FiN 6 THE METROPOLITAN BOROUGH OF FINSBURY. REPORT on the PUBLIC HEALTH OF FINSBURY 1907. Including Annual Report on Factories and Workshops. BY GEORGE NEWMAN, M.D., Medical Officcr of Health of the Metropolitan Borough of Finsbury {1907). London : Printed by Prince & Baugh, Ltd., 14, College Hill, Cannon St., E.C. 1908. Public Health Committee, 1907=8. Chairman : Councillor L. Phillips. Vice-Chairman : Councillor O. M. Richards. His Worship the Mayor (Councillor the Rev. Prebendary G. H. Perry, m.a., j.p.). Aldermen E. H. Tripp and T. Wildbore. Councillor W. F. Abrahams. Councillor C. J. Born. Councillor W. R. Corke. Councillor W. T. Page, m.r.c.s., l.r.c.p. Councillor J. J. A. Sherry, l.r.c.p., l.r.c.s. Councillor Rev. G. Smith. Councillor W. Smith. Councillor G. Standring. Public Health Department Staff. Chief Sanitary Inspector: William Green. Sanitary Inspectors : George E. J. Davis.*† Charles M. Longden.*† Ernest A. Norman.*† William S. Matson.* † William H. Draper.*† Albert A. Jackson.§ 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. Alexander M. Paterson. Percy Ogilvie. Disinfectcrs 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, W.C. Medical Officer of Health : George Newman, M.D., F.R.S.F.din., D.P.H.Camb. (resigned.) Charles Porter, M.D., B.Sc. (1908). § Certificate of Sanitary Inspectors Examination Board. * Certificate of Royal Sanitary Institute. †Meat and other Foods Certificate of Royal Sanitary Institute. ‡ Certificate of Central Midwives Board. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Finsbury. His Worship the Mayor : Councillor ihe Rev. Prebendary G. H. Perry, M.A., J.P. Gentlemen, I have the honour to submit herewith the Annual Report on the Public Health and Sanitary conditions of the Borough of Finsbury for the year 1907. 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. In response to the wish of the Council for a shorter Report than that of last year, I have greatly curtailed certain sections and also the Report generally, so that it is not so full as usual on that account. I may remind the Council that during the last fortnight of December, 1907, Dr. Charles Porter succeeded me as Medical Officer of Health. I desire to take this last opportunity of expressing my grateful appreciation of the support and assistance I have received from the Chairman and Members of the Public Health Committee of the Council during the year. I should like also very heartily to acknowledge the admirable work and loyal co-operation of the staff of the Department, not only during the year 1907 but during the whole time I have had the honour of serving the Council as their Medical Officer of Health. The results set out in the following Report do them the greatest credit, and should prove to them the highest incentive and encouragement. I am, Gentlemen, Your obedient Servant, GEORGE NEWMAN, Medical Officer of Health [1907). Public Health Department, Town Hall, Rosebery Avenue, E.C. 4th February, 1908, TABLE OF CONTENTS. A—VITAL STATISTICS. Page Population 7 Births 8 ,, Investigations into 9 Deaths 13 ,, in Public Institutions 14 ,, in Finsbury Districts 15 ,, according to age 16 „ from Senility 16 ,, of Infants 17 ,, in relation to Disease 17 from Infectious Diseases 18 ,, in relation to Tenements 19 Infant Mortality in Finsbury 21 ,, ,, Means of Prevention 30 Finsbury Infants' Milk Depot 30 Use of Modified Dried Milk 36 School for Mothers 40 B—RECORDS OF DISEASE. Notification of Infectious Disease 42 Small Pox 44 Diphtheria 45 Scarlet Fever 46 Enteric Fever 49 Discharge Notices 49 Puerperal Fever 50 Cerebro-Spinal Fever 51 Whooping Cough 53 Measles 54 Epidemic Diarrhoea 57 Phthisis 59 ,, Voluntary Notification of 59 ,, Deaths 60 Other Forms of Tuberculosis 63 Cancer 64 Alcoholism 65 C— FOOD SUPPLY. Meat Supply 67 ,, Prosecutions 69 Certification of Meat Products 70 Meat Confiscated 71 Diseased Sausage Casings 72 Slaughter-houses 72 Milk Supply 73 FOOD SUPPLY—continued. Page Report of Royal Commission on Tuberculosis 80 Examination of Milk Samples in Finsbury for Tuberculosis, &c 82 Sale of Food & Drugs Acts 90 Margarine 92 Restaurants, Food Stalls, Icecream, &c 92 D—THE HOUSING QUESTION Houses Let in Lodgings 98 House to House Inspection 99 Model Dwellings 101 Common Lodging Houses 101 Underground Rooms 102 Stable Dwellings 102 Customs and Inland Revenue Acts 103 E—FACTORIES AND WORKSHOPS. Introduction 104 Sanitation in Workshops 109 Bakehouses 113 Home Work 113 Outworkers' Lists 116 Inspection and Registration 121 Legal Proceedings 124 Special Enquiries 124 F—SANITARY ADMINISTRATION, &c. The Canal and Car.al Boats 126 Elementary Schools 129 Black Smoke Nuisances 136 Cleansing of Persons Act 137 Disinfection 137 Mortuaries 140 Reception Houses 141 Drainage Plans 141 Removal of Dust 141 Sanitary Inspection 142 Legal Proceedings 146 General Tables 149 Tables I., II., III., IV. and V. 159 Pauperism in Finsbury 163 Vaccination Returns 166 7 A. -VITAL STATISTICS. The Metropolitan Borough of Finsbury was created in November, 1900, under the London Local Government Act, 1899. It was formed by amalgamation of the following; constituent parts, namely :—The Parish of the Vestry of Clerkenwell, the Parish of the Vestry of St. Luke, Middlesex, the Liberty of Glasshouse Yard, the Liberty of the Charterhouse, and the Parish of St. Sepulchre Without. The population of the Borough is estimated at 96,732, and there are 8,500 inhabited houses. The area is 589 acres. The gross assessable value is £1,284,409, and the rateable value 1,037,302 7s. 6d. The Borough is bounded on the north by the Boroughs of Islington and Shoreditch; on the east by the Borough of Shoreditch; on the south by the City of London ; and on the west by the Boroughs of Holborn and St. Pancras. POPULATION.—The estimated population to the middle of 1907 in the Borough of Finsbury was 96,732, comprised as follows :— North Clerkenwell 33.395 South Clerkenwell 27,340 Finsbury (St. Luke) 34.431 St. Sepulchre 1,566 96,732 The sub-registration district of Glasshouse Yard (pop. 740) is now incorporated in the sub-registration district of Finsbury, making Finsbury (St. Luke) 34,431. 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. 8 The numbers of the population, of each sex, and at various ages at the census of 1901, were as follows:-— Totals at all ages. Under 5. 5-14. 15-13. 20-54. 55-75. Above 75. Males 49,910 6-58 10,371 5,l82 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 lunsbury (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. BIRTHS.—The total number of births registered in the district during 1907 was 3,361, as follows :— Sub-registration District. Total Births. Rate per 1,000 of the Population in 1907. North Clerkenwell 1,000 29.9 South Clerkenwell 756 27' 6 Finsbury (St. Luke) 1,581 45'9 St. Sepulchre 24 15'3 The Borough 3.361 34'7 9 The birth-rate for London was 25.6. Of the 3,361 births in Finsbury, 656 took place in the City of London Lying-in Hospital, and of this number only 100 righty belonged to the Borough, and, therefore, 556 must be subtracted. There were also 61 births that took place in the City Road Workhouse, and 18 were notified from other Boroughs, which must, therefore, be added. Consequently, after correction, the total number of births belonging to the Borough was not 3,361, but 2,884, which gives a birth-rate of 29.8 per 1,000 of the population. Of the 3,361 births registered, 1,687 were boys and 1,674 were girls. The birth-rates of Finsbury, based on Registrars' returns (in sub-registration districts), since the Borough was formed, have been as follows :— The Borough. * North Clerkenwell. South Clerkenwell. Finsbury. St Sepulchre. Corrected Birth Rates for the Borough. 1901 37.3 30.2 309 50.8 20.1 32.0 1902 36.0 30.1 30.4 45.6 23.1 31.7 1903 36.4 30.5 30.9 47.3 20.3 31.4 1904 36.4 31.5 29.7 47.1 20.5 31.3 1905 34.6 29.1 29.0 45.3 13.2 29.4 1906 35.5 30.7 30.0 45.1 24.7 30.9 1907 34.7 29.9 27.6 45.9 I5.3 29.8 * 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, after deduction of births not rightly belonging to Finsbury, is shown in the last column of the Table. It will be remembered that, at the beginning of 1905, arrangements were made by which the local Registrars should 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. We have also received weekly lists of 10 births from the London County Council, supplied by the midwives. Out of the 2.884 births we have collected a number of particulars respecting 1,392 infants, and it may be well briefly to refer to the data obtained. (a) Age at Registration—By the Births and Deaths Registration Act of 1874 (s. I), registration is required within 42 days of the birth. In practice it has been found that about two-thirds of the total births in England and Wales are registered within the six weeks' limit of the Act. In Scotland, by an Act of 1854, the period allowed for registration is 21 days, that is, three weeks in place of six weeks. The French Code (Civil Art. 55) provides for registration within three days of birth, and the new Notification of Births Act, 1907, which has been adopted in the Borough, reduces the period to 36 hours. This, however, is not a registration. When it is remembered that about one-third of the total deaths of infants takes place in the first month of life, it will be evident that many births first come to the knowledge of the Sanitary Authority on the bills of mortality, which, of course, effectually precludes any preventive action whatever. In Finsbury we find that between 50 and 60 per cent, of the births are registered within the appointed time and by the new Act it is hoped to secure earlier information in the future at least of the majority of births. (,b) Condition of the Home—Out of the 1,392 births under consideration, 1,017 were born in homes of two rooms or less. Taking, however, the total of all the homes, it was found that only 8.3 per cent, could be described as distinctly unclean and badly kept, and in as many as 53.9 per cent, of the total it could be said that the home was clean and well kept. (c) Condition of Child.—Few things are more remarkable in relation to this subject than the apparent physical vigour and equipment of infants at the time of birth, and this applies even to the children of the very poor. There appears to be a mean physical standard which is the inheritance of the people as a whole, and the tendency of the race is to maintain this inherited mean, 11 Thus it comes about that generally speaking about 80 per cent, of new-born infants reach a mean physical standard in spite of ill-environment, poverty, or poor physique of mother. In Finsbury, as a result of enquiry, 69 per cent, were found to be born healthy. (d) occupation of Mother during Pregnancy.—Another somewhat remarkable feature is that in 1,027 cases, or 73.5 per cent, of the total, the mother had no occupation except her home affairs; in 113 instances the mother had some home work of an industrial character; in 165 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 87 cases, or 6.2 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 and her absence from home, iboth during pregnancy and after the birth of the child, is one of the factors most directly affecting the health of the child. But 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 was also found that only 13.5 per cent, of the mothers of these 1,392 living children suffered from poor physique or ill-health. Subsequently we shall see that 38 per cent, of the mothers of dead infants suffer from marked ill-health. (e) Method of Feeding'. —One of the most interesting facts learned from this work has relation to the feeding of these children. As many as 1,123 of the total, or 80 per cent., were wholly breast-fed. Only 7.1 per cent, were fed wholly on cows' milk, and 2.4 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 almost 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 12 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 by far the most healthy for the child. Some of the principal facts concerning these visits may he tabulated as follows :— BIRTHS 1907. Method of Feeding. Condition of Child. Mother'8 Work. Total Number, Breast only. Breast, etc Cows Milk. Artificial and Condensed. Not Fed.* WeU Nourished. Fairly Nourished. Badly Nourished. None. Away from Home. Ditto Intermittent ‡ Some Home Work. 1392 1123 I 18 IOO 32 19 959 279 154 !0?7 87 165 t"3 °l ! O 806 8-4 7'I 2'4 1 '4 68y 2oO 110 73*8 62 11 8 81 * These were 19 infants who died within a few hours of birth, ‡ This figure includes work of Mothers for a few months of pregnancy, also intermittent work. Mother's Health. Condition of Tenement. No. of Rooms. Total Number. | Good. 11 different. Bad. Clean. Fairly Cleau. Dirty. One. Two. Three. Four or more. First Born. I.192 1104 252 36 75' 527 114 349 66S 280 95 225 01 0 793 io-9 2*6 54'0 37'8 8-2 25-0 4S0 20" I 6'8 160 13 DEATHS.—The total number of deaths registered in the district was 1,823, but as 49 these deaths were of persons who died in, but resided outside, the Borough, that number has been deducted, leaving a total of 1,774. This total includes 911 deaths of Finsbury persons who died in various institutions outside the district. The crude death rate is, therefore, 18.3 per 1,000 of the population, as against 20.7 last year. The death rate for the whole of London in 1907 was 14.6 per 1,000 living as compared with 15.0 in 1906. The intra-parochial death rate, that is, the death rate calculated on the number of persons who actually died inside the Borough, is 8.9, as compared with 10.6 in 1906. 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 :— 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 1906 20.7 22.7 18.6 20.3 24.7 1907 18.3 7.5 16.4 20.3 249 These death rates arc "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 cognisance 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 14 amongst adults, and also higher among males than females. Therefore it is evident that a district containing many young children and old people would have a higher death rate than a district composed more largely of young adults and females. It is this characteristic which makes "correction "necessary. The Registrar-General, in his annual summary, gives the "factor for correction for sex and age distribution "in the seventy-six great towns 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 1.0355, and the true or "corrected" death rate for this Borough, which allows for the mortality of each sex at different age periods, is 18.9 per 1,000 living. This compares favourably with the corrected death rates since the Borough was formed. It is probably the lowest corrected death rate yet recorded in this district of London. The following is a list of the outlying institutions and other places where 911 of the residents of the Borough died during the year 1907 :— I. General Hospitals. IV. Poor Law Institutions. St. Bartholomew's 155 Holborn Infirmary 287 Royal Free 37 Holborn Workhouse, King's College 4 City Road 175 Middlesex 9 Holborn Workhouse, University 6 Mitcham 44 Other Hospitals 10 Other Poor Law Institutions 19 II. Special Hospitals. 221 V. Asylums. 525 Great Ormond Street Caterham 3 (Children's) 26 Banstead 6 Homoeopathic 4 Dartford 3 Royal Chest 16 Colney Hatch 6 Other Hospitals 38 Claybury 4 84 Other Asylums 17 III. Fever Hospitals. 39 North Eastern 3 VI. Unclassi fiable 26 North Western 12 London Fever 1 Total 911 16 15 The following Table shows the figures relating to deaths in outside institutions, etc., for the last seven years:— Total Deaths. Deaths in Public Institutions. &c., outside District belonging to Finsbury. Percentage. 1901 2,160 876 40.5 1902 2,283 908 39.8 19 1,993 870 43.6 1904 2,084 965 46.3 1905 1,855 886 67.8 1906 2,020 1,020 50.5 1907 1,774 911 51.3 As regards their distribution, therefore, all the deaths belonging to Finsbury may be summarised briefly as follows :— Intra Parochial North Clerkenwell 313 = 863 South Clerkenwell 214 Finsbury (St. Luke) 317 St. Sepulchre 19 Extra-Parochial— 1. General Hospitals 221 = 911 2. Special Hospitals 84 3. Fever Hospitals 16 4. Poor Law Institutions 525 5. Asylums 39 6. Elsewhere (unclassifiable) 26 Total 1,774 16 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, 1901-1907 At all Ages. Under 1 Year 1 and under 5. 5 aud uuder 15. 15 and under 25. 25 aud under 65. 65 aud upwards. Total Death Bate. Census 1901 101,463 2,792 9.473 21,045 20,410 44.582 3,161 Deaths 1901 2,161 533 290 82 94 764 398 21.3 1902 2,283 558 339 81 82 805 418 22.7 I903 1.993 503 268 53 78 716 375 19.8 1904 2 084 522 257 56 68 755 426 21.1 1905 1,855 429 245 60 70 615 436 189 1906 2,020 474 366 66 75 669 370 20 7 1907 1.774 368 239 50 65 669 383 18.3 SENILE MORTALITY. The deaths of persons aged 65 years and over were as follows :— North Clerkenwell 120 South Clerkenwell 93 Finsbury (St. Luke) 157 St. Sepulchre 13 Total 383 Out of the total of 383, 113 were between 65-70 years of age, 197 were between 70-80, 62 were between 80-90, and 11 were between 90-100. 17 The claims of death at the two extremes of life, and the effect of season, are shown in the following table of total deaths, intraparochial and extra-parochial:— J an-March April-June July-Sept Oct-Dec Total Infants under 1 year 113 91 64 100 368 Persons of 65 years and upwards 133 103 65 82 383 DEATHS IN RELATION TO DISEASE. Mortality returns distributed in relation to disease—that is, cause—for one year must be accepted with reserve. They do not permit of generalisation, for which a number of years is necessary. Some note, however, should be included in this Report as to the main causes of death in 1907, and the ages mostly concerned. They were as follows :— Measles 43 Whooping Cough 44 Epidemic Diarrhoea 66 Cancer 86 Heart and Circulatory System 205 Tuberculosis 285 Other Respiratory Diseases 409 Total of seven causes 1,138 (Children under 5 yrs.) (Children under 5 yrs.) (Children under 2 yrs.) (Adults over 25 yrs.) Ditto. (Children under 15 and Adults between 25-45 yrs.) (under 5 and 25-65 yrs.) If phthisis be included among respiratory diseases, the total number of deaths attributable to diseases of the lungs is 652, or 36 per cent, of the total deaths in the Borough during the year. To what is this high figure due? Probably on the whole it is due to careless exposure of the young and of the aged— 18 an exposure often brought about by the inconveniences of the tenement housing system. It is also partly clue to alcoholic excesses and partly to the exigencies of occupation in Finsbury. From Table IV. (page 162) it will be seen that what may be called the tragic causes of death—alcoholism, accident, overlaying, and suicide—amounted, as a direct cause of death, to 118. There were 17 deaths due to suicide. DEATHS FROM ZYMOTIC OR INFECTIOUS DISEASES. The deaths from Zymotic Disease occurring in the Borough (intra-parochial and extra-parochial) during the year numbered 187, and were caused as follows :— Small-pox. Scarlet Fever. Diphtheria and Membranous Croup. Enteric Fever. Puerperal Fever. Measles. Whooping Cough. Diarrhoea. Total. 1901 8 19 36 11 4 49 37 95 259 1902 32 15 37 9 6 83 68 84 334 1903 — 12 12 11 4 69 52 100 260 1904 3 17 14 8 5 60 26 145 278 1905 — 21 11 9 — 31 32 111 215 1906 — 13 25 14 5 115 55 144 371 1907 — 16 15 2 1 43 44 66 187 These returns yield a zymotic death rate of 1.9 per 1,000 as compared with 1.4 for London as a whole. The amount paid to medical practitioners for furnishing notification certificates was £68 19s. 6d., as against £77 5s. in 1906. The Local Authority is recouped for this expenditure by the Metropolitan Asylums Board. The fees paid for Voluntary Notification of| Phthisis amounted to £15 is. 6d. 19 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 from all causes and from the diseases named. This is an instructive result when it is considered that each of the five years tells the same story. 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 1907 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. 20 Finsbury, 1903-1907. Death Rates from All and Certain Causes in Houses or Tenements of Several. Sizes. Size of Tenements. Census Population, 1901, 101,463‡ All Causes. Infectious Diseases (Zymotic). Phthisis. Respiratory Disease (excluding Phthisis). Death rate per 1000. Death rate per 1000. Death rate per 1000. Death rate per 1000. Death rate per 1000. Death rate per 1000. Death rate per 1000 Death rate per 1000. Death rate per 1000. Death rate per 1000. Death rate per 1000. Death rate per 1000. Death rate per 1000. Death rate per 1000. Death rate per 1000. Death rate per 1000. Death rate per 1000. Death rate per 1000. Death rate per 1000. Death rate per 1000. 1903. 1904. 1905 1906. 1907. 1903. 1904. 1905 1906. 1907. 1903. 1904. 1905 1906. 1907. 1903. 1904. 1905. 1906. 1907. One-room tenement 14,516 38.9 40.6 32.7 39.0 328 5.6 5.1 3.4 6.4 3.2 4.5 4.5 3.5 3.4 3.9 9.3 9.8 6.4 8.3 8.0 Two-room tenement 31,482 22.6 21.9 19.5 22.5 18.5 3.8 4.1 2.8 5.5 2.7 2.8 2.2 2. i 2.3 2.4 5.3 4.9 5.2 4.8 5.6 Three-room tenement 21,280 11.7 14.7 12.3 14.8 12.6 1.8 2.1 1.8 2.6 1 .4 1.2 2. 3 1.3 1.4 1.6 2.4 3.4 2.8 2.9 3.4 Four room tenement and upwards of four rooms 33.185 5.6 7.5 6.6 6.4 6.2 o.54 0.1 0.69 0.8 0.7 0.63 1.2 0.81 0.93 0.7 0 .84 1.4 1.4 1.2 1.6 Institutions* 1,000 16.0 28.0 8.0 33.0 63.0 - - - 3.0 1.0 7.0 5.0 - 14. 0 16.0 4.0 8.0 6.0 7.0 15.0 Deaths not traced† — 273 21.6 268 185 177 12 11 18 22 4 13 25 28 38 33 10 62 69 23 49 The Borough Death Rates - 19.8 21.1 18.9 20.7 18.3 2.6 2.8 2.06 3.7 1.9 2.2 2.5 2.1 2.3 2.4 3.9 4.8 4.4 4.0 5.0 *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 four 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. 21 INFANTILE MORTALITY. There were 368 deaths of infants in Finsbury during 19°?) as compared with 429 in 1905 and 474 in 1906. On the total number of births this yields an infant mortality rate of 109, the lowest figure ever recorded in this district of London. The returns since 1871-80 are as follows :— London.* Finsbury. 1871-80 158 158 1881-90 152 154 1891-00 158 152 1901 148 122 1902 139 154 1903 130 137 1904 144 145 190s 129 126 1906 131 137 1907 116 109 1 * Registrar General's Returns. Expressed in other words, it may be said that prior to the formation of the Borough the average infant mortality was 155 per 1,000 births. During the existence of the Borough it fell to 137, and in 1907 it fell to T09, which means that the saving of infant life has been, on these figures, 46 per 1,000 children born. It will be noted, however, that this rate is obtained before deduction of the births not belonging to Finsbury. Deducting such births, 368 infant deaths yield an infant mortality rate of 22 128, which reveals an almost precisely similar reduction since 1902, when the figures were first "corrected." The Borough. North Clerkenwell. South Clerkenwell. Finsbury (St. Luke). St. Sepulchre. No. of Infant Deaths Infant Mortality No. of Infant Deaths Infant Mortality No. of Infant Deaths Infant Mortality No. of Infant Deaths Infant Mortality No. of Infant Deaths Infant Mortality 1901 *533 163.8 158 149.2 124 139.6 172 137.0 6 162.1 1902 558 749 183 173.3 152 172.7 217 178.4 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 1.82 98 121.7 178 165.5 7 33 3.4 1906 474 157.3 183 172.5 116 135.9 166 157.0 9 2195 1907 368 128.0 119 116.5 105 135.1 136 128.3 8 307.7 *The return for 1901 includes 73 infant deaths taking place in institutions outside the Borough but belonging to Finsbury, and which c?nnot 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, and the births taking place in City Road Workhouse, &c., belonging to Finsbury, have been included. It will be noted that the rates in the above table are higher than those recorded on p. 21, which is due to the fact that the number of births on which they are calculated excludes the births taking place in the Lying-in Hospital in the Borough which do not from the point of view of residence belong to it, and yet which, of course, furnish a number of the infant deaths. This no doubt is the reason why the Registrar-General has formerly based his calculation on the total births, though in the table on p. 23, which is quoted from his report, the outside births have been excluded. But whichever way the figures be stated the conclusion must inevitably be the same, namely, that there has been a substantial reduction, indicating a great saving of life. 23 Table Showing the Distribution of Infant Mortality Throughout London since 1902, according to the Registrar General. Borough.