Au 341 Fin 5 THE METROPOLITAN BOROUGH Of FINSBURY. REPORT on the PUBLIC HEALTH OF FINSBURY 1905. 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.O. 1906. THE METROPOLITAN BOROUGH OF FINSBURY. REPORT on the PUBLIC HEALTH OF FINSBURY 1905. Including Annual Report on Factoriies and Workshops. BY GEORGE NEWMAN, M.D., Medical Officer of Health of the Metropolitan Borough of Finsbury. i London: Printed by Thomas Bean & Son, Golden Lane, E.C. 1906. PUBLIC HEALTH COMMITTEE, 1905-6. Chairman : Councillor George M. Gillett. Vice-Chairman : Councillor the Rev. Prebendary G. H. Perry, m.a. His Worship the Mayor (Councillor William Reason, j.pv) Alderman T. Wildbore. Councillor Kvan 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. Rigby 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.®† Sanitary Inspectors : William P. Ensor.® George E. J. Davis.®† Charles M. Longden.® Robert W. Hindhauoh® (resigned August). Ernest A. Norman.® Arthur E. Powell®! (resigned January) James W. Hall® (temporary, February-October). William S. Matson.®§! William H. Draper®§ Inspectors for Special Purposes: For Meat: George T. Billing.®† For Factories and Workshops: George Peverett.§ Lady Sanitary Inspectors : (Mrs.) Florence J. Greenwood®§ (Miss) Mildred G. Jones.§ Clerks in the Department: T. Gordon Collins. Albert A. Jackson.§ Alexander M. 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. § Certificate of Sanitary Inspectors Examination Board. 9 Certificate of Royal Sanitary Institute. † Meat Certificate of Royal Sanitary Institute. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Finsbury. His Worship the Mayor: Councillor William Reason, J.P. Gentlemen, I have the honour to submit, herewith the Annual Report of the Public Health and Sanitary conditions of the Borough of Finsbury for the year 1905. 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 the usual sections. 1 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 work and loyal co-operation of the staff of the Department. The excellence of their work is evident in the record of the Report. I am, Gentlemen, Your obedient Servant, GEORGE NEWMAN, Medical Officer of Health. Public Health Department, Town Hall, Rosebery Avenue, E, C. January 19th, 1906. TABLE OF CONTENTS. A—VITAL STATISTICS. Page Population 11 Births 12 „ Investigations into 13 . Deaths 17 „ in Public Institutions 19 „ in Finsbury Districts 20 „ according to age 21 ,, of Infants 21 „ Investigations into 24 „ from Senility 29 „ from Infectious Diseases 29 „ in relation to Tenements 30 B- RECORDS OF DISEASE. Notification of Infectious Disease 35 Small Pox 37 Chicken Pox 38 Diphtheria 38 Scarlet Fever 41 Enteric Fever 46 Discharge Notices 47 Measles 48 Whooping Cough 52 Puerperal Fever 52 Epidemic Diarrhoea 52 Phthisis 59 „ Voluntary Notification of 59 „ Deaths from 62 Other Forms of Tuberculosis 68 Cancer 71 Alcoholism 72 C-FOOD SUPPLY. Meat Supply 77 Meat Prosecutions 79 Meat Confiscated 86 Unsound Rabbits 90 Slaughter-houses 92 The Milk Supply 93 Sale of Food and Drugs Act 99 Analysis of Spirits 101 Margarine 104 Restaurants, Food-stalls, Icecream, &c 104 Water Supply 106 Infants' Milk Depot 107 D-HOUSE PROPERTY, &c. Page Housing 119 Insanitary Areas (Part I.) 119-126 „ (Part II.) 130-133 Vacant Tenements in October 126 Dwelling Houses Closed 133 Houses Let in Lodgings 136 House Inspection 137 Overcrowding 140 Common Lodging Houses 144 Model Dwellings 145 Underground Rooms 145 Stable Dwellings 145 Customs and Inland Revenue Acts 146 Water Supply to Tenement Houses 146 The Housing Question 147 E-FACTORIES AND WORKSHOPS. Introduction 153 Sanitation in Workshops 157 Bakehouses 163 Homework 163 Outworkers' Lists 165 Inspection and Registration 169 Legal Proceedings 173 F— SANITARY ADMINISTRATION, &c. The Canal and Canal Boats 177 Stables 180 Elementary Schools 181 Verminous Children 188 Black Smoke Nuisances 191 Cleansing of Persons Act 193 Disinfection 193 Mortuaries 196 Reception Houses 197 Removal of Human Remains 197 Drainage Plans 197 Removal of Dust 197 Sanitary Inspection 198 Lady Sanitary Inspectors 201 Legal Proceedings 204 General Tables 210 Tables I., II., III., IV., V. 219 Vaccination Returns, 1903-1905 225 Summary and Conclusions 231 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 Yestry 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 98,207, and there are 8,500 inhabited houses. The area is 589 acres. The gross assessable value is £1,234,914, and the rateable value £1,007,532. The Borough is bounded upon the north by the Boroughs of Islington and Shoreditch; on the east by the Borough of Slioreditch ; on the south by the City of London; and on the west by the Boroughs of llolborn and St. Pancras. Population.—The estimated population to the middle of 1905 in the Borough of Finsbury was 98,207, comprised as follows:— North Clerkenwell 33,904 South Clerkenwell 27,756 Finsbury (St. Luke) 34,957 St. Sepulchre 1,590 98,207 The sub-registration district of Glasshouse Yard (pop. 740) is now incorporated in the sub-registration district of Finsbury, making Finsbury (St. Luke) 34,957. 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), were as follows:— 12 Totals at all ages. Under 5. 5-14. 15-19. 20-54. 55-75. Above 75. Males 49,910 6,158 10,37I 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 1905 was 3,398, as follows:— Sub-registration District. Total Births. Rate per 1,000 of the Population in 1905. North Clerkenwell 985 29.1 South Clerkenwell 805 29.0 Finsbury (St. Luke) 1,587 45.3 St. Sepulchre 21 13.2 The Borough 3,398 34.6 13 The birth rate for London was 27.1. Of the 3,398 births in Finsbury, 622 took place in the City of London Lying-in Hospital, and of this number only 110 rightly belonged to the Borough. Consequently, after correction, the total number of births belonging to the Borough was not 3,398, but 2,886, which gives a birth rate of 29'4 per 1,000 of the population. Of the 3,398 births in Finsbury, 1,681 were boys and 1,717 were girls. The birth rates of Finsbury (in sub.registration districts) since the Borough was formed have been as follows:— The Borough. North Clerkenvell. South Clerkenwell. Finsbury. St. Sepulchre. 1901 37.3 30.2 30.9 50.8 20.1 1902 36.0 30.1 30.4 45.6 231 1903 36.4 30.5 30.9 47.3 20.3 1904 36.4 31.5 29.7 47.1 20.5 1905 34.6 29.1 29.0 45.3 13.2 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 rates for the last five years have been, 1901, 32.0 ; in 1902, 31.7; in 1903, 31.4 ; in 1904, 31.3 ; and in 1905, 29.4. Out of the total of 2,886 births belonging to Finsbury in 1905, 2,220 have been visited by the lady inspectors. It will be remembered that at the beginning of the year arrangements were made by the Registrar.General, by which the local registrars might supply the local authority with a return of the births registered from week to week. This has been done, and as we have received these returns the lady inspectors have taken the names and addresses of those infants in which it seemed that good might come of the visit of an inspector. Out of the 2,220 we have collected a number of particulars respecting 1,859 infants, and it may be well, briefly, to refer to the data obtained. 14 (a) Age at Registration.—In a general way it may be said that most births in the Borough are registered between the 4th and 7th weeks. In those four weeks 1,42!) (or 76 per cent.) out of the 1,859 cases of which we have records, were registered. Further, it should be added that though some 170 births visited were set down as aged one, two, or three weeks, this was not the actual age of birth registration but the age of death, those being infants who had succumbed before their births were registered. (b) Condition of the home.—Out of the 1,859 births under consideration 1,359 were born in homes of two rooms or less. Taking, however, the total of all the homes, it was found that only 6 per cent, could be described as distinctly unclean and badly kept, and in as many as 68 per cent. of the total it could be said that the home was clean and well kept. That seems to me to be a satisfactory feature, and one which might not have been expected. (c) Occupation of Mother during Pregnancy. —Another somewhat remarkable feature is that in 1207 cases or 64.9 per cent. of the total, the mother had no occupation except her home affairs; in 233 instances the mother had some home work of an industrial character; in 276 other cases the mother went out from time to time during her pregnancy to do work, such as charing or cleaning, and in a few cases factory work ; and only in 143 cases (or 7.6 per cent.) was the mother away from her home all day during the time she was pregnant. In some districts, particularly in the large manufacturing towns of the North of England, the occupation of the mother, both during pregnancy and after the birth of the child, is one of the factors most directly affecting the health of the child. Hut in Finsbury, in the light of these figures, it can hardly be supposed that the mother's occupation is frequently detrimental to the child she bears. It should, of course, be remembered that this does not exclude any influences unfavourable to the mother's health prior to the time of her marriage. It is not, therefore, surprising to learn that of the 1,859 children visited, as many as 1,368 (or 73.5 per cent.) were found to be in a fairly healthy and well-nourished condition. Only 11.3 per cent. of the total were found to be badly nourished or ill. 15 (d) Method of Feeding. One of the most interesting facts learned from this work has relation to the feeding of these children, of whom about 1,400 may be considered to have been healthy at the time of visit. As many as 1,503 of the total (or 80.8 per cent.) were wholly breast-fed. Only 5 per cent, were fed wholly on cows' milk, and 2.0 per cent. were fed on "condensed" milk or artificial foods. It must be borne in mind that the investigation was generally made before the child was two months old, and always before the end of the third month. It may therefore be said that in Finsbury, up to the end of the third month, 80 per cent. of the children are breast-fed. Of the remaining 20 per cent. a large proportion die, as will be seen subsequently. Further, it is probable that if we had obtained the returns three months later, nothing like 80 per cent. would have been found to be breast-fed. But the fact remains that in the first trimester of life the majority of Finsbury children are breast-fed, and of that method of feeding these two things may be said:—first, it is the most economical for the family, and secondly, it is the most healthy for the child. It may be added that in connection with these visits to births 175 sanitary notices were served for defects found in the homes of these infants; 12 of them had relation to overcrowding, 14 had relation to unclean bedding, and the remainder dealt chiefly with unclean rooms. Some of the principal facts concerning these visits may be tabulated as follows:— Feeding. Condition of Child. Mother's Work during Pregnancy. Condition of Home. No. of Infants. Breast only. Breast, etc. Cows' Milk only. Condensed or Artificial. Not Fed. Healthy and Well Nourished. Fair. Badly Nourished. None. Away from Home. Intermittent. Some Home Work. Clean. Fair. Dirty. 1859 1503 177 104 38 37 1368 280 211 1207 143 276 233 1273 473 113 % 8o.8 9.5 5.o 2.0 1.9 73.5 15.0 11.3 64.9 7.6 14.8 12.5 68.4 25.4 6.0 * These were 37 infants who died within a few hours of birth. 16 During the year the following revision of the infant feeding leaflet was circulated : — The Metropolitan Borough of Finsburv. THE CARE AND FEEDING OF INFANTS. i.—Feeding. Thousands of infants die every year from improper feeding. If the mother has plenty of hreas' milk, the infant should not have any other food until it is gradually weaned during the 8th or 9th month. During the first 2 months it should not be suckled oftener than every 2 hours, and after the 3rd month not oftener than every 3 hours. Regularity in feeding is most important. Do not feed between meals " just to keep the baby quiet." During the suckling period the mother requires good plain wholesome food, including milk or milk puddings. Beer or other stimulants are not desirable unless ordered by the doctor. If the mother has not sufficient milk, it should be supplemented with cow's milk and water, or barley water, made as below. If the mother cannot suckle her child, it should be fed with cows' milk and water, or barley water, with a little sugar added (as below). Skimmed milk should not be used. It is best to boil the milk, especially in summer. During the first fortnight. Boil together ¼ pint of fresh milk, ½ pint of water, and a small tablespoonful of sugar, and keep in a clean corked bottle or covered jug. Three tablespoonfuls of this should be given every 2 hours. Between 2 weeks and 2 months. — Boil together ½ pint milk, ¾ pint of water and a tablespoonful of sugar. Five tablespoonfuls should be given every 2 hours. During the 3rd and 4th months.—Boil together ¾ pint milk, ¾ pint water, and a tablespoonful of sugar. Eight tablespoonfuls to be given every 2½ or 3 hours. During $th to gth months. Boil together 1 pint of milk (5th month) 1¼ pint (6th month), 1½ pint of milk (7th to 9th month), with ¾ pint water, and a tablespoonful of sugar. 10 to 12 tablespoonfuls to be given every 3 hours. Use a boat-shaped feeding bottle, with a rubber teat and no tube. After each feed the bottle and teat should be well washed in hot water and soda, and kept in clean water. Never keep food over in the bottle for the next meal. 17 At 9 months old the milk may be thickened with one or two tablespoonfuls of cornflour, and some broth or beef tea may be given. At 10 months old the child may have bread and milk, bread and butter, and cornflour or porridge, but not meat. Children require plenty of milk until the age of 3 years, as they cannot digest the mine food as grown, up persons. After 18 months they may have fresh fish, gravy and bread crumbs, eggs, etc., once a day. Do not give them beer, spirits, wine, cheese, pickles, pastry, fruits, nuts or sweets. Do not give them teething powders, sleeping draughts or soothing syrups. 2.—General Requirements. Keep infants warm with flannel underclothing, and take them out during the day whenever it is fine, but not at night. Fresh air and sunlight are nearly as important as food. If they can be kept sufficiently warm they should sleep in cots or cradles rather than in bed with parents; a clean box, such as an orange box, or a clothes basket will do, if a cradle is not readily obtainable. Many babies are overlaid every year from sleeping with their parents. Wash them all over at least once a day with soap and warm water. Rooms should be kept very clean and well ventilated, and the windows open at the top. Public Health Department, Finsburv Town Hall, Rosebery Avenue, E.G. 1905. Deaths.—The total number of deaths registered in the district was 1,900, but as 45 of these deaths were of persons who died in, but resided outside, the Borough, that number has been deducted, leaving a total of 1,855. This total includes 886 deaths of Finsbury persons who died in various institutions outside the district. The crude death rate is therefore 18.9 per 1,000 of the population, as against 21.1 last year. The death rate for the whole of London in 1905 was 15.6 per 1,000 living as compared with 16.6 in 1904. The intra-parocliial death rate, that is, the death rate calculated on the number of persons who actually died inside the Borough, is 10'3, as compared with 11.9 in 1904. This figure is, of course, of no value except for local comparative purposes. The crude death rates in the Borough since its formation may be stated as follows:— 18 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 1905 18.9 18.5 17.3 20.2 25.2 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 of 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 animal summary gives the "factor for correction for sex and age distribution" in the seventy.six great towns in 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 10355, and the true or "corrected" death rate for this Borough, which allows for the mortality of each sex at different age.periods, is 19.5 per 1,000 living. This compares favourably with the corrected death rate (22.0) of last year, when Finsbury occupied the unenviable position of having the highest death rate in London. 19 The following is a list of the outlying institutions and other places where 886 of the residents of the Borough died during the year 1905:— I. General Hospitals. St. Bartholomew's 156 Royal Free 28 King's College 9 Middlesex 6 University 5 Great Northern. 3 Metropolitan 2 London 2 St. Mary's 1 212 II. Special Hospitals. Royal Chest (i Italian 2 National 1 Hospital for Women, Euston Road 4 Great Ormond Street (Children's) 36 East London 1 French 1 Homoeopathic 1 Infants' Hospital, Hamp stead 3 German 1 Qneen Charlotte 1 Mildmay 1 North Eastern, Hackney 1 Evelina 1 Mount Vernon 1 6l III. Fever Hospitals. Eastern 10 North Western 12 North Eastern 1 South Western 6 29 IV. Poor Law Institutions. Holborn Infirmary 248 Holborn Workhouse, City Road 236 Holborn Workhouse, Mitcham 25 Shoreditch Infirmary 9 Islington Infirmary 7 Islington Workhouse 1 St. Pancras Infirmary 8 Camberwell Workhouse 1 City Infirmary 2 Whitechapel Infirmary 1 Bethnal Green Infirmary 1 Hampstead Workhouse 1 540 V. Asylums. Banstead 8 Dartford 2 Cane Hill 2 Darenth 1 Claybury 1 Colney Hatch 1 London County, Norwood 1 London County, IIford 1 Horton Asylum, Epsom 1 18 VI. Unclassifiable. St. Luke's House, Kensington 2 Freidenheim Home 3 On way to St. Bartholomew's Hospital 5 In Gray's Inn Road 1 In Coptic Street 1 In a cab in Archway Road 1 Belgrave Hospital 1 St. Peter's Hospital 1 St. Joseph's House, nington 1 Salvation Army Maternity Home, Hackney 1 New Douglas Nursery, Shepherdess Walk 1 Law Society's Hall, Chancery Lane 1 In Gt. Ormond Street 1 In Regent's Canal 1 Amen Corner 1 H.M. Prison, Wormwood Scrubs 2 H.M. Prison, Brixton 1 H.M. Prison, Holloway 1 26 Total 886 20 The following Table shows the figures relating to deaths in outside institutions, &c., for the last five years:— Total Deaths. Deaths in Public Institutions, &c. outside District belonging to Finsbury. Percentage. 1901 2,161 876 40.5 1902 2,283 908 39.8 1903 1,993 870 43.6 1904 2,084 965 46.3 1905 1,855 886 47.8 As regards their distribution, therefore, all the deaths belonging to Finsbury may be summarized briefly as follows:— Intra-Parachial— North Clerkenwell 338 969 South Clerkenwell 244 Finsbury (St. Luke) 364 St. Sepulchre 23 Extra-Parachial— 1. General Hospitals 212 886 2. Special Hospitals 61 3. Fever Hospitals 29 4. Poor Law Institutions 540 5. Asylums 18 0. Elsewhere (unclassifiable) 26 Total 1855 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, 1901-1905. 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 20.1 1905 1,855 429 245 60 70 615 436 18.9 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 1905, as we have seen, there were 3,398 births in Finsbury. This includes the births in the City of London Lying-in Hospital. The total deaths of infants under one year was 429, out of the whole total of deaths of 1,855. The infantile mortality rate is therefore I48 6, and the infant mortality percentage on total deaths is 23'1. 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. 22 In the whole of London during 1905 there were deaths of infants (16,602) equal to a rate of 131.1 per thousand births. The mean rate for the last 10 years in London is 150. 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 146 148.2 South Clerkenwell 98 121.7 Finsbury (St. Luke) 178 165.5 St. Sepulchre 7 333.4 The Borough 429 148.6 Tlie infant mortality rates for eacli 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. Pinsbury (St Luke). St. Sepulchre. No. of Infant Deaths Infant Mortality No of Infant Deaths Infant Mortality Mo. of Infant heaths Infant Mortality No of Infant Deaths Infant Mortality No. of Infant Deaths Infant Mortality 1901 *533 163.8 158 149.2 124 139.6 172 137.0 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 522 168.6 191 177-2 123 147.8 206 178.7 2 60.6 1905 429 148.6 146 148.2 98 121.7 178 165.5 7 333.4 •The return for 1901 includes 73 infant deaths taking place in institutions outside the Borough but belonging to Finsbury, and which cannot now be distributed in districts. Throughout the table, births taking place in the City of London Lying-in Hospital, but not belonging to Finsbury, have been excluded. 23 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 1905 Months. 0— 1— 2— 3— 4— 5— 6— 7— 8— 9— 10- 11— Totals North Clerkenwell 31 15 21 14 15 7 6 9 11 8 5 4 146 South Clerkenwell 32 12 9 2 7 4 5 5 4 5 5 8 98 Pinsbury (St. Luke) 60 13 10 15 10 13 13 5 15 7 10 7 178 St. Sepulchre ... 2 2 1 ... ... ... ... 2 ... ... ... 7 Totals 123 42 42 32 32 24 24 19 32 20 20 19 429 Turning now to the causes of death in these infants, we find the record is as follows:— Causes of Death. Diarrhoea. Prematurity. Marasmus. Bronchitis. Pneumonia. Convulsions. Suffocated in Bed. Measles. Whooping Cough. Developmental Diseases. Tuberculosis Disease*. Diphtheria, Son riot, Fever. Miscellaneous. Totals. North Clerkenwell 21 20 10 14 6 8 11 2 10 14 5 1 24 146 South Clerkenwell 14 17 8 7 9 5 7 2 2 7 5 ... 15 98 Finsbury (St. Luke) 42 28 13 20 14 12 11 1 3 11 5 2 16 178 St. Sepulchre ... ... 4 ... ... 1 ... ... ... ... ... 1 1 7 Totals, 1905 77 65 35 41 29 26 29 5 15 32 15 4 56 429 The number of infant deaths due to Epidemic Diarrhœa fell from 116 in 1904 to 77 in 1905. 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 nearly a quarter of all the deaths in Finsbury, in 1905, was of infants under one year of age. A careful enquiry has been made into the cause of death of nearly all children dying in the Borough, under 12 months of age. Four 24 hundred and twenty-nine children thus died in 1905. Of that number the lady inspectors have visited 418, and in 374 cases were able to obtain certain particulars. (a) Age Incidence and cause of Death.—From the death returns I have drawn up the following table,* which is divided into three columns: first, the number of deaths between the time of birth and the end of the third month (the first trimester of life); in the second column the number of deaths in the second trimester; and in the third column the number of deaths in the last two trimesters of the first year of life. This classification is adopted by the Registrar-General, and used by me on that account. Certified Cause of Death. Months 0-3 Months 3-6 Months 6 12 Total. Epidemic Diarrhœa 20 23 34 77 Prematurity 67 1 — 68 Marasmus and Debility 31 12 7 50 Bronchitis 16 7 12 35 Pneumonia 7 10 28 45 Convulsions 16 5 9 30 Suffocated in Bed 17 8 4 29 Tuberculosis 1 3 10 14 Measles — 3 3 6 Whooping Cough 2 5 8 15 Miscellaneous 29 10 21 60 TOTALS 206 87 136 429 In this table three things may be seen: first, the chief causes of death in infancy in Finsbury; secondly, the age incidence of the mortality *The apparent discrepancy between this table and the one immediately preceding it is due to the fact that in many instances more than one cause of death appears on the certificate. In the former table the first disease stated has been taken, in the latter the disease which in all probability caused death. 25 from each disease; and thirdly, the broad fact, which is of so much importance, that the deaths of infants mainly occur in the first few weeks of life. The deaths of infants are not distributed uniformly throughout the 12 months. Nearly half of them occur in the first three months, and if that trimester be again subdivided it will be found that more than half occur within the first 4 weeks of life. In point of fact, of the 206 deaths in the first quarter of the twelve months, as many as 147 (or 34.4 per cent. of all the infant deaths) occurred at or in the first month, and 68 (or 15.9 per cent. of all the infant deaths) in the first week. When we turn to the causes of the deaths we see that certain diseases produce death at different periods of the twelve months Prematurity, of course, in the first trimester; and the same applies to marasmus, bronchitis, convulsions, and suffocation in bed. Epidemic diarrhoea is usually more marked, on the other hand, in the second and subsequent trimester, and the same applies to pneumonia, tuberculosis, and whooping cough. (b) Condition of the Home.—It is interesting to observe that a somewhat higher percentage of one-room homes and a somewhat lower percentage of clean homes occur in the table of infant deaths than of births. But it is not marked, and it is evident that these conditions are not playing a chief part in the death of infants. The following table sets out the more important facts in respect of the 374 dead infants:— Infant Deaths in Finsbury. 1905. a table ok the results ok enquiry into 374 infant deaths. No. of Deaths. CAUSE OF DEATH. Method of Feeding. Mothers' work. Condition of Tenement. No. of Rooms in Tenement. Age in Months. Breast only. Breast, etc. Cows* Milk. Condensed. Not Fed. No occupation. Away from home. Do. Intermittently. Some Home Work. Clean. Fair. Dirty. One. Two. Three. Four or more. 0 1 2 3 1 5 6 7 8 9 10 11 70 Diarrhœa 15 9 36 17 ... 4.3 5 9 1.3 54 12 4 17 33 13 7 7 6 7 8 9 5 8 8 4 4 3 1 55 Prematurity 10 2 12 1 30 35 7 8 5 45 6 4 12 27 16 ... 47 4 3 1 ... ... ..• ... ... ... ... • •• 30 Marasmus 8 5 14 3 19 3 8 ... 16 10 4 14 11 3 2 4 2 8 4 1 4 ... 2 4 1 ... 11 Atrophy and Debility 3 ... 5 2 1 6 4 ... 1 8 l 2 3 2 2 4 8 1 ... 2 ... ... ... ... ... ... ... ... 36 Bronchitis 20 9 6 1 ... 26 2 6 2 18 16 2 6 15 9 6 5 5 1 5 1 1 4 1 2 4 3 1 29 Pneumonia 7 5 10 7 ... 21 4 3 1 13 ll 5 5 17 1 3 1 ... 3 1 ... 1 2 2 4 3 4 5 31 Convulsions 11 8 7 3 2 24 3 2 2 19 11 1 14 13 ... 1 7 2 5 . 4 3 1 ... 3 1 2 3 27 Suffocated in bed 20 6 1 ... ... 16 3 5 3 11 12 1 9 9 5 4 4 7 5 3 4 ... 2 1 ... ... ... 1 5 Measles ... 2 1 0 • •• 2 1 2 ... 3 1 1 3 2 ... ... ... ... ... ... 2 ... ... ... 1 1 ... 1 14 Whooping Cough 5 4 3 2 ... 7 5 2 ... 11 2 1 6 6 1 1 ... ... 1 2 2 1 1 1 2 2 1 1 15 Tuberculosis m 7 3 3 2 ... 7 2 2 4 11 4 ... 6 7 1 1 ... ... ... ... 2 2 3 1 2 5 ... ... 51 Miscellaneous 27 3 10 4 7 30 4 8 9 32 16 3 15 23 7 6 21 7 1 2 2 1 2 1 6 .. 1 4 371 1.33 49 108 41 40 236 43 55 40 244 102 28 110 165 61 38 101 34 37 28 27 21 23 17 28 20 18 17 26 27 (c) Occupation of the Mother.—Whilst 7.5 per cent. of the mothers of Finsbury children in general are occupied away from home, 11.5 per cent. are thus absent from the homes where infant deaths have occurred. That also is a slight rise but it is not marked. The occupations of the mothers of both dead and living infants are substantially the same. No. Of Infants. Feeding. Mothers' Work. Condition of Home. Breast only Breast, etc- Cows Milk only. Condensed or Artificial. Not Fed. None. Away from Home. Intermittent. Some home work. Clean. Fair. Dirty. 374 133 49 108 44 40 230 43 55 40 244 102 28 % 35.8 13.1 28.8 11.7 10.6 63.1 11.5 14.7 10.6 65.2 27.2 7.5 (d) Method of Feeding.—But when we come to inquire into feeding there is a very different result. Of the mothers of the living children 80 per cent. breast-fed their infants. Of the mothers of the dead infants only 35 per cent. breast-fed their children. That is a marked and decisive point of difference. It should not be forgotten, however, that the majority of the investigations into deaths took place, as a rule, at a later period in the twelve months than similar investigations into births. As many as 108 of the dead infants were fed only on cows' milk and were not suckled at all; 44 were fed on "condensed" milks and other artificial "foods only." On the whole, therefore, it may be said that the broad difference between the treatment which the living infants and the dead infants have received in Finsbury is a difference of feeding. But we must go a step further back than that to explain the deaths from prematurity, marasmus and convulsions. Most of these deaths would appear to depend not wholly upon feeding, for the infants only lived a few days, but upon the physical conditions of the mother. From either point of view the 'problem of infant mortality is mainly a question of motherhood. 28 The following table from the Registrar-General gives the comparative figures of infant mortality at each quarter since the Borough was formed (calculated on total births):— Year. Period of year. No. of Births. No. of infant Deaths from all causes. Deaths under 1 year to 1,000 Births registered. 1901 Jan.-March 961 109 113 April-June 891 113 127 July-Sept. 967 161 166 Oct.-Dec. 943 156 165 1902 Jan.-March 959 141 147 April-June 900 122 136 July-Sept. 899 146 162 Oct.-Dec. 939 162 173 1903 Jan.-March 962 131 136 April-June 940 94 100 July-Sept. 877 136 155 Oct.-Dec. 914 137 150 1904 Jan.-March 927 111 120 April-June 900 98 109 July-Sept. 857 178 208 Oct.-Dec. 909 117 129 1905 Jan.-March 891 111 125 April-June 822 91 111 July-Sept. 818 141 172 Oct.-Dec. 865 90 104 29 SENILE MORTALITY. The deaths of persons aged 65 years and over were as follows:— Intro-Parochial— North Clerkenwell 53) =173 South Clerkenwell Finsbury (St. Luke) 50) 59) St. Sepulchre 11) ExtrarParochial (Hospitals, Poor Law Institutions, etc.) 263 Total 436 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 1 year 107 89 148 85 429 Persons of 65 years and upwards 124 91 91 130 436 Out of the total of 436, 117 were between 65-70 years of age; 212 were between 70-80; 101 were between 80-90; 6 were between 90-100. DEATHS FROM ZYMOTIC OR INFECTIOUS DISEASES. The deaths from Zymotic Disease occurring in the Borough (intra-parochial and extra-parochial) during the year numbered 220 and were caused as follows:- 30 Small-pox Scarlet Fever Diphtheria and Membranous Croup Enteric Fever Puerperal Fever Erysipelas Measles Whooping Cough Diarrhœa Total 1901 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 1905 — 21 11 9 — 5 31 32 111 220 These returns yield a zymotic death rate of 2.24 per 1,000. The amount paid to medical practitioners for furnishing notification certificates was £71 19s. 6d. as against £80 7s. (id. in 1904. The Local Authority is recouped for this expenditure by the Metropolitan Asylums Board. The fees paid for Voluntary Notification of Phthisis amounted to £11 5s. 6d. DEATHS IN RELATION TO TENEMENTS. This year we have again classified the deaths in relation to the number of rooms occupied by the persons who have died. 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. The results appear to show that the smaller the tenement the higher is the death rate of all causes and of the diseases named. This is an instructive result when it is considered that each of the three years tells the same story and that as many as 4,000 deaths are tabulated on a population of approximately 100,000 persons. It is necessary, however, to recognise that the figures are of relative value only, for it must not be assumed that a man dying of phthisis in a one-roomed tenement in 1905 has lived all his life in that tenement. He may only have been living there a few months or years, his disease having been contracted elsewhere. But even as a relative return the figures are striking and illustrate in a marked manner the broad fact of the evil effects of living under "overcrowded" conditions. 31 Finsbury, 1903, 1904 and 1905. Death Rates from All and Certain Causes in Houses or Tenements of several sizes. Size of Tenements. Census Population 1901. All Causes Zymotics Respiratory Disease (excluding Phthisis). Death per 1000. 1903. Death per 1000 1904. Death per 1000. 1905. Death per 1000 1903. Death per 1000 1904. Death per 1000 1905. Death per 1000 1903. Death per 1000. 1904. Death per 1000. 1905. Death per 1000 1903. Death per 1000 1904. Death per 1000. 1905. One-room tenement 14,516 389 40.6 32.7 5.6 5.1 3.4 4.5 4.5 3.5 9.3 9.8 6.4 Two-room tenement 31,482 22.6 21.9 19.5 3.8 4.1 2.8 2.8 2.2 2.1 5.3 4.9 5.2 Three-room tenement 21,280 11.7 14.7 12.3 1.8 2.1 1.8 1.2 2.3 1.3 2.4 3.4 2.8 Four-room tenement and upwards of four rooms 33,185 5 6 7.5 6.6 0.51 0.1 0.69 0.63 1.2 0.81 0.84 1.4 1.4 Institutions" 1,000 16.0 28.0 8.0 ... ... ... 7.0 5.0 ... 4.0 8.0 6.0 Deaths not traced ‡ ... 273 216 268 12 11 18 13 25 28 10 62 69 The Borough 101,463 ‡ 19.6 21.1 18.2 2.6 2.8 2.06 2.2 2.5 2.1 3.9 4.8 4.4 ° 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, or for special reasons the deaths were not visited. † For the purposes of this Table it has been necessary to use the Census Population (1901), for all three of the years included in the Table. It should not, however, be forgotten that the population is declining, and the Death Rates for each year in this Table are, therefore, approximate only. B.- RECORDS OF DISEASE 35 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), Diarrhœa, Measles, and Whooping Cough. The notification clauses of the Public Health (London) Act, 1891 (Sections 55-57), deal with small-pox, cholera, diphtheria and membranous croup, erysipelas, scarlet fever, typhus, typhoid, relapsing, continued and puerperal fevers. During 1905 there were 745 notifications, as compared with 806 in 1904, and 586 in 1903. The returns as forwarded to the Metropolitan Asylums Board are as follows:- First Qtr. Second Qtr. Third Qtr. Fourth Qtr. Total for 1905 Small-pox - - - - -- Scarlet Fever 68 71 164 153 456 Diphtheria (including Membranous Croup) Fevers- 32 27 35 32 126 Enteric 4 6 22 10 42 Typhus — — — — — Continued — — — — — Erysipelas 25 24 31 35 115 Puerperal Fever 1 3 2 — 6 Totals 130 131 254 230 745 Note.—Chicken-pox, temporarily notifiable in 1904, produced 197 cases. In the year 1905, 185 cases have been notified by the schools in the Borough. The following Table compares the notifications of notifiable diseases and removals to hospital since the Borough was formed:- 36 Year Number of Notifications Received. Notifications per 1,000 of the Population. Percentage of Cases Removed to Hospital. 1901 1,101 10.8 85.5 1902 1,026 10.1 82.4 1903 566 5.5 78.8 1904 609 6.1 72.5 1905 745 7.5 81.8 In the above Table notifications for Chicken-pox are excluded. Table III. (see end of report) sets out a number of further particulars respecting these notifications, from which it will be seen (a) that 561 out of 745 infectious cases occurred in children under 15 years of age, that is to say, broadly, of school age; (b) that although the population of North Clerkenwell and St. Luke are approximately the same, many more cases of infectious disease (120 in fact) occurred in the St. Luke division; and (c) that out of 745 patients 610 (or 81.8 per cent.) were removed to hospital. Respecting the second conclusion, it will be observed that the excess in the St. Luke division was mostly due to scarlet fever. Doubtless the explanation for this excess is to be found in the greater density of population and the larger percentage of persons living in model dwellings. The amounts paid in fees under the Public Health (London) Act to medical practitioners notifying since 1901 has been as follows:— Year. Amounts paid to Medical Practitioners. Cost per 1,000 of Population. £ s. d. £ S. d. 1901 109 11 6 1 1 7 1902 (including Chicken Pox) 175 16 6 1 14 8 1903 (including Chicken Pox) 61 7 6 0 11 9 1904 (including Chicken Pox) 80 7 6 0 l6 2 1905 71 19 6 0 14 10 37 It may be of interest to note that of 140 cases of "notified" Diphtheria, 14 (or 10 per cent.), were returned from the Metropolitan Asylums Board Hospitals as not so suffering; out of 45 "notified" cases of Typhoid 3 (or 6.6 per cent.) were returned; and out of 479 cases of notified Scarlet Fever, 23 (or 4.8 per cent.) were returned. This yields a total of 604 notified cases, out of which 40 were returned as not correctly diagnosed, being only 6.0 per cent. small-pox. There were no cases of Small-pox in Finsbury in 1905. 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 1905 0 0 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 1905 0 0 0 38 CHICK EN-POX (Varicella) On March 29th, 1904, the London County Council made the following Order "The London County Council do hereby Resolve and Order that Section 55 of the Public Health (London) Act, 1801, 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 (he recent increase in the number of cases of Small-pox in Loudon 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, 1904). We received 197 notifications. In 1905 notification was not in force, and we heard of cases of chicken-pox only through the schools; but they amounted to 185, nearly as many as through notification by medical practitioners. DIPHTHERIA. There have been 126 notifications of Diphtheria (including Membranous Croup) received during the year, as compared with 125 in 1904, 119 in 1903, 216 in 1902 and 289 in 1901. This result shows a marked and satisfactory decline on 1901. During the year til bacteriological examinations were made of doubtful cases, yielding 12 positive and 49 negative results. The age incidence of Diphtheria and its mortality for 1905 was as follows:— 39 Ages in Years Under 1 year 1-5 5-15 15-20 20-30 30-40 40- Totala No. of Notified Cases Males Females 5 | 30 16 2 3 1 1 58 3 27 25 4 4 3 2 68 Totals 8 57 41 6 7 4 3 126 Deaths from 2 7 1 - - - 1 11 Diphtheria. Percentage on Cases. 