's throat contained the diphtheria bacillus and Alice's throat did not. Amelia was accordingly notified as suffering from Diphtheria, but the hospital authorities held that she was not suffering from the disease, and so she was not accepted by them. The throats of the family were, however, so suspicious that we carried out further swabbing with the following results:— 41 Name. Age. Clinical Characteristics of Throat. Bacteriological Diagnosis B. Diphtheria present + Absent - First Examination. Second Examination. Whether notified and whether received into Hospital. Rose S. 16 Diphtheria diagnosed from clinical symptons No bact. diagnosis No bact. diagnosis Notified and received. Amelia S. 10 Fauces natural, no inflammation, no membrane + ... Notified but not received Alice S. 4 Tonsils swollen and inflamed, no membrane ? + Notified and received. Lily S. 2½ Both tonsils swollen, no membrane, excoriation of upper lip and alae nasi ? + Notified and received. John S. 12 Both tonsils red and inflamed,superficial ulceration and moist sticky exudation on left tonsil, no membrane No bact. diagnosis ... Notified but not received Alfred S. 8 Vomiting and headache, fauces inflamed and red, submaxillary gland enlarged, no membrane - + Notified but not received Frederick S. 4½ mths No exudation and no signs of inflammation, fauces normal, no membrane + + Not notified. These facts raise several questions of some practical importance. First, it is probable that Amelia S. had previously suffered from Diphtheria, and subsequently, after recovery, acted as a " carrier " of infection to her sister Rose, the first case notified. Secondly, none of the last six cases had a diphtheric membrane in the throat. Thirdly, there is the difficult question of the relation between bacteriological diagnosis and notification. It is now well known that the true bacillus of Diphtheria may be present in the throat of an apparently healthy person, who may thus act as a " carrier," a source of infection, to other persons who may contract the clinical 42 disease of Diphtheria. This family history illustrates that point, and there can be little doubt that it is by such unrecognised cases —having a slight sore throat or no sore throat at all—that the infectious genn is disseminated in the community. To discover such cases and prevent them infecting their neighbours is the business of preventive medicine. In accordance with this view we have in a number of cases made bacteriological examinations of the throats of " contact " persons. In some cases where the Diphtheria bacillus was found we have notified the cases and had them returned as not cases of clinical Diphtheria as may be seen in the above family. Probably it is desirable that the Metropolitan Asylums Board's Hospitals should not admit as cases of Diphtheria, persons who though they may have the bacillus in their throats are not suffering from the clinical symptoms of the disease, lint it will be evident that these persons are yet a danger to the community, and are in my opinion one of the chief causes of the spread of the disease in Finsbury. What is to be done with them ? I think they should be isolated as much as practicable at home and kept from school and their neighbours; and also direct throat treatment should be adopted with a view of clearing their throats of the infective bacillus ; and if any throat symptoms occur in addition to the presence of the bacillus they should not only be notified but admitted to hospital, and not discharged until it has been bacteriologically demonstrated that their throats are clear. If this view be right I think Alfred S. should have been received into hospital. Another family in which diphtheria occurred also raises difficulty. A little boy, William S., aged 4 years, of 1, R. Street, contracted diphtheria and was removed to hospital. His sister Amelia, aged 11, slept with him and suffered from a similar sore throat, and two little brothers, aged 9 and 7 years respectively, contracted the sore throat and " bad coughs." I visited the family and took careful swabs of each child, four in all. The bacteriologist found the diphtheria bacillus not to be present in any of the four throats, but in all four he found diplococci, a staplylococci, and in two he found streptoccus. I am satisfied that the same illness affected these children. One is isolated as suffering from Diphtheria, the 43 other four are left in the community, and yet it is not improbable that they possessed infectious throats. This question of double infections is illustrated in another case. William F. L., aged 7, living at 15, I. R. This boy contracted Scarlet Fever at school, and went to hospital on March 7th. He was discharged on May 19th in apparently good health. He went to the seaside for convalescence. On June 7th Dr. Sandilands saw him and found the following conditions present. Both tonsils were enlarged and pale in colour. Mucous membrane of the fauces, pharynx and soft palate was anaemic ; no signs of inflammation; no exudation from crypt of tonsils or elsewhere ; mucus or mucopurulent discharge from the right nostril and excoriation of the nostril. A swab was taken (June 7th) from the throat and the Diphtheria bacillus was found. Desiring to be sure of our position we swabbed this boy again (June 8th), and again the Diphtheria bacillus was found. On June 6th the baby sister of this boy was notified by a medical practitioner as suffering from Diphtheria, but on reaching hospital the child was found to be suffering from Scarlet Fever. I notified William F. L. as Diphtheria and he was returned as suffering from no infectious disease. The explanation appears to be that the boy suffered from Scarlet Fever from which he had almost recovered but still retained some infection. Then he suffered from Post-Scarlatinial Diphtheria from which he appeared quickly to recover. But his baby sister contracted Diphtheria or Scarlet Fever or both from him. Nor are these the only cases in which difficulties have arisen, owing to the subtlety of diphtheria infection and the methods by which the infection of it is conveyed. Diphtheria in Cats.—This year again we have come across some further cases of diphtheria which may have been contracted from diseased cats—six in all. In three cases it has not been possible to have any bacteriological examination made of the suspected cats, which had been destroyed. In one of these cases this was very unfortunate as all the evidence pointed rather definitely to the infected child having contracted infection from the cat. In three other 44 instances we were able to send the suspected cat to Mr Fonlerton, of the Middlesex Hospital. In one case he obtained a negative result. In two other cases the result was not definite, but organisms similar to the Klebs-Loffler bacillus of diphtheria were found, but as they did not give the pathogenic reactions of the diphtheria bacillus it is not possible to say that it was proved that the suspected cats were actually suffering from clinical diphtheria as we know it. The total number of doubtful cases of diphtheria examined bacteriologically was 91, of which 22 gave a positive result. SCARLET FEVER. The total number of notifications received during the year for Scarlet Fever was 323, as against last year's 283, and 381 in 1902. The age and sex incidence was as follows :— Ages. 0- I- 5- 10- 15- 2O- 30-40 Total Males 3 55 64 13 4 5 2 146 Females 2 64 72 26 6 6 1 177 Total 5 119 136 39 10 11 3 323 From these figures it will be seen that 260 out of the 323 cases occurred in children under 10 years of age. In relation to school influence, it is of interest to note that nearly 90 per cent. of the cases occurred in children at school ages. These returns show a higher incidence than usual upon children at school age. Not only is Scarlet Fever a disease of children, but it is most fatal in young children. There were in all 17 deaths, distributed as follows :— Showing the Rise and Fall of SCARLET FEVER each week during 1904. Showing the Rise and Fall of SCARLET FEVER each week during 1904. 45 Years Under 1 year 1 and under 5 5 and above 5 At all Ages Number of cases notified 5 119 199 323 Number of deaths — 11 6 17 Percentage of deaths at each age period attacked 9.2 3.0 5.2 Seventeen deaths yield a Scarlet Fever death rate of 0.17 per 1,000. The comparative figures for the last eight years are as follows:— Years Number of Cases notified Number of Deaths Death llate per 1.000 1897 597 26 0.24 1898 518 30 | 0.27 1899 480 18 0.16 1900 227 12 0.ll 1901 495 19 0.18 1902 381 15 0.14 1903 283 12 0.11 1904 323 17 0.17 The distribution of the disease in Finsbury in 1904 has been fairly uniform, although there have been one or two groups around certain schools. The incidence of Scarlet Fever, since the Borough's formation, is shown in the following table:— 46  No. of Cases per 10,000 of population. No. of Deaths per 10,000 of population. Case Mortality. No. of Deaths per 100 cases notified. 1901 48.1 1.8 3.8 1902 37.9 1.5 3.9 1903 28.1 1.2 4.2 1904 32.6 1.7 5.2 Direct personal infection has been traceable to other cases of Scarlet Fever in the same family in 59 instances. Direct personal infection has been traceable in other cases in schools in 10 instances. These seem to be fairly definitely proved cases of direct personal infection in which it was possible to determine the person from whom infection had been derived. Enquiry has also elicited the fact that in 69 other cases personal infection was indirectly obtained in school or in the same buildings or playground. Eight cases of the disease appear to have been contracted in hospitals, and five cases were apparently derived from "return" cases. Two cases were possibly due to contact with infected clothes after the removal of the patient, but it is quite probable that in practice this channel of infection plays a larger part than is commonly supposed. Marked insanitary conditions were found in 38 homes in which Scarlet Fever had occurred. The five " return " cases were traced to previous patients in the same family having been returned from hospital apparently not completely healed. The cases were as follows :— 1. J. C. W., m., 25 years, 160, G. Buildings. Notified March 20th. Onset, of illness, March 12th. Return case, daughter E., aged 6 years, returned from hospital February 24th. Sequelæ: marked coryza. 2. E. L., f., 16 months, 15, I Row. Notified June 6th. Onset of illness, a few days previously. Return case, brother, returned from hospital May 18th. Sequelæ: nasal discharge. 47 3. A. M., m., 2½ years, 256, N. Buildings. Notified October 4th. Onset of illness, October 3rd. Return case, brother, returned from hospital October 1st. Sequelæ: enlarged submaxillary glands, marked coryza. 4. W. S., m., 5 years, 18, C. Row. Notified October 24th. Onset of illness, October 21st. Return case, sister, returned from hospital October 12th. Sequelæ: excoriated lips and nose. 5. F. M., f., 3 years, 97, C. Buildings. Notified October 31st. Onset of illness, October 29th. Return case, brother Albert M., returned from hospital October 8th. Sequelæ: nasal discharge. In each of these cases all other probable sources of infection were definitely excluded. SCARLET FEVER AND SCHOOL INFLUENCE. During the first 6 months of the year, 148 cases of Scarlet Fever were investigated by Dr. Sandilands (to whom 1 am indebted for these notes), with especial reference to the influence of school attendance on the spread of the disease. In addition to the usual school register a second record was kept showing the actual class-rooms attended by Scarlet Fever patients or their contacts. 19 cases in all were traced with some degree of probability to schools, but when these cases came to be critically examined in the light of the classroom records only 6 afforded any evidence of having been infected by contacts or previous cases attending the same class. The 13 cases remaining must be assumed to have acquired Scarlet Fever by contact with infectious school-fellows in the playgrounds or precincts of the school, if they are to be admitted as cases of "school infection." Even assuming this mode of infection to have been the true one, it still appears that the part played by schools in the spread of Scarlet Fever was a small one and only accounted for 13 per cent. of the total cases. A case of some interest was that of A. C., a boy, aged 7 years, who was notified as suffering from Scarlet Fever on March 17th, 1904. He was then in the " peeling " stage. He sat in the same class with W. M., who was then suffering from Scarlet Fever, on February 12th, and probably acquired the disease from this boy. Although A. C. continued to attend school Showing the Rise and Fall of TYPHOID each week during 1904. Showing the Rise and Fall of TYPHOID each week during 1904. 49 not be out of place to point out the absurdity of neglecting to remove the known sources of infection, merely because a certain number of the unknown are bound to be passed over. The very uncertainty of the mode of infection in two-thirds of the total cases may be taken as evidence that the grosser and more obvious sources of infection can in most instances be robbed of their power for harm by prompt removal and disinfection. The failure of Scarlet Fever to spread in the class-rooms of schools is in the first place due to the fact that the greater number of patients are too ill to attend school on the day of onset, and in the second place to early notification, which enables the contacts to be removed from school and quarantined immediately they have become a source of danger. The absence of school infection is a valuable criterion of the success of preventative measures, and a proof that, at least as far as Scarlet Fever is concerned, school attendance cannot be represented as an added source of danger to child life under an effective system of isolation. Diphtheria and School Influence.—Sixty cases of Diphtheria, occurring during the first half of the year, were investigated with reference to school infection, and more particularly to class-room infection, a school and class record being kept as for Scarlet Fever, Four cases were traced to schools, but only one of these had actually sat in the same class with a diphtheria contact. The infection was in every instance indirect. The spread of the disease seems to have been less influenced by school attendance than the spread of Scarlet Fever, and the same deductions hold good for both. It should perhaps be added that the inferences drawn have been based on the experience of the Borough of Finsbury, and that their value is consequently comparative rather than absolute. ENTERIC FEVER. In Finsbury during 1904 there were only 40 cases of Typhoid or Enteric Fever. There were 65 cases in 1901, 77 in 1902, and 47 in 1903. There were in 1904 eight deaths among the 40 cases removed to hospital for treatment. This number of deaths gives 50 a death rate of 0.08 per 1,000, and a percentage mortality of 20.0 on the total number of cases. The age distribution of the cases was as follows:— Ages Under 5 5-15 15-30 Above 30 Totals Males 2 6 9 3 20 Females 2 2 13 3 20 Totals 4 8 22 6 40 Of these 40 notifications 8 were received in the first quarter, 6 in the second, 9 in the third, and 17 in the fourth. The two common characteristics of Enteric Fever, namely, that it attacks young adults and that it appears more frequently in the autumn, are illustrated by the cases which occurred in Finsbury in 1904. But the autumnal rise was much less marked than is usual. There was not at any time during the year any sign of an outbreak of the disease, nor is there evidence that Enteric Fever has been conveyed by water or milk. Careful enquiries have been instituted in each case notified, and in 10 cases it has been possible to determine, personal contact as the channel of infection. Nine cases attributed their infection to the consumption of shell-fisli. In 12 houses sanitary defects were found. The incidence of Enteric Fever since the Borough's formation is shown in the following table:— 51  No. of Cases per 10,000 of Population. No. of Deaths per 10,000 of Population. Case Mortality. No. of Deaths per 100 Cases notified. 1901 6.4 1.1 16.9 1902 7.6 0.9 11.7 1903 4.7 1.1 23.4 1904 4.0 0.8 20.0 During the year the blood of 19 patients was examined bacteriologically, and 10 were found to yield a positive result. Discharge Notices —The Metropolitan Asylums Board has continued to send discharge certificates, notifying us of the return home of each case of infectious disease which has been sent to hospital. Each case has been visited by us and a written report made. The total number of certificates received was 214, concerning 309 cases of discharge. The result of our visits has been that, apparently, all the patients had completely recovered (except perhaps some general weakness), with the exception of 37, in whom were found some definite sequelæ:— Discharged cases of Scarlet Discharged cases of Diphtheria— Fever— Nasal discharge 2 Sore Throat 2 Paresis of limbs 10 Coryza 3 Sore throat 1 Paralysis of left side 1 Enlarged glands 1 Ottorrhœa 6 Ottorrhœa 2 Desquamation 6 Albuminuria 1 16 19 Discharged cases of Typhoid Sequelæ in Scarlet Fever 19 Fever— Do. Diphtheria 16 Paresis of limbs 1 Do. Typhoid Fever 2 Diarrhœa 1 2 37 We were unable to trace any return cases of Diphtheria or Typhoid Fever, and only five of Scarlet Fever. 52 MEASLES. As this is not a notifiable disease we can only gauge its prevalence and degree of severity by means of the death returns and school returns. Including both intra and extra-parochial returns there were 60 deaths attributed to Measles during the year, giving a death-rate of 0.61 per 1,000. The London death-rate for Measles for 1904 was 0.49 per 1,000, there being 2,261 deaths from that cause as against 2,046 in 1903. It is probable that these figures do not fully indicate the destruction of life due to Measles, for this disease is often complicated with bronchitis or other respiratory disease, and hence some deaths due to Measles are entered in the returns as due to bronchitis, &c. In 1904 the secondary causes of death in the 60 cases were:—pneumonia 42, bronchitis 13, convulsions 5. This gives 55 out of 60 (or 91 per cent.) deaths due to lung complication. Measles and Whooping Cough—both of which are looked upon generally as slight ailments—caused more deaths in Finsbury (namely, 86) during 1904 than all the notifiable infectious diseases put together. It may be pointed out that the remedy for this state of things lies most largely in the hands of parents and others having the care of children. There are strong reasons against the inclusion of Measles under the notification clauses of the Public Health (London) Act, 1891, and hospital provision for this disease is at present impossible. Careful nursing of individual cases and closure of Infants' Departments of schools during an outbreak, coupled with disinfection when necessary, seem to be the best methods of reducing the high death-rate from this disease, which mainly affects children under 5 years of age. Tt will be remembered that in 1903 new powers were granted to the Local Authority in respect of Measles, which was to be treated as a "dangerous infectious disease." The disease was not, however, made notifiable. We have during 1904 received 802 intimations of the occurrence of the disease as follows:— 53 Information of cases received from the sources as follows : 1904. 1903. Schools—Amwell Street 7 — Ann „ 10 32 Baltic ,, 6 26 Bath ,, 35 33 Central „ 2 13 Chequer „ 37 33 Compton „ 29 35 Hugh Myddelton 80 21 Martyrs' Memorial 23 24 Moreland Street 9 39 Risinghill „ 68 80 St. Barnabas 2 — St. John's Lane 1 12 St. Luke Parochial 14 — SS. Peter and Paul 1 — Winchester Street 46 14 370 362 Schools outside Borough 23 14 393 376 County School Visitors — 2 Other Sources— Sanitary Inspectors 333 130 Relieving Officers 5 4 Superintendents of Dwellings 16 4 Parents and Guardians 27 43 Medical Practitioners 5 16 Other Borough Councils 23 2 802 577 The age and sex incidence of the cases intimated was as follows:— Under 1 year. 1—5. 5—10. 10—15. 15- Total. Males 33 256 98 5 3 395 Females 20 267 115 4 1 407 Total 53 523 213 9 4 802 54 Preventive Measures.—Every case of the disease has been visited and enquiries made as to sanitary conditions, etc. In almost every case we have also carried out disinfection of dwellings, bedding, clothing, etc., the exceptions being houses in which the occupiers carried out their own disinfection. The following card of instructions has been widely distributed by the inspectors and also by the superintendents of model dwellings to whom I have sent large numbers:— MEASLES. 1. Measles is very prevalent in Finsbury at the present time. 2. It is a dangerous infectious disease. More children die of Measles and of Whooping Cough than of all the other infectious diseases added together. In all cases therefore, Measles requires careful nursing. Medical advice should be obtained. 3. Children and other persons suffering from Measles must not now go to school or public meetings of any kind ; nor may they now mix with other children or persons; nor may they travel by train or any public conveyance (under penalty of £5.) They must be kept at home isolated from other persons until free from all infection. 4. Rooms and clothing must be disinfected by the Sanitary Authority after Measles as after Diphtheria and Scarlet Fever. (Signed) GEORGE NEWMAN, M.D., Medical Officer of Health. Public Health Department, Finsbury Town Hall, Rosebery Avenue, E.C., 1904. WHOOPING COUGH There were 26 deaths from Whooping Cough, giving a death rate of 0.26. This disease shows a considerable decrease. Whooping Cough is a disease of about two months' duration, and is chiefly characterised by bronchial catarrh and a frequent paroxysmal cough. It generally occurs as an epidemic late on in the winter, say from January to March. Though no age is absolutely exempt from Whooping Cough, it is essentially a children's disease, most of the cases being met with in children 55 under seven years of age. It is most fatal in the second year of life. The disease is almost entirely spread directly from patient to patient, the patient being infectious from the very commencement of the attack, and remaining so as long as the "whoop" is present. Owing to its infectiousness, isolation of the patient from other children should be enforced until there is no longer any sign of the "whoop." EPIDEMIC DIARRHŒA. During 1904 there were 145 deaths attributed to this disease, 116 of these cases being infants under one year of age. This gives a death rate for Epidemic Diarrhoea of 1.46 per 1,000. Years. Finsbury Epidemic Diarrhœa, heath Rate. London Death Hate. 1900 1.50 0.78 1901 1.20 0.80 1902 0.81 0.53 1903 0.99 0.64 1904 1.46 1.03 Out of the total of 116 deaths of infants, 95 occurred in the third or summer quarter of the year. The disease may therefore be considered from that point of view. Now in the third quarter of 1904 there were 183 deaths of infants in Finsbury, that is, of children under 12 months of age.* This works out at a mortality of 173.0 per 1,000 births. The infant mortality rate for the whole of 1903 was 159.1 per 1,000 births, and the intra-parochial rate for the same period was 129.6 ; the average for London in 1903 was 129.7. If we take this last figure as average standard for the Metropolis, it will be seen that during the third quarter of 1904 the infant mortality in Finsbury rose 43.3 above 129.7 ; or if it be compared with the infant mortality rate of *For the purposes of this note concerning deaths in the third quarter children returned as dying at " twelve months of age " are included. 56 the third quarter of 1903, which was, in Finsmry, 121.5, it is 51.5 in excess. The infant mortality rate per 1,000 births in Finsbury for the third quarter of the years 1901-1904 was as follow :— 1901 141.0 1902 121.7 1903 121.5 1904 173.0 Broadly, therefore, it may be said that the infant mortality rate in 1904, in the third quarter (July, August and September), has been higher than at any other time since the formation of the Borough. The number of deaths of infants, and the age incidence, may be expressed as follows :— Deaths of Infants from all Causes—Third Quarter. Months. 0- 1- 2_ 3- 4- 5- 6- 7- 8- 9- lO- 11- 12- Total. 1901 33 11 13 18 10 18 15 13 6 14 11 2 11 175 1902 44 8 11 19 7 18 13 12 8 7 7 10 8 172 1903 30 11 12 10 13 12 8 11 7 6 11 9 5 145 1904 28 16 18 20 18 18 8 20 7 13 5 7 5 183 135 46 54 67 48 66 44 56 28 40 34 28 29 675 Deaths of Infants from Epidemic Diarrœa only—Third Quarter. Months. o- 1- 2- 3- 4- 5- 6- 7- 8- 9- 10- 11- 12- Total. 1901 4 4 7 10 9 13 10 7 4 11 9 o 5 93 1902 5 2 4 11 4 3 10 3 2 3 3 6 5 . 61 1903 2 4 4 1 6 4 5 8 1 3 1 5 3 47 1904 2 9 11 16 9 12 6 12 4 3 3 5 3 95 13 19 26 38 28 32 31 30 11 20 16 16 16 296 57 An examination of the causes of death in these 183 infants reveals the fact that 95 (or 51.9 per cent.) of them were due to the disease commonly known as epidemic diarrhœa (zymotic enteritis); whereas, if the year be taken as a whole, instead of the third quarter only, it will be found that the number of deaths due to this disease is, as pointed out above, much less. For example, in 1903 only 15.3 per cent. of the deaths of infants were due to this disease; and even in 1901, when the infant mortality was high in the third quarter, the percentage of deaths due to epidemic diarrhoea in the whole year was only 17.5 per cent. The other chief diseases to which deaths were due were marasmus, bronchitis, measles, convulsions, prematurity, &c. It is therefore clear that by far the chief cause of the high infant death rate in the third quarter of 1904 was this disease of epidemic diarrhoea. Our knowledge of the cause, or causes, of this disease is by no means complete, but something of the favourable conditions is known, and a brief note may be added concerning these conditions. The disease is looked upon as a bacterial disease, and its occurrence depends, wholly or partly, upon a high surrounding temperature and deficiency of rainfall, the dust pollution of food—chiefly milk— and all the conditions of unwholesome life in cities. The exact relationship which these conditions bear to each other is not yet known. (a) The Relation of Season. The main effect of season depends upon dryness and heat. A hot dry Summer favours the disease ; a cool, wet Summer, or a Summer that is either cool or wet, exerts an unfavourable effect on the disease. In 1901 there were in Finsbury in the Summer quarter 93 deaths from Epidemic Diarrhoea. The Summer was a hot one, the maximum temperature of the air rising as high as 68.4° F., and having a mean throughout the quarter of 61.7° F. The rainfall was very small (4.63 inches). 58 In 1902 there were in the Summer quarter 61 deaths of infants from Epidemic Diarrhœa The Summer was a dry one (only 6.02 inches of rain fell), but it was also a cool Summer, the mean maximum temperature of the four-foot earth thermometer never rising higher than 57.5° F., and the temperature was above 58° F. on only three successive weeks. In 1903 there were in the Summer quarter 58 deaths of infants from this disease. The Summer was a warmer one than that of 1902, the maximum temperature rising to 59° F., and being above 58° F. on nine successive weeks. But the rainfall was exceptionally heavy, as much as 15.56 inches of rain falling in the quarter, as compared with 6 inches in 1902. Briefly, therefore, 1901 was a hot, dry Summer; 1902 was a cool, dry Summer; and 1903 a warm, wet Summer. Both the latter seasons were, therefore, unfavourable to the occurrence of epidemic diarrhoea and 1901 was favourable, and these conditions in part explain why the diarrhoea rate in 1901 was high and in 1902 and 1903 was low. In 1904, the Summer quarter particularly under consideration, the season was warm and dry. The temperature of our four-foot earth thermometer in Wilmington Gardens rose to 61° F., and had an average of 59.1° F., and was for nine successive weeks above 58° F. The rainfall was only 4.88 inches. The conditions were, therefore, favourable to the occurrence of the disease, and, in point of fact, 95 deaths of infants were registered as due to epidemic diarrhoea during the quarter. These facts may be presented in tabular form as follows :— Third Quarter Year. No. of Infant Deaths from Epidemic Diarrhoea. Mean Max. Temp. Rainfall. 1901 93 61.7° F. 4.63 1902 61 57.5° F. 6.02 1903 58 58.1° F. 15.56 1904 95 59.1° F. 4.88 59 The facts concerning the relationship between seasonal conditions and diarrhœal deaths in the summer quarter of the present year (1904) may be tabulated as follows:— Summer Quarter, 1904. July. August. September. Dates of months (in weeks). 3-9 1016 1723 2430 31-6 July 7-13 14- 20 2127 28-3 Sept 4. 10 11- 17 18- 24 25- 30 Mean temperature. Fourfoot thermometer. 56.1 57.4 58.9 59.7 60.3 60.9 6o.6 59.9 59.6 59.4 58.8 57.9 57.o 0.14 Rainfall (4-88 in.) 0.22 0.01 0.04 1. 83 0.08 0 .06 0.47 0.22 1.01 0.36 5 0.24 0 .20 No. of deaths from Epidemic Diarrhcea. 195) 2 1 5 10 18 15 15 8 6 6 2 2 (b) Relation to methods of Feeding. An enquiry has been made into each of the fatal eases of diarrhoea with a view of obtaining information as to surroundings and method of feeding. In 82 cases out of the 95 the following facts have been obtained :— Breast-fed only 11 or 13.4 per cent. Cows' milk only 22 or 26.8 „ Condensed milk only 14 or 17.0 „ Breast-fed and cows' milk 13 or 15.9 „ Breast-fed and condensed milk 10 or 12.2 „ Cows' milk and condensed milk 12 or 14.6 „ 82 100.0 That is to say, 86 per cent. of the children under one year dying of epidemic diarrhoea in Finsbury, in the third quarter of 1904, were fed on cows' milk or condensed milk, or in other words, upon milk which might be, and in fact is, liable to great contamination. There can be no doubt in the mind of anyone who knows how the 60 poor live in an urban district like Finsbury, that, quite apart from the lesser suitability of condensed or cows' milk for infant feeding, these two forms of milk readily become contaminated with dirt and dust. Much pollution arises at the farm and in transit, or at the milkshop, and much also in the home of the consumer, particularly during a warm, dry summer. The conclusion is inevitable that epidemic diarrhoea in Finsbury affects children who are not breast-fed more than it affects others. But it may be urged that these figures are too small and far too short in period to be reliable. It may therefore, be well to add that year by year increasing evidence is obtained in support of the view that much of the epidemic diarrhoea of urban communities is derived from the consumption of polluted milk. Reference was made to this matter in my reports for 1902 and 1903. During 1904 we have carried out further enquiry into the conditions of life obtaining in relation to 465 infant deaths. The total infant deaths were 522. Into 465 of these cases it has been possible to make enquiry; 116 of the deaths enquired into were due to epidemic diarrhoea, and the feeding of 111 of these cases has been investigated on the same lines as last year (when 190 were enquired into). It is thus possible to give the results of enquiry into 301 cases of fatal diarrhoea of infants. The return is as follows :— Age in months. Human Milk. Artificial or Condensed Milk. Human and Artificial. Cows' Milk. Human and Cows'. Totals. 0-3 19 22 11 27 19 98 4-6 13 25 13 28 13 92 7-9 9 14 12 20 14 69 10-12 12 9 3 11 7 42 Totals 53 70 39 86 53 301 61 From these figures it will be seen that :— 53 or 17.6 per cent. were breast fed. 109 or 36.2 per cent. were fed wholly or partly on artificial milks. 139 or 46.1 per cent. were fed wholly or partly on cows' milk. That is to say that 82 per cent. of the children under one year of age dying of epidemic diarrhoea in Finsbury during 1903 and 1904 were fed on artificial or cows' milk, or in other words, upon milk which might be, and in fact is, liable to great contamination. The evidence which is obtainable for 1904 is therefore in no way exceptional, and only bears out the findings of 1903 and 1902. Indeed, the larger the number of deaths investigated in regard to this point of infant feeding, the more is the case against it strengthened. The remedy is to feed infants on human milk, or, if that be impracticable, then on clean pure cow's milk, suitably modified for infant consumption. If both of these are impossible, then recourse must be had to sterilised milk.* The results of the enquiry into the conditions of life of the 465 infant deaths (out of 522) from all causes of death, may be set out in the following table:— Age in months. Human Milk. Artificial or Condensed Milk. Human and Artificial Milk. Cows Milk (Bottle). Human and Cows' Milk. Total. One room. Two rooms. Three rooms. Four rooms. o-3 104 27 15 50 15 211 73 101 23 14 4-6 26 13 12 32 14 97 28 41 20 8 7-9 15 15 14 24 10 78 14 39 15 10 10-12 11 7 24 22 15 79 25 38 11 5 Totals 156 62 65 128 54 465 140 219 69 37 * See also appendix to this Section, p. 82, for some notes by Dr. Sandilands on Infant Feeding. 62 From this table it will be seen that:— 156 or 33.5 per cent. of the cases were fed on breast milk (compared with 17 per cent. in deaths due to epidemic diarrhœa.) 127 or 27.3 per cent. of the cases were fed wholly or partly upon artificial milk. 182 or 39.1 per cent. of the cases were fed wholly or partly on cows' milk. It will therefore be seen that the manner of feeding in the infants who died of epidemic diarrhœa is open to more criticism than those dying of other diseases. The percentages as to accommodation are much the same : 140 deaths or 30.1 per cent occurred in one-roomed dwellings, and 359 in all, or 77.2 per cent. occurred in homes of two or less than two rooms. (c) Relation to housing and Poverty. Of the 82 deaths of epidemic diarrhœa under consideration— 25 or 30.5 per cent. occurred in one-roomed dwellings. 34 or 41.4 ,, „ two-roomed „ 11 or 13.4 „ ,, three-roomed „ 12 or 14.6 „ „ four or more roomed dwellings. It is therefore evident that upwards of 70 per cent. of these deaths occurred in dwellings of not more than two rooms. Further it must be said that, broadly, the fatal cases have occurred in houses characterised by poverty, uncleanliness, and more or less overcrowding. In 17 cases the mother was constantly employed away from home, and presumably the child may have suffered from an increased degree of maternal neglect. But maternal neglect and ignorance does not appear to be rare. Eight of the deaths were of illegitimate children. There can be little doubt that the fatality follows the actual occurrence of the disease, and, therefore, presumably we must conclude as follows :— That epidemic diarrhoea in Finsbury mostly affects the children of the very poor, who lire surrounded by uncleanliness, in overcrowded conditions, and in houses overcrowded per acre. 63 (d) Methods of Prevention. 1.—There appears now to be almost indisputable evidence that the chief cause of epidemic diarrhœa in infants is inappropriate feeding. If infants were breast fed, and therefore nourished on milk (a) which is suited to their physical requirement, and (b) which is sterile, we should get very little, if any, epidemic diarrhoea. The influences of season and uncleanliness would appear to be indirect influences affecting the quality of milk and food other than human milk. Therefore the great requirement is the breast feeding of infants, and where that is really impossible the provision of modified pure milk. Elsewhere will be found particulars of the establishment of an Infants' Milk Depot in the Borough (see p. 115). 2.—Secondly, there is an evident need for teaching mothers the right methods of rearing children, as much negligence occurs owing to ignorance. For this purpose it is important to visit the homes in which new births have taken place, rather than make enquiry only into deaths of infants. We are endeavouring just now in Finsbury to carry out this work. 3.—Thirdly, something should be done in teaching girls the elements of domestic hygiene and infant management. 4.—Fourthly, there can be no doubt that the effectual and frequent cleansing of streets, courts and alleys, and the maintenance of cleanliness and good sanitary conditions in houses and tenements requires the continued attention of the Borough Council. PHTHISIS The Voluntary Notification of Phthisis. — The number of notifications of Phthisis remain about the same. The system of voluntary notification was adopted in this district in October, 1900. In 1901 there were 70 notifications; in 1902, 121; in 1903, 219 ; and in 1904, 210, as follows:— 64 Notified Cases. Under 10 years. 10- 20- 30- 40- 50- 60- Total. Males — 13 23 37 31 29 11 144 Females 1 6 11 23 15 7 3 66 Total 1 19 34 60 46 36 14 210 Most of these 210 notifications are of inmates in the Highgate Infirmary, and are of cases in an advanced stage of the disease. These are two characteristics which greatly reduce the advantage of the system, which is to obtain notifications of the disease in all classes of the community, and in the early stages of the disease as well as the later. It is, I think, matter for regret that we do not receive more notifications in all classes of the community. I fully recognise the difficulties which occur in general practice in relation to the notification of this disease and which are common to all districts. On the other hand I am satisfied that the utility of notification is in proportion to the number notified. The advantages of the system are (a) the giving of advice as to precautions and arranging for disinfection of houses, etc., in order to prevent dissemination of the virus of infection during the life of the patient; and (b) the collection of some facts, even if they be not complete, respecting the incidence of the disease. Unfortunately these advantages fall short of what is really needed. Voluntary notification comes too late to render very much service to the patient or indeed to the community. It ought not to be so, but in practice it works out so. Secondly, there is no system of isolation for cases notified, and thirdly, "removals" are so frequent that it is almost impossible to trace infection or to follow up the case. For these reasons reliable deductions cannot be drawn on the data obtained by voluntary notification as it works out in a district like Finsbury. Probably the way out of the difficulty as to notification is a system of compulsory notification as in force in New York and in Sheffield 65 (for a period of seven years). The advantages of such a system are the obvious ones of having a complete, or nearly complete, return of the most infectious cases in a district among all classes, and of earlier notification. The disadvantages are chiefly two—(a) that the disease is of long duration, and in its early stages difficult of diagnosis ; and (6) that the notification of all persons suffering from the disease might lead to some degree of hardship. It must, however, be remembered that notification is mainly beneficial in the case of those who are too poor to be able to adopt the necessary measures to protect others. Better-class patients are relatively few. Dr. Scurfield, the Medical Officer of Health of Sheffield, informs me that the compulsory notification clauses for Phthisis have worked quite smoothly in Sheffield up to the present time, and he has not heard of any hardship whatever being inflicted by the system. During 1904 he received 840 notifications (the population of Sheffield is 432,940). Two inspectors are engaged in visiting consumptives, in distributing leaflets of advice, supplying pocket spittoons, disinfecting, etc. In respect to isolation, it must be said that some kind of isolation is an indispensable part of the measures necessary if we are to secure a more marked diminution of tuberculosis than has occurred in the past. It must not, of course, be forgotten that the disease has diminished more than one-half during the last fifty years, due not to any hospital or sanatorium isolation, but to the advance of sanitation, improvement of housing, the raising of the standard of personal hygiene, and the social and physical condition of the people. And broadly it is still upon these conditions that we must rely for further diminution. Nevertheless it cannot be doubted that the absence of suitable sanatorium treatment is blocking the way of municipal authorities in London in their dealings with consumption. Further, it should not be forgotten that there is a double need to be met by isolation. First, it is important that there should be sanatoria for the repair of consumptive patients in the early stages of the disease. Secondly, institutions are required where advanced cases can be isolated, in order thus to remove the most dangerous sources of infection from the rest of the community. In 1903 the Borough Council concurred in the views of the 66 Kensington Borough Council as to the desirability of the unused accommodation provided by the Metropolitan Asylums Board for small-pox at Dartford being utilised for the treatment of persons suffering from consumption; and further, that the cost of the provision and of the administration of such treatment be a charge upon the Metropolis generally. The resolution was laid before the Local Government Board. Owing to lack of unanimity among the Metropolitan Boroughs, the Metropolitan Asylums Board wrote in January adjourning the whole question for 12 months. Subsequently the Board decided that the proposal involved so considerable an extension of the duties and responsibilities of the Board, and so large an increase in their expenditure, as to call for some authoritative expression of opinion by the Local Government Board before any definite action could be taken. I understand that the Managers of the Metropolitan Asylums Board are still awaiting the decision of the Local Government Board. Deaths from Phthisis.—The total deaths. due to Consumption in 1904 were 251, as compared with 238 in 1903. The death rate for the year is therefore 2.5 per 1,000, which is about the average rate for the last five years :— Deaths 0— 10— 20— 30— 40— 50— 60— Total Males 16 8 22 42 37 21 12 158 Females 13 7 12 16 25 12 8 93 Total 29 15 34 58 62 33 20 251 In the first quarter of the year there were 84 deaths ; in the second, 53 ; in the third, 52 ; and in the fourth 62. The number of males is, as usual, much in excess of the females. This fact is probably accounted for by the greater degree of exposure of men, not only to infection but to all the disadvantages of occupation, inclement weather, exhaustion, fatigue, etc. Men run the risks of infection in workshops, public-houses, and public places much more than do women ; and their work also frequently 67 brings them within the influence of predisposing conditions (dust, constrained positions, ill-ventilated premises, etc.), as well as being generally of a more sedentary character. It is probable also that alcoholism, which is an important predisposing condition of phthisis, plays its part in increasing the incidence upon men, who not only drink more, but who come more within the range of public house infection. Dr. MacLearn, the Medical Superintendent of the Holborn Infirmary, Archway Road, N., writes to me under date January 3rd, 1905:- " The total number of deaths from phthisis, occurring in the Holborn Union Workhouse Infirmary, during 1904, was 156 ; of these, 113 were of patients coming from Finsbury. The number of phthisis cases now under treatment here, and who are residents of Finsbury, is 112 ; of these, 18 are women and 94 are men." The following table sets out the comparative death rates since 1896 Year 0—10 10—20 20—30 30—40 40—50 50—60 60—70 Totals Death rates 1896 35 11 38 64 63 31 10 252 2.33 1897 23 11 50 58 63 32 20 257 2.39 1898 28 15 43 58 57 42 10 253 2.35 1899 16 14 34 63 92 33 13 265 2 ..4.8 1900 11 13 47 68 88 28 12 267 2.51 1901 18 13 26 59 60 40 10 226 2.22 1902 38 15 28 72 48 33 15 249 2.45 1903 18 19 27 57 52 36 29 238 2.39 1904 29 15 34 58 62 33 20 251 2.54 These are not the full number of deaths, which probably reached at least 300 in each year, or 1,500 per five years, but the 68 deaths of which we have full particulars as to age, address, etc. These returns are of interest, and illustrate a variety of points in connection with the ravages of Phthisis in Central London, and particularly the age incidence of the disease. To measure this incidence accurately it is necessary to state the deaths per 10,000 of the population at each age period as follows :— SEX. No. of Cases per 10,000 of the Population at certain age periods. 0-10. 10 20. 20-30. 30-40. 40-50. 50-60 60 and upwards. Totals. 