* Infant Mortality Rate, 1902-1906. Infant Mortality Rate, 1907. Shoreditch 167 150 Finsbury 159 130 Bermondsey 156 123 Southwark 153 138 Poplar 152 124 Bethnal Green 151 138 Stepney 144 117 Kensington 140 128 Hammersmith 140 117 Fulham 140 122 Deptford 136 108 Chelsea 135 122 Lambeth 134 120 St. Pancras 132 108 Holborn 132 131 Battersea 131 114 Camberwell 131 115 St. Marylebone 130 101 Greenwich 129 100 Hackney 128 112 Islington 125 116 City of London 121 94 Paddington 118 109 Wandsworth 118 99 Woolwich 116 112 City of Westminster 115 102 Stoke Newington 113 100 Lewisham 109 90 Hampstead 90 69 * The Boroughs are placed in order of Infant Moitality Rate, 1902-1906. Of the 368 deaths of infants which took place in 1907, 100, or 27 per cent., occurred in Institutions; 23 took place in Poor Law Institutions, 75 in Hospitals, and 2 in Holloway Prison. This by no means implies that the children had careful nursing and attention during their last illness, for in many instances they were not taken to the Hospital until in a dying condition, and in some instances they arrived at the Hospital dead. Inquests 24 were held in connection with the deaths of 52 infants, or nearly 14 per cent. of the total number, and the causes of death found to be the following:—Suffocation in bed, 26; Convulsions, etc., 9; Heart Failure, Collapse, Exhaustion, etc., 9; Conditions brought about by Accidents, 2; Imperfect Expansion of Lungs, 2; other causes, 4. Of the 26 deaths from Suffocation five were due to want of attention at birth, the mothers being alone at the time; one was stated to be due to regurgitation of milk in the air passages. The remaining 20 were "overlain," and of these 13 died between Saturday night and Monday morning. As regards age incidence we know that as a general rule mortality diminishes from the first, month onwards to the twelfth. The following tables furnish the returns at the various ages and for the chief fatal diseases distributed in sub-registration districts:— Months. 0- l- 2- 3- 4- 5- 6- 7- 8- 9- 10- 11- Totals North Clerkenwell 44 11 12 10 7 6 8 9 3 2 3 4 119 South Clerkenwell 33 11 6 9 3 4 6 6 5 4 7 11 105 Finsbury (St. Luke ) 42 18 13 12 11 5 9 5 5 6 4 6 136 St. Sepulchre 4 ... ... 2 ... ... ... 1 1 ... ... ... 8 Totals 123 40 31 33 21 15 23 21 14 12 14 21 368 And the following table represents the causes of death in the same way:— Causes of Death. Diarrhœa. Prematurity. Marasmus. Atrophy, &c. Bronchitis. Pneumonia. Convulsions. Suffocation. Measles. Whooping Cough. Tuberculosis. Meningitis. Miscellaneous. Totals. North Clerkenwell 13 25 18 10 9 12 8 6 3 6 1 3 5 119 South Clerkenwell 10 16 7 5 15 16 4 5 6 2 1 3 15 105 Finsbury (St. Luke) 18 19 9 15 12 21 2 13 3 7 4 4 9 136 St. Sepulchre 1 1 ... 2 ... ... ... 2 ... 1 ... ... 1 8 Totals, 1907 42 61 34 32 36 49 14 26 12 16 6 10 30 368 25 It is necessary to study these two tables in more detail if we would obtain a general view of the problem as it is presented in Finsbury. For this purpose the following table has been drawn up, in which is stated in the first column the number of deaths between the time of birth and the end of the third month (that is, the first three months or 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 in accordance with the practice of the Registrar-General. Certified Cause of Death. Months 0-3 Months 3-6 Months 6-12 Totals. Diarrhœa 12 20 10 42 Prematurity 60 1 0 61 Marasmus and Debility 21 7 6 12 Atrophy and Developmental Disease 26 5 1 32 127 Bronchitis 13 10 13 36 Pneumonia 13 9 27 49 85 Convulsions 8 3 3 14 Suffocation 22 3 1 26 Measles 0 1 11 12 Whooping Cough 3 2 11 16 28 Tuberculosis 0 3 3 6 Meningitis 1 3 6 10 Miscellaneous 15 2 13 30 Totals 194 69 105 368 In this return we see the chief causes of the deaths of infants in Finsbury, and the age incidence of mortality for each disease. More than half the total deaths occur in the first trimester, and are due largely to Immaturity. For convenience I have added together the diseases of each group, as classified by the Registrar-General, with the result that we find that three diseases only are chiefly responsible for our infant mortality in 1907, viz.:— Immaturity 127 Lung Disease 85 Fpidemic Diarrhœa 42 Total 254 26 That is to say that 69 per cent. (68 in 1906) of the total infant deaths are attributable to these three conditions, and 34 per cent. of the total deaths are due to immaturity. Under this term is included prematurity (children born before their time), developmental or congenital diseases, atrophy, and marasmus, or wasting —all that group of conditions which means that the child has been born prematurely, or so weakly as to be unfit to survive a separate existence from its mother. It is indeed less a question of actual disease than of mere unfitness to live. Eighty per cent. of these deaths occur very soon after birth. That this result is not exceptional is obvious from the following table, which shows the infant deaths from Immaturity in Finsbury since 1901. 1901 1902 1903 1904 1905 1906 1907 Total. Premature Birth 65 79 70 63 65 52 61 455 Other immature conditions. (Atrophy, Congenital. &c.) 97 90 86 89 67 90 66 585 Total Deaths from Immaturity 162 169 156 152 132 142 127 1040 Total Infant Deaths 533 558 503 522 429 474 368 3387 Percentage of Immaturity Deaths on Total Infant Deaths 30.4 30.3 31.0 29.1 30.7 29.9 34.5 30.7 Unfortunately we have no figures for Finsbury anterior to 1901, as these sort of figures were not thought of sufficient importance to preserve. As far as the Finsbury figures go back (to 1901), it appears that there has not been any marked increase in this cause of death within that short period. But I have elsewhere shown* that in England and Wales since 1866 and in London since 1845 there has been a marked increase, in London amounting to 71 per cent, in the number of deaths attributed to Immaturity. Allowing for discrepancies due to medical certification, it cannot be doubted that there has been, during the last halfcentury, a steady increase in the number of children born unfit to maintain mere physical existence. * Infant Mortality, pp. 54-60. 27 INFANT DEATHS IN FINSBURY, 1907. A TABLE OF THE RESULTS OF ENQUIRY INTO 212 INFANT DEATHS. Methods of Feeding. Mother's Health. Mother's Work. Condition of Tenement. Number of Rooms in Tenement. Age in Months. Breast only. Breast, & c. Cows Milk. Artificial & Condensed. Not Fed. Good. Indifferent. Bad. None. Away from Home. Do. Intermittently. Some Home Work. Clean. Fair. Dirty. One. Two. Three. Four or more. 0 1 2 3 4 5 6 7 8 9 10 11 21 Diarrhœa - 4 12 5 - 15 6 - 17 3 1 - 5 14 2 10 8 2 1 1 2 1 6 6 1 2 1 - - - 1 32 Prematurity 10 1 6 - 15 1 14 5 23 3 5 1 19 10 3 16 9 3 4 31 1 - - - - - - - - - - 21 Marasmus 7 7 5 2 - 12 6 3 11 3 7 — 7 12 2 10 8 3 1 3 4 4 2 3 1 2 — 1 1 — — 11 Atrophy and Developmental 4 3 3 4 5 3 3 6 1 4 2 7 2 3 6 2 — 9 1 — 1 — — — — — — — — 18 Bronchitis 10 3 3 2 — 10 7 1 12 2 3 1 8 8 2 4 9 5 — 2 3 2 2 1 2 — 2 — 2 2 — 38 Pneumonia 24 5 7 2 — 27 11 — 26 5 7 — 19 13 6 15 12 9 2 3 4 6 1 1 2 7 3 2 3 2 4 5 Convulsions 4 - - 1 — 3 2 — 2 - 1 2 4 1 — 2 3 - — 2 2 — 1 — — — — — - — — 19 Suffocated in Bed 13 1 1 — 4 15 3 1 14 2 3 — 8 12 1 7 7 3 2 8 6 4 - - - 1 - - - - - 8 Measles 1 3 1 3 — 6 2 — 5 1 2 — 2 5 1 2 3 2 1 - - - - - - - - 2 1 1 4 11 Whooping Cough 6 1 1 3 — 8 2 1 7 3 — 1 8 3 — — 4 4 3 — 1 1 1 — 1 1 2 1 1 2 — 6 Tuberculosis 2 1 2 1 — 5 — 1 4 1 1 — 1 3 2 2 4 - — — — — 1 1 2 — — 1 — — 1 7 Meningitis, including Tubercular 5 2 - - 5 2 - 5 1 1 2 5 1 3 3 1 - — — 2 — 2 2 — — — — 15 Miscellaneous 8 4 3 — — 11 2 2 7 4 2 2 9 6 — 7 5 2 1 9 1 — 1 - - - - - 1 1 2 212 94 32 44 19 23 35 60 17 139 29 32 12 94 97 21 79 81 38 14 69 25 18 16 14 9 15 10 7 9 8 12 28 It is obvious that this condition of things must be due, in large measure, to the physical condition of the mother, and indeed we have proved it to be so, both in 1906 and 1907 (see Report for 1906, p. 50). In spite of the tendency of Nature on behalf of the new-born child, poor physique and ill-nutrition of the mother exert, in a considerable number of cases, an injurious effect on the infant. The attached table sets out a number of facts ascertained by the Lady Inspectors with regard to 212 out of the 368 infant deaths occurring during the year. This table may well be compared with that appearing in last year's Report at p. 53. A few notes may be added as follows:— (a) Conditions of Homo.—Most of the homes, indeed as many as 75 per cent., consisted of only two rooms or less, but this is not remarkable in a district so largely composed of such tenement dwellings. What is more noticeable is that only 10 per cent, of the homes in which the infant deaths occurred were thoroughly unclean and badly kept. The percentage of unclean homes was somewhat higher in the cases of death from Epidemic Diarrhœ than from all causes. (b) Occupation of the Mother—As last year we find a comparatively small fraction (13.7 per cent.) of the mothers are absent from homes where infant deaths have occurred. The majority (65 per cent.) of the mothers of these dead infants had no work of any kind except to attend to their family duties, and as many as 85 per cent. of them were able to devote the necessary time to the tendance of infancy.* *Our attention has been drawn this year to several cases of respectable young mothers who have lost their husbands shortly before or shortly after the birth of a child, also to mothers with young infants at the breast whose husbands are in institutions entirely incapacitated by mental or bodily ill-health. In nearly every instance out relief was either absent or the amount granted was so inadequate that the mother was obliged to put her infant out to nurse, and go to work, the only alternative offered by the Poor Lw being to give up her home and go into the workhouse with the child, a course repugnant to many respectable women. It is a wellknown fact that the mortality among children, put out to nurse is higher than among children under their mother's care, and it is not surprising that several of these children died. It would appear as if a modification of the rules regulating the administration of outdoor relief to respectable widows or wives deprived of their husbands' support might lessen the mortality among infants, as these cases are not infrequently met with. 29 (c) Health of the Mothers—Eight per cent. of the mothers of these dead children suffered from very bad health; 28 per cent. more from indifferent health, and 63 per cent. had good health. These figures are almost identical with those of 397 dead infants recorded in 1906. On the whole the conditions as to home and mothers' occupation are much the same in both dead and living infants. (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 44 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 12 months than similar investigations into births. As many as 20 per cent. of the dead infants were fed only on cows' milk, and were not suckled at all. 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 atrophy. Most of these deaths would appear to depend not mainly upon feeding, for the infants only lived a few days, but upon the physical conditions of the mother. From whichever point of view we judge the matter, whether it be as to bad feeding, leading to diarrhœal diseases, or as to exposure, leading to lung diseases, or as to mere physical unfitness to live, leading to premature death, the problem of infant mortality is mainly a question of motherhood. CONCLUSIONS.—The conclusions to which all these facts lead are indisputable. Broadly, there are three main diseases which cause 70 per cent. of the deaths of infants in Finsbury, and they are due to three main evils connected with infancy. 1. Immaturity,due to low standard of physical motherhood; 2. Epidemic Diarrhoea, due to improper feeding; 3. Lung Disease, due to mismanagement and exposure. 30 MEANS OF PREVENTION. The measures adopted to combat infant mortality in 1907 in Finsbury have been as follows:— 1. General Sanitary Work and Visiting of Births.— All practical sanitary work tends in the direction of reduction of infant mortality, and much work has been done in various directions in Finsbury of this character. In addition the Lady Sanitary Inspectors have made a large number of visits to the mothers of new-born infants, and have given necessary advice as to satisfactory infant management from the beginning. I have no doubt as to the value of this work in many homes. 2. The Infant Milk Depot.—In December, 1905, a special report was issued by instruction of the Public Health Committee, on the establishment of an Infants' Milk Depot by a voluntary society in the Borough, the Social Workers' Association.* The commencement of this 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 Milk Depot under proper control and on satisfactory lines for a few children, combined with personal visiting and the education of the mothers of the children. It was, therefore, a Milk Depot and a school for mothers. The whole of the necessary funds were subscribed privately. The principles by which the Medical Committee wished to be guided were:— (a) Absolute control of the milk and the avoidance of the serious fallacy of sterilising unclean milk. It was felt that it is unsatisfactory to attempt to prepare a suitable milk for weakly infants from the general market supply, which has been shown not infrequently to be open to grave criticism, and it was also felt that such unclean, and sometimes infected, milk cannot be made thoroughly wholesome merely by sterilising it. It therefore became necessary to seek out a model farm where absolute *See Report on Public Health of Finsbury, 1904, pp. 115-123, 31 reliance might be placed in the high quality and purity of the milk produced. The Association was fortunate in receiving the cooperation of Mr. Carson, who has done much to improve the dairy industry in this country, and the milk for the Depot was therefore obtained from the Jersey herd on his farm in Essex, and the refrigeration, modification, and bottling and, if necessary, pasteurisation (150° F. for 20 minutes), were carried out at the farm, which is managed on sanitary and hygienic lines. (b) Medical supervision of the entire management of the Depot and of the infants using the milk was also laid down as a necessary principle. (c) A discriminating and careful distribution of the milk only to infants of the poor who could not by any means be breast fed. (d) The systematic study of the effect of the milk on the children, coupled with personal advice to the mothers, both at the Depot and in their own homes ; and (e) The sale of the milk to be as far as practicable at ordinary market prices. The object of the enterprise was intended to be educational as well as preventive or ameliorative; it sought to meet a pressing local need, and it was expressly stipulated that it should be so managed as not to encourage artificial feeding where natural feeding could be secured. Moreover, it combined for the first time in England an improved and suitable infant milk supply with the teaching of the mother. It is evident that these were not easy principles to carry out, and many difficulties were encountered. On the whole, however, the work of the Depot from its inception in November, 1904, met with marked success, and in March, 1906, it had so far justified itself that it was taken over by the Borough Council, who recognised their responsibilities in regard to the necessity of special measures for the reduction of infant mortality. The same principles were acted upon as formerly, which have now been adopted by other Milk Depots in this countryParticulars as to methods of milking have been fully dealt with in former reports, where also will be found a study of results. Since its commencement 543 children have used the milk, including those already on the Depot at the beginning of the past year and those 32 on at the end of December. 253 children have used the milk in 1907. The reasons for which the mothers and guardians of these 253 children sought the Depot were as follows:— Mothers who had no breast milk or an insufficiency of milk 74.9 Death or illness of mother 13.1 The breast milk not agreeing with the infant 7.0 Infants unable to suckle or similarly defective 2.0 The mother at work 3.0 100.0 It may be said that 32 2 per cent. of the children on the Depot were introduced by the Lady Sanitary Inspectors of the Borough Council, 26 8 per cent. were introduced by medical practititioners in the Borough, 13.0 per cent. of the cases were sent to the Depot by St. Bartholomew's Hospital, and the remainder from neighbours' recommendations (28 0 per cent.). The children belonged, with very few exceptions, to the poorer classes. Twenty-two per cent. of the children came from homes of one room only, and another 61 percent. from two-roomed homes. So that not less than 84 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. Another point of importance is that 70.5 per cent. of the children admitted were either in poor health or absolutely ill at the time of admission, and some of them were practically dying. The remainder (29.5 per cent.) were in good health. Almost without exception the children were being wholly fed by artificial means before they came on to the Depot. Turning to some of the results of this milk feeding, it may be desirable to deal with two matters, namely, the general improvement and increase in weight of the Depot-fed infants, and the saving in life which has been achieved. 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 71bs.; 33 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 subsequently, but roughly it may be said that throughout the twelve months of infancy the average increase ought to be about 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 the 253 infants 198 (or 78 per cent.) have each gained an average of 4 oz. per week, (i.e., approximately a pound per month). Of the 198 infants 62 were first children, 30 were second, 42 were third or fourth, and as many as 64 were fifth children or more than fifth. Of the mothers of these 198 children only 79 could be described as at all healthy. Secondly, as to the saving of life. There were 9 cases of death out of the 253 infants (4 from epidemic diarrhcea). This yields an infant mortality rate of 35"5 per 1,000 births. The infant mortality rate for the Borough during 1907 was 109 per 1,000 births Comparison is impossible between these figures, as they are affected by very different circumstances. In 1906 the Depot infant mortality worked otit at 65*5 per 1,000 births (the Borough rate being 157 3). Without making any close comparison between these various figures, some things may at least be said :— (1) That the death-rate among the Depot-fed children in 1907 was extraordinarily low, two-thirds less than among other children in the Borough, even though the Depot children were more frail and ill than the others. The broad fact is that here were 253 artificially fed infants (70 per cent. of them ill or ailing), of whom only 9 died. Yet it is from this identical class of the community that Finsbury has, in past years, experienced an excessive infant mortality. (2) That much of this substantial saving of life has been due to careful infant management in addition to suitable milk. The two things go together. The true milk Depot, properly controlled, is also a School for Mothers, as the French workers pointed out years ago. It is idle to credit an improved milk 34 supply alone as being the one and only panacea for preventing infant mortality. Anyone who studies the causes of infant mortality knows that other conditions besides the food factor affect the question. There are, it is true, the alimentary diseases which indicate the influence of the food factor, and these are of the greatest importance. But there are also the deaths of infants due to lung disease (owing to exposure) and to immaturity (owing to poor physical motherhood), and these cannot be met wholly, or only, by dealing with the food factor. They must be met, as they have been in part met in Finsbury, by improved infant management.* (3) That during the three years that the Borough has had the advantage of an Infant Milk Depot, the total infant mortality in the district has shown a marked and substantial decline. (4) And that, apart from the actual saving of infant life, the children on the Depot have, with few exceptions, steadily improved in health and physique, some of them in quite a remarkable degree. Thus there can be little doubt that the Depot has served not only as an instrument of preventive science, but that it has exerted also a positive effect in helping to lay the foundations of a good constitution in most of the children who have used the milk. Not the least difficult part of the working of an Infant Milk Depot is its financial control. This, indeed, has been our chief difficulty in Finsbury. On the one hand, it is important to charge as little as possible for the milk in order to bring it within the reach of those most needing its aid; on the other, the efficiency of such a Depot involves an outlay beyond the mere price of the milk, due to production under excep- tional conditions and to the expenses of distribution. In Finsbury, the principle has been adopted of charging the ordinary market price of milk (4d. per quart) to the mothers attending the Depot, meeting the expenses of distribution otherwise. The balance-sheet prepared by the Borough Accountant for the twelve months to 31st December, 1907, is as follows :— * There can be no doubt that much of the exceptionally good result of the work of the Depot in 1907 is due to the careful supervision of Miss Jones, the Lady Sanitary Inspector, who was specially deputed by the Committee to assist in this experimental work. 35 INFANTS' MILK DEPOT. Income and Expenditure for the year ended 31st December, 1907. Income. £ s. d. £ s. d. Mothers' Fees 283 7 5 Milk 421 15 7 Deficiency for period to 31st December to be charged on Rate 438 10 3 Carriage 116 12 6 Bottles, Washers, Teats, &c. 95 0 1 Boxes 10 19 0 Depot Fittings 0 9 0 Honorarium to Nurse 12 10 0 Rent 31 4 0 Printing 1 1 0 Gas 4 3 1 Petty Disbursements 3 17 5 Wages 24 6 0 £721 17 8 £721 17 8 £530 was the estimated net charge to he borne by the rate for the year to 31st March, 1908. 36 The heaviest item of expenditure is, of course, the milk, but an unduly heavy item is carriage from the farm to the depot, and this transit is also partly responsible for the large amount expended on bottles, breakages being somewhat more than was anticipated. On the whole, however, and compared with other English milk depots, the expenditure has not been excessive nor does it proportionately exceed the twelve-months estimate of £530. Still there falls a charge upon the rates of £438 10s. 3d., and that is, of course, a serious item. Nor is it practicable to suggest, for the same scheme, a much smaller loss. It might be possible to work some other scheme at a less cost, but even so, there is the difficulty of income, the payments of the mothers being insufficient and too irregular to ensure a settled and satisfactory revenue. It is much to be regretted that an enterprise of this kind cannot, seemingly, be made self-supporting. Of its medical benefit, and of its far-reaching value, both in the saving of life and in securing and maintaining a better standard of infant management—after all a thing of national importance—there can be no doubt. 3. The use of Modified Dried Milk.