25.0 12.3 2.4 - - - 33.3 8.7 It will be seen that the chief incidence of the disease has fallen on children, as many as 100 out of 126 being of school age, which is almost exactly the same proportion as in 1904. The following table shows the seasonal occurrence:— Months Jan. Feb. Mar. April. May. June July. Aug. Sept Oct. Nov. Dec. Number of Cases 9 10 13 9 10 8 13 9 13 l6 2 Totals 32 27 35 32 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. 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." 40 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 notified. 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 1905 12.8 1.1 8.7 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 (if more than one sanitary defect was found in any one house it has not been included):— I.—Insanitation— Houses, in which Diphtheria occurred, found to be damp or dirty 23 Defective drains, sanitary conveniences, sinks, etc. 23 Defective paving in yard and accumulation of refuse in yard 5 Total 01 II.—Channels of Infection— Previous cases in the same house or family 13 Personal contact with Diphtheria in vicinity 20 Following Scarlet Fever 1 Total 34 There has been no marked outbreak of diphtheria during the year, though there was a threatening of such in the residential quarters of the Honourable Artillery Company's Barracks in the City Road. There are 15 families living there, and in the summer 41 these families comprised 34 adults and 39 children. It appears that on June 25, after a few days' illness, a little boy, aged 5, died of some throat complaint, which from its history, at least, simulated diphtheria. Another child, a playmate, contracted diphtheria, and was notified to me on June 21, and subsequently six other children and an adult in the barracks suffered from this disease. Stringent measures were taken, in which I am glad to acknowledge the co-operation of the military authorities, and no extension of the outbreak occurred. There were four or five instances of small groups of diphtheria infection among families or playmates. There were no school outbreaks nor any sign of milk-borne infection. In two cases it appeared probable that infection had been derived from cats which were suffering from sore throat affection. Bacteriological examinations were made of these two animals, but no sign of diphtheria was found. SCARLET FEVER The total number of notifications of Scarlet Fever received during the year was 456, as against last year's 323, and 283 in 1903. This figure of 456 includes 7 cases of Scarlet Fever which occurred in the Holborn Infirmary in Islington, as part of an outbreak in that institution. The infection was not derived in Finsbury, which, however, was credited with 19 cases in all, 12 of which were returned as not suffering from Scarlet Fever. We have, therefore, only included the 7 cases. The age and sex incidence of the 456 cases was as follows :— Ages 0- 1- 5- 10- 15- 20- 30-40 Total Males 5 93 76 17 5 9 3 208 Females 6 90 116 26 3 4 3 248 Total 11 183 192 43 8 13 6 456 From these figures it will be seen that 386 out of the 456 cases occurred in children under 10 years of age. In relation to school 42 influence, it is of interest to note that about 94 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 21 deaths, distributed as follows:— Years Under 1 year 1 and under 5 5 and above I5 At all Ages Number of cases notified 11 183 262 456 Number of deaths 2 12 7 21 Percentage of deaths at each age period 18.2 6.5 2.6 4.6 attacked Twenty-one deaths yield a Scarlet Fever death rate of 0.21 per 1,000. The comparative figures for the last eight years are as follows:— Years Number of Cases notified Number of Deaths Death Rate per 1.000 1897 597 26 0.24 1898 518 30 0.27 1899 480 18 0.16 1900 227 12 0.11 1901 495 19 o.18 1902 381 15 0.14 1903 283 12 0.11 1904 323 17 0.17 1905 456 21 0.21 43 The distribution of the disease in Finsbury in 1905 has been fairly uniform, although there has been one marked group. The incidence of Scarlet Fever, 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 populat on. Case-mortality. No. of Deaths per 100 eases 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 1905 46.4 2.1 4.6 and its seasonal incidence is shown as follows:— Months Jan. Feb. Mar. Apr. May June July Aug Sep Oct Nov. Dec. Number of Cases. 17 19 32 14 27 30 39 46 79 60 44 49 Totals 68 71 164 153 Direct personal infection has been traceable to previous cases of Scarlet Fever in the same family in 69 instances, in schools in 29 instances, and in the same house or buildings in 167 cases. That is, that out of the total of 456 it has been possible in 265 cases (or 58 per cent.) to trace direct personal infection. Some 40 cases of Scarlet Fever occurred in Guinness' Buildings in Lever Street, between June and August, and there were another score of cases in the vicinity also set up as part of the same outbreak. Nearly all these cases were of children under 10 years of age and half of them were under five years. There was another outbreak of smaller proportions in the Northampton Buildings. Six centres of infection in the Borough originated in children returning from country holidays bringing infection back with them. 44 More or less marked insanitary conditions were found in 83 houses in which Scarlet Fever occurred. The "return" cases were as follows: — 1. This is a group of cases arising apparently from a case of Scarlet Fever returned home in an infectious state. (a) Winifred G., aged 9 years, was removed from 37, C. Street, on Feb. 2nd, suffering from Scarlet Fever. She returned home on Wednesday, March 29th, in apparently good health, save for slight swelling of the ankles. The mother reported that she had noticed some loose skin on one of Winifred's feet, the day after her return. On Friday, March 31st, twelve days after her return, Winifred complained of swollen glands in the neck, and on the evening of the following Monday, a sister and brother, Irene and Reginald, fell ill. She does not appear to have complained of sore throat, or to have had any cold in the head. On April 13th, the fauces were normal. There was no diarrhoea or rhinorrhœa or any history of ear-ache. The feet and hands showed no desquamation. The submaxillary glands on both sides were slightly enlarged, but not tender, and any inflammation there had been was subsiding. The Medical Superintendent of the North-Western Hospital at Hampstead wrote me on April 16th, stating that this child's "attack of Scarlet Fever was of the simple type; the only "complication being a mild adenitis affecting the cervical "glands on the right side. This lasted from Feb. 27th to "March 15th. On the latter date she was quite well and "left the Hospital 14 days later. At no time during her "illness had she any discharge from either her ears or nose, "and when dismissed she was quite free from desquamation." (b) Irene G., aged 5 years, sickened with Scarlet Fever on Monday, April 3rd; had not been in contact with any children outside her family. She left school on Feb. 2nd, and had not been back to school since that date, except to pay a visit to her teacher on the day she sickened, viz.:—April 3rd. Her mother used to allow her to take money from the customers, many of whom were children, but the shop was closed on Saturday, March 26th, and had not been re-opened. Thus, the last time she was exposed to this indirect contact with other children was nine days before she fell ill. She spent her afternoons in the Bunhill Fields Cemetery, but, according to her nurse, did not play there with other children. 45 She had not been taken to visit at houses containing children during the month, neither had any children visited at 37, C. Street. (c) Reginald Charles G., aged 6 months, sickened on the same day (April 3rd), as his sister Irene, namely, Monday, April 3rd, 1905, and was almost certainly infected from the same source. His chances of contact with sources of infection other than his elder sister, Winifred, were even more remote than those of Irene. (d) John H. G., aged 2 years, fell ill with Scarlet Fever on April 12th, 1905. Slept in the same room as the baby Reginald on April 4th, the baby then being ill with Scarlet Fever. After the 4th he was separated, and did not again come in contact with Reginald or Irene, who were removed on the 6th and 5th respectively. Thus he was last directly in contact with a Scarlet Fever patient 8 days before he developed the disease. He was doubtless exposed to indirect contact through his mother and nurse on the 5th and 6th; therefore he was exposed to sources of infection other than his sister, Winifred, and is not an undoubted "return case." (e) Henry G., aged 36 years, the father of these children, next contracted the disease (April 15th), and was removed to hospital on April 17th, where he died on April 24th. (/) On or about April 20th, the housekeeper at this house commenced to suffer from a feverish attack of an indefinite character. She attended all the patients, and the children slept in the same bed with her prior to their removal. She was not seen by a doctor, and was not notified as a case of Scarlet Fever. (g) On Tuesday, May 2nd, a man named Charles H., aged 22, slept at 37, C. Street, as a lodger, and he was attended to by the housekeeper. On May 6th he commenced illness, and was removed with Scarlet Fever on May 11th. It should be added that the bouse had been disinfected after each case, but there is collateral evidence to show that there was in this family a large measure of carelessness, aud indeed negligence, in respect of precautions against the spread of infection. 2. Eleanor T., aged 3 years, 322, G. Buildings. Notified as Scarlet Fever, August 29th, onset August 28th. Return case, sister, 46 Jane T., aged 10, admitted to hospital June 16th, discharged August 23rd, with desquamation on cheek and lips, supposed to be from a cold. The age distribution was as follows:— Ages Under 5 5-15 15-30 Above 30 Totals Males 1 4 10 5 20 Females — 3 10 9 22 Totals 1 7 20 14 42 ENTERIC FEVER. In 1905 there were again only a few cases (42) of this disease, less than a half per cent, of the population being attacked. Of these 42 notifications 4 were received in the first quarter, 6 in the second, 22 in the third, and 10 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 1905. 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 14 cases it has been possible to determine personal contact as the channel of infection. Six cases attributed their infection to the consumption of shell-fish. There were no groups of cases. In 14 houses sanitary defects were found. The incidence of Enteric Fever since the Borough's formation is shown in the following table:— 47 No. of Cases Notified. 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 65 6.4 1.1 16.9 1902 77 7.6 0.9 11.7 1903 47 4.7 1.1 23.4 1904 40 4.0 0.8 20.0 1905 42 4.3 0.9 21.4 During the year tlie blood of 21 patients was examined bacteriologically, and 4 were found to yield a positive result. Discharge Notices.—The Metropolitan Asylums Board has continued to send discharge cerl ificates, 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 327, concerning 458 cases of discharge. The result of our visits has been to find that, apparently, all the patients had completely recovered (except perhaps some general weakness), with the exception of 42, in whom were found some definite sequelæ:- Discharged cases of Scarlet Fever— Sore Throat 3 Coryza 3 Ottorrhœa 9 Desquamation 4 Nasal Discharge 4 23 Discharged cases of Typhoid Fever— Paresis of limbs 1 Weakness 1 2 Discharged cases of Diphtheria— Nasal discharge 2 Slight Paresis of limbs 11 Sore throat 1 Enlarged glands 3 17 Summary— Sequelfe in Scarlet Fever 23 Do. Diphtheria 17 Do. Typhoid Fever 2 42 48 We were unable to trace any return cases of Diphtheria or Typhoid Fever, and only two of Scarlet Fever. 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 31 deaths attributed to Measles during the year, giving a death-rate of 0.32 per 1,000. The London death-rate for Measles for 1905 was .37 per 1,000, there being 1,715 deaths from that cause as against 2261 in 1904. 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 1905 the secondary causes of death in 30 of the 31 cases were:—pneumonia 18, bronchitis 10, convulsions 2. This gives 28 out of 31 (or 90.3 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, 63) during 1905 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. It 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 1905 received 561 intimations of the occurrence of the disease as follows:— 49 Information of 561 cases has been received from the following sources:— Schools in Borough— 1905. 1904. 1903. Albion Place 12 1 12 Amwell Street 13 7 — Ann Street 18 10 32 Baltic Street 4 6 26 Bath Street 5 35 33 Central Street 38 2 13 Chequer Street 22 37 33 Compton Street 30 29 35 Hugh Myddleton 74 80 21 Moreland Street 34 9 39 Risinghill Street 8 68 80 St. John Street (Martyrs' Memorial) 20 23 24 Winchester Street 1 46 14 St. Barnabas 11 2 — St. Luke 2 14 — SS. Peter and Paul 10 1 — 302 370 362 Schools outside Borough 19 23 14 321 393 376 Other Sources— County Council School Visitors — — 2 Medical Practitioners 26 5 16 Other Borough Councils 7 23 2 Registrars of Births and Deaths 3 — — Relieving Officers — 5 4 Sanitary Inspectors 190 333 130 Superintendents of Dwellings — 16 4 Parents and Guardians 14 27 43 561 802 577 The age incidence of the intimaled cases of Measles during the last three years in Finsbury has been as follows:— 50 Age Incidence of Intimated Cases of Measles, 1903-5. Year. Under one Year of Age. 1- 2- 3- 4- 5-10 10-15 Totals. 0-3 3-6 6-9 9-12 1903 1 4 9 15 57 58 107 170 150 6 577 1904 — 5 16 28 117 110 148 149 219 10 802 1905 — 7 19 21 75 73 106 103 156 1 561 Totals 1 16 44 64 249 241 361 422 525 17 1940 From this Table it would appear that the disease occurs most commonly in the third and fourth year of life. It has, however, to be remembered that these figures are of intimated cases only (though there is no reason to suppose they are exceptional), and are not "corrected" as regards population at these ages. Broadly, however, they represent the incidence of the disease. The deaths occur mostly in the second year of life, as shown in the following Table:— Year. Under one Year of age. 1- 2- 3- 4- 5-10 10-15 Totals. 0-3 3-6 6-9 9-12 1903 — 3 2 13 29 9 10 1 1 69 1904 — — 5 9 24 12 5 2 3 60 1905 — 2 2 1 14 7 4 — 1 — 31 Totals — 5 9 23 67 28 19 3 5 1 100 All cases of measles and all deaths from the disease are now investigated, and it may be well to add a brief note as to the channel of infection in cases and deaths belonging to the second year of life (when the mortality is highest). In 1905 there were 75 cases and 14 deaths in the second year of age period. Of the total of 89 we have positive findings in 77 with regard to the 51 source of infection. It appears from these investigations that 55 of the 77 (or 71.4 per cent.) contracted their infection at home from elder children in the same families (10 from children in their third year, 18 from children in their fourth year, and 27 from children in their fifth year). Most of these infecting children attended Infant School. Preventive Measures.—Every case of the disease of which we have been cognizant, has been visited and inquiries 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 school of SS. Peter and Paid, in Rosoman Street, was partly closed, and disinfected by us on account of measles. 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. 52 WHOOPING COUGH. There were 32 deaths from Whooping Cough, giving a death rate of 0.32. 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 110 age is absolutely exempt from Whooping Cough, it is essentially a children's disease, most of the cases being met with in children PUERPERAL FEVER. In 1905, there were six cases of Puerperal Fever, one of which ended fatally. Each patient was visited by one of the Lady Inspectors, and a full report of the case sent to the London County Council. EPIDEMIC DIARRHŒA. During 1905 there were 111 deaths attributed to this disease, 77 of these cases being infants under one year of age. This gives a death rate for Epidemic Diarrhoea of 113 per 1,000. Years. Finsbury Epidemic Diarrhœa, Death Rate. I.ondon Death Rate. 1900 1.50 0.78 1901 1.20 0.86 1902 0.81 0.53 1903 0.99 0.64 1904 1.46 1.03 1905 1.13 0.73 It has already been shown that 429 children died in infancy in Pinsbury in 1905, of which number 77 (or 17.9 per cent.) died of this disease. It will be convenient to consider this disease in relation to age incidence, season, methods of feeding, occupation of the mother, and housing conditions. 53 (a) Age Incidence at Death. Of the 77 deaths of infants under one year, 20 occurred in infants under three months, 23 in the second three months, and 34 in the last six months of the first year. The distribution was therefore fairly uniform in each trimester of the first year. The Registrar-General's latest returns (1903) show that this disease as a rule has the heaviest incidence of fatality in the second trimester, and declines in the third and fourth. The Finsbury figures do actually show the same feature but not in a marked degree. (b) The Relation of Season. The main effect of season shows itself in the third quarter of the year and depends upon dryness and heat. A hot dry Summer favours the occurrence of the disease; a cool, wet Summer, or a Summer that is either cool or wet, exerts an unfavourable effec on the occurrence of the disease. In 1901 there were in Finsbury in the Summer quarter 93 deaths from Epidemic Diarrhœa. 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.) In 1902 there were in the Summer quarter 61 deaths of infants from Epidemic Diarrhoea. The Summer was a dry one (only 6.02 inches of rain fell), but it was also a cool Summer, the mean temperature of our 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 of the four-foot earth thermometer, 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. In 1904 the Summer season was warm and dry. The temperature of our four-foot earth thermometer 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 54 infants were registered as due to epidemic diarrhœa during the quarter. In 1905 the four-foot earth thermometer gave an average in the third quarter of 59.8° F. In August it rose to 61.4° F. on three successive days, and was above 58° F. for eleven consecutive weeks. The rainfall was 5.45 inches. The conditions were therefore favourable to the occurrence of epidemic diarrhoea, but only 65 deaths took place. These facts may be presented in tabular form as follows:- Third Quarter Year. No. of Infant Deaths from Epidemic Diarrhœa. Mean Temp. 4-ft. earth thermometer. 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 1905 65 59.8° F. 5.45 The facts concerning the relationship between seasonal conditions and diarrhœal deaths in the summer quarter of the present year (1905) may be tabulated as follows :— Summer Quarter, 1905. July. August. September. Dates of months (in weeks). 2-8 9-15 1622 23- 29 to-5 July 6-12 1319 2026 27-2 Sep 3-9 1016 1723 2430 Mean temperature. Fourfoot thermometer. (Average 598° F ) 57.4 58.7 60.0 60.8 61.3 61.1 60.8 60.3 60.9 59.9 59.6 58.5 57.7 Rainfall (5.45 in.) 0.03 0.26 0.02 0.53 0.45 0.16 0.03 0.48 1.21 0.68 0.32 0.01 1.27 No. of deaths from Epidemic Diarrhœa. (65) 1 1 4 7 4 10 11 9 6 4 — 5 3 55 It will be seen from these figures that "Ballard's law" (of increase of diarrhœal fatality after the 4-foot earth thermometer is above 56° F.) does not appear to have held good. No marked rise occurred until the temperature was 60° F., and although the summer was hot and fairly dry the total deaths were much less than the year before. I can offer no explanation of this. It is possible that the Infants' Milk Depot saved some of the infant lives that would otherwise have been lost in the third quarter. (c) Relation to methods of Reeding. An enquiry has been made into each of the fatal cases of diarrhœa with a view of obtaining information as to surroundings and method of feeding. In 70 cases out of the 77 the following facts have been obtained Breast-fed only 15 or 21.5 per cent. Cows' milk only 34 or 48.6 ,, Artificial or "condensed" milk only 19 or 27.1 „ Breast-fed and cows' milk l or 1.4 ,, Breast-fed and condensed milk l or 1.4 ,, 70 100.0 That is to say, 79 per cent. of the children under one year dying of epidemic diarrhœa in Finsbury, in the third quarter of 1905), 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 poor live in an urban district like Finsbury, that, quite apart from (he unsuitability 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 occur in a period too short to be reliable, It, may, therefore, be well to add 56 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 1902-4. During 1905 we have carried out further enquiry into the conditions of life obtaining in relation to 374 infant deaths; 77 of these deaths were due to epidemic diarrhoea, and the feeding of 70 of these cases has been investigated on the same lines as in previous years when 301 deaths from this disease were investigated. It is thus possible to give the results of enquiry into 371 cases of fatal diarrhoea of infants. The return (1902-5) is as follows:— Age in months. Human Milk. Artificial or Condensed Milk. Human and Artificial. Cows' Milk. Human and Cows'. Totals. 0-3 26 23 11 39 19 118 4-6 18 32 13 38 13 114 7-9 11 21 13 30 14 89 10-12 13 13 3 13 8 50 Totals 68 89 40 120 54 371 From these figures it will be seen that:— 68 or 18.3 per cent, were breast fed. 129 or 34.7 per cent, were fed wholly or partly on artificial milks. 174 or 46.8 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 diarrhœa in Finsbury from 1902 to 1905 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 1905 is therefore in no way exceptional, and only bears out the findings of three years. 57 Indeed, the larger the number of deaths investigated in regard to this point of bad 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 cows' milk, suitably modified for infant consumption. If both of these are impossible, then recourse must be had to sterilised milk. (d) Occupation of the Mother. Out of the 70 deaths from epidemic diarrhoea in infants it appears that only five of the mothers worked away from home altogether, 9 others were intermittently occupied, 13 did some home work, and 43 did no industrial work of any kind. This means that 93 per cent. of the mothers were more or less entirely engaged at home and could give all necessary attention to their children. It is therefore clear that the fact of mothers going out to work had little or nothing to do with these deaths. (e) Relation to Housing and Cleanliness. Of the 70 deaths of epidemic diarrhœa under consideration 17 or 24.3 per cent, occurred in one room dwellings. 33 or 47.1 „ „ two room „ 13 or 18.5 „ „ three room ,, 7 or 10.0 ,, ,, four and more rooms. It is therefore evident that upwards of 70 per cent. of these deaths occurred in dwellings of not more than two rooms. It appears that in only 16 cases could any reasonable complaint of uncleanliness be made in these 70 homes, which is verv satisfactory. (/) Relation to Previous Health of Children It has been possible to obtain some information respecting the condition of the child previous to the fatal illness in many of the 70 cases of deaths investigated. In 15 cases (or 21 per cent.) the children were apparently in good health, in 14 cases (or 20 per cent.) their health was only fair, and in those remaining, which constituted 59 per cent., there was definite history of weakness or illness. Some examples may be cited:— 58 P. R. died from epidemic diarrhoea at 7 months of age, had suffered from the disease a month before fatal attack. H. F. (5 months) never well since vaccination, abscess formed. A. S. (4 months) died a few days after vaccination. A. G. (8 months), a premature child, and weak from birth. J. M. (2 months), R. S (5 months), H. B. (3 months), E. O. (12 days), W. H. (4 months), P. (2 months), E. B. (4 months), W. T. (6 months), E. W. (8 months), A. F. (9 months), L. L. (22 days), were all frail children from birth and suffering from wasting, &c. W. B. (6 weeks) and L. R. (3 weeks), suffered from abscesses. E W. (7 months), two children had "consumptive bowels," and E. W. had possibly contracted the disease from them. Three cases of such personal infection were met with, two from children and one from the mother who was suffering from diarrhœa. J. P. (10 months) was always liable to convulsions. E. B. (6 months) was under the hospital for Ophthalmia and eventually died in hospital from epidemic diarrhoea. F. V. was a case of gross neglect and much dirt and filthiness at home. J. W. (9 months) was much weakened by teething. Four further cases of fatal diarrhoea occurred immediately after weaning in the summer quarter. 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 59 milk (a) which is suited to their physical requirement, and tb) 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. 107). 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 jusl 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 are about 30 less than last year. 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; in 1904, 210; and in 1905, 178, as follows:— Notified Cases. Under 10 yt'ars. 10- 20- 30 40- 50- 60 Total. Males — 5 16 31 30 25 16 123 Females 1711 9 16 7 4 55 Total 1 12 27 40 46 32 20 178 60 Most of these 178 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. In the first place, voluntary notifications, if only of advanced cases, come too late to render very much service to the patients 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. 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. It, may be that the way out of the difficulty as to notification is a system of compulsory notification as in force in New York and in Sheffield (for a period of seven years from 1903). 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 (b) 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 61 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 a greater degree 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 to hospital and institutional isolation, to the advance of sanitation, improvement of housing, the raising of the standard of personal hygiene, cheap food, 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 this Borough Council concurred in the views of the 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 1904, adjourning the whole question for 12 months. Subsequently 62 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. In May 1905, in response to a communication from the Metropolitan Asylums Board, the Borough Council again affirmed their former resolution approving the principle of the establishment of sanatoria for the treatment of consumptives at the cost of the Metropolis generally. Deaths from Phthisis.—The total deaths due to consumption in 1905 were 215, as compared with 251 in 1904. The death rate for the year is therefore 2'2 per 1,000 (the London rate being 1'43), which is about the average rate for the last five years:— Under 1 1 and under 5 5 and under 15 15 and under 2; 25 and under 651 65 and over Total Males 3 6 3 10 115 5 142 Females 3 5 3 13 47 2 73 Total 6 11 6 23 162 7 215 In the first quarter of the year there were 53 deaths; in the second, 54 ; in the third 37; and in the fourth, 71. 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 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. 63 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, 1906:—" The total number of deaths from phthisis, occurring in the Holborn Union Workhouse Infirmary, during 1905, was 127 (being 29 less than in 1904), of these, 97 were of patients coming from Finsbury. The total number of phthisis cases now under treatment in this Infirmary is 197, of these cases 134 (22 women and 112 men) belong to Finsbury." The following table sets out the number of phthisis deaths in institutions as follows:— Total Number of Phthisis Deaths. Phthisis Deaths in Holborn Union Infirmary. In other Institutions. Total in Institutions. Percentage of Deaths in Institutions. 1901 216 82 39 121 56.0 1902 240 88 20 108 45.0 1903 223 97 20 117 52.5 1904 251 113 27 140 55.7 1905 215 97 31 128 59.5 From this table it will be seen that more than half the deaths from this disease in Finsbury occur in institutions, and, with few exceptions, poor law institutions. This means, in the first place, that more than half the deaths are of the very poor, and secondly, it means that more than half of the advanced and dying cases of this disease are isolated from the community, and in this way a large body of infection is removed from the district, which is a matter of the greatest importance as a means of prevention of the spread of the disease. Rut our greatest need at the present time in dealing with phthisis in Finsbury is earlier and more frequent isolation of the patient, both for his own sake and the protection of the community. 64 To measure the age incidence accurately it is necessary to state the deaths per 10,000 of the population at each age period as follows:— SEX. No. of Deaths 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 3.9 211 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 7.8 232 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 1905 Males 9.7 4.1 17.9 38.0 65.5 96.5 47.1 28.4 Females 8.7 7.7 8.4 16.3 38.1 24.8 12.1 14.1 The incidence of Phthisis since the Borough's formation, therefore, may be shown as follows:— 65  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 1905 18.1 21.9 Each notification and death has been enquired into. Many of the former naturally become the latter 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 64 cases (out of 215 deaths) were directly infected by relatives, which is 30 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 (though somewhat lower than usual). 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 amongst relatives which in the greater number of instances furnishes the clue to infection, and this clue is generally wanting where the histories of fellow workmen, lodgers, etc., in past years are enquired into. But there is abundant evidence to show that infection may be derived from such sources. Seven cases in 1905 appear to have derived their disease from the workshops in which they worked, and 17 were directly or indirectly affected by alcoholism. The history of the fatal cases shows that 39 suffered for less than six months before death, and 46 between 6 and 12 months, the remainder appear to have suffered for a longer 66 period up to 8 years. In 142 cases it has been possible to make exact enquiries into the number of rooms occupied by the patient at the time immediately before death or removal to an institution. 25 deaths occurred in one room tenements. 74 „ „ two „ 21 „ ,, three „ 22 „ ,, four rooms or more. The 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:— Number of previous cases of Phthisis notified in former years, or having died in same house. Totals. One. Two. Three. Four. Five. Notifications in 1905 25 12 4 — — 41 Deaths in 1905 29 9 6 2 1 47 Totals 54 21 10 2 1 88 From this table it will be evident that 47 deaths or 32.1 per cent. of the total deaths occurred in houses already infected. Though the majority of these cases were probably 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 isolation and 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. 67 3. Spit only into a spittoon or cup kept tor 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.O. 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 62 were taking precautions. 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 previous reports, 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 where marked. 4. During the year further action has been taken with a view to preventing the dissemination of the disease in public-houses by circulars and notices, and notices have been printed advising no spitting in workshops. 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. 68 Other forms of Tuberculosis.-In addition to the 215 deaths from Phthisis (Tuberculosis of the Lungs), there were also 52 deaths from tuberculosis of the membranes of the brain, and all other forms of tuberculosis, making a total of 267 deaths from this disease, as compared with 318 in 1904. An investigation has been made into the infant deaths due to this disease, and in 13 cases some particulars have been obtained, of which the following are the chief:— 69  Sex and Age. Address and No. of Rooms in Brackets. Certified cause of Death. Phthisis now in Family, or History of such. Milk. Condition of Homes and General Remarks. M., 5 mos. 33, S. St. [2] Tuberculous Enteritis History of Phthisis and father Consumptive Human for 3 months, then condensed Child began illness 10 days after commencing condensed milk. A very clean home. P., 5 mos. 13, C. St. [6] Acute Tuberculosis of Lungs — Human and artificial Child weakly from birth. M., 8 mos. 27, S.St. [1] Tuberculosis Marked History of Phthisis Human, 2 months, cow's, 6 months — M,, 6 mos. 12, A. St. [I] Tubercular Meningitis History of Phthisis and father in Consumption Hospital Human only — M., 8 mos. 31, P. St. [2] Tubercular Meningitis and general Tuberculosis (P.M.) — Human only — M., 6 mos. 101, C. B. [3] Tubercular Meningitis — Human only — M., 8 mos. 18, A. St. [2] Tuberculosis of Lungs and Intestines (P.M.) Marked History of Phthisis Human only — 70  Sex and Age. Address and No. of Rooms in Brackets. Certified cause of Death. Phthisis now in Family, or History of such. Milk. Condition of Homes and General Remarks. F., 8 mos. 31, A. St. [2] Tubercular Meningitis Sister died of Phthisis; father, Chronic Cough Human only — M., 4 mos. 26, B. St. [1] Tubercular Meningitis (P.M.) Father Consumptive Human only Mother at work. F., 9 mos. 27, R. St. [2] Tubercular Meningitis — Human only — F., 8 mos. 28, I. St. [2] Tuberculosis, Exhaustion History of Phthisis Human only — F., 6 mos. 1, S. St. [1] Tuberculosis, Diarrhœa — Cow's only Mother always out at work. F., 5 mos. 336, C. Rd. [1] Tubercular Meningitis Marked History of Phthisis Human and condensed — 71 From these facts it would appear that in 8 of these cases there was definite history of phthisis infection in the family to which the child belonged. In five cases there was no such history. There was no direct evidence in any case of infection through tubercular cow's milk. CANCER AND MALIGNANT DISEASE There were 65 deaths certified during 1905 as due to cancerous or malignant disease, which gives a special death rate of 0.66 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 50 and under 60 60 and under 70 70and upwards Total Males 1 2 — 1 4 6 8 7 29 Females — — — — 7 9 10 10 36 Totals 1905 1 2 — 1 11 15 18 17 65 Totals 1904 1 1 3 5 13 22 22 12 79 Totals 1903 — I 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 ease 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. 72 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 65 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 hate 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. 1905. Totals. Face, Tongue, Jaw — 7 12 7 7 33 Throat, Neck, Gullet — 8 7 8 8 31 Stomach 9 12 16 8 7 52 Intestines 10 17 11 14 10 62 Liver 10 6 13 11 3 43 Pancreas — — 3 3 1 7 Breast 6 9 12 4 11 42 Uterus 16 12 9 14 11 62 Various 21 1 9 10 7 48 Totals 72 72 92 79 65 380 An examination of the returns for 1905 reveals the following two facts: (a) the cases of cancer in men recorded in Finsbury numbered 29, of which 27, or 79.3 per cent., were cases of cancer of the alimentary canal including jaw and tongue; (b) the cases among women numbered 36, of which 9, or 25 per cent., were cases of cancer of the alimentary canal, and 22, or 61.1 per cent., were cases of cancer of the breast or womb. ALCOHOLISM. During 1905 eight deaths were directly attributed to alcoholism and delirium tremens. These figures do not, of course, represent 73 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 1905 there were, as already pointed out, 29 deaths so caused. Cirrhosis of the liver, a condition due, as a rule, to alcoholic excess, caused the death of 22 persons. Hence it may be said that at least 30 deaths were probably due to alcoholic excess. The figures are as follows:— Years. Alcoholism. Cirrhosis of Liver. Total. 