1901 Males 8.6 3.9 21.1 47.6 83.5 78.9 12.8 29.2 Females 6.9 8.6 6.2 32.5 22.5 35.8 21.2 15.5 1902 Males 23.3 3.9 20.1 58.0 53.3 76.0 51.3 32.2 Females 9.5 10.5 9.4 39.4 31.2 19.2 9.1 17.1 1903 Males 6.0 7.8 17.9 53.0 53.3 84.8 81.3 29.8 Females 7.8 9.6 11.5 25.7 36.4 30.3 24.2 17.2 1904 Males 13.8 7.8 23.2 57.0 65.7 61.4 51.3 31.6 Females 11.2 6.7 12.5 21.7 43.3 33.0 24.2 18.2 The incidence of Phthisis since the Borough's formation, therefore, may be shown as follows:— 69  Number of Cases notified per 10,000 of Population. (Voluntary notification). Number of Deaths per 10,000 of Population. 1901 6.9 22.2 1902 12.0 24.7 1903 21.8 23.7 1904 21.2 25.3 Each death and notification has been enquired into. Many of the latter naturally become the former in a few months, so that the enquiries into deaths, as a general rule, furnish the most reliable facts. From these enquiries it appears that 111 cases (out of 251 deaths) were infected by relatives, which is 44.2 per cent. of the total. When it is considered that there may be no outward signs of early phthisis, that it is frequently to the patient's interest to conceal the disease, and that the greater number of cases go about for years without medical attendance, or are detected only in the later stages or at death, this percentage of cases where a definite history of personal contact was made out must be counted as high. In many of these cases the history indicated family infection through several generations. The number of cases with a history of probable infection by persons not related must always be small, since it is the cause of death among relatives which in the greater number of instances furnishes the clue to infection, and this clue is always wanting where the histories of fellow workmen, lodgers, etc., in past years are enquired into. Cut there is abundant evidence to show that infection may be derived from such sources. 'Ihe number of cases of phthisis occurring in houses where other persons had been notified as suffering from, or had died from the disease, was as follows:— 70  Number of previous cases of Phthisis notified in former years, or having died in same house. Totals. One. Two. Three. Four. Five. Notifications in 1904 29 8 3 6 14 60 Deaths in 1904 54 18 3 0 4 79 Totals 83 26 6 6 18 139 From this table it will be evident that 79 deaths or 32.1 per cent. of the total deaths occurred in houses already infected, and that 18 cases occurred in houses where there had been no less than five previous cases. Though the majority of these cases were propably infected by members of their own family, they demonstrate none the less the urgent necessity of disinfection, education of the patient, and, if the means were available, of an efficient and extensive scheme of sanatorium training to this end. Preventive Measures—1. Each case of the disease notified to us has been visited and advised as to precautions which should be taken to avoid dissemination of the disease. Printed leaflets of advice have also been left, and a card to the following effect:— To Prevent Consumption. 1. Keep the windows always open at the top day and night, and the room well ventilated. Never let it get " stuffy." 2. Keep the room very clean. 3. Spit only into a spittoon or cup kept for the purpose. The cup should contain a little water or liquid disinfectant. Once a day clean the cup at the sink with boiling water. 4. Boil all milk before use. 5. Live in the fresh air as much as you possibly can. (Signed) George Newman, M.D., Medical Officer of Health. Public Health Department, Finsbury Town Hall, Rosebery Avenue, E.C. 71 I am satisfied that more care is being taken in the Borough as to these matters. For instance, we have found that out of the total number of cases, as many as 71 were using spittoons, and 20 others were using special handkerchiefs of cloth and paper which were burned after use. This means that nearly half the cases are taking some measures of precaution, which is certainly a higher proportion than in former years. 2. Disinfection is offered and in most cases carried out, almost invariably so after deaths from this disease. 3. Sanitary enquiries are instituted, and a number of sanitary defects are remedied. It is interesting, however, to observe, as was pointed out clearly in my last report, (p. 56), that only some 20 to 30 per cent. of the infected houses show marked sanitary defects. Exposure to infection, rather than insanitation, seems to be the chief cause of dissemination, though there can be no doubt whatever that insanitation in its broadest meaning, including lack of personal hygiene, is the main predisposing cause of the disease. In 39 houses where the disease occurred, dampness, poor light and uncleanliness were marked. 4. During the year special action has been taken with a view to preventing the dissemination of the disease in public-houses. The following letter was sent by me to the owners or occupiers of licensed premises, numbering 302, and personal visits were paid by the Chief Inspector:— Public Health Department, Finsbury Town Hall, Rosebery Avenue, E.C. September, 1904. Dear Sir, The Public Health Committee desire me to draw your attention to the extreme importance of properly cleansing and keeping clean the floors of public bars in all Licensed Premises, in view of the wide prevalence of Consumption in Finsbury, the common habit of spitting on floors in these places, and the consequent danger of this Infectious Disease being conveyed to yourselves, your servants, and the public. 72 The greatest risk is incurred by the servants who sweep bar floors, but the licensed victuallers themselves run no inconsiderable danger of infection. The Registrar-General has shown that— (a) More than one-quarter of the deaths of innkeepers and their servants in London. result from Consumption. (b) More than one-third of the deaths of public-house servants, barmen and potmen, in London, are due to Consumption. (c) The mortality from Consumption amongst London inn- keepers and their servants is more than twice as great as the mortality from this disease of all occupied males, and the mortality amongst the servants alone is more than three times as great. The following are the two principal methods for diminishing the danger of public-house infection :— (1) Spitting on the floors, except into proper spittoons, should be discouraged by every practical means. The exhibition of a notice requesting customers not to spit seems to be the most convenient method to recommend, and has been adopted in several districts of London and many of the large provincial cities. The Public Health Committee consider this the best plan, and ask for your hearty co-operation in the matter, as you no doubt already understand the necessity for it. Such notices may be obtained free from me, and I now enclose several copies. (2) The floors, walls, seats, furniture, &c., in the bar should be cleansed daily. The best way to do this is not by sweeping, brushing, or dusting, which raises dust in the air (for this is probably the chief cause of infection among public-house servants), but floors should be washed with a mop dipped in hot water or disinfectant solution, and the walls should be swilled or a hose used. Counters, seats, furniture, &c., should be cleansed with a wet duster, which should afterwards be placed in hot water and boiled. Spittoons should be cleansed with boiling water or disinfectants, and the sawdust burned. 73 I am particularly anxious not to put you to any undue inconvenience, but I trust you will assist us in endeavouring to prevent the spread of this prevalent disease by exhibiting the enclosed notices discouraging spitting in your bars. I am, Dear Sir, Yours faithfully, (Signed) George Newman, M.D., Medical Officer of Health. I am glad to report that most of these owners have responded and displayed the notice, which was as follows :— "Prevention of Consumption. " You are earnestly requested not to spit on the floor. " Public Health Department, Finsbury Town Hall, 1904." 5. We have, of course, adopted many measures for the general improvement of the health and sanitation of the Borough, which exert a direct or indirect effect upon this disease, such, for example, as control of the milk supply, the reduction of overcrowding, the cleansing of houses and workshops, etc. Other forms of Tuberculosis —In addition to the 251 deaths from Phthisis (Tuberculosis of the Lungs), there were also 27 deaths from tuberculosis of the membranes of the brain, and 40 deaths from all other forms of tuberculosis, making a total of 318 deaths from this disease. An investigation has been made into all the infant deaths (26) due to this disease, and in 21 cases some particulars have been obtained, of which the following are the chief:— 74 75 Sex and Age. Address, and No. of Rooms in Brackets. Diagnosis. Phthisis now in Family, or History of such. Milk. Condition of Home and General Remarks. M., 7 mos. 46, S. St. [4] Tubercular Meningitis — Human only — M., 11 mos. 43, R. St. [1] Rickets and Phthisis History of Phthisis Artificial only Mother weakly. M., 8 mos. 29, I. Row [1] Bronchitis & Miliary Tuberculosis Phthisis in family Cows' milk only — M., 4 mos. 25, C. Close [1] Tuberculous Disease of Bowels History of Phthisis Artificial and cows' M„ 11 mos. 29, M. St. [1] Tubercular Meningitis History of Phthisis Artificial only Mother weakly. M., 10 mos. 53, R. St. [2] General Tuberculosis — Human and cows' (said to be boiled) History of lung disease in family. M., 11 mos. 1, G. St. [2] Tubercular Meningitis History of Phthisis Human only — F., 7 mos. 10, Gt. S. St. [2] Pulmonary Tuberculosis History of Phthisis Human and artificial — F., 3 mos. 137, G. Bldgs. [2] Tubercular Meningitis — Human and artificial Clean and airy rooms. Great poverty. F., 7 mos. 4, G. Terr. [1] Tubercular Meningitis & Pulmonary Tuberculosis Father and mother both have Phthisis Human, artificial and cows' Great poverty. F., 5 mos. 16, G. Terr. [1] Tubercular Enteritis — Artificial only Parents healthy, but child's uncle died of Phthisis. Fairly clean room. M., 4 mos. 2, M. Place [3] Tuberculosis mesenterica,convulsions Father has Phthisis Human Rooms dirty. " Two other children died of consumption." M., 4 mos. 57, M. St. [2] Pulmonary Tuberculosis Father died of Phthisis before child's birth Human, artificial and cows' Mother has " weak chest." M., 7 mos. 1, A. St. [1] Tuberculosis Adenitis History of Phthisis Cows' and artificial Fairly clean. F., 9 mos. 53, R. L. St. [2] General Tuberculosis History of Phthisis Human Clean, but ill-ventilated. F., 8 mos. 20, R. St. [1] Tubercular Enteritis (No information obtainable) Artificial only Parents intemperate ; children neglected. M., 4 mos. 6, W. L. St. |2] Tubercular Meningitis (No information obtainable) (No information obtainable) M., 4 mos. 20, A. St. [2] Tubercular Cerebral Meningitis Mother has Phthisis and History of Phthisis Human Clean and airy rooms. M., 11 mos. 5, B. Bldgs. [2] Tuberculosis, Broncho-Pneumonia Father has Phthisis; History of Phthisis Human and cows' Dirty and ill-ventilated. M, 6 mos. 6, S.St. [2] Pulmonary and General Tuberculosis Father has Phthisis; History of Phthisis Human and cows' Man's first wife and one child died of consumption. M., 10 mos. 99, R. St. [1] General Tuberculosis — Human History of lung disease in family. 76 From these facts it would appear that in 15 of these cases there was definite history of phthisis infection in the family to which the child belonged. In four cases there was no such history, and in two instances no information could be obtained. There was no direct evidence in any case of infection through tubercular cow's milk. CANCER AND MALIGNANT DISEASE. There were 79 deaths certified during 1904 as due to cancerous or malignant disease, which gives a special death rate of 0.79 per 1,000. The age and sex incidence of these deaths was as follows:— Ages Under 10 years 10 and under 20 20 and under 30 30 and under 40 40 and under 50 60 and under 60 60 and under 70 70 and upwards Total Males 1 — 1 1 3 9 10 7 32 Females — 1 2 4 10 13 12 5 47 Totals 1904 1 1 3 5 13 22 22 12 79 Totals 1903 — 1 2 10 13 29 23 14 92 Totals 1902 — — — 1 16 17 18 20 72 Totals 1901 1 2 2 8 14 18 14 13 72 The occupation of each person dying of Malignant Disease has been noted. These have been various, and in no case is there any obvious connection between the occupation and the cause of death. Eighty-eight per cent. of the cases occurred in persons over 40 years of age. As to local distribution, it may be remarked that the distribution was fairly uniform throughout the Borough, and there was no instance of more than one case in a house. 77 It is not probable that these returns are strictly accurate. They are in all probability under the mark, though in some instances the diagnosis included in the 79 cases must be accepted with reserve. Cancer is not always readily diagnosed. Moreover, it is likely that the deaths of a certain number of persons have been attributed to other causes when they should have been allocated to Cancerous Disease. The parts of the body mainly affected with Cancerous Disease were as follows :— Cancer and Malignant Disease of various parts of the body. 1901 1902. 1903. 1904. Totals. Face, Tongue, Jaw — 7 12 7 26 Throat, Neck, Gullet — 8 7 8 23 Stomach 9 12 16 8 45 Intestines 10 17 11 14 52 Liver 10 6 13 11 40 Pancreas — — 3 3 6 Omentum — — 1 — 1 Breast 6 9 12 4 31 Uterus 16 12 9 14 51 Testis — — 1 — 1 Bladder — — 1 1 2 Various 21 1 6 9 37 Totals 72 72 92 79 315 An examination of the returns for 1904 reveals the following two facts : (a) the cases of cancer in men recorded in Finsbury numbered 32, of which 27, or 84.3 per cent., were cases of cancer of the alimentary canal including jaw and tongue ; (b) the cases 78 among women numbered 47, of which 23, or 48.9 per cent., were cases of cancer of the alimentary canal, and 18, or 38.2 per cent., were cases of cancer of the breast or womb. ALCOHOLISM. During 1904 nineteen deaths were directly attributed to alcoholism and delirium tremens. These figures, do not, of course, represent more than a small proportion of the mortality really caused by alcoholism. It is more than likely that some of the deaths of infants attributed to being "laid upon " in bed, are really caused indirectly by alcoholism. During 1904 there were, as already pointed out, 31 deaths so caused. Cirrhosis of the liver, a condition due, as a rule, to alcoholic excess, caused the death of 25 persons. Hence it may be said that at least 44 deaths were probably due to alcoholic excess. The figures are as follows :— Years. Alcoholism. Cirrhosis of Liver. Total. 1901 II 22 33 1902 27 21 48 1903 22 29 51 1904 19 25 44 Of the 19 deaths due directly to alcoholism, 17 occurred between the ages of 25 and 60, none occurred under 25, and two occurred over 60. There can be no doubt that a large number of other deaths during the year were caused indirectly, or accelerated, by alcoholic excesses. There are in Finsbury 309 licensed premises, or one to every 329 persons. In about 100 of these, notices of dilution under the Food and Drugs Acts are exhibited with the view of protecting the vendor in the event of prosecution for selling adulterated spirits. APPENDIX TO SECTION B. 82 METHODS OF FEEDING & INFANT MORTALITY. The following Table and Notes have been drawn up by Dr. Sandilands with a view of demonstrating the influence of different methods of feeding on the infantile mortality of Finsbury:— Percentage of Infants at several Ages Fed in Different Ways. Age in Months. Causes of Death and Survivors. Condensed Milk Human and Condensed. Cow's Milk. Human and Cow's. Total Artificial. Human Milk. Totals. Under 3 Months. Diarrhœa 16 15 14 31 76 24 100 All other Causes 7 9 10 10 36 64 100 Survivors 6 2 10 2 20 80 100 3-6 Diarrhoea 24 21 22 19 86 14 100 All other Causes 12 16 17 15 60 40 100 Survivors 7 2 12 2 23 77 100 6-9 Diarrhœa 14 19 17 33 83 17 100 All other Causes 18 9 12 18 57 43 100 Survivors 9 16 3 15 4 31 69 100 9-12 Diarrhœa 7 23 22 68 32 100 All other Causes 4 16 10 33 63 37 100 Survivors 17 5 32 6 60 40 100 12-18 Survivors 25 6 45 9 85 15 100 83 The figures opposite the heading "Survivors" show the percentages of infants fed in five different ways during the first 18 months of their lives, and are based on euquiries made into the feeding of 280 children of the poorer classes in Finsbury ; 132 of these infants were 9 months old at the time of the enquiry, and 148 had attained the age of 18 months. Thus 280 children were ascertained to have survived for the first 9 months of life, and are represented by the percentages for the first three age periods, whilst the percentages for the last two periods deal with the smaller number of children who were visited at the age of 18 months. The investigation has made it possible to establish what may be described as an average incidence of death on infants grouped according to the manner of their feeding. It is apparent that if all the infants in a community are breast-fed, 100 per cent. of infant deaths must occur in breast-fed children. If 50 per cent. are breast-fed and 50 per cent. are bottlefed, and if the feeding of an infant has no effect on its chances of living or dying, then the infant deaths will necessarily be equally divided between the naturally and artificially fed In other words the percentages opposite the heading " Survivors," which show the proportion of children fed in different ways, may also be taken as representing the average distribution of deaths which would obtain amongst these children, were feeding a negligible factor in the causation of death. For purposes of comparison, the deaths from Diarrhoea and from "All other Causes" in former years have been placed immediately over the numbers representing an average distribution of deaths. During the first three months of life 80 per cent. of 280 children were fed on breast milk alone, whilst 20 per cent. received some form of cows' milk, so that the infant population of Finsbury under the age of three months would yield 80 deaths in breast-fed children for every 20 deaths in those brought up by hand if the death rates in the breast-fed and artificially-fed populations were the same. From the Table it appears that the deaths from diarrhoea in breastfed children under three months constituted only 24 per cent. of the total, whilst the remaining 76 per cent. were deaths in the artificially-fed, that is to say the deaths amongst the artificially-fed were nearly four times the number that ought to have occurred, on 84 the supposition of an average distribution of deaths from diarrhœa among infants fed in different ways. The same excessive mortality in the hand-fed continues up to the ninth month of life. In the last three months of the first year of life the diarrhoea mortality approximates to the average. The immediate cause of the high death rate from diarrhoea among children whose mothers do not suckle them is polluted milk, but there are other factors which do not come far behind in importance. Insufficient nourishment is not strictly speaking a cause of diarrhoea, but it may well be a potent predisposing cause of death from this disease. Whether the food is insufficient in quantity or in nutritive power, or whether the fault lies in the inability of a child to digest what it is given, the same condition of malnutrition will result, and ill-nourished children will always succumb rapidly and in large numbers to epidemic diarrhœa. The poorer classes dilute the condensed milk they give to their infants to an extent which makes it deficient in nutritive power, and give both condensed and cows' milk in insufficient quantities and in a manner totally unsuited to the digestive capacity of their children. so that if the pollution of milk is the cause of the onset of diarrhoea, it is at least probable that a previous condition of malnutrition is as often as not responsible for a fatal termination. The diminution in the death rate from diarrhœa in the artificially fed, after the ninth month, would appear to be due to the well-nourished condition of bottle-fed children at this age. Sixty per cent. of them have been started in life with six months at the breast, and have thus acquired powers of resistance which result in the comparatively low mortality from which they suffer when they come to be fed on cows' milk of doubtful purity. Again, the mortality after the ninth month is comparatively high among the breast-fed, many of whom obtain insufficient nourishment from the milk of mothers who are not equal to the strain of nine months' lactation, but do their utmost to continue suckling their babies, in order to save the cost of cows' milk and to minimise their chances of again becoming pregnant. Out of 148 mothers visited, no less than 22 had suckled their babies for 18 85 months. The inevitable result to the child is a lowered vitality, and a liability to death from any disease to which it may fall a victim. If diarrhoea is excluded, the evil influence of artificial feeding, though less marked, is still apparent among other causes of death, whence it may be inferred that the debility of a child deprived of its mother's milk is a very real thing, and must be taken as a factor of some importance in the mortality from diarrhœa. It appears from the table that the mortality from diarrhœa amongst infants fed on condensed milk is nearly three times the average mortality in the first six months, whilst the mortality amongst those fed on cows' milk is less than twice the average. Between the sixth and ninth months, condensed milk still gives a higher mortality, but the discrepancy is less marked. The difference in the two mortalities admits of both the following explanations, one that fermentative changes in the condensed milk are more deadly than similar changes in cows' milk, and the other that children fed on condensed milk are virtually starved and consequently ready victims to fatal diarrhoea. There would seem to be little doubt that the poor of Finsbury in the greater number of cases feed their babies on condensed milk from motives of economy and of necessity. The want of money which leads them to substitute condensed milk for cows' milk, only too often compels them to give even the condensed milk in quantities which are altogether insufficient. The result of such feeding is an enfeebled constitution, which would seem to predispose to fatal diarrhœa almost as certainly as fermentative changes in the milk initiate the attack. Further evidence of the unfavourable influence of condensed milk is shown by the deaths from " other causes." Between the third and ninth months the deaths from other causes in those fed on condensed milk is twice the average number, whilst the deaths in those fed on cows' milk are, in the first age period, equal to the average, in the second period, only slightly above, and in the third age period actually below. The enfeebled constitution resulting from the use of condensed milk is the direct cause of this high 86 mortality in the case of wasting diseases, and the indirect cause of the fatal termination of other ailments less intimately connected with feeding. It would thus appear that condensed milk is the worst food for infants, that cow's milk greatly increases their liability to death, and that all artificial feeding is attended by a high mortality. Some of the excessive infantile death rate in the artifically fed may with fairness be attributed to unsound milk, but the essential cause is the deficiency in the supply of human milk for which no adequate substitute can be devised. The best and purest cow's milk, if undiluted, is an unsuitable food for infants, and even when modified with care and intelligence is no more than a makeshift in the absence of the natural milk of the mother. Thus artificially fed children will always start their life with a heavy handicap which can be lessened, hut which will never be altogether removed. If cow's milk is in its nature unsuitable for human sucklings, it can nevertheless be kept free from the added disadvantages of adulteration, delivery in dirty cans, from which it is transferred to dirty feeding bottles, and a host of other evils which can be avoided. Public opinion is awakening to the necessity of a better milk supply, and already in Paris the small milk can, with the dark secrets of its interior, has been abolished, and milk is delivered in stoppered glass bottles, whilst in Finsbury a system is on foot by which the milk supplied to infants is controlled from the time when it leaves the udder of the cow up to the moment when the baby takes it from the bottle in which the milk was originally modified to resemble human milk. Efforts are also being made to educate mothers in the proper care and feeding of their children, so that a great deal of labour is being spent in robbing the artificial feeding of infants of those dangers which can be avoided, and there is every reason to believe that the result will be to lessen the discrepancy between the mortalities of the breast-fed and artificially-fed infant populations of Finsbury. C.—PROTECTION OF FOOD SUPPLY. 89 PROTECTION OF THE FOOD SUPPLY. During the year 1904 a large amount of time and labour has been spent upon the protection of the Food Supply. This has comprised meat inspection and seizure, registration and inspection of the milkshops and dairies, the general inspection of food and fruit, and the administration of the Sale of Food and Drugs Acts. The various premises in which the preparation of food takes place, directly or indirectly, have also been inspected, including slaughter-houses, butchers' shops, cowsheds, milkshops, bakehouses, restaur ant kitchens, &c. MEAT. At the time of the formation of the Borough of Finsbury in 1900, the Extra-Corporation meat market came within its jurisdiction. This market is the second largest dead-meat market in London, the City Corporation markets adjoining it being of course the largest. In December, 1900, the Borough Council appointed a Special Meat Inspector, Inspector G. T. Billing, to take supervision of this market and of meat shops or meat and food stores generally throughout the Borough. His work requires that he shall be on duty in the market at an early hour in the morning, and at intervals he inspects food elsewhere in the Borough. Meat is also inspected in every part of the Borough by the Sanitary Inspectors, each in his own district, and on Saturday nights and Sundays the "market streets" are also regularly visited. The mode of precedure is as follows: If a salesman or owner of meat calls in the Inspector to examine suspicious meat and at once surrenders what is unfit for food, this meat is confiscated and destroyed, the Council not being liable. In cases of difficulty the Medical Officer of Health is sent for and consulted. But if the Inspector takes the first step, and on his round comes across meat or other food which is unfit for human consumption, exposed for sale, or deposited in any place for the purpose of sale or of preparation for sale, he may deem it right to "seize " the meat. In this 90 event it is thoroughly examined by the Medical Officer of Health, and if found to be diseased or unsound and therefore unfit for food, it is submitted to the presiding Magistrate at the Police Court. Permission is always granted for experts to examine the meat on behalf of the persons from whom it has been seized, and such meat lies at the Town Hall for this purpose for 24 hours after seizure. After the meat is condemned, the case in all its particulars (except the name of the person from whom it was seized and the place where it was seized, is laid before the Public Health Committee. It there is any difficulty in the case, and the person from whom it was seized wishes to lay before the Committee any extenuating or mitigating circumstances, he is permitted to see the Committee on his own responsibility. Each case is carefully considered by the Committee on its merits, and after all the circumstances have been stated, their instructions as to prosecution or otherwise are carried out. During the year under review there have been 17 prosecutions for unsound meat, fish, and fruit, as follows:— TABLE OF MEAT PROSECUTIONS, &c., 1904. Date of Trial. Name and Address. Article. Where seized and Name of Inspector. Penalty and Costs inflicted. Feb. 9 Elijah Morley, Foulmere, Royston, Cambridge Two carcases of pork, weighing 100 lbs.— diseased. These carcases were badly diseased with advanced generalised tuberculosis, the whole of the glands and also the pleura of each carcase being freely marked with tuberculous lesions. The plucks were not sent to market, but it was admitted in evidence that they were diseased, and, in fact, were buried for that reason. Both carcases were emaciated. 93, Cowcross Street, Finsbury (Inspector Billing) £20 and £5 costs. 91 Date of Trial. Name and Address. Article. Where seized and Name of Inspector. Penalty and Costs intlicted. Feb. 10 Charles Tattam, Clifton, Biggleswade, Bedfordshire. One carcase of pork and one pig's head, weighing 191 lbs.-- diseased. This carcase was badly diseased with advanced generalised tuberculosis. The whole of the glands, especially the pharyngeal, were enormously enlarged and very tubercular. The joints of the right shoulder were greatly enlarged, and had become stiffened from the effects of this disease, and the synorial membranes surrounding these joints were freely marked with tuberculous lesions. The pluck was not sent to market, but it was afterwards confiscated at Clifton by my Inspector, and found to be very tubercular. 101, Charterhouse Street, Finsbury (Inspector Billing) Six weeks' imprisonment, without the option of paying a fine. Feb. 12 Joseph Brooks, Westbury, Wells, Somersetshire Four quarters of beef and one beef head and tongue, weighing 566 lbs.— diseased. This beef was diseased with parturient fever, and was in a very bad state indeed —the flesh was almost black in colour, very sticky to the touch, full of blood, and smelt very offensively. The whole of the glands were enlarged and badly congested. It was admitted in evidence that the cow in question had died several days after calving. 109, Charterhouse Street, Finsbury (Inspector Billing) £50. Mar. 9 Samuel John Cory, Germansweek, Devonshire One carcase of mutton, weighing 42 lbs.— diseased. This was the carcase of an ewe sheep which had suffered from some wasting disease, the carcase being practically a frame and what little meat there was on it was very dropsical. 93, C o w c r o s s Street, Finsbury (Inspector Billing) £25 and 4s. costs. 92  Date of Trial. Name and Address. Article. Where seized and Name of Inspector. Penalty and Costs inflicted. Mar. 18 Joseph Bowmer, Rochdale, Lancashire Four quarters of cow beef, weighing 496 lbs.diseased. This beef was badly diseased with generalised tuberculosis ; many of the diseased parts had been removed, but patches of tubercles were present on the pleura of each forequarter, and the whole of the glands were more or less enlarged and tubercular. The beef was also badly bruised and several ribs were broken. No internal organs were sent to market. 109, Charterhouse Street, Finsbury (Inspector Billing) £21 and £21 costs. May 11 Ralph Lustig, 26 and 67, Chapel Street, Finsbury Seventeen pieces of beef, weighing 88 lbs.—unsound. This was Argentine beef, and was in a very advanced stage of decomposition, the meat was in parts green in colour and the whole of it smelt offensively. 26 and 67, Chapel Street, Finsbury (Inspector Billing) £3 and 2s. costs. May 11 Ralph Lustig, 20 and 67, Chapel Street, Finsbury Twelve pieces of beef, weighing 200 lbs —unsound. This was also Argentine beef and in a similar condition to the above. 26 and 67, Chapel Street, Finsbury (Inspector Billing) £3 and 2s. costs. June 8 John Davies, 14, Chapel Street, Finsbury One carcase and seven pieces of pork, weighing 122 lbs.—diseased. This pork was badly diseased with advanced generalised tuberculosis, the whole of the glands, especially the pharyngeal, were more or less much enlarged and very tubercular. Some of these glands were quite obvious without cutting the meat. 14, Chapel Street, Finsbuny (Inspector Billing) £13. 93 Date of Trial. Name and Address. Article. Where seized aud Name of Inspector. Penalty and Costs inflicted. June 13 John Mike Hemeter, 40, Chalk Pit Hill,Chatham, Kent A barrel of pieces of horseflesh, weighing 80 lbs.— diseased. These were small pieces of horse-flesh averaging in weight about 4 ozs. The meat had a soapy feel and a sickly smell. It was very lean and coarse in texture. What little fat there was present was very yellow and oily. The meat was very dark in colour and badly congested. There were several glands present and these were very much congested. 95, Charterhouse Street, Finsbury (In spector Billing) £50 and £5 5s. costs. The defendant in this case was arrested at Chatham on a warrant on June 11, and was brought before the magistrate on June 13, and was remanded in custody (in default of finding bail in two sureties of £100 each, and himself in £200) till June 15, when he was convicted. A summons could not be served on the defendant, although one was issued on Nov. 25, 1903, as he had left this country and did not return till June 11. July 22 Joseph Wood, 39, Chapel Street, Finsbury Forty baskets of strawberries, weighing about 400 lbs.—unsound. These strawberries were very soft, many were mouldy and all were more or less sour. At a stall in Chapel Street, Finsbury (Inspector Billing) £10 and 2s. costs. Aug. 3 Albert John Clark, 82, Chapel Street, Finsbury Thirty-six pieces of beef and 40 pieces of lamb, weighing 116 lbs.—unsound. The whole of this meat was foreign and had been frozen. It was all in an advanced stage of decomposition, the meat was in parts green in colour, and the whole of it smelt offensively. 82, Chapel Street, Finsbury (Inspector Billing) £10 and 2s. costs. Aug. 12 Ebenezer Thomas Cowell, 42, Chapel Street, Finsbury Sixty sheep's tongues - unsound. The whole of these tongues were in an advanced stage of decomposition, very soft, in parts green in colour, and smelt offensively. 4 2, Chapel Street, Finsbury (Inspector Billing) £5 and 2s. costs. 94 Date of Trial. Name and Address. Article. Where seized and Name of Inspector. Penalty and Costs inflicted. Aug. 12 Ebenezer Thomas Cowell, 42, Chapel Street, Finsbury Sixty sheeps' heads and 100 half heads -unsound. The whole of these heads were in an advanced stage of decomposition, they were in parts green in colour and the whole smelt offensively. 42, Chapel Street, Finsbury (Inspector Billingi £5 and 2s. costs. Aug. 30 Giovanni Parmigiani (Senior), 33, Warner Street, Finsbury Fifty pieces of beef, weighing 65 lbs.—nnsound. This beef was in an advanced stage of decomposition, it was in parts green in colour, and the whole of it smelt offensively. At the time of seizure this meat was being prepared for Salami sausage making. 39, Warner Street, Finsbury (Inspector Longden £10 and £2 2s. costs. Oct. 4 Thomas Blake Frost (trading as Brewster & Frost), Central Meat Market, London, E.C. Three hundred and seventytwo carcases of mutton, weighing 21,297 lbs.— unsound. These were carcases of New Zealand sheep, and the whole of them were more or less spotted with black, white and yellowish moulds both inside and outside the carcases. Several carcases were almost black with moulds. The whole of the mutton had a nasty mouldy smell of decomposition. The London and India Docks Company's Cold Air Stores, St. John Street, Finsbury (Inspector Billing) £25 and £21 costs. Nov. 8 Albert Jackson, (trading as Jackson Bros.), 28, Chapel Street, Finsbury Twenty - seven rabbits, weighing 65 lbs.—unsound. The whole of these rabbits were in an advanced stage of decomposition. All were discoloured, some being in parts quite green, and all smelt offensively. 28, Chapel Street, Finsbury (Inspector Billing) £15 and £5 costs. 95 Date of Trial. Name and Address. Article Where seized and Name of inspector. Penalty and Costs inflicted. Dec. 31 F. W. Waide & Company, Limited, Broad Yard, Turnmill Street, Finsbury Five hundred and twentyeight tins of salmon unsound. The whole of this salmon was more or less discoloured, some of the tins of salmon were of a dirty yellowish colour, some were marked with black patches, and many of the tins contained small pellets of solder. All had a stale appearance, many were quite pulpy, and all smelt more or less offensively. A very large proportion of the tins were blown and a great many appeared to have been pricked and resoldered. Samples of these tins were submitted to the Public Analyst who certified that the tins of salmon contained formalin. At a potted meat and fish factory, Broad Yard, Turnmill Street, Finsbury (Inspector Billing) Case dismissed Without costs. The learned Magistrate, in giving his decision, said he was not satisfied that the defendants did intend to use these particular tins of salmon for the purpose of preparation for sale, and the tins of salmon which had been used, although part of the same parcel, may possibly have been good. The question as regards these particular tins was not, however, before the court. It has been my practice to advise prosecution only in rases about the seriousness of which there could be no doubt whatever; that is to say, we have only taken to Court cases where the meat seized was extremely unsound or in a state of advanced disease, or cases where continued warnings had been of no avail. In other cases, where extenuating circumstances of one kind or another existed, we have been satisfied with reprimanding or warning the owner of the meat, and in that way have given him the benefit of any doubt. This policy has been adopted, not from any desire to diminish the absolute strictness of meat inspection, and, where necessary, prompt prosecution, but from a knowledge of the ordinary exigences and difficulties of the trade, especially in hot weather. 96 Of the 17 prosecutions it will be seen that only one was dismissed. [This was the last case, quoted on page 95, in which Inspector Billing, on entering a factory, found a number of tins of salmon open on a table where mixing was going on. These tins were unsound and unfit for food. They were part of a consignment of 11 cases, of 48 tins each, all of which were examined by me and found to be unsound. They were therefore all seized, and condemned by the magistrate sitting at the Clerkenwell Police Court. We left four tins behind at the owners' request, and we took four tins, also unsound, which were remaining from a previous case—sent as a sample—of the same consignment. The. other 44 tins of the sample case had been used for food. The presumption was that they also were unsound, and that the remainder of the consignment was about to be used in the same way as the sample had been used. It seemed to me that under all the circumstances the onus of proof that the same were not intended for the food of man rested with the owner (Public Health (London) Act, 1891, Sec. 47 (i).) It should be added that the whole consignment bore evidence of not being first-class goods. The tins were all unlabelled; most of them were "blown"; they had all been pricked and resoldered; they all contained a pellet of lead in the fish substance; and four which were analysed by Mr. Colwell contained the antiseptic formalin. Further, the owner admitted obtaining this consignment at a cost much below market price. I was present at the seizure, and was unable to obtain from the owners any satisfactory explanation of the presence of these tins with other salmon, which was good, on the mixing table. The position taken up by the defendant was that these tins which were seized were waiting for inspection by the head of the firm, and were, therefore, not "deposited for the purpose of sale, or of preparation for sale, and not intended for the food of man." I do not assert that this was not so; but it is my duty to state that 44 tins of this same consignment had already been used for the manufacture of the potted salmon. Further, there was ample provision in the factory for examining tinned goods elsewhere than in the mixing room, and in actual fact the owners admitted on examining the sample case that the condition of the salmon was not first class—yet it was used. The facts were placed before the Public Health Committee in due course, and the heads of the firm attended the Committee and made a long statement on their behalf None of the facts, as above stated, were disputed. The Committee, not being satisfied with the defendants' explanation, instructed a prosecution. At the trial these various facts were put in, and after a somewhat prolonged hearing, the learned magistrate (E. T. d'Eyncourt, Esq.) dismissed the case as unproved, but without costs against the Council, as, in his opinion, the case had been rightly taken. The learned magistrate expressed the view that whatever presumption there might be, and whatever carelessness was evident on the part of the firm, he was satisfied by the defendants that there was not the actual intention to use the remainder of the consignment, namely that seized, for human food.] The Table on the following page shows the amount and character of the food confiscated during 1904. About 80 per cent, of the total meat surrendered was of foreign origin (chiefly Dutch and American). Summary of Diseased and Unsound Meat, Offal, &c., confiscated during the year ending December 31st, 1904. Diseased. Sides of Beef 4 Sheep's Livers 6,441 Quarters of Beef 33 „ Lungs 317 Barrel of boneless Beef 1 „ Kidneys 2 Carcases of Mutton 3 Beef Livers 647 „ Pork 25 „ Lungs 272 Sides of Pork 6 „ Heads 28 Pieces of Pork 2 „ Tongues 15 Pork Kidneys 2 „ Hearts 5 Carcases of Veal 21 „ Kidneys 4 „ Stirks 2 „ Tripe 1 Pieces of Veal 2 Calves' Plucks 2 Pigs' Plucks 21 „ Livers 5 „ Livers 110 „ Lungs 11 „ Lungs 77 „ Kidneys 6 „ Omentums 2 Sheep's Plucks 8 „ Mesenteries 2 Carcase of Goat 1 „ Spleens 2 Tons. Cwts Qrs. Lbs. Total weight 16 14 2 0 Decomposed. Quarters of Beef 19 Cases of Pigs' Plucks 50 Pieces of Beef 203 Sheep's Fry (lbs.) 11 Barrels of boneless Beef 3 Boxes of Wet Fish 12 Cases of Beef 4 „ Dried Fish 1 „ „ Tongues 3 Tins of Salmon 528 „ „ Cheeks 2 Beef Hearts 44 Barrels of Beef Tongues 2 „ Spleens 70 Hamper of Beef Kidneys 1 „ Tripes 277 Stones of Beef Kidneys 12 „ Kidneys 20 Carcases of Mutton 373 Calves' Livers 20 Pieces of Mutton 3 „ Plucks 50 Pieces of Lamb 41 „ Hearts 8 Carcases of Pork 9 „ Feet 4 Pieces of Pork 214 „ Tongue 1 Carcases of Veal 55 „ Head 1 Piece of Veal 1 Pigs' Plucks 68 Beef Livers 1,961 „ Livers 366 „ Brains 3 „ Head 1 „ Lungs 123 „ Lungs 9 „ Tails 174 Lambs' Heads 301 „ Heads 3 Barrels of Pigs' Plucks 5 „ Tongues 133 „ „ Tongues 2 Sheep's Heads 477 „ „ Kidneys 39 „ Plucks 224 „ „ Livers 4 „ Livers 982 „ „ Trotters 1 „ Hearts 50 Tins of Spiced Beef 36 „ Lungs 50 „ Beef Brawn 15 „ Tongues 133 Case of Eggs 1 „ Kidneys 20 Turkeys 21 Cases of Rabbits 92 Cases of Turkeys 2 Rabbits 369 Boxes of Pigeons 6 Crates of mixed Offal 2 Cases of Cheese 7 Cases of Sheep's Kidneys 9 Fowls 7 Barrels of Pork Pieces 2 Cheeses 9 Sides of Bacon 7 Barrel of Oysters 1 Pieces of Bacon 4 Sacks of Peas 15 Barrels of Pork Rinds 3 Basket of Tomatoes 1 Baskets of Pigs' Chitterlings.. 35 Barrel of Apples 1 Kegs of Tripe 9 Baskets of Strawberries 80 Boxes of Tripe 7 „ Plums 7 Sausages (lbs.) 80 „ Raspberries 2 Cases of Lambs' Plucks 50 Tons. Cwts. Qrs. Lbs. Total weight (Decomposed) 60 5 1 13 Total weight (Diseased) 16 14 2 0 Grand total weight (Meat only) 76 19 3 13 98 Interim Report of the Royal Commission on Tuberculosis.