— In connection with this subject I must also place on record an experiment in the use of Dried Milk, which has been carried on in Finsbury, at first under the observation of Dr. Frances Harper. Subsequently, after her departure from the district, the matter came under my observation, although of course the Borough Council was in no way responsible for the undertaking. By the good offices of Messrs. J. Nathan & Co , a number of children (53 in all) who could not obtain the depot milk, and who could not be fed on breast milk, have been fed on modified " Dried Milk," and we have thus had the opportunity of watching an experiment which has been extremely interesting, especially in comparing depot milk fed children and children fed on Modified Dried Milk. This substance is the dried essence of whole milk, suitably modified, and when reconstituted forms a liquid milk, having much the same constituent parts as ordinary modified miik.* It has, of course, the immense advantage that in powder form it can be kept for long * I understand that this Dried Milk is now placed on the market under the name "GLAXO." 37 periods, does not go bad, and is not affected by hot weather. There can be no doubt that it provides an excellent substitute, not for breast milk, and not for really good cows' milk, but for much of the milk upon which infants are now fed. But even if it were as good in quality as the milk at the depot, the advantages of the depot system as a school of infant management would be lost, and even if it were as good in quality as human milk, it would still be liable to contamination if improperly used. Still, that it can be well used and when so used yield excellent results will be clear from the following table carefully prepared by Mrs. Greenwood, who has made it part of her business carefully to watch the effect of this Dried Milk. The facts of the table speak for themselves. The table includes six Finsbury babies who were fed on Dried Milk under Dr. Franees M. Harper's supervision, and who had discontinued the Dried Milk before she left the Leysian Medical Mission Dispensary. At the time Dr. Harper left eleven Finsbury babies were taking the Dried Milk, three ceased to use it, but eight continued on the milk until they were twelve months old. In addition, 36 other babies have had the Dried Milk for varying periods as shown in the table. It should be added that in this experiment it has not been possible to exert any direct control, as in the Depot work, over the actual feeding of the children. We have been able to visit and supervise only to a very limited extent. To be really effective any such method of feeding calls, of course, for the most careful supervision of each case to ensure the proper use of the Dried Milk. 38 CHILDREN FED ON MODIFIED DRIED MILK. No. Initials. Sex. Age when began Milk. Weight. Percentage of Normal. Age when Milk discontinued or 31st Dec., 1907. Weight. Percentage of Normal. No. of weeks on Milk. Average increase per Week. REMARKS. Weeks lbs. ozs. Weeks lbs. ozs. ozs. 1 W.M. M 5.5 7 4 92 14 10 8 102 8.5 6.1 Under Dr. Harper. 2 G.C. M 6 8 4 103 14 11 13 115 8 7.1 11th child, home conditions unsatisfactory. 3 T.S. M 7 6 11 80 10 7 7 81 3 40 Home conditions unsatisfactory. 4 J.A. F 7 5 0 60 55.5 16 2 81 48.5 37 A twin, 5 incisors. (12 Mos.) 5 G.E. M 7.5 6 4 75 13.5 9 2 90 6 7.7 Died of Epidemic Enteritis. 6 F.S. M 8 7 2 84 52 15 8 81 44 3.0 Eight incisors, two molars. (12 Mos.) 7 H.M. F 8.5 8 12 100 20.5 13 8 108 12 6.3 Under Dr. Harper. 8 G.W. F 9 7 11 87 27.5 14 6 99 18.5 5.8 Two incisors. (6 Mos.) 9 J.W. M 10 8 9 93 29 13 10 92 19 4.3 13th child, home conditions unsatisfactory. 10 A.S. F 10 8 1 88 20 12 2 80 10 4.0 Home conditions not very satisfactory. 11 W.W. M 10 7 8 82 12 9 0 93 2 12.0 Taken ill with whooping cough, and went into Infirmary. 12 L.W. F 10 9 4 100 19 9 10 80 9 0.6 Two former children have wasted. 13 R.S. F 10.5 6 6 68 54.5 17 4 87 44 4.0 Illegitimate; had severe whooping cough, also D. and V. 14 M.T. F 11 7 13 82 32 11 3 72 21 2.6 Illegitimate : mother a hard drinker. 15 H.K. M 11 9 0 95 15 9 8 90 4 2.0 Under medical advice all the time. 10 D.W. F 11.5 9 8 99 24 16 0 117 12.5 8.3 Steady progress throughout H.C. good 17 E.L. F 12 8 0 82 30 16 0 98 24 5.3 Two incisors. (8 Mos.) 18 D.L. M 12 10 4 105 41 19 6 113 29 5.0 Two incisors. (9 Mos.) 19 E.L. F 13 8 7 84 23 9 9 72 10 1.8 Went into Infants Hospital. 20 R.W. M 13 8 6 84 31.5 11 8 75 18.5 2.7 Under Dr. Harper. [(12 Mos.) 21 J.H. F 13.5 10 2 100 52 19 8 101 38.5 3.9 Flight incisors, two molars, much bronchitis 22 S.R. M 14 5 14 57 31.5 9 2 59 17.5 3.0 Under Dr. Harper. 23 E.A. M 14 12 14 126 35 18 0 112 21 4.0 A severe illness in October. 24 R.C. F 14.5 8 0 77 52 19 0 99 37.5 4.7 Steady progress throughout. 25 V.T. F 16 11 2 102 32 15 4 98 16 4.1 26 L.J. F 16 8 4 76 54 14 13 75 38 2.8 A twin, six incisors, home conditions (12 Mos.) 27 R.J. F 16 9 6 80 56.5 15 6 76 40.5 2.4 ,, ,, not very satisfactory 28 E.S. F 19 7 4 61 30 11 2 74 11 5.6 Under Dr. Harper. 39 29 C.B. M 19 10 10 89 39.5 17 0 100 20.5 5.0 Steady progress throughout. 30 E.H. F 19.5 8 10 72 67.5 18 2 80 48 3.3 Bad health throughout. 31 S.B. F 23.5 7 8 56 29.5 10 2 68 6 7.0 Much neglected, mother a drinker. 32 S.O. F 24 10 8 77 44.5 13 2 73 20.5 2.0 Under Dr. Harper. 33 W.C. M 24 16 3 119 31.5 19 2 124 7.5 6.3 ,, ,, 34 A.C. M 25 10 14 78 51.5 16 8 86 26.5 3.4 Several incisors, much bad health (11 Mos.) 35 J.R. M 26.5 10 12 75 55.5 18 0 91 29 4.0 ,, ,, steady progress. ,, 36 E.G. F 31.5 9 2 59 43.5 14 5 81 12 7.0 Steady progress, had been very ill. 37 H.E. M 31.5 17 10 114 42.0 20 8 120 10.5 4.4 Four incisors. (9 Mos.) 38 C.W. M 35.5 9 11 60 66.5 17 9 78 31 4.0 Eight incisors, brother to No. 12, was much wasted. (15 Mos.) 39 A.A. F 38.5 9 12 59 65 18 10 84 26.5 5.4 Had been much underfed. 40 H.P. F 39.5 15 4 90 63.5 19 6 89 24 2.8 Five incisors. (14 Mos.) 41 L.C. F 9 9 10 109 52 18 6 95 43 3.3 4 incisors, fairly steady progress. (12 Mos.) 42 C.H. F 12.5 8 0 81 36.5 14 2 87 24 4.1 Steady progress throughout. 43 D.W. M 14 8 3 80 46 19 2 102 82 5.5 ,, ,, four incisors. (10 Mos.) 44 M.A. F 7 7 5 87 43 17 0 97 36 4.3 A twin, mostly breast, no teeth, sister to No. 4. (10 Mos.) 45 A.G. F 8.5 6 4 71 10.5 6 10 71 2 3.0 A twin. 46 M.C. F 8.5 6 11 76 10.5 7 10 81 2 7.5 ,, 47 S.H. M 8.5 8 6 96 16.5 9 12 89 8 2.8 Mother had much anxiety which affected child. 48 F.M. F 8.5 8 0 91 43.5 18 2 103 35 4.6 Steady progress throughout. 49 W.W. M 9.5 6 6 71 17.5 8 10 77 8 4.5 Home conditions unsatisfactory. 50 H.H. M 11.5 9 0 93 30.5 14 10 97 19 4.7 Steady progress. 51 A.C. F 16.5 11 0 100 18.5 11 12 101 2 6.0 A twin. 52 C.C. F 16.5 9 0 82 18.5 10 4 88 2 10.0 ,, 53 E.H. F 17 7 15 71 28.5 11 11 80 11.5 5.2 Steady progress. Average increase per week, 4.66 ozs. Nos. 41, 42 and 43 had breast supplemented by dried milk for the first two or three months ; then dried milk only. Nos. 44 to 53 ,, ,, ,, throughout period under observation. In 29 children the percentage improvement rose above five. In 16 ,, ,, ,, remained practically stationary. In 8 ,, ,, ,, decreased below five. 40 With two or three exceptions, the children were drawn from the poorest class, residing chiefly in Peerless Street, Baldwin Street, Galway Street, Radnor Street and Lever Street. Many of the fathers were out of work or in hospital or in a Poor Law Infirmary, the mothers being quite unable to contribute any regular weekly sum for the food supplied. The standard of life in this district being low, the home conditions in many cases were very unsatisfactory, but the interest of the mothers in the progress of their babies was greatly stimulated by the weekly weighing which took place in a room kindly lent by the Leysian Mission. It should be added that the progress made (average increase per week 4.6 ozs.) indicates not only that the milk itself was nourishing, but the increased care given to the babies, and in some cases the more suitable clothing which some of the mothers were induced to provide for them. In addition to the 53 infants enumerated in the foregoing table, we have particulars of 40 other children outside the boundary of the Borough who were fed on Dried Milk by Dr. Harper in the Summer of 1906. The average weekly increase of these children was 4.15 ozs. This figure is not necessarily comparable with the 4.66 ozs. recorded as the average weekly increase in the children in the above table, as no doubt the climatic conditions of 1906 were less favourable to infant life. 4. A School for Mothers.—A special effort has been made by the Lady Sanitary Inspectors to keep in touch with a number of young mothers who have been encouraged to come to weekly or fortnightly talks on the welfare of the baby, and instruction has been given on the simple rules which may be observed for keeping the baby in health. This work was separate and distinct from the work of the Depot as a school of Infant Management. These classes have been held at the Depot and at 165, Goswell Road (Social Workers' Association], in conjunction with the Health Visitor of that Association (Miss Irene Cox). 41 No. of meetings held 26 No. of attendances 311 No. of mothers with 1st child 54 No. of mothers with 2nd child 25 No. of breast-feeding mothers 50 No. of hand-feeding mothers 29 Average attendance per week 12 All these mothers have attended and the children have been weighed periodically. Little talks have been given on various health subjects, * and the periodical weighing of the children has greatly stimulated the interest of the mothers in their development. livery mother has also been encouraged to make suitable woollen garments for her child. In nearly every case these were completed before Christmas, and therefore ready for the coldest weather. The best wool was supplied to them at cost price, and where possible help has been given. The same applies to the baby's cot. A banana box was s arranged that, for a few pence, it made an attractive bed for the baby, and all those mothers who were not already using some k nd of suitable cot were encouraged to do so—advice, of course, being given as to the best means of keeping the child warm. This work has been carried out in the main by the Lady Sanitary Inspectors (Mrs. Greenwood and Miss Jones) at times not included in official hours, and they have been greatly helped by the Health Visitor of the S.W.A. (Miss Cox), who has also carried out a large amount of separate health work in the prevention of infant mortality. *Summer diarrhæa—its prevention and treatment. The baby's small ailments. The great advantages of breast feeding. The correct methods of bottle feeding. The necessity of regular feeding. Wearing and subsequent feeding. The correct way to bath a baby—illustrated. Fresh air and ventilation. Warmth and cleanliness of the skin, with diagrams, suitable clothing, etc. 42 B.—RECORDS OF DISEASE. THE INFECTIOUS DISEASES The principal Infectious Diseases are seven in number, namely Small-pox, Scarlet Fever, Diphtheria, Fever (including typhus, typhoid or enteric, and simple or continued), Diarrhoea, Measles, and Whooping Cough. The notification clauses of the Public Health (London) Act, 1891 (Sections 55-57), deal with small-pox, cholera, diphtheria and membranous croup, erysipelas, scarlet fever, typhus, typhoid, relapsing, continued and puerperal fevers. During 1907 there were 735 notifications, as compared with 764 in 1906, and 745 in 1905. The returns as forwarded to the Metropolitan Asylums Board are as follows First Qtr. Second Qtr. Third Qtr. Fourth Qtr Total for 1907. Small-pox - - - - - Scarlet Fever 61 114 159 137 471 Diphtheria (including Membranous Croup) 24 20 40 43 127 Fevers— Cerebro-spinal Meningitis 2 1 — 1 4 Enteric 5 3 8 6 22 Typhus - - - - - Continued - - - - - Erysipelas 29 24 27 28 108 Puerperal Fever 3 — — — 3 Totals 124 162 234 215 735 43 The following Table compares the notifications of notifiable diseases and removals to hospital since the Borough was formed :— Year. Number of Notifications Received. Notifications per 1,000 of the Population. Percentage of Cases Removed to Hospital. 1901 1,10l 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 1906 764 7.8 76.9 1907 735 7.6 83.4 In the above Table " Notifications" for Chicken-Pox are excluded (203 in 1907.) Table III. (see end of report) sets out a number of further particulars respecting these notifications, from which it will be seen (a) that 571 out of 735 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, fewer cases of infectious disease (19 in fact) occurred in the Clerkenwell division; and (c) that out of 735 patients 613 (or 83.4 per cent.) were removed to hospital. Respecting the second conclusion, it will fee observed that the excess in the St. Luke division was mostly due to scarlet fever. The infectious diseases are usually highest in St. Luke owing to the greater density of population. The amounts paid in fees under the Public Health (London) Act to medical practitioners notifying since 1901 lias 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 1906 77 5 0 0 15 10 1907 68 19 6 0 14 3 44 It may be of interest to note that of 151 cases of "notified" Diphtheria, 24 (or 16.0 per cent.) were returned from the Metropolitan Asylums Board Hospitals as not so suffering; out of 24 "notified" cases of Typhoid, 2 (or 9.0 per cent.) were returned; and out of 499 cases of notified Scarlet Fever, 28 (or 5.6 per cent.) were returned. This yields a total of 673 notified cases, out of which 54 were returned as not correctly diagnosed, being only 8.0 per cent. The larger proportion of errors (namely, 57.5 per cent.) have occurred at the general hospitals and not in private practice. SMALL-POX. There were no cases of Small-pox in Finsbury in 1907. The cases ol Small-pox in Finsbury during the last decade have been as follows:— Years. No. of Cases. No. of Deaths. 1895—1900 18 0 1901 83 8 1902 187 32 1903 1 0 1904 3 3 1905 - — 1906 - — 1907 — — Total 307 43 Showing the Rise and Fall of DIPHTHERIA each week during 1907. 45 The incidence of Small-pox, since the Borough's formation, is shown in the following table:— No. of Cases per 10,00 of population. No. ot 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 — — — 1906 — — — 1907 — - — DIPHTHERIA. There have been 127 notifications of Diphtheria (including Membranous Croup) received during the year, as compared with 151 in 1906. During the year 122 bacteriological examinations were made of doubtful cases, yielding 51 positive and 71 negative results. The age incidence of Diphtheria and its mortality for 1907 was as follows :— Ages in years. Under 1 year. 1-5 5-15 15-20 20-30 30-40 40- Totals. No. of Notified Cases Males 2 38 19 5 2 — — 66 Females 3 32 24 — 2 — — 61 Totals 5 70 43 5 4 — — 127 Deaths from Diphtheria. 2 13 - - - - - 15 Percentage on Cases. 40.0 18.6 — - — — — 11.8 46 It will be seen that the chief incidence of the disease has fallen on children, as many as 118 out of 127 being of school age, which is a larger proportion than in 1906. Two-thirds of the cases occurred in the second half of the year. 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 1906 15.5 2.5 16.5 1907 12.7 1.5 11.8 SCARLET FEVER. The total number of notifications of Scarlet Fever received during the year was 471 as against last year's 422. The ago and sex incidence of the 471 cases was as follows:— Ages. 0- 1- 5- 10- 15- 20- 30-40 Total. Males 3 63 90 46 13 6 1 222 Females 5 90 109 36 5 4 — 249 Total 8 153 199 82 18 10 1 471 From these figures it will be seen that 360 out of the 471 cases occurred in children under 10 years of age. In relation to school influence, it is of interest to note that about 76.4 per cent, of the 47 cases occurred in children at school ages. These returns show a less 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 16 deaths, distributed as follows :— Years. Under 1 year. 1 and under 5. 5 and under 25. At all Ages. Number of cases noti- fied 8 153 310 471 Number of deaths 1 10 5 16 Percentage of deaths at each age period attacked 12.5 6.5 1.7 3.4 Twenty-six deaths yield a Scarlet Fever death rate of 0.26 per 1,000. The comparative figures for the last ten 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 0.18 1902 381 15 0.14 1903 283 12 0.11 1904 323 17 0.17 1905 456 21 0.21 1906 422 13 0.26 1907 471 16 0.17 48 Between May 6th and June 4th, we received 22 notifications of Scarlet Fever in children. This outbreak was localized to Central Finsbury, and was due to infection spread by personal contact. It originated in a case of disease in a little girl F. T., aged 6 years, who was supposed to be suffering from Measles, and was accordingly not isolated in hospital. Unfortunately she was suffering from Scarlet Fever. From this origin the disease was spread to 15 children, who either themselves attended the Martyrs' Memorial School, or who lived in houses the children of which attended that school. Seven other children contracted the disease by playing with infected children. All practical steps were taken to pre.ent the spread of the disease, and the school and each of the houses was thoroughly disinfected. 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 population. Case-mortality. No. of Deaths per 100 cases notified. 1901 48.1 1.8 3.8 1902 37.9 1.5 3.9 1903 28.1 1.2 4.2 1904 32.6 1.7 5.2 1905 46.4 2.1 4.6 1906 43.5 2.6 6.1 1907 48.6 1.6 3.4 and its seasonal incidence is shown as follows :— Months. Jan. Feb. Mar. Apr May. June. July. Aug. Sept. Oct. Nov. Dec. Number of Cases 11 26 24 24 52 38 46 54 49 67 47 23 Totals 61 114 159 137 Showing the Rise and Fall of SCARLET FEVER each week during 1907. 50 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 329, concerning 487 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 31, in whom were found some definite sequelae :— Discharged Cases of Scarlet Fever— Sore Throat 4 Coryza 5 Desquamation 4 Nasal Discharge 6 19 Discharged Cases of Diphtheria— Slight Paresis of limbs 7 Sore throat 1 Eyes 1 9 Discharged Cases of Typhoid Fever— Weakness 3 3 Summary— Sequelae in Scarlet Fever 19 Do. Diphtheria 9 Do. Typhoid Fever 3 31 PUERPERAL FEVER. In 1907 we received three notifications of puerperal fever. Each of these cases was investigated by one of the Lady Inspectors and reported upon to the London County Council. There was one death. There are 26 registered midwives in Finsbury. Unfortunately various unqualified persons also undertake midwifery in the district. Of the three cases, one patient was attended by a medical practitioner, the second by a midwifery student, and the third by an unregistered and1 unqualified midwife residing in Finsbury. 51 In the two first cases the patients recovered, but in the third case the patient died of Puerperal Septicaemia 14 days after the birth of her child. The particulars of the last case are as follows: The patient, an Italian, was delivered of her second child on the 2nd January, 1907, by Mrs. T., an ignorant Italian woman who attends her compatriots as a midwife. Mrs. T. had previously attended an Italian woman in Islington, who had developed and died of Septicaemia on the 7th January, 1907, and she had taken no precautions with regard to personal disinfection or disinfection of apparatus before coming to the case in Finsbury. This midwife does not understand English, and is unacquainted with the rules regulating the practice of midwives as well as being too profoundly ignorant to comply with them. We have evidence that in July she attended a patient in Holborn who developed Puerperal Fever and died, so that within seven months* three deaths have followed in the wake of this person. Not being on the register and not advertising herself as a midwife, the London County Council have no power to deal with her. It is fortunate that in 1910, when the whole of the Midwives Act comes into force, such persons will be forbidden to practice. CEREBRO-SPINAL FEVER. During the year we have had intimated to us four cases of Cerebrospinal meningitis ("spotted fever"), of which it is necessary to record the particulars. (1.) On February 9th, we received an intimation from Dr. Gray, the Resident Medical Officer at Great Ormond Street Hospital, of a case of cerebro-spinal meningitis (so called "spotted fever"), in the person of a child, J. D., aged seven months, of 39, Warren Street, Pentonville, N. *Mrs. F. B. 44, Warner Street, died 12/7/07, of Puerperal Fever, attended by Mrs. T. Information from Holborn Borough Council. 52 The patient had died the previous night, and the body was removed, in due course, to the mortuary, where it was kept prior to burial. Thorough disinfection was immediately carried out, and the house and family were kept under daily supervision for 14 days. I visited the hospital and made full enquiries into the case. It appears that the infant was brought to hospital on Tuesday, February 5th, and again on the 6th, when it was admitted. What is now regarded as the specific germ of the disease was detected, and both on the facts of the clinical diagnosis and the autopsy there can be no doubt that the case was one of epidemic cerebro-spinal meningitis, of which there have recently been outbreaks in Belfast and in Glasgow. The disease is not of very rare occurrence in the United Kingdom, though this was the first case to occur in the Metropolis at the present time. Every step was taken to prevent the spread of infection, and no further cases occurred, nor was there any kind of illness in the house in which the case occurred. I took the precaution of sending a letter to each medical man practising in the Borough, with a copy of the memorandum respecting the disease, issued by the Local Government Board, asking for an early intimation of any cases of illness simulating this disease which might occur. Unfortunately, the disease has various anomalous forms in addition to its typical form, which increases the difficulty of diagnosis. Whether the disease is spread by direct infection from person to person is a matter of uncertainty; indeed, there is no definite knowledge as to the way or ways in which its transmission may take place. Throughout the investigation we were not able to trace the source of infection in any of the four cases we have had. The second case was notified on March 25th, from St. Bartholomew's Hospital, a child, A. C., aged 2¼ years, of 76, Bastwick Street. The specific organism was isolated. On 29th June, I received the third notification from St. Bartholomew's Hospital, in the person of J.H , aged 30, of 13, Gastigny Place, Old Street, E.C. This case presents somewhat exceptional characteristics. It appears that on the night of Saturday, 15th June, this man was assaulted in the street in the vicinity of his home, or at all events was involved in some street quarrel in which he seems to have received various blows on his head. Two or three days later he 53 was admitted to St. Bartholomew's Hospital, suffering from severe headache and other symptoms which were suspicious of a fractured skull. He grew steadily worse, showing marked signs of mania and ultimately of coma and collapse. He died on the 27th. At the autopsy it was discovered that there were diffuse and well-marked signs of inflammation of the membranes of the brain and spinal cord with the formation of pus. The specific microbe was found to be present (Diplococcus intra cellularis). At the inquest, which was held on 1st July, and which I attended, medical evidence was given to the above effect, and the Jury formed the opinion that the man died from natural causes (namely, cerebro-spinal fever), and not from the blows which he had received. It is impossible to say whether the injuries did, in point of fact, serve as a starting-point of the disease, and if so, in what degree. It should be added that there was no history of previous illness in the family or house in which the diseased lived. The premises were thoroughly disinfected on receipt of the notification, and the family was kept under observation. The fourth case occurred in an infant, D. C., aged 4 months, of 9, Crawford Passage, who was notified on December 17th from the Royal Free Hospital, where he had been an in-patient since December 9th. The specific organism was isolated. By an order of the London County Council of March 12th, 1907, the disease was made notifiable for six months. On September 13th, this notification was extended for a further period of eighteen months. WHOOPING COUGH. There were 44 deaths from Whooping Cough, giving a death rate of 0.45. Whooping Cough is a disease of about two months' duration, and is chiefly characterised by bronchial catarrh and a frequent paroxysmal cough. It generally occurs as an epidemic late on in the winter, say from January to March. Though no age is absolutely exempt from Whooping Cough, it is essentially a children's disease. 