1901 11 22 33 1902 27 21 48 1903 22 29 51 1904 19 25 44 1905 8 22 30 All of the 8 deaths due directly to alcoholism occurred between the ages of 33 and 43. 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. Out of the 8 deaths due directly to alcoholism, 3 were women, one of whom was a barmaid aged 31, who died of delirium tremens after three days' illness. Out of the 22 deaths due to alcoholic liver (a more chronic form of poisoning), 10 were women. Three of the 12 men were barmen. The Public Health Committee were instructed by the Council to circulate in the Borough, in pursuance of the advice of the Physical Deterioration Committee's Report, the following statement on the injurious effect which may be produced by excessive consumption of alcohol:— 74 METROPOLITAN BOROUGH OF FINSBURY. Alcoholism. It is conclusively proved by the Report of the Departmental Committee presented to Parliament by command of His Majesty: 1. That the abuse of alcoholic stimulants, whether in the form of spirits, wine, or beer, is largely responsible for physical deterioration; it leads to disease in most tissues and organs in the body. 2. That alcoholic excess reduces the natural power of resistance to disease possessed by healthy individuals, rendering them especially liable to certain inflammatory disorders, causing them to suffer more severely from any illness they may contract, and making their recovery slow. 3. That intemperance predisposes to consumption. 4. That children of intemperate parents are seriously affected; they not infrequently suffer from paralysis, epilepsy, and idiocy, which lead, if not to death, to their permanent disablement. From statistics obtained it was found that the mortality among children of intemperate parents was much greater than among children of sober parents of the same class. 5. That the increase in lunacy is largely due to intemperance, and that there is also an increase in the number of cases of general paralysis from the same cause. (5. That alcoholism is a disease or chronic poisoning, resulting from the continued and excessive use of spirits, wine and beer, even though such excess or abuse does not always produce drunkenness. 7. That alcohol has no real value as a food. 8. Parents sometimes give alcohol in one form or another to children. It is likely to be decidedly injurious to them, and should in no case be given except by order of a doctor. 9. That, finally, alcoholism is a relentless enemy to family happiness, to personal health, and to national prosperity. The members of the Departmental Committee are impressed with the necessity of widely disseminating the conclusions arrived at from expert opinions placed before them. The Finsbury Borough Council have decided, therefore, to publish the above facts in order to bring home to men and women the disastrous results of alcoholic excess or abuse to the health and life of individuals and their offspring, and to the efficiency of the State. Finsbury Town Hall, Rosebery Avenue, E.C. December, 1905. C.—PROTECTION OF THE FOOD SUPPLY. 77 PROTECTION OF THE FOOD SUPPLY. During the year 1905 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, restaurant 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 procedure 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, neither the vendor or the Council 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 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. 78 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. If 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. Our method of Meat Inspection may therefore be summarized as follows:— (а) Seizure of the unsound or diseased meat by the Inspector, unless voluntarily surrendered. (b) Examination of the meat by the Medical Officer of Health. (c) Submission of the meat to the Magistrate presiding at the Police Court for an order of condemnation and destruction, the owner being permitted to have the meat seen on his behalf by experts if he so wishes. (d) Report of the facts of the case to the Public Health mittee. The owner, under exceptional circumstances, meets the Committee and lays his interpretation of the facts before them. (e) Carrying out the Committee's instructions in regard to prosecution or otherwise. During the year under review we have only had 9 prosecutions; in each case a conviction has been obtained. The table of prosecutions 1901-1905 is as follows:— 79  Years. No. of cases of Meat Prosecution. No. of Convictions. Cases Dismissed. Weight of Meat, &c. confiscated (in tons) 1901 24 24 — 30 1902 16 16 — 75 1903 19 18 1 101 1904 15 15 — 76 1905 9 9 — 94 The case in 1903, in which we failed to get a conviction, was dismissed on a point of law as to whether the master was liable, under sub-section 3 of section 47 of the Public Health (London) Act, 1891, for the acts of his servant—i.e., selling unsound meat for the food of man. A case was stated for consideration by the King's Bench Division of the High Court, but was subsequently abandoned, as the defendant had in the meantime become an inmate of a lunatic asylum. His friends guaranteed the costs incurred by the Council. TABLE OF MEAT, &c., PROSECUTIONS, 1905. Date of Trial. Defendants' Name and Address. Article Where seized and Name of Inspector. Penalty and Costs Inflicted. Jan. 11 John Herbert, 160, Whitecross Street, Finsbury. Eleven tins, four bowls and two pieces of brawn, 12 sheep's tongues, and a quantity of pieces of meat, weighing in all 168 lbs. The brawn was mouldy, slimy and smelt offensively. The sheep's tongues and also the pieces of meat were all in an advanced stage of decomposition, as shown by the discoloration and offensive smell. 160, Whitecross Street, Finsbury. (Inspector Billing.) £8 and £4 4s. costs. Mar. 8 Messrs. Chas. and Fredk. Rapson (trading as Rapson's Stores), 1, Lamb's Conduit Street, Holborn. One hundred and sixtyone and a half pounds of prunes. These prunes were much discoloured, many were rotten, and the whole smelt very offensively. 57, Chapel Street, Finsbury. (Inspector Billing.) £3 3s. costs. 80  Date of Trial. Defendants' Name and Address Article Where seized and Name of Inspector Penality and Costs Inflicted. Mar. 17 William Westacott, Hardaway Head, Barnstaple, Devonshire. Two hind quarters of beef, one head, one heart, one liver and one tripe. This beef was extremely emaciated, and there were tubercles in the lungs and liver. It was admitted in evidence that the fore quarters were not fit to send to London, and were therefore sold for dogs' food. It was also stated by the defendant that this meat and offal was intended for dogs' food. 93, Cowcross Street, Pinsbury. (Inspector Billing.) £15 and £15 costs. July 21 Frederick Mundy, 10, Chapel Street, Finsbury. Two pieces of mutton, weighing 43 lbs. This mutton was foreign and very mouldy, slimy and smelt offensively. 10, Chapel Street, Finsbury, (Inspector (Billing.) £3 and 2s. costs. Aug. 3 William Quinton, 154, Weedington Road, Kentish Town, N.W. One hundred and eightysix pieces of bacon, weighing 140 lbs. This bacon was much discoloured, and smelt very offensively, and appeared to have been imperfectly cured. On a stall in Chapel Street, Finsbury. (Inspector Billing.) £5 and 2s costs. Aug. 9 Walter S. Chapman, 24, North Street, Grantham, Lincolnshire Two carcases of mutton. These carcases were extremely emaciated, flabby and wet. The joints, especially the stifle joints, were much enlarged, and the surrounding tissues were much inflamed. Several abscesses had formed near the joints. Both carcases were blown and also generally dressed to represent lamb. 93,Charterhouse Street, Finsbury. (Inspector Billing.) £10 and £10 costs. 81  Date of Trial. Defendants' Name and Address Article Where seized and Name of Inspector Penality and Costs In flicted. Sept. 13 Michael John Ludgate, 214, Bartholomew Buildings, Seward Street, Finsbury. A quantity of pears weighing about 200 lbs. These pears were rotten and almost unsaleable. On a stall in Whitecross Street, Finsbury. (Inspector Billing.) 10s. and 2s. costs. Nov. 23 Harry James Green, 39, Bath Street, Finsbury. Thirty-three pieces of beef weighing 376 lbs. The whole of this beef was foreign—and was mouldy, slimy and smelt very offensively. 39, Bath Street, Finsbury. (Inspector Billing.) £15 and £5 5s. costs. Dec. 5 Lipton Ltd., (Secretary, W. S. Carmichael), Registered Office, City Road, B.C. Five pieces of pork weighing 282 lbs. These five pieces of pork consisted of a head, a piece of collar, a piece of the pillars of the diaphragm, and two sides from which the head, collars, flanks, kidneys and kidney fat had been removed. The whole of it was affected with generalised tuberculosis. At a Sausage Factory in the occupation of Lipton, Ltd., situated in Cayton Street, City Road. (Inspector Billing.) £50 and £21 costs. It has been my practice to advise prosecution only in cases 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 have 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 exigencies and difficulties of the trade, especially in hot weather. 82 It is desirable that I should report somewhat fully upon the last case, the facts of which are as follows:— On November 7th, about 7 a.m., Inspector Billing visited Messrs. Lipton's Sausage Factory in Cayton Street, City Road, E.C. This factory is a large building of three floors. The ground floor is used for boning and mincing meat preparatory to the making of sausages. There are five mincing machines and several benches on which the meat is cut up and boned. There is also a refrigerator. The other floors are used for weighing, filling and platting sausages, and for the preparation of German sausages. On November 7th, Inspector Billing visited this place at an unusual hour, his ordinary visits having been made about once a fortnight at about 11 a.m. On the present occasion he found a quantity of glands on a box near the weighing machine. Some of these were tuberculous. He was informed that these glands were removed from pork which had arrived that morning. On a bench near at hand there were about 30 pigs' heads. On examining the first of these he found it contained tuberculous deposits. The other heads were free from this disease. The Inspector then asked the foreman (Russell) where the remainder of the carcase was to which this tuberculous head belonged. Russell replied, "The two sides must be in the refrigerator, and the pieces are somewhere about on these benches." Subsequently, some pieces ("collar" and "pillars of diaphragm") were found with marked signs of tuberculosis. These pieces were amongst good meat there and then being prepared for the machines. The two sides, which it was stated were portions of the same tuberculous carcase, were removed from the refrigerator. Inspector Billing sent for me. On arrival, I found these five pieces of tuberculous meat which had been taken from four different parts of the factory and the small pile of glands. I asked where the meat was from which these glands had been taken, but no one could furnish me with an answer to that question. I did not then examine the sides, but accepted them on the word of the Secretary, Mr. W. S. Carmichael, as part of the tuberculous carcase. I do not assert that they were part of the carcase, and I told Mr. Carmichael that I was compelled to accept with reserve his statement that all these parts and pieces were one and the same carcase. I saw seven or eight men actually engaged in boning and trimming pork and four or five others assisting, The "boners" were removing glands and trimmings from the meat. They did not examine the glands in any way whatever to see whether they were healthy or diseased. They simply cut out all glands and passed the meat for food. I pointed out to Mr. Carmichael that such a process of gland removal was highly unsatisfactory, as the removal 83 of such glands did not remove the virus from the tissues of the carcase, which, without the glands, would still be unfit for food. He replied to the effect that if the diseased glands were removed the meat should be considered lit for food. I then reminded him that two years ago (November 1903) I had occasion to tell him exactly the same thing, namely, that the removal of glands did not necessarily remove the virus of the disease. Mr. Carmichael then said that the practice of the firm was to remove all glands healthy or otherwise, as, in any event, they could not be used in sausage making. Inspector Billing disputed that statement and said that glands could be used in the process, and by other firms were in fact used, if healthy. On looking round the factory we found that the practice of gland removal was not either invariable or uniform even at Messrs. Lipton's, for we found some glands going into the mincing machine. I am bound to say I saw no evidence of careful inspection of the meat that was being prepared, though I saw abundant evidence of the removal of glands by the boners then at work. The glands were not examined in any way, but were at once thrown under the tables or cast aside. In the pile of glands above referred to (numbering 44) we found that eight were tuberculous. Mr. Carmichael informed me that since November, 1903, all the pork carcases received in this factory (about 200 a week) were treated in this way, and many of them were delivered with the chief superficial glands already removed. I pointed out that the entire practice was open to grave criticism as by such stripping of glands, the very signs of disease by which tuberculosis could be diagnosed were being removed before inspection could be made either by the Sanitary Authority or by the firm. Mr. Carmichael claimed that this pork had come from the Islington Cattle Market, and had therefore been already inspected and passed for food by Inspector King. The head, having 14 tuberculous glands or parts of glands still remaining attached to it, the "collar" and" pillars," and the two sides were seized and subsequently further examined by me at the Town Hall, and condemned by the Magistrate (Mr. Cluer) at the Worship Street Police Court. They were all affected with generalized tuberculosis. Subsequently the meat was seen by Dr. Collingridge, the Medical Officer of Health of the City of London, as statements were being made that the disease might not after all be tuberculosis, and corroborative medical evidence was therefore thought advisable. Dr. Collingridge was of opinion that there could be no doubt whatever that the whole of the seized meat was affected with generalized tuberculosis. It was alleged by Mr. Carmichael that in the seizure which had taken place the whole of this tuberculous carcase had been 84 removed by us from the factory. That of course was not so. The flanks, kidneys, and kidney fat were not found by us, and we had no evidence that the pieces and glands we seized were all from one and the same carcase. On Wednesday, November 8th, Inspector Billing again visited Messrs. Lipton's Sausage Factory at 6.15 a.m. He was informed by Russell that pork carcases were not expected. He had good reason however to return again at 6.45, and found 12 sides of pork being delivered from Gosport, from the owner of the tuberculous pork seized by us at Messrs. Lipton's in 1903. From each of these sides the mammary and pharyngeal glands had been removed before delivery. On November 9th, Inspector Billing called again at 7 a.m., although we had been informed that the firm did not receive pork carcases on Thursdays. He was surprised to find 30 sides of pork being received from Bast Ham, many of which were stripped of their glands, and one carcase was affected with generalised tuberculosis (this we confiscated). Whilst the Inspector was engaged in examining this meat six more sides of pork were delivered from Walthamstow. These six sides were of excellent quality, all the glands being intact and healthy. Acting on the instructions of the Public Health Committee, a summons was issued against Messrs. Lipton, and the case was heard before Mr. Cluer at the Worship Street Police Court on Tuesday, December 5th. Mr. R. D. Muir appeared for the Finsbury Borough Council, and Mr. Horace Avory, K.C., with Mr. Charles Matthews, for Messrs. Lipton. Inspector Billing proved evidence of seizure, and I gave evidence on the condition of the meat. No other witnesses were called on behalf of the Borough Council. For the defence it was admitted that the meat was diseased and had found its way into the factory owing to the negligence of a servant. Two witnesses were called, namely, Mr. Malpas, a meat dealer, from whom, on November 6th, Messrs. Lipton obtained certain pigs, and Mr. James King, M.R.C.V.S., Superintendent Inspector of the Cattle Market at Islington. Both witnesses gave evidence to the effect that the meat seized by us had been inspected at the Cattle Market. Mr. Malpas, however, had to admit in cross-examination that during only the last two years meat belonging to him, and declared by him to have been inspected at the Cattle Market, had been confiscated by us on seven different occasions. Mr. King admitted that it was impossible to examine all the pork carcases killed at the Cattle Market (78,000 annually), but that he did examine some pigs belonging to Malpas on November 6th, and passed them, as being sound, for food. 85 Mr. Muir reminded the Magistrate that in 1903 Messrs. Lipton were previously convicted for a similar offence at the same sausage factory and were fined £25 and costs, and the learned Magistrate (Mr. Cluer) now imposed the full penalty of £50 and twenty guineas costs. This conviction, of course, concerns the actual seizure of tuberculous meat which was being prepared with other meat for human food, but I think it is my duty to point out to the Council that the entire practice of gland stripping, and of receiving stripped carcases, is open to grave criticism, and is a process which should not be continued. The Table on the following page shows the amount and character of the food confiscated during 1905, which was 19 tons more than in 1904. About 80 per cent. of the total meat surrendered was of foreign origin (chiefly Dutch and American). 86 Summary of Diseased and Unsound Meat, Offal, &c., confiscated during the year ending December 31st, 1905.  Diseased. Sides of Beef 4 Sheep's Plucks 122 Quarters of Beef 19 ,, Kidneys 27 Hamper of boneless Beef 1 Beef Livers 874 Carcases of Mutton 2 ,, Lungs 294 „ Pork 69 „ Heads 51 Sides of Pork 8 „ Tongues 20 Pieces of Pork 12 „ Hearts 9 Carcases of Veal 23 „ Tails 21 Quarters of Veal 3 „ Kidneys 4 Carcases of Stirk 7 ,, Tripe 1 Pigs' Plucks 231 „ Udders 4 „ Livers 136 Calves' Plucks 6 „ Mesenteries 3 „ Livers 2 Stirk's Pluck 1 ,, Lungs 8 Sheep's Livers 8,975 „ Kidneys 6 „ Lungs 1,410 „ Heads 2 Total weight Tons. Cwts. Qrs. Lbs. 30 12 0 27 Decomposed. Sides of Beef 4 Calves' Spleen 10 Quarters of Beef 88 „ Tripes 6 Pieces of Beef 74 „ Plucks 90 Carcases of Mutton 13 ,, Livers 16 Pieces of Mutton 18 „ Head 1 Piece of Lamb 1 „ Tongues 21 Carcases of Pork 5 Pigs' Plucks 385 Pieces of Pork 69 , Livers 100 Carcases of Veal 80 Lambs' Heads 2 Piece of Veal 7 ., Plucks 70 Beef Livers 672 „ Livers 153 „ Hearts 228 Barrels of Pigs' Plucks 13 „ Brains 20 „ „ Heads 2 „ Tripes 6 „ ,, Tongues 23 „ Lungs 2,495 „ „ Kidneys 31 ,, Tails 1311 Cases of Eggs 24½ „ Milts 528 Eggs 2,900 „ Heads 27 Baskets of Tomatoes 8 ,, Tongues 216 Boxes of Tomatoes 54 „ Udders 3 Baskets of Cherries 3 „ Kidneys 139 „ Strawberries 4 Sheep's Heads 469 „ Pears 16 „ Plucks 729 „ Raspberries 22 „ Livers 1,876 „ Damsons 1 „ Hearts 28 Cases of Plums 4 ,, Kidneys 691 „ Prunes 18 Sides of Bacon 2 Box of Cabbage 1 Crates of mixed Offal 5 Prunes (lbs) 161½ Rabbits 265 Raisins (lbs.) 112 Cases of Rabbits 61 Boxes of Bananas 6 Cases of Sheep's Kidneys 15 Blackberries (lbs.) 29 Pieces of Bacon 190 Tub of Butter 1 Barrels of Pork Rinds 10 Bottles of Lemon Curd 1,200 Baskets of Pigs' Chitterlings 6 Tins of Milk 186 Cases of Beef Kidneys 5 „ Beans 36 1 „ „ Livers 2 Box of Sweets „ „ Sweetbreads 1 Bex of Grapes 1 „ „ Tails 4 „ Potatoes 1 Calf's Heart 1 Combs of Honey 20 Total weight (Decomposed) Tons. Cwts Qrs. Lbs. 63 8 0 14 Total weight (Diseased) 30 12 0 27 Grand total weight (Meat only) 94 0 1 13 87 There are two points in this meat report which call for mention. First, there is the decline in the number of prosecutions, and second, there is the disadvantage of the lack of uniform methods of meat inspection in London. The number of prosecutions in 1905 is less than half the number in 1901. What does this indicate? It can indicate' only one of two things. Either there is less bad meat being sold or the inspectors are less vigilant. I have not the least hesitation in saying that the former answer is the correct one. The high penalties of 1901, amounting to upwards of £600, had a most salutary effect upon the whole meat trade in Finsbury, and it was recognized that this Sanitary Authority intended to enforce the law respecting the sale of diseased and unsound meat. The police court proceedings of 1902 and 1903 served to confirm that understanding. My observation leads me to believe that there has been a very great and steady improvement in the quality of meat placed on the Finsbury market. Inspector Billing has certainly not been less vigilant in 1905 than in previous years, and yet we have come across much less bad meat. That is a good sign, and the best and most natural result of efficient inspection. I need scarcely add that this satisfactory position can only be maintained by a continuance of vigilant and efficient inspection. During the last 5 years, in a number of meat cases, we have had evidence of absence of uniformity in meat inspection in London. The recent case against Messrs. Lipton affords further illustration of the same thing. This firm was detected in the act of preparing tuberculous pork meat for sausages. The defence instituted in court was that the meat had already been passed by the inspectors at the Islington Cattle Market. At the time of the action this firm, as will be seen from the report (p. 84), was receiving large quantities of pork meat from Gosport, East Ham and Walthamstow, which had not passed any inspection, so it is idle to suppose that all their meat had been properly inspected. But, however that may be, it most be admitted that the case raises the question of uniform inspection as a somewhat urgent requirement. To secure an effectual and uniform inspection of meat in this country, the following arrangements are necessary:— 88 (a) The establishment of public abattoirs and the gradual extinction of private slaughter-houses (in the terms of Recommendation A in Report of Royal Commission on Tuberculosis, 1898). (b) The appointment of a sufficient staff of properly qualified inspectors by all Local Authorities responsible for meat inspection. (c) The adoption of some system of marking or stamping meat, showing that it has been officially examined. (d) An official standard laying down a uniform basis of seizure and condemnation. Meat inspection is carried on in Berlin, in some of the British Colonies, and elsewhere on these lines, and has been found to work satisfactorily. With regard to (a) and (c), practically speaking, very little has been done in this country. Under recommendations (b) and (d) considerable advance has been made. Most inspectors devoting the whole of their time to meat examination are now specially qualified*. Further, a standard of meat condemnation has been recommended by the Royal Commission on Tuberculosis in their report of 1898, and the adoption of this standard has been "strongly urged" by the Local Government Board upon all Local Authorities and upon the Metropolitan Borough Councils. But, unfortunately, it appears not to be always followed. In my judgment, it should be absolutely adhered to and made compulsory, or withdrawn. The standard, as last issued by the Local Government Board on September 6th, 1901, is as follows:— "We are of opinion that the following principles should be observed in the inspection of tuberculous carcases of cattle:— *Four of the Sanitary Inspectors at Finsbury hold the Meat Certificate of the Royal Sanitary Institute. 89 (a) When there is miliary tuberculosis of both lungs (b) When tuberculous lesions are present on the pleura and peritoneum (c) When tuberculous lesions are present in the muscular system, or in the lymphatic glands embedded in or between the muscles (d) When tuberculous lesions exist in any part of an emaciated carcase The entire carcase and all the organs may be seized. (a) When the lesions are confined to the lungs and the thoracic lymphatic glands (b) When the lesions are confined to the liver (c) When the lesions are confined to the pharyngeal lymphatic glands (d) When the lesions are confined to any combination of the foregoing, but are collectively small in extent The carcase, if otherwise healthy, shall not be condemned, but every part of it containing tuberculous lesions shall be seized. "In view of the greater tendency to generalisation of tuberculosis in the pig, we consider that the presence of tubercular deposit in any degree should involve seizure of the whole carcase and of the organs. "In respect of foreign dead meat, seizure shall ensue in every case where the pleura have been ' stripped.' " The Board drew attention to this matter in the circular letter which they addressed to the Councils of Boroughs and Urban and Rural Districts on the 11th March, 1899, and they again referred to it in 1901, strongly to urge upon every Borough Council to direct those of their officers who are employed as Meat Inspectors to act in accordance with these principles as laid down by the Royal Commission. These Regulations are perfectly clear and systematic, and it is absurd to suggest, as is not infrequently done, that the wording is indefinite and that the whole matter should be left to the discretion of each Inspector. Something must always be left to the discretion 90 of each Inspector, and no Sanitary Authority would be wise to seize and destroy, for example, whole carcases of pork in which there were some sign of old localised tuberculosis. But if the throat glands are affected, it is not carrying out the instructions of the Local Government Board merely to cut off the head and pass the carcase—yet this is, I am informed, the practice in some places in the United Kingdom. I venture to submit that this matter and the practice of stripping carcases of their superficial glands, so that signs of disease are removed, call for the early attention of the Local Government Board. In Finsbury we make it our invariable rule to follow the recommendations of the Royal Commission on Tuberculosis, as printed above. Unsound Rabbits.—During the last few years we have confiscated a large number of unsound rabbits. In 1901 the total reached 16,950; in 1902, 871; in 1903, 1,728; and in 1904, 2,597. In the present year we have also confiscated 1,404. In November some similar rabbits were seize in another district of the metropolis, as it was believed that they were affected with a serious infective disease. It seemed, therefore, desirable that some of the rabbits confiscated by us as merely unsound from the same consignment should be submitted to careful examination. Two rabbits were therefore sent to Mr. A. G. R. Foulerton, F.R.C.S., D.P.H., the Director of the Bacteriological Department, Middlesex Hospital, London. His report was received as follows:— Bacteriological and Public Health Department, The Middlesex Hospital, London, W. 21th November, 1905. REPORT on changes found in two " imported" rabbits received from Dr. Newman on 7th and 11th November respectively. The carcases contained the lungs, heart, liver and kidneys, except that in the rabbit received first the left kidney had been removed. The appearances with regard to the abnormal conditions were the same in both animals, the surface of the liver, the 91 anterior surface of the kidney, and the abdominal aspect of the diaphragm had small yellowish white nodules scattered over their surface. The right kidney in Rabbit I. had a few small nodules just below the surface. With the exception of the last-mentioned organ all the nodules observed were clearly deposited on the surface of the respective organs. On microscopic examination it was found that these nodules consisted mainly of various forms of bacterial life, amongst which a mould mycelium and large spherical bodies were especially noticeable. So far as could be determined these nodules did not contain any animal tissue cells. And I am certain that the nodules were the result of growth of bacteria or moulds on the surface of the organs after death of the animals had occurred. The culture experiments resulted in the isolation of various saprophytic species from the nodules. Cultures made from the heart blood of Rabbit II. resulted in the isolation of a saprophytic bacillus and a sarcina. Two rabbits were inoculated, one with a considerable quantity of blood which was found in the heart of Rabbit II., the other with emulsion made from one kidney of the same animal. The inoculated animals were quite unaffected by the inoculation, and at the present time—13 days after the inoculations—are apparently quite well and healthy. I was unable to find any lesions in either body which could suggest that the imported rabbits had suffered from septicæmia; and this conclusion is strongly supported by the fact that the rabbits inoculated with the heart blood remained quite healthy. I am of opinion that the appearances in the rabbits submitted for examination are entirely due to contamination after death, and subsequent growth of saprophytic organisms. (Signed) ALEX. G. R. FOULERTON, Director. From this report it will be seen that there is scientific evidence to show that our view that the rabbits were unsound but not affected with infective disease is correct. It therefore seems probable that the importer is not responsible for dispatching from the Colonies diseased rabbits, but that the rabbits become unsound 92 after leaving his hands. It need scarcely be added that rabbits, whether unsound or diseased, if unfit for food, would at once be seized by us if exposed for sale. Our attention was called to the rabbits which have been confiscated, and to which reference has been made above. They were not seized by us. Slaughterhouses.—The following are the three slaughterhouses now situated in Finsbury:— 14, Penton Street (cubic capacity 2,451 feet). 20, Amwell Street (cubic capacity 3,227 feet). 191, Goswell Road* (cubic capacity 1,554 feet). 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 slaughter-house marked with an asterisk is licensed only for the killing of small cattle. The application to renew the licence of the slaughter-house at No. 39, Bath Street, was opposed by us at the October Licensing Committee of the London County Council, and at an adjournment, owing to the facts—(i) That the only approach to the slaughterhouse was through the shop ; (ii) The unsuitability of the premises; and (iii) That the applicant had been convicted at the Lambeth Police Court in 1904 for selling unsound meat. This Sanitary Authority naturally objected to a person coming into Finsbury to carry on a trade in which he had already been convicted of an infringement of the law. Subsequently, on November 23rd, 1905, this same man was convicted at Worship Street Police Court on a prosecution by us for depositing 33 pieces of unsound beef in the slaughter-house, and was fined £15 and £5 5s. costs. This second conviction was, therefore, brought against him by us in objecting to the granting of a slaughter-house licence, and the Licensing Committee refused to grant it. The premises at 39, Bath Street, are, therefore, no longer licensed as a slaughter-house. This reduces the number of slaughter-houses to three. In 1887, twenty These consignments of frozen rabbits are always certified after examination at the time of export. It is not, in fact, permissible to export them without such Government certificate. 93 years ago, the number of slaughter-houses in what now constitutes the Borough was 25, so that there has been a marked and satisfactory diminution in the number of these places. MILK SUPPLY. During the year we have been carrying out the proposals made in my report for 1903 in the direction of exercising control over the milk supply. Registration.—Under the Dairies, Cowsheds and Milkshops Order, 1885, Clause 6, 21 milkshops have been registered, and 29 have been removed from the register. These have been as a rule the smallest kind of general shop, selling a few pints of milk with every other kind of article. These places are, from a health point of view, very objectionable, as it is well nigh impossible to keep milk clean under such conditions. The total number of milk premises now on the register is 262. 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 402 visits, and have served 96 sanitary notices for defects of one kind or another. The inspectors and myself 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 1903, 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. 94 Inspection of Cowsheds.—I have this year paid further attention to the cowsheds still existing in the Borough. They are as follows:— No. Name of Occupier. Situation of Premises. Actual No. of Cows. Licensed No. of Cows. 1 John Richards 4, Sermon Lane 40 51 2 Rees Jones 1, George Street 3 12 3 David Timothy 27, Whiskin Street 2 20 4 John Davies 40, Rawstorne Street 7 10 5 John James 230, St. John Street 28 30 6 Mrs. David Hughes 39, Baldwin Street 15 17 The numbers of cows in the first column of the above table refer to the cows actually found at the last inspection. There have been three changes in proprietorship during the year. 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. At the October Licensing Committee of the London County Council I was instructed by the Public Health Committee to raise objection to a renewal of licence in 5 out of the 6 cowhouses existing in the Borough, owing to various unsatisfactory features found by us, and subsequently viewed by the Committee, including careless milking, contamination of the milk, and ill construction and position of the cowsheds which are so placed as to be in immediate proximity to dwelling-houses, so that in summer, at all events, considerable nuisance was likely to arise. The objection was not pressed by the Borough Council and the licences were renewed with additional warning to the holders as to the necessity for more care in conducting their trade. Sampling.—Under the Sale of Food and Drugs Acts 349 samples of milk have been taken. Each Inspector samples in his 95 own district monthly, and once a quarter takes a number of "special" samples in the evening and on Sundays at irregular hours. Thirty-eight of the samples of milk taken, or 10.9 per cent., were found to be adulterated. This shows a marked reduction in percentage of adulteration. In 1904 the figure was 13.9, and in 1903, 16.7. The following Table shows the results obtained during the last ten years:— 69 Sex and Age. Address and No. of Rooms in Brackets. Certified cause of Death. Phthisis now in Family, or History of such. Milk. Condition of Homes and General Remarks. 