—It will be remembered that in September, 1901, I reported to the Council the appointment of a Royal Commission to inquire and report with respect to tuberculosis: (1) whether the disease in animals and man is one and the same; (2) whether animals and man can be reciprocally infected with it; (3) under what conditions, if at all, the transmission of the disease from animals to man takes place, and what are the circumstances favourable or unfavourable to such transmission. The Commissioners appointed were Sir Michael Foster, K.C.B., Professor Sims Woodhead, Professor Sidney Martin, Professor John MacFadyean, and Professor Rubert Boyce. The Commissioners have now issued (under date June 1st, 1904), an interim report on their labours. The first line of enquiry upon which they entered may be stated, in their own words, as follows:— " What are the effects produced by introducing into the body of the bovine animal (calf, heifer, cow), either through the alimentary canal as food, or directly into the tissues by subcutaneous or other injection, tuberculous material of human origin—i.e., material containing living tubercle bacilli obtained from the various cases of tuberculous disease in human beings, and how far do these effects resemble or differ from the effects produced by introducing into the bovine animal, under conditions as similar as possible, tuberculous material of bovine origin—i.e., material containing living tubercle bacilli obtained from cases of tuberculous disease in the cow, calf or ox ? " We have up to the present made use in the above inquiry of more than 20 different " strains " of tuberculous material of human origin—that is to say, of material taken from more than 20 cases of tuberculous disease in human beings, including sputum from phthisical patients and the diseased parts of the lungs in pulmonary tuberculosis, mesenteric glands in primary abdominal tuberculosis, tuberculous bronchial and cervical glands, and tuberculous joints. We have compared the effects produced by these with the effects produced by several different strains of tuberculous material of bovine origin. " In the case of seven of the above strains of human origin, the introduction of the human tuberculous material into cattle gave rise 99 at once to acute tuberculosis, with the development of widespread disease in various organs of the body, such as the lungs, spleen, liver, lymphatic glands, &c. In some instances the disease was of remarkable severity. "In the case of the remaining strains, the bovine animal into which the tuberculous material was first introduced was affected to a less extent. The tuberculous disease was either limited to the spot where the material was introduced (this occurred, however, in two instances only, and these at the very beginning of our inquiry), or spread to a variable extent from the seat of inoculation along the lymphatic glands, with, at most, the appearance of a very small amount of tubercle in such organs as the lungs and spleen. Yet tuberculous material taken from the bovine animal thus affected, and introduced successively into other bovine animals, or into guineapigs from which bovine animals were subsequently inoculated, has up to the present, in the case of five of these remaining strains, ultimately given rise in the bovine animal to general tuberculosis of an intense character ; and we are still carrying out observations in this direction. "We have very carefully compared the disease thus set up in the bovine animal by material of human origin with that set up in the bovine animal by material of bovine origin, and so far we have found the one, both in its broad general features and in its finer histological details, to be identical with the other. We have so far failed to discover any character by which we could distinguish the one from the other; and our records contain accounts of the post-mortem examinations of bovine animals infected with tuberculous material of human origin which might be used as typical descriptions of ordinary bovine tuberculosis. " The results which we have thus obtained are so striking that we have felt it our duty to make them known without further delay in the present interim report." The Commissioners have deferred to a further report the narration of the details of their experiments and a number of subsidiary matters of scientific interest. But they have made this interim report because the result at which they have arrived is one of importance in practical administration. The result may be expressed in a sentence, namely, " that tuberculosis of human origin can give rise in the bovine animal to tuberculosis identical with 100 ordinary bovine tuberculosis"—that is to say, the Commission conclude that human tuberculosis and cow tuberculosis are identical, generically one and the same disease, and intercommunicable.* Since Dr. Koch's announcement in 1901, at the British Congress on Tuberculosis, there has been in some quarters a modification of the practice hitherto in vogue as to the protection of milksupplies and seizure of tuberculous meat. This Council, however, having considered the memorandum of its Medical Officer, resolved, on September 5th, 1901, to adopt the recommendation of the Public Health Committee " to continue to use all the powers at their disposal and to relax no effort whatever to protect the public against the spread of tuberculosis by milk and meat, and that the Medical Officer of Health and Inspectors do continue to act as heretofore." (Minutes of Council, April to September, 1901, p. 660). The findings of the Royal Commission, as stated above, furnish very substantial justification, if further justification were needed, for the action taken by this Council, which was, I believe, the first official decision following Dr. Koch's statement. We were also the first Local Authority to obtain a conviction and penalties in a case of seizure of tuberculous meat. From September 5th, 1901, to December 31st, 1904, the Public Health Department has had eleven cases of tuberculous meat before the Police Courts, and in every case has obtained a conviction and penalties. In two cases the • It may be desirable to add that a preliminary report by the Tuberculosis Commission, appointed by the German Imperial Health Office (Drs. Kossel, Weber and Heuss), has also been made recently. As a result of experimental work, this Commission has come to the conclusion that the bacillus of human tuberculosis can, with few exceptions, be distinguished from that of bovine tuberculosis, as, in the opinion of the Commission, the two organisms possess different characters. The Commission, however, reports that bovine tuberculosis may be produced by the human species of bacillus, and milk from tuberculous cows may set up the disease in human beings, although such infection is somewhat rare in comparison with infection from human source. The German Commission therefore agrees with the British Commission that the diseases are intercommunicable.—(Tuberkulose Arbeiten aus dem Kaiserlichen Gesundheitsamte, 1904, 1 Heft, pp. 34-35.) 101 defendants were sent to prison without the option of a fine. It has also confiscated more than seven tons of tuberculous meat. I have no doubt at all that the action of the Public Health Department in regard to tuberculosis is the main cause of the marked reduction in the amount of tuberculous meat brought into Finsbury. Unwholesome Venison.—On March 11th, Inspector Billing brought for my examination a piece of venison which, although not showing signs of putrefaction, was, in fact, not wholly satisfactory. As it seemed to be one of those cases where it is difficult, to form a precise opinion as to quality, and as such conditions of meat have before now been the cause of disease in persons consuming the meat, I thought it desirable to have a careful bacteriological examination made of it. Accordingly it was submitted to Mr. Foulerton, Director of the Bacteriological Laboratories at the Middlesex Hospital. His report is as follows :— Bacteriological Department, The Middlesex Hospital, W. Report on a sample of venison received from Dr. George Newman, Medical Officer of Health to the Metropolitan Borough of Finsbury, on 11th March, 1904. The fore-quarter of venison received had a faint smell, not, however, resembling that of putrefaction. Various plates and tubes of culture media were inoculated from portions of meat taken from the interior of the joint; and these were subsequently incubated under both ærobic and anæerobic conditions. The media incubated under anærobic conditions remained sterile; on the other media colonies of three different species of micro-organisms were obtained. These included : (a) A few colonies of a yellow sarcina. (b) A few colonies of a coccus, with a growth of white appearance; and (c) Very numerous colonies of a bacillus, corresponding in character with Bacillus enteritidis of Gaertner. Further examination showed that organisms (a) and (b), were not possessed of any actively pathogenic characters. The strain of Bacillus enteritidis thus isolated was of active virulence, and 102 rabbits were killed by small doses of it within 20 hours. Mice were also rapidly killed by the organism, guinea-pigs were less acutely affected. It was then decided to observe the effect on the joint of further hanging, which was accordingly hung in a moderately dry atmosphere until 19th April, when a further examination was made. On the latter date there was not any obvious change in the appearance of the joint, except a certain amount of shrinking up. The meat was already in a dry condition when received, and not in a state in which it would undergo putrefaction, so long as it was kept in a dry atmosphere. After this further hanging the meat was still free from any pronounced smell, nor did it present any of the appearances of putrefaction. A further bacteriological examination shewed that organisms (a) and (b), as mentioned above, had by this time died out; and a pure culture of Bacillus enteritidis was obtained on all the ærobic plates prepared from the meat. A careful examination demonstrated the absence of any sporing organisms, whether of ærobic or anærobic habit. On testing the cultures of Bacillus enteritidis obtained at this second examination, it was found that the organism retained the high degree of virulence observed in the strain isolated at the previous examination. (Signed) Alex. G. R. Foulerton, F.R.C.S., Director of the Bacteriological Laboratories at the Middlesex Hospital. 0th May, 1904. Mr. Foulerton further points out, and I entirely agree with him, that it is obvious that meat containing large quantities of this bacillus is totally unfit for human food. Bacillus enteritidis (Gaertner) is not only highly pathogenic for some of the lower animals, but it has been found as the cause of intense enteritis, followed in some eases by death, in man, and has been shown on more than one occasion to be the cause of so-called "ptomaine poisoning" and meat-borne outbreaks of illness. It is true that in the ordinary process of cooking this bacillus would probably be destroyed, but when present in such large quantities, as proved to be the case in this venison, the meat would 103 be permeated with the toxins which this bacillus is known to produce, and these toxins would not be affected by the amount of heat necessary for cooking processes. It should never be forgotten that much of the danger due to the consumption of unsound meat is owing to such toxins (or ptomaines) as the B. enteritidis and allied organisms produce. This also is the chief reason for condemning the meat of animals which have died unbled. The dangerous qualities of this meat are, therefore, unmistakeable ; and a joint of this kind would be all the more dangerous in that the dryness produced by the hanging to which venison is subjected would check, or prevent, the occurence of putrefaction, and so an important danger signal would be altogether wanting. The case is, therefore, of exceptional interest, and illustrates the importance of scrupulous care on the part of the trade to avoid exposing such meat for sale, and for the Council the importance of thorough meat inspection. Slaughter-houses.—The following are the four slaughterhouses situated in Finsbury :— 14, Penton Street. 191, Goswell Road.* 20, Amwell Street. 39, Bath Street.* These slaughter-houses have been regularly inspected. The premises are comparatively small and are not well situated. They are, however, kept clean, and the paving and drainage is good. The application to renew the license of the slaughter-house at No. 39, Bath Street was opposed by the Inspector of the County Council, owing to the fact that the only approach to the slaughterhouse was through the shop. Eventually, however, the license was granted. The application to renew the license of the slaughterhouse at No. 37, Chiswell Street was also opposed by the Inspector of the County Council, his objection being that the site and arrangement of these premises rendered them unsuitable for the purposes of a slaughter-house. The renewal of the license in this case was refused by the County Council. The slaughter-houses marked with an asterisk are licensed only to kill small cattle. 104 MILK SUPPLY. During the year we have been carrying out the proposals made in last year's report in the direction of exercising control over the milk supply. Registration.—Under the Dairies, Cowsheds and Milkshops Order, 1885, Clause 6, 15 milkshops have been registered, and six have been removed from the register. The total number of milk premises now on the register is 270. This number does not vary much from year to year. Inspection of Milk Premises—The inspectors have made periodical visits to the milkshops in their districts, numbering in all 348 visits, and have served 58 sanitary notices for defects of one kind or another. The chief inspector and I have also paid a large number of visits to these premises, particularly with a view to ascertaining how far the circular of instructions, issued at the beginning of the year, is being followed. That circular, which appeared in my report for 1903 (page 177), laid emphasis upon the importance of cleanliness of milkshop furniture and fittings, the cleansing of milk vessels, the covering of milk pans, the storage of milk, and the freedom of milk from infection. I am glad to report that in all these respects there has been marked improvement, though there is much yet to be done. Almost all milk-dealers in Finsbury now cover their milk pans, and take increased precautions as to storage. In many of the little general shops which deal in milk there is still much dirt and mismanagement, and it is to be feared that persons obtaining milk at these shops can not often receive a pure and clean article. A continual and steady enforcement of the law is, in my opinion, the effectual and equitable means of reform. Inspection of Cowsheds.—I have this year paid further attention to the cowsheds still existing in the Borough. They are as follows:— 105 No. Name of Occupier. Situation of Premises. Actual No. of Cows. Licensor No. of Cows. 1 Richards, John 4, Sermon Lane 33 51 2 Jones, Rees 1, George Street 3 12 3 James, John 27, Whiskin Street 1 20 4 Davies, John 40, Rawstorne Street 9 10 5 Timothy, David 230, St. John Street 22 30 6 Hughes, David 39, Baldwin Street 17 17 One cowshed, that at 30, Great Sutton Street, lias been closed during the year by its owner. The numbers of cows in the above table refer to the cows actually found at the last inspection, and not to the number for which the sheds are licensed. Our inspections have been of a systematic nature and have concerned cubic capacity per cow, paving of shed and yard, litter, dung storage and removal, water supply, drainage, and general sanitation. We have also inspected the cows and the methods of milking. For the most part the cows are shorthorns or their cross, and on my first inspection I found very few of the 111' cows then stalled clean and well kept. On subsequent visits, however, things had greatly improved. In August, I found at 40, Rawstome Street a red shorthorn dairy cow showing various symptoms of disease. I therefore communicated with the Veterinary Surgeon of the London County Council, with the result that the cow was at once slaughtered. It was found to be suffering from acute dysentery and localized tuberculosis. There was evidence to show that it had been wholly unfit for milking purposes for several weeks. Sampling.—Under the Sale of Food and Drugs Acts 346 samples of milk have been taken. Each Inspector samples in his own district monthly, and once a quarter takes a number of " special" samples in the evening and on Sundays at irregular hours. Forty-eight of the samples of milk taken, or 13'9 per cent., were found to be adulterated. This shows a marked reduction in percentage of adulteration. In 1903 the figure was 16'6, and in 1902,19 7. The following Table shows the results obtained during the last ten years:— 106 No of Samples Analysed. No. of Samples Adulterated. Percentage of Adulterated Samples. Added Water. Percentage of Watered Milks in Samples Analysed. Removal of Fat. Percentage of Milks with fat removed on Samples Analysed. Under 5% 5% or over. 10% or over. 15% or over. 20% or over. Under 5% 5% or over. 10% or over. 15% or over. 20% or over. 1895 121 36 29.7 3 10 4 6 2 20.7 l 1 2 — 7 9.0 1896 235 74 31.5 8 23 9 7 6 22.6 — 6 3 5 7 8.9 1897 187 46 24.6 4 14 11 5 2 19.3 — 2 2 4 2 5.3 1898 197 42 21.3 2 14 14 3 1 17.3 — 1 4 1 2 4.0 1899 205 55 26.8 9 16 9 4 6 21.5 — 2 2 6 1 5.3 1900 228 36 15.8 5 12 6 4 2 12.8 — — 4 1 2 3.0 1901 251 56 22.3 17 13 2 3 2 14.7 2 7 4 3 3 7.6 1902 269 53 19.7 15 15 3 2 3 14.2 2 6 3 2 2 5.5 1903 348 58 16.7 19 20 6 1 1 13.5 3 5 3 — — 3.2 1904 346 48* 13.9 14 4 2 1 1 6.0 2 8 6 2 2 5.5 * This figure includes 6 samples of milk which were adulterated with preservatives. 107 This table is based upon an examination of the milk of all milksellers in the Borough, without any exception. Occasionally, by arrangement or by accident, some vendors are sampled twice or thrice in the year, and others, perhaps, only once. But the methods adopted are such as work automatically and cover the whole trade, the large dealer and the small dealer, without partiality.¤ ¤During the existence of the Borough Council (1901-1904) there have been prosecutions for milk adulterations resulting in convictions and penalties as follows:— MILK. Year. No. of Convictions. Fines amounting to. Costs amounting to. 1901 32 £44 17 6 £17 12 6 1902 23 £33 5 0 £33 7 0 1903 26 £68 0 0 £22 8 0 1904 20 £40 0 0 £16 4 0 Totals for the 4 years 101 £186 2 6 £89 11 6 Total for Fines and Costs = £275 14s. Oct. 108 The Annual Report of the Local Government Hoard for 1903—1904 gives the returns for London, as follows:— Metropolitan Borough. No. of milks examined. No. found to be adulterated. Percentage of adulterations. St. Pancras 257 79 30.7 Hackney 343 100 29.1 Shoreditch 344 84 24.4 Stepney 626 144 23.0 Finsbury 354 64 18.1 Wandsworth 376 65 17.3 Lewisham 278 48 17.2 Westminster, City 690 99 14.3 Fulham 169 24 14.2 Loudon as a whole 9475 1276 13.5 Southwark 1109 147 13.2 Poplar 140 18 12.8 London, City 518 60 11.6 Bethnal Green 327 37 11.3 Battersea 217 23 10.6 Holborn 308 32 10.3 Lambeth 494 51 10.3 Camberwell 337 34 10.0 Islington 508 50 9.8 Stoke Newiugton 56 5 8.9 Bermondsey 390 34 8.7 Paddington 250 21 8.4 Woolwich 405 24 5.9 Hammersmith 139 8 5.7 Kensington 193 11 5.7 Hampstead 95 4 4.2 Greenwich 82 3 3.6 Deptford 139 4 2.8 Chelsea 103 1 0.9 St. Marylebone 228 2 0.9 There can be on question that more adulteration goes on in Finsbury than in many other London districts. A high return, as an exception, might bear another interpretation, but a continuously high return over 10 years is a fairly reliable indication. The comparative figures for 1903 (the most recent obtainable) work out as follows:— 109 Percentage of Milk Adulteration. Borough of Finsbury 18.1 London 13.5 Twenty largest towns of England and Wales 10.7 The rest of England and Wales 8.5 The percentages of adulteration for every five years since 1877 for England and Wales may also be added for comparative purposes:— MILK No. of Samples in 1903. Percentage of Adulteration in 1903. 1902. Quinquennium. Examined Found Adulterated 1897-01. 1892-96. 1887-91. 1882-86. 1877-81. 33,090 3,430 104 11.6 10.6 12.3 13.2 16.7 21.1 An examination of the table of results of analysis will show that much the most common adulteration is that of added water. It is, of course, the easiest to manage, and appears to the offender a less formidable undertaking than absolutely "tampering" with the milk. SALE OF FOOD & DRUGS ACTS. Under the Bye-laws of the Borough Council, each Sanitary Inspector acts, in his own sanitary district, as an Inspector under the above Acts. During the year 1904 the Inspectors collected 610 samples, of which 73 (or 11.9 per cent.) were adulterated. There were 29 prosecutions under the Acts, the aggregate amount of fines and costs inflicted being £82 3s. 6d. In 1903, 14.1 per cent, of the samples were found to be adulterated, and there were 46 prosecutions. 110 The samples collected were as follows:— Samples taken. Adulterated. Samples taken. Adulterated. Milk 346 480 Lard 11 ... Butter 120 13 Dripping 2 ... Cheese 11 ... Margarine 2 ... Cocoa 3 ... German Sausage 1 ... Coffee 15 3 Sausages 4 2 Coffee and Chicory 5 ... Cod Liver Oil 3 ... Mustard 32 1 Purified Cream of Tarter 2 ... Pepper 20 ... Brandy 6 5 Demerara Sugar 9 1 Whiskey 4 ... Sugar 7 ... 610 73 Baking Powder 1 ... Ground Ginger 6 ... RESTAURANTS, EATING-HOUSES, ETC. The annual inspection of these premises took place during the summer. There is a total of 230 such places in which about 400 men and 600 women are occupied in the preparation of food. These figures do not include waiters and waitresses, but only persons actually engaged in the preparation of food. In some cases such employees live on the premises, By the courtesy of proprietors I am able to say that the number of persons using restaurants in Finsbury daily is at least 60,000. In 1902 it was found necessary to take action for the remedy of sanitary defects in 150 instances (out of 220) which showed that 68 per cent. of all these places were defective in one way or another. In 1903 it was necessary to serve 137 sanitary notices *This figure, as in Table on page 106 includes six cases of milk adulterated with preservatives. 111 (out of 232 premises), which gives a percentage of 59 as being sanitarily defective. This year it has been necessary to serve 94 notices (out of 230 premises) which gives a percentage of 40.8. This would appear to show some improvement, but it is evident that continuance of strict supervision is necessary. The chief defects were dirty floors, walls and ceilings, some of them extremely so; unclean yards or areas where food was being prepared ; a number of premises without proper or sufficient dustbin accommodation ; and a number also in which the sanitary conveniences were either quite insufficient or defective. In a certain number of cases infringement of the Bye-laws were met with in respect to the regulation that no sanitary convenience shall communicate directly with a room in which food is prepared. Whilst it may be said that many of the proprietors of these establishments conduct their business in a suitable manner and wholly within the meaning of the law, the same cannot be said of all. Some of the kitchens and cellars were in a bad condition, and food prepared in them could not but be open to grave criticism. Sweetmeat Makers.—We have in Finsbury eleven manufacturers or makers of sweetmeats. One or two of these are large firms with extensive premises, whose produce has a world-wide market. Seven or eight of them, on the other hand, are in a small way of business, and naturally require more supervision from us. They supply local shops. In one of the Central Districts of Finsbury there are some 60 shops selling sweetmeats, but in only three cases do the vendors actually make sweets. These workplaces have been carefully inspected, and various recommendations made for the protection of the produce from contamination. Food Stalls.— In Chapel Street, Exmouth Street and Whitecross Street there is carried on a considerable food trade from stalls. These are periodically inspected at irregular periods every week, including Sundays and Saturday nights. A number of seizures or confiscations of diseased or unsound food have been made during 1904, and in some cases prosecution has followed. One of the most difficult foods to inspect is shell-fish, and from 112 time to time information reaches the Department of illness attributed to the consumption of shell-fish. A number of enquiries have been made in such cases, and sometimes apparently clear evidence is forthcoming incriminating the shell-fish. These are generally obtained from Billingsgate or some near sea-side town. In some cases undoubtedly shell-fish fattened at sewage outfalls become contaminated and poisonous. In other (rases the contamination is derived from their storage. Hawkers and stall-holders frequently keep their little stock of shell-fish in dirty buckets in dirty yards, and in this way it is possible that they may become polluted. ICE-CREAM. The sale of ice-cream as carried on from barrows in London streets is largely in the hands of Italians, and the cream is for the most part made upon the premises where the barrow men live. In London there are, according to the Census (1901) Italians to the number of 10,889. Of this total 1,065 live in the Borough of Finsbury. In 1903 we found, as a result of enquiry, that about 1,400 Italians live in Finsbury. Most of these persons reside in what is called the "Italian Quarter," and many of them are engaged in the manufacture of ice-cream. During 1904 the system of registration adopted in 1901 has been followed out. At the end of 1903 there were 101 registered premises in which this trade was carried on ; during 1904 one has been removed, so that there are now 100 on the register. On November 1st, 1903, the ice-cream clauses of the London County Council (General Powers) Act, 1902, Part VIII., Sections 42-45, came into force, giving this Council powers to enforce the following requirements :— (a) Ice-cream must be made and stored in sanitary premises, (b) It must not be made or stored in living rooms. (c) Strict precautions must be taken as to protection from con- tamination, (d) Cases of infectious disease must be reported. (e) The name and address of the maker must appear on street barrows. During the year these regulations have been enforced, 206 visits of inspection having been made by the inspectors, and 48 intimation and statutory notices served for nuisances, &c. 113 With regard to Clause (e), it has been necessary to institute proceedings against five Italians for failing to have their barrows marked with the name and address of the maker. Convictions were obtained in four cases, the fifth summons being adjourned sine die as the defendant had returned to Italy. The manufacture of ice-cream in Finsbury was fully dealt with in my Annual Report for 1902, pages 109-115. WATER SUPPLY. The water supply of the Borough is derived from the New River Company. According to the official water examinations, made under the Metropolis Water Act, 1871, the quality of the water is excellent. Taking the mean of the 12 months (monthly bacterial examinations), the New River unfiltered water contained 360 bacteria per c.c. and the filtered water, as delivered, contained only 10. This is the purest water, from a bacterial point of view, in London. An examination of the Tables of the average composition, chemical and bacteriological, of the London Water Supply proves that the quality, as a whole, is excellent, and that the high standard of previous years was well maintained during 1904. The wells existing in the Borough, which are still used, are as follows:— 1. Richmond Street (No, 25).—This is an artesian well, about 400 feet deep. The water is used for the purpose of supplying a gas engine only. The domestic supply is derived from the New River Company. 2. Bunhill Row (No. 125).—This place is used by a firm of engineers and artesian well borers. They have an artesian well about 450 feet deep, and use the water for all purposes, not having any other supply. 3. Cowper Street (Nos. 7 and 8).—There is a well here which is dug for a depth of about 80 feet, and then bored for a depth of another 60 feet. The water is not used for drinking purposes under ordinary circumstances, but sometimes in the summer those employed on the premises are likely to take a drink of the well water. It is ordinarily used for the machinery only. 114 4. City Road (Messrs. Lipton).—The firm using these premises has an artesian well in their cocoa factory about 300 feet deep, the water from which is used for all purposes. They have a supply laid on from the New River Company as reserve. 5. City Road (No. 102).—There is an artesian well at these premises which is 370 feet deep ; the water is used for all purposes, and there is also a supply from the New River Company. 6. Old Street (Bovril, Limited).—This firm has an artesian well 400 feet deep. The water is used for all purposes. On being analysed the water was found satisfactory. 7. Bunhill Row (Messrs De La Rue & Co.).—An artesian well has been bored recently on premises known as the "Crown Works." The depth of the well is 450 feet, and the water is used for all purposes. There is also a New River supply. 8. Bunhill Row (No. 52—Messrs. William List & Co.).—This firm has three wells on its premises, two about 80 feet each, and one about 350 feet deep. On analysis the water was found to be good, but it is only used for manufacturing purposes. There is also a New River supply. 9. Finsbury Square (13, 14, 15 and 16—Royal London Friendly Society).-—These premises, recently rebuilt, and used as offices, &c., are supplied with water obtained from an artesian well 480 feet deep, which is used for all purposes. When analysed the water was found to be satisfactory. There is no supply from the New River Company. 10. Chiswell Street (Whitbread & Co.).—This firm derives part of its water supply from two wells, one about 150 feet deep and the other 180 feet deep. The water is used for all purposes. There is also a New River supply. The well waters are frequently analysed and have been found satisfactory. 115 INFANTS' MILK DEPOT. During the year I was instructed by the Council to draw up a report supplementary to my report on The Milk Supply of Finsbury (published 1903), as to the Infants' Milk Depot at Battersea, and on infant milk supply generally. That report will be found in the Minutes of the Council, year ending March, 1905, pp. 20-24. As I have pointed out elsewhere, there is a two-fold problem in respect of the milk supply. First, the supply of a naturally pure whole milk for all consumers; secondly, the supply of a modified and, if necessary, sterilised milk for infants. The first question is dealt with in The Milk Supply of Finsbury (1903), and need not be further considered here. The second question is one of supplying a modified milk as a substitute food for infants containing the essential constituents of breast milk, viz., fat, albuminoids and milk sugar, combined in such proportions as will suit the requirements of each individual infant, and free from injurious and other bacteria and their toxins. Now infantile mortality has a definite relationship to (a) the feeding of infants, (b) personal care of infants by parents, (c) housing accommodation, and (d) certain meteorological conditions affecting temperature and the dissemination of dust. Other elements enter into the problem, but, so far as municipal action is concerned, those are the four main elements. If we can succeed in raising the quality, as regards purity, of the milk on which infants are fed, we shall at the same time educate and improve the sense of duty towards their infants on the part of parents. The mischief lies in polluted milk. The sources of the pollution are not only in unsatisfactory methods of milking, and in storing and conveying the milk supplied, but also in dirty domestic conditions, and particularly in carelessness in the use of feeding bottles. Successfully to attack, by municipal administration, all the sources of pollution is at present impossible, but the ideal of public health administration in respect of the artificial feeding of infants is a pure milk supply which needs no sterilisation ; and towards that end all our efforts should be directed. Modification of such cow's milk for infant use will still be necessary. Meanwhile 116 we must do the best possible under existing conditions, and that involves sterilisation, modification, and protection from home contamination. It is also essential that such a milk supply should be under medical supervision and adopted only in suitable cases. Without entering into unnecessary details, it would appear that there are five possible means of supplying a suitable and pure milk for infants—(1) By means of Municipal Milk Depots as at Battersea, Liverpool and other places; (2) By one or more milk vendors or dairymen undertaking, by private enterprise, to furnish such modified milk (certified) under medical supervision; (3) By obtaining such a supply from some central institution, company, or society, such, for example, as the Walker-Gordon Laboratory; (4) By means of medical milk commissions, as is done, in part, by the milk commissions established in the United States of America; (5) By means of a voluntary health society supplying such milk under necessary supervision and control of sources and usage, as is done, in part, by the York Health and Housing Association. The essential points requiring attention are (1) such modification of the cow's milk as will make it, like human milk, suitable for infant consumption, (2) absolute control of its source and handling prior to its modification, and (3) prevention of home contamination by delivery in sealed bottles. At present it would also be necessary, frequently if not generally, to pasteurise or sterilise such milk. In this connection it is my duty to report that the Social Workers' Association of the Borough of Finsbury (established 1904), appointed a Voluntary Health Committee during the year to carry out various work in the Borough. Amongst other work this Committee arranged for a series of lectures on Public Health questions, to which reference is subsequently made. The Committee also arranged for the establishment of a Modified Milk Depot,¤ to be managed after the manner of Budin and Dufour in France. *The management was placed in the hands of a Medical Committee, consisting of Evan Jones, M.R.C.S, D.P.H. (Chairman), E. N. Féré, M.D., Lewis Hawkes, M.D., W. F. Roe, L.R.C.S.I., J. E. Sandilands, M.D., F. Wallace Wilson, M.R.C.S., and George Newman, M.D. (Hon. Sec.). 117 The Committee supervised all the details of arrangement for the Depôt and execution of the same, and it is desirable to incorporate in the present report the main facts concerning the methods adopted. Preparation of the Milk.—By the kind offices of J. Carson, Esq., of Theydon Bois, the milk used at the Depôt is obtained from his farm in Essex and modified according to our prescription at the farm immediately after milking. The Committee at the outset decided first, that it is of primary importance that the milk itself should be absolutely pure before modification, and secondly, that any modification should be carried out immediately after milking and at the farm. We feel strongly that clean and healthy methods of dairying are of vital importance, and that it is undesirable to use milk at an Infants' Depôt which is either unclean or has been long on the railway before treatment. The Committee therefore feel that one of the essential requirements is proper dairying. The cows used by Mr. Carson, which consist of a herd of about 60, are carefully selected for milking purposes, are regularly inspected, and have all passed the tuberculin test. Their feeding ' also is kept under strict control, no brewers' grains being used. In summer the cows feed on grass, linseed oil cake, and a small quantity of cotton seed cake and bran ; in winter they have hay, mangolds, maize, germ meal, and linseed and cotton seed cake. The farm is extremely well kept, and maintained under strict sanitary control, the health and cleanliness of the cows being the one thing aimed at. Probably the conditions obtaining at the farm are unsurpassed in England for excellence. The cows are milked in the byre adjoining the sterilising plant. Both cowsheds and cows are continually maintained in cleanliness, the former being large, light and well ventilated. The floors are concreted. The udders of the cows are cleaned before milking, and it is required that milkers also shall be clean in person and management of milking. Clean white overalls are used by the men. All utensils, cans, churns, &c., are kept scrupulously clean and are sterilised regularly by steam. Immediately after milking, 118 the milk is removed into an adjoining room, strained through a metal screen, cooled over a Lawrence refrigerator, and at once separated by an ordinary Laval separator, which acts in part as a method of purifying milk. The separated milk is then at once modified as described below, and poured by means of a mechanical automatic bottle-filler into bottles. The milk in bottles is then, within a few minutes of leaving the udder, placed in the steriliser and maintained at 140 °F. for twenty minutes. The bottles have been previously sterilised at 220 °F. for sixty minutes. After pasteurisation the milk is cooled to 53 °F., and kept at that temperature until ready for packing into wooden travelling cases (holding one hundred bottles each), for transmission to the Distributing DepOt at 264, Goswell Road, Finsbury. It may be added here that it is not intended to continue sterilisation or pasteurisation of the milk if it is found in practice that no heating at all is required. The ideal is to provide a pure modified unsterilised milk, and we are now conducting investigations with a view of determining if any sterilisation at all is necessary. Modification of the Milk.—The Medical Committee, with the assistance of Mr. J. Kear Colwell, F.I.C., Public Analyst, carefully considered the subject of standards of modification, and finally decided to commence with the three following degrees:— A.—One part milk, two parts water + 8 ozs. cream + 7 ozs. milk sugar to the gallon. B.—One part milk, one part water +11 ozs. cream + 5 ozs. milk sugar to the gallon. C.—Two parts milk, one part water + 12 ozs. cream + 5 ozs. milk sugar to the gallon. Various degrees of modification were made with the average milk supplied by Mr. Carson's herd, and the above were found on analysis to yield desirable milks, and approximately comparable to human milk :— 119 Human Milk. Modification A. Modification B. Modification C. Total Solids 12.50 9.53 11.05 12.49 Fat 3.70 2.51 3.28 3.86 Proteids 2.30 1.24 1.91 2.48 Lactose 6.20 5.49 5.45 5.56 Ash 0.30 0.29 0.41 0.59 These three modifications are used as follows:— Standard of Modification. Age of Infant No. of Bottles, per day. Amount per bottle. Amount per day. A Under i month old 9 2 18 oz. 1—2 months old 9 3 27 oz. 2—3 months old 8 4 32 oz. B 3—6 months old 7 5 35 oz. C 6—9 months old 6 6 36 oz. 9—12 months old 6 7 42 oz. Variations in quantity are made from time to time, and the modification is not applied in any hard and fast manner. The particular milk for each child, whatever its age, is carefully considered after the first medical examination. Measured bottles are used with a removable stopper, which comes clear away from the bottle. When required for use the bottle is placed in a jug of hot water to bring the temperature of the milk up to blood heat. The stopper is then removed and a clean teat placed on the bottle—from which the child can then be fed. Each day a thoroughly clean and sterile teat is issued in place of the teat, provided the day before, which is returned to the Depôt, washed in warm boracic lotion, soaked all night in boracic lotion, and in the 120 morning washed under the tap. It is then again ready for use. Other instructions will be found on the leaflet printed below. Method of Working Depôt.—The objects of the Depôt are, broadly speaking, two. First, the provision of suitably modified milk, sterilised or otherwise, in bottles containing "one feed," for infants who cannot be breast-fed. Secondly, the practical illustration for, and instruction of, mothers in the rearing of infants. The Depot is intended to be both a remedy and a school—a remedy by supplying suitable nourishment to infants debarred from natural mother's milk and, where necessary, a school of infant management. It is not a milkshop where any person can obtain milk, and there is no desire or intention in any way to injure or affect the milk trade in Finsbury. It is a specialised milk supply, for special circumstances which cannot be met by the trade. The Depôt was established primarily for infants of the poor, but the Medical Committee would be prepared to consider any cases introduced by medical men, or any cases in which the infant is requiring the milk. These principles have been borne in mind in arranging the method of procedure. Mothers desiring to use this milk must apply to the Depôt (applications are received daily at noon). They must be prepared to pay the necessary fee and must be residents of Finsbury. If they cannot pay the fee they must bring a recommendation form from the Clerk to the Board of Guardians. On the Wednesday following the date of application the infant is brought to the Depôt and medically examined. A number of particulars are entered in a record book by the two members of the Medical Committee who are present, including the address and occupation of parents, physical condition of infant, in addition to weight and length, and the milk which it is decided shall be supplied. Instructions are given to the mother respecting the mode of feeding and any precautions to be taken. The milk is called for daily at noon and distributed in wire baskets. The following leaflet is supplied :— 121 Social Workers' Association for the Borough of Finsbury. INFANTS' MILK DEPÔT. Depôt 264, Goswell Road, E.C. 1 All charges for a supply of Modified Milk are payable in advance:— Per day. Per week. For infants under 6 months 3d. 1/6 „ „ from 6 to 8 months 3½d. 1/9 6 oz. bottles. „ „ over 8 months 4d. 2/- 7 oz. bottles. The Depot is open from 12 to 1 p.m. on weekdays, and from 12.30 to 1.30 p.m. on Sundays. 2. The milk will be supplied in bottles in a basket. Each bottle contains sufficient milk for one meal, the amount varying with the age of the child. Infants under two months receive nine bottles per day ; older children receive fewer bottles, as they should be fed less frequently. 3. If children are sent for the milk, they must be warned not to tamper with the stoppers of the bottles. On no account must a bottle be opened until the infant is ready to be fed. 4. Teats can be bought for 2d. each. The teats must be kept scrupulously clban ; after use, they should be thoroughly washed in soda and hot water, then rinsed in cold water, and afterwards placed in a jar of clean cold water, where they should be kept until required for the next feed. The teat must be returned each day with the empty bottles. 5. Just before use each bottle should be placed unopened in a basin or jug of hot water for about five minutes, and warmed. The bottle should then be opened and the teat put on. The child must be fed at regular intervals, and fed from these bottles only. On no account should any other feeding bottle be used. 6. When all the milk in one bottle is not used, the remainder must not be warmed up again, but a fresh bottle opened for the next meal. 7. On no account should bread or other food be given with the milk. The milk will be found to be quite sufficient if given regularly. 8. Immediately after use, the bottle should be well rinsed in cold water. 9. Full value will be charged for all bottles, baskets, stoppers, &c., not returned to the Depot. 10. The child must be brought once a fortnight to be weighed, on Wednesdays at 2.30 p.m. 122 11. The presence of infectious disease (including whooping cough, measles and chicken-pox) in a house must be at once notified at the Depôt 12. Names of applicants for the milk will be received at the Depôt daily at 12 noon. N.B.— The milk must never be used in preference to mothers' milk, which is the best of all foods for young infants. The Medical Committee were fortunate in securing the voluntary services of Miss Elliott as Lady Manager of the Depôt, and she instructs the mothers as to points needing their attention, and, either herself or with her colleagues, arranges periodical visits to each home represented, in order to see that, as far as possible, the instructions of the Committee are carried out. Particulars as to the sanitary condition of the house or tenement occupied are furnished through the Public Health Department, and a number of special facts bearing on the social life of the child are obtained in due course by the lady visitors. The child is brought once a fortnight to the Depôt to be examined and weighed. The Depôt was opened on Nov. 23rd with four children. At the end of the year there were 15 on the books in daily receipt of the milk. Nearly all these infants have thrived on the milk and have increased in weight. It would have been possible to have taken many more children, but owing to unavoidable circumstances we had not sufficient bottle-stoppers of the kind desired, and only by the kindness of Dr. McCleary, of Battersea, and Mr. Seebohm Rowntree, of York, who lent us a large number of stoppers, were we able to proceed at the outset. It is not the intention of the Committee to undertake to supply more than 50 children at present. The advantages of the system as adopted in Finsbury may be said to be in the main the following :— 1. The Depot is carried on by a voluntary society and not out of the municipal rates. Whether it is wise or equitable to carry on such a Depôt out of the rates is not here discussed, 123 but it is submitted that, at all events during the experimental stage, it is better to advance at present on the basis of a voluntary society. 