54 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 43 deaths attributed to Measles during the year, giving a death rate of 0.44 per 1,000. The London death rate for Measles for 1907 was 0-38 per 1,000, there being 1801 deaths from that causc as ag'ainst 1910 in 1906. It is probable that these figures do not fully indicate the destruction of life due to Measles, for this disease is often complicated1 with bronchitis or other respiratory disease, and hence some deaths due to Measles are entered in the returns as due to bronchitis. 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 certain 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 agt. It will be remembered that in 1903 new powers were granteA 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 1907 received 478 intimations of the occurrence of the disease as follows:- 55 SCHOOLS IN THE BOROUGH. 1903. 1904. 1905. 1906. 1907. Albion Place 12 1 12 7 11 Amwell Street - 7 13 13 31 Ann Street 32 10 18 4 3 Baltic Street 26 6 4 18 5 Bath Street 33 35 5 27 21 Central Street 13 2 38 22 23 Chequer Street 33 37 22 18 27 Compton Street 35 29 30 22 31 Hugh Myddelton 21 80 74 101 68 Moreland Street 39 9 34 51 21 Risinghill Street 80 68 8 75 30 St. John Street 24 23 20 17 11 White Lion Street - — — 38 4 Winchester Street 14 46 1 40 11 St. Barnabas — 2 11 — - St. Joseph — — — - 7 St. Luke — 14 2 8 10 St. Mark, Brewer Street* — — - 3 3 SS. Peter and Paul — 1 10 1 — Totals 362 370 302 465 317 Schools outside Borough 14 23 19 35 54 Totals 376 393 321 500 371 Other sources:— London County Council School Visitors 2 - — - — Medical Practitioners 16 5 26 — 2 Other Borough Councils 2 23 7 2 - Registrars of Births and Deaths — - 3 60 14 Relieving Officers 4 5 — 1 1 Sanitary Inspectors 130 333 190 445 65 Superintendents of Dwellings 4 16 - 2 17 Parents and Guardians 43 27 14 26 8 Grand Total 577 802 561 1036 478 * Closed during 1907. 56 Age Incidence of Intimated Cases of Measles, 1903-1907. 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 1906 1 8 35 36 184 182 176 189 214 11 1036 1907 - 3 8 14 39 57 50 92 203 12 478 Totals 2 27 87 114 472 480 587 703 942 40 3454 From this table it would appear that the disease occurs most commonly in the second to the sixth years 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 1 69 1904 — — 5 9 24 12 5 2 3 — 60 1905 — 2 2 1 14 7 4 — 1 — 31 1906 — 1 8 10 56 17 13 6 3 1 115 1907 — 1 2 9 20 2 7 2 — — 43 Totals - 7 19 42 143 47 39 11 8 2 318 Disinfection has been carried out in 466 cases, but it is very doubtful indeed if the gains have been commensurate with the extent of this work. 57 EPIDEMIC DIARRHŒA. During 1907 there were 66 deaths attributed to this disease, 42 of these cases being infants under one year of age. This gives a death rate for Epidemic Diarrhoea of 0.68 per 1,000. Years. Finsbury Epidemic Diarrhæa, Death Rate. London 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 1906 1.48 0.93 1907 0.68 0.32 It has already been shown that 368 children died in infancy in Finsbury in 1907, of which number 42 (or 11.4 per cent.) died of this disease. In 1906 there were 109 infant deaths thus caused. It will be convenient to consider this disease in relation to age incidence, season, methods of feeding, occupation of the mother and housing conditions. Ago Incidence at Death—Of the 42 deaths of infants under one year, 12 occurred in infants under three months, 20 in the second three months, and 10 in the last six months of the first year. The distribution was therefore highly characteristic of the disease. The Registrar-General's returns show that this disease, as a rule, has the heaviest incidence of fatality in the second and third trimesters, and declines subsequently. The Finsbury figures show the same feature. Under three months the fatality is low. It is at the weaning period that it is high, which clearly suggests that it is mainly caused by food. 58 Relation of Season.-In 1907 the average four-foot earth temperature in the third quarter of the year was 57.2, but a higher temperature than usual occurred in October. The rainfall was low. On the whole the summer was not so unfavourable as that of 1906 (see Report 1906, pp. 103-105). In the third quarter there were only 17 deaths from this disease as compared with 100 last year. These facts may be presented in tabular form as follows:— Third Quarter Year. No. of Deaths from Epidemic Diarrhæa. 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 1906 100 59·4° F. 3·78 1927 17 57·2° F. 3·77 The facts concerning the relationship between seasonal conditions and diarrhæal deaths in the summer quarter of 1907 may be tabulated as follows:— Summer Quarter, 1907. July. August. September. Dates of months (in weeks). 30 June to July 6 7-13 14- 20 21- 27 28 July to Aug. 3 4-10 11- 17 18- 24 25- 31 1-7 814 1521 2228 Mean temperature. Fourfoot thermometer. (Average 57·2º F.) 54·4 54·8 55·8 56·9 57·5 58·0 58·3 58·8 58·3 58·3 58·1 57·9 57·4 Rainfall (3.77 in.) 0·l6 0·22 0·00 0·51 0·40 0·18 0·71 0·96 0·16 0·44 0·00 0·00 0·03 No. of deaths from Epidemic Diarrhæa.. (17) 0 0 1 1 1 1 0 1 1 1 1 1 8 59 The findings as to methods of feeding, the occupation of the mother, the previous health of the children dying of this disease, and the effect of housing conditions, are confirmatory of last year's experience (Report 1906, pp. 105-108). PHTHISIS. The Voluntary Notification of Phthisis.—The number of notifications of Phthisis are exactly the same as 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; in 1905, 178; in 1906, 217; and in 1907, 217, as follows:— Notified Cases. Under 10 years 10- 20- 30- 40- 50- 60- Total. Males 1 1 32 37 26 25 21 143 Females 1 8 12 19 15 11 8 74 Total 2 9 44 56 41 36 29 217 Most of these 217 notifications are of inmates in the Highgate Infirmary, and are of cases in an advanced stage of the disease. In former years I have discussed the pioneer work in voluntary notification which this Borough Council has been able to undertake, and I think there can bo little doubt that good has resulted. But without the provision of more isolation accommodation the advantages are greatly reduced. 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. Another sort of institution which would be of the greatest value is a phthisis dispensary. 60 Deaths from Phthisis.—The total deaths due to consumption in 1907 were 243, as compared with 232 in 1906, and 215 in 1905. The death rate for the year is therefore 2.5 per 1,000 (the London rate being 1.4), which is about the average rate for the last five years :— Under 1 1 and under 5 5 and under 15 15 and under 25 25 and under 65 65 and over Total Males 1 7 2 18 111 3 142 Females 5 6 4 10 71 5 101 Total 6 13 6 28 182 8 243 In the first quarter of the year there were 67 deaths; in the second, 63; in the third, 51; and in the fourth, 62. The number of males is, as usual, 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, alcoholism, exhaustion, fatigue, etc. Dr. MacLearn, the Medical Superintendent of the Holborn Infirmary, Archway Road, N., writes to me under date January, 1903:—"The total number of deaths from phthisis, occurring in the Holborn Union Workhouse Infirmary, during 1907, was 137 (being 10 more than in 1905, and 21 more than in 1906), of these, 108 were patients coming from Finsbury. The total number of phthisis cases now under treatment in this Infirmary, who are residents of Finsbury, is 16 women and 153 men. 61 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 59·3 1906 232 85 58 143 61·6 1907 243 108 51 159 65·4 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. But our chief 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. 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:- 62 SEX. No. of Deaths per 10,000 of the Population at certain age periods. 0-10 10-20 10-30 30-40 40-50 50-60 60 and upwards Totals 1901 Males 8·6 3·9 21·1 47·6 83·5 78·9 12·8 29·2 Females 6·9 8·6 6·2 32·5 22·5 35·8 21·2 15·5 1902 Males 23·3 3·9 20·1 58·0 53·3 76·0 51·3 32·2 Females 9·5 10·5 9·4 39·4 31·2 19·2 9·1 17·1 1903 Males 6·0 7·8 17·9 53·0 53·3 84·8 81·3 29·8 Females 7·8 9·6 11·5 25·7 36·4 30·3 24·2 17·2 1904 Males 13·8 7·8 23·2 57·0 65·7 61·4 51·3 31·6 Females 11·2 6·7 12·5 21·7 43·3 33·0 24·2 18·2 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 1906 Males 8·6 8·8 13·7 32·6 53·3 67·2 85·6 25·8 Females 14·7 13·4 15·7 29·.9 32·9 24·8 21·2 19·9 1907 Males 10·3 2·9 21·1 49·0 49·7 81·8 59·9 28·2 Females 10·4 8·6 9·4 32·6 41·6 38·.5 30·2 19·8 63 The incidence of Phthisis since the Borough's formation, therefore may be shown as follows:— Total No. of Notifications. No. of Cases notified per 10,000 of Population. (Voluntary notification). Number of Deaths per 10,000 of Population. 1901 70 6·9 22·2 1902 121 12·0 24·7 1903 219 21·8 23·7 1904 21O 21·2 25·3 1905 178 l8·1 21·9 1906 217 22·2 23·8 1907 217 22·4 24·6 These tables are of great interest, and bring to light various matters of importance respecting the incidence of this disease in Finsbury. Unfortunately there is not space in the present report fully to discuss their import. Other forms of Tuberculosis.—In addition to the 243 deaths from Phthisis (Tuberculosis of the Lungs), there were also 42 deaths from tuberculosis of the membranes of the brain, and all other forms of tuberculosis, making a total of 285 deaths from this disease, as compared with 280 in 1906. 64 CANCER AND MALIGNANT DISEASE. There were 86 deaths certified during 1907 as due to cancerous or maligant disease, which gives a special death rate of 0.89 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 70 and upw'rds Total Males 1 3 1 4 2 10 12 6 39 Females - - - 2 11 9 10 15 47 Totals, 1907 1 3 1 6 13 19 22 21 86 Totals, 1906 — — 2 3 12 17 31 19 84 Totals, 1905 1 2 — 1 11 15 18 17 65 Totals, 1904 1 1 3 I5 13 22 22 12 79 Totals, 1903 — 1 2 10 13 29 23 14 92 Totals, 1902 — — — 1 16 17 18 20 72 Totals, 1901 1 2 2 8 14 18 14 13 72 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 86 cases must be accepted with reserve. Cancer is not always readily diagnosed. Moreover, it is likely that the deaths of a certain number of persons have been attributed to other causes when they should have been allocated to cancerous disease. 65 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 1901 1905 1906 1907 Totals Face, Tongue, Jaw — 7 12 7 7 7 9 49 Throat, Neck, Gullet — 8 7 8 8 12 13 56 Stomach 9 12 16 8 7 8 9 69 Intestines 10 17 11 14 10 20 12 94 Liver 1O 6 13 11 3 13 1O 66 Pancreas — — 3 3 1 — 2 9 Breast 6 9 12 4 11 8 4 54 Uterus 16 12 9 14 11 9 13 84 Various 21 1 9 10 7 7 14 69 Totals 72 72 92 79 65 84 86 550 An examination of the returns for 1907, reveals the following two facts:-(a) The cases of cancer in men recorded in Finsbury numbered 39, of which 18, or 46.1 per cent. were cases of cancer of the alimentary canal; (b) the cases among women numbered 47, of which 14, or 29.7 per cent., were cases of cancer of the alimentary canal, and 17, or 36 per cent., were cases of cancer of the breast or womb. ALCOHOLISM. During 1907, twenty deaths were directly attributed to alcoholism and delirium tremens. These figures do not, of course, represent more than a small proportion of the mortality really caused by alcoholism. It is more than likely that some of the deaths of infants attributed to being "laid upon" in bed, are really caused indirectly by alcoholism. During 1907 there were, as already 66 pointed out, 20 deaths so caused. Cirrhosis of the liver, a condition due, as a rule, to alcoholic excess, caused the death of 26 persons. Hence it may be said that at least 46 deaths were probably due to alcoholic excess. The figures are as follows:— Years. Alcoholism and Delirium Tremens. Cirrhosis of Liver. Total. 1901 11 22 33 1902 27 21 48 1903 22 29 51 1904 19 25 44 1905 8 22 30 1906 21 31 52 1907 20 26 46 Totals (1901-1907) 128 176 304 Ten of the 20 deaths due directly to alcoholism occurred between the ages of 30 and 50. There are in Finsbury some 309 licensed premises, or one to every 329 persons. In many of these, notices of dilution under the Food and Drugs Acts are exhibited with a view of protecting the vendor in the event of prosecution for selling adulterated spirits. Out of the 20 deaths due directly to alcoholism, 7 were women. Out of the 26 deaths due to alcoholic liver (a more chronic form of poisoning), 12 were women. One of the 14 men was a barman. 67 C.—PROTECTION OF THE FOOD SUPPLY. During the year 1907 a large amount of time and labour has been spent, as formerly, 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, etc. MEAT. At the time of the formation of the Borough of Finbury 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 has been 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 nor 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 68 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, lie 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. 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 twenty-four 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 summarised as having been 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 an his behalf by experts if he so wishes. (d) Report of the facts of the case to the Public Health Committee. 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. 69 During the year under review we have only had 2 prosecutions. The table of prosecutions 1901-1907 is as follows:— Years. No. of Cases of Meat Prosecution. No. of Convictions. Cases Dismissed. Weight of Meat, Ac., confiscated (in tons). 1901 24 24 — 30 1902 16 16 — 75 1903 19 18 1 101 1904 15 15 — 76 1905 9 9 — 94 1906 5 3 — 121 1907 2 2 — 100 TABLE OF MEAT, &c., PROSECUTIONS, 1907. Date of Trial. Defendant's Name and Address. Article. Where Seized and Name of Inspector. Penalty and Costs Inflicted. June 11th Charles Harris, 5, Smith Street, Canning Town, Essex. Four quarters of Beef weighing 224 lbs. This Beef was very emaciated and devoid of fat. The pleura had been partly stripped from the walls of the chest. On the marginal portions there were numerous tubercles. All the glands were enlarged, and some were also tuberculous. In a cart at Cowcross Street, Finsbury. (Inspector Billing.) £10, and £2 2s. costs. Dec. 3rd David Van Gelder. 307, Camden Road, N. A carcase of Mutton weighing 42 lbs. This carcase was extremely emaciated. The pleura and also the peritoneum had been partly stripped. The marginal portions of pleura and peritoneum were much thickened, and also flabby and wet. There were several abscesses on the sternum and also on the flanks. 101, Charterhouse Street, Finsbury. (Inspector Billing.) £50. 70 It has been my practice to advise prosecution only in cases as to the seriousness oi which there could be 110 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 tliu 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. There has been a marked decline in prosecutions since 1904, which is a sign, I believe, not of lack of vigilance, but of an improved meat traffic. Certification of Meat Products.—The Committee considered a communication from the Local Government Board, calling attention to their recent memorandum on the certification of meat products intended for export to Argentina and stating that they had been applied to by Bovril, Limited, and other firms for the designation of a certifying officer to certify their products intended for export to Argentina as produced under good sanitary conditions; and stating that, if the Council and the Medical Officer of Health assent, the Board would designate the Medical Officer of Health as certifying officer for this Borough. The Medical Officer of Health having expressed his assent to act in the manner suggested, it was resolved by the Council to signify to the Local Government Board their assent to the Medical Officer of Health being designated Certifying Officer for this Borough, under the regulations of the Board. The Table on the following page shows the amount and character of the food confiscated during 1907. About 80 per cent, of the total meat surrendered was of foreign origin (chiefly Dutch and American). 71 Summary of Diseased and Unsound Meat, Offal, &c., Confiscated During the Year Ending 31st December, 1907. Diseased. Sides of Beef 20 Sheep's Livers 13,027 Quarters of Beef 29 ,, Lungs 2,456 Pieces of Beef 2 ,, Plucks 90 Carcases of Mutton 2 Beef Livers 1,165 „ Pork 37 „ Lungs 458 Pieces of Pork 2 ,, Heads 53 Carcases of Stirk 9 ,, Hearts 2 „Veal 13 „ Tongues 41 Pigs' Plucks 112 „ Udders 9 „ Mesenteries 6 ,, Kidneys 16 ,, Head 1 „ Tripes 1 „ Livers 12 Bundles of Sausage Casings 3 Stirk's Head 1 Calves' Plucks 4 Stirks' Livers 2 Tons. Cwts. Qrs. Lbs. Total Weight 33 13 1 5 Decomposed. Sides of Beef 1 Turkeys 54 Quarters of Beef 12 Geese 21 Pieces of Beef 85 Fowls 7 Carcases of Mutton 56 Cases of Calves' Tongues 2 Pieces of Mutton 13 ,, Beef Cheeks 23 Carcases of Lamb 145 „ ,, Tails 2 „ Pork 9 „ ,, Kidneys 93 Pieces of Pork 38 „ „ Pieces 7 Carcases of Veal 105 ,, „ Sweetbreads 2 Pieces of Bacon 156 „ „ Tripe 4 Hams 37 „ „ Bacon 1 Quarters of Venison 14 „ Sheep's Kidneys 305 Rabbits 489 ,, „ Hearts 30 Parcel of Sausage Meat 1 „ Lambs' Plucks 18 ,, Sausages 1 „ Pigs' Kidneys 34 ,, Sweetbreads 7 ,, Rabbits 651 Pieces of Brawn 2 „ Chicken 1 Beef Livers 219 Barrels of Pigs' Plucks 29 „ Hearts 13 „ „ Feet 1 ,, Lungs 758 ,, „ Kidneys 17 „ Tails 970 ,, Sausage Casings 1 „ Milts 367 Hampers of Sheep's Plucks 2 „ Heads 36 „ Mixed Offal 2 „ Tongues 2,235 Barrels of Herrings 3 „ Udders 32 Boxes of Kippers 2 Sheep's Heads 418 „ Plaice 1 „ Plucks 810 „ Cod 1 ,, Livers 1,852 „ Hake 1 „ Hearts 87 ,, Skate 8 „ Lungs 328 ,, Mackerel 5 ,, Kidneys 287 „ Haddock 4 Lambs' Heads 22 Crates of Bananas 11 „ Livers 184 Boxes of Oranges 7 „ Plucks 16 Cases of Tomatoes 24 Calves' Tongues 86 Baskets of Plums 2 „ Plucks 27 „ Sprouts 1 „ Heads 17 „ Mushrooms 4 Pigs' Plucks 321 „ Apples 4 ,, Livers 118 Bags of Chestnuts 2 „Tops 300 Rolls of Celery 9 Baskets of Chitterlings 4 Barrel of Gerkins 1 Bags of Sheep's Hearts 2 Tins of Fruit 300 ,, „ Trotters 3 ,, Vegetables 300 Tons. Cwts. Qrs. Lbs. Total Weight (Decomposed) 66 9 2 4 Total Weight (Diseased) 33 13 1 5 Grand Total Weight 100 2 3 9 72 Diseased Sausage Casings.—On February 15th. Inspector Billing, in the course of his duties, met with a considerable consignment of ox-gut, characterised by the presence of numerous nodules in the wall cf the intestine. This material was being used for sausage casings. On examination it appeared to be of parasitical origin, probably the particular parasite known as (Esophagostomum Columbianum. As it was contended that this condition was in no wray detrimental to the quality of the material, I considered it best to have a microscopical examination made and accordingly sent some typical specimens to Dr. Foulerton, the Director of the Bacteriological and Pathological Laboratories at the Middlesex Hospital. His report was as follows — "There is no doubt but that the guts represent cases of 'nodular disease of the intestine,' the fullest description of which is given by Curtice. Curtice described the disease as it occurred in sheep in the Eastern States of the United States, and christened the parasite (Esophagostomum Columbianum (from Columbia, where the disease principally occurred). In the guts which you sent the embryo worm can be fairly easily demonstrated in the nodules which I have examined, and in some of the larger nodules more than one embryo (two or three) are present. In one of the smallest nodules I found an earlier encysted form. I see that in the United States of America guts such as these are not used for sausage-casing; and because of the prevalence of the disease there, some of the States sausage-makers have to import sheeps' guts from elsewhere. And I, personally, would not think that such disease gut should be used for sausage making in London. I have seen similar nodules in the human large intestine, but have not been able to demonstrate any cause for them. Theobald Smith had previously to Curtice examined the disease in sheep, but did not discover the cause; he apparently thought that the disease might be tuberculosis." In accordance with this confirmation of our view, we arranged for the confiscation of the guts, which, however, were at once withdrawn from the market and returned to Deptford, whence they came. We informed the authorities at Deptford, and communicated with the various sausage makers in the Borough, warning them that in future all such diseased material for sausage casing will be seized as unfit for food of man, whether or not it has been "passed" in Germany or America. Slaughter-houses.-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). 73 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. 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, 72 milkshops have been registered, and 69 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 259. 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 481 visits, and have served 67 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 and again in 1906, 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 74 creased 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 cannot often receive a pure and clean article. A continual and steady enforcement of the law is, in my opinion, the effectual and equitable means of reform. Inspection Of Cowsheds.—We 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 30 51 2 David Timothy 27, Whiskin Street 1 20 3 John Davies 40, Rawstorne Street 15 15 4 John James 230, St. John Street 30 30 5 Mrs. David Hughes 39, Baldwin Street 16 17 The number of cows in the first column of the above table refer to the cows actually found at the last inspection. 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 suppply, drainage, and general sanitation. We have also inspected the cows and the method of milking. Sampling.—Under the sale of Food and Drugs Acts 329 samples of milk have been taken. Each Inspector samples in his own district monthly, and once a quarter takes a number of "special" samples in the evening or on Sundays at irregular hours. Thirtyeight of the samples of milk taken, or 11.5 per cent., were found to be adulterated. In 1903 the figure was 16.7; in 1904, 13.9; in 1905, 10.9; and in 1906, 13.5. 75 It should be stated that the principles guiding us in our work under the Sale of Food and Drugs Acts are broadly three, namely, first, to carry out the Acts with a view to the detection of adulteration; secondly, in contemplating the taking of proceedings against vendors whose milk, on analysis, falls below the recognised standard, we take into consideration, as far as possible, all the circumstances bearing on the question in addition to the actual findings of the Analyst; and thirdly, we so organise the sampling as to distribute it uniformly over the Borough and over the trade. By the practice of these principles we aim at a fair administration of these Acts. Even so, much remains to be desired, for it cannot be doubted that it would be to the advantage of the community if we were able to extend the operations of these Acs, not only as to quantity of sampling, but also as to the prevention, as far as practicable, of the sale of milk which though not adulterated is of poor quality. The following table shows the results obtained during the last ten years:— 76 No. of Samples Analysed. No. of Samples Adulterated. Percentage of Adulterated Samples. Added Water. Percentage of Watered Milks in Samples Analysed. Removal of Fat. Percentage of Milks with fat removed on Samples Analysed. Under 5% 5% or over. 10% or over. 15% or over. 20% or over. Under 5% 5% or over. 10% or over. 15% or over. 20% or over. 1896 235 74 31.5 8 23 9 7 6 22.6 — 6 3 5 7 8.9 1897 187 46 24.6 4 14 11 5 2 19.3 — 2 2 4 2 5.3 1898 197 42 21.3 2 14 14 3 1 17.3 — 1 4 1 2 4.0 1899 205 55 26.8 9 16 9 4 6 21.5 — 2 2 6 1 5.3 1900 228 36 15.8 5 12 6 4 2 12.8 — — 4 1 2 3.0 1901 251 56 22.3 17 13 2 3 2 14.7 2 7 4 3 3 7.6 1902 269 53 19.7 15 15 3 2 3 14.2 2 6 3 2 2 5.5 1903 348 58 16.7 19 20 6 1 1 13.5 3 5 3 — — 3.2 1904 346 48* 13.9 14 4 2 1 1 6.0 2 8 6 2 2 5.5 1905 349 38* 10.9 16 1 1 — 1 5.4 7 8 1 1 1 5.1 1906 377 51* 13.5 10 11 1 2 — 6.3 9 8 1 — 1 5.0 1907 329 38* 11.5 7 4 4 — — 4.5 5 9 4 — 2 6.0 *These figures include samples of milk which were adulterated with preservatives. 