8., 5 mos. 33, S. St. [2] Tuberculous Enteritis History of Phthisis and father Consumptive Human for 3 months, then condensed Child began illness 10 days after commencing condensed milk. Avery clean home. F., 5 mos. 13, C. St. [6] Acute Tuberculosis of Lungs - Human and artificial Child weakly from birth. M.., 8 mos. 27, S. St. [1] Tuberculosis Marked History of Phthisis Human, 2 months, cow's, 6 months - M.., 6 mos. 12, A. St. [1] Tubercular Meningitis History of Phthisis and father in Consumption Hospital Human only - M., 8 mos. 31, P. St. [2] Tubercular Meningitis and general Tuberculosis (P.M.) - Human only - M., 6 mos. 101, C. B. [31] Tubercular Meningitis - Human only - M., 8 mos. 18, A. St. [2] Tuberculosis of Lungs and Intestines (P.M.) Marked History of Phthisis Human only - 97 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 (1901-5) there have been prosecutions for milk adulteration 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 1905 5 £400 £2 13 0 Totals for the 5 years 106 £190 2 6 £92 4 6 Total for Fines and Costs = £282 7s. od. The Annual Report of the Local Government Board for 1904— 1905 gives the returns for London as follows:— 98 Metropolitan Borough. No. of milks examined. No. found to be adulterated. Percentage of adulterations. Hackney 425 110 25.9 St. Pancras 380 96 25.3 Shoreditch 365 86 23.5 Stepney 641 126 19.6 Battersea 452 77 17.0 Fulham 245 41 16.7 Wandsworth 400 62 15.5 Bethnal Green 378 55 14.5 Finsbury 346 48 13.9 Southwark 1183 151 12.8 London as a whole 10610 1327 12.5 Poplar 130 15 11.5 Stoke Newington 61 7 11.5 Lambeth 515 57 11.1 Lewisham 258 28 10.9 Westminster, City 772 80 10.4 Paddington 289 29 10.0 Chelsea 178 17 9.5 Woolwich 370 34 9.2 Islington 601 47 7.8 Greenwich 118 9 7.6 Camberwell 318 24 7.5 London, City 469 35 7.5 Bermondsey 469 33 7.4 Hammersmith 130 9 6.9 Kensington 213 14 6.6 Deptford 215 13 6.0 Holborn 256 13 5.0 St. Marylebone 260 7 2.7 Hampstead 173 4 2.3 The comparative figures for 1904 (the most recent obtainable) work out as follows:— 1904. Percentage of Milk Adulteration. Borough of Finsbury 13.9 London 12.5 Twenty largest towns of England and Wales 10.1 The remainder of England and Wales 10.6 99 The percentages of adulteration for every five years since 1877 for England and Wales may also be added for comparative purposes. No. of Samples in 1904. Percentage of Adulteration in Examined Found Adulterated 1904. 1903. 1902. Quinquennium. 1897-01. 1892-96. 1887-91. 1882-86 1877-81. MILK 36,413 4,031 11.1 10.4 11.6 10.6 12.3 13.2 167 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 1905 the Inspectors collected 620 samples of which 73 (or 11.8 per cent.) were adulterated. There were 22 prosecutions under the Acts, the aggregate amount of fines and costs inflicted being £45 10s. 0d. In 1904, 11.9 per cent. of the samples were found to be adulterated, and there were 29 prosecutions. The samples collected were as follows:— 100  Samples taken. Adulterated. Samples taken. Adulterated. Milk 349 38 Lard 9 ... Butter 113 11 Epsom Salts 2 ... Bread and Butter 11 3 Cayenne Pepper 1 ... Bread and Dripping 1 ... Vinegar 6 ... Dripping 5 ... Olive Oil 5 ... Mustard !3 1 Tapioca 1 ... Pepper 7 ... Borax 1 ... Cocoa 9 ... Margarine 2 ... Coffee 19 6 Castor Oil 1 ... Arrowroot 3 ... Paregoric 1 ... Demerara Sugar 15 3 Liquorice Powder 1 ... Sweets 6 ... Brandy 5 5 Camphorated Oil 1 ... Gin 5 ... Cod Liver Oil 2 ... Rum 5 2 Cheese 9 ... Whisky 5 4 Coffee and Chicory 2 ... Oatmeal 1 ... Totals 620 73 Sago 4 ... The method of sampling adopted is as follows:- (a) 500 ordinary samples, including milk; (b) 100 extra samples of milk only; (c) 40 samples of spirits (gin, rum, brandy, whisky). As will be seen by the above table, the 500 ordinary samples include milk, butter, cheese, coffee, mustard, pepper, &c. These samples are taken by each inspector in his own district monthly. Every salesman of these or similar articles is sampled at some time during the year. 101 The extra milk samples have been taken at unusual hours (in the evening, on Sundays), or in the streets. The percentage of adulteration in these extra samples during 1905 was 10.4, as compared with a percentage of 11.8 in the ordinary samples. On February 21st, 1905, the Public Health Committee instructed the taking of 40 additional samples of spirits during the financial year ending March, 1906. On September 20th the first 20 of these samples were taken with the following results — Article. No. submitted to Analyst. No. Genuine. No. Adulterated. Gin 5 5 — Rum 5 3 2 Brandy 5 — 5 Whisky 5 1 4 Totals 20 9 11 On these findings the Public Analyst (Mr. J. Kear Colwell, F.I.C.), issued a special report (with an appendix), from which the following paragraphs are here quoted for reference:— Gin.—Gin was originally understood to be a spirit brewed from grain flavoured with juniper and re-distilled, but of late years it has become the custom to add flavouring agents to any plain spirit and re-distil. A variety of materials are used for flavouring, as each firm engaged in the production of gin appears to have some secret mixture for producing the desired effect. Gin may therefore be regarded as a fairly pure alcohol flavoured. The analytical data obtained from it are similar to those given by plain or patent still spirit; at present the only standard being that contained in Section 6 of the Sale of Pood and Drugs Act Amendment Act, 1879, which limits the reduction of gin to 35 degrees under proof. So long, therefore, as the public obtains a fairly pure alcohol of the requisite strength it is of relatively small importance from what source it is derived, as by chemical treatment and the use of patent stills most objectionable matters may be eliminated. The five samples in question all give such figures as might be expected from patent still spirits. 102 Rum.—Rum has until recently been defined to be a spirit obtained by the distillation of the fermented juice of the sugar cane or molasses in a pot still, and genuine Jamaica rum has the characteristics of such a spirit, but in Demerara and other places the pot still is said to have been replaced by the patent still, a very different article being produced. In Jamaica rum the esters, one of the secondary products which determine the character of the spirit, rarely fall below 400 parts per 100,000 of absolute alcohol and are frequently far higher, whereas in the Demerara or patent still product they are much less, a fact which was successfully pleaded on behalf of the defendant in a recent case. It is obvious that the addition of patent still spirit to Jamaica rum would produce a mixture similar to Demerara rum. In the five samples analysed the esters in each case were far below what might have been expected in the Jamaica article, but as they were purchased as " rum," and may possibly be Demerara rum, I have not certified them as containing patent still spirit, although some must certainly be regarded as doubtful. Two of the samples were below the limit of spirit strength (25 degrees under proof). Brandy.—Brandy is a spirit obtained from wine (the fermented juice of the grape) distilled in a pot still, and should contain at least 80 parts of esters per 100,000 of absolute alcohol. From the results obtained it will be noted that in no instance was the quantity of esters up to the standard. In one case the deficiency was so slight as to be negligible, but the spirit strength had been reduced far below the legal limit (25 degrees under proof). In the other samples there had been an undoubted addition of plain spirit, or the spirit had been made in some other way than that in which brandy should have been produced. Whisky.—Whisky consists of spirit derived from malted barley or a mixture of malted and unmalted barley or wheat distilled in a pot still. A spirit produced in this way contains at least 380 parts (coefficient of impurity) of those secondary bodies per 100,000of absolute alcohol which impart to genuine whisky its peculiar characteristics. Of the five samples examined only one exceeded this figure, the others being far below. There is no doubt that all these contained a large proportion of plain spirit, some being practically plain spirit flavoured. In one case the spirit strength was 46 degrees below proof. At the present time there is little doubt that the great majority of the public imagine whisky to be a product derived from malt. brandy from wine, and rum from the juice of the sugar cane, and when they ask for either of them they expect to receive liquids so obtained, and they certainly ought not to get a mixture containing plain spirit or one having similar characteristics. If either is blended with plain spirit or has not been prepared in the proper manner, then the purchaser should have an opportunity of rejecting it. There is no reason why mixtures may not be sold provided they are adequately labelled and the purchaser thoroughly understands the exact nature of the article the vendor proposes to supply. 103 Whether patent spirit is more or less harmful is a question for medical men, but there is no doubt that brandy and rum owe much of their medicinal value to the presence of those ethers and secondary products which are absent in patent spirit. Other evidence which may or may not have some bearing on the question is to be found in the fact that the growing condemnation of the use of alcoholic stimulants by the medical profession has been coincident with the increasing output of patent still spirit. It is alleged that genuine whisky must be blended with plain spirit to render it palatable, but it must be remembered that for many years, in consequence of the scarcity of good brandy, there has been a great demand for whisky, and the stocks of matured whisky have been practically used up. As genuine whisky requires to be matured before consumption, the distillers, in many cases, have been unable to await the effects of time and have blended comparatively new whisky with a featureless alcohol like plain spirit, and so obtained a quicker return and prevented much capital lying idle. But doubtless the real reason for the use of plain spirit is its cheapness, for it can be made from anything capable of conversion into sugar. It may be bought for about 1s. per gallon, whereas whisky or brandy costs three, four, or more times as much. In the year 1900 nearly (60 million gallons of proof spirit of all kinds were produced in the United Kingdom, and during that period a sum of 20 million pounds sterling was paid in duty. The larger portion of this spirit was probably disposed of as whisky, so that, if the statement of one of the trade authorities that four-fifths of the whisky sold in the United Kingdom consists of plain spirit is to be accepted, some idea may be gathered of the large quantity of plain spirit which must have been sold at the price of whisky. It may be of interest to add that about 90 per cent. of the spirit made in France is produced from maize or beetroot, whilst over 80 per cent. of Germany's spirit is derived from potatoes. Practically all the Finsbury spirits now under consideration, with perhaps one or two exceptions, have the composition of mixtures largely composed of plain spirit. In most places where they were purchased notices were exhibited stating that they were either sold as diluted spirit or that the quality was not guaranteed. It is necessary to point out once more that this wholesale evasion of responsibility by the vendor hanging some vague but all-embracing notice in some obscure corner is grossly unfair to the purchaser, and one which calls for effective legislative amendment. As has already been pointed out, something more definite is wanted so that the honest trailer may be protected. This question of plain spirit and whisky has been taken up by the United States Government Chemists, and as a result it is announced that, after the 1st November next, no whisky will be allowed into the United States unless fully described as to its composition and the respective quantities of pot still and patent spirit which it contains. 104 Some regulation of the same nature is wanted here, for this practice is not confined to Finsbury or London, but is general throughout the country. MARGARINE. Under the Margarine Act, 1887, Sec. 9, and the Sale of Food and Drugs Act, 1899, Sec. 7 (4) it is necessary for manufacturers of margarine and margarine cheese, and for wholesale dealers in the same to register with the Local Authority. In 1900, 24 such registrations were made (including the portion of Finsbury then belonging to Holborn); in 1901, two; in 1902, three; in 1903, two; and in 1904, nil. Last year (1905) there were five, as follows:- Pearks, Ltd., Bayer Street, Golden Lane, E.C. The Mazawattee Tea Co., 50, Exmouth Street, E.C. Mr. H. Husberg, 28, Cow Cross Street. W. Baker & Co., Ltd., 1, Paul Street, E.C. The United Kingdom Tea Co., 1, Paul Street, E.C. RESTAURANTS, FOOD STALLS, ICE CREAM, &c. The annual inspection of restaurant kitchens, &c., took place during the summer. There is a total of 274 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 restraurants in Finsbury daily is approximately 60,000. The results of our inspection since 1902 are as follows:— Year. No. of Restaurants. No. of Notices Served. Percentage of Premises having Defects. 1902 220 150 68 1903 232 137 59 1904 230 94 40 1905 274 173 63 105 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 some also in which the sanitary conveniences were either 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. We have in Finsbury about a dozen 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. These workplaces have been carefully inspected, and various recommendations made for the protection of the produce from contamination. 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. During 1905 the system of registration of ice-cream vendors, 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 was removed, so that there were then 100 on the register; there are now 103. These places are regularly inspected, and the regulations enforced; 192 visits of inspection having been made by the inspectors, and 36 intimation and statutory notices served for nuisances, &c. There has been one prosecution for an unmarked barrow. 106 WATER SUPPLY. The water supply of the Borough is derived from the Metropolitan Water Board (New River). 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 examination), the New Fiver unfiltered water contained about 180 bacteria per c.c. and the filtered water, as delivered, contained only 11. 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 1905. The wells existing in the Borough, which are still used, are as follows :— 1. Richmond Street (No. 25).—This is an artesian well, about 25 feet deep. The water is used for the purpose of supplying a gas engine only. The domestic supply is derived from the Metropolitan Water Board (New River). 2. Bunhill Row (No. 125).—This place is used by a tirm 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. 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 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. 6. Old Street (Bovril, Limited).—This firm has an artesian well 400 feet deep. The water is used for all purposes. On being analysed 107 the water was found satisfactory. A supply is laid on from New River mains to be used by meter, but little is used. 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. 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. INFANTS' MILK DEPOT. In December, 1905, a special report was issued by instruction of the Public Health Committee, on the establishment by a voluntary society in the Borough of an Infants' Milk Depot (see Report, 1904, pp. 115-123). The milk is obtained from Mr. Carson's farm in Essex, and the modification, and if necessary, sterilisation, and bottling, is carried out at the farm, which is managed on strictly sanitary and hygienic lines. The commencement of the Social Workers' Association furnished the occasion for the establishment of the Finsbury Depot, and the work entailed was undertaken by a voluntary Committee of medical men, assisted by some lady visitors. The object was to establish a Depot on a small scale, under proper control and on satisfactory lines, for a few children, rather than to work a larger institution for a considerable number. The whole of the necessary funds were subscribed by a few friends of the enterprise. The principles by which the Medical Committee wished to be guided were- 108 (a) absolute control of the milk, and the avoidance of the serious fallacy of sterilising unclean milk; (6) medical supervision of the entire management of the Depot, and of the infants using the milk; (c) a discriminating and careful distribution of the milk only to infants who could not be breast-fed; and (d) the systematic study of the effect of the milk on the children. The Committee desired to make the method as individual as possible, and in no way to lessen the responsibility of the mother. It is evident that these are not easy principles to carry out, and many difficulties have been encountered. 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 separated milk, two parts water + 8 ozs. cream + 7 ozs. milk sugar to the gallon. B.—One part separated milk, one part water +11 ozs. cream + 5 ozs. milk sugar to the gallon. C.—Two parts separated 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: — 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:— 109 Standard of Modification. Age of Infant No. of Bottles. per day Amount per bottle in ounces. Amount per day in ounces. A Under 1 month old 2 18 1—2 months old 9 3 27 2—3 months old 8 4 32 B 3—6 months old 7 5 35 C 6—9 months old 6 6 36 9—12 months old 6 7 42 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. Generally, however, it may be said that children receiving A modification consume from 6-10 ozs. of pure milk daily, those receiving B between 15 and 20 ozs., and those receiving C from 20-30 ozs. of pure milk daily. Chemical and bacteriological examinations of the milk have been made at intervals in order to check the process. The examinations made in London without any notice to the farm workers have shown a steady quality of milk approximating as nearly to the standard set out above as the natural variations in cows' milk will permit. From a bacteriological point of view, the milk has been found to be sterile, or, when pasteurised only, containing a few lactic acid organisms per cubic centimetre. The daily stock of milk is sent up by rail every night in sealed bottles packed in specially prepared cases. On arrival at the distributing centre, 264, Goswell Road, it is placed in a cool room, and in summer in a refrigerator. The Depot, or distributing centre, consists of two rooms on the first floor of a large tenement house, one a dressing room, the other a weighing room. In the latter room there is a refrigerator and shelves and cupboards for storing milk if necessary. There is also the weighing balance (a 110 Walker-Gordon cradle balance), and record and register books. All unnecessary expense has been avoided. It is not so much upon apparatus as upon methods that a distributing centre depends for success. Infants requiring the milk are introduced to the Depot by medical practitioners, hospitals, nurses, sanitary inspectors, birth registrars, and others. The parents or guardians must pay the necessary price of the milk in advance, and must be residents of Finsbury. The price charged is the ordinary market price of milk in the district—namely 4d. per quart. On the Wednesday following the date of application the infant is brought to the Depot, medically examined by a member of the Medical Committee, and weighed. Particulars respecting the child are entered in the Record Book, and a second page is devoted to fortnightly entries as to progress, increase or otherwise of weight, and general physical condition. It is obligatory that the child shall be brought once a fortnight to be weighed, and, if necessary, examined. The milk is only supplied on this condition. No medicine is given, and if medical advice is required the mother is instructed to consult a medical man or go to a hospital. The Depot is not a "consultation de nourrissons" but a " goutte de lait." After medical examination the suitable degree of modification is ordered from the farm, and the mother sends for the milk daily. Each child fed on the Depot milk is visited in its own home once a week, and in some cases more frequently. In this way a direct personal influence is brought to bear on the mother, and homely advice is given and precautions taken as to the management of the infant. Sanitary conditions and their effect on the health of the child are noted. Moreover, it has been found in practice that printed instructions as to the way in which the milk is to be used are not properly understood by the mother apart from personal advice or actual demonstration. Preparation and bottling at the farm protect the milk from home contamination, but it is necessary that the infant should take the milk direct from the bottle in the proper way if such contamination is to be absolutely avoided. Good practice in this respect is obtained by 111 personal visits. I attribute much of the success of the Depot to these personal visits and assistance. They have been of the greatest value to both mothers and infants. Since July the whole of this part of the work has been done by Miss Frith, who is a certificated hospital nurse (St. Bartholomew's Hospital), and certified under the Midwives Act 1902. She instructs the mothers as to points needing their attention, and visits each home at least once a week to see that the instructions are being properly carried out. She keeps a visiting diary in which periodical notes respecting each child's progress are kept; she also keeps a register and account book of payments for the milk. Miss Frith has devoted practically the whole of her time to the work of the Depot. The Depot has not been generally advertised in any way. Circulars have been sent to the medical practitioners in the district, the neighbouring hospitals, the clergy, etc. Notices have also been affixed in the birth-register offices by the courteous consent of the Registrars. But it will be understood that not all mothers unable to feed their infants are willing to conform to the somewhat stringent conditions of the Depot, and the Committee have been in no hurry to admit large numbers of infants. They have been satisfied to deal with a few cases in a thorough and scientific manner rather than work a general sort of depot for all who chose to apply. The reasons for which mothers sought the Depot were as follows:— Mothers who had no breast milk 74 Mothers who had an insufficiency of milk 24 Abcess of the breast, &c. 13 The breast milk not agreeing with the infant 10 Infants unable to suckle or otherwise defective 6 The mother at work 2 129 It may be said that 37 per cent. of the children on the Depot were introduced by the Lady Sanitary Inspectors of the Borough Council, 33 per cent. were introduced by medical practitioners in the 112 Borough, and 23 per cent. of the cases were sent to the Depot by St. Bartholomew's Hospital. It should be added that the children admitted to the Depot are only such as belong to Finsbury. The Depot was opened on November 23rd, 1904, and up to November 22nd, 1905, 129 children had been entered on the books. They belonged, with very few exceptions, to the poorer classes. Twenty per cent. of the children came from homes of one room only, and another 43 per cent. from two-roomed homes. So that not less than 63 per cent. lived in homes of two rooms or less, and very few indeed lived in homes of four rooms or more. It may be taken, therefore, that the children came as a rule from poor homes. A second point of importance is that 75 per cent. of the children admitted were ill at the time of admission, many of them were very seriously ill, and some of them dying. It is obvious that healthy children would not usually be introduced by medical men, who sent fully 55 per cent. of the total number. But many of the others were ill, under-fed and wasting, and the mothers sought the Depot on that account. Previous to admission 58 per cent. of the children had been fed on some form of cows' milk, and 42 per cent. on condensed milk or artificial foods. In a number of cases the child had had a little breast milk during the first few days of life. The age and sex of the children admitted were as follows :— Infants. Months. Totals. Under 1 month. 1-2 2-3 3-4 4-5 5-6 6-7 7-8 8-9 910 10-11 11-12 Male 9 15 11 11 7 7 3 3 2 3 1 1 73 Female 14 12 13 5 4 - 5 — 2 1 — — 56 Totals 23 27 24 16 11 7 8 3 4 4 1 1 129 Before mentioning some of the results of this milk feeding in detail, it may be desirable to deal with two matters, namely, the 113 general increase in weight, and the cause of death in the 10 cases which ended fatally. First as to increase in weight. The importance of the weight of an infant as a criterion of its health and progress is well known. Indeed, the weight is often the only criterion as to whether the infant is improving in health or not. At birth the average weight is about 7 lbs. ; at three months it may be about 9 to 11 lbs. ; at six months about 13 to 15 lbs. ; at nine months about 16 to 17 lbs.; and at 12 months 19 to 20 lbs. Dufour's standard has been used in the Finsbury Depot, as in French Depots. It is well known that the standard rise in weight in the early months of life is greater than subseauently, but roughly it may be said that throughout the 12 months of infancy the average increase is one pound a month (12 lbs. + 7 lbs. at birth = 19 lbs.). We have taken that as a standard, with the following result Out of 118 infant", 74 have attended more than one month and of these 60 (or 81 per cent.) have gained more than halfa-pound each per month and on an average 16½ ozs. per month ; the remaining 14 (or 19 per cent.) have gained less than half-a-pound per month. Of the 14 infants who, though taking the milk for at least a month, did not gain even average standard weight and therefore did not prove satisfactory, three died, five were fed irregularly and not in accordance with the instructions, and six were suffering from disease during the period they were on the Depot. Secondly as to the deaths. There were 10 cases of death out of the 118 infants (5 from epidemic diarrhoea). Three of these were children brought to us in a dying condition, and at special and urgent request were given a little of the milk for a few days before the fatal issue. Ten cases of death yield an infant death rate per 1,000 births of 84.7, but if these 3 exceptional cases be excluded the death rate is 57 5 per 1,000 births. ° In 1904 the infant mortality rate for Finsbury was 168.5 and for London 146.1. I do not suggest a comparison, as the Depot figures are small. 114 The Infant Milk Depot at Liverpool, which is the largest in this country, yields an infant death rate of 89 per 1,000 births. It should, however, be remembered that the average age at commencement of the use of the milk at Liverpool has been four-and-a-half months, whereas at Finsbury it has been three-and-a-half months, and more than half the infants were admitted under the age of three months, and more than a quarter were under six weeks of age. Moreover, the percentage of admissions of sickly children is higher than at Liverpool. The report next discusses the clinical results of each group of children fed at the depot :— A.—Infants who have shown steady improvement throughout. B.—Infants who, whilst taking the milk, suffered from epidemic diarrhoea and the results of the attack. C.—Infants brought to the Depot suffering from epidemic diarrhoea and who recovered on the milk. D.—Infants brought to the Depot suffering from grave constitutional disease and for whom this milk-feeding has done little or nothing. (Charts are issued with the report showing the increase in weight). The Summary of Conclusions was as follows :— 1. That the Finsbury Infant Milk Depot seems to illustrate the essential principles upon which such work should be carried on. The chief of these appear to be :— (a) Direct control of the milk at the farm ; (b) Treatment of the milk, whatever it may be, immediately after its yield, and before the contained micro-organisms have had time to multiply or secrete their products ;® (c) Medical supervision of the Depot and of the infants using the milk. * The importance of this matter is not sufficiently recognised by Dairy-farmers generally. 115 (d) A discriminating and careful distribution of the milk only to children who cannot be breast-fed, and the use of a suitable modification for each child ; (e) The systematic study of the effect of the milk on each child, accompanied by medical examination and periodical weighing ; (f) The adoption of a policy of increasing rather than decreasing the sense of responsibility of the mother. 2. That the milk used in the Depot under consideration is prepared under exceptionally good conditions, but not such as cannot be adopted by other dairy farms. Not the least valuable part of the work which has been done seems to me to be the practical demonstration which it furnishes in model dairying, which could, and should, be more widely practised in this country. 3. That as far as can be judged, the Depot has saved the lives of some children and strengthened the physical condition and constitution of others. Eighty-one per cent. of the children who consumed the milk for a period of not less than a month gained the standard average weight of one pound per month. Whilst it is admitted that an Infants' Milk Depot is only a palliative method of preventive medicine, these results show that under certain circumstances it may be of substantial value in the reduction of infant death rates. 4. That there is evidence to show that the Depot will serve as an important training school of infant management. ° It is, of course, perfectly clear that the number of infants using the Depot has been very small. Therefore death rates and deductions must be accepted as tentative only. The total death rate, however, for the year of the children fed at the Depot is 84.7 per 1,000 births ; 168.6 per 1,000 births in the Borough of Finsbury in 1904; and 146.1 in London as a whole. The infant death rate in the third quarter of 1905 in the Borough of Finsbury was 207.9 per 1,000 births, whereas the death rate of the Depot-fed infants in the same period was 87.7. Reservations with regard to these figures will be found in the Report, and in any case they are not comparable owing to variation in age incidence at death. 116 Its value in this respect, as well as in respect of nourishing and saving life, would appear to depend in large measure upon the personal assistance and advice of a skilled visitor at the homes of the children. 5. That the history of the first year of this experimental Depot, particularly the clinical record, confirms the view that infants, even when properly and well fed on artificial lines, may still suffer from one of the most preventable and fatal of children's diseases—epidemic diarrhoea. It would therefore appear that, however much this disease may be spread by milk—and undoubtedly such is the case—it may also be communicated to infants in other ways. Uncleanliness in the home, and particularly the common use of articles known as "comforters" and other similar appliances which readily collect dust and dirt, may contribute largely to this result, especially in the summer months.* The clinical records of Depot-fed infants suffering from this disease further seem to indicate that with careful dieting the disease may often be prevented or cured, and death averted. No doubt there are points in the working of this experimental Depot which are open to criticism, and which should receive the attention of the Medical Committee responsible; but, on the whole, the results show an exceptional measure of success, and such as justify the establishment of similar Depots elsewhere. On receipt of this report the Council resolved to ask the Local Government Board to legalize institutions of this nature in order that they might be established by Metropolitan Borough Councils. * Evidence is accumulating to show the pollution of the air of houses by infective or injurious dust and dirt being present in the houses. Many years ago Cornet demonstrated the presence of the tubercle bacillus in the dust of houses, and others have proved the same fact. In the present year Dr. M. H. Gordon has shown that the air entering and leaving the House of Commons contained microbes and particulate matter of intestinal origin (from manure) derived from Members' boots. If that be so, it is much more likely that tenement houses in Finsbury will be affected in the same way, and in a greater degree. Recently also, Dr. Niven, of Manchester, has collected facts which increase the probability that house-flies act as transmitters of the virus of summer diarrhoea by carrying infected filth to food or other material. D.—HOUSE PROPERTY AND OVERCROWDING. 119 THE HOUSING QUESTION. The housing policy of the Finsbury Borough Council was stated in my Report 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 sidered; 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. 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. 120 I—INSANITARY AREAS IN FINSBURY UNDER THE LONDON COUNTY COUNCIL. (Part I of the Housing Act.) 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 Kate per 1,000. Deaths of Children under 5 years. Percentage on Total Deaths. Aylesbury Place Area 73 511 364 — 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) Mouses on the Areas.—The history of the matter as regards houses may be set out in the following way:— 121 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 Inquiry. 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. 1905. 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 8 60° 62 49 11 65 446 Garden Row July, 1899 ,, 69 407 — 1 17 23 7 21 69 — — 69 — 407 Roby Street ,, ,, 50 218 — — 30 7 — — 37 — — 50 — 218 Baltic Street ,, ,, 55 351 — — 13 16 11 5 45 37 34 19 7 344 Honduras Street ,, ,, 17 217 — — — 1 1 1 3 17 3 — 104 113 Totals ... ... 264 1704 1 4 62 63 41 35 214 116 86 149 176 1528 ° Eight houses in this area were closed before 1900. † The figures in this column include workshops and other houses which are not dwelling-houses. 122 The closures have, it will be seen, taken place chiefly in 1902, 1903, 1904 and 1905. 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 1905.] Aylesbury Place Area.—Aylesbury Place, 25 [4]; Aylesbury Street, 6 [0]; Bishop's Court, 12 [0]; Jerusalem Passage, 1 [5]; St. John's Square, 2 [0] ; Jerusalem Court, 14 [1]. Total closures—60. Garden Row Area.—The last 20 houses in this area were closed in 1905 and the whole area was cleared. Roby Street Area. —[Cleared and new accommodation provided.] Baltic Street Area.—Baltic Street, 15 [1]; Middle Row, 6 [2]; Baltic Place, 3 [1]; Baltic Court, 8 [0]; New Court, 7 [0]; Thomas Place, 4 [1] ; Hatfield Street, 2 [2]. Total closures—45. Honduras Street Area.—Honduras Street, 1 [8]; Baltic Street, 2 [1]; Golden Lane, 0 [4]. Total closures—3. The decline in houses step by step is seen in the following table:— Dwelling-Houses Occupied at emd of each Year. 1899. 1900. 1901. 1902. 1903. 1904. 1905. Aylesbury Place 70 61 58 56 40 18 10 Garden Row 69 69 69 51 28 21 — Roby Street 37 37 37 7 — — — Baltic Street 52 52 52 39 23 12 7 Honduras Street 16 16 16 16 15 14 13 244 235 232 169 106 65 30 123 Tn addition to closed houses, there are upon the areas from time to time several houses empty temporarily. "Closure" should he understood to mean that the house is boarded up or locked by the County Council. (ii) Population on the Areas. The total population 011 the five areas in 1899 was 1,704. At the end of 1904 it was 443, and now it is 180. The approximate changes are set out in the following table. The figures for 1899, 1902 and 1905 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. 1905. Aylesbury Place 511 480 470 464 213 93 65 Garden Row 407 407 407 344 179 159 — Roby Street 218 218 218 44 — Baltic Street 351 351 351 285 174 77 7 Honduras Street 217 217 217 215 193 114 104 Total 1,704 | 1,673 1,663 1,352 759 443 176 It appears that during 1905, 267 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 1905. 28 159 — 70 10 267 (iii) Deaths on the Areas.—The five clear calendar years following the schemes for these five areas were 1901-1905. During these five years 179 deaths occurred on the areas. The deaths and death-rates (calculated on the changing population), are set out as follows:— 124 1901. 1902. 1903. 1904. 1905. Areas. No. of Deaths. Death Kates. No. of Deaths. Death Kates. 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 3 32.4 Garden Row 10 24.5 13 37.8 9 50.3 5 31.5 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 2 25.9 Honduras Street 4 18.4 6 27.9 5 25.9 5 43.9 2 17.5 Totals 52 31.2 56 41.4 36 47.4 22 51.9 12 27.1 Boro'of Finsbury 2,161 21.3 2,283 22.7 1,993 19.8 2,084 21.1 1,855 18.9 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 the time of condemnation matters have not improved. Indeed, as would be expected, the reverse has happened. There are a number of defects and nuisances now existing on each of the areas, except those which have been cleared. Many of the houses are dirty and verminous in a high degree. Since March, 1900, the date of the inquiries, a large number of sanitary works have been carried out, and the areas have necessitated constant supervision and extra inspection during the last five 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 125 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 of 1900. 