2. The milk is obtained under healthy and satisfactory ditions, and is immediately modified on the farm. No time is lost between milking and treatment of the milk as is inevitable if the milk be sent by rail to London before treatment. The serious fallacy of "sterilising" unclean milk is wholly avoided. The milk is from a Jersey herd of healthy, clean, tubercle-free cows, and the milking operations are all under control. The milk also is examined periodically, both bacteriologically and chemically, and its cleanliness ensured. 3. The management of the Depôt is under strictly medical supervision. The milk is not used indiscriminately, or supplied to casual customers, but only on medical advice after examination of the child. 4. A record is kept of each child and its progress or otherwise definitely ascertained and recorded. Each child is examined and weighed fortnightly, and is regularly visited at home. 5. The method is individualised and the responsibility of the mother is not removed. Indeed, great care is taken to see that the mother understands how much she has to do if she would rear a healthy child. The Depôt does not act in any way as a "foster-mother," and does not supply any milk if the child can be breast-fed. D.—HOUSE PROPERTY AND OVERCROWDING. 127 THE HOUSING QUESTION. The housing policy of the Finsbury Borough Council was stated in my repôrt for 1901. Only certain portions of that policy come within the duties of the Public Health Department, and these have received attention during the year. Briefly, they are three. First, the improvement of insanitary areas and houses. Secondly, the keeping of a register of all persons displaced. Thirdly, the enforcement of the Public Health (London) Act, in respect to house property and overcrowding. In previous reports I have discussed in some detail the general position of the housing question in Finsbury and the necessary steps that should be taken. The past year has been occupied in continuing to take these steps. I propose to deal strictly with the above-mentioned points of insanitary areas and the maintenance of sanitation in house property. A register is being kept of persons displaced in any houses closed on account of Borough Council action. For convenience this section dealing with the Housing Question will be sub-divided under three main headings. In the first place the insanitary areas under the London County Council will be considered; then the smaller insanitary areas receiving the attention of this Department; and thirdly, the general question of the maintenance of sanitation in house property and the reduction of overcrowding. The particulars which follow, respecting the areas now being dealt with by the London County Council, bring the facts of the case up to date. These facts are printed here for purposes of reference, and because of their importance. They show in a very clear manner the steady degeneration of property in the areas during the process of reform, and furnish many illustrations of the difficulties of housing work in Finsbury, and the causes of the overcrowding in some parts of the Borough. 128 I—INSANITARY AREAS IN FINSBURY, UNDER THE LONDON COUNTY COUNCIL. (Part I of the Housing Act.) In my Report for 1902 (see pp. 126-140), a detailed statement will be found respecting these areas, and it will only be necessary this year to report the present condition and the changes which have taken place during the last twelve months. The areas form two schemes, namely, the Aylesbury Place Area Scheme and the Garden Row Area Scheme. The latter includes four small areas designated Garden Row, Roby Street, Baltic Street, and Honduras Street. The representations were made in respect of Aylesbury Place Area in 1897, the inquiry was held in 1900, and closures commenced in that year. The representation was made in respect of the Garden Row Areas in 1899, the inquiry was held in 1900, and closures commenced in 1901. The state of affairs existent at the time of condemnation may be set forth as follows:— Five Years, 1895—1899. Houses. Population. Death Rate per 1,000. Deaths of Children under 5 years. Percentage on Total Deaths. Aylesbury Place Area 73 511 36.4 - Garden Row 69 407 42.2 55 Roby Street 50 218 32.5 53 Baltic Street 55 351 42.1 44 Honduras Street 17 217 40.5 35 Averages and Totals of Garden Row Area 191 1193 39.3 46 The present position of these areas and the recent changes in them may be set out briefly under several sub-headings, and the first will concern the houses on the areas:— (i) Houses on the Areas.—The history of the matter as regards houses may be set out in the following way:— 129 The Insanitary Areas in Finsbury under the London County Council. (Housing of the Working Classes Act, 1890. Part I.) Area. Date of Representation. Date of Enquiry. No. of Houses at time of Scheme. No. of Population at time of Scheme. No. of Dwelling Houses Closed in each year. Present position. 1900. 1901. 1902. 1903. 1904. Total No. Closed No. of Houses still Standing. No. of Dwelling houses Closed or Empty, but not demolished. No. of Houses Demolished. Approximate population now resident. Approximate population displaced from beginning of Scheme to the present time. Aylesbury Place Dec. 1897 Mar., 1900 73 511 1 3 2 16 22 52¤ 62 41 11 93 418 Garden Row July, 1899 „ 69 407 - 1 17 23 7 48 69 48 Nil 159 248 Roby Street „ „ 50 218 - - 30 7 — 37 Nil - 50 Nil 218 Baltic Street „ „ 55 351 - - 13 16 11 40 52 37 3 77 274 Honduras Street „ „ 17 217 - - - 1 1 2 16 2 Nil 114 103 Totals ... ... 264 1704 1 4 62 63 41 179 199 128 64 443 1261 ¤ Eight houses in this area were closed before 1900. 130 The closures have, it will he seen, taken place chiefly in 1902 1903 and 1904. As regards distribution they are as follow: [In square brackets have been placed the number of houses in each street or court occupied at the end of 1904.] Aylesbury Place Area.-Aylesbury Place, 20 [9]; Aylesbury Street, 6 [0]; Bishop's Court, 10 [2]; Jerusalem Passage. 0 [6]; St. John's Square, 2 [0] ; Jerusalem Court, 14 [1], Total closures—5 2. Garden Row Area.—Garden Row, 15 [8]; Clarence Place, 11 [1] ; Clarence Street, 1 [3] ; Europia Place, 6[2] ; Central Street, 5 [2] ; Lever Street, 10 [5], Total closures—48. Roby Street Area. —[Cleared.] Baltic Street Area.—Baltic Street, 12 [4]; Middle Row, 5, [3]; Baltic Place, 3 [1] ; Baltic Court, 7 [1] ; New Court, 7 [0] ; Thomas Place, 4 [1] ; Hatfield Street, 2 [2], Total closures—40. Honduras Street Area.—Honduras Street, 1 [8]; Baltic Street, 1 [2] ; Golden Lane. 0 [4], Total closures—2. The decline in houses step by step is seen in the following table:— Dwelling-Houses Occupied at end of each Year. 1899. 1900. 1901. 1902. 1903. 1904. Aylesbury Place 70 61 58 56 40 18 Garden Row 69 69 69 51 28 21 Roby Street 37 37 37 7 — — Baltic Street 52 52 52 39 23 12 Honduras Street 16 16 16 16 15 14 244 235 232 169 106 65 131 In addition to (dosed houses, there are upon the areas from time to time several houses empty temporarily. " Closure should be understood to mean that the house is boarded up or locked by the County Council. (ii) Population on the Areas—The total population on the five areas in 1899 was 1,704. At the end of 1902 it was 1,352, and at the end of 1903 it was 759, and now it is 443. The approximate changes are set out in the following table. The figures for 1899, 1902, 1903 and 1904 are correct, and the result of actual enumeration of persons on the area at those dates, but the figures for 1900 and 1901 are estimated :— Areas. Population on Areas 1899. 1900. 1901. 1902. 1903. 1904. Aylesbury Place 511 480 470 464 213 93 Garden Row 407 407 407 344 179 159 Roby Street 218 218 218 44 — — Baltic Street 351 351 351 285 174 77 Honduras Street 217 217 217 215 193 114 Total 1,704 1,673 1,663 1,352 759 443 It appears that during 1904, 316 persons have left these areas for one cause or another:— Aylesbury Place Area. Garden Row Area. Roby Street Area Baltic Street Area. Honduras Street Area. Total. No. of persons displaced in 1904. 120 20 - 97 79 316 132 (iii) Deaths on the Areas.—The four clear calendar years following the schemes for these five areas were 1901, 1902 1903 and 1904. During these four years 167 deaths occurred on the areas. The deaths and death-rates (calculated on the changing population), are set out as follows:— 1901. 1902. 1903. 1904. Areas. No. of Deaths. Death Rates. No. of Deaths. Death Rates. No. of Deaths Death Rates. No. of Deaths Death Rates. Aylesbury Place 19 40.3 21 45.2 4 18.8 8 86.0 Garden How 10 24.5 13 37.8 9 50.3 5 31.5 Roby Street 8 36.7 3 68.1 — — — — Baltic Street . 11 34.9 13 45.6 18 103.4 4 51.9 Honduras Street 4 18.4 6 27.9 5 25.9 5 43.9 Totals 52 31.2 56 41.4 36 47.4 23¤ 51.9 Boro of Finsbury 2,161 21.3 2,283 22.7 1,993 19.8 2,084 21.1 This table of death-rates is accurate, but too much emphasis should not be placed upon the figures as they are necessarily drawn up for small areas, and whilst of comparative value in relation to each other, are of little value in relation to the death rates for the Borough. (iv) Insanitation on the Areas.—The five areas were, of course, condemned on the ground of insanitation, ill-construction, &c. I have to report that since March, 1900, matters have not improved. Indeed, as would be expected, the reverse has happened. There are a large number of defects and nuisances now existing on each of the areas, except the Roby Street area. Many of the houses are dirty and verminous in a high degree. Since March, 1900, the date of the enquiries, a large number ¤ One of these deaths occurred in a person removed some months ago from the Roby Street area. This was the case of a woman, aged 69, who died from Chronic Bronchitis. 133 of sanitary works have been carried out, and the areas have necessitated constant supervision and extra inspection during the last four years. (v) Closure and Demolition of Dwelling Houses.— Subsequently to the carrying out of the requirements of the law under Part I. of the Housing of the Working Classes Act, 1890, the London County Council is occupied in executing the Scheme. The three steps are (a) acquisition of property, (b) closure of houses, (c) demolition of houses, and the following Table sets out the history of these proceedings :— Areas. No. of Condemned Houses occupied at end at 1900. 1901. 1902. 1903. 1904. Houses acquired. Houses closed. Houses* demolished. Houses acquired. Houses closed. Houses demolished. Houses acquired. Houses closed. Houses demolished. Houses acquired. Houses closed. Houses demolished. Aylesbury Place 61 ... 3 ... 16 2 ... 5 16 ... 49 22 11 Garden Row 69 1 1 ... 35 17 ... 33 23 ... ... 7 ... Roby Street. 37 ... ... ... 34 30 ... 3 7 37 ... ... ... Baltic Street. 52 1 ... ... 14 13 ... 33 16 ... 4 11 3 Honduras Street 16 ... ... ... 3 ... ... 10 1 ... 3 1 ... Total. 235 2 4 ... 102 62 ... 84 63 37 56 41 14 It is expected that the work of demolition of the Garden Row Area will commence in April or May, 1905. (vi) Rebuilding.—Roby Street is the only area upon which complete demolition has been carried out. At the end of 1902 seven houses were still occupied. By May, 1903, five of them had been closed, and subsequently the remaining two were closed and the area entirely cleared. The County Council, for some time, ¤ Demolition refers only to houses demolished under the Act by the County Council. It does not include "ruins." 134 ad had building plans ready, and the tender for these buildings (to be called the Wenlake Buildings) on the Roby Street area was accepted by the County Council on December 8th, 1903. (estimated cost, £18,861). These buildings are to consist of two blocks, known as the angle block and the straight block. For the angle block, excavations commenced on February 5th, 1904, and the foundations were commenced on March 7th. The brickwork was finished on September 29th. The outside and inside finishing work is approaching completion, and it is expected that this block will be ready for occupation in March, 1905. The block contains 20 tenements of two rooms, 20 of three rooms, and 5 of four rooms; in all 45 tenements containing 120 rooms. Excavation for the straight block commenced March 2nd, 1904, and the brickwork was finished on October 26th. It is expected that the block will be ready for occupation in April, 1905. The block consists of 10 tenements of two rooms, 20 of three rooms and 10 of four rooms; in all 40 tenements containing 120 rooms. The two blocks together are intended to accommodate 496 persons, and I understand the rentals will vary from 6/6 to 10/per week. II.—INSANITARY AREAS IN FINSBURY UNDER THE BOROUGH COUNCIL. (Part ii. of the Housing Act and the Public Health (London) Act.) During the year attention has also been devoted to a number of small insanitary areas unsuitable for treatment by the London County Council, under Part I. of the Housing of the Working Classes Act. These have, therefore, been approached from the point of view of Part II. of the Act, which is applicable to all Sanitary Districts, and is to be enforced by the Local Authority. It provides inter alia for the closure and demolition of buildings 135 which are unfit for human habitation. In dealing with such houses the procedure to be adopted must depend upon a variety of circumstances. In some cases it is preferable to proceed under the Housing Act (Part ii.), in other cases under the Public Health (London) Act, which is also enforceable by the Local Authority. These two Acts furnish the Borough Council with considerable powers, of which it should avail itself if necessary. Before advising the Council to put these powers into force, I have made it my duty to see the owner in each of the following areas, and have fully set before him, or his solicitors, the various defects of the property. Further, I have pointed out, where necessary in unmistakable terms, that unless the owner himself would sufficiently repair or close the properties in question, it would be necessary for me to proceed under the Acts abovementioned. It has seemed to me that this method of first approaching the owner in a personal way before issuing legal notices against him has considerable advantages to recommend it, and affords the owner ample opportunity of discharging his duties to his property and tenants. I have to report that in t he following eight areas in which this course has been adopted it has resulted in each case in the owner himself undertaking the necessary sanitary repair rather than the Local Authority. This is, in my judgment, as it should be. Property has its duties as well as its rights. In the event of non-compliance, or non-acceptance of responsibility for the insanitary conditions existing, it would, of course, be necessary for me to advise the Borough Council to proceed with strictness against such owners. Area A.—An area near Sermon Lane containing 12 houses and a population of 53. Closure and demolition was commenced and completed during 1902. Area B consists of two small courts, Caroline Place, and Kemp Place, Baker's Row, containing 8 houses and a population of 39. The floors, walls and roofs were defective, the paving of the yards in a bad condition, no through ventilation for the houses, and defective drainage. The owners, while admitting the serious 136 defects and insanitation, believed that they could remedy the condition of things by extensive repairs. Works were therefore carried out extending over several months, and a number of the sanitary defects have been rectified. This attempt was not made by my advice, but on the whole it would appear that the eight houses have been made fairly habitable. There can be no doubt at all that the property has been greatly improved. Wherever possible effort should be made to improve residential property rather than close it, and I view with satisfaction any such remedial works as these if they are adequate and result in makiny houses habitable within the meaning of the law. The alterations were completed in April, 1903. Area C was Providence Place, a blind court on the east side of Baker's Bow, Farringdon Boad. It consisted of ten houses, five on each side. There were 52 persons resident in Brovidence Place. The structural conditions of the houses in this Place were of such a nature as to make palliative alterations of no avail. The only improvement that could be made was closure and demolition, which was carried to completion in 1903. Fifty-two persons were displaced, of whom twenty-nine found accommodation in the vicinity. Area D is Easton Place, which opens to the south-west end of Easton Street. The entrance is under two arches, passing under Nos. 2 and 3, Easton Blace. The court in front of the houses is about 90-100 feet long and 7 feet wide. The small yard at the back of each house is about 3 feet by 11. In these back yards stand the sanitary conveniences, but the dustbins stand in the front court. There are nine houses, consisting in the main of a ground floor of one room, and a first and second floor, each of one room. The cubic capacity of the rooms is from 700-800 cubic feet. The back ventilation was very limited, consisting only of a small window or skylight on each staircase. The floors were unventilated, and the houses were worn out and damp. In some instances the drainage of the houses was also defective. The number of people resident in the court was about 70. 137 I laid these facts before the owner and informed him that unless he was prepared to carry out extensive repairs it would be necessary to close the premises under Part II. of the Housing Act. The owner selected to repair, and works were carried out and completed in 1903. Area E is a square of property bounded by York Road, Ironmonger Row, Lever Street, and Hull Street, the outside of the square consisting of about 30 houses. Inside the square of property stood eleven cottages and a ginger-beer factory. The cottages constituted Garden Court and Charles Court, entered by narrow passages from Hull Street. All the houses in this property were old and worn out, with many defects, but particularly was this true of the two small courts. These, with the ginger-beer factory, were also unsatisfactory in that they prevented light aud air gaining access to the backs of the houses facing the outer sides of the square. These facts were laid before the owners of the property; and arrangements were come to by which the whole of the property is to be rebuilt in the course of two or three years. But in order to improve the houses on the outside of the square at once, the inside of the square was to be cleared during 1903. The owners fulfilled their contract with me, and these eleven cottages (population 81) were closed and demolished during 1903. The operations were completed and the ground inside the square cleared by July 21st, 1903. Area F is that of Collier Place, Pentonville, N. I inspected this area and examined every house in 1901, and I then laid before the owners the facts as to its insanitary condition. Collier Place itself consisted of a court, entered from Collier Street by an archway. The court contained 12 cottages of two rooms each. They were all worn-out dilapidated houses, defective in almost every particular. Some of the cottages were practically back-to-back houses The drainage was defective. The walls, floors, roofs, windows and stairs were defective. The yards to some of the houses were extremely small and ill-paved. The sanitary conveniences in these yards were in a bad state. The houses were damp, dark and insanitary. The occupants of the Place numbered 33 adults and children ; total, 48. 138 There were also eight houses in Collier Street, in front of Collier Place, which were found to be insanitary. The drainage was defective and the houses were worn out. The ceilings and walls showed many signs of decay. The forecourts were unpaved and damp, and the yards at the back of the houses, that is, between the rear of these houses and the rear of the Collier Place houses, were small and ill-paved. The houses were dark, and almost every room was defective in various ways. The houses, in brief, were insanitary and unfit for habitation. There were 27 adults and 9 children living in these eight Collier Street houses; total, 30. Upon these facts the owners ultimately decided to close and demolish rather than attempt repair. After much delay, some of which was unavoidable, all these 20 houses have been closed and demolished. The number of persons displaced was 84. Area G consisted of 11 cottages in Sermon Lane. These houses formed two sides of a small court on the south side of Sermon Lane. Some of them were practically back to back, and all were insanitary and defective. The small forecourts in front of the houses were unpaved or ill-paved. The houses were dark and damp, the floors being slightly below the level of the court. I drew the attention of the owner to the condition of these houses in 1902, and finding their condition still worse in the present year I urged upon him the importance of closure and the necessity for action on our part if nothing was done by him. He resolved to close the houses, which has since been carried out and the entire property has now been demolished. The number of people displaced was 39 adults and 12 children, total 51. Accommodation has been found for most of these persons in the vicinity. Area H consists of Sidney Place, a court opening out of Sidney Street and containing 18 houses, occupied by 56 adults and 57 children, or a total population of 113 persons. All 18 houses were carefully examined by me and found to be in a bad condition, they were old and worn out, many of them being seriously dilapidated. Walls, floors, and roofs were defective, as were also the 139 yards, sanitary conveniences, and drainage. The houses were dirty throughout, and a large amount of structural repair was necessary to made them habitable. These facts were laid before the owner who had several consultations with me at the Town Hall. I pointed out to him that he must make up his mind to carry out very extensive repairs or close the houses within a limited period. Finally he decided to carry out repairs, and during the last two or three months he has been engaged in the necessary works. Each house is to be inspected by me before it is re-let as a habitable dwelling, and the owner has agreed to carry out all necessary alterations to bring each house up to our requirements. Dwelling-houses closed in 1904.-In addition to the closures on the insanitary areas or on account of insanitation, there have been a number of dwelling-houses closed by their owners, or by the County Council, for reconstruction on the sites of premises for commercial or industrial purposes, or for street improvement schemes. As I have pointed out elsewhere, the Borough tends to become more and more a commercial district, and dwelling-houses are being superseded every year by business premises. How rapidly this is taking place will be seen in the following returns. Further, it is to be noted how considerable is the reduction in resident population brought about by these changes. During 1904 dwelling houses have been closed in the following streets:— 140 Streets. No. of Houses Closed. No. of Persons Displaced. Adults. Children. Totals. Cottage Lane 4 8 8 16 Moreland Street 8 65 32 97 Central Street 7 41 28 69 City Road 8 59 31 90 North Street, Pentonville 1 2 6 8 Featherstone Street 1 13 5 18 Bunhill Row 3 10 4 14 Whitecross Street 8 29 5 34 Blyth Yard 2 9 0 9 Old Street 2 — — — Ironmonger Row 2 14 7 21 Finsbury Square 1 2 0 2 Paul Street 1 13 0 13 Osman Place 6 21 11 32 Great Arthur Street 4 24 14 38 Little Arthur Street 4 21 15 36 Goswell Road 17 42 40 82 Compton Street 2 9 9 18 Clerkenwell Green 1 11 7 18 Mount Pleasant 1 14 5 19 Red Lion Street 1 12 6 18 Benjamin Street 1 10 7 17 Berkley Street 1 2 0 2 St. John Street Road 1 5 0 5 Totals 87 436 240 676 141 All these dwelling-houses have been closed in order to make room for business premises or street widening. This table does not include any closures for insanitary reasons. Most of the closures, it will be seen, occur in the southern portion of the Borough contiguous to the City of London. Only 5 houses (or 6 per cent. of the total closures) have taken place in the northern part of the district. No evidence could be more complete of the change which is proceeding year by year in the character of the Borough than the facts disclosed in these figures. The total record for 1904 is as follows :— Houses closed in 1904. Persons Dishoused in 1904. (Approximate Number.) Five Insanitary Areas (L.C.C.) 41 316 Insanitary Closures (F.B.C.) 31 135 Closures for Commercial reasons, Street Widening, &c. 87 676 Totals 159 1127 Last year 161 houses were closed, and 1,349 persons displaced; in 1902, 140 houses were closed and 839 persons were dishoused; the total for the three years is therefore 460 houses and 3,315 persons. It is unnecessary to add that there are considerable changes taking place in the use of house property, e.g. private dwelling-houses being transformed into business premises without closure or demolition of houses, and which are not included in the above returns. Lastly, we have endeavoured to trace the destination of the removals in the closed properties under our jurisdiction, that is to say, the removals from the areas A, C, E, F and G, and from the houses closed for street improvements, &c., with the result that it is found about half the persons displaced leave the district, the other half finding accommodation elsewhere in the Borough. A record is kept of the destination of displaced persons as far as possible. 142 III– the maintenance of sanitation in house property. The sanitary supervision of existing houses is one of the most important parts of the housing question in Finsbury. It cannot be doubted that the problem of housing in London is what it is to-day very largely indeed because in the past strict sanitary supervision of existing houses has been neglected. This sanitary supervision, to be effective, must be two-fold in its application, namely, it must deal (i) with house structure and sanitary maintenance (houses let in lodgings, house to house inspections, etc.), and (ii) with overcrowding of persons. During 1904 a large amount of time has been devoted to this subject. For convenience it may be reported in sections as follows :— 1. Houses let in Lodgings, etc.-—When the Borough was formed there were a number of houses let in lodgings, registered under Bye-laws of Section 94 of the Public Health (London) Act, 1891. Bye-laws first came into force in this district in 1897, and from that year to 1900 the total number of houses registered in all the constituent parts of the new Borough was 327. During 1901 new Bye-laws had to be framed. After considerable discussion and amendment these Bye-laws were ratified by the Local Government Board in November, 1901, and then became law. The two chief objects of the Bye-laws are (a) the maintenance of sanitation and cleanliness, and (b) the restriction of overcrowding. The former is attained by several Bye-laws (9-17), and the latter by Byelaws 3 and 4. In 1902 we inspected and placed on the register 612 houses, which with 327 gave a total of 939 registered houses in the Borough. In 1903 the Committee added 170 more, and in 1904 we have registered 52. Some twenty or thirty had to be removed from register on account of demolition and the total number of houses now registered is therefore 1,131 in 120 streets and courts. During the year the usual inspections have been made, and a number of notices served. In the spring many of the registered houses were cleansed, in accordance with the requirements of the Bye-laws. But a number of owners were negligent in this respect 143 owing to the suspension of the Bye-laws during the cleansing period (the month of April). Overcrowding also has been reduced in many registered houses, and there is a steady improvement in their general sanitation. There are still remaining out of the 9,000 houses in the Borough a number which ought to be registered, and these will be proceeded with in due course. In a general way it may be said that it is tenement houses of the poorer class which require registration. Such houses are exempt when the landlord resides upon the premises, and the letting by such landlord is to not more than one lodger. During the present year it has been necessary to modify the by-laws for houses let in lodgings under the Public Health (London) Act, 1891, section 94, owing to certain judgments of the High Court. The first judgment was given on 9th December, 1903, by the Lord Chief Justice in the High Court (King's Bench Division) in the case of Nokes and Nokes v. the Mayor, Aldermen and Councillors of the Metropolitan Borough of Islington, to the effect thai bye-law No. 26 made by the County Council under section 39 of the Public Health (London) Act, 1891, in relation to the number of waterclosets in proportion to the number of inmates in lodging-houses is invalid, as it does not provide for notice to be given before action is taken. The bye-law in question provides, inter alia, as follows— " The landlord or owner of any lodging-house, shall provide and maintain in connection with such house, watercloset, earthcloset, or privy accommodation, in the proportion of not less than one watercloset, earthcloset, or privy, for every twelve persons." Summarising his judgment, the Lord Chief Justice said:— " Why I think the bye-law which does not contemplate any notice being given to the landlord or owner before he is proceeded against for a penalty is bad, is because I find that in Section 37 (the Sanitary Authority being the persons who are to say what is the minimum number of water closets which according to the circumstances are to be required), and the Sanitary Authority 144 being the persons who have power with regard to any house whether built before or after the commencement of the Act to say what is sufficient water closet accommodation for a given number of people, and who have to give a statutory notice calling upon the landlord or owner to provide that the terms of the section shall be carried out, and that if not he shall be liable to a penalty of £5, it contemplates that the Local Authority shall give notice to the landlord or owner before proceedings are taken. I think, therefore, this objection to a bye-law which imposes a penalty for a breach of it, especially when you remember it is intended to be put in force against people who are not in fact owners but put in the position of owners, is a good one, and that there should be the same kind of notice given to them before proceedings are taken as is contemplated by Section 37. I think, therefore, this bye-law which provides that proceedings may be taken and that the landlord shall provide, and does not make provision for a notice to be given before proceedings are taken, is not a reasonable bye-law." As a result of this judgment the London County Council added to Bye-law 26 of the Bye-laws under Section 39, the following clause:— Provided that the landlord or owner of any lodging-house shall not be deemed to have offended against the last-mentioned requirement of this bye-law until the sanitary authority shall have caused, notice to be served on such landlord or owner requiring him forthwith or within such reasonable time as may be specified in the notice to provide and maintain in connection with such house, watercloset, earthcloset, or privy accommodation in the proportion as aforesaid, and he shall have failed to comply with the notice. The second judgment concerned two cases, and was given on 5th February, 1904, by the High Court (King's Bench Division), to the effect that certain bye-laws as to cleansing houses let in lodgings were invalid, as they did not provide for notice to be given before action was taken. In the first case. Stiles v. Galinski, the appellant was a sanitary inspector of the Stepney Borough Council, and the respondent a landlord within the meaning of the bye-laws in force in Stepney as to houses let in lodgings. At the Thames Police Court, on 23rd June, 1903, an information was preferred by the appellant against the respondent, that he, being the landlord of a 145 house, did not, in the first week of April, cause every part of the premises to be cleansed, contrary to the bye-laws in such case made and provided. In this case the magistrate dismissed the summons. In the second case, Nokes and Nokes v. the Mayor, Aldermen and Councillors of Islington, the appellants were the landlords within the meaning of the bye-laws, the information preferred was similar to that in the first case, and the magistrate sitting at the Clerkenwell Police Court convicted the appellants and fined them 10s. and costs. The Lord Chief Justice, in delivering judgment in both eases, stated that in his opinion the bye-laws were bad because they did not provide that the persons who were made responsible for seeing that the things were done should receive the necessary notice. In his opinion, the bye-laws in both cases' required remodelling, with the point of view not of removing the liability of the landlord, but of giving him notice before subjecting him to penalties. Mr. Justice Wills and Mr. Justice Kennedy agreed that the bye-laws could not be supported for the reasons given by the Lord Chief Justice. The appeal in the first case was dismissed with costs. The appeal in the second case was allowed with costs. The bye-laws, which were the subject of the above decisions, were made by the Stepney and Islington Borough Councils respectively, under Section 94 of the Public Health (London) Act, 1891, and were substantially the same as those in operation in Finsbury. The section provides that every sanitary authority shall make and enforce such bye-laws as are therein specified as to houses let in lodgings. Section 114 of the Act provides that all bye-laws made by any sanitary authority under the Act shall be made subject and according to the provisions with respect to bye-laws contained in sections 182 to 186 of the Public Health Act, 1875, and under section 184 of that Act the bye-laws require the approval of the Local Government Board. 146 Owing to these judgments it became necessary to revise our bye-laws, inserting a clause requiring the giving of notice before prosecuting for penalties. This was at once proceeded with, and completed to the satisfaction of the Local Government Board on July 29th. Whilst we obtained our new bye-laws at an earlier date than almost any other Metropolitan Borough Council, it will be understood that from February to July we were, practically speaking, without operative bye-laws, and this fact has without doubt exerted an unfortunate effect upon the work of exercising control over registered houses during the year. It has also prevented the taking of proceedings for overcrowding, uncleanliness, etc. It may be remarked that the new bye-laws do not in fact alter our method of procedure in Finsbury, as it was our invariable custom to serve such a notice as is now required by law. Before leaving this matter it is interesting to observe, in relation to the cases mentioned in my Report for 1903 (pp. 146-148), that the Lord Chief Justice held that the laying down of a definite period during which the annual cleansing shall be done did not invalidate these bye-laws, as the intention of the statute was to fix dates when it should be done. The following are the amended Bye-laws now in force:— PUBLIC HEALTH (LONDON) ACT, 1891. Bye-laws made by the Mayor, Aldermen and Councillors of the Metropolitan Borough of Finsbury, with respect to Houses let in Lodgings, or occupied by Members of more than one Family, in the Metropolitan Borough of Finsbury. Interpretation of Terms. 1. In these Bye-laws, unless the context otherwise requires, the following words and expressions have the meanings hereinafter respectively assigned to them, that is to say:— "Council" means the Mayor, Aldermen and Councillors of the Metropolitan Borough of Finsbury in the Administrative County of London. "Lodging-house" means a house or part of a house which is let in lodgings or occupied by members of more than one one family. 147 "Landlord," in relation to a house or part of a house which is let in lodgings or occupied by members of more than one family, means the person (whatever may be the nature or extent of his interest in the premises) by whom or on whose behalf such house or part of a house is let in lodgings or for occupation by members of more than one family, or who for the time being receives, or is entitled to receive, the rent or profits arising from such letting. "Lodger," in relation to a house or part of a house which is let in lodgings or occupied by members of more than one family, means a person to whom any room or rooms in such house or part of a house may have been let as a lodging or for his use and occupation. Exempted Houses. 2. In the following case a lodging-house shall be exempt from the operation of these Bye-laws, that is to say :— When the landlord resides upon the premises and the letting by such landlord is to not more than one lodger. General. (a) For fixing the number of persons who may occupy a house or part of a house which is let in lodgings or occupied by members of more than one family. (b) For the registration of houses so let or occupied. (c) For the inspection of such houses. (d) For enforcing drainage for such houses, and for promoting cleanliness and ventilation in such houses. (e) For the cleansing and lime-washing at stated times of the premises. (f) For the taking of precautions in case of any infectious disease. 3. A lodger in a lodging-house, and, subject to the provisions of these Bye-laws, the landlord of the lodging-house, shall not knowingly cause or suffer a greater number of persons than will admit of the provision of three hundred cubic feet of free air space for each person of an age exceeding ten years, and of one hundred and fifty cubic feet of free air space for each person of an age not exceeding ten years to occupy, at any one time, as a sleeping apartment, a room which is used exclusively for that purpose, and which is under the control of such landlord or which has been let to such lodger respectively, as the case may be. 148 4. A lodger in a lodging-house, and, subject to the provisions of these Bye-laws, the landlord of the lodging-house, shall not knowingly cause or suffer a greater number of persons than will admit of the provision of four hundred cubic feet of free air space for each person of an age exceeding ten years, and of two hundred cubic feet of free air space for each person of an age not exceeding ten years, to occupy, at any one time, as a sleeping apartment, a room which is not used exclusively for that purpose, and which is under the control of such landlord or which has been let to such lodger respectively, as the case may be. 5. The landlord of a lodging-house, within a period of fourteen days after he shall have been required by a notice in writing from the Council, signed by the Medical Officer of Health, and duly served upon or delivered to such landlord, to supply the information necessary for the registration of such house by the Council, shall himself, or by his agent duly authorised in that behalf, sign and furnish to the Council a true statement of the following particulars with respect to such house ; that is to say— (а) The total number of rooms in the house: (b) The total number of rooms let in lodgings or occupied by members of more than one family: (c) The manner of use of each room: (d) The number, age and sex of the occupants of each room used for sleeping: (e) The Christian name and surname of the occupier of each room: (f)The amount of rent or charge per week payable by each lessee. 6. In any case where the landlord of a lodging-house occupies or resides in any part of the premises, or retains a general possession or control of the premises, such landlord, and in any case where the landlord of a lodging-house does not occupy or reside in any part of the premises or retain a general possession or control of the premises, every lodger who is entitled to have or to exercise the control of the outer door of the premises shall, at all times when required by the Medical Officer of Health, the Sanitary Inspector, or any other officer specially appointed or authorised by the Council in that behalf, afford any such officer free access to the interior of the premises for the purpose of inspection. 7. Every lodger in a lodging-house shall, at all times when required by the Medical Officer of Health, the Sanitary Inspector, or any other officer specially appointed or authorised by the Council in that behalf, afford any such officer free access for the purpose of inspection to the interior of any room or rooms which may have been let to such lodger. 149 8. Where the Medical Officer of Health, the Sanitary Inspector, or any other officer specially appointed or authorised by the Council in that behalf, has, for the purpose of inspection, obtained access to the interior of a lodging-house or to the interior of any room or rooms in such house, a person shall not wilfully obstruct any such officer in the inspection of any part of the premises, or, without reasonable excuse, neglect or refuse, when required by any such officer, to render him such assistance as may be reasonably necessary for the purpose of such inspection. 9. In any case where a lodger in a lodging-house is entitled to the exclusive use of any court, courtyard, area, or other open space within the curtilage of the premises, such lodger, and in any case where two or more lodgers in a lodging-house are entitled to the use in common of any court, courtyard, area, or other open space within the curtilage of the premises, the landlord shall, subject to the provisions of these Bye-laws, cause such court, courtyard, area, or other open space to be thoroughly cleansed from time to time, as often as may be requisite for the purpose of keeping the same in a cleanly condition. 10. Subject to the provisions of these Bye-laws, the landlord of a lodging-house shall cause every drain or means of drainage with which any water-closet belonging to such house may communicate to be maintained at all times in good order and efficient action. He shall also cause all such means of ventilation as may be provided in such water-closet or in connexion therewith to be maintained at all times in good order. 11. Every lodger in a lodging-house shall cause all solid or liquid filth or refuse to be removed once at least in every day from every room which has been let to him, and shall once at least in every day cause every vessel, utensil, or other receptacle for such filth or refuse to be thoroughly cleansed. 12. In every case where a lodger in a lodging-house is entitled to the exclusive use of any staircase, landing, or passage in such house, such lodger shall cause every part of such staircase, landing, or passage to be thoroughly cleansed from time to time as often as may be requisite. 13. A lodger in a lodging-house shall not cause or suffer any animal to be kept in any room which has been let to such lodger or elsewhere upon the premises in such a manner as to render the condition of such room or premises filthy. 14. Subject to the provisions of these Bye-laws, the landlord of a lodging-house shall cause every common passage or staircase in such house to be thoroughly cleansed from time to time, as often as may be requisite. 150 15. Subject to the provisions of these Bye-laws, the landlord of a lodging-house shall at least once in every year, in the month of April, cause every part of the premises to he cleansed. He shall at the same time, except in such cases as are hereinafter specified, cause every area, the interior surface of every ceiling and wall of every water-closet belonging to the premises, and the interior surface of every ceiling and wall of every room, staircase and passage in the house, yard, and area, to be thoroughly lime-washed. Provided that the foregoing requirement with respect to the lime-washing of the internal surface of the walls of rooms, staircases, and passages shall not apply in any case where the internal surface of any such wall is painted, or where the material of or with which such surface is constructed or covered is such as to render the lime-washing thereof unsuitable or inexpedient, and where such surface is thoroughly cleansed, and the paint or other covering is renewed, if the renewal thereof be necessary for the purpose of keeping the premises in a cleanly and wholesome condition. 