77 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 (1901-7) 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 £4 0 0 £2 13 0 1906 15 £29 10 0 £10 15 0 1907 14 £42 1 0 £22 13 0 Totals for the 7 years 135 £261 13 6 £125 12 6 Total for Fines and Costs = £387 6s. 0d. 78 The Annual Report of the Local Government Board for 1906-1907 gives the returns for London as follows:— Metropolitan Borough. No. of milks examined. No. found to be adulterated. Percentage of adulterations. Fulham 273 79 28.94 Shoreditch 344 96 27.90 St. Pancras 408 106 25.98 Stepney 785 174 22.16 Hackney 521 97 18.61 Westminster, City 856 158 18.45 Stoke Newington 79 12 15.19 Bethnal Green 425 62 14.58 Bermondsey 596 83 13.92 Finsbury 377 51 13.53 Paddington 304 41 13.48 London as a whole 12626 1675 13.26 Battersea 757 96 12.68 Hammersmith 230 29 12.61 Islington 637 75 11.77 Holborn 224 24 10.71 Lewisham 281 29 10.32 Wandsworth 527 54 10.24 Poplar 132 13 9.84 Greenwich 177 17 9.60 Southwark 1257 120 9.54 St. Marylebone 184 17 9.24 Woolwich 425 39 9.17 London, City 562 44 7.83 Camberwell 398 31 7.79 Kensington 265 20 7.54 Hampstead 200 15 7.50 Deptford 246 17 6.91 Chelsea 194 13 6.70 Lambeth 962 63 6.55 It may be convenient to add here a table of quarterly returns for Finsbury during 1907:— 79 MILK Quarter of the year. No of Samples taken. No. of Samples Adulterated. Percentage Adulterated. No. of Prosecutions Instituted. Fines and Costs. 1st 66 4 6.0 1 £ s. d. 28 0 0 2nd 102 18 17.6 1 0 13 6 3rd 74 10 13.5 10 14 9 6 4th 87 6 6.9 5 21 11 0 Total for year 339 38 11.5 17 £64 14 0 The comparative figures for 1906 (the most recent obtainable) work out as follows:— 1906. ntage of Milk Adulteration. Borough of Finsbury 13.5 London I3.2 Twenty largest towns of England and Wales 12.3 The remainder of England and Wales 12.1 The percentage of adulteration for every five years since 1877 for England and Wales may also be added for comparative purposes. MILK No. of Samples in 1906. Percentage of Adulteration in 1906. 1905. 1904. 1903. 1902. Quinquennium. Examined. Found Adulterated. 1902-06. 1897- 01. 1892-96. 1887-91. 1882-86. 1877-81. 42,335 5,280 12.5 10.5 11.1 10.4 11.6 12.3 10.6 12.3 13.2 16.7 21.1 80 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. Report of Royal Commission on Tuberculosis. On 2nd February an interim report of this Commission recorded a series of experiments with the bovine tubercle bacillus (i.e., the tubercle bacillus derived from tuberculous disease in the cow) and the human tubercle bacillus (derived from tuberculous disease in man). As the practical conclusions of the Commission concern the conveyance of this disease by means of milk, reference is made to the subject in the present Section. 1. The Bovine Tubercle Bacillus, when injected, has now been shown to set up a general progressive or a limited retrogressive tuberculosis with fatal results in the animal inoculated, young pigs being particularly susceptible. The factors determining the extent or degree of the disease produced are the dose of the virus and the susceptibility of the animal. It is important to note that the anthropoid ape, so nearly related to man, readily contracts generalised tuberculosis by feeding on material impregnated with the bovine tubercle bacillus. 2. The Human Tubercle Bacillus also produced like results, and its effect appeared to the Commission to be "absolutely identical with the effects of the bacillus of bovine tuberculosis." "We have," the Commissioners say, "wholly failed to discover any essential differences between the one and the other; both are equally able to set up tuberculosis in bovine and other animals." These words apply to a strain of the human bacillus resembling the bovine baci'lus. Experiments were also made with a strain of lower virulence which did not set up generalised tuberculosis, and the Report contains a number of scientific facts respecting the character of different forms assumed by the tubercle bacillus whether of bovine or human origin. It was found that these differences were of degree only. 81 General Conclusions:— The general results so far attained by the inquiry may be summed up in the following conclusions:— 1. That the effects of the bacillus of bovine and human tuberculosis are one and the same, though wide variation in degree of virulence may occur. 2. That the human body can be infected by bovine tuberculosis; and the bovine body can be infected by tuberculosis of a human source. 3. That there can be no doubt but that in a certain number of cases the tuberculosis occurring in the human subject, especially in children, is the direct result of the introduction into the human body of the bacillus of bovine tuberculosis; and there can also be no doubt that in the majority at least of these cases the bacillus is introduced through cows' milk. Cows' milk containing bovine tubercle bacilli is clearly a cause of tuberculosis and of fatal tuberculosis in man. 4. That a very large proportion of tuberculosis contracted by ingestion is due to tubercle bacilli of bovine source. 5. That a very considerable amount of disease and loss of life, especially among the young, must be attributed to the consumption of cows' milk containing tubercle bacilli. The presence of tubercle bacilli in cows' milk can be detected, though with some difficulty, if the proper means be adopted, and such milk ought never to be used as food. There is far less difficulty in recognising clinically that a cow is distinctly suffering from tuberculosis, in which case she may be yielding tuberculous milk. The milk coming from such a cow ought not to form part of human food, and indeed ought not to be used as food at all. 6. That our results point clearly to the necessity of measures, more stringent than those at present enforced, being taken to prevent the sale or the consumption of such milk. 82 Examination of Milk Samples in Finsbury for Tuberculosis, &c. In accordance with the instructions of the Public Health Committee of 12th February, I had 25 samples of milk purchased at various representative shops in the Borough, with a view of determining their condition and quality from the point of view of cleanliness and infection. It will be understood that the sampling of milk which usually takes place is carried out under the Sale of Food and Drugs Act, and has for its purpose the detection of adulteration only, as, for example, the addition of water or abstraction of fat. In view of the fact that this fails to determine the more important matter of cleanliness, purity, and freedom from infection, the Committee deemed it wise occasionally to have an examination made for these latter purposes alone. Twenty-five samples were therefore obtained and submitted to Dr. Foulerton, the Director of the Bacteriological Laboratories at the Middlesex Hospital, for examination. His report was as follows:— Bacteriological Department, The Middlesex Hospital, London, W. Gth May, 1907. The samples of milk referred to in this Report were received from Dr. Newman on the dates following:— Monday, 25th February, 1907— Samples 1, 2, 3. Wednesday, 27th ,, ,, ,, 4, 5, 6. Friday, 1st March, ,, ,, 7,8,9. Monday, 4th ,, ,, ,, 10, 11, 12. Wednesday, 6th ,, ,, ,, 13, 14, 15. Friday, 8th ,, ,, ,, 16, 17, 18. Monday, 11th ,, ,, 19, 20, 21. Wednesday, 13th ,, ,, ,, 22, 23, 24 and 25. All the above samples were received in my laboratories on the respective mornings of the dates given above, and were contained in clean 6-ounce glass bottles. I was informed that each sample had been taken within two hours of the time when it was delivered in the laboratories, and in every case the bacteriological examination was commenced immediately on the receipt of the sample. 83 One hundred and fifty cubic centimetres (150 c.c.), equal to 5.28 ounces, British, of each sample were submitted to examination in the following way, All the solid particles in each sample of milk were collected as a deposit by prolonged centrifugation in a Runne machine. The amount of sediment thus collected was then estimated by bulk. Next, six "coverglass specimens" were prepared from the sediment, and stained for microscopic examination. The residue of the sediment was used for the biological test, being divided into two equal portions, each of which was administered to a guinea-pig. [The results in detail of the examination were set out in the Council's Minutes ] I. The Condition of the Samples with respect to General Cleanliness. In the first place it may be mentioned that, excepting sample 20, which was heavily tinged with anatto, none of the samples presented any obvious appearance of added colouring matter. The amount of foreign dirt present in each sample was carefully estimated by gauging the amount of sediment thrown down after a prolonged centrifugation of the milk. The term "foreign dirt," it may be explained, is used as denoting extraneous solid matter which has gained access to the milk after it has left the cow, and not as including pus, which is presumably yielded by the cow with the milk. In one or two of the samples, however, and notably in the case of sample 24, the estimated bulk of foreign dirt does include a relatively small quantity of pus; but, generally speaking, the sediment on which the classification of these samples is founded consisted of foreign dirt only. Sample 10, which was heavily contaminated with pus, contained only a small quantity of foreign dirt. This foreign dirt, under the conditions of the taking of these samples, may obviously gain access to the milk either whilst still in the cowsheds, during process of transit, during storage with the retailer, or in the process of delivery to the consumer by the retailer. The methods of examination available will not, as a rule, afford any reliable indication as to the particular stage at which the bulk of the foreign dirt which may be present gained access to the milk. An endeavour was made to classify the varying degrees of cleanliness or dirtiness of these samples, according to an arbitrary figure scale, as follows:— 1.—Not more than three or four obvious particles of dirt in the sediment thrown down from 150 cubic centimetres of the milk. 2.—Rather more dirt than indicated by "1," but still not sufficient to form a coherent sediment. 3.—A small, but definite, coherent sediment of dirt particles. 84 4.—Suspiciously dirty, that is to say, containing sufficient dirt to suggest at least the possibility of carelessness, or neglect, at some stage in the handling or storage of the milk. 5.—Distinctly dirty. 6.—Excessively dirty. Short of actually weighing the amount of dirt present in the milk, a process which because of technical difficulties in some cases would, however, be open to objection as an accurate standard of comparison, some such comparative scale as the above furnishes the best criterion of cleanliness that is available. And, in my opinion, milks which would be classified under "5" or "6" of this scale might, as a general rule, be described as being either unsound or unwholesome or unfit for the food of man. The dirtiest sample of all those examined was sample 9, which contained one part of "foreign" dirt in about 750 parts of the milk by bulk; this sample, it may be remarked, was particularly rich in cream. The twenty-five samples of milk were classified according to the above scale as follows:— A—Clean, free from any excess of foreign dirt 15 B—Containing a "suspicious" amount of dirt 5 C—Unwholesomely dirty 5 25 Thus it will be seen that 60 per cent. of the samples were satisfactorily clean, that 20 per cent. contained an amount of dirt which suggested carelessness in the handling of the milk, and that 20 per cent. were so dirty that from this cause alone they were unfit, in my opinion, for the food of man. II. The Results of The Examination For Bacillus Tuberculosis. Twenty-four only out of the twenty-five samples were adequately tested by the biological test for the presence of B. Tuberculosis, the test failing in the case of sample 25 from accidental causes. Four samples proved to be infected with the tubercle bacillus. Thus out of twenty-four samples which were tested for the presence of B. Tuberculosis, 16 6 per cent, proved to be infected by that organism. So far the quality of the samples has been considered only with reference to general cleanliness and the presence of B. Tuberculosis, with the result that eight out of twenty-five samples must be condemned as unfit for use as food. 85 To the samples thus condemned a ninth, sample 10, may be added without any hesitation. Sample 10 was the very worst milk of its kind that I have ever examined. It contained but little "foreign" dirt (it is classified under "2" on the scale of general cleanliness), but on centrifugation a deposit of pus cells equal in bulk to rather more than 35 parts in 150 of the milk was obtained. In other words, the pus cells constituted at least 1 part in 430 parts of the milk by bulk And, since the formed pus cells would constitute only a smaller part of the fluid pus cells in the milk, one would be well within a reasonable estimation in saying that the milk originally contained at least one part of pus cells in 200, a proportion of pus cells which would be equal to one pint in twenty-five gallons of milk. To recapitulate, the nine samples condemned were condemned for the following reasons:— One sample (No. 3) because of the presence of B. Tuberculosis and of an excessive amount of dirt. Three samples (Nos. 17. 18 and 23) because of the presence of B. Tuberculosis. One sample (No. 10) because of the presence of a very large quantity of pus cells. Four samples (Nos. 6, 8, 9, 24) because of general dirtiness. III. Certain oth'r Results of the Examination which tended to cast suspicions on the Wholesomeness of other Samples. Whilst the results of the examination in the case of each of the nine samples to which detailed reference has been made were such as to enable one to affirm without hesitation that the milk was so unwholesome as to be unfit for use as food, in some other instances the results of the microscopical examination were merely such as to throw a certain amount of suspicion on the sample. That is to say, either the microscopical examination suggested the presence of pus, or the results of the biological test proved the presence of organisms which were pathogenic for the guinea-pig, and which would not be found in a milk obtained from a perfectly healthy cow and handled throughout with proper care. These results, it must be clearly understood, do not necessarily show that the particular milks would have been injurious to the human consumer, they merely raise a certain amount of suspicion as to the wholesomeness of the milk, a suspicion which is accentuated in some cases on comparison with the results of the examination with respect to the general cleanliness. (For particulars, see Minutes of Council, p. 85.) Conclusions. It will be seen that the results of this series of examinations are very much more serious than those obtained in a similar series made some two years ago. 86 n partial explanation of this it may be pointed out that this second examination has been a more searching one than the other: (1) in the first examination attention was mainly directed to the question of the presence of B. Tuberculosis, and a less detailed examination with respect to general cleanliness of the samples was made; (2) the sediment examined was from a greater quantity of milk (150 cubic centimetres in the present examination, 100 cubic centimetres in the former one), and so the chance of detection of B. Tuberculosis and other pathogenic micro-organisms was considerably increased. Of the twenty-five samples examined— Seven, or 28 per cent., were satisfactory in every respect. Nine, or 36 per cent., must be absolutely condemned as unwholesome, and Nine, or 36 per cent., presented features which gave rise to a certain degree of suspicion. With regard to the nine last-mentioned samples, this may be said:— In two samples (5 and 21), the evidence derived from microscopic examination upon which suspicion was founded was very slight, the mere finding of Streptococci in the sediment; but both samples had previously been classified under the head of "suspiciously" dirty. One sample (4) had been classified as a "clean" milk, but contained definite pus cells in addition to Streptococci. Four samples, two of which (2 and 11) had been classified as "clean," and two (12 and 25) as "suspiciously" dirty, produced disease in one of the pair of guinea-pigs to which the sediment had been administered. Two samples (14 and 20), both classified as "clean" milk, produced disease in both of the guinea-pigs to which the sediment had been administered. In conclusion, I think it only fair to say that, in my opinion, the unfavourable results obtained in the examination of this series of milks should not be taken as representative of the condition of the milk supply generally. I am entirely ignorant of the source of these particular samples, but the results of the examination would strongly suggest that a considerable proportion of them have passed through the hands of retailers who are themselves supplied from sources which are not carefully selected, and who are either unable to handle the milkunder cleanly conditions or who are neglectful of proper precautions in this way. (Signed) ALEX. G. R. FOULERTON, Director of the Bacteriological Department, the Middlesex Hospital, and Hon. Consulting Sanitary Officer to the Hospital. The Middlesex Hospital, W. 6th May, 1907. 87 It may be convenient to add the following Table of Results in each case:— Date of Purchase. No. of Sample. Whether Finsbury Cows or not.* Condition of Milk. 1907. February 25th 1 No — 11 2 No (Produced disease.) ” 3 No Distinctly dirty. Tubercle bacillus present. ” 27th 4 No Contained pus. ” 5 Yes Suspiciously dirty. 1” 6 Yes Excessively dirty. March 1st 7 No — ” 8 No Distinctly dirty. ” 9 Yes Excessively dirty. „ 4th 10 Yes Pus. ” 11 No (Produced disease.) ” 12 No Suspiciously dirty. „ 6th 13 Yes — ” 14 No (Produced disease.) ” 15 No — „ 8th 16 No ” 17 No Tubercle bacillus present. ” 18 No Suspiciously dirty. Tubercle bacillus present. „ 11th 19 No — ” 20 No (Produced disease.) ” 21 No Suspiciously dirty. „ 13th 22 No — ” 23 No Tubercle bacillus present. ” 24 No Excessively dirty. ” 25 No Suspiciously dirty. ” 26 Yes Pus present. * That the cows were not kept in Finsbury means, of course, that the milk came from country farms. It should also be added that immediately the extremely bad condition of milk No. 10 sample was reported to me, I informed Mr. W. F. Shaw, F.R.C.V.S., the Veterinary Inspector of Cows 88 for the London County Council, and he visited the cowshed from which this milk was obtained. His report is as follows:— LONDON COUNTY COUNCIL. Public .Health Department, 15th May, 1907. Dairies, Cowsheds and Milkshops Order of 1899. Special Report, re Cows at 39a. Baldwin Street, Finsburv. To Dr. Newman, Medical Officer of Health, Finsbury Borough Council. Sir, On 14th March I received notice from you that pus had been found in the milk from these premises. I attended the next day and made a careful examination of all the cows in the cowshed. The examination was made by me in the following manner, viz :—I milked each cow myself and drew each teat into a clean white saucer ; by this means I found three cows were giving pus in their milk. Two of these cows were known by the cowman to have defective quarters, and the milk from these cows was not used, but the third cow was not known by the cowman or owner to have any defect of the udder, and the milk from this cow was being sold for human food ; this milk would have been sold for food, perhaps for many weeks, had not your Chief Sanitary Inspector taken samples from the milk pan. The importance of continually taking samples of milk for examination is clearly shown by this case; here was a cow giving pus in her milk from an udder which to all appearance was healthy; there was no enlargement, induration, or anything that could be detected by external manipulation; it was necessary to draw each teat with care into a shallow white vessel before the pus in the milk could be found; in a case of this kind it is useless to draw the milk from the teat into one's hand, as the colour of the hand gives the milk a deceptive appearance. With the consent of the owner, I marked the cows by cutting the whip hair off their tails, and isolated the animals at the extreme end of the shed. I made frequent visits at different times of the day to see that the cowman kept good faith until the cows were sent out to the Public Slaughterhouses to be killed, at which time they were in good condition. Your Obedient Servant, (Signed) WILLIAM F. SHAW, F.R.C.V.S. Veterinary Inspector, L.C.C. 89 I have thought it best to let the evidence concerning these milks speak for itself. It may be convenient, however, if I summarise very briefly the main conclusions to be drawn:— Twenty-five samples of milk were purchased, without any notice whatever to any of the vendors. Five of these samples were taken from milk sellers who keep their own cows. Only one of these samples is thoroughly good and clean, and only two of them escape condemnation. The other three were excessively dirty, so dirty as to be unwholesome ; and one of them contained large quantities of pus (" matter ") from abscesses in the udder. The other twenty samples were all obtained from milk sellers not keeping their own cows, but who retailed milk received from the country. Of these twenty samples only six were thoroughly satisfactory, or, in other words, 70 per cent. were not satisfactory, and four (or 20 per cent.) contained the infective virus of tuberculosis. Summarising the whole twenty-five samples under the three headings selected by Dr. Foulerton, it appears that only 28 per cent. were satisfactory. Forty per cent. were " suspiciously " or " excessively " dirty. Sixteen per cent. were tuberculous milks.* Seven milks contained the infective agents of inflammatory disease. I agree with Dr. Foulerton that it would be unjust to assume that these unfavourable results represent the conditions of the Finsbury milk supply generally. They do, however, reveal a somewhat grave state of affairs, and one which, I venture to think, calls for action on the part of the Borough Council, especially in view of the recent findings of the Royal Commission on Tuberculosis as to the danger of using tuberculous milk. * It may be convenient to state here that milk placed on the market in this country has been reported frequently to contain the tubercle bacillus, in some investigations as much as 14 per cent. of the milks sampled being found to be tuberculous. The most recent returns have been those recorded in the City of London in 1906, when eight per cent. were found tuberculous; and in Liverpool, from 1896-1905, of all country milks sampled, 6.5 per cent. were found to be tuberculous. In Finsbury, in 1903, '25 samples were examined, and yielded no bacilli of tubercle. 