1901. 1902. 1903. 1904. 1905. Houses acquired. Houses closed. Houses* demolished. 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 70 8 11 Garden Row 69 1 1 ... 35 17 ... 33 23 ... ... 7 ... ... 21 69 Roby Street 37 ... ... ... 34 30 ... 3 7 37 ... ... ... ... ... ... Baltic Street 52 1 .. ... 14 13 ... 33 16 ... 4 11 3 ... 5 15 Honduras Street 16 ... ... ... 3 ... ... 10 1 ... 3 1 ... ... 1 ... Total 235 2 4 ... 102 62 ... 84 63 37 56 41 14 70 35 95 (vi) Rebuilding.—Roby Street and Garden Row are the only areas upon which complete demolition has been carried out. Upon the former (Roby Street Area) new buildings (known as the Wenlake Buildings), have been erected by the London County Council for the accommodation of about 390 persons. The buildings consist of two blocks, known as the angle block and the straight block. The former contains 20 tenements of two rooms each, 20 of three rooms, and 5 of four rooms ; in all there are 45 tenements, containing 120 rooms; the latter contains 10 tenements of two rooms, 20 of three rooms and 10 of four rooms, in all 40 tenements containing 120 rooms. The rentals vary from (is. 6d. to 10s. per week. The Aylesbury Place Improvement Scheme of 1899 was modified by the London County Council under sanction of the Home Secretary (1) to include certain surplus land in connection with the St. John Street widening ; (2) the reduction of the accommodation to be Demolition refers only to houses demolished under the Act by the County Council. It does not include " ruins." 126 provided on the Aylesbury Place area for 200 persons to 164 persons; and (3) the increase of accommodation to be provided on the Union Buildings area for 1,200 persons to 1,236 or such other number as the buildings will accommodate when erected in accordance with approved plans. As a result of these arrangements and of the former scheme, new buildings (known as the Mallory Buildings) are in process of erection in St. John Street, adjoining the Aylesbury Place Area. Excavations were commenced on September 20th. 1904, and the buildings are now nearly completed. They consist of one block, containing 1 tenement of one room, 16 tenements of two rooms, and 16 of three rooms ; making 33 tenements and 81 rooms. It is expected that this block will accommodate about 164 persons. In addition there are 5 ground floor shops without living rooms. At the time of reporting, the above comprise the new housing accommodation provided in the Borough under the London County Council Improvement Schemes. The Borough Council has also during the year devoted considerable attention to the question of providing increased and more suitable housing accommodation in Finsbury. As a result the Housing Committee of the Borough Council suggested two schemes: (a) one in the City Road, and (6) one in Galway Street. The City Road scheme was a proposal to purchase nine houses, and adapt them as good class tenement houses under the Council. The proposal was accepted by the Council, and it was resolved to borrow the necessary money. The London County Council, however, were not satisfied with all the details of the scheme, and withheld their sanction to a loan. At the end of 1905 the matter was still under consideration. The Galway Street scheme proposed to take over 28 houses in Galway Street, Gastigny Place, and Radnor Street, and adapt them as good class tenement houses under the Council. The Committee's proposal in respect of these houses failed to pass the Council. Vacant Houses and Tenements in the Borough. During the consideration of these housing schemes there arose the question as to what, if any, vacant housing accommodation 127 existed in the Borough, it being felt that before the Borough Council embarked on any scheme which involved a claim on the rates, it was important to discover how urgent was the need of increased accommodation. In accordance therefore with the instructions of the Council on October 5th, a return of empty dwelling-houses and tenements in the Borough was made. The figures of this return were obtained from three sources, namely : a careful enumeration made throughout the Borough by the sanitary inspectors, facts kindly supplied by the superintendents of the model dwellings (with one exception), and advertisements appearing on one date in the local press. There is an almost daily variation in the number of tenements to let in a district like Finsbury, and these figures can only be taken as correct on the day of counting (October 12). At the same time it is clear that, if anything, the returns are under-estimatecl, as there are certainly tenements to let from time to time of which no public notice is given. The character of these vacant houses and rooms, of course, varied considerably, some being tenement property of a rather poor description and other vacant houses and rooms being of a much higher standard. The term "tenement" is used in a general way, for convenience, to cover all rooms which were to let and which were less than whole houses. As far as such figures were obtainable the rentals in each case were stated in the report issued. There are in the Borough 36 sets of " model" dwellings accommodating some 17,000 persons. According to the returns kindly supplied by the superintendents (with the exception of St. Bartholomew Buildings), it appeared that there were at the time of reporting 64 vacant tenements in these model dwellings comprising 165 rooms. The empty "closed" houses on the insanitary areas or widening schemes under the London County Council and under the Borough Council were not included; nor were the empty houses in the proposed housing scheme in City Road included. All vacant business premises and offices were also excluded. 128 It may be convenient briefly to summarize the findings of this enquiry :— Total number of vacant dwelling-houses 204 containing 1,304 rooms. The annual rentals of these 204 vacant houses were as follows:— £ 10-20 per ann. 22 20-30 15 30-40 „ 39 40-50 „ 33 50-60 „ 41 60—70 ,, 27 70-80 „ 17 80-90 „ 2 90-100 „ 2 100 or upwards per ann. 5 Unknown 1 Total 204 Some 30 or more of these houses, situated on the St. Bartholomew's Estate, had been emptied for repairs, nearing completion at the time of enquiry, and this may appear to invalidate the return. On the other hand it would be well nigh impossible to select any period of the year when no such empties occurred. The time of counting (October) may have been exceptional in this respect, but there is no evidence of that at present. Probably vacancies for repairs would not be less in the spring. Subsequently, it was found that the occupation of many of the vacant houses on the St. Bartholomew's Estate involved the emptying of other dwellings in the vicinity. In addition to the 204 vacant houses we counted 530 vacant tenements, containing 980 rooms, distributed as follows:— No. of vacant one-room tenements 202 total rooms 202 „ two-room „ 227 „ 454 „ three-room „ 85 „ 255 „ four-room „ 14 „ 56 ,, tenements of more than four rooms 2 „ 13 Total vacant tenements 530 total rooms 980 129 The rental of these 530 vacant tenements were as follows:— Weekly rentals from 2/- to 3/- per tenement 2 tenements „ „ 3/- to 4/- „ 33 „ „ „ 4/- to 5/- „ 54 „ „ „ 5/- to 6/- ,, 85 „ „ „ 6/- to 7/- „ 82 „ „ „ 71- to 8/- „ 102 „ „ „ 8/- to 9/- „ 63 „ „ „ 9/- to 10/- „ 29 „ ,, ,, 10/-andupwards ,, 44 „ Unknown or unobtainable 36 „ 530 If the number of rooms be reckoned without distinction as to house or tenement, or rent, it will be seen that there was a total of 1,304 plus 980, or 2,284 empty habitable rooms in the Borough at the date of counting, and for which the owners professed to desire tenants. Viewing the matter broadly, and taking into consideration the question of varying cubic capacity of rooms, it would appear that in these vacant dwelling-houses and tenements there must have been accommodation for not less than 5,000 persons (including children). But it is difficult, even approximately, to arrive at a correct estimate on that point. It should not be forgotten that in addition to this available accommodation for, approximately, 5,000 persons, there will shortly be provided by the London County Council further accommodation, as stated above, for 164 persons in St. John Street, in respect of the Aylesbury Area, and for, approximately, 1,000 persons on, or near, the Garden Row Area, in pursuance of the requirements for re-housing under Part 1 of the Housing of the Working Classes Act. 130 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 1. 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 which are unfit for human habitation. In dealing with such houses the proceedure 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 ray 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 unmistakeable 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 above-mentioned. 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 the 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 the Borough Council to proceed with strictness against such owners, 131 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 consisted of two small courts, Caroline Place and Kemp Place, Baker's Row, containing 8 houses and a population of 39. Capable of improvement if extensive alterations made. Necessary alterations completed in 1903. Area C was Providence Place, a blind court on the east side of Baker's Row, Farringdon Road (10 houses, population 52). Closed and demolished in 1903; 52 persons displaced, of whom 29 found accommodation in vicinity. Area D was Easton Place, which opens to the south-west end of Easton Street (9 houses, population 70). Owner selected to alter and repair, and the work was completed in 1903. Area E was 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, defective, dilapidated houses, some being backto-back. The drainage was defective. The occupants of the Place numbered 33 adults and 15 children ; total, 48. There were also eight houses in Collier Street, in front of Collier Place, which were found to be insanitary and unfit for habitation. There were 27 adults and 9 children living in these houses; total, 36. 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 were closed and demolished in 1904. The number of persons displaced was 84. In 1905 commodious factory premises were built on the site of demolished houses. Area F consisted of 11 cottages in Sermon Lane. These houses formed two sides of a small court on the south side of Sermon Lane. The property was all closed and demolished in 1904. The number of people displaced was 39 adults and 12 children, total 51. Accommodation was found for most of these persons in the. vicinity. 132 Area G 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 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 18 months he has been engaged in the necessary works. Many of the houses I have already re-inspected after repair, and although they are still open to criticism in some respects, I am glad to report a decided improvement, and one which goes far to make the houses habitable. Unfortunately the class of tenants has not been of the best, and this has caused delay and complication. It is expected that the work will be completed at an early date. Area H is a square of property bounded by Dingley Road, Ironmonger Row, Lever Street and Hull Street, the outside of the square consisting of 35 houses. Inside the square of property stood 11 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 and 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 should 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 cleared during 1903. The owners fulfilled 133 their contract with me, and these 11 cottages (population 81) were closed and demolished during 1903. The operations were completed and the ground inside the square cleared by July 21st, 1903. It was at that time intended to leave the "shell" of the square (consisting of 35 houses), until the owners' convenience. But in 1904 and 1905 it became apparent that a marked deterioration was taking place in the condition of the property, and this was having a highly injurious effect upon the persons living there. For the years 1902, 1903 and 1904, the death rate worked out at 48'3 per 1,000, as compared with 21 in the Borough of Finsbury, and 16 for London as a whole. In view of these facts I communicated with the owners in May, 1905, and re-opened negotiations with them. As a result the whole of the property was closed and demolished before the end of the year, with the exception of two public-houses which were in better sanitary condition than the adjoining houses. In the 33 houses demolished there lived 114 persons over 10 years of age, and 49 children ; total 163. About 25 of these displaced persons removed to other districts, but the remainder moved into houses in the immediate vicinity. The men were nearly all casual labourers. In passing, it may be remarked that the owners of other property in the Borough which was becoming insanitary, have during the year carried out considerable repairs and improvements. Bastwick Street has again changed hands, and the new owner, since obtaining possession, has carried out various cleansing and painting works, and in nine cases has added an annexe at the back of the house with new sanitary convenience accommodation. Further, a cottage range, a dresser, and a sink, have been fixed in the back room on each floor. Mason's Place, containing 19 small cottages, has been thoroughly overhauled by the owners, who have similarly treated much of their other property as the leases have fallen in. Dwelling=houses closed in 1905.—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 134 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 1 he reduction in resident population brought about by these changes. During 1905 dwelling-houses have been closed in the following streets:— Streets. No. of Houses Closed. No. of Persons Displaced. Adults. Children. Totals. Central Street 43 235 170 405 Mitchell Street 3 8 5 13 Myddelton Street 1 — — — Rosoman Street 3 — — — Sermon Lane 3 7 — 7 Pentonville Road 3 22 23 45 Collier Street 2 6 6 12 Percival Street 2 15 2 17 Whitecross Street 3 11 2 13 Bunhill Row 2 — — — Finsbury Street 2 5 2 7 Ropemaker Street 2 4 1 5 Cottage Lane 3 8 9 17 Totals 72 321 220 541 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 135 the closures, it will be seen, occur in the southern portion of the Borough contiguous to the City of London. Only 8 houses (or 11 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 fact disclosed in these figures. The total record for 1905 is as follows:— Houses closed in 1905. Persons Dishoused in 1905 (Approximate Number.) Five Insanitary Areas (L.C.C.) 35 267 Insanitary Closures (F.B.C.) 33 163 Closures for Commercial reasons, Street Widening, &c. 72 541 Totals 140 971 The following Table shows the closure of houses and the number of persons displaced since 1902:— Year. No. of Houses closed. No. of Persons Displaced. 1902 140 839 1903 161 1349 1904 159 1127 1905 140 971 Total, 1902-05 600 4286 136 That is to say, that, calculating on the census returns for 1901 (9,000 houses and 101,463 population in the Borough), 6.6 per cent. of all the houses have been closed, and 4.2 per cent. of the population have been displaced. It is unnecessary to add that there are considerable changes taking place in the use of house property, e.g., private dwellinghouses being transformed into business premises without closure or demolition of houses, 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 H, 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. 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 1905 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 ot 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 137 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. Subsequently, in 1904, it was found necessary to insert a new Bye-law (see Report, 1904, pp. 142-151). 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 obtained by several Bye-laws (9-17 ), and the latter by Bye-laws 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, in 1904 we registered 52, and in 1905 45 more were added to and 7 taken off, the register. The total number of houses now registered is therefore 1,109 in about 130 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 and action had to be taken to obtain compliance with the Bye-laws. 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, arc 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 1905 the systematic house inspections thus made numbered 1729, as against 1548 in 1904. Out of the total number inspected 780 or 45T per cent. were found to have sanitary defects. These houses were situated in the streets shown in the following table :— 138 Stieet or Buildings. No. of houses or occupancies inspected. No. of houses in which delects were found. Percentage of houses with defects to houses inspected No. of families living in One room. Two rooms Three rooms Four rooms & over. Peabody Buildings, 17 6 35 5 1 10 8 — Roscoe Street Peabody Buildings, 5 2 40 — 2 4 — Dufferin Street Whitecross Street 15 14 95 12 7 5 7 Royley Street 27 27 100 15 16 19 8 Norway Street 5 4 80 4 9 1 2 Old Street 9 8 88 2 2 1 7 Northampton Buildings 468 147 31.4 66 149 239 10 Eagle Dwellings 25 14 64 — 19 6 — Sidney Grove 15 15 100 14 18 3 — Sidney Place 14 14 100 11 11 10 — Central Street 16 13 81 30 30 3 6 Macclesfield Street 10 2 20 7 16 8 — Moreland Street 6 1 16.6 3 6 5 — Peerless Street 5 3 60 6 5 3 1 President Street 5 3 60 1 5 1 1 Rahere Street 5 2 40 5 10 3 — Nelson Street 6 2 33.3 12 11 4 — Bartholomew Buildings 38 4 10.5 — 19 17 2 Bartholomew Square 7 3 43.0 — 14 19 — Bastwick Street 26 20 77.0 76 47 2 — Church Row 5 5 100.0 10 10 — — Galway Street 18 18 100.0 28 23 3 — Gee Street 13 9 69.2 23 22 11 1 Guinness Buildings 26 3 12 — 12 13 — 139 Street or Buildings No. of houses or occupancies inspected. No. of houses in which defects were found Percentage of houses with defects to house inspected No. of families living in One room. Two rooms Three rooms Four rooms & over. Helmet Row 5 5 100.0 1 5 6 3 Ironmonger Row 9 8 88.8 13 16 6 — Ironmonger Street 8 8 100.0 7 11 6 2 Lizard Street 17 15 88.2 35 26 5 — Radnor Street 12 11 91.6 22 26 3 — Waterloo Street 19 17 89.5 44 34 2 — Allen Street 9 9 100 6 4 5 2 Northampton Street 45 12 26.6 36 38 19 8 Coldbath Buildings — 10 — — — — — St. Paul's Buildings 72 21 29.16 — 24 48 — Victoria Dwellings 139 44 31.6 7 63 69 — Little Sutton Street 50 50 100 9 39 1 — Buildings Dundee Buildings 25 9 36 — 25 — — Smithfield Buildings 20 10 50 — 20 — — Hewetts Buildings 13 5 38.4 11 2 — — Penny Bank Chambers 16 3 18.75 — 8 8 — Salisbury Buildings 6 3 50 — 6 — — Corporation Buildings 143 25 17.4 — 70 73 — Coldbath Buildings 94 10 10.6 12 42 34 6 Richard Street 22 16 72.7 20 23 14 7 Henry Street Buildings 12 8 66.6 — — 12 — Cumming Street 15 10 66.6 9 12 9 9 Collier Street 47 37 78.7 23 42 13 12 Jays Buildings 8 1 12.5 — 8 — — White Lion Buildings 9 9 100.0 — 4 5 — I 140 Street or Buildings No. of houses or occupancies inspected. No. of houses in which defects were found. Percentage of liouses with defects to liouses inspected. No. of families living in One room Two moms Three rooms Four rooms & over. Charlotte Place 10 8 80.0 — 8 1 1 East Place 6 4 66.6 — — — 6 Chapel Place 6 4 66.6 — — — 6 White Conduit Street 8 4 50.0 9 14 1 3 Forty-six other streets in 98 65 — 98 103 36 21 which less than five houses per street were inspected 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. 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 59 cases, however, overcrowding has been reduced. This figure does not include 59 other cases of overcrowding abated in registered houses. Total 118. We have not (as in 1901, 1902, 1903 and 1904) carried out any systematic inspection by day and night in certain streets and areas known to be overcrowded, as we have reason to believe that the vigorous action taken in previous years has practically removed the nuisances of extensive overcrowding in certain streets. (See Report, 1904, pp. 153-157.) It should, however, be added that on the night of February 17th a " night inspection " was made by the Inspectors in co-operation with the Public Health Department of the London County Council, 141 in their attempt to make a Census of "Homeless Persons" wandering in the streets of London between the hours of 1 a.m. and 3 a.m. Every part of the Borough was visited by the ten men from this Department who went into all streets, courts, alleys, entries, passages, and many model dwellings, registered lodging-houses, &c. The results were as follows :— (a) North Clerkenwell.—In this district 8 homeless men and 3 homeless women were counted. Some 400 other persous were also seen, some of whom in all probability belonged to a class of unfortunate women, and many of whom were labourers, workers in bakehouses, ostlers, stablemen, coachmen, and persons who had been turned out of public houses. Some 25 blocks of buildings were visited. (b) South Clerkenwell.—In this district 4 homeless men and 5 homeless women were counted and very few other persons were seen, probably not more than another dozen. In all 41 blocks of buildings were visited, and 7 out of 9 persons were found on the staircases of these premises. (c) St. Luke.—In this district 18 homeless men and 3 homeless women were counted. Some 70 or 80 blocks of dwellings were inspected and probably some 300 persons in all were seen. Some of these probably belonged to the unfortunate class, but the majority were labourers, people turned out of public-houses, &c. As a result of this night census, it may be said that, with the exception of one or two localised areas including in all only a few streets, very few persons of any kind are to be found out and about between the hours of 1 a m. and 3 a.m. in the Borough of Finsbury. The total number of persons accurately to be described as homeless, on this particular night, was 41, or 0.4 per cent. of the whole of the population of the Borough. The Medical Officer of the London County Council, Sir Shirley F. Murphy, reported (March 1st, 1904), " that in a particular area of London 1,463 men, 116 women, 46 boys and 4 girls were found by the Council's officers to be walking the streets on that night, the boys and girls appearing to be under 16 years of age. 100 males and 68 females were also found asleep on staircases, in doorways and 142 under arches, the total number of homeless persons being 1,797. On the same night, 23,442 persons slept in common lodginghouses, of whom 21,058 were single men, 1,517 were single women, and 390 were married couples. There were also in such houses 54 boys and 33 girls below 16 years of age. The number of vacant beds in common lodging-houses on that night was 6,074, this total being made up as follows—5,365 unoccupied beds for men, 603 for women, and 53 for married couples. "The results of the census on February 17th, 1905, which covered the Metropolis generally, are shown in the following extracts from the report of the Council's medical officer of health :- " 1,869 men and 312 women were found in the streets or on staircases, or under arches, or 2,181 in all; of these 827 men and 39 women were in Wych Street, Strand, where food was being given away by the Salvation Army, and 161 men and 60 women in Whitechapel Road, where food was also being given away by the Salvation Army. In a tent of the Church Army, in Clare Market, Strand, 300 men were, or had been, chopping wood. These men had received two meals during the night, and were given tickets for beds in common lodging-houses. The tickets, however, were not available for use until the following night, so that 300 men should be added to the total. There were also 64 men in premises of the Salvation Army in Wych Street, who subsequently were admitted into the Salvation Army shelter in Millbank Street. These are not therefore regarded as homeless." The medical officer points out that in the common lodginghouses and shelters that night there were 23,690 persons, viz., 21,254 single men, 1,688 single women, 357 married couples and 34 children under 10 years of age. His report proceeds :— " Among the inmates of the common lodging-houses were 1,600 men who had been given tickets for their lodging by the Church Army. " The same night there was vacant accommodation in the common lodging-houses for 4,610 men, 856 women and 62 married couples. " There was also vacant accommodation in the casual wards for 337 men, 213 women and 117 women and children. " The number (2,481) of homeless persons found on the night of 17th February, 1905, is greater by 684 than the number found on the 29th January, 1904, but the fact that the Church Army gave away 1,600 tickets for beds, and the Salvation Army gave free beds to 64 persons, suggests a difference as large as 2,348. In the districts not included in the first census 196 persons were found. 143 "The experience of the Council's officers in making the inquiry, especially in the Stepney district, was somewhat remarkable, inasmuch as staircases and gateways, usually frequented by homeless persons, were, on the night in question, found to be locked or otherwise fastened up. This would not, I think, affect the total number of homeless poor found, but would increase the number of persons found aimlessly wandering the streets, who would, of course, be included in the figures. " I caused further inquiries to be made on a subsequent night, when these staircases were found to be occupied as usual. The result was as follows — "Duval Street—7 men and 11 women. " Little Paternoster Row—1 man and 33 women. " Shepherd Street Buildings—2 men and 2 women. "I submit a table showing the number of persons found on the night of 17th February, 1905, in the several districts of London, also the number of persons turned away for various causes from common lodging-houses." Local Authority. Men. Women. Bermondsey 75 — Camberwell 8 8 Chelsea 21 11 City of London 59 2 Finsbury 30 11 Hammersmith 11 3 Islington 12 — Kensington 5 7 Lambeth 43 9 Paddington — 2 St. Marylebone 7 11 St. Paneras 1 — Shoreditch 8 — Southwark 74 81 Stepney 303 116 Westminster 1,212 51 1,869 312 "Table showing the number of persons turned away from common lodging houses on the night of 17th February, 1905:— 144 Reason why turned away. Men. Women. Married Couples. Total. No money 670 64 4 742 House full 198 1 6 211 Drunk 7 1 — 8 Too dirty 21 — — 21 Creating disturbance — 1 — I Bad characters 5 — — 5 Totals 901 67 10 988 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. There are no Salvation Army Shelters in Finsbury. There is one Church Army Asylum 145 in Banner Street. Three Common Lodging-houses (with accommodation for 176 persons) have been closed in the last three years. 5. Model Dwellings.—There are 204 blocks of so-called " model dwellings " in Finsbury, containing 4,063 tenements, and accommodating 17,300 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 24 illegal occupations of underground rooms abated. In a large number of other instances re-adjustment in the house has reduced the illegal occupation. 7. Stable Dwellings.—During the year an inquiry has been made into the number and condition of the stable dwellings in the Borough. The number and occupancy may be set out as follows:— Premises. No. of Occupancies. No. of Persons. Adults. Children. Total. Claremont Mews 31 37 15 52 Garnault Mews 1 2 — 2 Jay's Buildings 16 41 37 78 Holford Yard 2 4 1 5 Holford Mews 3 7 6 13 Sidney Grove 42 101 75 176 Rosoman Mews 2 3 3 6 Davis' Yard 1 2 — 2 Baker's Row 1 4 5 9 Totals 99 201 142 343 At the time of the inquiry 20 occupancies over stables were found to be empty. In some of these dwellings the same family 146 had been living for many years, in one instance 25, in another 35 years. In other cases the period of residence was only a few weeks. Practically speaking, no overcrowding was found, but the general conditions are not of a high standard of hygiene. The inquiry also included an estimation of death rates which worked out at 181 per 1.000, that is, below the ordinary death rate of the Borough as a whole. This is somewhat remarkable when it is considered that these persons are living under conditions not likely to be conducive to a high standard of health, and in premises which, with few exceptions, show marked signs of degeneration. Most of the stables which these dwellings adjoin now belong to cab proprietors and railway contractors, whereas some at least were constructed for private owners. 8. Customs and Inland Revenue Acts.- Certificates were issued under these Acts by the Medical Officer of Health in five instances, viz.:—Wenlake Buildings (1-40); 65 and 67, St. John Street; York House, King's Cross Road ; Wenlake Buildings (41-85). Water Supply to Tenement Houses.—At the end of 1904 (December 16th), a case was heard in the Woolwich Police Court of which the facts were as follows :— The Medical Officer of Health of Woolwich having reported in September, 1904, that No. 1, High Street, Woolwich, a house consisting of six rooms on three floors, with an unoccupied basement, and occupied by five families, was dependent for its water supply upon a stand pipe in a yard approached from the rear of the premises, the Public Health Committee of the Woolwich Borough Council decided to serve the owner of the premises with a Statutory Notice requiring him to provide a water supply to the first and second floors of the house with properly fitted stoneware sinks, and trapped waste pipes to discharge over the yard gully. Failing compliance with the terms of this notice, the Council, on the 2nd December, 1904, issued a summons, under the provisions of Sections 2, 5 and 48 of the Public Health (London) Act, 1891, against the owner alleging default in compliance with the Statutory Notice, whereby a nuisance arose. It was proved on the hearing that each floor was occupied by different families, together comprising nine persons; that from the 147 yard, where the supply of water was, to the top floor there were 34 stairs ; that beyond a dilapidated unusable copper and a standpipe, both in the yard, there was no other provision of water, sink, scullery or wash-house; that in consequence the tenants stored water in open vessels on each floor, where it was liable to pollution ; and that owing to the labour in carrying up the water, an insufficient quantity was used to ensure cleanliness, both of persons and of rooms. It was also proved that a draw-off tap and sink could be fixed on each landing. The Defendant contended that there was an ample supply of water available if the tenants chose to fetch it, that it was not practicable, or necessary, to provide a separate supply to each floor, and that no nuisance existed on the premises. Medical evidence in support of the prosecution showed that the want of a separate supply was a nuisance dangerous or injurious to health. The Magistrate, Mr. Rupert Kettle, in giving his decision, said that the stand-pipe in the yard was not a proper and sufficient supply within the meaning of the Act, and that there should be a separate supply to each floor, and made an Order to abate the nuisance accordingly, with £5 5s. costs. A sink and tap was subsequently provided on the landings of each of the first and second floors with satisfactory results. In view of this case the London County Council drew the attention of each Metropolitan Borough Council to the importance of faking "all possible steps fo secure the provision of a proper and sufficient supply of water for the tenants of every floor of a tenement house." We have not lost sight of the importance of this subject, but it is generally admitted that Section 48 may be variously interpreted by different Magistrates, and that so long as a tenement house, particularly a small one, is provided with " a proper and sufficient supply of water " it would be impracticable to enforce a separate supply to each floor. Concluding Note.—A study of the conditions prevailing in Finsbury, in respect of the housing question, makes it evident (i) that the population of Finsbury is a declining one ; (ii) that the density of the 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 coupled with strict sanitary super- 148 vision 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. On the whole, however, I am of opinion that it is becoming less acute each year. 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 housing 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. There is evidence to show that the difficulty in Finsbury is due to rents rather than accommodation. Overcrowding is being reduced, insanitary areas are being cleared, and actual house accommodation is not wanting in anything like the degree that is generally supposed. But it is nevertheless certain that, owing to the high rents demanded, a very large number of persons are badly accommodated, and the fact that there may be, theoretically, vacant provision for 5,000 persons (see p. 129) does not in any way alter that fact. The housing policy of the Public Health Committee may be expressed in the following propositions :— 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. 149 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. The importance of improvement in transit. Without some improved means of transit (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. One of the most hopeful signs in Finsbury during the last five years has been the marked improvement in means of transit (e.g. the Tube Railway from the " Angel" to South London, which is being extended to King's Cross; the new tramways down Rosebery Avenue; the various extensions of the District Railway connecting with the Metropolitan Railway at Farringdon Road; the new services from King's Cross ; and the Tube Railway from Finsbury Park to the Bank). E.—FACTORIES AND WORKSHOPS. 153 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 this subject, and within its pages will be found reference to everything which has concerned the Public Health Department in 1905 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 were 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 was therefore 78,377. Out of this number, 28,669 were "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 also 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. 154 Occupations of Persons in Finsbury over 10 years of age. Mules. 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 29 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, Seamstresses, Shirt Makers, Boot and Shoe Makers, Artificial Flower Makers, &c. 1517 3840 5357 6.9 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 100.0 155 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 resided in Finsbury, 16,593 were engaged in occupations; 10,769, or 6.17 per cent. of the unmarried females, and 5,824, or 25.8 per cent. of the married or widowed females were so employed (this latter percentage being the fifth highest in London.) The total, 78,377, includes all adult persons and also all children who were 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 were 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. were 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 tin Borough where work is done which are now registered in the Public Health Department:— Workshops and Workplaces 1859 Factories 476 Bakehouses 61 Restaurant Kitchens, &c 274 Ice-cream Premises 103 Home Workers 421 Stables 500 Total 3694 The following Table shows the various trades and occupations carried on in the workshops and workplaces now on the Register:— 156 Workshops and Workplaces in Finsbury on Register. Clocks and Watches 128 Brush-making 13 Jewellery 95 Children's Clothing 13 Cabinet-Making, Polishing, &c. 87 Wire-workers 13 Wood, Ivory and Bone Turners 13 Tailors and Clothiers 82 Engravers, Embossers and Chasers 73 Opticians 12 Upholstery 12 Leather Goods 60 Embroidery and Lace 11 Building Trades 54 Packing-case Makers 11 Underclothing, Shirts, Skirts, Blouses, &c. 53 Hag and Paper Waste 11 Sign and Ticket Writing 11 Stables ... 