16. Subject to the provisions of these Bye-laws, the landlord of a lodging-house shall provide adequate means of ventilation in or in connection with every common passage or staircase in such house, and shall cause such means of ventilation to be maintained at all times in good order. 17. Subject to the provisions of these Bye-laws, the landlord of a lodging-house shall cause all such means of ventilation as may be provided in or in connection with any room in such house to be maintained at all times in good order. 18. In every case where, in pursuance of any statutory provision in that behalf, an order of a Justice has been obtained for the removal from a lodging-house to a hospital of a person who is suffering from any dangerous infectious disease and is without proper lodging or accommodation, the landlord of such house, and the lodger to whom any room whereof such person may be an occupant has been let shall, on being informed of such order, forthwith take all such steps as may be requisite on the part of such landlord and of such lodger, respectively, to secure the safe and prompt removal of such person in compliance with such order, and shall, in and about such removal, adopt all such precautions as, in accordance with any instructions which such landlord and such lodger, respectively, may receive from the Medical Officer of Health of the Council, may be most suitable for the circumstances of the case. 19. Where a duty imposed upon or a prohibition applied to the landlord of a lodging-house is by any Bye-law expressly imposed or applied subject to the provisions of these bye-laws, proceedings shall not be taken against the landlord for an offence against the bye-law unless and until the landlord, after service upon him of a 151 notice in writing from the Council, signed by the Medical Officer of Health, requiring him within such reasonable time as is specified in the notice to comply with the bye-law has failed to comply with the bye-law within the time so specified. Penalties. 20. Every person who shall offend against any of the foregoing Bye-laws shall be liable for every such offence to a penalty of five pounds, and in the case of a continuing offence to a further penalty of forty shillings for each day after written notice of the offence from the Council: Provided, nevertheless, that the justices or court before whom any complaint may be made or any proceedings may be taken in respect of any such offence may, if they think fit, adjudge the payment as a penalty of any sum less than the full amount of the penalty imposed by this bye-law. Repeal. 21. From and after the date of the confirmation of these Bye-laws, the Bye-laws with respect to houses let in lodgings or occupied by members of more than one family, which were made by the Mayor, Aldermen and Councillors of the Metropolitan Borough of Finsbury, on the sixth day of June, in the year one thousand nine hundred and one, and were confirmed by the Local Government Board on the sixteenth day of October in the same year, shall be repealed. The Common Seal of the Mayor, Aldermen and Councillors of the Metropolitan Borough of Finsbury was, by Order dated 2nd June, 1904, hereunto affixed on the 2nd day of June, 1904. (Signed) MIDDLETON CHAPMAN, Mayor. (Signed) G. W. PRESTON, Town Clerk. Allowed by the Local Government Board this Twenty-ninth day of July, 1904. (Signed) S. B. PROVIS, Secretary. Acting on behalf of the said Board under the Authority of their General Order, dated the Twentysixth day of May, 1877. 152 Table of House-to-House Inspections. Brewer Street. Little Arthur Street. Brewer Street North. Leonard Street. Buxton Street. Playhouse Yard. Margaret Place. Baldwin Street. New Buildings. Peerless Street. Goswell Terrace. York Road. St. Helena Place. Rahere Street. Douglas Place. Sidney Place. Brunswick Close. Sidney Grove. Noble Street. Moreland Street. Easton Street. Central Street. Easton Place. Cottage Lane. Northampton Road. Macclesfield Place. Ann Street. Ironmonger Row. Wilmington Place. Little Northampton Street. Pine Street. Scotswood Street. Merlin's Place. Baker's Row. Bastwick Street. Crawford Place. Europa Place. Pump Court. Galway Street. Fox Terrace. Gee Street. Stewart's Place. Ironmonger Row. Union Place, Clerkenwell Close. John's Place. Albion Place. Lever Street. Little Sutton Street Buildings. Mitchell Street. Dundee Buildings. Radnor Street. Berkley Court. Leage Street. Wynford Road. Hatfield Street. Albert Street. Royley Street. Risinghill Street. Baltic Street. Rodney Street. Honduras Street. Godson Street. Norway Street. Fry's Buildings. Baird Street. James Gardens. Beckford Square. Penton Residences. Tilney Court. Russell Place. Great Arthur Street. West Place. Osman's Place. Thornhill Cottages. 153 2. House to House Inspection is a second means for attaining the ultimate object of sanitation in house property. By this arrangement houses, whether registered or not, are periodically inspected and a complete sanitary survey thus carried out. Each inspector undertakes this work in his own sanitary district. When sanitary defects are present notices are at once served for their repair. The facts obtained are entered in the House Record Book. In this register are particulars as to owner, mode of occupation, cubic space, conditions of sanitation, drainage, &c. This record is constantly of service in the work of the Department, and of considerable permanent value. During 1904 the systematic house inspections thus made numbered 1,548. These houses were situated in the streets shown in the table opposite. 3. Overcrowding.—In the third place, regular work is being done in the reduction, as far as known and as far as practicable, of any nuisances arising by reason of overcrowding. The prevalence of overcrowding in Finsbury was considered in some detail in the Housing Report issued in 1901 by the Medical Officer (see pp. 57-67), and it will therefore be unnecessary to enter into the facts there set forth. Since the publication of that Report the Census Report for 1901 has been issued (in 1902), and contains figures and facts concerning the degree of overcrowding existent in Finsbury. The number of houses is 9,280, and hence the number of persons per house is 10.9. This is only a relative figure on account of the " model dwellings," for which the census enumerators return "separate blocks" as houses. But even with adjustments, the return of persons per house conies out at 9, as compared with the London average of 7.8 per house. The Borough of Finsbury unfortunately occupies the unenviable position of being one of the most " overcrowded " in London. The explanation of this will be found in relation to house property (the increase of commercial premises over dwelling-houses) and the transition stage in which Central Districts, and particularly Finsbury, find themselves. Finsbury is characterised more than any other Borough in London by tenement dwellings of less than five rooms. As many as 14,516 persons live in single-room tenements (14.3 per cent. of the 154 entire population ; 31,482 persons live in two-room tenements (or 31.2 per cent.), and 21,280 persons live in three-room tenements (20.9 per cent.). Summarily, it may be said that 45.5 per cent. of the population of Finsbury live in houses of two rooms or less, and 77'4 per cent. of the population live in tenements of four rooms or less. It is this condition which affects the people of Finsbury more almost than any other single fact. During the year a large number of complaints of alleged " overcrowding" have been made to the Department and each of these has received careful investigation. Most of them proved to be unfounded or grossly exaggerated. In 123 cases, however, overcrowding has been reduced. This figure does not include 127 cases of overcrowding abated in registered houses. Total 250. We have also (as in 1901, 1902, and 1903) carried out systematic inspection by day and night in certain streets and areas known to be overcrowded. On the morning of August 17th, between the hours of 12 midnight and 4 a.m., a night inspection of certain of the registered houses let in lodgings was made. In all, 50 houses were visited, comprising 185 occupancies or tenements, containing 753 persons. The figures herewith reported are drawn up as in my previous reports, on the standard laid down in Bye-law No. 4 of the Regulations for Houses Let in Lodgings. The Bye-law is as follows:— 4. The landlord of a lodging-house or a lodger therein shall not knowingly cause or suffer a greater number of persons than will admit of the provision of four hundred cubic feet of free air space for each person of an age exceeding ten years, and of two hundred cubic feet of free air space for each person of an age not exceeding ten years, to occupy, at any one time, as a sleeping apartment, a room which is not used exclusively for that purpose, and which is under the control of such landlord, or which has been let to such lodger, respectively, as the case may be. Out of the 185 tenements which were inspected, 51 were found to be overcrowded, as judged by this Bye-law. This gives a percentage of overcrowding of 27.5. Previous night inspections have yielded the following results:— 155 Date of Night Inspection. Number of occupied tenements inspected Number overcrowded. Percentage. December 20th, 1901 (Bastwick Street) 64 47 73 .4 February 25th, 1902 (Bastwick Street) 129 78 59.6 July 5th 1902 23 15 65.1 November 18th, 1902 (Bastwick Street) 87 38 43.6 November 18th, 1902 225 59 26.2 June 24th, 1903 (Bastwick Street and other streets) 296 115 38.8 August 17th, 1904 (Bastwick Street) 185 51 27.5 It will be seen that the percentage of overcrowding in registered houses differs according to locality—some parts of the Borough being much worse than others. To arrive at comparable results, and find the present position and the result of action of the Borough Council, it is necessary to state the returns according to district. (For details see Minutes of Council). Eighty-eight tenements were inspected in Bastwick Street, of which 18 (or 20.4 per cent.), were overcrowded; 33 tenements in Memel Street, Ann Street, &c., were inspected, and 12 (or 36.3 per cent.), were overcrowded ; and 64 tenements in the Italian Quarter yielded a percentage of overcrowding of 32.8. (a) Bastwick Street.—On the present occasion we visited 26 houses in Bastwick Street, in which were living 300 adults and 127 children; 88 tenements were occupied and 18 were overcrowded. This gives a percentage of 20.4. It will be remembered that we have paid four previous night visits to this street. On the first occasion (December, 1901), the overcrowded tenements comprised 73.4 per cent. of the total. Notices were issued against the defaulters. On the second occasion it had fallen to 59.6 per cent. Summonses were issued against the defaulter (Mr. Gehringer), and convictions and penalties were obtained (£15 18s.). On the third night visit the overcrowding had fallen to 43.6 per cent. Summonses 156 were issued against the owner (Mr. Gehringer), who was again convicted and fined £10 8s. He then got rid of the property, which passed into the hands of another house-owner. On June 24th, 1903, we made a fourth inspection, which resulted in finding that the overcrowded tenements had now been further reduced to 21.8 per cent. Notices were served upon the new owner, and I wrote explaining our previous action and the intention of the Borough Council to insist upon having this street kept under better management than had hitherto prevailed. He replied (July 20th, 1903), that it was his intention to assist us and comply with the law, and he had made arrangements which he hoped would lead to a better condition of things. The fifth inspection reveals a percentage of overcrowded tenements of 20.4. Notices have again been served upon the new owner, and unless the overcrowding is further reduced it will be necessary to take further proceedings. At the same time it is right to add that, whereas three years ago 84 per cent. of the overcrowding in Bastwick Street was of a serious degree, leading to evident physical and moral deterioration of the persons living under such conditions, I have now to report that only about 33 per cent. of the overcrowding is of what may be termed a serious character. In a large number of cases one-room tenements have been converted into two-room tenements as a result of our action. It should be added that 16 empty tenements were met with, from which it may be inferred that above 20 per cent. of the house accommodation in Bastwick Street is unoccupied. (b) Houses in several Streets (Memel Street, Ann Street. &c.)— Night visits were also paid to eight houses in five different streets, with the result that, out of 33 occupied tenements, 12 were found to be overcrowded, six badly so. The percentage of overcrowded tenements on occupied tenements was 36.3. (c) The Italian Quarter (Italian houses only).—On this occasion 16 houses were visited in the Italian Quarter. These houses are situated in Baker's Row, Great Bath Street, Coldbath Square, Bath Court, Warner Street, Caroline Place and Corporation Row. The 157 16 houses contained 64 occupied tenements, of which 21 were overcrowded. This yields a percentage of overcrowding of 32.8. It will be remembered that in July, 1902, we made a night inspection of a number of Italian houses in this district, with the result that 58.4 per cent. of overcrowding was found, and in June, 1903, 50.5 per cent. were overcrowded. On both occasions some of the overcrowding was of a serious degree. It is probable that in the summer the overcrowding of Italians is not so marked as in the winter, as during the summer many of them are sleeping out or are away in the provinces temporarily, hawking their goods (ice creams, plaster casts, etc.), laying asphalte, or organ grinding. This last inspection reveals a more satisfactory state of affairs, which is due to the strict instructions which we have given to house owners in this district that we cannot permit overcrowding. Of the 21 overcrowded tenements 13 (or 62 per cent.) were of a serious degree (4) Common Lodging Houses.—The following six Common Lodging-houses are situated in the Borough:— Address. Registered Owner. Registered Number of Occupants. Average Attendance. Clerkenwell Green, 35 J. H. Claytor 73 70 Old Street, 97 Wm. Cragg 82 70 Pentonville Road, 19 Mr. Callagher 23 20 Do. 21 Do. 36 30 St. John's Lane, 34 Mrs. Hensman 51 36 White Lion Street, 57 Mrs. Shuttleworth 98 88 363 314 These Common Lodging-houses have been visited and inspected on various occasions during the year. One in Whitecross Street, 158 accommodating 98 persons, has been closed during the year. There are no Salvation Army Shelters in Finsbury. There is one Church Army Asylum in Banner Street. Three Common Lodging-houses (accommodating 176 persons) have been closed in the last two years. (5) Model Dwellings.—There are 202 blocks of so-called "model dwellings" in Finsbury, containing 3,978 tenements, and accommodating 17,000 persons. A list of these appeared in my report for 1903 (p. 154.) (6) Underground Rooms.—Under Sections 96 and 97 of the Public Health (London) Act, 1891, there have been 20 illegal occupations of underground rooms abated. In a large number of other instances re-adjustment in the house has reduced the illegal occupation. (7) Customs and Inland Revenue Acts.—No action. General Conclusions.—As we have seen in previous reports :— 1. The population of Finsbury reached its zenith between 1851 and 1861. 2. The number of inhabited houses was greatest in 1851. 3. Since these respective dates there has been a steady and uninterrupted decline both in houses and population. But whereas the population has declined 21 per cent., the number of inhabited houses has declined 31 per cent. The chief decline in the houses occurred between 1881 and 1891, whilst the chief decline in the population took place in the decennium between 1871 and 1881. These changes occurred in the most marked degree in those portions of the Borough in immediate proximity to the boundary of the City of London. Such changes inevitably resulted in overcrowding, and there was, in fact, a greater number of persons per house in Finsbury in 1901(10.9), as compared with London as a whole (8.0). From these figures it is clear (i) that the population of Finsbury is a declining one; (ii) that the density of population per acre is a declining one ; but (iii) that the density per house is an increasing one. Time and the ordinary process of events, if 159 coupled with strict sanitary supervision and enforcement of the Public Health Act, will ultimately solve the insanitary housing problem in the Borough. But in the meantime, and during the transition period, the problem is an acute one. The difficulty of the housing question in Finsbury is of course that the price of land and of building is too high to permit of letting at low rents. The prices are such as can only be paid for commercial concerns. It is this of course which also leads to the overcrowding of houses per acre in Finsbury. In London there are eight houses to the acre, in Finsbury there are 19. There is also considerable overcrowding of persons, therefore merely increasing house accommodation is not only impracticable but is inadvisable. To rehouse large numbers of people within some Boroughs may be and doubtless is the primary and essential remedy. In Finsbury such a policy on the part of the Local Authority might seriously and permanently aggravate the evil conditions at present existing. To this there is one exception, namely, the rehousing of persons displaced by law from insanitary property. This would appear to be a requirement; and the Housing Committee of the Borough Council has endeavoured to meet it. But owing to the force of facts above quoted they have not up to the present met with any success. The Committee has reported as follows to the Council:— Resolved—To report to the Council that the Committee have since their appointment considered the particulars of a considerable number of sites both within and without the Borough, many of which they have personally inspected, and have caused to be prepared plans and statistics of five definite schemes, but that they reluctantly find themselves at present unable owing to the many difficulties attending the housing question in this Borough, to submit to the Council any schemes which would not entail a greater or lesser charge upon the rates ; and to recommend that the matter be again referred to the Committee if and when reappointed. The policy which has been adopted by this Department since 1901, may be expressed in a few words as follows:— 160 1. The strict sanitary supervision and maintenance of existing houses. 2. The strict enforcement of the Public Health (London) Act, 1891, as it affects house property and overcrowding, as far as is practicable and equitable. 3. Action under Part II. of the Housing of the Working Classes Act for houses and small areas which are beyond repair, when necessary (and, where action possible, under Part III). 4. To urge the importance of improvement in transit.‡ ‡ Without some improved means of transt (cheap and rapid) the carrying out of the provisions of the Housing of the Working Classes Act and the Public Health (London) Act, must involve the incurrence of considerable hardship upon persons it was the object of these Acts to assist, and in this and other ways, a satisfactory early solution of the housing problem in Central London is largely impracticable and ineffectual. e.—factories and workshops. 163 factories and workshops. The Factory and Workshop Act, 1901, came into force at the beginning of 1902, and has thrown upon the Local Authority a number of additional duties. Section 132 of the Act requires that the Medical Officer of Health of every District Council shall report specifically every year on the administration of the Act in workshops and workplaces in the district under his supervision, and transmit a copy to the Secretary of State for the Home Department. This portion of the Annual Report on the Health of Finsbury is devoted to the subject, and within its pages will be found reference to everything which has concerned the Public Health Department in 1904, in relation to workshops or workplaces. The only exceptions are stables, which will be reported on subsequently, and restaurants, sweet-shops, and milkshops, which come more suitably in the section of the Report dealing with the Protection of the Food Supply. It is well known that the population of the Borough of Finsbury is largely industrial. Out of the total census population of 101,463 there are 23,086 persons under 10 years of age. These may be set on one side as far as concerns factories and workshops. The number of persons over 10 years of age is therefore 78,377. Out of this number, 28,669 are " retired " or unoccupied, leaving a total of 49,708 workers, or nearly one-half of the entire population. Subtracting 9,708 as approximately the total number of those occupied in Government service, defence of the country, professional and commercial occupations, and employers of labour, we get a rough estimate of 40,000 persons, resident in Finsbury, employed in factories, workshops or workplaces. Doubtless many more than 40,000 persons come into Finsbury daily for work. I have abstracted from the Census Report for 1901 a table giving the returns of persons resident in Finsbury, under each of the 23 headings of the Census Report, except "Fishing," which occupies no persons in Finsbury. Hence we have 22 classes of workers. The chief industries of Finsbury come under domestic and hotel service, conveyance of men and goods, metals and machinery, jewellery and watchmaking, builders, carpenters and plumbers, furniture and decorations, skin and feather work, paper and printers, and dress and textile fabrics. 164 Occupations of Persons in Finsbury over 10 years of age. Males. Females. Total. Percentage on Adult Population. i. General or Local Government 942 43 985 1.2 ii. Defence of the Country 127 — 127 0.2 iii. Professional Occupations 787 559 1346 1.7 iv. Domestic and Hotel Service, Charwomen and Laundresses 738 4117 4855 6.2 v. Commercial Occupations 1610 291 1901 2.4 vi. Conveyance of Men,Goods,&c. 6863 173 7036 8.9 vii. Agriculture, Nurserymen and Florists 35 53 88 0.1 viii. Mines and Quarries 66 7 73 0.1 ix. Metals, Machinery, &c. 2613 213 2826 3.6 x. Jewellery, Watch Making. &c. 1965 375 2340 2.9 xi. Building, Carpentry, Painters, Plumbers, &c. 2767 1 2768 3.5 xii. Furniture and Decorations 1738 352 2090 2.7 xiii. Brick, Potteries, Glass, &c. 354 26 380 0.5 xiv. Chemical Works 353 266 619 0.8 xv. Skins, Leather, Hair and Feathers 682 747 1429 1.9 xvi. Paper, Printers, and Stationery 3367 3143 6510 8.3 xvii. Textile Fabrics 574 581 1155 1.5 xviii. Dress, Tailors, Milliners, stresses, Shirt Makers, Boot and Shoe Makers, Artificial Flower Makers, &c. 1517 3840 5357 1.5 xix. Food,Tobacco,Restaurants,&c. 3204 1289 4493 5.7 xx. Gas, Water and Electricity 183 1 184 0.2 xxi. Other, General, and Undefined Workers and Dealers 2630 516 3146 4.1 xxii. Without Specified Occupations or Unoccupied 5238 23431 28669 36.6 Totals 38353 40024 78377 100.0 165 It is unnecessary to discuss this Table, although it is full of interest. It may, however, be stated that of the total number of females (40,024) over ten years of age who reside in Finsbury, 16,593 are engaged in occupations; 10,769, or 617 per cent, of the unmarried females, and 5,824, or 25'8 per cent, of the married or widowed females are so employed (this latter percentage being the fifth highest in London.) The total, 78,377, includes all adult persons and also all children who are at work. It does not include children at school or infants (roughly 23,000). It will be seen that a very large proportion of the persons in the Borough are engaged in unskilled or casual labour (Vide Nos. iv., vi., xix., xxi., xxii.). If we include unspecified occupations, probably as much as 50 per cent, are so employed. In section- xxii. the total of 28,669 is a large one. It includes 297 persons retired from business, 56 pensioners, 477 "living on their own means" (what is called "independent"), and 27,839 "without specified occupation." It may be convenient to summarize the various premises in the Borough where work is done which are now registered in the Public Health Department:— Workshops and Workplaces 1745 Factories 354 Bakehouses 61 Restaurant Kitchens, &c. 230 Ice-cream Premises 102 Home Workers 255 Stables 494 Total 3241 The following Table shows the various trades and occupations carried on in the workshops and workplaces now on the Register:— 166 Workshops and Workplaces in Finsbury on Register. Clocks and Watches 115 Book and Card-edge Gilders 13 Jewellery 87 Children's Clothing 13 Cabinet-Making, Polishing, &c 84 Wire-workers 13 Brush-makers 12 Tailors and Clothiers 71 Opticians 12 Engravers, Embossers and Chasers 63 Upholstery 12 Embroidery and Lace 11 Building Trades 55 Packing-case Makers 10 Leather Goods 53 Rag and Paper Waste 10 Underclothing, Shirts, Skirts, Blouses, &c 44 Shop-fitting, Show-cases, &c. 10 Enamelling and Japanning 9 Box-Makers 39 Pianos and Organs 9 Stick-makers and Mounters 37 Barometers and Thermometers 8 Gilding and Plating 36 Coppersmiths 8 Ties, Scarves and Belts 36 Sign and Ticket Writing 8 Stables 35 Harness-making 7 Furriers and Skin-Dressers 34 Linen Collars 7 Gold and Silversmiths 34 Marble and Stone-masons 7 Glass-workers 33 Pipe-makers 7 Boots and Shoes 30 Timber-yards, &c. 7 Mantles and Costumes 27 Wine and Spirit Stores 7 Laundries 24 Athletic Goods 6 Hats and Caps 23 Basket-workers 6 Fancy Goods, Toys, &c. 21 Cloth-workers 6 Artificial Flowers 20 Tailors' Busts, &c 6 Brass Workers 20 Electrical Goods 6 Picture-frames and Mouldings 20 Firewood-choppers 6 Coach-building and Wheelwrights 19 Gold-blockers 6 Plaster-cast makers 6 Stationery, Publishing, &c. 19 Stamp and Die-cutters 6 Druggists' Sundries, Perfumers, &c 18 Wood Carvers 6 Bedding and Bedsteads 5 Jewel and Instrument Cases 18 Cycles and Motors 5 Millinery 18 Christmas Cards 4 Dressmaking 17 Confectionery 4 Engineers 16 Lamps 4 Instrument-makers 16 Saw-piercers 4 Umbrella-makers 16 Silk Goods 4 Farriers and Smiths 15 Tin-workers 4 Iron and Metal Workers 15 Automatic Machines 4 Ironmongery and Hardware 15 Miscellaneous 162 Feather Workers 14 Total 1745 Paper and Cardboard 14 Wood, Ivory and Bone Turners 14 In 1903 we instituted a factory register which, though not a statutory requirement, will prove of considerable value. 167 The following Table shows the various trades and occupations carried on in factories in the Borough of Finsbury which are now on the factory register of this department :— Factories on Register. Printers and Stationers 79 Distilleries, &c. 4 Engineers 30 Horse-hair, Feathers, &c. 4 Shirts, Skirts, Blouses, &c. 16 Engravers, &c. 4 Box-makers 15 Foundries 4 Book-binders 13 Joinery Mills, &c. 4 Ivory, Wood, &c., Turners 10 Leather Goods 4 Stick Mounters and Makers 10 Paper Goods 4 Gilders and Platers 8 Pipe-makers and Mounters 4 Cigar and Cigarette Makers 7 Silk Weaving 4 Cycles and Motors 7 Cloth Shrinkers, &c. 3 Laundries & Collar Dressers 7 Coach and Van Builders 3 Cabinet-makers 6 Infants' Clothing, &c. 3 Glass Workers 6 Rubber Goods 3 Wire Workers, &c. 6 Surgical Instruments, &c. 3 Cocoa, Confectionery, &c. 5 Wheelwrights 3 Mantle-makers 5 Miscellaneous 82 Pianoforte-makers 5 Total 371 The difference between the above total (371) and the number of factories on the register (354) is accounted for by the various businesses carried on in the tenement factories. I. Sanitary Condition of Workshops. (a) Cleanliness.—Speaking generally, it may be said that the large workshops, which are in the majority of cases situated in comparatively new buildings, are kept in a clean condition. Many of these have to do with the making of dress materials or wearing apparel, and cleanliness is essential to success in such business. The same cannot be said of a great number of the small workshops situated in 168 or at the back of residential houses. Many of these are of long standing and associated with the early industries of Clerkenwell and the parish of St. Luke, such as jewellery, watchmaking, plating, etc. Many of such workshops are not kept as cleanly as they might well be. This is partly due to deterioration of premises and decline of trade, and partly to their situation. It is almost impossible to maintain cleanliness in small sheds in back yards. Sometimes too, the processes themselves are of a nature to make cleanliness difficult. Perhaps 30 or 40 per cent, of these workshops are open to criticism on account of uncleanliness. During the year 118 workshops have been found to require notices for cleansing. (b) Air Space.—Taking the standard of 250 cubic feet per head as laid down in Section 3 of the Act, it may be said that few Finsbury workshops have been found in 1904 to be overcrowded. In only 5 cases has it been necessary to issue notices. In other cases a slight re-arrangement of workers has provided that each person shall have at least 250 cubic feet. In many of the large workshops the air space provided is liberal. In general, workshops in Finsbury are not ventilated by fan or other artificial means. Nine notices have been sent to the Home Office in respect of factories and workshops which were not effectually heated. By our instructions 21 gas stoves, etc., have been provided with hoods or flues. (c) Ventilation.—It has already been pointed out in previous reports that the majority of workshops in Finsbury are provided with sufficient means of ventilation, but that a certain number of them do not conform to the section of the Act (7-i), which requires that " sufficient ventilation shall be maintained." The means of ventilation provided are not always taken advantage of, and it is no easy matter to compel their use. If the windows of a workshop are open at the time of inspection, the persons responsible appear to be doing their best to maintain a pure atmosphere; and without a chemical test of the air, the period during which the available means of ventilation have been in use must remain a matter of conjecture. An apparatus has lately come into use by which the amount of carbonic acid gas present in the air of any room can be 169 estimated on the spot in less than ten minutes, the method used being simpler and more expeditious than that of Pettenkofer, and apparently almost as reliable. This apparatus, which bears the name of the inventor, Dr. Haldane, was provided by the Public Health Department, and some preliminary experiments have been carried out by Dr. Sandilands (to whom I am indebted for the notes under this heading), with a view to forming an opinion as to the reliability of the machine, and to the possibility of its universal use in any workshop where there might be reason to suppose that the air was not kept in a reasonably pure state. Owing to a defect in one of the taps the machine at first gave irregular readings, but ultimately read accurately in a series of experiments in which it was checked by Pettenkofer's method and finally by another Haldane's apparatus. In 7 underground bakehouses the highest readings were 10 and 11 parts of C02 in 10,000 of air. These results were obtained in 2 bakehouses where the ventilation was poor. The experiments were made late on the morning of a warm May day, when all available means of ventilation were in most cases in use. The air in 7 underground kitchens was sampled, and high readings were obtained in 2. In 1 of these the excess of C02 was due to the use of a gas oven with no hood or other means of preventing the products of combustion mixing with the air of the kitchen ; in the other to the presence of two large gas rings and the absence of sufficient ventilation. Nineteen experiments were made in 12 workshops and factories, and gave the following results: In 4 workshops and 1 factory the air was reasonably pure. In the remaining 7 it was highly polluted, one room containing no less than 48 parts of C02 in 10,000 of air. The high results obtained were all due to the combustion of large quantities of gas, and the failure to put in use means of ventilation which were available and would have been adequate if employed. The highest result obtained from human respiration alone was 16. If a standard of permissible impurity, expressed in terms of C02, were to be established, Dr. Haldane's machine would be a valuable and convenient means of enforcing the maintenance of a pure atmosphere, which has 170 already been made possible in theory by the provision of adequate air space and means of ventilation. In the absence of such a standard the machine may still do much to prevent the deliberate neglect to use the means of ventilation with which the greater number of workshops have been provided.¤ (d) Drainage of Floors where wet processes are carried on.—The only "wet processes" carried on in Finsbury, speaking generally, are small laundries, of which there are 24 on the register. In three instances it has been necessary to advise more adequate drainage. (e) Provision of Suitable and Sufficient Sanitary Conveniences.— In respect to this matter we have found it necessary to take considerable action. Speaking of small workshops it must be said in the first place that the sanitary conveniences are situated in the back yards near the workshops as a rule, and do not gain in suitability on that account, in the second place, they were constructed for the use of the residents in the house, at one time a single family, and latterly several families living on the tenement system, and now have to serve also as the sanitary convenience for the workshop. Consequently we may have one sanitary convenience, not infrequently ill-situated, acting for the house and workshop. This is undesirable, but it is impracticable in many cases to arrange otherwise. It is obvious how this state of things has come to be. One family in former days occupied the whole house and possessed a workshop, say, on the ground floor or in the back yard. Prosperity of trade necessitated the engagement of one or two additional workers not belonging to the family. Sometimes such workers lived in the house, in other cases they lived elsewhere. Eventually, perhaps, the owner himself moved out and sub-let his house in tenements, retaining the ground floor and the workshop. Thus we have the present position a tenement house containing three or four families, a workshop in the back yard, the employés of which come in from other districts. The sanitary convenience acts for both parties, the residents and non-resident workers. With regard to workshops, particularly in the Eastern Division of the Borough, the chief difficulty is due to the fact that whole * For details of experiments vide Appendix page 199. 171 floors of, or rooms in, large buildings are let out without reference to, or arrangements for, sanitary convenience accommodation as regards the separation of sexes. In large firms owning entire buildings there is generally ample provision. In enforcing section 9 of the Act we have not been without difficulties, which are not lessened by the facts that many of the industries in these small workshops are seasonal, and that the trade is occasionally in the hands of one family, both sons and daughters working in the workshop. The standard we have used is that contained in the Order of the Home Office (February 4th, 1903)— In pursuance of Section 9 of the Factory and Workshop Act, 1901, I hereby determine that the accommodation in the way of sanitary conveniences provided in a factory or workshop shall be deemed to be sufficient and suitable within the meaning of the said section if the following conditions are complied with and not otherwise:— 1. In factories or workshops where females are employed or in attendance there shall be one sanitary convenience for every 25 females. In factories or workshops where males are employed or in attendance there shall be one sanitary convenience for every 25 males: provided that— (a) In factories or workshops where the number of males employed or in attendance exceeds 100, and sufficient urinal accommodation is also provided, it shall be sufficient if there is one sanitary convenience for every 25 males up to the first 100, and for every 40 after ; (b) In factories or workshops where the number of males employed or in attendance exceeds 500, and the District Inspector of Factories certifies in writing that by means of a check system, or otherwise, proper supervision and control in regard to the use of the conveniences are exercised by officers specially appointed for that purpose, it shall be sufficient if one sanitary convenience is provided for every 60 males, in addition to sufficient urinal accommodation. Any certificate given by an Inspector shall be kept attached to the general register, and shall be liable at any time to be revoked by notice in writing from the Inspector. In calculating the number of conveniences required by this order, any odd number of persons less than 25, 40, or 60, as the case may be, shall be reckoned as 25, 40, or 60. 2. Every sanitary convenience shall be kept in a cleanly state, shall be sufficiently ventilated and lighted, and shall not communicate with any work-room except through the open air or through an intervening ventilated space: provided that in work-rooms in use 172 prior to 1st January, 1903, and mechanically ventilated in such manner that air cannot be drawn into the work-room through the sanitary convenience, an intervening ventilated space shall not be required. 3. Every sanitary convenience shall be under cover and so partitioned off as to secure privacy, and if for the use of females shall have a proper door and fastenings. 4. The sanitary conveniences in a factory or workshop shall be so arranged and maintained as to be conveniently accessible to all persons employed therein at all times during their employment. 5. Where persons of both sexes are employed, the conveniences for each sex shall be so placed or so screened that the interior shall not be visible, even when the door of any convenience is open, from any place where persons of the other sex have to work or pass; and, if the conveniences for one sex adjoin those for the other sex, the approaches shall be separate. 0. This order shall come into force on the 1st day of July, 1003. 7. This order may be referred to as the Sanitary Accommodation Order of 4th February, 1903. A. Akers Douglas, One of His Majesty's Principal Secretaries of State. Home Office, Whitehall, 4th February, 1903. Since the formation of the Metropolitan Borough Council in 1900, we have had a considerable number of cases where it has been necessary to require increased sanitary convenience accommodation, separate accommodation, &c., and since the issue of the Order of the Home Secretary, 4th February, 1903, we have adopted that standard as the one guiding us in all such cases in this Borough, although previously we adopted one in twenty as a uniform standard, and this was always complied with. Therefore the Home Secretary's Order was more lenient than the practice which had been in vogue in this Borough previously. Under the guidance of the Order of the 4th February, 1903, we have issued Notices in 81 instances, in all of which there has been compliance. In no case has it been necessary to contest the point in court. From the following Table of illustrative cases it will be seen that we have issued Notices for unsuitability as well as insufficiency, and have obtained compliance on both issues in all cases. 173 Action taken in Finsbury since adoption of Sanitary Accommodation Order as working standard. Premises. No. of Sanitary Conveniences Found. Result of Action Taken. 1 Leather goods factory 2 S.C's., used by 15 M. and 15 F. Separate accommodation provided for. 2 Woodworking factory 1 S.C. for 29 M. Additional accommodation provided. 3 Clothing factory 3 S.C's. with common lobby, 1 used by M. and 2 by F. S.C's. with common lobby to to be used by one sex only. 4 Blouse-making workshop 2 S.C's. for 74 F. Additional S.C. provided. 5 Blouse-making factory 1 S.C. for 50 F. Additional S.C. provided. 6 Grocery factory 2 S.C's. for 71 M. Additional S.C. provided. 7 Tailors' workshop 2 S.C's. for 63 M. Additional S.C. provided. 8 Christmas card workshop 1 S.C. for 40 M. and 1 S.C. for 51 F. Additional accommodation provided for both sexes. 9 Underclothing factory 6 S.C's. for 203 F. 2 additional S.C's. erected. 10 Underclothing factory 6 S.C's. for 188 F. 2 additional S.C's. erected. 11 Foundry factory 1 S.C. for 30 M. Additional S.C. erected. 12 Furriers' workshop 2 S.C's. for 70 F. Additional accommodation provided. 13 Furriers' workshop Women using S.C's. in common with men Additional S.C. erected. 14 Blouses, &c., workshop 1 S.C. for 50 F. 2 additional S.C's. erected. In many factories in the Borough the standard is much higher, at the instigation of the proprietors. The following Table of women's factories illustrates this point (the average is somewhat over one sanitary convenience for every 15 persons):— 174 Factory. No. of Females Employed. No. of S.C.'s for Females. Average No. of Persons per S.C. 1 Beer-bottling 100 6 17 2 Laundry 100 4 25 3 Bookbinding 132 9 15 4 Shirt-making 121 8 15 5 Skirt-making 90 6 15 6 Cigars, &c. 120 6 20 7 Optical Works 100 5 20 8 Stationery 70 5 14 9 Box-making 130 7 19 10 Stationery 96 4 24 11 Underclothing 200 10 20 12 Chocolate 75 7 11 13 Skirts, &c. 150 9 17 14 Printing 120 7 17 15 Cocoa 130 14 9 16 Bookbinding 92 4 23 17 Envelopes 200 14 14 18 Collars 223 12 19 19 Box-making 86 5 17 20 Printing 80 4 20 21 Drysalters 90 6 15 22 Cocoa 130 8 16 23 Stationery, &c. 400 27 15 24 Printing 130 16 8 25 Underclothing 162 8 20 26 Box-making 300 24 13 27 Skirts 140 9 16 28 Underclothing 150 11 14 29 Do. 125 8 16 30 Meat Extract 100 11 9 31 Millinery 170 7 24 32 Mantles 200 18 11 33 Underclothing 150 18 9 34 Printers 83 5 17 35 Box-making 85 6 14 36 Stationers 100 6 17 37 Bookbinders 100 6 17 38 Shirts, &c. 200 12 17 39 Feathers 90 5 18 The above facts are incorporated in this Report on account of the importance of the whole subject. It is evident that some general standard must be made. Under the Sanitary Act of 1866, Section 35, the Local Authority were required to make regulations for tenement houses, and they decided that not less than 1 for 20 was a suitable standard for sanitary conveniences. Thus it came about that the Local Authority decided that 1 for 20 was also suitable for factories and workshops. (See also 26 J.P., p. 262, 1862.) The standard of 175 1 to 20 in tenement houses was, however, found, in actual practice, to be insufficient, and was modified by the L.C.C. Bye-law 26, under the Public Health (London) Act, 1891, Section 39, which raised the standard to 1 for 12. The standard for factories and workshops remained, however, at 1 for 20 until the Home Office standard of 1 for 25 was laid down. We adopted the same standard in order to be uniform with other authorities, and this standard of 1 for 25 has been our invariable practice since. It may be desirable briefly to state the scientific reason for such a standard. The fundamental principle at the basis of the matter is the extreme importance of allowing for the free and normal action of physiological functions. And these matters must be thought of in two directions. First, ample provision must be made for actual usage ; and, secondly, such provision must be made that there will be no deterrence or postponement of the exercise of these functions, as may occur unless every facility is provided. The public do not recognise the vital importance of these physiological functions both to health and to life, and they thus take upon themselves considerable personal responsibility. But if the Local Authority by its powers requires too little accommodation in factories, it takes upon itself part of this responsibility for life and health, and must, therefore, order such provision as fully meets the case, and which will in no way, and under no passing circumstances of ill-health, allow such insufficient accommodation as to act as a deterrent. Hence the importance of a standard. Further, such a standard must be based upon the accepted facts of general medical knowledge. No evidence can be produced in a Court of law to prove that insufficiency of sanitary conveniences is not injurious to health, for the reason that the evidences of such injury are not obtainable. There is therefore a serious fallacy underlying the suggestion which is frequently made to us that the apparent health of a number of workers in a factory or workshop proves a sufficiency of sanitary convenience accommodation. Broadly speaking, the external evidences of general health are three in number: (a) the absence of notifiable disease; (b) a low death rate ; (c) a large measure of regular attendance at work. 176 But these conditions do not throw light upon injury to health resulting from insufficiency of sanitary convenience accommodation, for such injury is chiefly manifested not in these three conditions, but in certain other conditions not measurable at the time, but producing their effects, generally, many months or years afterwards. For example, anæmia, chlorosis, and other "poor blood" conditions, which are so prevalent among factory women and girls, may be thus caused, and these are well-known predisposing conditions of phthisis and other constitutional diseases. I have no doubt at all that not a little of the wide-spread chlorosis among these factory employees arises from the absorption into the blood of retained by-products in the alimentary canal. Diseased conditions of the alimentary canal and of internal organs may also be due to the failure to exercise these physiological functions, and it is a well-recognised medical fact that headache and conditions of lassitude and debility frequently arise from a similar origin. Lastly, the fact of there being one or more vacant sanitary conveniences available in a factory or workshop at any one time does not prove that a sufficient number has been provided, for it would thus be possible to prove that wherever there was a vacant sanitary convenience in any premises sufficient sanitary accommodation had been provided, which would, of course, be absurd. Moreover, the vacancy of sanitary conveniences depends on the hour of inspection, the amount of observation kept upon employees by forewomen and others, etc. Probably more accommodation is required for "piece workers" than for "time workers." Some of the difficulty in arranging these matters equitably and suitably arises from the questions of leasehold which constantly crop up in a district like Finsbury in the midst of a transition period between a residential Borough and an industrial Borough. During the year 62 notices have been served for insufficient sanitary convenience accommodation in relation to factories, workshops and workplaces, and 451 such conveniences have been cleansed and repaired. Insufficient sanitary convenience accommodation includes six cases in which no convenience of any kind 177 was provided, and in five cases the sanitary conveniences were unsuitable for use by both sexes. The remaining 51 were cases of insufficiency of accommodation. Summary of Defaults and Defects in Factories and Workshops.