90 SALE OF FOOD AND 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 1907 the Inspectors collected 603 samples, of which 52 (or 8.6 per cent.) were adulterated. There were 28 prosecutions under the Acts, the aggregate amount of tines and costs inflicted being £94 7s. 0d. In 1906, 12.4 per cent. of the samples were found to be adulterated, and there were 33 prosecutions. The samples collected were as follows:— Samples taken Adulterated. Samples taken. Adulterated. Milk 329 38 Olive Oil 1 - Butter 96 8 Chocolate 1 — Camphorated Oil 13 2 Cream of Tartar 2 — Cheese 13 — Sweets 8 — Margarine 1 — Gregory Powder 5 — Cocoa 17 — Flour 4 — Coffee 28 2 Tapioca 6 — Demerara Sugar 6 2 Ground Ginger 1 — Coffee and Chicory 1 — Malt Vinegar 1 — Jam 9 — Custard Powder 1 — Lard 11 — Quinine 3 — Mustard 21 — Cocoa Mixture 2 — Pepper 20 — Totals 603 52 Yellow Crystals 3 — The quarterly returns respecting all samples taken in 1907 were as follows:— 91 Quarter of the year. No. of Samples taken. No. of Samples Adulterated. Percentage Adulterated No. of Prosecutions Instituted. Fines and Costs. £ s. d. 1st 130 8 6.1 4 34 15 6 2nd 162 21 13.0 4 7 8 6 3rd 145 13 8.9 12 22 14 6 4rh 166 10 6.0 8 29 8 6 Total for year 603 52 8.6 28 94 7 0 The method af sampling adopted is as follows: (a) 500 ordinary samples, including milk; (b) 100 extra samples of milk only. As will be seen by the above table, the 500 ordinary samples include milk, butter, cheese, coffee, mustard, popper, etc. 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. 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 1907 was 21.0, as compared with a percentage of 6.5 in the ordinary samples. For convenience, I append a summary of the samples taken under the Food and Drugs Acts and examined during the year 1907, and a table comparing these figures with those of the six previous years:— Year. Total Examined. Genuine. Adulterated. Percentage of adulterated samples. Percentage of adulterated samples for whole of London. 1901 50I 413 88 17.56 11.4 1902 556 475 81 14.56 11.9 1903 610 524 86 14.10 10.8 1904 610 537 73 11.96 10.2 1905 620 547 73 11.77 10.2 1906 602 527 75 12.42 12.1 1907 603 551 52 8.62 Not yet available. 92 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); but since that date only one or two registrations have been made each year. RESTAURANTS, FOOD STALLS, ICE CREAM, &c. The annual inspection of restaurant kitchens, etc., took place during the summer. There is a total of 268 such places in which about 400 men and 600 women are occupied in the preparation of food. These figures do not include waiters and waitresses, but only persons actually engaged in the preparation of food. In some cases such employees live on the premises. By the courtesy of proprietors I am able to say that the number of persons using restaurants in Finsbury daily is 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 1906 265 134 50 1907 268 149 55 93 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. 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 1907 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. There are now 90. These places have been periodically inspected and the regulations enforced. 94 D.-THE HOUSING QUESTION. The housing policy of the Finsbury Borough Council was set out in detail in my Report for 1901. One portion of that policy concerned the work of the London County Council, under Part I of the Housing of the Working Classes Act, 1890. The other portion had to do in the main with Part II of that Act and the sanitary improvement of house accommodation generally. The Housing Problem became most acute in Finsbury during the last quarter of last century, and in my former Reports I have dealt in some detail with the attempts which have been made at solution. The evil condition of things formerly existing was revealed at the time of the Royal Commission on the Housing of the Poor in 1885, and in various Reports of the two Vestries of Clerkenwell and St. Luke, and I need not therefore discuss that side of the question. The attempts at solution were mainly three. First, by representation to the London County Council in 1897, and the taking over by that Council of various extensive and highly insanitary areas; secondly, somewhat similar work of the Borough Council in small areas; and thirdly, the work of the Borough Council in sanitary improvement and reduction of overcrowding. 1. The areas undertaken by the London County Council formed two schemes, namely, the Aylesbury Place Area Scheme and the Garden Row Area Scheme. The latter included 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 held in respect of the Garden Row Areas in 1899, the inquiry was held in 1900, and closures commenced in 1901. 95 The state of affairs existent at the time of condemnation may be set out as follows:— Five Years, 1895—1899. Houses. Population. Death Rate per 1,000. Deaths of Children under 5 years. Percentage on Total Deaths. Aylesbury Place Area 73 511 36.4 — Garden Row 69 407 42.2 55 Roby Street 50 218 32.5 53 Baltic Street 55 351 42.1 44 Honduras Street 17 217 40.5 35 Totals 264 1704 — — The present position (1908) is that all these areas have now been cleared, and, with the exception of Honduras Street, which is not completed, the houses have been demolished. These operations were prolonged and tedious, but it can at last be said that completion is at hand. Upon the 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 6s. 6d. to 10s. 0d. per week. 96 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 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 numberas the Buildingswill 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) have been erected in St. John Street, adjoining the Aylesbury Place Area. Excavations were commenced on September 20th, 1904, and the buildings are now completed and inhabited. 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. This block accommodates about 164 persons. In addition there are 5 ground floor shops without living rooms. On the Garden Row Area new dwellings (Chadworth Buildings) have also been erected. They consist of eight blocks, containing 1 tenement of five rooms, 10 of four rooms, 67 of three rooms, and 58 of two rooms, making 136 tenements and 362 rooms. These buildings are finished, and accommodate some 500 persons. Rentals vary from 6s. Od. to 10s. 6d. There are 19 lock-up shops on the ground floor, four of which have back parlours. It may therefore be said in general terms that from 1900 to 1907 some 1,700 people were displaced from these areas and new accommodation was provided for nearly 1,100. The persons re-accommodated were not of course as a rule the persons displaced. In addition to the advantages of the new and better accommodation there was of course the disappearance of the "open sores" of insanitation and degeneration. II. Attention has also been devoted by the Borough Council to small insanitary areas unsuitable for treatment by the London County Council under Part I. of the Housing of the Working 97 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 enforceable 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 procedure to be adopted must depend upon a variety of circumstances. In some cases it is preferable to proceed under the Housing Act (Part II.), in other cases under the Public Health (London) Act, which is also, of course, enforceable by the Local Authority. These two Acts furnish the Borough Council with considerable powers, of which it should continue to avail itself if necessary. Before advising the Council to put these powers into force, during the past seven years I have made it my duty to see the owner in cases of insanitary property, and have fully set before him or his solicitors the various defects of the property. Further, I have pointed out, where necessary in unmistakable terms, that unless the owner himself would sufficiently repair or close the properties in question, it would be necessary for me to proceed under the Acts 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 repairs rather than the Local Authority. This is, in my judgment, as it should be. Property has its duties as well as its rights. In the event of non-compliance or non-acceptance of responsibility for the insanitary conditions existing, it would, of course, be necessary for me to advise the Borough Council to proceed with strictness against such owners. In this way we have dealt with eight smaller insanitary areas, displacing upwards of 500 persons, and calling upon owners either to 98 clear the area or improve very radically the conditions existing. Details of this work will be found in my Reports (1901-1906). III. There has been carried out a large amount of house sanitation and an enormous reduction in overcrowding. The latter work was mainly undertaken from 1901—1905, and was made possible, as indeed was the whole of the housing work of the Council, by the zeal and determination of the Public Health Committee. Nothing short of that could have brought about the great changes which have undoubtedly taken place since the Borough Council was established. The former work (namely, the maintenance of a higher standard of house property) began in 1901 and has continued ever since. The chief directions it has taken have been (a) in the registration and inspection of houses let in lodgings; (b)house to house inspection; (c) the improvement of certain streets, courts and alleys; (d) the routine attention paid to overcrowding; and (e) the minor work possible in the maintenance of sanitation in stable dwellings, "underground" rooms, and model dwellings. (a) Houses let in Lodgings, etc.—When the Borough was formed there were a number of houses let in lodgings, registered under Bye-laws of Section 94 of the Public Health (London) Act, 1891. Bye-laws first came into force in this district in 1897, and from that year to 1900 the total number of houses registered in all the constituent parts of the new Borough was 327. During 1901 new Bye-laws had to be framed. After considerable discussion and amendment these Bye-laws were ratified by the Local Government Board in November, 1901, and then became law. 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, 99 The following table sets out the number of houses placed on, and removed from, the Register since 1900:— Year. No. placed on Register. No. Removed. On Register at end of Year. 1900 - - 327 19O1 — — 327 1902 612 — 939 1903 170 — 1,109 1904 52 30 1,131 1905 45 7 1,169 1906 111 26 1,254 1907 — 21 1,233 The total number of houses now registered is therefore 1,233 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. (b) House to House Inspection is a second means for attaining the ultimate object of sanitation in house property. By this arrangement houses, whether registered or not, are periodically inspected and a complete sanitary survey thus carried out. Each inspector undertakes this work in his own sanitary district. When sanitary defects are present notices are at once served for their repair. The facts obtained are entered in the House Record Book. In this register are particulars as to owner, mode of occupation, cubic space, conditions of sanitation, drainage, etc. This record is constantly of service in the work of the Department, and of considerable permanent value. During 1907 the systematic house inspections thus made numbered 806, as against 1,341 in 1906. Out of the total number inspected 406 or 100 50.4 per cent. were found to have sanitary defects. These houses were situated in the streets shown in the following table:— Street or Buildings. No. of houses or occupancies inspected. No. of houses in which defects were found. Percentage of houses with defects to houses inspected. No. of families living in One room. Two rooms. Three rooms. Four rooms & over. Bartholomew's Buildings 93 35 37.6 20 45 22 6 Busaco Street 36 19 52.7 27 25 l6 17 Collier Street 16 7 43.7 1 11 7 7 Corporation Row 20 6 30.0 1 12 14 4 Central Street 13 7 54.0 6 10 4 6 Church Row 8 7 87.5 2 13 - 5 Chapel Place 13 7 53.8 7 5 2 5 Dingley Road 14 14 100.0 14 10 5 6 Dufferin Street 25 4 l6.0 6 10 9 — Dundee Buildings 22 6 27.2 — 22 - — Eagle Dwellings 31 12 38.7 — 15 12 4 Elizabeth Place 9 6 66.6 7 7 2 — Galway Street 15 13 86.6 12 16 10 1 Godson Street 13 8 61.5 15 24 9 4 Helmet Row 15 10 66.6 18 8 8 6 Ironmonger Row 8 8 100.0 13 7 7 — James Gardens 15 15 100.0 54 21 - — Lever Street 23 16 69.5 15 10 4 17 Lever Street Buildings 12 1 8.5 5 — 5 1 Langton Avenue 10 10 100.0 - 9 9 1 Little Sutton Street Buildings 50 26 52.0 8 39 1 - Macclesfield Place 17 12 70.6 - 17 - - Macclesfield Street 14 10 71.4 5 9 3 8 Moreland Street 21 19 90.5 11 12 5 13 Muriel Street 9 5 55.5 3 8 3 3 Norman's Buildings 6 6 100.0 4 7 2 1 New Buildings 10 6 60.0 2 9 — — Pump Court 9 4 44.4 14 4 1 1 Peerless Buildings 72 15 20.8 — — 60 12 Peabody Buildings 62 13 20.9 8 22 22 — Radnor Street 8 8 100.0 6 14 5 1 Rodney Place 15 15 100.0 7 16 6 2 Risinghill Street 5 5 100.0 30 10 — — St. James's Street 11 2 18.1 46 11 4 — Smithfield Buildings 20 7 35 .0 - 20 - — Sidney Place 15 15 100.0 7 12 3 2 Winchester Street 10 7 70.0 8 8 2 2 Winchester Cottages 6 1 16.6 6 2 — 4 Wilmington Place 8 5 62.5 15 7 — — Weston Street 12 5 41.6 5 16 4 5 Other Streets in which less than five houses per Street were Inspected 15 12 75.0 5 12 3 — Totals 806 406 50.3 414 535 270 148 101 (c) In various parts of the Borough extensive improvement has taken place in the repair and sanitation of houses. (d) 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 54 cases, however, overcrowding has been reduced. This figure does not include 67 other cases of overcrowding abated in registered houses. Total 121. (e) To the list of "Model Dwellings" appearing in my Report for 1906, in pp. 182-183, must be added Chadworth Buildings, in Lever Street, built in 1907, and accommodating 509 occupants, making the total number of "blocks" in model dwellings in Finsbury 212, containing 4,251 tenements, and accommodating 17,133 persons, or nearly one-fifth of the total population of the Borough. The Common Lodging Houses now number six, as follows:— Address. Registered Owner. Registered Number of Occupants. Average Attendance. Pentonville Road, 19-23 Mrs. Shuttleworth 97 78 White Lion Street, 57 Do. 97 60 Clerkenwell Green, 35 J. H. Claytor 73 68 St. John's Lane, 34 Mrs. Hensman 48 33 Old Street, 97 Wm. Cragg 84 75 Banner Street, 6 Church Army 140 130 Totals 539 444 102 These Common Lodging Houses have been visited and inspected on various occasions during the year. 1 here are no Salvation Army Shelters in Finsbury. Three Common Lodging Houses (with accommodation for 176 persons) have been closed in the last five years. Under Sections 96 and 97 of the Public Health (London) Act, 1891, there have been six illegal occupations of underground rooms abated. In a large number of other instances re-adjustment in the house has reduced the illegal occupation. During the year an inquiry has been made into the number anc 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. Total. Adults. Children. Claremont Mews 13 37 19 56 Holford Yard 2 8 1 9 Holford Mews 3 4 s 9 Jay's Buildings 16 34 39 73 Garnault Mews 1 2 — 2 Sidney Grove 42 77 68 145 Baker's Row 1 5 4 9 14, Clerkenwell Close 1 3 — 3 93A, Charterhouse Street 1 2 1 3 Charterhouse Mews 2 4 3 7 1, New Court, Peters' Lane 1 2 2 4 82, Bath Street 1 2 1 3 119, Lever Street 1 6 1 7 Davis' Yard 1 3 3 Totals 86 189 143 333 103 Under the Customs and Inland Revenue Act, 1890 (Sect. 26), 3 certificates for exemption from Inhabited House Duty have been granted for Albany House (144, King's Cross Road), the flats in Mitchell Street (24-26 and 26-28), and Chadworth Buildings. Conclusion.—No one can study the extraordinary changes which have been taking place in Finsbury since 1901 without arriving at two fairly definite conclusions. In the first place there has been a decline in population, due to various reasons. An immense improvement in the means of transit * is fast revolutionising Finsbury and Central London generally; th : vigorous reduction of overcrowding and the displacement of persons from insanitary property is reducing the population ; and more than all else probably the invasion of Finsbury by commerce is profoundly altering its constitution in regard to the number and character of the population, and in that way profoundly modifying the problems of local government, which must now be faced. In the second place, there has been a substantial improvement, from a sanitary point of view, in the house accommodation of the people. Many old slums have vanished altogether, many others have been improved, and gross overcrowding has been reduced. In 1905 and 1906 vacant accommodation was found to exist in Finsbury for not less than 5,000 persons (2,196 empty rooms in 1906, 2,284 in 1905), which means definite relief to the densely congested areas of ten years ago. These changes are, on the whole, of good import and cannot fail to exert a direct and indirect effect upon vitality and mortality in Finsbury. They are due, in the main, to the invasion of commerce, the improved transit, and the action of the Borough Council in regard to its housing policy. * 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 South London to the "Angel," which is now extended to King's Cross; the new tramways down Rosebery Avenue, Clerkenwell Road, Old Street, Goswell Road, St. John Street and Pentonville; 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). 104 E.—FACTORIES AND WORKSHOPS. The Factory and Workshop Act, 1901, came into force at the beginning of 1902, and placed 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 1907 in relation to workshops or workplaces. The only exceptions arc restaurants, sweet-shops, and milk-shops, which come more suitably in the section of the Report dealing with the Protection of 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 of 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, 58,669 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. 105 Occupations of Persons in Finsbury over 10 years of age. Males. Females. Total. Percentage on Adult Population. i. General or Local Government 942 43 985 1.2 ii. Defence of the Country 127 — 127 0.2 iii. Professional Occupations 787 559 1346 1.7 iv. Domestic and Hotel Service, Charwomen and Laundresses 738 4117 4855 6.2 v. Commercial Occupations 1610 291 1901 2.4 vi. Conveyance of Men, Goods, &c. 6863 173 7036 8.9 vii. Agriculture, Nurserymen and Florists 35 53 88 0.1 viii. Mines and Quarries 66 7 73 0.1 ix. Metals, Machinery, &c. 2613 213 2826 3.6 x. Jewellery, Watchmaking, &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 58I 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 366 Totals 38353 40024 78377 100.0 106 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 summarise the various premises in the Borough where work is done which are now registered in the Public Health Department:— Workshops and Workplaces 1923 Factories 717 Bakehouses 61 Restaurant Kitchens, &c. 268 Ice-cream Premises 90 Home Workers 360 Stables 500 Total 3919 The following Table shows the various trades and occupations carried on in the workshops and workplaces now on the Register:— 107 Workshops and Workplaces in Finsbury on Register. Clocks and Watches 120 Timber-yards, &c. 12 Jewellery 91 Trunks, Bags and Portmanteaus 12 Cabinet Making, Polishing, &c. 68 Upholstery 12 Tailors and Clothiers 68 Electrical Goods 11 Engravers, Embossers and Chasers 63 Sign and Ticket Writing, &c. 11 Opticians 10 Stables, &c. 60 Pianos, Organs, &c. 10 Underclothing, Shirts, Skirts, Blouses, &c. 48 Tin-plate Workers, &c. 10 Umbrella-making 10 Leather Goods 46 Athletic Goods 9 Building Trades 44 Basket-workers 8 Gold and Silversmiths, &c. 43 Children's Clothing 8 Millinery 42 Gold-blockers 8 Fancy Goods, Toys, &c. 41 Harness-making 8 Furriers and Skin Dressers 40 Photographic Goods and Work 8 Provisions, Bacon, &c. 40 Wine and Spirit Stores 8 Hats and Caps 34 Cycles and Motors 7 Boots and Shoes 33 Wood Carvers 7 Engineers, Machinists, &c. 31 Bedding and Bedsteads 6 Gilding and Plating 31 Rubber Goods 6 Box Making 29 China and Earthenware 5 Glass Workers, &c. 29 Confectionery 5 Picture-frames, Mouldings, &c. 28 Firewood-choppers 5 Ties, Scarves and Belts 27 Lamps 5 Iron and Metal Workers 26 Pleating 5 Mantles and Costumes 25 Tailors' Busts, &c. 5 Stick-mounting and Making 25 Woollen Goods 5 Coach Builders, Wheelwrights, &c. 24 Automatic Machines 4 Cloth-workers 4 Ironmongery and Hardware 23 Cork Goods 4 Druggists, Perfumers, &c. 22 Enamelling and Japanning 4 Farners and Smiths 22 Glaziers' Diamonds 4 Feather-workers 22 Linen Collars 4 Laundries 21 Mount-cutters 4 Artificial Flowers and Plants 19 Pens and Pencils 4. Packing-case Making 19 Pipe-makers and Mounters 4 Jewel and Instrument Cases 18 Plaster-cast Makers 4 Book and Card-edge Gilders 17 Rag and Paper Waste 4 Paper and Cardboard 17 Scales and Balances 4 Shop-fitting, Show-cases, &c. 17 Wood, lvory and Bone Turners 4 Stationery, &c. 16 Locksmiths 3 Brush-making 15 Marble and Stone-workers 3 Embroidery and Lace 15 Phonographs, &c. 3 Instrument Makers 15 Saw-makers 3 Barometers and Thermometers 14 Saw-piercing 3 Brass-workers 14 Stamp and Die-cutting and Sinking 3 Christmas and Post Cards 14 Coppersmiths, &c. 14 Miscellaneous 107 Dressmaking 14 Wire-workers 14 Total 1923 Ink, Paint, Gum, &c. 12 In 1903 we instituted a factory register which, though not a statutory requirement, proves of considerable value. 108 The following table shows the various trades and occupations carried on in factories in the Borough of Finsbury which are now on the factory register of this Department. Factories on Register. Printers and Stationers 136 Horse-hair, Feathers, &c. 6 Engineers, Machinists, &c. 78 Ink, Paint, Varnish, &c. 6 Shirts, Skirts, Blouses, &c. 37 Instrument Cases, &c. 6 Gilding and Plating 34 Mantle-making 6 Book-binders, &c. 31 Pipe-making and Mounting 6 Jewellery, Silversmiths, &c. 29 Silk Weaving. &c. 6 Boxes and Paper Bags 25 Cloth-workers 5 Stick Making and Mounting 22 Laundries and Collar Dressers 5 Glass Workers 20 Pianofortes, &c. 5 Provisions, Bacon, Grocery, &c. 16 Shop-fitting, &c. 5 Ivory, Wood, &c., Turners 15 Type-founders, &c. 5 Cabinet-making 14 Brushes 4 Foundries 14 Cocoa, Confectionery, &c. 4 Scientific and Surgical Instruments 13 Corn, Forage, &c. 4 Brass and Copper Workers 12 Distilleries 4 Wheelwrights 10 Rubber Goods 4 Clock-makers 8 Packing-case Making 4 Cycles and Motors 8 Iron and Tin-plate workers 3 Joinery and Saw-mills 8 Paper Goods 3 Leather Goods 8 Pens and Pencils 3 Cigars, Cigarettes and Tobacco 8 Saw-making 3 Drug-grinding, &c. 7 Sports Goods 3 Engraving, &c. 7 Miscellaneous 79 Picture-frames, &c. 7 Total 753 Wire Workers 7 109 The difference between the above total (753) and the number of factories on the register (717) is accounted for by the various businesses carried on in the tenement factories. 1. Sanitary Condition of Workshops, &c. (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 maintain cleanliness in small sheds in back yards. Sometimes, too, the processes themselves are of a nature to make cleanliness difficult. Perhaps 30 or 40 per cent, of these workshops are open to criticism on account of uncleanliness. During the year, 145 workshops, out of 834 inspected, 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 1907 to be overcrowded. In only 5 cases has it been necessary to issue notices. In other cases a slight re-arrangement of workers has provided that each person shall have at least 250 cubic feet. In many of the large workshops the air space provided is liberal. (c) Ventilation.—It hns 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 thean 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 110 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 21 notices have been served for insufficient ventilation of workshops. In 11 other instances it has been necessary to serve notices requiring the provision of means for the carrying off of fumes from gas stoves, etc. Six notices have been sent to the Home Office in respect of factories and workshops which were not effectively heated, and three notices were sent in respect of insufficient ventilation in factories. (d) Drainage of Floors where wet processes are carried on.— The "wet processes" carried on in Finsbury, speaking generally, are small laundries, of which there are 21 on the register. In seven workshops and one factory, it has been necessary to require 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, but 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 fact that many of the 11l 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. 