47 Timber-yards, &c. 11 Ties, Scarves and Belts 44 Barometers andThermometers 10 Gilding and Plating 41 Coppersmiths 9 Furriers and Skin-Dressers 39 Enamelling and Japanning 9 Box-Making 38 Harness-making 9 Stick-mounting and Making 38 Linen Collars 9 Gold and Silversmiths, &c. 35 Pianos and Organs 9 Glass-workers 35 Basket-workers 8 Laundries 32 Athletic Goods 7 Mantles and Costumes 32 Firewood-choppers 7 Boots and Shoes 30 Marble and Stone-masons 7 Millinery 28 Pipe-makers 7 Hats and Caps 27 Stamp and Die-cutters 7 Fancy Goods, Toys, &c. 25 Wine and Spirit Stores 7 Artificial Flowers, &c. 24 Bedding and Bedsteads 6 Picture-frames and Mouldings 23 Cloth-workers 6 Stationery, Publishing, &c. 22 Cycles and Motors 6 Druggists' Sundries, Perfumers, &c. 21 Electrical Goods 6 Gold-blockers 6 Engineering 20 Plaster-cast makers 6 Brass Workers 19 Tailors' Busts, &c. 6 Dressmaking 19 Tin-workers 6 Coach-building and Wheelwrights 18 Wood Carvers 6 Christmas Cards 5 Jewel and Instrument Cases 18 Lamps 5 Farriers and Smiths 17 Automatic Machines 4 Feather Workers 17 Confectionery 4 Instrument-makers 17 Saw-piercers 4 Ironmongery and Hardware 17 Silk Goods 4 Umbrella-making 17 Miscellaneous 94 Shop-fitting, Show-cases, &c. 16 Total 1859 Iron and Metal Workers 14 Paper and Cardboard 14 Book and Card-edge Gilders... 13 In 1903 we instituted a factory register which, though not a statutoiy requirement, proves of considerable value. 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:— 157 Factories on Register. Printers and Stationers 102 Laundries & Collar Dressers 6 Engineers, Machinists, &c. 45 Mantle-makers 6 Shirts, Skirts, Blouses, &c. 22 Pipe-making and Mounting 6 Book-hinders, &c. 21 Wire Workers, &c. 6 Box and Bag Makers 19 Jewellery, Silversmiths, &c. 5 Gilders and Platers 15 Leather Goods 5 Ivory, Wood, &c., Turners 15 Pianoforte-making,&c. 5 Glass Workers 13 Silk Weaving, &c. 5 Stick Mounters and Makers 13 Cloth Shrinkers, &c. 4 Cabinet-making 12 Distilleries, &c. 4 Cigar and Cigarette Making 11 Horse-hair, Feathers, &c. 4 Foundries 10 Paper Goods 4 Cycles and Motors 9 Rubber Goods 4 Joinery Mills, &c. 7 Coach and Van Builders 3 Scientific and Surgical Instruments 7 Infants' Clothing. &c. 3 Cocoa, Confectionery, &c. 6 Wheelwrights 3 Miscellaneous 111 Engravers, &c. 6 Total 517 The difference between the above total (517) and the number of factories on the register (476) is accounted for by the various businesses carried on in the tenement factories. 1. 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 small workshops situated in or at the back of residential houses. It is almost impossible to 158 maintain cleanliness in small sheds in hack 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 113 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 1905 to be overcrowded. In only 11 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. In 12 instances it has been necessary to issue notices for the carrying off of fumes from gas heaters and acids. (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. During the year 18 notices have been served for insufficient ventilation of workshops. In addition, the Workshop Inspector has kept under observation those workshops in which high readings of CO2 were obtained with Haldane's apparatus in 1904, with the result that more efficient ventilation has been maintained in these places. (d) Drainage of Floors where wet processes are carried on.—The only " wet processes " carried on in Finsbury, speaking generally, 159 are small laundries, of which there arc 32 on the register. In one instance it has been necessary to advise more adequate drainage. (e) Provision of Suitable and Sufficient Sanitary Conveniences.- In respect to this matter we have again 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, bnt it is impracticable in many cases to arrange otherwise. In not a few cases the difficulty is due to the fact that whole 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)— The Sanitary Accommodation Order of 4th February, 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— 160 (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 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. 6. This order shall come into force on the 1st day of July, 1903. 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. 161 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 in 1905 issued Notices in 33 instances, in all of which there has been compliance. In no case has it been necessary to contest the point in court. Since 1903 the total of such instances has been (81 + 33, or 114. (See Report for 1904, pp. 170-177.) During the year 22 notices have been served for insufficient sanitary convenience accommodation in relation to factories, workshops and workplaces, and 433 such conveniences have been cleansed and repaired. Insufficient sanitary convenience accommodation includes six cases in which no convenience of any kind was provided, and in addition, in 4 cases the sanitary conveniences were unsuitable for use by both sexes, and in seven other cases were being improperly used. Summary of Defaults and Defects in Factories and Workshops.—In 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 3,657 visits of inspection have been made to factories and workshops by the Workshop Inspector and the Lady Inspectors, 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:— 162 Summary of Defaults and Defects in Factories, Workshops and Workplaces for which Notices were served during 1905. Workshops. Factories. Workplaces. Total. Dirty workshops and workplaces 113 — 2 115 Damp and dilapidated workshops, &c. 21 2 — 23 Dirty staircases, &c. 12 — — 12 Overcrowded workshops 11 — — 11 Insufficient ventilation 18 — 1 19 Fumes from gas, acids. &c. 12 — — 12 Drainage of floors 1 — — 1 No water supply 2 — - 2 Sanitary conveniences, cleansed 92 80 16 188 Sanitary conveniences, defects remedied 98 127 20 245 No sanitary convenience 2 — 4 6 Insufficient sanitary convenience accommodation 8 6 2 16 Unsuitable sanitary conveniences for two sexes 3 1 — 4 Improper use of sanitary conveniences by two sexes 5 2 — 7 Defective soil pipes 7 3 3 13 Yards cleansed, paved, or paving repaired 17 4 3 24 Defective sinks and gullies 27 23 18 68 Water-cisterns dirty and defective 9 22 8 39 Accumulations of refuse and manure 17 7 9 33 Dustbins and manure receptacles defective or absent 62 23 9 94 Drainage defective 23 21 17 61 Rain-water pipes defective, &c. 6 — 2 8 Stable paving defective 1 — — 1 Stables in need of limewashing 1 — 2 3 Black smoke emission — 1 — 1 Animals improperly kept 2 — — 2 Totals 570 322 116 1008 163 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 south, and Shoreditch and Islington Boundaries on the northeast, excepting some part done in 1902. 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 shows some results of the work done:— No. on Registers, 1904. No. added to Registers, 1905. Total No. on Registers. Nuisances, &c., Found. Intimation Notices Issued. Statutory Notices Issued. Notices to Factory Inspectors. Factories 11 89 100 181 59 6 14 Workshops 113 92 205 267 125 19 16 Workplaces — 32 32 54 30 8 — Totals 124 213 337 502 214 33 30 II. Special Sanitary Regulations for Bakehouses. No new Bakehouses have been opened, and none have been closed. There are in the Borough 21 above-ground, and 40 underground. They are regularly inspected, 166 visits having been paid by the Inspectors during 1905. III Home Work (including Outworkers). The Outworkers referred to in this section are persons or firms resident in Finsbury, to whom materials, generally cut out and prepared for making up, are distributed by firms belonging to Finsbury or other Boroughs, to be completed in the worker's home or contractor's factory or workshop. The work of the Department in relation to Home work and Outworkers during 1905, has been carried out by the Lady Sanitary Inspectors, and the result is set out in the table on p. 165. It will be seen that 359 home-workers' premises have been visited, and that 55 men and 351 women were found to be engaged in home work. Seventeen of these premises were reported to the Home Office as "Domestic Workshops," (i.e. a 164 workshop where only resident members of the same family are employed). Of the 55 men, 33 were tailors, and 22 were shoemakers, umbrella makers, &c. Of the 351 women, 120 were widows or single women ; these latter workers, generally speaking, work at greater-pressure owing to the fact that they are often entirely dependent upon such work for their livelihood. The greater number of the married women are obliged to work owing to the want of employment, or low wages, of the husband; a certain number of young married women and elderly married women, with few home duties, work from choice as well as for the extra money they are thus able to obtain. In some instances home work is taken in to assist in the support of an aged relative. From the table (p. 165), it will be seen that over 80 per cent. of the home workers live in 1, 2 or 3 room tenements, and the majority being married women, mostly with families, they are unable to take in the cleaner, finer or better paid classes of work, much of which is distributed from firms in Finsbury and the City to other districts. The work in many of the occupations is very irregular, such as the making of artificial flowers, millinery, fur linings, &c., and only occurs during short seasons of the year. Many of the married home-workers look forward to these periods to enable them to obtain a little extra income in order to provide clothes for their children, and to pay off arrears caused by sickness or other trouble. Much of the work made in the homes of Finsbury is cheap and commands a low price, nevertheless, the home-workers on the whole are a clean, hard-working, self-respecting class, comparing favourably with those amongst whom they live who are unwilling or unable to make the same effort towards supporting themselves and their families. The various occupations of the home-workers were as follows:— Tie, brace and belt making in 55 homes. Tailoring in 52 ,, Blouse, shirt and mantle making in 40 „ Ladies' and children's outfitting in 37 ,, Artificial flower making in 35 ,, Millinery in 32 „ Shoemaking in 18 „ Fur-lining, &c. 15 „ Various other industries 75 „ 359 165 OUT-WORKERS. Number of out-workers' premises visited 604 Total number of visits made 707 Number in which wrong address was given or outworkers had removed 147 Number of out-workers workshops (Particulars of which are included in the Report on Workshops) 98 Number of domestic workshops 17 „ of other home-workers'premises 342 „ of re-visits 103 HOME-WORKERS. Particulars relating to Work in 359 homes. Number in which work was done in work-rooms only 33 „ „ „ living-rooms 138 „ „ „ „ bed-rooms 21 „ „ „ „ bed and living rooms 167 359 „ of cases in which room was clean 211 „ „ „ „ in fair order 118 ,, ,, ,, „ dirty 30 359 „ of one room tenements occupicd 8l of two „ „ „ 136 „ of three „ „ „ 82 „ of four and more „ „ 60 359 „ of persons employed as home-workers 406 ,, ,, men 55 „ „ women 351 Sanitary defects remedied 61 Rooms stripped and cleansed 20 Floor and bedding cleansed 6 Sanitary conveniences cleansed 5 „ „ defects remedied 10 Overcrowding abated 1 Yard walls limewashed 4 Dust-bin absent or dilapidated 5 Other nuisances 10 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 166 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 employees 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 1905, we have received 215 lists from 124 employers, most of whom have acted in accordance with the Act; 95 have sent two lists during the year at or about the stated periods, and 25 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 87 lists received February 2nd to June 30th were practically all "first lists" due on February 1st, and the 59 lists received August 2nd to December 31st, should have been sent in not later than August 1st, So that, out of 215 lists, (69 were received at the statutory periods. It has been necessary to take action in 45 cases, 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 41 "reminder" notices and 45 summonses (8 for second infringements), on account of failure to send in the lists on the statutory dates. 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 90 lists of outworkers from 19 Local Authorities in whose districts outworkers are employed who live in Finsbury. In this way we have obtained the names and addresses of 488 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 compared with 1904:— 167 Lists received from Employers. 1905. 1904. Number of Lists. Number of Outworkers. Number of Lists. Number of Outworkers. Jan. 1st to Feb. 1st Due Feb. 1st. Feb. 2nd to June 30th 23 760 22 616 87 1605 59 1549 July 1st to Aug. 1st Due Aug. 1st. Aug. 2nd to Dec, 31st 46 1297 24 725 59 1026 63 1199 215 4688 168 4089 Lists received from 19 Local Authorities 90 488 62 152 Lists dispatched to 75 Local Authorities 84 4474 845 3891 The following circular, drawing attention to the new Order of the Home Secretary introducing for the first time certain trades (printed below in italics), was sent out in December to 124 firms employing outworkers, and in the present year will be sent out to makers of umbrellas, paper bags and boxes, brushes and stuffed toys. This new Order will supersede the Order of 14th July, 1902, and comes into operation in January, 1906:— METROPOLITAN BOROUGH OF FINSBURY. Factory and Workshop Act, 1901. The Home Work Order of 15th August, 1905. In pursuance of the powers conferred on me by Sections 107, 108, and 110 of the Factory and Workshop Act, 1901, I hereby make the following Order:— I. Section 107 (relating to lists of out-workers) and Section 108 (relating to employment in unwholesome premises) shall apply to the following classes of work:— 168 The making, cleaning, washing, altering, ornamenting, finishing, and repairing of wearing apparel and any workincidental thereto; The making, ornamenting, mending, and finishing of lace and of lace curtains and nets; Cabinet and furniture making and upholstery work; The making of electro-plate; The making of files; Fur-pulling; The making of iron and steel cables and chains; The making of iron and steel anchors and grapnels; The making of cart gear, including swivels, rings, loops, gear buckles, mullin bits, hooks, and attachments of all kinds; The making of locks, latches, and keys; The making of covers for, and the covering, finishing, altering or repairing of, umbrellas, sunshades, parasols, and articles of a similar character, and any work incidental thereto; The making of paper bags and of paper boxes; Brushmaking; and The making of stuffed toys. 11. Section 110 (relating to the prohibition of home work in places where there is infectious disease) shall apply to the following classes of work:— The making, cleaning, washing, altering, ornamenting, finishing, and repairing of wearing apparel and any work incidental thereto (as in the said section specified); The making, ornamenting, mending, and finishing of lace and of lace curtains and nets; Upholstery work; Fur-pulling; The making of covers for, and the covering, finishing, altering or repairing of, umbrellas, sunshades, parasols, and articles of a similar character, and any work incidental thereto; The making of paper bags and of paper boxes; Brushmaking; and The making of stuffed toys. 2. The lists of out-workers required to be kept by Section 107 and the copies thereof shall be kept and made in the form and manner and with the particulars shown in the Schedule.* * Form 44, to be obtained from Eyre & Spottiswoode, London, EC. 169 3. This Order may be referred to as the Home Work Order of the 15th August, 1905. 4. The Home Work Orders of the 11th December, 1901, and of the 14th July, 1902, are hereby revoked. A. AKERS-DOUGLAS, One of His Majesty's Principal Secretaries of Stale. Home Office, Whitehall. 15th August, 1905. [With the above circular was printed Sees. 107, 108 and 110 of the Factory and Workshop Act, 1901.] V. Inspection, Registration, &c. The inspection of factories, workshops, and workplaces in the Borough is carried out by Mr. George Peverett, who was appointed in 1902 for this special work. His duties may be set out as follows:—(a) The primary systematic inspection of all workshops and workplaces; (b) the re-inspection of men's and mixed workshops, &c.; (c) the inspection of sanitary arrangements in factories; and (d) attention to Home Office notices, except where these concern women's workshops only. The two lady inspectors carry out the re-inspection of workshops in which women only are employed, the primary inspection of such workshops as are met with in the course of their visits to tenements, and the inspection of outworkers' homes. 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 1904, there were on the register 1,745 workshops and workplaces. During 1905, 226 workshops and 43 workplaces, or a total of 209, were added, 155 170 were removed as obsolete entries, leaving a total now on the register of 1,859.* The following tables set out in brief the work done:— ° It should be added that owing to changes in the stall' of inspectors in the Department during the year it has been necessary for Mr. George Peverett, the Factory and Workshop Inspector, to undertake a considerable amount of temporary work outside his ordinary duties. This is the reason why somewhat less has been done in workshops. Inspector Peverett, in addition to his workshop inspection, has carried out 13 house inspections, 46 infectious disease investigations, and 23 canal boat inspections. He has taken 79 samples under the Sale of Food and Drugs Acts, and supervised 95 sanitary works or the remedy of nuisances. This additional work has involved 200 first visits and 394 revisits, in addition to the service of 35 intimation and 4 statutory notices and three prosecutions. 171 Inspection, Registration, &c. Workshops and Workplaces Workshops and Workplaces on Register at end of 1904 1745 Workshops placed on Register during 1905 226 Workplaces „ „ ,, 43 Total addition, 1905 269 Workshops & Workplaces removed from Register, 1905 155 114 Total on Register end of 1905 1859 Factories— Factories on Register at end of 1904 354 „ placed on Register during 1905 131 „ removed from Register during 1905 19 112 „ on Register at end of 1905 466 Factories—Inspections 249 Re-visits 459 708 Workshops—Inspections 643 Re-visits 1129 1772 Workplaces—Inspections 270 Re-visits 907 1177 Total inspections 1162 Total Re-visits 2495 3657 Workrooms measured, 1905 311 Complaints Received and Investigated— Personal 29 Anonymous 19 Home Office 25 Per London County Council 2 75 Number verified 65 „ not verified 10 References to other Authorities 7 172 The following Table is a record of the communications between this Department and the Home Office under the Factory and Work shop Act, 1901, and the Public Health (London) Act, 1891:— Home Office Certificates, &c. Notices received re existence of workshops (Sec 127, Sub-Sec. 3) 89 Complaint Notices (Sec. 51 25 Limewasliing needed 9 Sanitary conveniences 10 Dampness, refuse, &c. 4 Insufficient ventilation 3 Total defaults &c. 26 Notices sent to Home Office Inspectors 103 Factories- No abstract of Act, &c. 3 Workshop converted into factory 1 Fumes from gas engines, stoves, &c. 3 Lack of means for heating 3 Overcrowding 1 Limewashing needed 3 Drainage of floors 1 Dangerous machinery 2 Insufficient ventilation 9 Dampness 1 Total defaults, &c. 27 Workshops- No abstract of Act, &c. 55 Lack of means for heating, &c. 6 Illegal employment (Sec. 116) 1 Domestic workshops 17 Total defaults, &c. 79 106 173 VI. Legal Action. During 1905 we have issued 490 intimation notices respecting factories and workshops and 72 statutory notices. In 45 instances it has been necessary to issue summonses. The results were as follows:— Date. Name and Address of Defendant. Offence. Result. March 22 J. W. Woodhead, 166c, Pentonville Road Failing to send to Borough Council a list of Outworkers' Names and Addresses, due on February 1st. Fined £2 and 2s. costs. ,, 22 J. Field, 28, Penton Place Do. do. Fined £2 and 2s. costs. „ 23 W. H. Taylor, 4, Nichol's Buildings Do. do. Fined £1 and £1 3s. costs. Oct. 4 Antill & Son, Ltd., 43, Myddelton Street Failing to send to Borough Council a list of Outworkers' Names and Addresses, due on August 1st. Fined £1 and £l 2s. costs. ,, 4 J. Crawley & Son, 9-13, Cowcross Street Do. do. Fined £2 and £l 2s. costs. ,, 25 W. H. Burton, 165, Old Street Do. do. Fined £2 and £1 3s. costs. „ 25 Coates & May, Ltd., Bayer Street Do. do. Fined £1 10s. and £1 3s. costs. „ 25 A. S. Gant, 45, Golden Lane Do. do. Fined £1 and £1 3s. costs. „ 25 T. C. Grimes & Co., 40-46, Banner Street Do. do. Fined £1 10s. and £1 3s. costs. „ 25 Peiser, Phillips & Co., 10, Lensden Place Do. do. Fined £1 and £1 3s. costs. „ 25 A. H. Taylor, 4, Lensden Place Do. do. Fined £2 and £1 3s. costs. „ 25 Waterer & Green, 8, Roscoe Street Do. do. Fined £1 10s. and £1 3s. costs. 174 The following is a list of the summonses issued and withdrawn on the necessary lists being supplied and costs being paid:— March 22nd. At Clerkenwell Police Court. Messrs. Brailey & Co., 114, Pentonville Road; J. Crawley & Sons, 9-13, Cowcross Street; A. D. Curling, 206, Pentonville Road; and Ellis, Hallen and Ellis, Foresters' Hall Place, for failing to supply to the Council on or before the 1st of February, 1905, a list of the names and addresses of persons employed by them as outworkers as required by the Factory and Workshop Act, 1901. The lists having been supplied, and costs paid in each case (total £3 6s. 0d.), the summonses were withdrawn. March 23rd. At Worship Street Police Court. Messrs. B. Taylor & Son, 4, Lensden Place; Brice, Palmer & Co., 90-96, City Road; Coates & May, Ltd., Bayer Street; W. F. Coles, 9 & 11, Castle Street; G. H. Cox & Co., 13 & 14, Featherstone Street; A. S. Gant, 45, Golden Lane; R. Hirsch, 4, City Road; Kensett Evans & Co., 2, Playhouse Yard; P. Lehany, 47, Tabernacle Street; A. Mathews, 3, Fann Street; Peiser Phillips & Co., 10, Lensden Place; P. Wohlman, 5, Paul Street; S. Weiss & Co., 1, Dufferin Street; H. T. Willmott, 16, Dufferin Street; and P. Weingartner, 74, Fann Street, for failing to supply to the Council on or before the 1st of February, 1905, a list of the names and addresses of persons employed by them as outworkers. The lists having been supplied in each case, and costs paid (total £16 2s.), the summonses were withdrawn. October 4th. At Clerkenwell Police Court. Messrs. T. Cleverdon, 144-146, Pentonville Road; R. L. Morton-Day, 201, Rosebery Avenue; Ncwland & Gompertz, 44-45, Great Sutton Street; and W. R. Rolls, 34-37, Little Sutton Street, for having failed to supply to the Borough Council, on or before the 1st of August, 1905, a list of the names and addresses of all persons employed by them as outworkers. The lists having been supplied and costs paid (total £4 1s. 6d.), the summonses were withdrawn. October 12th. At Worship Street Police Court. Messrs. S. R. Clarke, 20, Chiswell Street; J. A. Curran, 84, Chiswell Street; Curzon Bros., 60, City Road; S. Flint, 58a, City Road; Lacy & Wheeler, 53, City Road; M. Lake, 17, Roscoe Street; S. Godebye, 63, Banner Street; F. C. Rogers, 12, Goswell Road; E. C. Vickers, 76-78, Golden Lane; and 11. White, 66, Goswell Road, for having failed to supply to the Borough Council, on or before the 1st of August 1905, a list of the names and addresses of all persons employed by them as outworkers. The lists having been supplied and costs paid (total £10 19s. 6d.), the summonses were withdrawn, F.—GENERAL SANITATION AND ADMINISTRATION. 177 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 5¾ acres, a portion of which has a through communication with the River Thames on the one hand and the Midlands on the other. The cul 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 cargoes, 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 cargoes" consist 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 22nd December, 1905, I have to report as follows:— 1.—The Canal Boats have been inspected by Inspector William Homer Draper, 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 1905 was 109 (22 being offensive cargo boats). There were 13 ments of the Acts and Regulations, necessitating 12 Complaint Notes being sent to those responsible for the abatement of the same. ° During the greater part of the year this work was undertaken by Inspector J. W. Hall, who was in the service of the Council for a temporary period in place of Inspector A. E. Powell, resigned, January, 1905. 178 Description of Boat. Number of Boats Inspected. Number of Infringements. Number of Complaint Notes Served. Offensive Cargo 22 3 3 Non-Offensive Cargo 87 10 9 Total 109 13 12 3.—Particulars of Infringements:— (a) Registration.—No infringements. This Local Authority has only powers of Inspection. (b) Notification of Change of Master.—No infringements. (c) Certificates.—Three infringements. The boat was working without a certificate on board in each case. (d) Marking.—No infringement. (e) Overcrowding.—Three infringements. One child in excess in all three cases. (f) Separation of the Sexes.—No infringements. (g) Cleanliness.—Two infringements. The aft cabins were in a dirty condition. (h) Ventilation.—Two infringements. The ventilating apparatus was blocked up with cargo in one case and was defective in the other. (i) Painting.—Three infringements. The re-painting of the interior surface of the cabin was required in each case. (j) Provision of Water Casks.—No infringements. (k) Removal of Bilge Water.—Two infringements. One boat had no pump on board, and the other had a defective bulk-head. (l) Notification of Infectious Disease.— No case notified as occurring among the occupants of the Canal Boats. (m) Admittance of Inspector.—Admittance to the Canal Boats has lways been readily granted. 179 In addition to the above, the following defects have been met with and remedied:— 1 Deck head leaky. 1 Boat leaky. 1 Cabin floor repaired. 1 Bulk head not water tight. 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 or disinfection. The following table gives a comparison of the past 7 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 1905 109 207 33 58 298 349 * The term children should be understood to include only those at ages as stated in the Regulation, viz.:—under the age of twelve years. From this point of view the total number of persons found on the boats may exceed the number for which the boat is registered aud yet not infringe the regulations. 180 Of the 109 Boats inspected it was found that 81 (including the whole of the Offensive Cargo Boats) were occupied by men only. Among the 87 non-offensive Cargo Boats inspected there were 28 occupied by women or children, and 2 by women only. We have always found the occupants of the Canal Boats ready and willing 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 about 500 stables containing in all about 5,500 horses. These premises are now entered in our registers as "workplaces," as decided in the case of Bennett v. Harding (see Report for 1904, p. 216). 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 500 separate premises used as stables. Only 13 of the 500 stables contain two horses or one horse; the remaining 487 stables contain more than two horses each. In 1904 these premises were systematically inspected, and the larger stables visited many times, particularly in the summer months. The points to which most attention was given by the inspectors were 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. During 1905 a number of visits were paid to stables, and action was taken with regard to manure removal. The circular requiring daily removal (Report, 1904, p. 219) previously issued to seven firms, was not issued to any firms in 1905, so that only seven firms are still registered as being liable to penalties if they do not remove manure daily. 181 ELEMENTARY SCHOOLS. The duties of the Borough Council as Sanitary Authority in relation to Elementary Schools are (a) direct and (b) indirect. In the former group of duties come the external sanitary arrangements of the school, in the latter the methods of prevention of the spread of infectious diseases, disinfection of school premises, etc. The Education Department of the London County Council, which is now the Education Authority for the metropolis, exercises control through its Medical Officer for education over all internal arrangements and the physical condition of the children. There are in Finsbury 22 Public Elementary (County Council) Schools, containing a roll of 18,203 children, as follows:— Schools. No. No. of Boys. No. of Girls. No. of Infants. Totals. Provided 14 4,784 4,853 5,283 14,920 Non-Provided 8 1,270 996 1,017 3,283 Totals 22 6,054 5,849 6,300 18,203 These figures and the following table of returns for each school are approximate only. In the present transition period it is impossible to state the figures accurately as the roll varies, according to the late Authority, the present Managers, and the standard recommended by the Education Authority (London County Council). 182 School Accommodation in 1905. PROVIDED. Boys on Roll. Girls on Roll. Infants on Roll. Total on Roll. Albion Place 224 241 246 711 Ann Street 265 292 309 866 Baltic Street 206 202 160 568 Bath Street 370 441 503 1314 Bowling Green Lane 278 268 377 923 Central Street 255 272 390 917 Chequer Street 253 330 219 802 Compton Street 374 354 406 1134 Hugh Myddelton (A) 665 640 698 2003 ,, ,, (B) 52 20 — 72 ,, ,, (C) 29 42 — 71 Moreland Street 370 393 439 1202 Risinghill Street 503 508 502 1513 St. John Street 139 126 173 438 White Lion Street 333 264 246 843 Winchester Street 468 460 615 1543 4784 4853 5283 14920 NON-PROVIDED. Amwell Street 346 317 178 841 St. Mark, Brewer Street — — 250 250 SS. Peter and Paul 61 61 148 270 St. Barnabas 60 61 107 228 St. Joseph 128 128 158 414 St. Luke 265 249 176 690 St. Mark, Old Street 180 180 — 360 St. Thomas Charterhouse 230 — 230 1270 996 1017 3283 Provided 4784 4853 5283 14920 Non-Provided 1270 996 1017 3283 6054 5849 6300 18203 Sanitation in Non-Provided Schools. The London County Council, as the Education Authority for the Metropolis, has made a sanitary survey of all the "non-provided" schools (viz.: the schools not provided out of the rates, under the 183 late London School Board), and in the course of this survey the 8 non-provided schools in Finsbury were inspected. The report of the County Council issued in April, 1905, dealt very fully with all the facts concerning these 8 schools, and the following abstracts briefly summarize the opinions expressed:— 1. Amwell Street, Clerkenwell. Accommodation under late Authority: Mixed, 585; Infants, 150; Total, 735. London County Council recommended accommodation: Mixed, 444; Infants, 117; Total, 561. This is an old school built in 1828; it is a rectangular building about 91 ft. by 43 ft., without internal walls, the floor being supported by iron columns; the ground floor is divided up by partitions and revolving shutters, with six class-rooms; two are used by the Infants, the remaining four by mixed classes; the first floor is divided up into five rooms, for mixed classes; all the class-rooms are practically passage rooms; there is a wooden staircase at each end of the building, one for boys, the other for girls; the place does not lend itself to a mixed school. Premises might be made suitable at a large expense and large sacrifice of accommodation. Drainage— Unsatisfactory to smoke and water tests. Recommendation of London County Council— Suitable, provided staircases with central corridors, so as to give separate entrance to each class-room, are built in the centre of this block, and other alterations and improvements made—involving loss of 347 places. [This Sanitary Authority had for some time previous drawn the attention of the Managers of this school to defective drainage, and the school was redrained 1899-1900]. 2. St. Mark's, Brewer Street North (Infants). Accommodation under late Authority: Infants, 220. London County Council recommended accommodation; Infants, 179. 184 This is a one-storey building of brick, slated, in Brewer Street North, but, with class-room over part of school-room, forms a two-storey building to Owen Court; the school has been neglected, and there are several cracks caused by settlement in walls, which may have to be cut out and rebuilt; the door from back to Owen Court is not used, as the level of the room is 6 inches higher than the door; there is a movable platform which has to be lifted up before the door can open; an additional step and new door is necessary; hearths broken, painting and distempering bad; premises suitable with alteration. Drainage— Fairly satisfactory to smoke and water test. Recommendation of London County Council— Suitable with alterations; school-room to be partitioned; cloakroom to be removed and thrown into school-room; babies' room to be cleared away; lighting and ventilation to be improved; part of babies' room to be converted into a covered playground; offices to be removed from cloak-room and rebuilt. [This school was redrained under our supervision in 1903]. 3. St. Peter and St. Paul (R. C.), Upper Rosoman street. Accommodation under late Authority: Mixed, 122; Infants, 148; total, 270. These premises consist of a two-storey building; the infants are on the ground floor; the first floor is used as a mixed school; the entrance for both departments is by a narrow passage from the street; the boys and girls reach the first floor by the same staircase; access to the girl's playground is by an iron winding staircase, and to the boys by an outside stone staircase; playgrounds are very small; the class-rooms are very low, about 9 ft. 8 in. high; the general arrangement of the school is cramped and inconvenient. Lease expires in 11 years. Drainage— Permission refused to allow the water test to be applied. Recommendation of London County Council— Unsuitable. Board of Education to be informed. [We have on more than one occasion inspected this school and supervised the carrying out of various works. A new drain was put in from sewer to the end of the passage in 1893, and minor sanitary defects were remedied in 1905.] 185 4 St. Barnabas, King's Square Accommodation under late Authority: Mixed, 121; Infants, 107; total, 228. This is an old brick building:, in bad state of repair, wedgeshaped on plan; built in 1837 in a very cramped position immediately behind the church, with only a passage between the church and school. There is no playground, and the offices are bad; there is no urinal for boys. The rooms are mostly top-lighted. Premises unsuitable for an elementary school. Drainage— Unsatisfactory to smoke and water tests; unventilated. Recommendation of London County Council— Unsuitable, owing to inadequate light and ventilation and other causes. Board of Education to be informed. 5. St. Joseph's (R. C.). Bunhill Row. Accommodation under late Authority: Mixed, 256; Infants, 158; Total, 414. Accommodation recommended by London County Council; Mixed, 288; Infants, 161; Total, 449. This is a brick building, built in 1901, of three storeys and base0172 ment, the basement being used as a chapel, etc.; the staircases are of patent stone with glazed brick dado, and are heated by radiators; the rooms are well lighted, heated and ventilated, but there are no emergency exits from end class-rooms; there is no gas which could be used in event of failure of the electric light; the staircase from infants' cloak-room landing to cookery class, etc., in basement is very dark, and on that account dangerous. The boy and girl infants' waterclosets are not divided, and there is no urinal for boy infants. Premises suitable with suggested alterations. Drainage— Satisfactory to water and smoke tests; well ventilated. Recommendation of London County Council Suitable with alterations. Boys', girls' and infants' main rooms to be partitioned, and additional exits to be provided. Outside iron gallery to be constructed for girls' and infants' departments. Improve sanitation. 186 [Various sanitary improvements and cleansing were carried out under our instructions in 1904.] 