—It may be desirable here to summarize the results of the year's work in regard to the sanitary condition of workshops, etc. During the year 3,760 visits of inspection have been made to factories and workshops by the Workshop Inspector and the Lady Inspector, and a large amount of work has been accomplished. In addition to this, the other inspectors in the ordinary course of their duties on their several districts have inspected 18 workshops. The chief matters arising in relation to this work are set out in the following table:— 178 Summary of Defaults and Defects in Factories, Workshops and Workplaces for which Notices were served during 1904. Workshops. Factories. Workplaces. Total. Dirty workshops, cleansed 118 — — 118 Damp and dilapidated workshops, repaired 9 — — 9 Dirty staircases, &c., cleansed 8 — 2 10 Overcrowded workshops 5 — — 5 Ventilation of workshops, improved 21 — — 21 Gas stoves, coppers, &c., flues, &c., provided 21 — — 21 Drainage of floors 2 — — 2 No water supply 1 — — 1 Sanitary conveniences, cleansed 103 67 20 190 Sanitary conveniences, defects remedied 106 106 49 261 No sanitary convenience 3 — 3 6 Insufficient sanitary convenience accommodation 38 9 4 51 Unsuitable sanitary conveniences for two sexes 2 3 — 5 Defective soil pipes, repaired or reconstructed 3 5 2 10 Yards cleansed, paved, or paving repaired 5 1 1 7 Defective sinks and gullies, repaired 12 7 2 21 Water-cisterns cleansed and defects remedied 24 5 — 29 Accumulations of refuse and manure 12 3 3 18 Dustbins and manure receptacles defective or absent 85 24 28 137 Drainage defective, repaired or reconstructed 12 14 9 35 Rain-water pipes defective, &c. 3 2 — 5 Stable paving defective 1 — — 1 Stable in need of limewashing — — 1 1 Black smoke emissions — 2 1 3 Totals 594 248 125 967 179 In addition to the routine work of the inspector, systematic inspection has been made of the factories, workshops and workplaces in an area bounded by Goswell Road on the west, Old Street on the north, Shoreditch Boundary on the east, and City Boundary on the south. This is part of a systematic survey of the workplaces of the whole Borough, and forms at present the major part of the Workshop Inspector's duties. The following table concerning this area includes some work done during 1903:— No. on Old Registers. No. added to Registers. Total No. on Registers. Nuisances, &c., Found. Intimation Notices Issued. Statutory Notices Issued. Notices to Factory Inspectors. Prosecutions. Factories 7 248 255 197 117 13 35 1 Workshops 94 287 381 478 258 32 58 1 Workplaces 3 165 168 113 77 10 - - 104 700 804 788 452 55 93 2 II. Special Sanitary Regulations for Bakehouses. This matter was reported upon very fully in my last Report, and it is therefore unnecessary to do more here than state what action was taken during 1904. At the end of 1903 there were 21 above-ground and 42 underground bakehouses. Of the latter there were nine still uncertified in which alterations were being made or negotiations pending. Early in January, seven out of these nine were made suitable in all respects and received the Borough certificate. Two, however, did not satisfy the Bakehouse sub-Committee, and were therefore closed. The final result of the administration of Section 101 of the Factory and Workshop Act, 1901, was :— (а) That 40 underground bakehouses were so altered and repaired as to meet the requirements of the law, and were duly certified—33 in 1903 and 7 in 1904. (b) That six underground bakehouses were closed as wholly unsui table. 180 The reasons why the percentage closed is comparatively small were discussed in my report for 1903 (pp. 193—194). Each Inspector has visited the bakehouses in his district, and the Chief Inspector, the Workshop Inspector, and myself have also paid many visits to underground bakehouses. On the whole, I am glad to report a marked improvement in the cleanliness and appointments of the bakehouses in Finsbury during the last two or three years. III. Home Work. This has reference to persons employed by firms carrying on various simple trade processes at home. They are out-workers doing work for firms belonging to Finsbury or other Boroughs, but all of them employed and resident in Finsbury. The work of the Department in relation to home work and out-workers during 1904 has been carried out by the Lady Sanitary Inspector (appointed April, 1904). As stated in last year's Report, it was impossible, with the then existing staff, to keep pace with this branch of the work, and the work having fallen into arrears accounts for the large number of home-workers who have been placed under the heading "Removed." As they will now be visited shortly after the lists are received, a larger number will probably be found at work. It is extremely difficult to estimate the number of home-workers in Finsbury as they are continually moving about, and there are many of whom we have not yet received notification, or who are not home-workers under the Act. Of the 185 homes visited, it was found that in 157 places one person was working, in 24 places two persons were working, and in 4 places three persons were working. In all these cases the persons were either related to each other, or were friends working in the same room but for different firms. In one instance a case of scarlet fever occurred in the home of an out-worker, and in several instances cases of measles have been found. Disinfection of the work and home have been carried out in all such cases. 181 Of the men employed, 7 were shoemakers, and 25 were tailors; of the women employed, 107 were married, and 78 were single or widows. These latter workers, generally speaking, are employed at greater pressure owing to the fact that they are entirely dependent upon such work for their livelihood. Of the 185 home-workers :— 43 were engaged in tailoring. 29 ,, ,, tie, brace, belt and collar making. 23 „ „ blouse and mantle making. 21 „ „ ladies' and children's outfitting. 13 „ „ shoemaking. 12 ,, ,, making artificial flowers. 10 „ „ hat-making. 6 „ „ fur-lining. 28 ,, „ various other industries. In two cases there was the occurrence of infectious disease in the homes of out-workers obtaining work from Finsbury firms, but residing in other Boroughs. The following summary of results of inspections of out-workers' and home-workers, premises speaks for itself:— 182 OUT-WORKERS Number of out-workers' premises visited 444 Total number of visits made 489 Number in which wrong address was given or outworkers had removed 137 Number who had given up home work 40 „ not out-workers under the Act 14 „ in which work was done in factories 5 „ „ „ „ workshops 63 (Particulars of which are included in the Report on Workshops.) Number of workshops in which no Abstract of Act was affixed 17 „ in which work was done in the home 185 „ of re-visits to home-workers 45 HOME-WORKERS. Particulars relating to work in 185 homes. Number in which work was done in work-rooms only 22 „ „ „ „ living-rooms 74 „ „ „ „ bed-rooms 11 „ „ „ „ bed and living rooms 78 185 „ of cases in which room was clean 126 „ „ „ „ in fair order 39 „ „ „ „ dirty 20 185 Sanitary defects on premises 26 Notices served 23 Number of persons employed as home-workers 217 „ „ men 3 „ „ boys 1 „ „ women 181 „ „ girls 4 183 IV. Outworkers' Lists Under Section 107 of the Act employers in certain industries, namely: (a) making, cleaning, washing, altering, finishing and repairing of wearing apparel; (b) ditto for lace, lace curtains, and nets; (c) cabinet and furniture making and upholstery work; (d) electro-plating ; (e) making of files and (f) fur-pulling, have to keep, in prescribed form, lists of employés working outside the factory or workshop. Such lists have to be sent on or before February 1st and August 1st in each year to the Borough Council. In cases where such outworkers do not reside within the limits of the Borough from which they obtain work, their names and addresses are to be sent on by this authority to the Council in whose district they reside. In Finsbury, during 1904, we have received 168 lists from 100 employers, most of whom have acted in accordance with the Act; 68 have sent two lists during the year at or about the stated periods, and 32 employers have sent once. It will be seen from the following Table that there has been considerable improvement in compliance with the requirements of the Act. The 81 lists received February 2nd to June 30th were practically all "first lists" due on February 1st, and the 87 lists received August 2nd to December 31st, should have been sent in not later than August 1st. So that, out of 168 lists, 46 were received at the statutory periods. It has been necessary to take action in one case, under Section 107, sub-section (5), to enforce more accurate returns. The penalty to which employers are liable for contravening this requirement of sending in lists is £2, or for second offence £5. Reference is made to this matter subsequently. We have issued 60 " reminder " notices on account of failure to send in the lists on the statutory dates. In future it may be necessary to issue summonses, but during the present year the matter has been complicated by depression in trade, when employers previously sending in lists have discharged their employes. These lists have chiefly been from firms concerned in the making or preparing of wearing apparel (section a). Sections (c), (d), (e) and (f) have, generally speaking, furnished no lists. We have received 62 lists of outworkers from 18 Local Authorities 184 in whose districts outworkers are employed who live in Finsbury. In this way we have obtained the names and addresses of 152 outworkers obtaining work from elsewhere but living and working in Finsbury. The following Table furnishes in brief the facts obtained under Section 107 of the Act:— Lists received from Employers. 1904. 1903. Number of Lists. Number of Outworkers Number of Lists. Number of Outworkers Jan. 1st to Feb. 1st 22 616 3 79 Due Feb. 1st. Feb. 2nd to June 30th 59 549 59 1416 July 1st to Aug. 1st 24 725 8 300 Due Aug. 1st. Aug 2nd to Dec. 31st 63 63 1199 39 1103 168 4089 109 2898 Lists received from 18 Local Authorities 62 152 90 342 Lists dispatched to 61 Local Authorities 845 3891 351 2814 V. Inspection Registration, &c. A Register of Workshops and Workplaces is kept in the Department which contains the names and addresses of the occupier, the trade or manufacture, the position and cubic capacity of the workrooms, the number of gas burners, the number of occupants permissible, the means of ventilation, and details respecting the sanitary arrangements. At the end of 1903, there were on the register 1,651 workshops and workplaces. During 1904, 294 workshops and 139 workplaces, or a total of 433, were added, 339 were removed as obsolete entries, leaving a total now on the register of 1,745. The following tables set out in brief the work done:— 185 Inspection, Registration, & c. Workshops and Workplaces- Workshops and Workplaces on Register at end of 1903 ... 1651 Workshops placed on Register during 1904 294 Workplaces „ „ „ 139 Total addition, 1904 433 Workshops & Workplaces removed from Register, 1904 339 94 Total on Register end of 1904 ... 1745 Factories— Factories on Register at end of 1903 ... 159 „ placed on Register during 1904 205 „ removed from Register during 1904 10 195 „ on Register at end of 1904 ... 354 Factories—Inspections 298 Re-visits 619 917 Workshops—Inspections 665 Re-visits 1488 Workplaces—Inspections 333 2153 Re-visits 375 Total inspections 1296 708 Total Re-visits 2482 3778 Workrooms measured, 1904 ... 560 Complaints Received and Investigated— Personal 33 Anonymous 20 Trade Society 1 Per London County Council 1 55 Number verified 43 „ not verified 12 References to other Authorities 5 186 The following Table is a record of the communications between this Department and the Home Office under the Factory and Workshop Act, 1901, and the Public Health (London) Act, 1891 :— Home Office Certificates, &c. Notices received re existence of workshops (Sec. 127, Sub-Sec. 3) 59 Complaint Notices (Sec. 5) 19 Limewashing needed 9 Sanitary conveniences 6 Overcrowding 2 Insufficient ventilation 2 Total defaults, &c. 19 Notices sent to Home Office Inspectors - "5 Factories— No abstract of Act, &c. 18 Workshops converted into factories 7 Fumes from gas engines, stoves, &c 6 Lack of means for heating 3 Illegal employment 3 Limewashing needed 3 Drainage of floors 2 Dangerous machinery 1 Insufficient ventilation 1 Domestic factory 1 Total defaults, &c. 45 Workshops— No abstract of Act, &c 67 Lack of means for heating, &c 6 Illegal employments 1 Domestic workshop 1 Total defaults, &c. 75 120 187 VI. Legal Action. During 1904 we have issued 540 intimation notices respecting factories and workshops and 72 statutory notices. In 4 instances it has been necessary to issue summonses. The results were as follows:— Date. Name and Address of Defendant. Offence. Result. Feb. 18th R. Walpole, 59, Fann Street For constructing a drain ventilating pipe contrary to London County Council bye-laws at 39, Featherstone Street Fined £1 and 2s. costs. April 7th Samuel Markheim, 88-90, Golden Lane, E.C. For failing to send to Borough Council a list of outworkers' names and addresses, due on February 1st Fined £1 and £2 2s. costs. April 29th A. Barnett, 30, Clifton Gardens, Maida Vale For failing to comply with notice requiring drainage of water from beneath floor of workshop at III, Pentonville Road Fined £5 and 2s. costs. July 1st Chambers & Sons, Ltd., 56, Wilson Street, E.C. For failing to amend a new w.c. not constructed in accordance with London County Council bye-laws, at 47, Wilson Street Dismissed, with £2 2S. costs against the Council. The last case is the only one which calls for remark. It was as follows:—In course of routine inspection of premises, Inspector Peverett found that the water-closet accommodation at Messrs. Chambers & Sons, Ltd., 47, Wilson Street, E.C., was not of a suitable character, i.e., there was not suitable and separate accommodation for the two sexes. He therefore served a notice under the Public Health (London) Act, 1891, section 38 (1), requiring suitable accommodation to be provided. The owners elected to put up an additional water-closet at the end of the workshop. Before construction they consulted us with regard to details of construction, and were furnished by word of mouth and by a printed statement with particulars governing the erection of water-closets in the Metropolis. In one particular, viz., the construction of the partition separating the water-closet from the workshop, the builder did not comply with the instructions given, and therefore we held that the construction was unsuitable, the partition separating the 188 closet not being of a solid and satisfactory character. The words of the Bye-law governing this matter are:—" He shall construct " such water-closet so that on any side on which it would abut on a " room intended for human habitation, or used for the manufacture, " preparation or storage of food for man, or used as a factory, " workshop or workplace, it shall be enclosed by a solid wall or " partition of brick or other materials extending the entire height "from the floor to the ceiling." The Owners received notice from me to the effect that the partition was unsuitable, but they took no steps to comply with the requirements of the Bye-law ; therefore in due course a statutory notice was served upon Messrs. Chambers & Sons, Ltd. The Sanitary Authority is the judge of what interpretation shall be placed on section 38 (1), as will be seen by reading section 38, sub-section 2, which is as follows:—"Where it appears "to a Sanitary Authority that this section (38 (1) ) is not complied "with in the case of any factory, workshop or workplace, the Sanitary "Authority shall, by notice served on the owner or occupier of such "factory, workshop or workplace, require him to make the altera"tions and additions necessary to secure such compliance, and if "the person served with such notice fails to comply therewith he "shall be liable to a fine not exceeding £20." But in cases where the unsuitabiltty of the water-closet is owing to some infringement of the London County Council Bye-laws, the London County Council may allow an appeal to be made to an Arbitration Committee of its own. as is clear from section 41 (3):— "Any person who thinks himself aggrieved by any notice or "act of a Sanitary Authority under this section in relation to any "water-closet, earth-closet, privy, ashpit or cesspool may appeal to "the County Council, whose decision shall be final." But in all cases taken out under Section 38 of the Public Health (London) Act, 1891, the Sanitary Authority has the power and right of saying whether or not the construction of the water-closet is suitable. Whichever way, therefore, the matter be viewed, it is evident that if Messrs. Chambers or their builder had constructed a partition which did not meet with the approval of the Sanitary Authority—in this instance the Finsbury Borough Council—the matter could be settled either by the Sanitary Authority, Section 41 (3), or an appeal to the London County Council, Section 41 (3). 189 The builder employed by Messrs. Chambers elected to have an appeal before the London County Council, and he wrote requesting such an appeal on April 18th, 1904 ; therefore I served the defendant with a Statutory Notice upon which to make his appeal to the County Council. Printed in red upon the Statutory Notice was a note reminding him of his opportunity for appeal, which is to be made within, seven days after the receipt of the Statutory Notice from us (Metropolis Local Management Act, 1855, Section 211.) We gave him, as a matter of fact, three weeks' grace in which time to make his appeal, but he did not make it, although he had particularly requested that that course should be taken. As, therefore, no action whatever was taken, and the partition was not amended, it was necessary for me to apply for a Summons to be served upon Messrs. Chambers & Son, which was done on June 9th, 1904. In view of these facts I deemed that in this case of Peverett v. Chambers, the point to press for in the Police Court where the Summons was taken out was a penalty for non-compliance with the Notice, irrespective of suitability of structure or otherwise. The defendant had already asked the opinion of the Sanitary Authority with regard to the suitability or otherwise of the partition, and had been informed that it was unsuitable, and what it would be necessary to do to make it suitable. Not accepting our opinion, he had asked for an appeal to the County Council, but when an opportunity offered for making his appeal he declined to do so. He had, therefore, I submit, placed himself outside the question of suitability of structure, as he had disregarded the requirements of the law on that point, and had thereby definitely waived his right on the question of suitability of the partition (see Vestry of St. John, Hackney v. Hutton, 61, J.P., 54 ; and Clerkenwell Vestry v. Feary, 54, J.P., 678.) When the case came before the Police Court, the learned magistrate, Mr. Cluer, took the view that the suitability of the partition was the point at issue, and he adjourned the case with the view of visiting the premises himself to form an opinion on that point. At the adjourned hearing of the case the learned magistrate, when he had viewed the partition, formed the opinion that it was suitable. He, therefore, dismissed the summons with £2 2s. costs against the Council. 190 I may add that I had, of course, myself carefully examined the partition which had been erected, and I considered it unsuitable on the following grounds:— (a) It was not a solid partition of brick or other similar materials, but consisted of a ¾-inch single match lining. (b) It was not accurately fitted to the walls at the side, and to the ceiling at the top, and (c) The consistence of the panelling was such that in the course of time it might probably warp, and become in every way wholly unsuitable. I may say that this opinion of mine is based upon our practice in Finsbury during the past, and on the practice of other Metropolitan Borough Councils. We hold that such a partition is not "a solid wall" within the meaning of the Bye-law, and that the term "other materials" in the Bye-law means other similar materials to brick. It is, of course, a matter of great importance that these sanitary conveniences in factories and workshops shall be properly constructed within the meaning of the Bye-laws, otherwise any sort of temporary and unsuitable structure will be erected by unscrupulous persons. So that whilst the case appears to be one concerning a small and unimportant point, viz. : the suitability or otherwise of a partition to a sanitary convenience, it is in point of fact a matter of importance. On the whole, the somewhat exceptional judgment of the learned magistrate (exceptional, i.e., in accordance with previous judgments on this point), indicates that it would be desirable to obtain such amendments to the Bye-law as will make it clear what the term " other materials " really means, and not leave the matter, as it is at present, for each Sanitary Authority in London to define in accordance with its own view. I reported the full facts of the case to the London County Council, and the following is a copy of the letter sent by the Clerk of the London County Council, to the Town Clerk of Finsbury, on September 10th, 1904:— 191 Sir, In reply to your letter of the 8th instant, I have pleasure in stating that the question of amending the bye-law, referred to in the ease of Peverett v. Chambers, in relation to the construction of waterclosets, is under the consideration of a Committee of the Council, in connection with other proposed amendments of the bye-laws under sections 16 and 39 of the Public Health (London) Act, 1891. I am, Sir, Your obedient Servant, (Signed) G. L. GOMME, Clerk to the Council. The Town Clerk, Metropolitan Borough of Finsbury. On one occasion during the year a temporary difficulty arose from obstruction by refusal to admit the Inspector to premises in the course of his duties. On September 1st, Inspector Peverett visited 150, Old Street, in the course of a systematic inspection of the district. These premises are occupied by a manufacturer of mosaic, marble, parquet and other floorings, and used as offices and showrooms. Some three or four persons are employed. The occupier refused to admit the Inspector as the place was "only used as an office and was not a workplace," and the Inspector was therefore "exceeding his duties" in asking for admission. The Inspector failing to gain entrance reported the matter to me and I wrote to the occupier, who was irritated at what he felt to be an unreasonable requirement on our part. After some correspondence I received a letter from the occupier, dated October 19th, in which he consented to allow the Inspector to visit the premises. Some minor defects were found. I am clearly of opinion that premises such as these should fall within the judgment given in the High Court in the case of Bennett v. Harding, and in any event a refusal to grant admittance is obviously a short-sighted and unwise policy. Happily no other employer during the year has taken up the attitude of the occupier in question. VII. Special Enquiries. Under this heading it is proposed to record enquiries in respect of Anthrax, a dust nuisance in a factory, and Dr. Sandilands' 192 special enquiry into the atmospheres of workshops. With regard to this last-named matter, reference is made to it under "Ventilation," on page 168, and here the appendix only is incorporated. (a) Anthrax. During the year we have had three cases of Anthrax. In 1902 we had four cases, and in 1903 no cases. (i.) On February 24th I received a notification from the Home Office of a case of Anthrax in the person of William C., aged 25, of 12, Locton Street, Old Ford, E., employed by Messrs. W. & C. Nightingale, 70 to 74, Old Street, E.C., Feather and Horse-hair Manufacturers. The usual enquiries were made. This firm receives horse-hair in bulk, which is hackled, milled and washed. The hackling is done while the hair is saturated with hot water, soap and soda; milling is carried out whilst the hair is dry. I was informed that milling was last done by the man William C. on February 19th. He had been employed at this factory for about 3½ years, and his work was sometimes hackling hair and sometimes milling. I was further informed that the firm only purchase English hair, and that beyond this no special precautions are taken to protect the workers from Anthrax. 1 gathered that on February 18th the patient had on his left arm, near the elbow, a small boil, of which, however, no notice was taken. He milled on the 19th, and on the 20th he was seized with illness which consisted, according to his own statement, of pains all over his body and blood poisoning in his left arm. He was duly admitted into the London Hospital, and came under the care of Mr. J. Hutchinson, Jr., F.R.C.S., Surgeon to the Hospital, to whose courtesy I am indebted for the following information. This case was one of typical local Anthrax. The lesion was near the left elbow joint. There had been no direct wound, but the man had scratched himself on this part of his arm with the fingers of his right hand when working in the horsehair. The presence of Anthrax Bacilli was verified in the blood serum of the sore. The entire pustule was excised by Mr. Hutchinson. The constitutional symptoms were relieved from that time and the patient made an excellent recovery. 193 This is the first case of Anthrax certified to me from this factory and I am informed no previous case has occurred. As I have pointed out in previous Reports, the means of preventing Anthrax are, in the first place, that manufacturers should deal only in horsehair coming from districts bearing a repute for being free from Anthrax infection. The trade look upon English horse-hair as being the least commonly infected, then the South American and Russian hair, and lastly the Chinese. Secondly, it is possible to disinfect hair before it is handled, and some firms require that this shall be done before they receive the goods. Lastly, there are contrivances available in factories for dust extraction or protective processes, consisting of wetting the horse-hair. I visited Messrs. Nightingale's premises, and am satisfied that this case did not occur on account of any negligence on the part of the firm, or persons whom they employ. I may, however, add that in my opinion workers in horsehair, which necessarily contains large quantities of dust, should be extremely careful to protect themselves whenever they have wounds, abrasions, sores, or boils on the hands, arms, or face. (ii.) On July 19th I received notification of a case of Anthrax in the person of Charles C., aged 40, of 08, Jupps Road, Mile End, E., employed by Messrs. William List & Son, of 51, Bunhill Row, E.C., Horse-hair Manufacturers. The usual enquiries were made. This firm receives horse-hair in bulk, which is hackled, milled and washed. The nature of the work done by this man, Charles C., was that of "a drawer of horse-hair." He had been employed at this factory for about 28 years, and he was engaged in handling large quantities of foreign (Siberian and Russian) horse-hair. It has not been possible to obtain any information as to how this man was infected, but in all probability he infected his neck by scratching it with unclean hands. His wife reports that she had noticed a pimple behind his right ear for about a week, and on Tuesday, July 12th, he suddenly became ill with swelling of the neck, headache, lassitude, &c. On Wednesday he went to the hospital, and he died on the following Friday. By the courtesy of Dr. H. D. Ledward, House Surgeon at St. Bartholomew's Hospital, I am able to add the following particulars 194 as to clinical condition. The patient was admitted on Wednesday, July 13th, with a large œdematous swelling on the right side of his neck, extending from the ear to the collar bone. Behind the lobe of his ear there was an abrasion which had evidently been produced by scratching. There was no appearance of malignant pustule. The swelling was incised, which gave relief, and through Thursday the patient appeared to be much better. On the Thursday night, however, he suddenly collapsed, and died at mid-day on Friday. A bacteriological examination was made on Friday morning of some discharge from the abrasion, which had by that time assumed a suspicious appearance, the edging being raised and red. The bacteriological examination showed that bacilli of Anthrax and Streptococci were present, and cultures gave a typical growth of Anthrax. After death further cultures were made from the heart's blood, which also showed abundant Anthrax bacilli and Streptococci. It would therefore appear that this man died from Anthrax Septicemia, possibly complicated with mixed infection of Streptococci. The condition, therefore, differed in degree, though not in kind, from the previous cases of Anthrax which have been notified in this Borough, and have been forms of local Anthrax or malignant pustule. This case, however, was one of Generalised Anthrax, leading in the first place to cellulitis of the tissues of the neck where the virus had been introduced, and extending to general septicaemia, which produced death, probably by causing great swelling of the windpipe, resulting in suffocation. An inquest was held on Tuesday, July 19th, at the City of London Coroner's Court, by Dr. Waldo. Dr. Ledward gave evidence, and said that the disease had developed with great rapidity, and was present in a most virulent form. The jury returned a verdict of "Death from misadventure." (iii) On November 11th , I received a notification from the Home Office of a case of Anthrax in the person of Henry A., aged 31 years, of 38, Ravenscroft Road, Barking Road, Canning Town, E., employed by Messrs. List & Sons, Horse-hair Manufacturers. The usual enquiries were made. The firm is the same as that mentioned above. The nature of the work done by Henry A. was 195 that of a wet hackler, in which process the employé takes the long hair after it is sorted, and combs and dresses it in a wet state. He has been employed at this factory for about 17 years, and much of the material which he handled is of foreign origin (Siberian, Russian, and probably some Hungarian and French horse-hair). It appears that this man whilst handling some hair scratched the skin over his right cheek bone on or about November 5th or 8th. On November 9th he was suffering from a local condition which was suspicious of Anthrax. He went to St. Bartholomew's Hospital, where a bacteriological examination was made and the bacillus of Anthrax was found to be present in the clean fluid from the slough. Cultivations yielded typical Anthrax bacilli, which on inoculation proved virulent to mice. On admission, the man's temperatuse was 101° F., and the slough on his face was about a quarter of an inch in diameter, and there was a moderate amount of redness and œdema around it. The glands at the angle of the jaw were enlarged. The patient was treated at the Hospital with an antianthrax serum made by Sclavo of Sienna. This treatment proved to be successful and the patient recovered.* * It is believed that this is the second case of Anthrax treated in England by the serum treatment of Professor Sclavo. In one former instance this serum was used but upon a hopeless case. The present case, therefore, is the first in which the treatment has had. a fair trial in this country. 40 c.c. of the serum were injected subcutaneously into the flank and into the abdomen on the afternoon of the man's admission into Hospital. No other treatment was adopted. At first the temperature rose to 1024 F. and in the evening to 103 F., and the pulse was 92. During the night the temperature fell, and the next few days wavered between 98'4 F. and 101.4 F., and the pulse from 80 to 99. The oedema at first increased, and there was some swelling and redness of the fauces. By November 12th, there was decided improvement, and a cultivation made from the tissues at the edge of the slough yielded no Anthrax Bacilli. Convalescence was rapid, and the slough came away on November 26th, 17 days after the administration of the serum. A small granulating surface was left which appeared likely to leave a scar scarcely more serious than that resulting from vaccination. The patient left the Hospital in good health on November 30th. {British Medical Journal, January 7th, 1905, page 16, C. B. Lockwood, F.R.C.S., and F. W. Andrewes, M.D.). 196 (b) Tetanus. In September, 1904, we first learned of a case of Tetanus, which apparently had been contracted in a factory in Finsbury, by a man residing in Shoreditch. On May 30th, 1903, Mr. W., aged 63, horse-hair dealer, residing in Essex Street, Shoreditch, and employed at Messrs. W. & Co., Feather and Bedding Manufacturers, in Finsbury, met with an accident to his hands whilst at work, in which his hands were crushed. He went to St. Bartholomew's Hospital the same day, and again on June 2nd, for the wounds to be dressed. Tetanus set in on June 4th, with convulsions, and the patient died at home, on June 5th This is the first recorded case of Tetanus since the formation of the Borough. The infective bacillus was in all probability present in the trade dust. (c) A Dust Nuisance at a Factory. In June we received several complaints respecting the emission of dust from a factory in Lamb's Passage, Bunhill Row, E.C., used for the manufacture of tar-felt for commercial purposes. Thirteen men and twelve women are employed. Briefly the process is this :— Flax and jute waste is received in bales on the top floor. and first passed by a woman into a cylindrical machine—the " wilier." From this it is raked through a hole in the floor to machines below, called " breakers." Then it is passed down a shoot to the floor below, where women feed it into machines, which send it in an even layer through melted pitch, and the final product is rolled up by men. The grosser dust and "sheaves" removed by the "wilier" fall, in part, inside the screen of the machine, but a considerable quantity escapes into the room. There is no means provided to carry off or minimise the amount of this dust. As the flax waste is raked through the floor, it was apparent that unnecessary dust was made through the material falling loose to the floor below. 197 In the "breaker" the waste passes round a "deviller," which disintegrates it, and then it is passed over wire netting. Dust, &c., is drawn through the wire by means of air suction by a fan, which then forces it into a tank. From this the draught is taken up to the top floor to the dust-room. The flax is sent through a " shoot " after going through the "breaker," and is fed into machines by women, who toss it loose to spread it evenly. Here again it is drawn over wire netting, but the air blast is taken direct to the dust room. The "dust-room" is on the top floor, and the heavier particulate matter falls to the floor, while the air is expelled through a cowl in the roof. Throughout the process there are no means provided for dealing with the dust in the rooms, and consequently it is blown through the open doors, windows, and cowl. At the time of my visit, over the whole of the roofs and in the gutters of the premises, there was a considerable quantity of the dust. The engineer stated that the gutters were cleared out periodically, and I gathered from observation that the creation of dust was very considerable, especially (a) where the flax was shaken on the top floor, and (6) where it was spread out by women on the machines. One of the complaints respecting this nuisance came from the authorities at the Roman Catholic Schools in Bunhill Row, and I paid visits to this school to make observations as to the existence and degree of the dust nuisance. In effect 1 found a considerable nuisance to be existing on account of the flax dust. Samples of this were collected for bacteriological examination, but apart from fibrous dust and material and a certain amount of siliceous dust nothing specific of a bacterial nature was found. I have no doubt however that the inhalation of this dust by the women engaged in the factory, and by the children in the school, is in a greater or less degree injurious. I formed the opinion, notwithstanding apparently contradictory statements, that to the women the injury must be great and permanent. 198 These facts were laid before the Home Office, and Commander Hamilton Smith, H.M. Superintending Inspector of Factories for Dangerous Trades, visited the factory, and his proposals as well as proposals from us, received the early attention of the occupiers of the premises. The two chief means of reduction of the nuisance adopted by this firm have been (a) the insertion of steam jets for laying the dust in the "dustroom" and preventing its escape into the yard and the schoolrooms, and (b) improved ventilation. The nuisance is now, I understand, abated. APPENDIX TO SECTION E. 200 201 ANALYSES OF AIR BY DR. HALDANE'S APPARATUS. UNDERGROUND BAKEHOUSES. Index Number. Nature of Premises. Description of Room. Number of Occupants and Space. Gas, Oil, or Electric Light, in use at time of test. Date, Time, and Position of Test. Volume of CO2 per 10,000. Means of Ventilation in in actual use at time of test. Remarks. Position, Process, &c Cubic Capacity, in feet. Height. Number present. Space per person. Date and Time. Where Sampled. Inside Room. Outside Air. 9 Bakehouse Underground. Baking in progress 1328 7 ft. 2 664 — 10.15 a.m., May 28th, 1904 Middle of room 10 Estimate 3.5 Windows all shut, door open leading to passage with open window Occupied all night by two men. 10 Bakehouse Underground. Baking in progress 1237 8 ft. 3 412 2 small gas jets 10.30 a.m, May 28th, 1904 Middle of room 8 3.5 Large light (window) door to yard wide open, also grating in rear 11 Bakehouse Underground. Baking in progress 1943 7 ft. 6 ins. 1 1943 2 gas jets 11 a.m, May 28th, 1904 Middle of room 6 3.5 Stall-board windows, 2 others wide open Two men working all night. 12 Bakehouse Underground. Baking in progress 1744 7 ft. 9 ins. 2 872 1 gas jet 11.15 a.m., May 28th, 1904 Middle of room 8 3.5 2 windows back and front wide open 13 Bakehouse Underground. Baking in progress 2040 8 ft. 6 ins. 5 408 3 gas jets 11.30a.m., May 28th, I904 Front of room under window 11 3.5 4 small windows; hoist to shop open No through ventilation. 14 Bakehouse Underground. Oven charged 2100 7 ft. 6 ins. 3 700 1 gas jet 11.45 a.m., May 28th, 1904. Middle of room 6 3.5 Large skylight, 3 small windows open 15 Bakehouse Underground. Baking in progress 1522 7 ft. 1 1522 1 gas jet 2.30 p.m., May 30th, 1904. Front of room, near oven 4.5 3.5 2 windows front, 1 in rear open Through draught. 2 men present most of the morning. KITCHEN WHERE FOOD IS PREPARED FOR SALE. 16 Restaurant Underground kitchen. No cooking in progress — — 1 - 1 gas jet 3 p.m.,May 30th Back of kitchen under hoist 7 Estimate 3.5 2 large windows, front, hoist at rear open 18 Sweetmeat Workshop Basement. Cooking in progress 2821 7 ft. 2 1410 1 gas jet 3.30 p.m., Body of room 5.5 3.5 Large open grating in rear, double row of gratings (pavement light) front, flue and hood over copper for sweetstuffs Good through ventilation. 202 203 Index Number. Nature of Premises. Description of Room. Number of Occupants and Space. Gas, Oil, or Electric Light, in use at time of test. Date, Time, and Position of Test. Volume of CO2 per 10,000. Means of Ventilation in in actual use at time of test. Remarks Position, Process, &c Cubic Capacity, in feet. Height. Number present. Space per person. Date and Time. Where Sampled. Inside Room. Outside Air. 19 Restaurant Basement kitchen. Cooking in progress 6048 8 ft. 4 1512 2 gas jets, gas oven 11 a.m., June 3rd Back part of premises, 1 ft. below joists 20 3.5 All ventilators open, gratings at side; windows under stall-board in front open. Flue of gas oven open to room. Ditto Ditto 6048 8 ft. 4 1512 Ditto Ditto Centre of room at breathing level 18 3.5 Ditto Ditto Ditto 6048 8 ft. 4 1512 Ditto Ditto Bench at side of room, best position 12 3.5 Ditto Ditto Ditto 6048 8 ft. 4 1512 3 gas jets, 3 large gas rings, 1 gas oven, 2 rings at top 10.30 a.m., Dec. 12th Centre of room, breathing level 11 5 All ventilators open, as above First visit to this kitchen was made on a warm day in June, the second on a cold day in December. Ditto Ditto 6048 8 ft. 4 1512 Ditto Ditto Centre, near gas stove, 1 foot below joists 14 5 Ditto The lower reading in December was probably due to the greater discrepancy between the temperature of the kitchen and the temperature outside, which would promote a more rapid interchange of air. 21 Restaurant Underground kitchen 6440 10 ft. 2 3220 1 gas jet 11.30 a.m., June 3rd Body of room 8 3.5 Large window open, small hoist, 1 pane in front, 5 perforated zinc frames in rear, open staircase 22 Restaurant Ground floor, at back. Cooking in progress 1680 7 ft. 6 in. 4 420 Gas stove, 3 dishes gas heated in centre 11.45 a.m., June 3rd Left-hand side of room 8 35 Large window opening to rear, a door to shop front, 4 ventilators in ceiling, open chimney ever gas stove Cubic space small, but ventilation good. 23 Restaurant Underground kitchen 3037 7 ft. 6 in. 6 506 Electric light, 2 large gas rings top of gas stove and i gas jet 11.55,a.m., june 3rd Centre of room, between central draught openings 11 3.5 Grating whole width of front, grating side by stairs, 2 gratings in coal store in rear, small hoist Ditto Ditto 3037 7 ft. 6 in. 6 506 Ditto Ditto Rear right-hand corner, above gas ring 11 3.5 Ditto 204 205 Index Number. Nature of Premises. Description of Room. Number of Occupants and Space. Gas, Oil, or Electric Light, in use at time of test. Date, Time, and Position of Test. Volume of CO2 per 10,000. Means of Ventilation in in actual use at time of test. Remarks. Position, Process, &c. Cubic Capacity, in feet. Height. Number present. Space per person. Date and Time. Where Sampled. Inside Room. Outside Air. 24 Eel & Pie Shop Underground kitchen 2970 (approx.) 