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, etc., and since the issue of the Order of the Home Secretary, 4th February, 1903, we have adopted that standard (approximately one for 25 persons) 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 1907 issued Notices in 33 instances. Since 1903 the total of such instances has been 144 plus 33, or 177. (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 455 such conveniences have been cleansed and repaired. Insufficient sanitary convenience accommodation includes live cases in which no convenience of any kind was provided, and in addition, in eleven cases the sanitary conveniences were being improperly used by the two sexes. Summary of Defaults and Defects in Factories and Workshops.—It may be desirable here to summarize the results of the year's work in regard to the sanitary condition of workshops, etc. During the year 3,645 visits of inspection have been made to factories and workshops by the Workshop Inspector, and 74 by the Lady Inspectors, a large amount of work being accomplished. In addition to this, the other inspectors in the ordinary course of their duties in their several districts have inspected 10 workshops. The chief matters arising in relation to this work are set out in the following table:— 112 Summary of Defaults and Defects in Factories, Workshops and Workplaces for which Notices were served during 1907. Workshops. Factories. Workplaces. Total. Dirty workshops and workplaces 145 — 2 147 Damp and dilapidated workshops, &c. 39 4 2 45 Dirty staircases, &c. 20 1 2 23 Overcrowded workshops 5 — — 5 Insufficient ventilation 21 — — 21 Fumes from gas stoves, &c. 11 — — 11 Drainage of floors 7 — — 7 No water supply 3 — — 3 Sanitary conveniences, cleansed 112 98 24 234 Sanitary conveniences, defects remedied 112 95 14 221 No sanitary convenience 3 — 2 5 Insufficient sanitary convenience accommodation 9 6 2 17 Improper use of sanitary conveniences by two sexes 8 3 — 11 Defective soil pipes 2 1 1 4 Yaids cleansed, paved, or paving repaired 25 3 5 33 Defective sinks and gullies 41 27 3 71 Water-cisterns dirty and defective 15 8 3 26 Accumulations of refuse 7 4 2 13 Dustbins defective or absent 74 14 2 90 Drainage defective 17 13 13 43 Rain-water pipes defective, &c. 7 2 6 15 Areas undrained — 1 2 3 Stables in need of limewashing 2 2 6 10 Stable paving or drainage defective 1 — 5 6 Totals 686 282 96 1064 113 During the year further progress has been made with the systematic suivey of the workplaces of the whole Borough, which forms at present the major part of the Workshop Inspector's duties. The factories, workshops and workplaces in an area bounded by Goswell Road on the east, Clerkenwell Road on the south, and St. John Street, Corporation Row, Bowling Green Lane, and Farringdon Road on the north-west, have been inspected. The following table concerning this area, shows some results of the work done:— No. on Registers, 1906. No. added to Registers, 1907. Total No. on Registers. Nuisances, &c., Found. Intimation Notices Issued. Statutory Notices Issued. Notices to Home Office. Factories 44 157 201 119 67 2 25 Workshops 286 181 467 372 211 27 60 Workplaces 3 39 42 27 17 2 — TOTALS 333 377 710 518 295 31 85 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 under-ground. They are regularly inspected, 113 visits having been paid by the Inspectors during 1907. 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 inspection of outworkers' premises during 1907 has been carried out by the Lady Sanitary Inspectors, and the result is set out in the table on p. 116. It will be seen that 214 home-workers' premises have been inspected, and 114 that 27 men and 217 women were found to be engaged in home work. Of the 27 men, about half were tailors, and the remainder were shoe-makers, umbrella makers, etc. Of the 217 women, 75 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 thel want of employment, or low wages, of the husband; a certain number of young married women and elderly married women, with few home duties, woirk 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. The Council's duties in regard to the home work provisions of the Factory and Workshop Act, 1901 (Sections 107-114), concern four points, viz.:—(1) outworkers' lists, (2) the communication of the addresses of outworkers to other districts, (3) the supervision of home workers' premises as regards insanitation and infectious diseases, and (4) the transmission to the Home Office of a copy of the Annual Report. In regard to (1), (2) and (4), comment is unnecessary. It may, however, be noted, that we receive the second largest number of names of outworkers in London, and we send out to other Authorities the second largest list under requirement (2), which of course entails a large amount of labour on the clerical staff. In regard to (3), it should be stated that less than 6 percent. of the homes of outworkers in Finsbury were found to be "insanitary," and, even then, the defects were minor ones. Cases of infectious disease are rare, and when occurring are at once removed to hospital. Three cases of scarlet fever and two of diphtheria, occurred in outworkers' homes during 1907. No case of infectious disease has been allowed to remain in the home of an outworker. In consequence of these facts the requirements of the law in Sections 108110 have again remained unused this year in Finsbury. From the table following, it will be seen that about 86 per cent. of the home workers live in 1, 2 or 3 room tenements, and many being married women with families, 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. 115 The work in many of the occupations is very irregular, such as the making of artificial flowers, millinery, fur lining, etc., and only occurs during short seasons of the year. Much of the work made in the homes of Finsbury is cheap and commands a low price, nevertheless, the home workers on the whole compare 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 visited were as follows:— Box and bag making 58 Tailoring 24 Artificial flower making 22 Tie, brace and belt making 18 Blouse, shirt, mantle, etc., making 16 Umbrellas 11 Millinery 10 Ladies' and children's outfitting 9 Shoe-making 9 Fur-lining, etc. 6 Various 30 214 In the following table are set out some of the particulars and figures relating to the inspection of home workers' premises during 1907. 116 OUT-WORKERS. Number of out-workers' premises visited 603 Number of visits made First visits 603 684 Re-visits 81 ,, ,, home-workers 214 „ ,, out-workers' workshops 19 Number in which wrong address was given or out-worker had removed 389 HOME-WORKERS. Particulars relating to work in 214 homes. Number in which work was done in work-rooms 21 ,, ,, „ ,, living-rooms 69 „ „ „ „ bed-rooms 13 „ ,, ,, ,, bed and living-rooms 111 214 ,, of cases in which room was clean 122 ,, „ ,, ,, in fair order 80 „ „ „ „ dirty 12 214 „ of one room tenements 50 „ of two „ „ 98 ,, of three „ ,, 40 „ of four or more „ 26 214 ,, of persons working as home-workers Men 27 Women 217 244 IV. Outworkers' Lists. Under Section 107 of the Act, employers in certain industries, namely: (a) making, cleaning, washing, altering, finishing and repairing of wearing apparel; (b) ditto for lace, lace curtains, and nets; (c) cabinet and furniture making and upholstery work; (d) electro-plating; (e) making of files; (f) fur-pulling; (g) making of cables and chains; (h) making of anchors and grapnels; (i) making of cart gear; (j) making of locks, latches and keys; (k) making, etc., of umbrellas; (l) making of artificial flowers; (m) making of nets; (n) making of tents; (o) sack making; (p) racket and tennis ball making; (q) paper bag making; (r) paper, chip and cardboard box making: (s) brush making; (t) pea picking; (u) feather sorting; 117 (v) carding, boxing, etc., of buttons, hooks, pins, etc.; (u) making of stuffed toys; (x) basket making; and any processes incidental to the above; 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 1907, we liave received 295 lists from 160 employers, most of whom have acted in accordance with the Act; 135 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 these lists have been composed of 6,003 names of outworkers. This number will be approximately double the actual number of workers, as in the lists for February 1st and August. 1st, the same outworker's name will often be repeated. The 97 lists received February 2nd to June 30th were practically all "first lists" due on February 1st, and the 65 lists received August 2nd to December 31st, should have been sent in not later than August 1st. So that, out of 295 lists, 133 were received at the statutory periods. In previous years we have found it necessary to issue summonses to enforce more accurate returns. In 1907 we have not prosecuted in any case, but in the second half of the year we sent out "reminder" post-cards to all the firms from whom lists were due, with the result that many more lists than usual were received at or about the proper date for their receipt. These lists received have chiefly been, from firms concerned in the making or preparing of wearing apparel (section a). A few lists have been received under sections (c), (d), (k), (l), (q), (n), and (s), but the other sections have furnished no iists. We have received 116 lists of outworkers from other Local Authorities in whose districts outworkers are employed who live in Finsbury. In this way we have obtained the names and addresses of 835 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 1901, 1905 and 1906:-- 118 Lists received from Employers. 1904. 1905. 1906. 1907. Number of Lists. Number of Outworkers. Number of Lists. Number ot Outworkers. Number of Lists. Number of Outworkers. Number of Lists. Number of Outworkers. Jan. 1st to Feb. 1st 22 616 23 760 68 1744 47 1273 Due Feb. 1st Feb. 2nd to June 30th 59 1549 87 1605 56 1164 97 1770 July 1st to Aug. 1st 24 725 46 1297 33 934 86 1904 Due Aug. 1st. Aug. 2nd to Dec. 31st 63 1199 59 1026 87 1911 65 1059 168 4089 215 4688 244 5753 295 6003 Lists received from other Local Authorities 62 152 90 488 76 449 116 835 Lists dispatched to other Local Authorities 845 3891 841 4474 527 5297 476 5353 119 In the course of the year the Home Secretary issued a new Home Work Order (May 23rd, 1907), which superseded the Order of the 15th August, 1905, and extended the provisions with regard to lists of outworkers, employment in unwholesome premises, and prohibition of home work in places when there is infectious disease to certain additional trades, which are printed in italics below. This new Order came into operation in July, 1907. METROPOLITAN BOROUGH OF FINSBURY. Factory and Workshop Act, 1901. The home Work Order of 23rd May, 1907. In pursuance of 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:— The making, cleaning, washing, altering, ornamenting, finishing, and repairing of wearing apparel; 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 malting of files; Fur-puliing; 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 or repairing of umbrellas, sunshades, parasols, or parts thereof; The making of artificial flowers; The making of nets other than wire nets; The making of tents; The malting or repairing of sacks; The covering of racquet or tennis balls; The making of paper bags; The making of boxes or other receptacles or parts thereof made wholly or partially of paper, cardboard, chip, or similar material; 120 The making of brushes; Pea picking; Feather sorting; The carding, boxing, or packeting of buttons, hooks and eyes, pins, and hair pins; The making of stuffed toys; The making of baskets; And any processes incidental to the above. II. 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 or repairing of umbrellas, sunshades, parasols, or parts thereof; The making of artificial flowers; The making of nets other than wire nets; The making of tents; The mak ing or repairing of sacks; The covering of racquet or tennis balls; The making of paper bags; The making of boxes or other receptacles or parts thereof made wholly or partially of paper, cardboard, chip, or similar material; The making of brushes; Pea puking; Feather sorting; The carding, boxing, or packeting of buttons, hooks and eyes, pins, and hair pins; The making of stuffed toys; The making of baskets; And any processes incidental to the above. 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. 121 3. This Order may be referred to as the Home Work Order of the 23rd May, 1907. 4. The Home Work Order of the 15th August, 1905, is hereby revoked. H. J. Gladstone, One of His Majesty's Principal Home Office, Whitehall, Secretaries of State. 23rd May, 1907. 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, etc.; (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, thel 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 1906, there were on the register, 1,843 workshops and workplaces. During 1907, 263 workshops and 40 workplaces, or a total of 303, were added, 223 were removed as obsolete entries, leaving a total now om the register of 1,923. In regard to the employment of women in factories and workshops it may be said that there are 104 workshops in which women only are employed, and 490 in which both men and women work together, giving a total of 7,094 women. In 361 factories there are 11,881 women employed. 122 The following tables set out in brief summary form the work done with respect to inspection, registration, and the investigation of complaints:— Inspection, Registration, &c. Workshops and Workplaces— Workshops and Workplaces on Register at end of 1906 ... 1843 Workshops placed on Register during 1907 263 Workplaces „ „ „ 40 Total addition, 1907 303 Workshops and Workplaces removed from Register, 1907 223 80 Total on Register end of 1907 1923 Factories— Factories on Register at end of 1906 ... 561 ,, placed on Register during 1907 193 ,, removed from Register during 1907 37 156 „ on Register at end of 1907 717 Factories—Inspections 365 Re-visits 502 Workshops—Inspections 837 867 Re-visits 1348 2185 Workplaces—Inspections 199 Re-visits 478 677 Total Inspections 1401 Total Re-visits 2328 3729 Complaints Received and Investigated— Personal 19 Anonymous 16 Home Office 25 Per London County Council 5 65 Number verified 58 „ not verified 7 123 The following table is a record of the communications between this Department and the Home Office, under the Factory and Workshop Act, 1901, and the Public Health (London) Act, 1891:— Home Office Certificates, &c.— Notices received re existence of workshops (Sec. 127, Sub-Sec. 3) ... 110 Complaint Notices (Sec. 5) ... 25 Lime washing needed 9 Sanitary conveniences 13 Overcrowding 1 Insufficient ventilation 2 Total defaults, &c. 25 Notices sent to Home Office Inspectors 106 Re Factories— No abstract of Act, &c. 19 Lack of means for heating 1 Lime washing needed 10 Drainage of floor 1 Dangerous machinery 1 Insufficient ventilation 3 Dangerous trade (Sec. 75) 1 Total defaults, &c. 36 Re Workshops— No abstract of Act, &c. 63 Lack of means for heating 5 Illegal employment (Sec. 24) 1 Domestic workshops 3 Total defaults, &c. 72 108 124 VI. Legal Action. During 1907 we have issued 489 intimation notices respecting factories, workshops and workplaces, and 81 statutory notices. In 4 instances it has been necessary to issue summonses. The results were as follows:— Date. Name and Address of Defendant. Offence. Result. Jan. 4 James Baker, Bydorp House, Hanwell. Amending w.c. without first giving written notice under Bye-laws at 35, Clerkenwell Road. Withdrawn on payment of 25s. costs. June 6 H. J. Tyler, 346, City Road, E.C. Failing to clear a choked drain at 2, Howard Buildings, Central Street. With drawn, work done and 23s. costs paid. Oct. 10 T. A. Smith & Co., Ltd., 3, Robin Hood Court, E.C. Partially constructing a drain in such a manner as to be a nuisance at 93, Cowcross St. Fined £3 and 2s. costs. Oct. 11 T. A. Smith & Co., Ltd., 3, Robin Hood Court, E.C. Partially constructing a drain at 93, Cowcross Street, without first depositing plans, &c. Fined £2 and 2S. COstS. Nov. 8 Henry Hemingway, 5, Clerkenwell Close. Constructing 2 w.c.'s without first giving written notice as required by L.C.C. Bye-laws at 18-20, St. John Square. Fined £1 and 2s. costs. Nov. 29 Henry Hemingway. 5. Clerkenwell Close. Constructing 2 w.c.'s contrary to the L.C.C. Bye-laws at 10-20, St. John Square. w.c.'s amended. Fined 10s. and 2s. costs. VII. Special Enquiries. Anthrax.—We received notification of two cases of anthrax during the year. The first, on August 7th, occurred in the person of A.C., aged 20, of Hoxton, employed by Messrs. W. List & Son, 51, Bunhill Row. He was engaged in carrying hair after boiling or dyeing. The patient was admitted to St. Bartholomew's Hospital and made a good recovery. The second case was that of a girl, A.J., aged 15½ years, an apprentice to dressmaking at the Haberdashers' School, Hoxton. On September 10th she and her uncle were playing outside their house when her neck was accidentally scratched by her uncle's finger-nail. The uncle has worked for Messrs. List & Son, 125 Bunhill Row, for the last fourteen years, but neither he nor any of his family have ever had anthrax. The patient was admitted to St. Bartholomew's Hospital. Trade Nuisances.—Five cases occurred during the year in which complaint was received of nuisance or annoyance arising from the manner in which certain businesses were conducted. Section 23 (2c) of the Public Health (London) Act, 1891, provides that no person shall carry on "any trade or business which occasions any noxious or offensive effluvia or otherwise annoys the neighbourhood or inhabitants, without using the best practicable means for preventing or counteracting such effluvia or other annoyance." The first case was one in which a ventilating fan discharged air laden with offensive fumes from a gas-producer plant situate in a basement occupied as a paper goods factory. In the second case, complaint was made of fumes arising in the process of mixing ingredients for electrical insulator making; the lower part of the premises being a factory and the upper part occupied as tenements. In both these cases improvements in the means of ventilation removed the cause of complaint. The third case was one in which a fan, used to exhaust the air from a basement in which gorgonzola cheese was stored, was fitted about 6ft. above pavement level, near the entrance of a narrow courtway. Complaint was made by neighbouring occupiers of the offensive smell, and the fan, was removed. In the fourth case, the exhaust outlet of a large gas engine was affixed to a factory wall in the rear of dwelling houses. The extension of the exhaust pipe obviated the nuisance caused by the noise and fumes. Lastly, complaint was made of a nuisance arising from petrol engines, which, while stationary and in a confined space, were run at high speed, producing offensive fumes from the burnt petrol end lubricant. The practice was discontinued. Such difficulties as these are almost bound to arise in a district such as Finsbury, in the transition stage between use for commercial and industrial purposes as distinct from residential. In no case dealt with during the year has it been necessary to have recourse to legal proceedings, as the persons responsible have been willing to take steps to remedy the nuisances when representations have been made to them by us. 126 F.—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 5f acres, a portion of which has a through communication with the River Thames on the one hand and the Midlands on the other. The major portion is a cul de sac with premises on either side occupied by various firms as factories, warehouses, and wharves, with a few residential houses. During the past year about 470 tons of sludge have been dredged out of the basin by occupiers of different wharves. It consisted in part of putrefying animal and vegetable matter, and was of an objectionable character. The carrying out of this work has made a great improvement in the condition of the several bays which have been dredged. There are two wharves at which boats load offensive cargoes, viz.:—22, Graham Street, and 26, Wharf Road. The former belongs to the Borough of Islington and the latter 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 21st December, 1906, I have to report as follows:— I.—The Canal Boats have been inspected by Inspector W. H. 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 the canal boats is included in the duties of the District Sanitary Inspector. 127 2.—The number of Canal Boats inspected during the year 1907 was 103 (17 being offensive cargo boats). There were 12 infringements of the Acts and Regulations, necessitating 7 complaint notes being sent to those responsible for the abatement of the same. Description of Boat. Number of Boats Inspected. Number of Infringements. Number of Complaint Notes Served. Offensive Cargo 17 — — Non-Offensive Cargo 86 12 7 Total 103 12 7 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 boats were working without a certificate in two cases, and in one the certificate was dilapidated. (d) Marking.—No infringement. (e) Overcrowding.—Two infringements. (f) Separation of the Sexes.—No infringement. (g) Cleanliness.—Two infringements. The cabins were in a dirty condition. (h) Ventilation.—No infringement. (i') Painting.—Three infringements. The repainting of the interior of the cabin was required in each case. (j) Provision of Water Cask.—No infringement. (k) Removal of Bilge Water.—No infringement. 128 (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 always been readily granted. In addition to the above the following defects have been met with and remedied:— 2 Deck heads leaky. 2 Cabin sides leaky. 1 Chimney defective. 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. The following table gives a comparison of the past eight 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.* 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 1906 101 217 28 29 274 327 1907 103 181 40 43 264 322 * The term children should be understood to include only those at ages as stated in the Regulations—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 boats are registered, and yet not infringe the Regulations, 129 Of the 103 boats inspected, it was found that 72 (including the whole of the offensive cargo boats) were occupied by men only. Among the 86 non-offensive cargo boats inspected, there were 29 occupied by women and children, and two 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. 