6. St. Luke's, Old Street. Accommodation under late Authority : Mixed, 536; Infants, 171; Total, 707. Accommodation recommended by London County Council: Mixed, 452; Infants, 153; Total, 605. This is a four-storey building, with basement, of brick and stone, slated. The main part was erected in 1870 for 400 children, the Telfer wing in the east being added in 1887. The front to Old Street has recently been re-pointed and done up; there is an inconvenient staircase to boys' department on third floor with many winders, and the offices are badly placed; the infants' and boys' offices are very had; there is not sufficient lavatory accommodation; the rooms on the ground floor, lately occupied by the schoolmaster, and those under infants' school have been let off; this is very undesirable in the event of fire. Premises suitable with alterations. Drainage— Fairly satisfactory to smoke and water tests, but not sound; various defects. Recommendation of London County Council— Suitable with alterations. In boys' department divide room (42 x 30); similarly in girls' department. Reconstruct or rebuild suitable staircases without winders. In boys' and girls' departments reduce width of school-rooms by forming passageway. [This school was re-drained under our supervision in 1901.] 7 St. Mark's, Old Street. Accommodation under late Authority: Mixed, 297. No Infants. Accommodation under existing Managers: Mixed (and a few Infants), 360. This is a brick building with stone facings, a slated roof erected in 1857 and enlarged in 1872. The stone copings are decayed, and the brick wall pointing is worn away. Unsuitable premises for an Elementary School. 187 Drainage- Most unsatisfactory. Cesspool under school-room floor, into which the whole of the drainage entered. Drains unventilated, no manholes, ventilating pipes or fresh air inlet. Recommendation of London County Council— Unsuitable as at present, but if Managers will submit scheme of re-construction, embodying certain recommendations, the whole matter to be re-considered. [This Sanitary Authority had previously drawn the attention of the Vicar to the highly unsatisfactory condition of the drainage, and a plan of re-construction was prepared by the Surveyor to the school, but was not acceptable to the Architect of the London County Council, and therefore had to be greatly modified. There has been much delay, attributed in part to the unfortunate illness of the Vicar, so that, although notices were served on the Vicar by us in the middle of March, and more than 15 visits of inspection and enquiry made by us, nothing whatever has yet been done (January, 1906). I am informed plans are about to be approved by the County Council, and that it is intended that works shall be commenced shortly]. 8. St. Thomas' Charterhouse, Goswell Road. Accommodation under late Authority: 708. Accommodation as recognised by existing Managers: 230. This is a three storey brick and stone building, slated, with basement, erected in 1853, and is in a very bad state, closely surrounded by the adjoining buildings, the chemical laboratory and rooms on the ground floor are very dark, and in a neglected condition, the dining hall has gallery over, used as a cloak room; the staircases are worn, bad and dangerous, and the offices very bad, the iron stanchions supporting same much rusted; the heating is by means of hot air introduced into rooms through gratings, but the system has been allowed to get foul, and is calculated to create disease. Premises unsuitable for an Elementary School. Drainage— Fairly satisfactory, except as regards soil and vent pipes. Recommendation of London County Council— Unsuitable, and cannot be made suitable. Board of Education to be informed. 188 [This Sanitary Authority drew the attention of the Managers of this school to many of the defects above enumerated in 1899, and subsequently, but no radical action was taken to remedy matters]. It will be seen from the above that four out of the eight schools, one in the Western Division of the Borough and three in the Eastern, were found to be unsuitable. Out of the 438 non-provided elementary schools in London 92 were found to be unsuitable. It will therefore be clear that whilst in London generally 20'9 per cent. of the non-provided schools were sanitarily unsuitable, in Finsbury as much as 50 per cent. were unsuitable. In a general note, the County Council reports that the staircases in many school buildings are dangerous in the event of fire or panic, and are besides very inconvenient for the work of the schools; ventilation and warming are in many cases very bad or quite inadequate for the needs of the children; closed stoves which easily get red-hot are particularly numerous, and should in all cases be replaced by modern grates with brick flues—the present flues are often faulty ; in several cases ventilation is secured only by opening both windows and doors, with resultant draughts and serious inconvenience to the scholars. The offices and sanitary arrangements are frequently badly placed, kept in an uncleanly condition, and defective. Verminous Children.—The Education Authority has continued the work of the late School Board in respect of Visiting Nurses. Those nurses who were first appointed to examine cases of Ringworm have had their duties extended to all forms of obvious uncleanness and disease. They also follow up the school work by home visits. The method of working which these nurses (12 in number) adopt is (a) to pay single visits here and there to different schools in their district, and (6) every third week begin a very thorough examination of one school and pay several visits at short intervals till it is deemed sufficiently cleansed. A staff of 12 is of course inadequate to an efficient system of inspection. But in the year ending March 189 31st, 1905, Dr. Kerr, the Medical Officer for Education under the London County Council, reports that 119,702 children were examined, of which 67,387 (or 56 per cent.) were clean, and 44,010 (or 37 per cent.) were "verminous." The nurse examines every child, noting those which have verminous heads. The parents are notified by a white card, on which is printed directions for cleansing. At the end of a week, if the child is not cleansed, a red card is served on the parents; and if, after another week, the child is not cleansed, the parents are prosecuted for sending the child in an unfit state to school. In the period above mentioned, 16,174 white cards were issued, 4,989 red cards, and 78 cases were prosecuted. The examination of children's heads has led to the discovery that their clothes and bodies may also be infested. Effort has been made to secure remedy in this event also under the Cleansing of Persons Act, 1897, and the General Powers (London County Council) Act, 1904. Under the former, verminous persons may be cleansed where facilities are provided (see p. 193). Under the latter, the Medical Officer of Education has notified the Borough Medical Officer of the occurrence of general verminous conditions, making it probable that the houses are infested, and in such event we have at once investigated the matter and carried out systematic disinfection as after the occurrence of an infectious disease. During 1905 I received from Dr. Kerr such notification respecting 22 homes, as follows: 58, St. Paul's Buildings.® 1, Mitre Court.® 81, Chapel Street.® 9, Thomas Street. 12, Risinghill Street. 86, Bartholomew's Buildings. 5, St. John's Place. 99, Bartholomew's Buildings. 14, Hall Street.® 8, Berkley Court.® 1, Spring Street. 2, Alpha Buildings.® 10, Thomas Place.® 1, Alpha Buildings.® 10, Hatfield Street.® 13, Seabrook Place.® 2, Lizard Street. 4, West Place. 13, Henry Street Buildings.® 43, Warren Street. 5, Peter's Lane. 12, James Street. 190 In eleven of these houses (marked with*) the rooms were dirty, or verminous, or both; in ten others they were clean, and the child had become infested with vermin elsewhere. One case, the last, appears to have been reported in error. Infectious Disease in Schools.—During 1905 there occurred 354 cases of notifiable infectious disease in School children and 916 cases of non-notifiable disease, as follows:— SCHOOLS. NOTIFIABLE. NON-NOTIFIABLE. Total. Scarlet Fever. Diphtheria. Enteric Fever. Measles. ing Cough. Chicken Pox. All other. Provided. Albion Place 10 2 1 12 — 1 4 30 Ann Street 9 5 — 18 20 10 20 82 Baltic Street 7 2 — 4 2 2 5 22 Bath Street 56 7 — 5 3 6 23 100 Bowling Green Lane 11 2 — — — — — 13 Central Street 17 8 — 38 10 14 45 132 Chequer Street 17 13 - 22 — 3 16 71 Compton Street 16 3 — 30 — — 35 81 Hugh Mvddelton 21 6 — 74 44 61 59 265 Moreland Street 9 3 — 34 4 29 8 87 Risinghill Street 10 2 2 8 20 3 17 62 St. John Street 2 1 — 20 4 10 8 45 White Lion Street 6 1 - - — — — 7 Winchester Street 4 2 — 1 24 31 9 71 Non-Provided. Amwell Street 20 5 — 13 12 8 21 79 St. Barnabas 5 — — 11 — 3 — 19 St. Joseph 6 1 — — — — — 7 St. Luke 39 5 — 2 — 1 5 52 St. Mark 3 1 — — — — — 4 St. Mark, Old Street 3 — - — — — 1 4 S.S. Peter and Paul 6 1 — 10 6 3 3 29 St. Thomas 2 — 2 — — 1 — 5 Totals 279 70 5 302 149 186 279 1270 We have received from the Education Department of the London County Council 169 certificates respecting cases of infectious disease relative to the exclusion of 305 children who had been in contact with those infected. Owing to the prevalence of measles in the Infants' Departments at St. Peter and St. Paul's School, Rosoman Street, and at the Hugh Myddleton School, the Infants' class-rooms 191 were closed for a time. The following is the basis of our practice as to the exclusion of children for measles: Children coming from houses where measles exists, but who are not themselves suffering from the disease, should be dealt with as follows:— 1.—Senior Departments. (а) If a child has had measles it need not be excluded from attendance at school. (b) If a child has not had measles it should be excluded from attendance at school for a period of 14 days from the date of the occurrence of the first case. 2.—Infants' Departments. All children should be excluded from attendance at school for a period of 14 days from the date of the occurrence of the last case. Sanitary Work in Schools, 1905 Fifty-six visits were made by the Inspectors to Schools in the Borough to make inquiries, test drainage and supervise sanitary work going on. In addition, the Lady Inspectors made some two dozen visits to schools respecting measles and verminous conditions, and the Disinfectors disinfected three class-rooms and one cloak-room after the occurrence of measles. BLACK SMOKE NUISANCES. The work of the Inspectors as to the occurrence of black smoke nuisances has continued to increase. During the year a very large number of observations have been made in respect of smoke nuisances, but in 156 instances where nuisances have occurred no action has been taken. In 46 other instances (out of the total of 20k observed nuisances) the occurrence of the nuisance has been used as evidence against the occupier of the premises, or notices have been served, or summonses have been issued. In 10 cases penalties have been obtained. The table of the 46 cases is as follows:— 192 No. Premises. Date. Duration in Minutes of Black Smoke. Action taken. 1 Northampton Institute, St. John Street Road Jan. 9 10 Summons: 2s. and 23s. costs. (Notices had been served for previous nuisances.) 2 Do. Oct. 23 14 Summons: £2 & 2s. costs. 3 Do. Nov. 6 3 No action. 4 Do. Nov. 20 7 Letter from Medical Officer. 5 Do. Dec. 8 7 Summons: £3 & 2s. costs. 6 Do. Dec. 16 3 No action. 7 Do. Dec. 19 6 Do. 8 Victoria Buildings Jan. 21 7 Notices. 9 Memel Street Factory Jan. 20 6 Summons: (for nuisance. Nov. 28, '04) £5 and 23s. costs. 10 Do. Feb. 28 6 No action. 11 Cannon Brewery Jan. 5 4 Do. 12 Do. Feb. 8 17 Summons: £3 3s. costs. 13 Do. July 17 4 No action. 14 Flatting Mills, Gloucester Street Feb. 27 13 Notices. 15 Do. Oct. 23 3 No action. 16 Compton Street School Jan. 24 5 Notices. 17 Cold Air Stores Mar. 13 6 Summons: £5 & 2s. costs. 18 55, Cowcross Street Mar. 17 30 Summons: £10 & 2s. costs 19 67-69. Turnmill Street Mar. 20 12 Summons: £2 & 2s. costs. 20 16-22, Lamb's Passage April 3 5 Prosecuted, but summons out of order. 21 135, Whitecross Street April 11 5 Notices. 22 86, Clerkenwell Road April 26 5 Do. 23 40-48, City Road May 18 8 Do. 24 Finsbury College April 12 15 Do. 25 90-92, Banner Street April 15 6 Do. 26 34, Chiswell Street June 26 9 Do. 27 152-166, Old Street July 14 5 Do. 28 Coventry Restaurant July 15 14 Summons: £1 and 21s. costs. 29 Alexandra Trust July 24 2 No action. 30 Do. Oct. 5 6 Notices. 31 7, Wilson Street Oct. 3 6 Do. 32 Baltic Street School Oct. 19 8 Do. 33 Do. Oct. 25 7 Do. 34 40-48, City Road Nov. 16 7 Summons: £4 and 23s. costs. 35 177, Whitecross Street Nov. 17 8 Notices. 36 179, Whitecross Street Nov. 18 5 Do. 37 Charterhouse Oct. 30 5 No action. 38 Coventry House Nov. 23 4 Notices. 39 Middle Row Factory Dec. 1 4 Do. 40 10, Garnault Place Dec. 4 8 Do. 41 Imperial Tobacco Co. Aug. 21 5 Do. 42 L.C.C. Stores Nov. 29 6 Do. 43 83-89, Pentonville Road Dec. 30 7 Do. 44 132, Goswell Road Oct. 31 20 Do. 45 80, Goswell Road Dec. 13 15 Do. 46 20-24, Old Street Dec. 22 10 Do. 193 We received two "information certificates" from the Coal Smoke Abatement Society and five from the Public Control Department of the London County Council during the year. CLEANSING OF PERSONS' ACT, 1897. Under this Act power is given to local authorities to provide free cleansing of persons infested with vermin, and disinfection of their clothing. Such assistance is not to be considered parochial relief or charitable allowance. Local authorities may expend any reasonable sum on buildings, appliances and attendants that may be required for the carrying out of the Act, and any expenses for these purposes may be defrayed out of any rate or fund applicable by the authority for general sanitary purposes or for the relief of the poor. This Act has hitherto been chiefly administered in the Metropolis by the Metropolitan Boroughs of Marylebone and St. Pancras. In 1905 we made full enquiry into the need which exists in this district, and into ways and means, and approached the Guardians of the Holborn Union with a view to making arrangements with them for this cleansing and disinfection in such cases as seemed desirable and which belong to Finsbury. The Guardians have now consented to accommodate us in this matter at their Casual Wards in Grays Inn Lane. The bathing accommodation consists of six baths on the men's side and three on the women's. Applicants are to attend at two p.m. daily, and be furnished with an Order, signed by the Medical Officer of Health. It is anticipated that the Guardians will incur extra expense in dealing with these cases, which it will be necessary for the Borough Council to meet. These arrangements are to come into force early in 1906. 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 194 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, and 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 1905:— 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Total. Beds 194 173 293 241 901 Mattresses 15 12 24 15 66 Pillows 224 112 337 446 1,119 Bolsters 105 105 90 113 413 Sheets 246 170 393 318 1,127 Blankets 281 142 304 333 1,060 Quilts 222 190 268 254 934 Cushions 60 20 38 48 166 Curtains — 8 8 15 31 Carpets 13 9 9 9 40 Wearing Apparel 299 319 359 399 1,376 Sundries 440 353 680 477 1,950 Burnings 6 6 3 8 23 Totals 2,105 1,619 2,806 2,676 9,206 The above Table deals with articles which have been disinfected. The actual number of occupancies disinfected during 1905, was as follows :— 195 Varicella Small-pox Scarlet Fever Diphtheria Enteric Fever Puerperal Fever Measles. Phthisis For Vermin, etc. Totals January — — 15 10 4 — 50 22 2 103 February — — 20 9 1 — 22 5 — 57 March — — 31 12 — — 45 10 — 98 April — — 15 10 — 1 50 14 1 91 May -- — 24 10 1 1 55 26 3 120 June — — 24 8 5 1 44 10 1 93 July — — 37 15 8 1 52 11 6 130 August — — 48 10 1 1 15 12 3 90 September — — 77 11 12 — 3 11 2 116 October — — 57 19 7 — — 4 5 92 November — — 38 18 2 — — 17 3 78 December — — 52 5 — — 3 13 3 76 — — 438 137 41 5 339 155 29 1144 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 porve 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. 196 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 69 51 120 Infectious diseases 5 8 13 Bodies deposited by Borough Orders 7 4 11 Bodies brought for convenience of relatives, &c. 107 84 191 Total 188 147 335 In addition to the inquests held at the Borough Mortuaries, 88 inquests have been held in places outside the Borough upon bodies of persons belonging to the Borough, making the total number of inquests held 208. The verdicts were as follows:— Natural Causes— Heart Disease 21 Other Diseases of the Circulatory System 12 Alcoholism 9 Pneumonia 22 Bronchitis 4 Septic diseases 3 Convulsions 12 Marasmus 4 Prematurity 6 Miscellaneous 24 117 Murder— Fracture of Larynx 1 Suicides— Poisoning 5 Hanging 2 Stabbing 1 Falls from Windows 2 Drowning 1 12 Accidental— Suffocation in Bed 27 Fracture of Skull 7 Fractured Limbs, Spine, etc. 18 Shocks from Scalds 3 Shocks from Burns 9 Complications from Falls 13 Tetanus 1 Poisoning (Accidental) 1 79 197 MISCELLANEOUS. 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 1905 was seventeen families of 61 persons. Removal and Re-interment of Human Remains.-On February 8th, it was reported to me by the Works Manager of a new building in Exmouth Street, that in the course of excavations he had come across a number of human remains. On receipt of this report. I at once visited the site and found one lead coffin and a layer of dried human bones (23 skeletons). I reported the matter at once to the Home Office, at the same time applying for the usual licence for removal of the human remains, under the Burial Act, 1857, Section 25. This licence was granted by the Home Secretary, and in accordance with its conditions, the encasement and removal of 23 skeletons and two lead coffins took place on February 10th. Drainage Plans.—All plans concerning drainage matters, including the provision of new, and alteration of old, water closets in all buildings, whether the result of a notice or not, are submitted to and considered by the Public Health Committee. During the year 169 sets of plans—of which number 45 related to combined systems of drainage, in which 100 premises were involved—have been dealt with. In some cases, of course, the plans as at first submitted are not such as will meet with approval, in which cases they have to be amended and again submitted for consideration. In all cases of old buildings, the work of repair and reconstruction is supervised by the Sanitary Inspectors, and in new buildings they supervise the construction of water closets and soil pipes. Removal of Dust, &c.—The system of dust removal adopted is that of a weekly removal of refuse from every house in the Borough, though in a few main thoroughfares a daily 198 collection is made; there are cases, however, where this rule is not adhered to, and as a result 144 complaints of non-removal have been entered in the book kept in this department for that purpose, and 30 have been received through the post and transferred to the Superintendent of the Cleansing Department. There were 14,311 loads of household refuse and 2,380 loads of trade refuse, weighing 26,706 tons, collected during the year, at a cost of £5,377, and destroyed at a cost of £4,026. There are two destructors, one at Phoenix Wharf, Blackfriars, and one at Wharf Road, City Road. The amount of house and trade refuse collected during 1904 was 14,372 loads of the former and 2,390 loads of the latter, weighing 26,819 tons, at a cost of £5,000 to collect and £4,102 to destroy. The Sanitary Inspectors examine the conditions of the dust receptacle in every house they visit. There were, in addition, 9,664 bins of offensive refuse collected from fish shops, &c., in the van specially constructed for that purpose. The Borough Council supply these bins, charging 8s. on each as a deposit, which amount is returned when the use of the bin ceases, but no charge whatever is made for the use of the bins, the occupier only paying from 1s. to 2s. (according to quantity) per week for removal. 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. 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, two Lady Inspectors, 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 Rale of Food and Drugs Acts. The Canal is taken by the Inspector 199 within whose district it is situate. There are five men regularly engaged in the work of Disinfection and the Mortuaries, etc. The Chief Inspector supervises the general work of the Staff. 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 inquiries 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 Special Meat Inspector visits the Extra-Corporation Meat Market in Finsbury, and all other meat and food factories, shops, &c., in the Borough. The duties of the Workshop Inspector are: (a) Primary systematic inspection of all workshops and workplaces; (b) reinspection of men's and mixed workshops, &c.; (c) inspection and re-inspection of sanitary arrangements of all factories; and (d) attention to Home Office notices, except where these concern women's workshops only. The Lady Inspectors (a) visit some of the births and all the infant deaths; (b) investigate the cases of, and deaths from, measles ; (c) inspect the homes of outworkers; (d) re-inspect the workshops in which women and girls only are employed; and (e) inspect primarily such workshops as are met with in visiting all the above or outworkers. 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. 200 Work of Sanitary Inspectors. Inspector Ensor. Inspector Davis. Inspector Longden. Inspector Norman. Inspectors Hindbaugh & Matson. Inspectors Hall & Draper. Total. Damp, dirty, or dilapidated houses nuisances remedied 161 208 234 281 212 298 1394 Defective doors, windows, floors, ceilings, sashcords, &c. 86 45 34 42 117 221 545 Illegal occupations of kitchens, cellars, or underground rooms remedied 7 — 1 3 7 6 24 Water-closets cleansed or repaired 284 225 295 248 363 189 1604 Additional water-closets provided 3 — 6 25 7 — 41 Urinals cleansed or provided 2 18 7 8 3 9 47 Defective soil-pipes and ventilating shafts repaired 12 20 5 4 6 15 62 Yards drained, paved, repaired, or limewashed 112 124 42 165 206 147 796 Waste and sink pipes repaired or remedied 48 21 9 19 21 63 181 Water cisterns cleansed or repaired 40 76 14 '9 54 32 235 Accumulations of rubbish, manure, &c., removed 49 52 10 15 2 36 164 Dung or dust receptacles repaired or renewed 47 76 30 107 144 55 459 Defective drains relaid 44 36 24 45 47 41 237 Drains cleared 10 5 24 27 27 35 127 Rain water pipes repaired, &c. 34 33 11 47 24 70 219 Defective roofs and gutters repaired 105 47 61 108 64 128 513 Areas paved, lime washed, orrepaired 13 47 5 27 50 21 163 Water supply to houses re-instated 2 5 6 — 8 21 Washhouses re-paved orrepaired 119 60 18 104 98 122 521 Bakehouses cleansed or repaired 10 8 4 7 1 4 34 Restaurants cleansed or repaired 16 74 34 26 10 13 173 Nuisances from animals abated — 7 1 14 — 9 31 Basements cleansed or repaired 23 8 7 8 43 9 98 Stables re-paved or repaired 17 6 — 3 — 8 34 Smoke nuisances abated — 64 2 4 3 2 75 Miscellaneous nuisances abated 33 35 27 25 32 10 162 House-to-house inspections 317 130 715 695 286 107 2250 First visits 011 complaints, &c. 880 1350 1232 1448 1136 1023 7069 Re-visits 4141 3733 5713 6103 3838 3783 27311 Intimation Notices served 753 520 827 1051 607 709 4467 Statutory Notices served 125 74 146 212 229 176 962 Infectious disease investigations 217 124 177 220 259 104 1101 Cases of overcrowding abated 14 17 8 7 7 6 59 Cases of overcrowding abated in registered houses 7 13 7 3 15 59 Canal boat inspections — — — — — 109 109 The above Table does not include any reference to particulars regarding the work of the Factory and Workshop Inspector or the Lady Inspectors, 201 THE WORK OF THE LADY SANITARY INSPECTORS. This includes three months voluntary work by Mi as M. G. Jones previous to her official appointment on 28th March, 1905. A summary of the work of the year will be found on p. 203. Investigation of the Deaths of Infants.—Investigations have been made into the causes and circumstances of the deaths of 418 infants, that is of children under 12 months. Information has been obtained in 374 cases, some of which is classified in the table on p. 2(i. In the column headed "Mother's Work," the occupation of the mother since the birth of the deceased child is indicated, except in deaths occurring under one month, when the occupation of the mother during pregnancy has been recorded. It is satisfactory to note that the general cleanliness of the tenements has greatly improved compared witli the conditions found last year. Of the 27 deaths of infants from suffocation (which have been investigated), three occurred when the infant was in bed alone and one when the infant was in bed with three other children, both parents being absent; of the remaining 23, only 39 per cent, occurred between Saturday night and Monday morning. All the children suffocated in bed with their parents were breast fed, with one exception ; in nearly every instance the mother admitted the practice of sleeping with her infant on her arm. Births.—A large number of visits and re-visits have been made in connection with births, and various particulars have been obtained in 1,859 cases, some of which are classified in the table on p. 15. *The particulars of a somewhat exceptional case are given as follows :— J. S., a healthy int'aut of six weeks, son of costermongers, had always slept in a cradle until night of death. Parents had removed into Finsbury on Saturday and had been working hard all day until midnight, mother then washed and suckled the baby and took it into her bed as the cradle was not ready for use, she slept soundly all night and woke at 7.40 a.m. to find the baby dead; a first child, not insured; the mother a young, healthy, sober-looking woman, very clean. 202 Factories and Workshops.—The work in connection with the inspection of workshops and factories is summarised in the following table. Some of the items tabulated are incorporated in the tables appearing on pp. 162, 171, 172, but the returns below concern only the work of the Lady Inspectors :— FACTORIES. Total number of visits and revisits 16 No. of Factories insiiected 13 „ revisits 3 „ complaints received (anon.) 1 Reports to Home Ottice— 5 Ventilation not maintained 4 Machine generating dust 1 Notice served (insufficient ventilation to w.c.) 1 WORKSHOPS. Total number of visits 420 No. of inspections of workshops (including those of 98 outworkers) 321 No. of revisits 99 Workshops visited already on the register 167 „ placed on 61 „ removed from 62 Workrooms inspected ... 389 Reports to Home Office— 55 No abstract 33 Absence of proper means of heating 3 Complaint of overcrowding outside the Borough 1 Infringement of Particulars Clause 1 Domestic workshops 17 Dirty workshops cleansed 20 Damp and dilapidated workshops repaired 4 Overcrowded workshops 4 Gas stoves, flues provided 2 Sanitary conveniences cleansed 13 „ „ defects remedied 9 Insufficient sanitary convenience accommodation 2 Unsuitable do. do. for two sexes 2 Dustbins absent or defective 8 Other nuisances 3 Out-workers and Home-workers.—The work in connection with the above will be found under Section iii. of the Report on Factories and Workshops, p. 163. Measles.—Of the 561 cases of measles recorded during the year, 464 were investigated by the Lady Inspectors and arrangements made for disinfection, the other cases being investigated by Dr. Sandilands. 203 Complaints from the Education Department of the London County Council.— Twenty-two of these cases have been investigated by Mrs. Greenwood and Miss Jones, and in every case steps have been taken to improve the conditions found. Summary ok Work Done during the Year. Mrs. Greenwood. Miss* Jones. First Visits:— Measles 117 178 Births 850 1235 Infant Deaths 189 189 Outworkers 427 141 Workshops 247 94 Factories 13 — Sundries 118 80 Revisits:— Measles 72 125 Births 467 453 Deaths 137 79 Outworkers 75 28 Workshops 69 30 Factories 3 — Sundries 33 18 Dirty rooms stripped and cleansed 55 29 Dirty floors and bedding cleansed 25 10 Dwelling rooms overcrowded 10 7 Dirty workshops 12 4 Workshops overcrowded 2 2 „ insufficiently ventilated 2 2 „ no separate sanitary convenience accommodation for sexes 2 - ,, no hood to gas stoves 2 — Underground rooms illegally occupied 3 — Sanitary conveniences cleansed 41 19 „ „ defects remedied 34 30 Dirty yards and defective paving 22 3 Dustbins absent or defective 15 13 Defective roofs 3 6 Wash-houses, walls and ceilings defective, &c. 20 - Other nuisances 6 15 Intimation notices served 176 112 Statutory notices served 23 11 In addition to the above nuisances the following matters have been referred to the District Sanitary Inspectors :—43 defective closets and drains; 24 dirty and dilapidated rooms and houses; 13 defective roofs; 10 dirty yards and defective paving ; and 13 other matters requiring structural alteration. The figures in this column include work from March 27th to December 30th only. 204 Legal Proceedings under the Public Health (London) Act, 1891, and the Metropolis Local Management Act.* Date. Name and Address of Defendant. Offence. Fesult. Jan. 24th The Governors of Northampton Institute, St. John Street Allowing black smoke to issue from the boiler chimney shaft Fined 2s. and £1 3s. costs. " George Dennison, 219, Pentonville Road Failing to cleanse a dirty room at 82, White Lion Street Ordered to pay £1 3s. costs. Feb. 9th Samuel Haskins & Bros., 22-24, O'd Street Allowing black smoke to issue from the boiler chimney shaft Fined £.5 and £.1 3s. costs. Mar. 8th Cannon Brewery Co., Ltd.,St. John Street Allowing black smoke to issue from the boiler chimney shaft Ordered to pay £3 3s. costs. „ 29th Martin Seal. 17, Montserrat Road, Putney Failing to alter and amend a defective drain at 7, Busaco Street Fined £5 and 2s. costs. April 11th London & India Docks Co., Leadenhall Street Allowing black smoke to issue from the boiler chimney shaft at Cold Air Stores, St. John Street Fined £5 and 2s. costs. „ Booth's Distillery, Ltd., Cow Cross Street Allowing black smoke to issue from the boiler chimney shaft Fined £10 and 2s. costs. ,, 28th Murray & Co., Ltd., Turnmill Street Allowing black smoke to issue from the boiler chimney shaft Fined £2 and 2s. costs. June 15th McNeill & Co., Lamb's Passage Allowing black smoke to issue from the boiler chimney shaft Dismissed. „ 21st A. Saunders, 36, Pembury Road, Hackney Failing to provide sufficient w c. accommodation at 24, Noble Street Fined £5 and 2s. costs. July 7th Thomas Payne, 30, St. Helena Place Failing to cleanse the lodging-house, 30, St. Helena Place, as required by the bye-laws Fined £2 and 2s. costs. The list of food prosecutions under the Public Health (London) Act, 1891, appears on page 79. 205 Date. Name and Address of Defendant. Offence. Result " Frances W. Miller, 9, Noble Street Failing to cleanse the lodging-house, 9, Noble Street, as required by the bye-laws Fined £2 and 2s. costs. " Joseph Cooper, 10, Noble Street Failing to cleanse the lodging-house, 10, Noble Street, as required by the bye-laws Fined £2 and 2s. costs. „ 21st Thos. Fowler, 39, St. Helena Place Failing to cleanse the lodging-house, 39, St. Helena Place, as required by the bye-laws Fined £2 and 2s. costs. „ James Harris, 54, Barnsbury Street Failing to cleanse the lodging-house, 20, Noble Street, as required by the bye-laws Fined £1 10s. and 2s. costs. „ James Harris, 54, Barnsbury Street Failing to cleanse the lodging-house, 10, Wilmington Place, as required by the bye-laws Fined £1 and 2s. costs. Aug. 22nd E. Freideberg, 17, Spencer Hill, Wimbledon Failing to cleanse the lodging-house, 21, St. James' Walk, as required by the bye-laws Fined £2 and 2s. costs. " Thos. McKay, 16, Northampton Road Failing to cleanse the lodging-house, 16, Northampton Road, as required by the bye-laws Fined £2 and 2s. costs. Sept. 19th James Harris, 54, Barnsbury Street Failing to provide a dustbin at 10, Wilmington Place Fined £1 3s. and 2s. costs. " Frederick Warman, Spencer House, Highbury Corner Failing to cleanse the lodging-house, 289, Pentonville Road, as required by the bye-laws Fined £2 and 2s. costs. " Frederick Warman, Spencer House, Highbury Corner Failing to cleanse the lodging-house, 29, Pentonville Road, as required by the bye-laws Ordered to pay 2s. costs. Nov. 14th The Governors of Northampton Institute, St. John Street Allowing black smoke to issue from the boiler chimney shaft Fined £2 and 2s. costs. ,, 23rd Otto G. Kranz, Coventry Restaurant, South Place Allowing black smoke to issue from the boiler chimney shaft Fined £1 and £1 1s. costs. 206 Date. Name and Address of Defendant. Offence. Result. Dec. 28th Johns, Son & Watts, 40 to 48, City Road Allowing black smoke to issue from the boiler chimney shaft Fined £4 and and £1 3s. costs „ 29th The Governors of Northampton Institute, St. John Street Allowing black smoke to issue from the boiler chimney shaft Fined £3 and 2s. costs. SALE OF FOOD AND DRUGS ACTS. Mar, 1st Emily Williason, 87, Cow Cross Street For selling butter adulterated with 85 per cent. of foreign fat Fined £1 and 12s. 6d. costs. „ 8th Emily M. Scott, 21, Finsbury Market For selling mustard adulterated with 30 per cent. of starch and other farinaceous matter Ordered to pay 12s. 6d. costs. „ 29th John Anderson, 20, Wynford Road For selling butter adulterated with 40 per cent. of foreign fat Fined 10s. and 12s. 6d. costs. Apr. 7th William King, 86, Farringdon Road For selling butter (on bread) adulterated with 92 per cent. of foreign fat Fined £3 and 12s. 6d. costs. „ 28th John Evans, 32, Rosoman Street For selling milk adulterated with 24·9 per cent. of added water Fined £3 and 12s. 6d. costs. May 4th Wm. Watson, 159, Whitecross Street For selling butter (on bread) adulterated with 92 per cent. of foreign fat Ordered to pay £1 5s. costs. " Thos. Griffiths, 124. Whitecross Street For selling butter adulterated with 86 per cent. of foreign fat Fined £2 and £1 5s. costs. " Horatio Jones, 67. Whitecross Street For selling butter (on bread) adulterated with 92 per cent. of foreign fat Fined £1 and £1 5s. costs " Wm. Davies, 127, Golden Lane For selling coffee adulterated with 24·5 per cent. of chicory Ordered to pay £1 3s. costs „ 25th Emma Williams, 10, White Lion Street For selling milk adulterated with 24·5 per cent. of added water Ordered to pay 12s. 6d. costs June 1st Alfred Stearn, 39, Central Street For selling as Demerara sugar, sugar crystals coloured with a dye Fined £1 and 12s. costs 207 Date. Name and Address of Defendant. Offence. Result. ,, 7th Annie Stanborough, 2, St. John Street Road For selling as Demerara sugar, sugar crystals coloured with a dye Fined 10s. 6d. and 2s. costs July 25th Henry Battesley, 108, King's Cross Road For selling coffee adulterated with 15 per cent. of chicory Fined £2 and 12s. 6d. costs Aug. 29th E. Roberts, 2a, Chapel Street For selling butter adulterated with 81 per cent. of foreign fat Defendant did not appear, warrant issued for his arrest. Warrant executed, and on the 29th of November he was fined £2 and 14s. 6d. costs Aug. 31st T. Claro, 50, Baldwin Street For selling milk from which 23 per cent. of its cream had been abstracted Fined £1 and £1 3s. costs. Oct. 18th George Wright, 2a, Chapel Street For selling butter adulterated with 87 per cent. of foreign fat Fined £5 and 12s. 6d. costs. " John C. Hammick, 25, Lloyd's Row For selling coffee adulterated with 50 per cent. of chicory Fined £3 and 12s. 6d. costs. Nov. 1st Mary Jones, 144a, King's Cross Road For selling milk adulterated with 8 per cent. added water Ordered to pay 12s. 6d. costs. 23rd William Evans, 136, Whitecross Street For selling butter adulterated with 82 per cent. of foreign fat Fined £5. Dec. 15th Jane Daley, 18, Collier Street For selling milk from which io-6 per cent. of its cream had been abstracted Ordered to pay 12s. 6d. costs. " Chrissie Ebner, 11, Sans Walk For selling butter adulterated with 82 per cent. of foreign fat Fined 10s. and 12s. 6d. costs. 208 LONDON COUNTY COUNCIL (GENERAL POWERS) ACT, 1902. Date. Name and Address of Defendant. Offence. Result. April 28th Emanuel Brattesani, 5, Sumner Street, Holborn For selling ice cream from a barrow on which the name and addiess of the manufacturer was not legibly inscribed Fined 5s. and 2s. costs. Aug. 18th A. Francesi, 1 & 3, Corporation Row For making ice cream in a room in which persons live and sleep Fined 10s. and 9s. 6d. costs. FACTORY AND WORKSHOP ACT. 1901. Mar. 22ndº J. W. Woodhead, 1660, Pentonville Road Failing to supply list of outworkers' names and addresses on or before February 1st, 1905 Fined £2 and 2s. costs. " J. Field, 28, Penton Place Do. do. Fined £2 and 2c. costs. Mar. 23rdº W. H. Taylor, 4, Nichols Buildings Do. do. Fined £1 and £1 3s. costs. Oct. 4thº Antill & Sons, Ltd,, 43, Myddelton Street Failing to supply list of outworkers' names and addresses on or before August 1st, 1905 Fined £1 and £1 2s. costs. " J. Crawley & Son, 9 to 13, Cowcross Street Do. do. Fined £2 and £1 2s. costs. Oct. 25th Wm. H. Burton, 165, Old Street Do. do. Fined £2 and £1 3s. costs. Oct. 25th Coates & May, Bayer Street Do. do. Fined £1 10s. & £1 3s. costs " A. S. Gant, 45, Golden Lane Do. do. Fined £1 and £1 3s. costs *On page 174 will be found a list of 33 firms, each of whom were summoned or a like offence, but the summonses were withdrawn on their supplying the necessary lists and paying costs. 