11 ft. 2 1440 No gas 12 noon, June 3rd Right-hand side centre 10 3.5 Large grating in front, grating at side, hoist and stairs Sample taken in a position where the air was stagnant. Ditto Ditto ditto 11 ft. 2 1440 Ditto Ditto Front left side 8 3.5 Ditto Sample from a more favourable position. workshops and factories. 33 Factory Laundry Ground floor. Gas ironing, &c. approx. I4500 12 ft. 25 580 10 gas jets, ii ironing machines, 12 box irons, gas heated Noon, Dec. 15th End of room, under exhaust fan 12 4.5 30-in. exhaust fan, stairs from basement, all windows shut The exhaust fan was stopped for 10 minutes before the last sample was taken. The reading showed that the CO2 rose rapidly in the interval. Ditto Ditto 14500 12 ft. 25 580 Ditto Ditto Body of room 10 4.5 Ditto Ditto Ditto 14500 12 ft. 25 580 Ditto Ditto End of room, under exhaust fan 20 4.5 Fan stopped for ten minutes 34 Linen Collar Workshop Ground floor. 50 machinists at work 121800 50 ft. (approx.) 56 2175 6 gas irons, 3 gas jets 2 p.m., Dec. 15th Body of room 16 4.5 Two cowls in roof, 1 Tobin tube, 2 hooded stoves The second sample was taken after the trap doors in the roof and an additional Tobin tube had been left open for 10 minuies. The CO2 had fallen. Ditto Ditto 121800 ditto 56 2175 Ditto Ditto Ditto 10 4.5 Two large trap doors in roof wide open, and 1 Tobin tube in addition to above 25 Cork-sock Manufactory Second floor 13650 Average 13 ft. 13 1050 11 gas jets alight gas stove beside fireplace 12.40 p.m., Dec. 12th, 1904 Body of room, at breathing level 31 5 One window open about 4 inches, holes at bottom of skylights Gas jets alight for drying materials, heat from fire being insufficient. Temperature high. Ditto Ditto Ditto Ditto Body of room, 2 feet below breathinglevel 29 5 Ditto 26 Feather Workshop Third floor 5544 11 ft. 10 554 6 gas jets alight 11.30 a.m., Dec. 12th, 1964 Body of room 48 5 All windows shut, chimney partly blocked off Practically unventilated stuffy and oppressive. 206 207 Index Number. Nature of Premises. Description of Room. Number of Occupants and Space. Gas, Oil, or Electric Light, in use at time of test. Date, Time, and Position of Test. Volume of C02 per 10,000. Means of Ventilation in in actual use at time of test. Remarks. Position, Process, &c Cubic Capacity, in feet. Height. Number present. Space per person. Date and Time Where Sampled. Inside Room. Outside Air. 27 Fur and Skin Dressers Workshop Second floor. Skin dressing 4000 10 ft. 9 444 None 11.50 a.m Dec. 12th 1904 Body of room, breathing level 11 5 All windows shut, 2 broken and partly blocked; staircase open, large stove on floor above creating up draught Work requires considerable muscular effort. 28 Copper-Plate Printing Works Fourth floor. 19 presses in use. 10438 9 ft. 18 580 8 gas jets alight and 1 gas ring; 19 presses, gas heated 2 P.m., Dec. 12th, 1904 Body of room 30 5 One skylight—open No artificial ventilation, and only one skylight open. 30 Book-edge Gilders' Workshop Second floor. Gilding in progress 12642 10ft.6ins. 23 550 7 gas jets, 2 heating tables 10.30 a.m., Dec. 15th, 1904 Body of room 16 4.5 Two large windows, 3 in. at top; 18 in. electric exhaust fan, stairs to floor above Ditto Third floor (ditto) 12820 10 ft. 19 675 8 gas jets, 2 heating tables Ditto Body of room 9 4.5 Two windows wide open, exhaust fan, stairs from below Free ventilation from end to end of room. The windows probably thrown open 15 minutes before sample was taken. 31 Clinical Thermometer-Work shop Basement, back. Glass blowing 732 7 ft 2 366 1 gas jet, 1 gas blow flare 11 a.m., Dec. 15th, 1904 Body of room 11 4.5 Small window, 2 in. at top, and door Ditto Basement, front. Glass blowing 1470 7 ft. 3 490 2 gas jets, 2 gas blow flares Ditto Body of room 7 4.5 Window, 3 in. at top and broken panes, door 32 Box Making Workshop Ground floor, rear 10600 10 ft. 8 1325 2 gas jets 11.45 a.m., Dec. 15th, 1904 Body of room 11 4.5 No ventilation except leakage between eaves of skylight and wall, and staircase to 1st floor This room is practically unventilated. The gas jets were two glimmers under glue pots, so that the excess of CO2 was practically all due to respiration. 35 Blouse and Skirt Factory Fourth floor. 38 machinists at work 40000 10 to 25 ft. in centre 38 1052 None 2.20 p.m., Dec. 15th 1904 Body of room 18 4.5 One window, 2 in. at top; no other ventilation CO2 entirely due to respiration; the room smelt stuffy, and was without ventilation except for leakage through the window sashes. 208 209 Index Number. Nature of Premises. Description of Room. Number of Occupants and Space. Gas, Oil, or Electric Light, in use at time of test. Date, Time, and Position of Test. Volume of CO2 per 10,000. Means of Ventilation in in actual use at time of test. Remarks. Position, Process, &c. Cubic Capacity, in feet. Height. Number present. Space per person. Date and Time Where Sampled. Inside Room. Outside Air. 36 Button workshop 2nd floor. Metal stamping, &c. 8835 9 ft. 6 in. 22 401 5 gas jets 3.30 p.m., Dec. 15th, 1904 Body of room 21 45 All windows shut; staircase from below This room received a constant supply of foul air from the staircase leading from 1st floor Ditto 3rd floor (ditto) 4408 10 ft. 3 1946 No gas Ditto Top of stails from 2nd floor 27 4.5 One window, 6 in. at top; staircase from below Supplied by staircase with foul air from lower floors. Ditto 1st floor (ditto) 8835 9 ft. 6 in. 9 926 3 gas jets Ditto Body of room 10 45 Two large windows, 2 in. at top; staircase to 2nd floor The air in this room was tested last, when the large windows had been open for twenty minutes, hence the wide discrepancy between the 1st and 2nd floors. 17 Joinery workshop Basement. Part partitioned off from kitchen approx. 7560 10 ft. 6 in. 3 2529 3 gas jets 3 p.m., May 30th, 1904 Body of room 10 3.5 (est'd.) Large window in front; no ventilation in rear Between first test, May 30th, and second test, Dec. 12th, an air shaft was constructed in rear of shop and through ventilation established. 25A Ditto Ditto Ditto Ditto 5 1512 4 gas jets 11 a.m.,Dec. 12th, 1904 Body of room... 6 Ditto Window in front and air shaft in rear F.-GENERAL SANITATION AND ADMINISTRATION. 213 GENERAL SANITATION AND ADMINISTRATION. The Canal and Canal Boats.—The portion of the Canal situated within the Borough of FinSbury and known as the City Road Basin is owned by the Regent's Canal and Docks Company, and consists of a waterway of about 5| acres, a portion of which has a through communication with the River Thames on the one hand and the Midlands on the other. The cut de sac has on either side premises occupied by various firms as factories, warehouses and wharves, with a few residential houses. There are three wharves at which boats load offensive cargo, viz. : 22, Graham, Street, 12, Macclesfield Street, and 26, Wharf Road. The first belongs to the Borough of Islington and the other two to the Borough of Finsbury. The " offensive cargo " consists of street sweepings and house refuse. Complying with section 3 of the Canal Boats Act, 1884, and the instruction of the Local Government Board, dated 21st December, 1904, I have to report as follows :— 1.—The Canal Boats have been inspected by Inspector Arthur Ernest Powell, the Inspector for that portion of the Borough in which the Canal is situated. There is no separate remuneration for this work as the inspection of Canal Boats is included in the duties of the District Sanitary Inspector. 2.—The number of Canal Boats inspected during the year 1904 was 101 (21 being offensive cargo boats). There were 20 Infringements of the Acts and Regulations, necessitating 10 Complaint Notes being sent to those responsible for the abatement of the same. 214 Description of Boat. Number of Boats Inspected. Number of Infringments. Number of Complaint Notes Served. Offensive Cargo 21 11 5 Non-Offensive Cargo 80 15 5 Total 101 26 10 3.—Particulars of Infringements :—• (a) Registration.—No infringements. This Local Authority lias only powers of Inspection. (b) Notification of Change of Master.—No infringements. (c) Certificates.—Three infringements. A boat was working without a certificate on board in one case, and in the other two cases the certificates did not identify the owner of the boats. (d) Marking.—No infringement. (e) Overcrowding.—One infringement. Two children in excess were sleeping in the aft cabin. (/) Separation of the Sexes.—No infringements. (g) Cleanliness.—Two infringements. The aft cabins were in a dirty condition. (h) Ventilation.—One infringement. The ventilating apparatus was blocked up. (i) Painting.—Six infringements. The re-painting of the interior surface of the cabin was required in each case. (j) Provision of Water Casks. —Seven infringements. One boat was without a water vessel, and the cans were dirty and defective in the other cases. (It) Removal of Bilge Water.—One infringement. The boat had no pump on board. (I) Notification of Infectious Disease. — No case notified as occurring among the occupants of the Canal Boats. (to) Admittance of Inspector.—Admittance to the Canal Boats has always been readily granted. 215 In addition to the above, the following defects have been met with, viz.:— 1 Aft cabin deck head defective. 1 Boat leaky at the side. 2 Cabins not in proper repair. 1 Defective stove in cabin. Notices have been served and the infringements rectified. 4.—No Legal Proceedings have been necessary to secure compliance with the Acts and Regulations. 5.—Any Infringements not rectified within the time specified on the Complaint Notes, have always been complied with after a written communication to the owners. 6.—No Infectious Disease has been notified or met with in the Canal Boats, therefore isolation has not been necessary. 7.—Cleansing.—In no instance has a Canal Boat been detained for the purpose of cleansing and disinfection. The following table gives a comparison of the past 6 years as regards the women and children employed on the Canal Boats visiting this district :— Year. Boats Inspected. Persons found on Boats. Totals. Registered for. Men. Women. Children.* 1899 100 206 38 77 321 356 1900 107 222 31 60 313 381 1901 102 207 34 64 305 360 1902 116 189 78 78 345 365 1903 106 183 45 51 279 346 1904 101 179 47 59 285 344 * The term children should be understood to include only those at ages as stated in the Regulations, viz :—under the age of twelve years. 216 Of the 101 Boats inspected it was found that 60 (including the whole of the Offensive Cargo Boats) were occupied by men only. Among the 80 non-offensive Cargo Boats inspected there were 41 occupied by women or children, and 7 by women only. In 29 cases it was found that the persons lived entirely on their boats. One Canal Boat has been the home of a man and his wife for 16 years ; during this time they have reared several children, all of whom are now earning their living elsewhere. We have always found the occupants of the Canal Boats ready and filling to accede to any request or suggestion which we have felt it our duty to make in view of cleanliness and good health. STABLES. We have in Finsbury 494 stables containing in all 5,519 horses. These premises are now entered in our registers as "workplaces," as decided in the case of Bennett v. Harding. It should be understood that separate premises used as stables, though in one and the same occupancy, have been considered as separate stables. Probably there are about 175 stable yards in the Borough, in which are situated the 494 separate premises used as stables. Only 13 of the 494 stables contain two horses or one horse ; the remaining 481 stables contain more than two horses each. In 1904 these premises have all been inspected, and the larger stables have been visited many times, particularly in the summer months. The points to which most attention is given by the inspectors are the number of stables and horses and the purposes for which they are used, the storage of fodder, the storage and removal of manure, the paving and drainage of the stables and stable yards, the water supply, and the arrangements as to periodical cleansing. The following table sets out some of these particulars for stables containing 20 or more horses :— 217 Address. Purpose of Horses. No. of Stables No. of Horses. Conditions as to Manure Removal. Sanitary Conditions, Paving, Water Supply, Cleanliness. St. John Street Road Carriers 3 36 Thrice weekly Good. Warren Mews Cabs 2 20 Do. Do. Do Carriers 2 30 Do. Do. Lorenzo Street Tramways 3 63 Alternate days Do. Holford Yard Cartage Contractor 2 20 Thrice weekly Do. Pentonville Road Commercial 4 50 Daily Fair. Angel Yard Tramways 8 50 Thrice weekly Good. Risinghill Street Cabs 4 69 Do. Do. White Lion Street Do. 3 25 Do. Bad. Claremont Mews Do. 11 24 Daily Do. Do. Carriers 6 22 Do. Do. Jay's Mews Cabs 4 36 Thrice weekly Do. Paradise Street Contractor, G.P.O., etc. 8 350 Daily Good. Castle Street Do. do. 5 355 Do. Do. Hill Street Do. do. 2 57 Do. Do. Castle Street Cartage Contractors 3 78 Thrice weekly Pavingdefective Goswell Road Commercial 6 60 Do. Good. Do. Cabs 2 22 Twice weekly Do. Do. Brougham & light van work 3 30 Daily Bad. Do. Carriers 22 346 Do. Good. Do. Railway Carriers 9 189 Do. Do. Do. General Carriers 23 348 Do. Do. Golden Lane Do. 3 52 Do. Do. New Street Contractor 1 40 Do. Do. Finsbury Street Carrier 8 75 Do. Do. Cross Street Cabs 4 40 Thrice weekly Do. Errol Street Carriers 4 80 Daily Do. Old Street Commercial 2 25 Thrice fortnightly Do. Do. Do. 4 49 Thrice weekly Do. Warwick Place Carriers 5 47 Daily Do. Chiswell Street Brewery 14 211 Do. Do. Brewhouse Yard Commercial 1 21 Twice weekly Do. St. Jolm Street Do. 2 57 Alternate days Do. Do. Do. 2 27 Do. Do. Do. Brewery 2 64 Daily Do. Turnmill Street Railway Co. 14 189 Do. Do. Cow Cross Street Commercial 2 20 Do. Do. Seward Street G.P.O. 23 470 Do. Do. Do. Carman 1 39 Alternate days Do. Clerkenwell Close Commercial 3 22 Thrice weekly Do. Allen Street Van work 2 24 Do. Do. Bowling Green Lane Newspapers 4 40 Twice weekly Do. Sekforde Street Carriers 5 37 Daily Do. Sans Walk Cartage 2 20 Thrice weekly Do. Granville Place Provision Merchants 9 80 Do. Do. Easton Street Cabs 2 23 Twice weekly Fair. River Street Do. 5 33 Do. Good. Baker Street Do. 4 70 Thrice weekly Do. Wharton Street Do. 2 28 Do. Fair. Graham Street Carriers 1 21 Twice weekly Good. Wharf Road Refuse removal 6 26 Daily Do. City Road Carriers 4 51 Do. Do. York Road Do. 17 263 Do. Do. Macclesfield Street Do. 2 69 Do. Do. Hall Street Commercial 5 69 Thrice weekly Do. Sidney Grove Cabs 10 28 Do. Fair. Smaller stables having less than 20 horses in various parts of the Borough Various 184 829 — — 494 5519 218 During the summer we received a large number of complaints as to nuisances arising from accumulations of manure. In a special report last year I entered somewhat fully into this question, which, in a Borough like Finsbury, is one of importance. The report was approved and adopted by the Council, and acting under the Public Health (London) Act, 1891, Sec. 36(2), it was resolved that the Council " do hereby order and direct that the person to whom " the same may belong be required to remove, or cause to be " removed, daily, all manure or other refuse matter from their " stables, cowhouses, or other premises situate in this Metropolitan " Borough, and that public notice of this requirement be given in " the district by bills generally circulated therein and delivered to " such persons as aforesaid at their respective premises." In accordance with this Resolution, the following notice was printed in large bill form and placed on the walls throughout the Borough :— REMOVAL OF MANURE. The Council of the above-mentioned Metropolitan Borough, being the Sanitary Authority for the District, hereby give notice that they require the Daily Removal of Manure or other refuse from all stables, cowhouses, or other premises in the said Borough. The Council further give notice that any person to whom the manure or other refuse belongs who fails to comply with this notice will be liable, under Section 36 (2) of the above-mentioned Act, without further notice, to a fine not exceeding 20/- for each day during which such non-compliance continues. By Order of the Council, (Signed) G. W. PRESTON, Town Clerk. Town Clerk's Office, Finsbury Town Hall, Rosebery Avenue, E.C. 3rd September, 1903. The following Circular was also sent to six firms possessing large stables in the Borough :— 219 METROPOLITAN BOROUGH OF FINSBURY. The Town Hall, Itosebery Avenue, E.C. 190 PUBLIC HEALTH (LONDON) ACT, 1891. REMOVAL OF MANURE. The Council of the above-mentioned Metropolitan Borough, being the Sanitary Authority for the District, hereby give notice that they require the daily removal of manure or other refuse from the stable, cowhouse or other premises occupied by you, and situate a in the said Borough. If you fail to comply with this notice, you will be liable, under Sec. 36 (2) of the above-mentioned Act, without further notice, to a fine not exceeding 20s. for each day during which such noncompliance continues. (Signed) Medical Officer of Health. To Mr of This circular was not sent to owners of small stables, and the Resolution has not been applied to such owners, as accumulations of manure at such places do not, as a rule, create a nuisance. SCHOOLS. There are in Finsbury 21 Public Elementary Schools, containing 18,108 children, as follows :— Schools. No. No. of Infants. No. of Boys. No. of Girls. Totals. Provided 14 5,283 4,784 4,853 14,920 Non-Provided 7 1,287 833 1,068 3,188 Totals 21 6,570 5,617 5,921 18,108 220 During the year 364 cases of notifiable infectious diseases occurred in children at school, as follows :— School. Scarlet Fever. Diphtheria. Enteric Fever. Chicken Pox. Total. Albion Place — 1 — 14 15 Ann Street 13 4 — 2 19 Baltic Street 3 4 3 4 14 Bath Street 15 3 — 6 24 Bowling Green Lane 12 1 2 15 Central Street 8 5 2 2 17 Chequer Street 6 4 1 5 16 Compton Street 28 8 1 15 52 Hugh Myddelton 33 5 — 5 43 Moreland Street 10 3 — 5 18 Risinghill Street 14 2 2 2 20 St. John Street Road 6 2 1 9 (Martyr's Memorial) White Lion Street 10 3 2 1 16 Winchester Street 12 2 1 — 15 Amwell Street 8 2 — 3 13 Brewer Street North — 1 1 King Square (St. Barnabas) 7 3 — — 10 St. Joseph's, Lamb's Passage 1 1 — 2 4 St. Luke's, Old Street 10 6 2 5 23 St. Mark's, Old Street 1 1 2 S.S. Peter and Paul 6 7 — 5 18 Totals 203 67 14 80 364 We have received from the Education Department of the London County Council 146 certificates respecting cases of infectious disease relative to the exclusion of 246 children who had been in contact with those infected. No schools or departments of schools have been (dosed during 1904 on account of infectious disease. We received four complaints respecting verminous children under the London County Council (General Powers) Act, 1904, from the Medical Officer of the Education Department (L.C.C.). Sanitary Work in Schools, 1904.—At the Hugh Myddelton (Laundry Centre) School and at the Baltic Street (Cooking Centre) School, certain drainage work, etc., has been carried out. Extensive re-drainage works have been constructed at the old Radnor Street School, and some minor works carried out at the School of St. Peter and St. Paul, Rosoman Street. 221 DISINFECTION. After all cases of infectious diseases, in a certain number of cases of verminous houses, and in most notified cases of Phthisis, and after all deaths from Phthisis, premises have been thoroughly disinfected. Where necessary the walls have been stripped. No charge is made for disinfection unless the householder requires it to be done at a time when the officers are not on duty. In such cases a nominal fee would be charged. Articles of clothing, bedding, carpets, curtains, etc., have been disinfected in the steam disinfecting apparatus (Goddard, Massey, Warner's and Thresh's machines). Two vans are used for the conveyance of the articles. One van for bringing the infected articles, and a second van for taking the disinfected articles back again. The following is the record of work done during 1904 :— 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Total. Beds 143 334 245 247 969 Mattresses 5 19 21 6 51 Pillows 237 486 488 368 1,579 Bolsters 72 154 119 130 475 Sheets 175 356 308 269 1,108 Blankets 207 372 211 257 1,047 Quilts 137 252 189 208 786 Cushions 21 46 32 15 114 Curtains — 60 6 — 66 Carpets 1 6 3 4 14 Wearing Apparel 120 294 180 131 725 Sundries 521 1,355 796 351 3,023 Burnings 7 7 7 5 26 Totals 1,646 3,741 2,605 1,991 9,983 The above Table deals with articles which have been disinfected. The actual number of occupancies disinfected during 1904, was as follows :— 222 Varicella Small-pox Scarlet Fever Diphtheria Enteric Fever Puerperal Fever Disinfection by request. Measles. Phthisis Totals January — — 16 10 5 — 2 3 21 57 February 2 — 19 5 2 — 4 14 23 69 March — 2 24 5 — — 2 32 17 82 April — 2 34 7 5 — 2 10 14 74 May 1 1 34 19 1 2 3 54 10 125 June — 4 28 13 1 — 4 90 13 153 July — 6 24 12 2 — 2 47 9 102 August — 5 24 13 5 1 5 — 7 60 September — — 40 13 2 1 5 15 13 89 October — — 38 10 5 — — 18 15 86 November — — 26 12 6 2 2 55 17 120 December — — 12 3 7 — 4 69 14 109 3 20 319 122 41 6 35 407 173 1126 In disinfection after infectious disease we use Formic Aldehyde gas (30 tabloids to every 1,000 cubic feet). After Phthisis we spray the room with Chloride of Lime (1—2 per cent). For disinfection of verminous rooms Sulphur is used. When necessary we employ Lingner's Glyco-Formal apparatus for schools, etc. By whatever method gaseous disinfection is practised it may prove ineffectual on account of the fact that what is required is that the disinfectant should be applied directly to infected surfaces of a room. It is therefore better, wherever practicable, to apply the disinfectant by washing or spraying. Accordingly we have adopted the spray method in certain cases, and disinfectant solution (chloride of lime, 1-2 per cent.) is sprayed on to walls, floors, etc. Thorough and wet cleansing of infected surfaces is the desideratum. 223 THE MORTUARIES. We have two Mortuaries, one at Warwick Place, in the Eastern Division, and the other at 47, Northampton Road, in the Western Division. The returns are as follows :— Northampton Road Mortuary. Warwick Place Mortuary. Total. Inquest cases 83 55 138 Infectious diseases 4 11 15 Bodies deposited by Borough Orders 1 7 8 Bodies brought for convenience of relatives, &c. 148 128 276 Total 236 201 437 In addition to the inquests held at the Borough Mortuaries, 95 nquests have been held in places outside the Borough upon bodies if persons belonging to the Borough, making the total number of nquests held 218. The verdicts were as follows :— 1. Natural Causes— 2. Accidental— Heart Disease 24 Fracture of Skull 6 Alcoholism 14 Fracture of Arm, Leg, &c. 4 Rupture of Liver 2 Pneumonia 12 Run over in Street 5 Poisoning 1 Phthisis .13 Injuries caused by fall 22 Cancer 3 Shock from Burns 11 Cerebral Hcemorrhage 8 Asphyxia by Choking 1 Ruptured Aneurism of Asphyxia by Drowning 5 Aorta 4 Miscellaneous 3 Bright's Disease 3 60 Nervous Diseases 6 Meningitis 2 3. Suicides— Convulsions 1 By Hanging 1 Asphyxia 31 By Poisoning 4 Premature Birth 2 By Drowning 2 By Cutting Throat 3 Miscellaneous 34 Miscellaneous 1 157 11 224 The following five-laws respecting the Mortuaries were made and ratified during the year :— METROPOLITAN BOROUGH OF FINSBURY. Public Health (London) Act, 1891. Bye-laws made by the Mayor, Aldermen and Councillors of the Metropolitan Borough of Finsbury with respect to the Management of the Mortuaries in the Metropolitan Borough of Finsbury. Interpretation. 1. Throughout these Bye-laws the expression " the Council " means the Mayor, Aldermen and Councillors of the Metropolitan Borough of Finsbury. General. 2. Rvery person who, in pursuance of permission obtained from the Council, has caused the body of one who has died of an infectious disease to be deposited in the Mortuary shall cause the body to be removed therefrom for the purpose of interment within a period of three days from date of death. 3. Every person who, in pursuance of permission obtained from the Council, has caused the body of one who has died of a non-infectious disease to be deposited in the Mortuary shall cause the body to be removed therefrom for the purpose of interment within a period of five days from the date of death. 4. Every person for the time being employed in depositing a body in the Mortuary, or in removing a body therefrom, shall, while so employed, conduct himself in all respects with decency and propriety. 5. Every person who, being a friend or relative of one whose body has been deposited in the Mortuary, has been admitted to view the body shall, while on the premises, conduct himself in all respects with decency and propriety. 225 6. Every person who, for the purpose of depositing a body in the Mortuary, uses a shell which has not been provided by the Council shall, in every case where the body is transferred from the shell before being carried from the Mortuary premises to place of burial, cause the shell, as soon as conveniently may be after the transfer of the body therefrom, to be removed from the premises, except when the shell has contained the body of one who has died of an infectious disease, when the certificate of the Medical Officer of Health, that the shell has been effectually disinfected, shall be obtained before it is removed. 7. Every person who shall offend against any of the foregoing bye-laws shall be liable for every such offence to a penalty of Five Pounds, and in the case of a continuing offence to a further penalty of Forty Shillings for each day after written notice of the offence from the Council. Provided, nevertheless, that the Justices or Court before whom any complaint may be made or any proceedings may be taken in respect of any such offence may, if they think tit, adjudge the payment, as a penalty, of any sum less than the full amount of the penalty imposed by this Bye-law. Repeal. From and after the date of the allowance of these Bye-laws, the Bye-laws made on the 25th day of October, 1895, by the Vestry of the Parish of St. Luke, for the management of their Mortuary, and allowed by the Local Government Board on the 17th day of December in the same year, shall be repealed. The Common Seal of the Mayor, Aldermen and Councillors of the Metropolitan Borough of Finsbury was, by order, dated 7th July, 1904, hereunto affixed on the 18th day of July, 1904. (Signed) Middleton Chapman, Mayor. (Signed) G. W. Preston, Town Clerk. Allowed by the Local Government Board this 5th day of October, 1904. (Signed) H. C. Monro, Assistant Secretary. Acting on behalf of the said Board under the authority of their General Order, dated the 26th day of May, 1877. 226 Reception Houses.—During disinfection of rooms, free accommodation is provided for the temporarily displaced persons. We have two reception houses, one (41, Macclesfield Street) in the Eastern Division of the Borough, and a second (47, Northampton Road), when necessary, in the Western Division. The total number using the reception houses in 1904 was twenty families of 80 persons. THE WORK OF THE LADY SANITARY INSPECTOR. On the 17th March, 1904, the Borough Council appointed Mrs. Greenwood (Diploma Nat. Health Society, Cert. Sanitary Inspectors' Exam. Board) as Temporary Sanitary Inspector, and on the 18th April, 1904, she began the following work, i.e., the inspection of houses where an infant death had occurred and investigation into the cause of death, investigation into cases of measles, the inspection of workshops where women and girls are employed, and the inspection of the premises of home workers. In October, 1904, the appointment was made permanent, and the results of her work are shown in the following pages Investigation of Deaths of Infants.—A systematic investigation has been carried out into the causes and circumstances of the deaths of infants, that is, of children under 12 months of age. Enquiries have been made into 385 infant deaths, and in 356 cases the information obtained has been classified in the adjoining table. Classified List of 356 Infants' Deaths, shewing Methods of Feeding, &c. No. of Deaths CAUSE OF DEATH Method of Feeding Mother's Work Condition of Tenement No. of Rooms in Ditto Age in Months Breast only Breast, &c. Cow's Milk Condensed Not Fed No Occupation Away from Home Do. Intermittently Soma Home Work Clean Fair Dirty One Two Three Four or more 0 1 2 3 4 5 6 7 8 9 10 11 106 Diarrhœa 12 12 50 32 — 68 17 8 13 43 42 21 31 45 17 13 4 11 13 14 9 14 5 17 4 4 4 7 54 Prematurity 13 — 7 3 31 38 4 3 9 33 14 7 13 22 10 9 49 4 1 — — — — — — — — — 46 Marasmus 10 4 20 10 2 34 4 4 4 14 17 15 16 24 2 4 7 8 11 4 2 4 3 3 — 1 — 3 27 Bronchitis 10 2 8 7 — 19 1 6 1 11 13 3 7 11 7 2 3 2 4 1 1 3 2 2 2 2 2 3 36 Pneumonia 9 13 8 5 1 24 2 7 3 7 22 7 10 17 5 1 1 2 — 2 2 3 3 3 3 3 3 11 16 Convulsions 8 2 4 2 — 9 2 3 2 11 4 1 5 9 — — 6 i — — 1 1 — 2 — 2 1 2 17 Suffocated in Bed 13 2 1 1 — 13 — 1 3 8 4 5 4 12 1 — 1 7 2 2 3 2 — — — — — — 11 Measles 3 4 4 — — 6 1 2 2 3 5 3 2 5 3 1 — — — — — — — — — 1 2 7 7 Whooping Cough 4 1 2 — — 3 — 2 2 1 3 3 3 2 1 1 — — 1 1 1 2 — — — 1 1 — 13 Tuberculosis 3 4 3 3 — 9 — 3 1 3 6 4 5 7 1 1 — — — 1 3 1 2 2 1 1 1 1 3 Diphtheria — 2 1 — — 2 — 1 — 1 — 2 1 1 1 — — — — — — — 1 1 — — — 1 20 Miscellaneous 9 2 6 1 2 19 1 — — 13 5 2 5 10 4 1 7 2 2 1 1 2 1 — — 1 3 — 356 94 48 114 64 36 244 32 40 40 148 135 73 102 165 54 35 78 37 34 26 23 32 17 31 10 16 17 35 22 228 It will be seen that, excluding the 36 who did not live long enough to take any food, 178 infants or 55 per cent. were fed artificially, and in the cases of Diarrhoea and Marasmus the per centage is much higher, 77 per cent. of the deaths from the former cause and 65 per cent. of the latter cause occurring among bottlefed infants. Scrupulous care and cleanliness are required successfully to rear such children, but it was found that in the cases of deaths from Diarrhoea 20 per cent., and in the cases of deaths from Marasmus no less than 34 per cent. of the tenements were dirty. The importance of a pure and clean milk supply for such infants, as can now be obtained at the Milk Depot in Goswell Road, cannot be over estimated. The difficulty is to make the mothers realise this fact. Of the 17 deaths from suffocation 47 per cent, occurred between Saturday night and Monday morning; the table shows that this fatality occurs much more frequently with breast-fed than bottle-fed children. On enquiry many of the mothers admitted their habit of "giving the breast" at night lying down. They frequently fall asleep during the process, sometimes with fatal results to the infant. In the column of the table headed "Mother's Work," "no occupation" indicates that the mother has not worked since the birth of the deceased child, except in the cases of prematurity, when the occupation of the mother during the previous year is recorded. That poverty is a very important factor in the high infant death rate in the Borough is shown by the fact that 90 per cent. of the deaths occurred in one, two and three-roomed tenements. Associated with poverty one finds overcrowding, lack of fresh air, and generally unhealthy conditions, which, together with ignorance and neglect, have a very disastrous effect on infant life. In the course of the investigation 53 nuisances were found, and 37 notices served and 189 re-visits paid. Sanitary Conveniences defects remedied 11 Rooms stripped and cleansed 9 Floors and Bedding cleansed 5 Sanitary Conveniences cleansed 8 Staircases stripped and cleansed 5 Washhouses limewashed 4 Other defects remedied 11 229 A large number of enquiries into the cases of measles occurring in the Borough during 1904 (see p. 52) have also been made :— Measles. No. of Oases investigated 680 „ Re-Visits paid 298 „ Nuisances found 52 „ Notices served 41 Rooms stripped and cleansed 9 Dirty Floors and Bedding 7 Staircases stripped and cleansed 8 Sanitary Conveniences cleansed 7 „ „ defects remedied 7 Overcrowding of Rooms abated 4 Yard Walls limewashed 3 Washhouses limewashed and repaired 3 Underground Rooms illegally occupied 2 Other Nuisances remedied 2 The Lady Inspector has also carried out a large amount of work in connection with the inspection of factories and workshops, particularly, of course, those places where women and girls were chiefly or only employed. This work has been of a kind which it is not easy, accurately, to summarize, but the following Table sets out briefly a record of such inspection, etc. Some of the items here tabulated are incorporated in the Tables appearing on pp. 185 and 186, but the returns below concern only the work of the Lady Inspector:— 230 Factories and Workshops. Total Number of visits and re-visits 372 No. of Factories inspected 9 „ Workshops „ (including those of 63 outworkers) 142 „ already on register 82 „ „ placed on „ 60 „ „ removed from „ 30 „ „ with no abstract affixed 25 „ Reports to Home Office 21 „ Workrooms inspected 227 „ „ measured 94 „ „ mixed (men and women) 77 „ „ women only 150 „ Women employed 1565 „ Workrooms in order 116 „ „ cleansed 60 „ „ overcrowded 2 „ Workshops with insufficient sanitary conveniences 2 „ „ „ no separate accommodation for the sexes 3 „ Sanitaiv Conveniences cleansed 23 „ „ „ defects remedied 8 „ other nuisances abated 15 „ Workplaces visited where no women were found to be employed 22 „ Notices served re Factories 2 „ „ „ re Workshops 58 „ re-visits to Workshops 169 „ „ to Factories 4 Complaint from Home Office (re Factory) 1 „ anonymous (re Workshop) 1 231 In addition to the nuisances of all kinds dealt with by the lady inspector, 35 involving structural alterations (including drainage) were handed on to the District Sanitary Inspectors. The work in connection with Out-workers and Home-workers, which has been done by Mrs. Greenwood, will be found under Section iii. of the Report on Factories and Workshops, p. 180. From the above facts it will be evident that an exceptionally large amount of excellent work has been done by the Lady Sanitary Inspector, a work which, in my opinion, has abundantly justified her appointment. I must also add that during the whole of the latter half of the year the Department was fortunate in receiving the voluntary services of Miss Mildred Jones, a fully-qualified lady sanitary inspector, who has done most valuable work in co-operation with Mrs. Greenwood. No doubt the large amount of work done has been due to this fact, as Miss Jones has assisted in all the sanitary work coming within the duties of the Lady Sanitary Inspector. I am satisfied that the work of these two ladies has been of substantial value to the Borough. LONDON COUNTY COUNCIL (GENERAL POWERS) ACT, 1904. The above Act came into force on August 15th, 11)04. The provisions of interest to Sanitary Authorities are contained mainly in Part IV., and are as follows :— Section 19 enables the Sanitary Authority, at their own expense, to cleanse, purify, or destroy any articles in any house, or part thereof, if in such a filthy or unwholesome condition as to affect or endanger health, or if such purification is requisite to prevent risk of, or to check infectious disease. The Sanitary Authority will have to coinpensate the owner if unnecessary damage be done, and reasonably to compensate him for any articles destroyed. Section 20 enables the Sanitary Authority to require the cleansing of houses infested with vermin—upon notice in writing to the owner or occupier of a house, or part thereof, requiring hiin within a specified 232 period to cleanse such house or any portion thereof, and, if so required, to remove the wall-paper, and to take such other steps for the purpose of destroying and removing vermin as the case may require. Section 21 enacts that section 59 of the Public Health (London) Act, 1891, "shall for the purposes" of the aforementioned sections 19 and 20, "extend and be applicable to the provision of means" for giving effect to these "as if the said section were re-enacted herein and in terms made applicable thereto." Section 22 enables the Sanitary Authority to require the removal or alteration of sanitary conveniences (urinals, etc.) accessible from any street, if so placed or constructed as to be a nuisance or offensive to public decency. Section 23 enables the Sanitary Authority to enforce the removal of a fixed ashpit where a moveable ashpit, "conforming with the requirements of any by-law or order made under any statutory power or authority in that behalf," shall have been provided. Section 24 gives the Sanitary Authority power of entry if they have reasonable cause to suppose any house, or part thereof, contains filthy, dangerous, or unwholesome articles, requiring to be purified (Section 19), or is "infested with vermin" (Section 20). Section 48 enacts that any pecuniary penalty inflicted in consequence of proceedings taken by a Sanitary Authority against any person in respect of any offence under "Part VIII. (Ice-creams)" of of the County Council's (General Powers) Act, 1902, shall be payable and paid to such Sanitary Authority. Part V. of the Act, dealing with "Tuberculosis of the Udder in Cows," enables the County Council's veterinary surgeon to cause any cow suspected by him to be suffering from that disease, to be removed from any dairy farm, or cowshed, situate in the county, and, after valuation, with a view to settling the amount of compensation payable to the owner, to be slaughtered. These provisions are important and some of them have definite application in Finsbury. For instance in the poorer districts of the Borough probably about 70 per cent. of the houses contain vermin, but in the better parts not more than 10—20 per cent. Vermin occurs mostly in wainscotting woodwork, floors, old wall papers and bedding. Probably it would be correct to say that about half of the articles disinfected in the steam disinfectors were infected with vermin. Then again in a number of cases we have received 233 plaints respecting sanitary conveniences at public houses and beer shops. About 250 of these premises (out of 309) are provided with " conveniences," and to many of these objection is taken. During the year there were seven cases of ill-construction which were ultimately remedied. Fixed ashpits are being reduced slowly and the new Act will give us necessary powers to expedite this reduction and removal. Medical Officers' Systematic Inspection —During the year I have carried out a systematic inspection of houses and properties in the following streets :—- Red Lion Street, Benjamin Street, Pump Court, Albion Place, St. John's Lane, Francis Court, Berkley Court, St. John Street, Union Place, Allen Street, Compton Street, Valetta Street, Sektorde Street, Rosoman Street, Noble Street, Merlins Place, Margaret Street, Ann Street, Spring Street, Sidney Street, Sidney Place, Sidney Grove, Percival Street, Raliere Street, President Street, Macclesfield Street, Macclesfield Place, Hall Street Cottage Lane, New Charles Street, Buxton Street, Rawstorne Street, Wynyatt Street, Goswell Terrace, Spencer Street, Albert Street, Sermon Lane, Chapel Street, James Gardens. A large number of defects and nuisances were found and remedied by sanitary notices. There is a decided improvement in the general sinitary condition in many of these streets, although constant attention is necessary to keep much of this property up to the mark. Fixed ashpits still exist in large numbers in certain streets in Cler ken well. SMOKE NUISANCES. During the year 135 observations of black smoke were made by the Inspectors. On 28 occasions the nuisance was of such degree and quantity that notices had to be served, and in 3 cases legal proceedings ensued. We received 11 official complaints from the Public Control Department of the London County Council. I am satisfied that much is being done year by year in this Borough in the direction of securing an atmosphere unpolluted with black smoke, and in a central district like Finsbury this is a matter of importance. 234 SANITARY INSPECTION. There are on the Staff of the Department a Chief Sanitary Inspector, a special Meat Inspector, six District Sanitary Inspectors, a Factory and Workshop Inspector, a Lady Inspector, and three Clerks, who devote the whole of their time to the work of the Department.® For purposes of sanitary inspection and supervision the Borough is divided into six districts, to which are attached six Inspectors, one to each district. In his sanitary district each Inspector undertakes duties under the Public Health and the Sale of Food and Drags Acts. There are five men regularly engaged in the work of Disinfection and the Mortuaries, etc. The ordinary duties of the Sanitary Inspectors include the inspection of dwelling-houses, milk-shops, bakehouses, etc.; the investigation of cases of infectious disease; the supervision of sanitary works and drainage; the enquiries respecting complaints made to the Department, and smoke and general nuisances. Reports are furnished to me by the inspectors from time to time having reference to the above matters, the more important matters being specially reported in writing. The construction of the drainage of new buildings is supervised by the Borough Surveyor (Mr. P. G. Killick). The Department also has the advantage of the advice and co-operation of the Borough Surveyor in all matters affecting drainage. Refuse collection and destruction, cleansing of streets, and regular emptying of dustbins,and dust-boxes is undertaken by the Wharf and Cleansing Department (Mr. A. May, Superintendent). The refuse of model-dwellings is removed bi-weekly, and from ordinary houses weekly. Rapid and effectual removal of refuse and dust and the satisfactory cleansing of streets, particularly in the months of July and August, is of great importance. The relationship between bad scavenging and disease is an intimate one, and there can be no doubt that a well scavenged town, other things being equal, will be characterised by a lower infantile death rate and a lower zymotic death rate than that occurring in a dusty and badly scavenged town. (*) During 1904 the Department has been fortunate in receiving the voluntary services of Dr. Sandilands and Miss M. Jones, who have carried out a large amount of special work mentioned in the foregoing Report. 235 Work of Sanitary Inspectors. Inspector Ensor. Inspector Davis. Inspector Longden. Inspector Norman. Inspector Hindhaugh. Inspector Powell. Total. Damp, dirty, or dilapidated houses nuisances remedied 176 138 173 272 188 144 1O91 Defective doors, windows, floors, ceilings, sashcords, &c 78 46 42 77 59 83 385 Illegal occupations of kitchens, cellars, or underground rooms remedied 3 - 2 9 2 4 20 Water-closets cleansed or repaired 278 215 265 198 253 216 1425 Additional water-closets provided 17 2 18 29 10 — 76 Urinals cleansed or provided 4 19 3 14 13 3 56 Defective soil-pipes and ventilating shafts repaired 13 17 4 15 9 8 66 Yards drained, paved, repaired, or limewashed 106 97 41 308 220 143 915 Waste and sink pipes repaired or remedied 45 23 10 22 18 21 139 Water cisterns cleansed or repaired 44 72 9 23 57 37 242 Accumulations of rubbish, manure, & c., removed 33 42 7 22 27 45 176 Dung or dust receptacles repaired or renewed 35 73 47 115 80 68 418 Defective drains relaid 33 46 36 83 56 57 311 Drains cleared 16 5 18 21 15 54 129 Rain water pipes repaired, &c. 17 27 9 56 48 21 178 Defective roofs and gutters repaired 67 28 33 116 66 79 389 Areas paved, lime washed, or repaired 18 5 8 37 67 15 150 Water supply to houses re-instated 11 5 12 3 1 8 40 Washhouses re-paved or repaired 121 7 8 155 91 45 427 Bakehouses cleansed or repaired — 2 - - 1 - 3 Restaurants cleansed or repaired Nuisances from animals abated 11 2 46 3 13 12 7 2 2 27 3 111 17 Basements cleansed or repaired 12 14 5 10 73 12 126 Stables re-paved or repaired 4 23 16 3 18 64 Smoke nuisances abated 1 8 — — 1 2 12 Miscellaneous nuisances abated 22 24 17 12 15 11 101 House-to-house inspections 316 240 272 336 150 234 1548 First visits on complaints, &c. 723 1116 994 1449 770 1473 6525 Re-visits 3751 4775 4426 5018 2970 4337 25277 Intimation Notices served 505 444 501 776 418 435 3079 Statutory Notices served III 80 76 169 158 95 689 Infectious disease investigations 224 93 257 305 256 124 1259 Cases of overcrowding abated 21 4 22 30 13 33 123 Cases of overcrowding abated in registered houses 16 25 33 25 10 18 127 Canal boat inspections - - - - - 101 101 The above Table does not include any reference to particulars regarding the inspection of Factories and Workshops. 236 LEGAL PROCEEDINGS UNDER THE PUBLIC HEALTH (LONDON) ACT, 1891, AND THE METROPOLIS LOCAL MANAGEMENT ACT. Date Name and Address of Defendant. Offence. Result. Jan. 7th J. W. Rowley. 