209 Date. Name and Address of Defendant. Offence. Result. Oct. 25th T. C. Grimes & Co., 40-46, Banner Street Failing to supply list of outworkers' names and addresses on or before August 1st, 1905. Fined £1 10s. & £1 3s. costs " Peiser, Phillips & Co., 10, Lensden Place Do. do. Fined £1 and £1 3s. costs " A. H. Taylor, 4, Lensden Place Do. do. Fined £2 and £1 3s. costs " Waterer & Green, 8, Roscoe Street Do. do. Fined £1 10s. & £1 3s. costs 210 SUMMARY OF PROCEEDINGS UNDER THE PUBLIC HEALTH & FACTORY & WORKSHOP ACTS The following Tables and Statement have been 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 1905. Premises. Number of Places— Number of inspections, 1905. Number of notices, 1905. Number of pro- seciuions 1905. On register at end of 1904. Added in 1905. Removed in 1905. On register at end of 1905. Milk premises 270 21 29 262 402 96 — Cowsheds 6 — - 6 69 4 — Slaughter-houses 4 — 1 3 104 — — Other offensive trade premises — — — — — — — Ice cream premises 100 4 1 103 192 36 1 Registered houses let in lodgings 1131 45 7 1169 79731 (a)° 59 (b) † 2710 (a)°Nil (b) † 12 * (a) For overcrowding. † (b) For other conditions. Overcrowding, 1905— Number of dwelling rooms overcrowded 118 Number remedied 118 Number of prosecutions Underground rooms— Illegal occupation dealt with during year 24 Number of rooms closed 211 Insanitary houses— Number closed under the Public Health (London) Act, 1891 Number closed under the Housing of the Working Classes Act, Part l.(for Part 2 see page 130) 33 Shelters provided, under sec. 60 (4) of the Public Health (London) Act, 1891— Number of persons accommodated during the year 61 Revenue Acts— Number of houses for which applications were received during the year 5 Number of tenements comprised therein 101 Number of tenements for which certificates were (a) granted, 101 ; (b) refused ; (c) deferred 101 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.— (f As to cesspools and privies, removal and disposal of refuse, etc — (g For securing the cleanliness of tanks, cisterns, (h) With respect to water closets, earth closets, etc. — (i) With respect to sufficiency of water supply to water closets — 212 (j) With respect to drainage, etc. (Metropolis Management Act, Section 202) — (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 335 Total number of infectious bodies removed 13 213 Inspection of Factories, Workshops and Workplaces. Class of Works. Number of Places.‡ Number of. Inspections, 1905. Number of Number of —Prosecutions, 1905. On Register at end of 1904. Added in 1905. Removed in 1905. On Register at end of 1905. Written Intimations, 1905. Notices, 1905. Under Factory Act. Under Public Health Act. Premises. Rooms. Factories Factory Laundries 8 - 2 6 - 4 - - - - Factory Bakehouses — - — — - — - - - - Other Factories 346 131 17 466 — 704 117 9 10 - Workshops* Workshop Laundries 24 8 - 32 - 41 9 1 - - Workshop Bakehouses 61 - - 61 - 166 34 — — - Other Workshops 1721 261 155 1827 - 1804 301 47 25 - Workplaces Places where Food is prepared for Sale † 330 47 3 374 - 542 209 - - - Workplaces other than the above Included in "other workshops." 1177 63 14 10 - § Home-workers' premises 238 330 147 421 - 467 61 5 - - Total 2728 777 324 3187 - 4905 794 76 45 - * In a separate Table (p. 156) 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. 214 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 118 9 127 — 127 — Want of Ventilation 16 3 19 — 19 — Want of Air Space: Overcrowding 11 — 11 11 — Sanitary Accommo- dation. Absent or insufficient 22 — 22 — 22 — Unsuitable or defective 423 10 433 — 433 — Not separate for Sexes 11 — 11 — 11 — Want of Drainage of Floors 1 — 1 — 1 — Other Nuisances 380 4 384 — 384 — Contraventions of Factory and Workshop Act,1901. Illegal occupation of Underground Bakehouse (s. 101) - - - - - - Breach of Special Sanitary Requirements for Bakehouses (ss. 97 to 100) — — — — — — Failure as regards Lists of Outworkers (s. 107) 86 — 86 - 41 45 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 106 — — 106 — - Totals 1174 26 1094 106 1049 45 215 Lists of Outworkers (s. 107). Class of Homework Number of Lists Received, 1905. 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 Outworkers Due Feb. 1st. Due Aug. 1st. Due Feb. 1st. Due Aug. 1st. Wearing Apparel— Furriers 5 24 6 34 19 29 300 188 Hats and caps 4 27 3 12 20 10 Mantles, costumes, &c 13 200 8 134 191 119 Millinery 9 300 6 72 283 66 Shoes and boots 7 154 8 187 139 172 Tailors and clothiers 23 142 20 145 122 130 Ties and scarves 4 204 3 177 193 170 Underclothing, shirts, skirts, blouses, etc. 39 1287 47 1542 1233 1474 Lace - - - - - - Cabinet making — - - - - - Fur pulling - - - - - - Other 6 27 4 20 19 13 Totals 110 2365 105 2323 2219 2183 300 188 Factories. Workshops. Workplaces. Total. Number of Outworkers (persons) on register at end of year 1905 6 98 421 525 Number of Outworkers' premises on register at end of year 1905 6 98 421 525 Total number of Outworkers (persons) dealt with during the year 1905 — — 5176 Total number of Outworkers' premises dealt with during the year 1905 - — — 672 216 Number of Notices prohibiting homework in unwholesome premises (s. 108) — Number of Cases of infectious disease notified in homeworkers' premises Number of Orders prohibiting homework in infected premises (s. 110) Cases reported to H.M. Inspector— Failure to affix Abstract 58 Replies as to action taken in cases notified by H.M. Inspector 25 Other matters 48 Number of underground bakehouses in use at the end of 1905 40 Certificates granted during the year (s. 101) Number of workshop rooms measured 311 LOCAL GOVERNMENT TABLES. 219 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 in District. Deaths of Residents registered beyond District. Deaths at all Ages Nett. 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 1905 98,207 3,398 34·6 429 148·6 1,014 10·3 38 45 886 1,855 18·9 * Rates calculated per 1,000 of estimated population. t The numbers in this column include births at City of Ixmdon Lying-in Hospital, not belonging to Finsbury (see p. 13). 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 rersons who have been taken out of the district on account of illness, and have died elsewhere. Area of District in acres ) (exclusively of area covered by water). I 589 Total population at all ages 101,463 Number of inhabited houses, 9,820 Average number of persons per house, 10.9. At Census of 1901. 220 TABLE II. Borough of Finsbury. Names of Localities 1—The borough 2— North clerkenwell 3—South Cierkenwell 4—Flinsbury (St Luke) 5—st sepulchre Year Population estimated to middle of each Year Births registered Deaths at all Age* 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 y«*nr Population estimated to middle of each Year Births registered Deaths at all Age* Deaths under 1 year Population estimated to middle of each Year Birt hs 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 1905 98,207 3,398 1,855 429 33,904 985 629 146 27,756 805 481 98 34,957 1,587 705 178 1,590 21 40 7 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 e of this table, and those of non-residents registered in the district excluded. (See note on Table ], 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. 221 TABLE III. Cases of Infectious Disease Notified during the year 1905. Borough of Finshury. 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 Finshury (St Luke) St. Sepulchre. North Clerkenwell Sourth Clerkenwell Finshury (St Luke) St. Sepulchre Small-pox — — - — — — — - - - - - - - - Cholera — — — — — — — — — — — — — — — Diphtheria 125 8 57 41 5 14 — 31 30 60 4 29 29 59 4 Membranous croup 1 — — 1 — — — — — 1 — — — 1 — Erysipelas 115 — 10 8 10 74 13 43 35 36 1 — — — — Scarlet Fever 456 11 183 235 21 6 — 123 99 227 7 121 94 225 7 Typhus Fever — — — — — — — — — — — — — — — Enteric Fever 42 — 1 6 13 21 1 19 11 12 — 19 10 11 — Relapsing Fever — — — — — — — — — — — — — — — Continued Fever — — — — — — — — — — — — — — — Puerperal Fever 6 — — — 3 3 — 2 2 2 — — — 1 — Plague — — — — — — — — — — — — — — — Totals 745 19 251 291 52 118 14 218 177 338 12 169 133 297 11 222 TABLE IV. Borough of Finsbury. CAUSES AND AGES AT DEATH DURING THE YEAR, 1905. Causes of Death. Deaths in District at subjoined Ages Deaths in Localities (at all ages ) Deaths in Public Institutions in the District, whether Residents or Non-Residents. All ages U nder 1 1 and under 5 5 and under 15 15 and under 25 25 and under 65 35 and upwards North Clerkenwell South Clerkenwell Finsbury (St Luke) St. Sepulchre Small-pox ... ... ... ... ... ... ... ... ... ... ... ... Measles 31 5 25 1 ... ... ... 9 9 11 2 ... Scarlet Fever 21 2 12 5 ... 2 ... 7 4 9 1 ... Whooping Cough 32 15 16 1 ... ... ... 19 6 7 ... ... Diphtheria and Membranous Croup 11 2 7 1 ... 1 ... 3 2 4 2 ... Croup ... ... ... ... ... ... ... ... ... ... ... ... Fevers Typhus ... ... ... ... ... ... ... ... ... ... ... ... Enteric 9 ... ... ... 3 6 ... 4 2 3 ... ... Continued ... ... ... ... ... ... ... ... ... ... ... ... Epidemic Influenza 12 ... ... ... ... 7 5 7 1 4 ... ... Diarrhæa 56 35 11 ... 1 2 7 16 14 26 ... ... Enteritis 55 42 11 1 ... 1 ... 13 7 34 1 ... Puerperal Fever ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 5 ... ... ... ... 4 1 4 ... 1 ... ... Olher Septic Diseases 9 1 ... 1 1 5 1 2 3 4 ... ... Phthisis 215 6 11 6 23 162 7 72 50 87 6 1 Other Tubercular Diseases 52 9 29 7 5 2 ... 19 16 16 1 ... Cancer, Malignant Disease 65 ... 2 ... 1 38 24 23 19 19 4 2 Bronchitis 229 41 22 ... ... 63 103 78 54 93 4 2 Pneumonia 180 40 48 4 11 54 23 65 53 60 2 2 Pleurisy 17 2 3 2 ... 6 4 6 4 7 ... ... Other Diseases of Respiratory Organs 4 ... ... 1 ... 2 1 2 1 1 ... ... Alcoholism 8 ... ... ... ... 8 ... 4 2 2 ... ... Cirrhosis of Liver 22 ... ... ... 1 17 4 3 7 12 ... ... Venereal Diseases 1 1 ... ... ... ... ... 1 ... ... ... ... Premature Birth 65 65 ... ... ... ... ... 20 17 28 ... 9 Diseases and Accdients of Parturition 2 ... ... ... ... 2 ... ... 2 ... ... ... Heart Disease 136 2 1 7 10 65 51 50 44 37 5 3 Other Diseases of Circulatory System 85 2 ... 1 3 42 37 24 23 36 2 2 Accidents 49 2 8 7 1 16 15 20 11 18 ... ... Suicides 12 ... ... ... ... 11 1 6 3 3 ... ... Renal Diseases ... ... ... ... ... ... ... ... ... ... ... ... Nervous and Cerebral Diseases 35 1 ... 2 ... 20 11 6 13 15 1 2 Senility 112 ... ... ... ... 1 111 28 32 49 3 2 Overlain in Bed 29 29 ... ... ... ... ... 11 7 11 ... ... Convulsions 39 26 13 ... ... ... ... 12 8 18 1 1 Developmental Disease 41 32 9 ... ... ... ... 19 10 12 ... 7 Diseases of Stomach 16 4 1 1 3 5 2 5 6 5 ... ... Inflammation and Softening of Brain 6 1 ... 2 ... 1 2 4 2 ... ... ... Meningitis 25 8 10 5 ... 2 ... 9 8 8 ... ... Nephritis and Bright's Disease 38 ... ... 1 ... 25 12 17 8 12 1 ... Intestinal Obstruction 13 3 1 1 ... 7 1 4 3 6 ... 1 Tumours and other Diseases of the Female Organs 6 ... ... ... 1 4 1 4 ... 2 ... ... Murder i 1 ... ... ... ... ... ... ... 1 ... ... Marasmus 37 35 2 ... ... ... ... 12 8 13 4 ... All other causes 74 17 3 3 5 34 12 21 22 31 ... 4 All causes 1855 429 245 60 70 615 436 629 481 705 40 38 223 TABLE V. Borough of Finsbury. Infantile Mortality during the Year, 1905. Deaths from stated Causes in Weeks and Months under One Year of Age. cause of death. Under 1 Week 1-2 Weeks 9-T Weeks 3-4 Weeks Total under 1 Month 1-2 Months 2-3 Months 3-4 Months 4-5 Months 4-6 Months 6-7 Months 7-8 Months 8-9 Months 9-10 Months 10-11 Months 11-12 Months Total Deaths under 1 Year Common Infectious Diseases— Small-pox — — - - - - - - - - - - - - - - Chicken-pox — — — — - - - - - - - - 1 - - - 1 Measles — — — — - - - - 2 - - - 1 1 - 1 5 Scarlet Fever — — - — - - - - - - - - - - - - 2 Diphtera: Croup - - - - - - - - - - - - 2 - - - 2 Whooping Cough — — — — — — 2 2 2 1 1 1 2 2 2 1 16 Diarrhœal Diseases— Diarrhœa, all forms — 2 2 3 7 6 9 8 10 6 8 9 4 6 4 1 78 Enteritis (not tuberculous) - - - - - - - - - - - - - - - - - Gastritis, Gastro-intestinal Catarrh — - 1 — 1 - - — - - - - 1 - - 1 3 Wasting Diseases— Premature Birth 48 5 2 1 56 4 4 1 - - - - - - - - 65 Congential Defects 8 2 1 2 13 2 - - - - 1 - 1 - - - 17 Injury at Birth 1 - - — 1 — - - - - - - - - - - 1 Want of Breast-milk - - - — — — — — — — — — — — — — - 224 CAUSE OF DEATH. Under 1 Week 1-2 Weeks 2-3 Weeks 3-4 Weeks Total under 1 Month 1-2 Months 2-3 Months 3-4 Months 4-5 Months 4-6 Months 6-7 Months 7-8 Months 8-9 Months 9-10 Months 10-11 Months 11-12 Months Total Deaths under 1 Year Atrophy, Debility, Marasmus 4 4 5 4 17 6 8 7 2 4 — 2 4 - 2 - 52 Tuberculous Diseases— Tuberculous Meningitis - - - - - - - - 1 1 2 - 1 1 — - 6 Tuberculous Peritonitis: Tabes Mesenterica - - - - - - - - 1 - 1 - - - - - 2 Other Tuberculous Diseases - - - - - - - - - 1 - 1 4 1 — — 7 Erysipelas - - - - - - - - - - - - - - - - - Syphilis — 1 1 — 2 4 1 — 1 — — — — — — - 8 Rickets — — — — — — — — — — — — - - - - - Meningitis (not Tuberculous) - — — - 1 — 2 1 1 1 — — — 2 1 9 Convulsions 8 — 1 — 9 2 5 — 5 3 1 - 3 - 2 2 32 Bronchitis 1 1 1 2 5 6 4 5 1 1 4 1 2 4 3 1 37 Laryngitis — — — — — — — — — — - - - - - - - Pneumonia — — 1 — 1 — 4 3 - 5 3 3 6 3 4 7 39 Suffocation, overlaying — — 4 — 4 9 5 3 5 - 2 1 - - - 1 30 Other Causes 2 2 3 1 8 1 - 1 1 1 - 1 1 1 - 2 17 All Causes (Certified) 72 17 22 13 124 41 42 32 32 24 24 19 33 19 21 18 429 Population, estimated to middle of 1905, 98,207. Deaths from al Causes at all Ages, 1,855. Births in the year: Legitimate, 3,370; Illegitimate, 28; Total, 3,398. 225 VACCINATION RETURNS. Total Retuhx for 1903. Return made on or before 8th February, 1905, by Mr. T. J. Garstang, Vaccination Officer of the Holborn Union, respecting the Vaccination of Children whose Births were registered in the Finsbury District, from 1st January to 31st December, 1903, inclusive. (Return made to the Board of Guardians.) Registration Sub-Districts comprised in the Vaccination Officer's District Number of Births returned in the "Birth List Sheets" us registered from 1st January to 31st Dec., 1903 Number of these Births duly entered by 31st January, 1905, in Columns I. II, IV and v of the "Vaccinution Register" (Birth List Sheets), viz.: Number of these Births which on 31st January, 1905. remained unentered in the "Vaccination Register'' on account (as shown by Report Hook) of:— Number of these Births remaining on 31st January, 1965, neither duly entered in the" Vaccination Register" (columns 3, 4, 5, 6, and 7 of this Return) nor temporarily accounted for in the "Report Book" (columns 8, 9, and 10 of this Return) Total Number of Certificates of Successful Primary Vaccination at ALL Ages received during each of the calendar years 1903 and 1904 Col I Successfully Vaccinated Col II Col IV Number in respect of whom Certificates of Conscientious Objection have been received Col v Dead, Un vaccinated Postponement hv Medical Certificate Removal to Districts, the Vaccination Officer of which has been duly apprise. Removal to 1'laces unknown, or which cannot be reached: and Cases not having been found Insusceptible of Vaccination Had Small Pox 1903 1904 1 2 3 4 5 6 7 8 9 10 1 1 12 13 1. Finsbury, St. Luke 1700 1041 2 0 1 205 8 365 77 1 1329 1229 2. Clerkenwell, North 1066 764 1 0 9 104 5 112 70 1 948 870 3. Clerkenwell, South 899 694 2 0 2 77 1 90 32 1 872 691 Total 3665 2499 5 0 12 386 14 567 179 3 3149 2790 Dated 3rd February, 1905. Signal, THOMAS .J. GARSTANG, Vaccination Officer. 226 VACCINATION RETURNS. Return for the Period January—June, 1904. Return to be made on or before 8th of February, 1905, by Mr. T. J. Garstang, Vaccination Officer of the Holborn Union, respecting the Vaccination of Children whose Births were registered in the Finsbury District, from 1st January to 30th June, 1904, inclusive. (Return made to the Board of Guurdians.) Registration Sub-Districts comprised in the Vaccination Officer's District Number of Births returned in the "Birth List Sheets" ns registered from 1st January to 30th June, 1904 Number of these Births duly entered by 31st January, 1905, in Columns 1, II, IV and V of the "Vaccination Register" (Birth List Sheets), viz.: Number of these Births which on 31st January, 1905, remained unentered in the "Vaccination Register" on account (as shown by Report Book) of:- Number of these Births remaining on 31st January, 1906, neither duly entered in the "Vaccination Register'' (columns 3, 4, 5, 6, and 7 of this Return) nor ternporarily accounted for in the "Report Book" (columns 8, 9, and 10 of this Return) Number of Certificates of Conscientious Objection actually received by the Vaccination Officer, irrespective of the dates of birth of the Children to which they relate, during the year 1904. Col I Successfully Vaccinated Col II Col IV Number in respect of whom Certificates of Conscientious Objection have been received Col V Dead, Unvaccinated Postponement by Medical Certificate Removal to Districts, the Vaccination Officer of which has been dulv apprised Removal to Places unknown, or which cannot be reached; and Cases not having been found Insusceptible of Vaccination Had Small Pox 1 2 3 4 5 6 7 8 9 10 1 1 1 2 1. Finsbury 828 483 1 0 3 98 15 154 54 20 8 2. Clerkenwell, North 560 379 1 0 3 61 5 63 42 6 4 3. Clerkenwell, South 421 305 1 0 1 37 10 40 22 5 4 Total 1809 1167 3 0 7 196 30 257 118 31 16 Dated 3rd February, 1905. Signed, THOMAS J. GARSTANG, Vaccination Officer. 227 VACCINATION RETURNS Total Return for 1904. Return made on or before 8th February, 1906, by Mr. T. J. Garstaug, Vaccination Officer of the Holborn Union, respecting the Vaccination of Children whose Births were registered in the Finsbury District, from 1st Jani ary to 31st December, 1904, inclusive. (Return made to the Board of Guardians.) Registration Sub-Districts comprised in the Vaccination Officer's District Number of Births returned in the "Birth List Sheets" as registered from 1st January to 31st Dec., 1904 Number of these Births duly entered by 31st January, 1906, in Columns I. II, IV and V of the "Vaccination Register" (Birth List Sheets), viz: Number of these Births which on 31st January, 1906. remained unentered in the "Vaccination Hegister" on account (as shown by Report Book) of:— Number of these Births remaining on 31st January, 1906, neither duiy entered in the "Vaccination Register" (columns 3, 4, 5, 6, and 7 of this Return) nor temporarily accounted for in the "Report Book" (columns 8, 9, and 10 of this Return) Total Number of Certificates of Successful Primary Vaccination at ALL AGES received during the calendar year 1905 Col 1 Successfully Vaccinated Col II Col IV Number in respect of whom Certificates of Conscientious Objection have been received Col V Dead. Unvaccinated Postponement by Medical Certificate Removal to Districts, the Vaccination Officer of which has been duly apprised Removal to Places unknown, or which cannot be reached; and Cases not having been found Insusceptible of Vaccination Had Small Pox 1 2 3 4 5 6 7 8 0 1 0 1 1 12 1. Finsbury, St. Luke 1668 1040 1 0 8 204 17 331 67 0 1254 2. Clerkenwell, North 1084 746 1 0 6 112 9 151 58 1 812 3. Clerkenwell, South 822 643 1 0 2 73 2 70 31 0 718 Total 3574 2429 3 0 16 389 28 552 156 1 2784 Dated 2nd February, 1906. Signed, THOMAS J. GARSTANG, Vaccination Officer. 228 VACCINATION RETURNS. Return for the Period January—June, 1905. Return to be made on or before 8th of February, 1906, by Mr. T. .J. Garstang, Vaccination Officer of the Holborn Union, respecting the Vaccination of Children whose Births were registered in the Finsbury District, from 1st January to 30th June, 1905, inclusive. (Return made to the Board of Guardians.) Registration Sub-Districts comprised in the Vaccination Officer's District Number of Births returned in the "Birth List Sheets" as registered from 1st January to 30th June, 1905 Number of these Births duly entered Insist January, 1906. in Columns I, 11, IV and V of the "Vaccination Register" (Birth List Sheets), viz: Number of these Births which on 31st January. 1906. remained unentered in the •• Vaccination Hegister" on account (as shown by Report Book; of Number of these Births remaining on 31st January, 1906, neither duly enu red in the "Vaccination Register" (columns 3, 4, it. 6, and 7 of this Return) nor temporarily accounted for in the "Report Book" (columns 8, 9, and 10 of this Return) Number of Certificates of Conscientious Objection actually received by the Vaccination Officer, irrespective of the dates of birth of the Children to wh ch they relate, during the year 1905. Col 1 Successfully Vaccinated Col II Col IV Number in respect of whom Certificates of Conscientious Objection have been received Col V Dead Un vaccinated Postponement by Medical Certificate Removal to Districts, the Vaccination Officer of which lias been duly apprised Removal to Places unknown. or which cannot be reached; and Cases not having been found Insusceptible of Vaccination Had Small Pox 1 2 3 4 5 6 7 8 9 10 11 12 1. Finsbury 787 493 0 0 2 80 12 126 58 16 4 2. Clerkenwell, North 497 346 0 0 4 45 10 52 32 8 9 3. Clerkenwell, South 415 316 2 0 3 37 11 26 15 5 7 Total 1699 1155 2 0 9 162 33 204 105 29 20 Dated 2nd February, 1906. Signed, THOMAS J. GARSTANG, Vaccination Officer. SUMMARY AND CONCLUSIONS. 231 SUMMARY AND CONCLUSIONS. It may be desirable again to summarise briefly the plain and outstanding characteristics of I lie public health of Finsbury which emerge from the large body of facts contained in the foregoing Report, in order to take, so to speak, a birds-eye view. Particularly may this be useful to those who find it difficult to read such a Report as this and assimilate its facts and figures. And, in the first place, reference may be made to the chief items in the vital statistics. The population is declining. In 1861 it was 129,031. Five years ago, at t.lie census, it was 101,463. Now it is estimated at 98,207. The birth rate too is declining. In 1901 it was 32 per 1,000 of the population. In 1905 it had fallen to 291. The Report contains a number of particulars (pp. 13-15) respecting the home conditions of many of these young children. The corrected death rate for the year was the lowest on record, namely, 19.5 per 1,000 persons living (p. 18), which compares favourably with the Borough death rate of last year (22.0), the highest in London. The death rate for the whole of London in 1905 was 15.6 per 1,000, so that Finsbury is still much above the Metropolitan average. Out of the total number of deaths in the Borough (1,900), 886, or 46 per cent., that is nearly half the total number, occurred in hospitals, workhouses, infirmaries, asylums, etc. (p. 19). The following table of comparative returns sets out these figures :— Institutions in which deaths took place. Percentage of Finsbury deaths, 1905. Percentage of Finsbury deaths, 1904. Percentage of deaths in all London, 1004. 1. Workhouses and Workhouse Infirmaries 28.4 26.8 18.1 2. Fever Hospitals (Met. Asyl. Board) 1.5 1.5 1.4 3. Other Hospitals 14.8 14.7 12.7 232 Thus it appears that about one in every two deaths in Finsbury in 1905, occurred in institutions and not in the homes of the persons dying ; one in every four deaths occurred in work houses or workhouse infirmaries ; and one in every six in hospitals. As in 1903 and 1904 the death rates from all causes and for certain diseases were highest in one-roomed tenements and lowest in houses of four rooms or upwards (p. 31). Indeed, death appears to have been at least four times more frequent in homes of one room than in homes of four or more rooms. This is significant, and confirmed each year, but the fact is of relative importance only and must be accepted with reservation, for the reason stated on p. 30. Nearly one quarter of the total deaths, or 429, occurred in children under twelve months of age, which yields an infant mortality rate of 148.6. Nearly one half of these infant deaths occurred in the first three months of the twelve months, and one third of the total occurred in the first month of life. As many as 08 died in the first week. Further, it must be added that most of these infant deaths were caused by conditions which are more or less directly preventable. In the Report will be found a number of particulars as to these causes and conditions (p. 21.28). Generally, it may be said that infant mortality in the first weeks of life is due in large measure to the physical conditions of the mother, leading to prematurity and debility of the infant; and in the later months of the first year infant mortality appears to be due largely to unsatisfactory feeding of the infant. But from either point of view it becomes clear that the problem of infant mortality is not one of sanitation alone, or housing, or indeed of poverty as such, but is mainly a question of motherhood. No doubt external conditions as those named are influencing maternity, but they are, in the main, affecting the mother, and not the child. They exert their influence upon the infant indirectly through the mother. Improved sanitation, bettor housing, cheap and good food, domestic education, a healthy life of body and mind—these are the conditions which lead to efficient motherhood from the point of view of child-bearing. They exert but an indirect effect on the child itself, who depends for its life in the first twelve months, not upon the State or the 233 municipality, nor vet upon this or that system of creche or milkfeeding, but upon the health, the intelligence, the devotion and maternal instinct of the mother. And if we would solve the great problem of infant mortality, it would appear that we must first obtain a higher standard of physical motherhood. Further, 1 am bound to add, that if it be true that part of the decline in the birthrate is due, as alleged, to the artificial prevention of birth, it is probable that those same injurious influences are responsible for some of the increase in the deaths of infants from prematurity and allied conditions. The chief infectious diseases caused 230 deaths, and consumption caused another 215. Sixty-five deaths were directly attributed to cancer and 30 to alcoholism. Turning to cases of infectious sickness certified to the Public Health Department, there were during 1905, 745 cases of notifiable infectious disease, 501 cases of measles and 178 cases of phthisis. The total number of cases of disease certified was therefore 1,424, as compared with 1,818 in 1904. With the exception of a small outbreak of scarlet fever in "Model Dwellings" in the Eastern Division of the Borough, there was no epidemic of any disease during the year, and our zymotic diseases were much below the average hitherto experienced. CONDITIONS OF LIFE IN FINSBURY. When we come to consider what are the conditions of life of which these 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. (1) 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. The Borough suffers from all the disadvantages of Central London. (2) 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 234 Finsbury. Seventy-seven per cent, of tlie 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 204 blocks of "model dwellings" containing 4,063 tenements and accommodating 17,300 persons. These figures taken as a whole indicate conditions of what is really overcrowding. Broadly, it may be said that nearly all homes of one room anil 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, in actual experience, "overcrowded " conditions. (3) 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 large number of houses which do not provide satisfactory accommodation for a healthy life. There lias 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 sanitary conveniences, the water supply, the cooking arrangements, the washing accommodation, the provision for refuse collection, ventilation, light, &e., 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 235 tenements, insufficient cooking apparatus, and general domestic insanitation. The above conditions are concerned broadly with housing accommodation and town life which obviously exerts primary influence upon health. But there are other matters also which directly affect the physical life of the people. (4) 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; (6) 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, resident in the Borough, 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," frequently alternating with unemployment. A somewhat exceptional proportion of the occupation in which women and girls in Finsbury are engaged (wearing apparel, book-binding, linenironers, &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. Tt should not be forgotten that the occupied population of the Borough is more than doubled, and perhaps trebled, during the day. (5) There are also certain conditions arising from the habits and customs of the people, which, on the whole, are exerting an unfavourable influence. Two such conditions may be mentioned as illustrations, namely, thriftlessness and alcoholism. The former reveals itself not only in a failure to save but much more in a failure to expend wisely and to the best advantage; the latter is I am informed, prevalent among women. It appears that a good many women habitually pawn their belongings on Monday, spend part of the money so obtained in the public-house, and redeem the articles pledged on Saturday, thus incurring an unnecessary expenditure for interest, as well as spending hard-earned money 236 unwisely. This pernicious system prevails to such an extent that not a few seem to practise it from week to week throughout the year, and unite in one habit both thriftlessness and alcoholism. Such conditions result in a two-fold effect, namely, money is wasted which should be spent on better food and clothing—which are among the greatest needs of many women and girls working in Finsbury—and an excess of alcohol-drinking brings its own quota of disease. (6) Then, lastly, there is Poverty. Absolute poverty is a difficult, if not impossible, tiling accurately to measure. Relative poverty, on the other hand, is so evident in Finsbury that it needs no measurement to emphasise its existence. Poverty, of course, means limited house accommodation and poor or unsuitable or insufficient food, and, indirectly, it leads to uncleanliness and the strain of continual effort in the struggle for existence. Many of the lifehistories which we have obtained of dead or sickly infants, reveal the acuteness of these conditions in many homes in Finsbury. It lias been known for a long time that poor districts have (a) a higher death rate, (6) a higher infant mortality, and (c) a lower physical standard than districts more favourably 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 arising from poverty, the stress of life, ignorance, and most of all perhaps, from a lower standard of constitution. Not that poverty necessitates a low standard of constitution—for there are thousands of poor homes which, happily, make such a conclusion impossible—but that the conditions which follow in the train of poverty tend more frequently than otherwise to surround people with an unsatisfactory environment, from which they cannot escape, and which, combined with lack of knowledge, exerts an injurious influence on their physical life. What effect these conditions have upon their moral well-being it is not within my province to discuss, though, in my opinion, there is a definite and intimate relation between morality and public and personal health. 237 I do not tliink it can be doubted tliat lack of knowledge, and in some cases poverty and the stress of life, lead to that mismanagement of child-bearing and of the first months of life which is revealed in the Report, and which is the source of so much suffering and death. 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 of well-qualified health visitors in the homes of the people, and the creation of a "health conscience." Any influence, also, which tends to counteract thriftlessness, alcoholism, and immorality is an influence in favour of health, ami 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, or should be contributing, to the betterment of life and health in Finsbury. THE WORK OF THE SANITARY AUTHORITY. Finally, it may fairly be asked, what is the Borough Council as the Sanitary Authority doing through its Public Health Committee to ameliorate the conditions of physical life in the Borough? The answer to this question may be summarised, for the details will be found in the pages of the Report. («) Measures of Preventive Medicine. Notification, isolation to Hospital, and investigation of channels ol infection (pp. 3.3-74.) Disinfection of premises (pp. 193-195), and vaccination (pp. 225-228); 610 infections cases have been removed to Hospital, 1,144 homes and 9,000 articles have been disinfected, and 1,000 investigations into infectious disease have been made. (6) Protection of Food and the maintenance of a high standard of quality and of purity (pp. 77-107); 94 tons of bad food have been confiscated and destroyed, 624 samples of food have been analysed, and 274 restaurants have been periodically inspected. 238 Under this heading may be mentioned the establishment by the Social Workers' Association of an Infant Miik Depot (pp. 107-116), which proved a most successful experiment in the reduction of infant mortality among children using the milk. (c) Housing Accommodation, and particularly the maintenance of sanitation in the dwelling-houses now existing (pp. 119-149); 33 insanitary houses have been closed by the Borough Council, and 35 more by the County Council, nearly 1,000 tenement houses have been cleansed, and 2,250 dwelling-houses have been systematically inspected. (d) The Sanitation of Factories, Workshops and Workplaces in which an industrial population spends such a large part of its life (pp. 153-171); 3,670 visits of inspection have been paid to factories and workshops, and in 1,008 of them insanitary defects have been remedied; more than 700 visits have been paid to 359 home-workers. (e) The Protection of Child-life from injurious conditions in the school and in the home (pp. 14-17, 23-28 and 181-191); upwards of 4,000 visits have been made to homes in the investigation of disease and death of children. (f) General Sanitation, including the reduction of smoke nuisances, improvement of drainage and paving of yards, street cleansing and removal of dust (under the Cleansing Department). Much of the work involved under this heading is tabulated on pp. 200 and 203, from which it will be seem that upwards of 35,000 sanitary visits have been paid during the year, in addition to those to which reference has been made. The figures in this summary represent a large amount of work, and as that work has been carried out by trained workers it ought to result, in time, in an improvement in the public health. No doubt progress is taking place, and it is certain that much disease and death is now prevented. And yet—hundreds of persons die every year in Finsbury from preventable disease, thousands more suffer, and life is more limited than it need be. The fact is that although the State, acting through the Local Authority, may do very much and every year is doing more, it cannot do everything. Personal hygiene, eating and drinking, moderation, cleanliness, 239 the ways and habits of life, the inter-relation of work, repose and recreation for mind and body, the charge of infancy—these are matters of individual concern and of individual knowledge and education, for which the State, as such, can do little or nothing. Yet these counsels for personal self-government, enforced from age to age by the ever-growing common experience of mankind, are of vital importance to the health of a community, and must on 110 account be deemed superfluous because Sanitary Authorities have been established and public health law is administered by boards of local government. It is idle to expect good results from the latter, if personal hygiene and the duties and rights of the individual be ignored. If it be true that the Empire depends upon the homes of the people, it is also true to say that homelife depends upon the well-being and health of individuals. For the individual is the unit of the home as the home is the unit of the State.