216, Green Lanes Failing to supply a dustbin to 59, Lever Street Fined £2 & £1 3s. costs. Feb. 17th E. L. Martin, Esq., M.B., St. Bartholomew's Hospital Failing to notify a case of Enteric Fever Fined 2s. and £1 3s. costs. „ 18th Richard Walpole, 58, Fann Street Fixing light iron ventilating pipe to drain at 39, Featherstone Street Fined £1 and 2s. costs. „ 19th Herbert P. Fletcher, 29, New Bridge Street Failing to repair defective water apparatus to water-closet at 34, Northampton Road Fined £5 and 2s. costs. " 19th Busby & Eames, Baron Street Failing to alter and amend a defective drain at Baron Street Fined £4 and 2s. costs. „ 24th J. P. Maley, 10, Waterloo Street Failing to alter and amend a defective drain at 29, Radnor Street Fined 1s. & £5 5s. costs. „ 24th J. B. Kyffin, 350, Mare Street Failing to make a return under the byelaws relating to houses let in lodgings Dismissed. „ 27th Geo. Billings, 254, Mare Street Failing to alter and amend defective drain at 4, Thomas Place Order made with £10 10s. costs. Mar. 18th School Board for London, Victoria Embankment Allowing black smoke to issue from the boiler chimney at Compton Street Schools Fined £5 and 2s. costs. April 7th Haskins Bros.,20-24, Old Street Allowing black smoke to issue from boiler chimney shaft Fined £1 & £1 3s. costs. „ 29th A. Barnett, 30, Clifton Gardens, Maida Vale Failing to provide a drain to carry off stagnant water under a workshop at 111, Pentonville Road Fined £5 and 2s. costs. May 6 th Barry & Barry, 64, Red Lion Street, W.C. Failing to provide additional dustbin accommodation at 167, Farringdon Road Fined £2 and 2s. costs. „ 20th Barry & Barry, 64, Red Lion Street, W.C. Failing to alter and amend a leaky roof at 32, Great Bath Street Prohibition Order made,£l 5s. costs. July 1st* Chambers & Son, Ltd., 56, Wilson Street Constructing a water-closet at 47, Wilson Street contrary to the London County Council bye-laws Dismissed. *See also page 187. 237 Data. Name and Address of Defendant. Offencce. Result- July 29th London and India Dork Co., l09, Leadenhall Street Allowing black smoke to issue from the 1 toiler chimney at Cold Air Stores, St. John Street Fined £10 and 2s. costs. Aug. l6th A. H. Pile, 1, La Bell Alliance Avenue, Ramsgate Failing to provide a supply of water to the dwelling house 35, Macclesfield Street Ordered to pay £10 10s. costs. SALE OF FOOD AND DRUGS ACTS. Jan. 1st F. W. Bartlett, 27, Caledonian Road For selling milk which had been adulterated by the addition of 10.8 per cent. of water Fined 10s. and 12s. 6d. costs. „ 28th Hollis & Co., 102, Bishopsgate Street Without, E.C. For selling vinegar 20.0 per cent. deficient of acetic acid Fined £1 & £2 4s. costs. Feb. 25th Emily Owen, 41, President Street For selling mustard adulterated by the addition of 30.0 per cent. of starch Fined £1 & £1 3s. costs. „ 28th C. H. Hammick, 25, Lloyd's Row For selling butter adulterated by the admixture of water 1.3 per cent. in excess of standard Fined 5s. & 12s. 6d. costs. Mar. 25th Enoch Lewis, 13, Yardley Street For selling butter adulterated with 79.0 per cent. foreign fat Fined £2 & 12s. 6d. costs. >> Do. do. For exposing margarine for sale without a label Fined £2 & 12s. 6d. costs. » Samuel Francis, 2, St. John Street Rd. For selling milk adulterateed with 10.5 per cent. added water Fined £1 & 12s. 6d. costs. April 12th Thomas Lewis, 44, Margaret Street For sell.ng butter adulterated with 2.3 per cent. of water in excess of standard Fined £1 & 12s 6d. costs. ,, Maria Mella, 37, Warner Street For selling milk adulterated with 7.2 per cent. added water Fined 12s. 6d. costs. ,, 14th Isaac Davies, 52, Old Street For selling margarine in an unstamped wrapper Fined £5 & £1 3s. costs. „ 29th Ann Rees, 3, Penton Street For selling milk from which 14.0 per cent.of its cream had been abstracted Fined £1 & 12s. 6d. costs. . „ 29th Chas. Farrer, 3, Great Bath Street For selling milk from which 11.0 per cent, of its cream had been abstracted Fined £2 & 12s. 6d. costs. „ 29th Giovanni Parmigiani, 33, Warner Street For selling milk from which 14.0 per cent. of its cream had been abstracted Fined £1 & 12s. 6d. costs. 238 Data. Name and Address Of Defendant. Offence. Result May 26th Francis Rhind, 27, Bastwick Street For selling milk from which 12.6 per cent. of its cream had heen abstracted Fined £1 & 12s. 6d. costs. June 8th Isaac and Amelia Higgs, 8, Hermes Street For selling milk adulterated with 19.6 per cent added water Fined £6. July 1st Jane Jones, 76, Compton Street For having margarine exposed for sale unlabelled Fined £3 & 12s. 6d. costs. ,, 7th Dinah Jones, 87, Central Street For selling milk 20.3 per cent. deficient in cream Fined £3 & 12s. 6d costs. „ 7th Frank Barries, 131, Lever Street For selling milk 24.0 per cent. deficient in cream Fined £4 & 12s. 6d, costs. „ 29th Henry Wright, 11, Matilda Street, N. For selling milk 14.0 per cent. deficient in cream Fined £1 & 12s. 6d costs. „ 29th Jane Jones, 76, Compton Street For selling milk 10.0 per cent. deficient in cream Fined 10s. and 12s. 6d. costs. „ 29th William Jenkins, 6, Aylesbury Street For selling milk 11.3 per cent.deficient in cream Fined £1 & 12s. 6d costs. Aug. 19th Noah Spiers, Garnault Place For selling milk adulterated by the addition of 8.0 per cent. of water £1 13s. 6d costs. „ 25th William Owen, 40, East Road For selling milk deficient in cream to the extent of 15.0 per cent. £2 costs. „ 25th David Hughes, 37, Baldwin Street For selling milk deficient in cream to the extent of 7.3 per cent. £2 costs. Oct. 25th Henry Styles, 31, Penton Street For selling milk deficient in cream to the extent of 6.3 per cent. and adulterated by the addition of 5.0 per cent. of water Fined £3 & 12s. 6d costs. " 27 th Thomas Bubb, 207, Whitecross Street For selling butter adulterated with 85.0 per cent. foreign fat Fined £1 & 12s. 6d costs. Nov. 22nd Harriett Rennells, 70, Margaret Street For selling milk deficient in cream to the extent of 8.0 per cent. 12s. 6d. costs. Dec. 22nd Dinah Jones, 87, Central Street For selling milk adulterated by the addition of 29.6 per cent. of water Fined £5 & £1 3s costs. „ 23rd John Rowland, 24, Collier Street For selling milk adulterated by the addition of 14.8 per cent. of water Fined £10 and 12s. 6d. costs. 239 LONDON COUNTY COUNCIL (GENERAL POWERS) ACT, 1902. Date. Name and Address of Defendant. Offence. Result. Mar. 25th Johanni Decicia, 1, Sumner Street, Back Hill For selling ice-cream from a barrow on which the name and address of the manufacturer was not legibly inscribed Fined 10s. and 2s. costs. April 12th Michael Tufani, 247, Liverpool Road Do. do. Fined 5s. and 2s. costs. May 6th Luigi Biondi, 4, Henry St. Buildings Do. do. 2s. costs. ,, Antonio Araniello, 4, Henry St. Buildings Do. do. 2s. costs. „ 20th Emannielli Bratersini, 5, Sumner St., Back Hill Do. do. Adjourned sine die. FACTORY AND WORKSHOP ACT, 1901. April 7th S. Markheim, 88 and 90, Golden Lane Failing to supply list of outworkers' names and addresses See also page 187 Fined £1 and 2s. costs. 240 SUMMARY OF PROCEEDINGS UNDER THE PUBLIC HEALTH & FACTORY & WORKSHOP ACTS. The following Tables and Statement have heen drawn up in accordance with suggestions received from the Medical Officer of Health of the Administrative County of London in order to facilitate uniformity in stating returns for the various Metropolitan Boroughs :— Proceedings during 1904. Premises. Number op Places— Number of inspections, 1904. Number of notices, 1904. Number of prosecutions, 1904. On register at end of 1903. Added in 1904. Removed in 1904. On register at end of 1904. Milk premises 261 15 6 270 348 58 - Cowsheds 7 — 1 6 42 7 — Slaughter-houses 5 — 1 4 101 — - Other offensive trade premises - - - - - - - Ice cream premises 101 — 1 100 206 48 - Registered houses let in lodgings 1079 52 — 1131 9036 {1 (a)*131 { (6)* 883 {(a)* Nil {1(b)* 4 • (a) For overcrowding. • (b) For other conditions. Overcrowding, 1904. Number of dwelling rooms overcrowded 250 Number remedied 250 Number of prosecutions — Underground rooms. Illegal occupation dealt with during year 20 Number of rooms closed 3 Insanitary houses— Number closed under the Public Health (London) Act, 1891 — Number closed under the Housing of the Working Classes Act 72 241 Shelters provided under sec. 60 (4) of the Public Health (London) Act, 1891— Number of persons accommodated during the year 86 Revenue Acts— Number of houses for which applications were received during the year — Number of tenements comprised therein Number of tenements for which certificates were (a) granted (brefused (c) deferred — Number of prosecutions under By-laws under Public Health Act, 1891— (a) For prevention of nuisance arising from snow, ice, salt, filth, etc. — (b) For prevention of nuisance arising from offensive matter running out of any manufactory, etc. — (c) For the prevention of keeping animals in such a manner as to be injurious to health — (d) As to paving of yards, etc., of dwelling houses — (e) In connection with the removal of offensive matter, etc. — (/) As to cesspools and privies, removal and disposal of refuse, etc. 2 (g) For securing the cleanliness of tanks, cisterns, etc. — (h) With respect to water closets, earth closets, etc. 1 (i) With respect to sufficiency of water supply to water closet 1 (j) With respect to drainage, etc. (Metropolis Management Act, Section 202) 4 (k) With respect to deposit of plans as to drainage, etc. Metropolis Management Acts Amendment (By-laws) Act, 1899— Mortuaries— Total number of bodies removed 437 Total number of infectious bodies removed 15 A.- Inspection of Factories , Workshops and Workplaces. Class of Works. Number of Places.‡ Number of Number of Prosecutions, 1904. On Register at end of 1903. Added in 1904. Removed in 1904. On Register at end of 1901. Number of Inspections, 1904. Written Intimations, 1904. Notices, 1904. Under Factory Act. Under Public Health Act. Premises. Rooms. Factories Factory Laundries 4 4 8 - 44 3 - Factory Bakehouses - — - — — - — - - - Other Factories 155 201 10 346 — 873 121 16 - l Workshops* Workshop Laundries 30 3 9 24 - 1 4 - - - - Workshop Bakehouses 63 - 2 61 - - - - - - Other Workshops 1621 430 330 1721 — 2139 275 38 l 2 Workplaces Places where Food is prepared for Sale † 333 8 11 330 - - - - - Workplaces other than the above Included in "other workshops." 708 83 14 — — § Home-workers' premises 274 149 185 238 — 489 22 1 — — Total 2480 795 547 2728 — 4267 504 69 l 3 * In a separate Table (p. 166) the more important classes of workshop industry are set out. † A Register is required by s. 131 in the case of Workshops only. ‡ Under this head are included the Kitchens of Hotels, Restaurants, Eating Houses of all sorts, Tripe, Fried Fish and Eel Shops, Ice Cream Premises, and other places where food is prepared. § Not being factories or workshops, domestic or otherwise, and in which the occupations carried on are limited to those specified in s. 107. 242 243 Matters dealt with in connection with Factories, Workshops and Workplaces, Particulars. Number op Defects. Notices Issued Prosecutions Found Notified by Home Office Remedied Notified to Home Office Matters under the Public Health (London) Act, 1891. Want of Cleanliness 119 9 128 - 128 — Want of Ventilation 40 2 42 - 42 — Want of Air Space: Overcrowding 5 2 7 — 5 Sanitary Accommodation. Absent or insufficient 57 - 57 - 57 - Unsuitable or defective 445 6 451 - 451 1 Not separate for Sexes 5 — 5 — 5 — Want of Drainage of Floors 2 - 2 - 2 - Other Nuisances 2 77 - 277 - 277 2 Contraventions of Factory and Workshop A ct, 1901. Illegal occupation of Underground Bakehouse (s. 101) 2 2 2 - Breach of Special Sanitary Requirements for Bakehouses (ss. 97 to 100) - - - - - - Failure as regards Lists of Outworkers (s. 107) 61 — 61 60 1 Givingoutwork to be done in premises which are Unwholesome (s. 108) — - - Infected (s. 110) — — - - Allowing Wearing Apparel to be made in Premises infected by Scarlet Fever or Smallpox (s. 109) - - - - - - Other Contraventions 120 — — 120 - - Totals 1133 19 1032 120 1029 4 244 Lists of Outworkers (s. 107). Class of Homework Number of Lists Received, 1904. Number of Addresses of Out-workers Due Feb. 1st Due Aug. 1st Forwarded to other Authorities Received from other Authorities No. of Lists No. of Outworkers No. of Lists No. of Out- workers Due Feb. 1st. Due Aug. 1st. Due Feb. 1st. Due Aug. 1st. Wearing Apparel— Furriers 5 25 5 31 21 26 Hats and caps 2 7 3 14 5 12 Mantles, costumes, &c 9 101 7 130 96 117 Millinery 2 16 2 34 16 28 Shoes and boots 7 188 7 186 175 177 Tailors and clothier 15 178 18 111 166 99 Ties and scarves 3 183 3 174 173 167 Underclothing, shirts, skirts, blouses, etc. 32 1405 30 1188 1362 1155 83 69 Lace - - - - - - Cabinet making - - - - - - Fur pulling - - - - - - Other 6 62 12 56 54 42 Totals 81 2165 87 1924 2068 1823 83 69 Factories. Workshops. Workplaces. Total Number of Outworkers (persons) on register at end of year 1904 11 104 255 370 Number of Outworkers' premises on register at end of year 1904 11 104 254 369 Total number of Outworkers (persons) dealt with during the year 1904 — — — 4241 Total number of Outworkers' premises dealt with during the year 1904 — — — 538 245 Number of Notices prohibiting homework in unwholesome premises (s. 108) Number of Cases of infectious disease notified in homeworkers premises 9 Number of Orders prohibiting homework in infected premises (s. 110) — Cases reported to H.M. Inspector— Failure to affix Abstract 85 Replies as to action taken in cases notified by H.M. Inspector 19 Other matters 35 Number of underground bakehouses in use at the end of 1904 40 Certificates granted during the year (s. 101) 7 Number of workshop rooms measured 560 LOCAL GOVERNMENT TABLES. 249 TABLE I. Name of District—Metropolitan Borough of Finsbury. For Whole District. Year. Population estimated to middle of each Year. births. Deaths under one year of age. DEATHS AT ALL Ages. Total. Deaths IN Public instituTIONS. Deaths of nonresidents registered District, Deaths of Residents registered beyond District. Deaths at all Ages NRtt Number. Rate.* Number. Rate per 1,000 Births registered Number. Rate.* Number, Rate.* 1 2 3 4 5 6 7 8 9 10 11 12 13 1901 101,463 3,792 37.3 461 121.6 1,318 13.0 33 29 880 2,169 21.4 1902 100,487 3,624 36.0 558 153.9 1,411 14.0 40 35 907 2,283 22.7 1903 100,487 3,664 36.4 503 159.1 1,169 11.6 43 46 870 1,993 19.8 1904 98,958 3,603 36.4 522 144.9 1,174 11.9 59 55 965 2,084 21.1 *Rates calculated per 1,000 of estimated population. Note--The deaths to be included in Column 7 of this table are the whole of those registered during the year as having actually occurred within the district or division. The deaths to be included in Column 12 are the number in Column 7, corrected by the subtraction of the number in Column 10 and the addition of the number in Column 11. By the term "Non-residents" is meant persons brought into the district on account of illness, and dying there; and by the term " Residents" is meant persons who have been taken out of the district on account of illness, and have died elsewhere. Area of District in acres Total population at all ages 101,463 (exclusively of area 589 Number of inhabited houses, 9,820 At Census of 1901. covered by water). Average number of persons per house, 10 9, 250 TABLE II. Borough of Finsbury. Names of Localities 1—The Borough 2—North Clerkenwell 3—South Clerkenwell 4—Finsbury (ST luke) 5—St Sepulchre year Population estimated to middle of each Year Births registered Deaths at all Ages Deaths under 1 year Population estimated to middle of each Year Births registered Deaths at all Ages Deaths under 1 year Population estimated to middle of each Year Births registered Deaths at all Ages Deaths under 1 year Population estimated to middle of each Year Births registered Deaths at all Ages Deaths under 1 year Population estimated to middle of each Year Births registered Deaths at all Ages Deaths under 1 year a b c d a b C d a b c d a b C d a b c d 1901 101,463 3,792 2,161 461 35,028 1,059 699 158 28,676 888 583 124 36,116 1,808 848 173 1,643 37 31 6 1902 100,487 3,624 2,283 558 34,691 1,056 783 183 28,400 881 593 152 37,769 1,649 873 217 1,627 38 34 6 1903 100,487 3,664 1,993 503 34,691 1,060 667 163 28,400 879 519 125 35,769 1,692 776 210 1,627 33 31 5 1904 98,958 3,603 2,084 522 34,163 1,078 743 191 27,968 832 529 123 35,225 1,660 775 206 1,602 33 37 2 Notes—(a) The separate localities adopted for this table should be areas of which the populations are obtainable from the census returns, such as wards, parishes or groups of parishes, or registration sub-districts. Block 1 may, if desired, be used for the whole district; and blocks 2, 3, &c., for the several localities. In small districts without recognised divisions of known population this Table need not be filled up. (b) Deaths of residents occurring beyond the district are to be included in sub-columns c of this table, and those of non-residents registered in the district excluded. (See note on Table 1, as to meaning of terms "resident" and "non-resident.") (c) Deaths of residents occurring in public institutions are to be allotted to the respective localities, according to addresses of the deceased. 251 TABLE III. Cases of Infectious Disease Notified during the year 1904. Borough of Finsbury. Notifiable Disease Cases Notified in Whole Distict Total Cases Notified in each Locality No. of Cases removed to Hospital from each Locality At All Ages At Ages—Year 1 2 3 4 1 2 3 4 Under 1 1 to 5 5 to 15 15 to 25 25 to 65 65 and upwards North Clerkenwell South Clerkenwell Finsbury (St. Luke) St. Sepulchre. North Clerkenwell South Clerkenwell Finsbury (St. Luke) St. Sepulchre Small-pox 13 1 2 — 4 6 — 3 5 5 — 3 \5 5 — Cholera — — — — — — — — — — — — — — — Diphtheria 122 4 57 45 11 4 1 32 37 52 1 31 37 51 1 Membranous croup 1 — 1 — — — — — — 1 — — — 1 — Erysipelas 105 4 4 12 13 65 7 28 27 48 2 — — — — Scarlet Fever 323 4 118 176 17 8 — 100 119 101 3 94 119 101 3 Typhus Fever — — — — — — — — — — — — — — — Enteric Fever 40 — 3 14 10 13 — 15 3 21 1 15 3 21 1 Relapsing Fever — — — — — — — — — — — — — — — Continued Fever — — — — — — — — — — — — — — — Puerperal Fever 5 — — — 3 2 — 1 1 3 — 1 1 1 — Plague — — — — — — — — — — — — — — — Varicella 197 21 107 69 — — — 56 59 75 7 Totals 806 34 292 316 58 98 8 235 251 306 14 144 165 180 5 252 TABLE IV. Borough of Finsbury. CAUSES AND AGES AT DEATH DURING THE YEAR, 1904. Causes of Death. Deaths in District at subjoined Ages. Deaths in Localities (at all ages ) Deaths in Public Institutions All ages Under 1 1 and under 5 5 and under 15 15 and under 25 25 and under 65 65 and UP- wards North Clerkenwell South Clerkenwell Finsbury (St Luke) st. Sepolehre Small-pox 3 1 1 ... ... 1 ... ... 2 1 ... ... Measles 60 16 41 3 ... ... ... 22 15 23 ... ... Scarlet Fever 17 ... 11 6 ... ... ... 6 3 8 ... ... Whooping Cough 26 15 11 ... ... ... ... 15 6 5 ... ... Diphtheria and Membranous Croup 14 3 10 ... 1 ... ... 5 4 5 ... ... Croup 2 ... 2 ... ... ... ... ... 1 1 ... ... Fevers Typhus ... ... ... ... ... ... ... ... ... ... ... ... Enteric 8 ... ... 1 3 4 ... 1 1 5 1 ... Continued ... ... ... ... ... ... ... ... ... ... ... ... Epidemic Influenza 11 1 ... ... ... 6 4 5 2 4 ... ... Diarrhoea 121 99 16 ... ... 1 5 36 34 50 1 1 Enteritis 24 17 3 ... ... 3 1 10 4 10 ... 1 Dysentery ... ... ... ... ... ... 1 ... 1 ... ... ... Puerperal Fever 5 ... ... ... 1 4 ... 2 ... 3 ... 1 Erysipelas 4 ... ... ... ... 3 1 1 2 1 ... ... Other Septic Diseases 26 4 2 1 1 7 11 6 9 11 ... 2 Phthisis 251 5 14 5 29 195 3 82 78 87 4 1 Other Tubercular Diseases 40 14 15 4 ... 6 1 17 9 12 2 1 Tuberculous Meningitis 27 7 17 2 1 ... ... 13 4 8 2 ... Cancer, Malignant Disease 79 ... 1 1 1 55 21 28 25 25 1 8 Bronchitis 255 45 20 1 ... 79 110 83 72 97 3 2 Pneumonia 179 53 53 4 6 46 17 64 44 71 ... 1 Pleurisy 11 ... 3 ... ... 5 3 4 5 2 ... ... Other Diseases of Respiratory Organs 12 ... 1 ... ... 6 5 4 3 5 ... ... Alcoholism 19 ... ... ... ... 17 2 5 6 8 ... ... Cirrhosis of Liver 25 ... ... ... 23 2 7 5 12 1 ... Venereal Diseases 15 13 ... ... ... 2 ... 5 2 8 ... 1 Premature Birth 63 63 ... ... ... ... ... 21 17 25 ... 9 Diseases and Accidents of Parturition 9 ... ... ... 1 8 ... 7 1 1 ... 2 Heart Disease 127 ... 2 9 8 72 36 50 35 37 5 4 Other Diseases of Circulatory System 90 1 ... 1 1 50 37 34 22 31 3 ... Accidents 53 2 6 6 2 25 12 18 13 19 3 Suicides 12 ... ... ... 1 8 3 3 4 4 1 ... Renal Diseases 3 ... ... ... ... 2 1 2 ... 1 ... 1 Nervous and Cerebral Diseases 58 ... ... 4 ... 36 18 21 13 24 ... 4 Senility 95 ... ... ... ... ... 95 38 17 37 3 1 Overlain in Bed 31 31 ... ... ... ... ... 10 6 15 ... ... Convulsions 19 19 ... ... ... ... ... 7 3 9 ... 3 Developmental Disease 40 33 7 ... ... ... ... 16 8 16 ... 11 Diseases of Stomach 21 6 1 ... 1 11 2 9 5 7 ... ... Inflammation and Softening of Brain 5 ... ... ... 1 ... 4 1 3 1 ... ... Meningitis 20 11 6 1 ... 2 ... 7 8 5 ... ... Nephritis and Bright's Disease 48 ... ... 1 2 32 13 20 7 20 1 ... Intestinal Obstruction 16 1 1 ... 1 7 6 5 4 6 1 ... Tumours and other Diseases of the Female Organs 3 ... ... ... ... 2 1 2 1 ... ... ... Murder ... ... ... ... ... ... ... ... ... ... ... ... Marasmus 63 56 6 1 ... ... ... 25 9 28 1 1 All other causes 73 6 7 5 7 37 11 26 16 27 4 4 All causes 2084 522 257 56 68 755 426 743 529 775 37 59 SUMMARY AND CONCLUSIONS. 255 SUMMARY. The broad facts as to disease and death in Finsbury during 1904 may be readily stated. The crude death rate was 21T and the corrected death rate 22.0 per 1,000 living. This will in all probability be found to he one of the highest death rates in London (the death rate of which as a whole in 1904 was 16.7 per 1000). Out of the total number of deaths (2,084) 965, or 46 per cent. occurred in hospitals, workhouse infirmaries, asylums, &c. As in 1903, the death rate was highest, for all causes, in the oneroomed tenements, and lowest in the homes of four rooms or upwards. Nearly one quarter of the total deaths, or 522, occurred in children under twelve months of age, which yields an infant mortality rate of 161 per 1,000 births. Many, if not most, of these infant deaths were directly preventable (see p. 18). The chief infectious diseases caused 282 deaths, and consumption caused another 251 deaths. Seventy-nine deaths were directly attributed to cancer, and 44 to alcoholism. Turning to cases of infectious sickness certified to the Public Health Department, there were, during 1904, 806 cases of notifiable infectious disease, 802 cases of measles, and 210 cases of phthisis. The total number of cases of disease certified was therefore 1818. CAUSES AND CONDITIONS. When we come to consider what are the causes and conditions of which these mortal statistics are the result, we are met by a large body of facts not readily to be stated in figures. There are, however, some figures which bear upon the matter. First, there is a density of 19.1 houses per acre in Finsbury as compared with 8'2 in London generally. That is to say, the land in Finsbury is more than twice as densely covered with houses as the land in London generally. There are also, of necessity, fewer open spaces. 256 Secondly, owing to the decline in inhabited houses being more rapid than the decrease in population, the density of persons per house increases. Tenements and model-dwellings abound in Finsbury. Seventy-seven per cent. of the whole population of the Borough live in tenements of less than five rooms ; 14.3 per cent. of the entire population live in homes of one room, and 31.2 per cent. of the population live in homes of two rooms. That is to say, that 45 per cent. of the people of Finsbury live in homes of two rooms or less, and the Borough is characterised more than any other district in London by tenement dwellings of less than five rooms each. Further, there are 202 blocks of " model dwellings " containing 4,000 tenements and accommodating 16,970 persons (see pp. 142-158.) These figures taken as a whole indicate conditions of overcrowding. Broadly it may be said that nearly all homes of one room and most homes of two rooms are overcrowded in the sense that the accommodation is not sufficient to allow of a healthy life, either of family or of individual. Further, many homes of more than two rooms are overcrowded, and, therefore, in a general way, probably not less than 40 per cent. of the entire population of Finsbury is living under what are overcrowded conditions. Besides that general fact, we have evidence that in certain parts of the district there is a much higher degree of overcrowding than 40 per cent., even when judged by a much lower standard, namely, that of the Bye-laws for Registered Houses (see pp. 142-157). Thirdly. Whilst a fair standard of sanitation is maintained in most of the dwelling-house property, there is a considerable measure of what may be called " domestic insanitation." That is to say, that though few houses in Finsbury are so conditioned, either in themselves or in relation to other houses, as to be so insanitary as to call for action under the Housing of the Working Classes Acts, there are a very large number of houses which do not provide satisfactory accommodation for a healthy life. There has been a steady and wide-spread degeneration in dwelling-house property. Many of the houses were built as residences for persons of one family. The private house has now, however, become a tenement house, and yet has not been adapted for such. The 257 sanitary conveniences, the water supply, the cooking arrangements, the washing accommodation, the provision for refuse collection, ventilation, light, &c., were all designed for one family but now have to serve for, perhaps, four, or six, or even eight, families. The house and its tenants have, therefore, lost caste together. The result is uncleanliness, ill-ventilation, lack of light in certain tenements, insufficient cooking apparatus, and general domestic insanitation. The above conditions are concerned broadly with housing accommodation and " urbanization" which obviously exerts primary influence upon health. But there are other matters to consider. There are Conditions of Employment. Finsbury is an industrial Borough, upwards of 70 per cent. of the people being employed in industrial work. The occupations which engage the largest number of persons in Finsbury are—(a) conveyance of men and goods; (b) printing ; (c) the making of wearing apparel ; (d) servants, porters and charwomen; and (e) work in food, tobacco and at restaurants. These five lines of occupation employ upwards of 28,000 persons, and each occupation has its own perils to health and life. In some it is exposure and accident, in others it is sedentary employment. Only second to this latter influence comes the strain and resulting fatigue of " piece work." A somewhat exceptional proportion of the occupation in which women and girls in Finsbury are engaged (wearing apparel, book-binding, linen-ironers, &c.), is carried on under this condition, and I do not doubt that it exerts considerable influence on the health of persons physically weak or unfit. A study of the occupation of 10,000 persons dying in Finsbury in five years brings vividly to mind the intimate relationship which exists between occupation unhealthily carried on and disease. Then, lastly, there is Poverty. Absolute poverty is a difficult, if not impossible, thing accurately to measure. Relative poverty, on the other hand, is so evident in Finsbury that it needs no measurement to emphasise its existence. Mr. Rowntree has divided families living in poverty into two clases : (a) " families whose total earnings are insufficient to obtain the minimum 258 necessaries for the maintenance of merely physical efficiency" and (b) " families whose total earnings would be sufficient for the maintenance of merely physical efficiency were it not that some portion of it is absorbed by other expenditure either useful or wasteful."* He found that in York 9.91 per cent. of the total population were in a state of " primary poverty," and 17.93 per cent. were living in "secondary poverty." In the result 27.84 per cent. of the population of that city are living in such poverty that physical efficiency was not being maintained. We have no similar figures for Finsbury, but there can be little doubt that much the same conditions exist as in York, although there would of course be certain differences. On the whole, however, the differences are in favour of York. On the general question of poverty in Finsbury I have received the following letter from the Clerk to the Parochial Charities (Mr. Paterson), and I have his permission to put in this letter as broad evidence on the general question :— Charity Organization Association, City, Hol.born and Finsbury Committee, 4, Goswell Road, E.C., 30th January, 1905. Dear Sir, I have carefully considered the subject referred to in your letter of the 23rd instant. After 18 years of close acquaintance with Finsbury, and with all classes of the population resident in the Borough during this time, it is my opinion that there is a very close connection between the particular kind of poverty to be found in Finsbury, and the Death Rate, which I understand is large. Of late years the social and moral conditions of the Borough have been getting steadily worse, and while there were always certain centres of criminal population [instances quoted] the number of persons of bad character has in the last decade largely increased "Poverty : A Study in Town Life. B. S. Rowntree. First Edition, p. 80. 259 Where there was merely genuine poverty caused by lack of means there is now, in many parts, poverty caused by thriftlessness of a gross type ; mal-nutrition of children ; the secret drinking and dram-taking of women ; idleness, shiftlessness, and debauchery of men who belong, mostly, to the lowest class of " casual " labourer or criminal. There are of course many respectable people living in the streets I have named, and even in the worst quarters many individual cases of sober, hard-working, reputable family-life are to be found, but the majority of the inhabitants of the streets and courts, of which I append a list [63), are sadly deficient in the moral power or the will, to bring up their children either physically or morally, in a proper manner. There is besides a marked difference in the class of people, socially, inhabiting the large blocks of buildings, and the morale of the people in certain blocks of buildings is lower than in certain others [instances are named]. I think it will be found that this affects the Death Rate In view of the changes I have noted I fear that alcoholism is on the increase and thrift decreasing in the Borough, but I have no statistics on these points. It is certain that the total amount of poverty arising from bad moral, and social conditions, has increased during the last 10 years. At the same time I should end by saying that the sanitation of the district has been much improved of late years by the activity of the Public Health Department of the Borough Council, and the efforts of private medical men and others. Further, the public and charitable bodies in the Borough have lately become conscious of the need of strenuous co-operative action in the improvement of the moral and social condition of the poor in Finsbury, and are now working systematically together to attain that end. In ten years time there may be a different story to tell. I am, Yours faithfully, (Signed) A. H. PATERSON, Secretary. George Newman, Esq., M.D. Medical Officer of Health, Town Hall, Rosebery Avenue, E.C. 260 Before passing on I may say, in regard to Mr. Paterson's remark as to certain streets being characterised by increased poverty, that, broadly, these are the streets in which most deaths occur (both from phthisis and from all causes.) It has been known for a long time that poor districts have (a) a higher death rate, (b) a higher infant mortality, and (c) a lower physical standard than districts more favorably conditioned. But frequently this has been attributed to external conditions of insanitation, naturally more marked as a rule in poor districts. In point of fact it is probably more due to internal conditions due to poverty, of which I propose to name five as chiefly operative in Finsbury. 1. Lack of Food. —Very few persons, if any, die in Finsbury from absolute starvation, but a considerable proportion of people suffer from insufficiency of food, especially many women, girls and children. If a child is insufficiently fed he does not grow, but becomes stunted in body and warped in mind. If a man has not enough to eat he cannot work efficiently. If a woman is insufficiently fed she produces unfit offspring. 2. Uvsuitability of Food.—However limited may be the number of persons actually unfed, there can be no doubt that the number of persons ill-fed is very great. The diet of the majority of the industrial population of Finsbury is improper, irregular, and innutritious. The ordinary factory girl's diet consists far too much of tea, bread, jam, and artificially prepared foods. She spends her money more upon dress, personal adornment and amusement than upon food or the healthy nourishment of her body. Many girls of this class do not touch solid food until the middle of the day, and are irregular in the proper distribution of meals as well as ignorant of the right selection of foods. As mentioned above many of the tenements in Finsbury are without grates of proper service for cooking, and this exerts an enormous effect on the practice of the culinary art, What is true of women and girls is not equally true of the men workers, though they also are by no means wise in the selection of diet. There is also much carelessness and ignorance in the feeding of infants. 261 There are two chief requirements of a satisfactory diet. First, such a diet must contain food which will provide sufficient energy to enable a man to do work (average, 3,500 units of energy), and, secondly, it must provide for the upkeep of the tissues of the body (average, 125 grammes of proteid). Now it has been found by investigation that the diet of the Edinburgh working man is deficient by 280 units of energy and 13 grammes of proteid, while in York the average diet was 17 per cent. below standard in energy and 29 per cent. too low in proteid. We have no similar figures for Finsbury, but it cannot be doubted that the diet of the larger proportion of the workers in this Borough is, at least, equally deficient. Yet nutrition is the most important factor in physical growth and development. 3. Inferior Housing, Overcrowding and Domestic Insanitation.— Reference has already been made to the influence of this result of poverty. It is unnecessary at the present day to emphasise the gross physical and moral evil of such conditions as overcrowding and insanitary housing. 4. Strain of Continual Effort.—Fatigue and insufficient rest are two conditions which exercise an unfavourable influence upon health. Sir James Paget said that " in every-day practice fatigue has a larger share in the promotion or permission of disease than any other single casual condition you can name." The continual strain and anxiety of the poor to battle against their poverty and the evils which follow in its train, unquestionably affect their health. Further, it is noteworthy how little refreshing sleep is obtainable in some insanitary tenement houses, especially those which are verminous and overcrowded or adjoining public houses or in streets used for night traffic. 5. Uncleanliness.—Dust and dirt follow in the train of poverty. It is thus that food, especially milk, becomes contaminated ; houses retain tubercle infection; lungs become diseased ; tenements become filthy and the home of every kind of domestic insanitation. Cleanliness may come next to godliness in ethics, but it stands first as a preventive of physical disease. 262 All-round cleanliness would do more than any other single agency to raise the standard of health of a community. Before leaving this part of the subject it is necessary to state that in addition to these conditions of life which are unfavourable to health, there is the moral character of the people. It is not within my province to discuss this subject, but it is my duty to point out that there is a definite and intimate relation between morality and the public health. If, as I am informed, there is increasing laxity in domestic discipline and personal morality in Finsbury, the public health will suffer. 1 am bound to assert that I have seen conditions in many houses in Finsbury (particularly in night inspections) where it is impracticable, in some cases even impossible, for boys and girls to be brought up to lead decent lives. This should not be so. Enlightened public opinion would not permit it to be so. PROPOSED REMEDIES. It is now necessary to offer a few simple suggestions and notes respecting what may be done and what is being done to remedy the evil conditions above-named. 1. The Feeding and Management of Infants.—One in every six children born in Finsbury does not live to be twelve months old. Of the 522 infants who died in 1904 there are three chief groups 152 died from debility, prematurity and developmental disease— in brief, most of these did not get a fair start because their mothers were not physically fit to give them it*—106 more died from infantile diarrhoea, and 98 others died from bronchitis or pneumonia. Most of the diarrhoea deaths were due, as pointed out in the report, to bad feeding (see pp. 82-86), and the deaths from lung disease were mostly due to exposure. ®ln this connection it should be remembered that the feeding of mothers is sometimes more important than feeding infants, and the counsel of health visitors than an ideal infant milk supply. 263 This subject of infant life is of vital importance to Finsbury, and upon it I wish to make two remarks First, the health and physical condition of infants depends on the devotion, capacity, and physical fitness of the mother more than on any other single thing. Secondly, the most needed requirement for the solution of the infant life problem in a district like Finsbury is therefore the enforcement of maternal responsibility, and the inculcation of habits of thrift, temperance, and domestic hygiene. Let me take an instance affecting the high death rate from lung diseases among infants in Finsbury. It appears that mothers allow their young children to be exposed to cold in many ways. One way which may be mentioned is the practice of taking infants out late at night. On Saturday, November 20th, 1904, between 9 and 10 p.m. (a raw, cold evening with dense fog), I counted in walking down Chapel Street 67 infants in arms, and elsewhere in Finsbury between the same hours 76 other infants in arms. I visited 20 or 30 public houses and found a large number of women drinking, in many cases carrying infants with them. On Saturday, December 24th, Chief-Inspector Green counted 47 infants in arms in walking through Chapel Street, and on Saturday, January 7th, 64. On the same dates he visited for me 47 public houses to count the number of persons. These visits were made between 7 and 10 p.m. with the following results :— 3 No. of Persons counted at the No. of moment of visit. Public Total. Houses visited. Infants Other Men. Women. in Arms. Children December 24, 1904 47 903 710 66 60 1739 January 7, 1905 47 1071 724 66 71 1932 264 The public-houses visited on the second night were the same as on the first, and the visits were made at a time of " exceptional distress" and poverty. Yet the average number of persons per house at a given moment was 39, and if this be taken as an average for all the licensed premises in Finsbury (309) it would yield a total of 12,051 persons. In any event, and allowing for seasonal influences, these figures denote a custom which cannot but exert an evil influence upon health. Not the least serious effect produced is the exposure of infants to heat and cold at late hours. There is also the whole question of infant clothing and feeding. These matters are, in my judgment, primarily within the duty of the parent, and not the State. Everything that decreases the sense of responsibility of the parents is to be avoided.* 2. Dissemination of Knowledge.—One of the findings of the Physical Deterioration Committee (1904), is that, "the people perish for lack of knowledge." This is very true of Finsbury and much requires to be done in the direction of educational work in public health.‡ Especially important is the training of girls in domestic hygiene, food values, and infant management, the personal guidance and teaching by well qualified ladies in the homes of the people, and the creation of a " health conscience." Much has been done in Manchester and other cities by the method of lady health visitors and it would be well for Finsbury if all the district visitors acted also as health visitors who could and would advise the people on matters concerned with cleanliness, ventilation, the selection of food, infant management, etc. * As I pointed out last year, the infants of Italian mothers in Finsbury are better cared for than those of English mothers of the same class. The same is true, broadly, of the Jewish race. The reason is that Jewish and Italian mothers suckle their children more than do the English of the same class, and in this and other ways more fully accept maternal responsibility. They are less ignorant and less neglectful, and go out less to work. ‡ During the latter part of 1904 six health lectures were delivered to social workers, district visitors and others, at the Town Hall, under the auspices of the Social Workers' Association. A wide extension of this kind of thing is greatly needed. 265 3. It is certain that thriftlessness, alcoholism, and immorality abound, and are gravely affecting certain classes in the Borough. Any influence, therefore, which tends to counteract these things is an influence in favour of health, and the same is to be said for all social and religious agencies and influences which tend to raise the moral tone of the community or the character of the individual. For this reason it must not be forgotten that voluntary workers of many different views and creeds are all contributing to the betterment of physical life and health in Finsbury. 4. It is difficult to see any practicable means of providing more open spaces in Fiusbury, though such are greatly needed. Where there is least open space in the Borough death rates from all causes, and particularly from phthisis, are highest. For the same reason cheap and quick transit from the centre and to the centre are needed. 5. The effectual cleansing of streets and frequent removal of refuse is another important requirement, for street dust and dirt bears a direct relation to infant diarrhoea and other diseases. 6. Lastly, there is the equitable and uniform administration of the Public Health Acts. The sphere of influence of the Local Authority is chiefly perhaps in the administration of the law as it concerns the public health. Few things are more characteristic of our time than the increasing share which the State (as represented by the Local Authority), takes in protecting the life of the individual. What is being done in Finsbury in this way is discussed in the foregoing Report. Speaking in a general way the chief work of a Sanitary Authority is to deal with broad commonsense requirements, and to create and maintain as far as possible a healthy environment for all persons in the community. An atmosphere unpolluted by smoke, effluvia, or dust; pure food, milk and meat, each of them sold unadulterated and without prejudice or injury to the purchaser; a pure and ample water supply; clean streets and houses; sanitary school accommodation; healthy factories, workshops and workplaces; the exercise of powers in respect of insanitary property and overcrowding; the prompt removal of 266 refuse and sewage ; the effectual separation of diseased persons from the healthy in order to diminish the chances of infection ; the investigation and prevention of disease; the postponement of the event of death -these are the broad lines of policy for every Sanitary Authority, accepted by all well-informed persons as a reasonable policy which stands, it is true, on science, but also on commonsehse and human experience. It Is broad and simple, but it is essential. The highest welfare of the community, indeed its very life, depends in no small measure upon the efficiency of the public health work of a Local Authority. Whatever else is neglected or left undone the Local Authority cannot afford to neglect to provide the primary requirements of healthy physical life. It is upon the healthy bodies and minds of the people in local cominunities that the State is built. The business of a Sanitary Authority is therefore not small or ignoble and should not depend upon party opinions or vested interests, for its duty is to extend in all directions, for all men, the frontier of life.