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 under the Education Act of 1902 the Local 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 18 Public Elementary Schools (County Council), of which 13 were "Provided" and 5 "Non-provided." The total accommodation available is for about 17,897 children, and the number on the roll is 17,180, as follows:— 130 SCHOOLS. NUMBER ON ROLL. ACCOMMODATION FOR Boys. Girls. Infants. Mixed. Total. Boys. Girls. Infants. Mixed. Total. Provided. Albion Place 229 220 193 — 642 246 246 248 - 740 Ann Street 325 344 336 — 1005 334 334 425 — 1093 Baltic Street 212 210 175 — 597 240 240 320 — 800 Bath Street 467 453 570 — 1490 480 480 510 — 1470 „ „ Special — — — 73 73 — — — 60 60 Central Street 269 255 367 — 891 255 244 352 - 851 Chequer Street 273 284 300 - 857 355 355 363 - 1073 Compton Street 452 402 326 — 1180 420 420 428 — 1268 Hugh Myddelton— Senior 514 488 659 — 1661 600 600 806 — 2006 Junior — — — 796 796 — — — 813 813 Deaf — — — 108 108 — — - 144 144 Mentally Def. — — — 129 129 — — — 100 100 Moreland Street 362 359 455 — 1176 350 350 464 — 1164 Risinghill Street 455 471 472 — 1398 458 458 574 — 1490 St. John Street — 96 87 — 183 - 85 117 — 202 White Lion Street 321 328 324 — 973 302 302 312 — 916 Winchester Street 417 474 561 — 1452 412 460 512 — 1384 4296 4384 4825 1106 1461 4452 4574 5431 1117 15574 Non-Provided. Amwell Street 264 276 150 - 690 - - 117 444 561 St. Mark's, Brewer Street* - - 191 - 191 - - 179 - 179 SS. Peter and Paul - - - 291 291 - - 134 134 258 St. Joseph, R. C. 148 142 138 - 428 144 144 161 - 449 St. Luke 276 267 183 — 726 280 280 228 — 788 St. Mark, Old Street 114 81 48 — 243 119 101 47 — † 267 802 766 710 291 2569 543 525 866 568 2502 Totals— Provided 4296 4384 4825 1106 14611 4452 4574 5431 1117 15574 Non-Provided 802 766 710 291 2569 543 525 866 568 2502 5098 5150 5535 1397 17180 4995 5099 6297 1685 18076 * Closed during 1907. † Accommodation approximate only. 131 Sanitation in Elementary Schools. During the past year a systematic survey has been made by the Chief Sanitary Inspector of the sanitation of all the Elementary Schools in Finsbury. The total number of children on the roll is 17,180, and for these there are 386 sanitary conveniences. Most of these are of the "single" variety and of modern construction. In nine instances, however, they are "troughs." On the whole, these conveniences are properly maintained, and are in good order. In two schools they are without doors. Ventilation in all the 19 schools is "natural," and by no means as good as it should be in many of them. Cleanliness is fair throughout, and in some schools exceptionally good. During the year 185 visits were made by the Sanitary Inspectors to schools in the Borough to make inquiries respecting infectious disease, test drainage, supervise sanitary work, etc. The following works have been carried out:— Central Street School.—New wing for use of caretaker built and drainage for same constructed. Si. John Street School (Martyr's Memorial).—Drainage and sanitary conveniences reconstructed. SS. Peter and Paul School (Rosoman Street).—Drainage and sanitary conveniences reconstructed. St. Mark's School {Brewer Street North).—Drainage repaired. Infectious Disease in Schools. — During 1907 387 children were excluded from school on account of notifiable infectious disease, and 1,639 on account of non-notifiable disease, as follows:— 132 SCHOOLS. NOTIFIABLE. NON-NOTIFIABLE. Total. Scarlet Fever. Diphtheria. Enteric Fever. Measles. Whooping Cough. Chicken Pox. All other. Albion Place 31 - - 36 31 28 84 2I0 Amwell Street 9 — — 56 12 4 16 97 Ann Street 2 — — 5 1 8 12 28 Baltic Street 7 2 I 10 10 2 15 47 Bath Street 21 4 — 41 7 — 120 193 Bowling Green Lane 1 - — — - 1 1 3 Central Street 51 4 — 46 12 14 50 177 Chequer Street 12 - - 48 2 1 12 75 Compton Street 25 10 — 75 15 27 26 178 Hugh Myddelton. 48 13 — 108 24 41 57 291 Moreland Street 16 2 — 31 36 18 98 201 Risinghill Street 24 16 1 52 4 24 26 147 St. John Street 5 — — 11 1 4 2 23 White Lion Street 26 2 — 15 17 8 20 88 Winchester Street 29 16 — 42 22 29 25 163 St. Joseph, Bunhill Row - 3 - - - - - 3 St. Luke, Old Street 2 - — 17 8 3 11 41 *St. Mark Brewer St. 2 2 — 7 9 35 6 61 St. Mark, Old Street — — — — — — — — S.S. Peter and Paul, Rosoman Street - - - - - - - - Totals 311 74 2 600 211 247 581 2026 * Closed during 1907. We have received from the Education Department of the London County Council 745 certificates respecting cases of infectious disease relative to the exclusion of 2,026 children who had been in contact with those infected. Administration as to Infectious Diseases in Schools.—Owing to changes which have been made it is desirable to state in this Report the practice respecting keeping children from school on the occurrence of infectious disease in their homes. 133 (a) Notifiable Diseases.—On receipt of the notification from the Medical Officer of Health the following action is taken at the schools:— (1) The head master sends the notice to the head teachers of the other departments. (2) All affected children (whether suffering or coming from the home in which the disease exists) are excluded from school. (3) Head teachers of all departments forward on the same day the names and addresses of all children affected by the notice, to the Divisional Superintendent and the Medical Officer (Education), on a form specially provided for the purpose. (4) The notification is then filed at the school until the end of the school year. (5) Children coming from houses in which Erysipelas and Typhoid, or Enteric Fever exists, but who are not themselves suffering from the disease, should not be excluded from school. (6) Children excluded on account of a notifiable infectious disease occurring either in themselves or others in the houses in which they live, must not be allowed to return to school unless a certificate has been received from the Medical Officer of Health, stating that the premises are free from infection. (7) Head teachers will note that the certificate forwarded by the Medical Officer of Health merely states that the premises from which the children come are free from infection, and does not certify that the children are in a condition to be permitted to resume attendance at school, for it may be that, though the premises are free from infection, the children coming from such premises may be 134 sickening for an infectious disease. It will be necessary, therefore, for a further period of seven days to elapse before the return of such children to school, unless the Medical Officer of Health shall specially certify that a longer period of absence is necessary. (8) No child who has been in an infectious disease hospital should return to school for at least a fortnight after discharge from the hospital. (9) The London County Council have passed the following resolution in respect to diphtheria:— "That the Education Committee be authorised to refuse, during the presence of diphtheria in any district, readmission to school of children excluded on account of diphtheria or sore throat until such children shall have obtained a medical certificate of freedom from infection, based on a bacteriological examination." In the event of diphtheria becoming prevalent in a district the school teachers will therefore be instructed not to readmit any child who is absent from sore throat or diphtheria, until they receive a certificate of freedom from diphtheria, based on the results of a bacteriological examination. The Medical Officer of Health will be kept informed of any such orders to teachers. A card will be used for such cases when they are sent home from school, giving the reason for exclusion, and stating that the certificate can be signed by the patient's own doctor, or, if necessary, the Medical Officer of Health can be communicated with and will give such certificate, when the child is free from infection. The present occasion may possibly afford an opportunity for me to draw the attention of medical practitioners in the Borough to the importance of bacteriological recognition of diphtheria and the fact that when diphtheria is prevalent only certificates based on bacteriological diagnosis will be accepted at once as satisfactory. The necessity of a gradual education of the public to the importance of this step forward, will justify its application being gradual, and only to schools where diphtheria is actually prevalent and threatening. 135 (6) Non-notifiable Diseases— The School Management Code has now been modified in regard to these diseases, and is as follows:— (1) Children suffering from the following diseases must be excluded from school for the undermentioned periods: Measles : For at least one month. Mumps : For one month. Chicken-pox: For at least two weeks, or until every scab has fallen off the scalp or body. Whooping Cough: For as long as the cough continues, and not less than five weeks from the commencement of the whooping. (2) Children coming from houses in which either measles, mumps, chicken-pox, or whooping-cough exists must be dealt with as follows: (a) Children in schools, other than infants' schools, who have not had the disease, and all children in infants' schools must be excluded. (b) Children in schools, other than infants' schools' who have had the disease, need not be excluded. (3) Children living in infected houses and excluded from school under Section (2) (a) must absent themselves for the undermentioned periods: Measles: (1) Children attending other than infant schools, until the Monday following the expiration of 14 days from the occurrence of the first case. (2) Children attending infants' schools, until the Monday following the expiration of 14 days from the occurrence of the last case. Mumps: For such time as the Medical Attendant dealing with the case deems necessary, or, in cases where there is no Medical Attendant, for three weeks. Chicken-pox : For two weeks. Whooping Cough: For two weeks. 136 BLACK SMOKE NUISANCES. During the year 130 observations have been made in respect of smoke nuisances, 41 of which were for 3 minutes or more, and in 89 instances the nuisance was not considered serious enough to justify proceedings. The table of the 41 cases is as follows:— No. Premises. Date Duration in Minutes of Black Smoke Action taken. 1 Northampton Institute, St. John Street Jan. 4 11 Fined £4 and '2s. costs. 2 20, 22 & '24, Old Street Jan. 14 3½ Cautioned. 3 Do. Jan. 15 4 Do. 4 Do. Feb. 27 3 Do. 5 Do. Oct. 22 3 Do. 6 70-4, Old Street July 1 6 Ordered to pay £2 2s. costs. 7 Do. July 11 11 Cautioned: summons ing. 8 Do. May 31 5 Notices. 9 196, Old Street Jan. 10 3 Cautioned. 10 14, Tysoe Street Jan. 25 7 Do. 11 16 Do. Nov. 5 6 Notices. 12 117, Central Street Feb. 18 3½ Do. 13 Hugh Myddleton School Mch. 14 4½ Do. 14 58-60, St. John's Street. Oct. 7 6 Do. 15 Clarence Place Apr. 25 4 Cautioned. 16 261, City Road Jan. 22 8 No action. 17 Do. Jan. 31 9 Cautioned. 18 Do. Feb. 11 4 Do. 19 Do. Feb. 12 7 Do. 20 Do. Apr. 4 4 Do. 21 40-48 Do. Jan. 24 9 No action. 22 Do. Apr. 4 3 Cautioned. 23 Do. Nov. 20 10 Notices. 24 Victoria Buildings, Golden Lane Feb. 8 15 Do. 25 Star Works, Bunhill Row Feb. 22 3 Cautioned. 26 Do. May 6 6 Notices. 27 Do. Dec. 5 3 Cautioned. 28 Main Works,BunhillRow Dec. 6 3 Do. 29 92, Banner Street Feb. 26 3 Do. 30 36, Goswell Road Mch. 25 7 Notices. 31 York Factory, Dingley Road Apr. 25 4 Do. 32 2, Dufferin Street May 27 6 Do. 33 Do. June 14 3 Do. 34 18-22, Lamb's Passage Sept. 10 13 Do. 35 16-18, Macclesfield St. Mch. 26 4 Do. 36 Liptons, Gayton Street. Oct. 30 4½ Do. 37 Northampton Institute. July 10 8 Do. 38 162, Farringdon Road Aug. 30 4 Cautioned. 39 63, Chapel Street Apr. 20 4 Do. 40 132 -8, Pentonville Road Apr. 29 3 Do. 41 65, Southampton Street Nov. 12 3 Do. We received one "information certificate" from the Coal Smoke Abatement Society and four from the Public Control Department of the London County Council during the year. 137 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. The Guardians consented to provide for us in this matter at their Casual Wards in Gray's Inn Lane. The bathing accommodation consists of six baths on the men's side and three on the women's. Applicants may attend at four p.m. daily, if furnished with an Order, signed by the Medical Officer of Health. During the year 51 persons applied and 34 were cleansed, at a cost to the Borough of £10 4s. Od. DISINFECTION. After all cases of infectious diseases, in a certain number of cases of verminous houses and in most notified cases of Phthisis, and after all deaths from Phthisis, premises have been thoroughly disinfected. Where necessary the walls have been stripped. No charge is made for disinfection unless the householder requires it to be done at a time when the officers are not on duty. In such cases a nominal fee would be charged. Articles of clothing, bedding, carpets, curtains, etc., have been disinfected in the steam disinfecting apparatus (Goddard, Massey, 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 the work done during 1907:— 138 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Total. Beds 131 146 196 188 66l Mattresses 6 15 21 9 51 Pillows 205 283 382 287 1,157 Bolsters 65 89 116 90 360 Sheets 156 242 291 210 899 Blankets 185 208 203 239 835 Quilts 127 107 222 180 636 Cushions 23 22 27 36 108 Table Cloths 2 0 2 0 4 Curtains 12 18 20 1 51 Carpets 11 10 3 6 30 Wearing Apparel 342 419 909 585 2,255 Sundries 556 331 219 395 1,501 Totals 1821 1890 2611 2226 8,548 The above table deals with articles which have been disinfected. The actual number ot occupancies disinfected during 1907 was as follows:— Cerebro-spinal Meningitis. Scarlet Fever. Diphtheria. Enteric Fever. Puerperal Fever. Measles. Phthisis. For Vermin, etc. Totals. January — 12 11 2 1 6 14 3 49 February 1 27 5 4 1 14 10 2 64 March 1 25 16 — 1 51 13 2 108 April — 19 11 3 — 24 12 5 74 May — 53 7 — — 37 8 3 108 June 1 39 9 — — 48 7 — 104 July — 40 19 3 — 37 9 5 113 August — 52 10 1 — 15 6 — 84 September — 63 10 4 — 12 8 4 101 October — 61 15 2 — 13 6 3 100 November. — 43 12 1 — 11 2 1 71 December 1 23 4 2 — 8 9 2 49 4 457 129 22 3 276 104 30 1025 139 In disinfection after infectious disease we use Formic Aldehyde gas (30 tabloids to every 1,000 cubic feet). After Phthisis we spray the room with chloride of lime (1-2 per cent.). For disinfection of verminous rooms sulphur is used. When necessary we employ Lingner's Glyco-Formal apparatus for schools, etc. By whatever method gaseous disinfection is practised it may prove ineffectual on account of the fact that what is required is that the disinfectant should be applied directly to infected surfaces of a room. It is therefore better, wherever practicable, to apply the disinfectant by washing or spraying. Accordingly we have adopted the spray method in certain cases, and disinfectant solution (chloride of lime, 1-2 per cent.) is sprayed on to walls, floors, etc. Thorough and wet cleansing of infected surfaces is the desideratum. The number of separate rooms disinfected in 1907 was 1,178 comprised as follows:—874 cases of one room, 120 of two rooms, 16 of three rooms, and 4 of four rooms each. 140 THE MORTUARIES. There are two Public Mortuaries in the Borough, one at Warwick Place, in the Eastern Division, and the other at 47, Northampton Road, in the Western Division. The returns for 1907 are as follows:— Northampton Road Mortuary. Warwick Place Mortuary. Total. Inquest cases 75 57 132 Infectious diseases 5 8 13 Bodies deposited by Borough Orders 7 7 14 Bodies brought for convenience of relatives, &c. 83 127 2IO Total 170 199 369 In addition to the inquests held at the Borough Mortuaries, 74 inquests have been held in places outside the Borough upon bodies of persons belonging to the Borough, making the total number of inquests held 215. The verdicts were as follows: I Natural Causes— Suicides— Cerebral and other hæmorrhages 18 Alcoholism 16 Heart Disease 18 Convulsions 8 Pneumonia 10 Bronchitis 3 Kidney Disease, &c. 2 Malnutrition and want of attention 10 Congestion, &c., of Lungs 7 Tubercular Diseases 14 Cancer 1 Cerebro Spinal Meningitis 1 Miscellaneous 15 123 Drowning 1 Injuries from Fall 1 Poisoning 11 Hanging 1 Cutting Throat 3 17 Accidental— Injuries to Skull 11 Suffocation in Bed 21 Injuries from Falls 5 Injuries to Limbs, &c. 11 Shocks from Burns 9 Knocked down by vehicles 9 Poisoning 3 Suffocation in Feeding 2 Drowning 1 Suffocated by Smoke 2 Operation 1 75 141 MISCELLANEOUS. Reception Houses.—During disinfection of rooms, free accommodation is provided for the temporarily displaced persons. We have had 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 former house has now been closed. The total number using the reception houses in 1907 was 10 families of 43 persons. 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 204 sets of plans-of which number 44 related to combined systems of drainage, in which 98 premises were involved—have been dealt with. In some cases, of course, the plans as at first submitted are not such as 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 collection is made; there are cases, however, where this rule is not adhered to, and as a result 92 complaints of non-removal have been entered in the book kept in this department for that purpose, and some have been received through the post and transferred to the Superintendent of the Cleansing Department. 142 There were 14,308½ loads of household refuse and 2,823½ loads of trade refuse, weighing 26,008 tons, collected during the year, at a cost of £5,353, and destroyed at a cost of £3,640. There are two destructors, one at Phcenix Wharf, Blackfriars, and one at Wharf Road, City Road. The Sanitary Inspectors examine the condition of the dust receptacle in every house they visit. There were, in addition, 7,224 bins of offensive refuse collected from fish shops, etc., 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 Is. to 2s. (according to quantity) per week for removal. Refuse collection and destruction, cleansing the streets, and regularly 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 Sale of Food and Drugs Acts. The Canal is taken by the Inspector 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 143 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, etc., 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, etc.; (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 (2,648 visits) and most of the infant deaths (324 visits); (b) investigate the cases of, and deaths from, measles (372 visits); (c) inspect the homes of outworkers (713 visits); (d) re-inspect the workshops in which women and girls only are employed (74 visits); and (c) inspect primarily such workshops as are met with in visiting all the above. During 1907 they have also made 1,040 visits in respect of infant feeding, puerperal fever, complaints, etc. They were both absent for three months each for midwifery training, and were successful in the examination for the Certificate of the Central Midwives Board. During their absence they provided two efficient substitutes (Miss Matheson and Miss Dora Elliott), who carried out a large amount of most satisfactory work. 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, 144 Work of Sanitary Inspectors. Inspector Davis. Inspector Longden. Inspector Norman. Inspector Matson. Inspector Draper. Inspector Jackson. Total. Houses damp,dirty or dilapidated remedied 92 108 110 120 169 118 717 Doors, windows, floors, ceilings, sash cords, &c., repaired 31 13 25 192 108 20 389 Overcrowding cases abated in other than registered houses 7 4 19 2 16 6 54 Illegal occupations of underground rcoms - 2 - 2 1 1 6 Water-closet defects remedied 220 356 341 328 318 201 1764 Water-closets erected 109 15 14 213 74 24 449 Urinal defects remedied 7 11 8 13 3 3 45 Urinals erected 2 2 2 3 9 Soil pipe and ventilating shaft defects remedied 14 2 8 7 8 11 50 Soil pipes and ventilating shafts erected 18 8 20 44 20 5 115 Yard defects remedied 76 33 103 233 158 80 683 Waste pipe defects remedied 17 9 33 23 36 11 129 Waste pipes erected 16 2 45 18 6 87 Water cistern defects remedied 16 5 20 42 12 10 105 Rubbish, manure, &c., accumulations removed 24 7 12 34 24 18 119 Dung or dust receptacles repaired or renewed 35 44 150 53 39 46 367 Drains relaid or amended 38 35 69 59 58 61 320 Drains cleared 7 15 41 25 25 8 121 Rain water pipes repaired or renewed 53 7 39 12 25 22 158 Water supply to houses re-instated 1 1 5 1 1 1 10 Roofs and gutters repaired 12 28 77 49 68 26 260 Area defects remedied 7 20 15 57 26 24 149 Washhouse defects remedied 24 9 72 89 109 37 340 Bakehouses cleansed or repaired 9 2 3 6 4 2 26 Animal nuisances abated 2 2 3 1 1 7 16 Basement defects remedied 4 10 1 78 44 1 138 Stables cleansed or repaired 2 — 4 3 6 2 7 Miscellaneous nuisances abated 43 2 9 16 17 7 94 Restaurants cleansed or repaired 64 28 12 7 15 10 136 Smoke observations 20 39 12 29 16 11 127 Overcrowding cases abated in registered houses 5 5 39 3 8 7 67 Registered houses cleansed throughout 90 194 227 197 149 303 1160 Registered houses — Intimation Notices served 90 197 235 197 151 303 1173 Registered houses — Statutory Notices served 33 40 121 79 26 91 390 First visits on complaint, &c. 943 1311 1560 1074 1258 1532 7678 Re-visits 4286 4902 5168 4012 4371 3758 26497 Intimation Notices served 400 469 745 438 489 401 2942 Statutory Notices served 57 52 102 35 45 52 343 Infectious disease house inspections 113 229 254 225 108 304 1233 House inspections 12 209 I06 198 160 445 1130 House to house inspections 102 126 121 176 219 62 806 Canal boats inspected - - - - 103 - 103 145 Work of Lady Sanitary Inspectors. Mrs. Greenwood. Miss Jones. First Visits: Measles 316 22 Births 1196 421 Infant deaths 157 91 Outworkers (home) 430 202 Workshops 34 31 re Depot children — 636 Revisits: Measles 34 Births 914 117 Infant deaths 45 31 Outworkers 72 9 Workshops 6 3 Sundries (Puerperal fever, complaint, etc.) 229 175 Dirty rooms stripped and cleansed 2 — Dirty floors and bedding cleansed 8 — Workshops dirty 3 2 Sanitary conveniences cleansed 4 1 „ ,, defects remedied 1 — Intimation Notices served 16 — Nuisances referred to District Inspectors:— Dirty and dilapidated houses 12 — Yards and basements dirty 5 — Defective sanitary conveniences and drains 10 — Defective roof I Rooms overcrowded 8 — Tenement houses not on register 2 — Other Nuisances 4 — 146 Legal Proceedings under the Public Health (London) Act, 1891, and the Metropolis Local Management Act. Date. Name and Address of Defendant. Offence. Result. Jan. 4th James Baker, Bydorp House, Hanwell Amending water-closet without first giving notice under bye-laws at 35, Clerkenwell Road. Summons withdrawn; paid £1 5s. costs. ,, The Governors of the Northampton Institute, St. John Street Allowing black smoke to issue from the boiler chimney shaft. Fined £4 and 2s. costs. Mar. 5th Senecal & Co., 83, Hatton Garden Constructing a water-closet at 31-33, Banner Street contrary to bye-laws. Withdrawn; paid £1 3s. costs. „ 12th George Lichtenberg, 129, Highbury New Park Failing to repair water-closet at 43, Warren Street. Fined £5. ,, Maria Bohringer, 112, Shoe Lane Failing to provide proper water-closet accommodation at 14, Thomas Street. Fined £2 and £2 2s. costs. April 9th Donald Barry. Brook House, West Drayton Failing to amend water-closet at 167, Farringdon Road. Fined £2 ; 2s. costs. May 17th A. J. Hutton, 158, Lordship Road, Stoke Newington F ailing to provide water supply to watercloset at 19, Warren Street. F ined £4 ; 2s. costs. „ 24th Abraham Munday, 137, Victoria Park Road Failing to provide water supply to watercloset at 53, Warren Street. Fined £5; 2s. costs. June 6th H.J. Tyler, 346, City Road Failing to clear a choked drain at 2, Howard's Buildings, Central Street. Withdrawn; paid 23s. costs. July 23rd Frederick Reeves, 95, White Lion Street Failing to provide proper water supply to water-closet at 7, Charlotte Place. Fined £5; 2s. costs. ,, Frederick Reeves, 95, White Lion Street Failing to provide water supply to watercloset at 6, Charlotte Place. Ordered to pay 2s. costs. Aug. 13th George Jenner, 1, Waterloo Street Failing to cleanse the lodging house at 4, Radnor Street. Fined £3 and £2 2s. costs. George Jenner, 1, Waterloo Street Failing to cleanse the lodging house at 3, Ironmonger Street. Fined £3 and £2 2s. costs. ,, George Jenner, 1, Waterloo Street Failing to cleanse the lodging house at 9, Ironmonger Street. Fined £3 and £2 2s. costs. ,, W. & C. Nightingale, 70-74, Old Street Allowing black smoke to issue from the boiler chimney shaft. Ordered to pay £2 2s. costs. Oct. 10th T. A. Smith & Co., Ltd., 3, Robin Hood Court, F..C. Partially constructing a drain at 93, Cowcross Street without first depositing a plan. Fined £2 and 2s. costs. 147 Date. Name and Address of Defendant. Offence. Result. Oct. l0th T. A. Smith & Co., Ltd., 3, Robin Hood Court, E.C. Partially constructing a drain in such a manner as to be a nuisance at 93, Cowcross Street. Fined £3 and 2s. costs. „ 22nd N. Solomons, 10, Lloyd Square Failing to cleanse the lodging house 4, Sidney Street. Fined £3 1s. and £3 3s. costs. ,, N. Solomons, 10, Lloyd Square Failing to cleanse the lodging house 5, Sidney Street. Fined £3 1s. and £3 3s. costs. Nov. 8th Henry Hemingway, 5, Clerkenwell Close, E.C. Constructing two water-closets without first giving notice under bye-laws at 18-20, St. John Square. Fined £1 and 2s. costs. „ 29th Henry Hemingway, 5, Clerkenwell Close, E.C. Constructing two water-closets contrary to bye-laws at 18-20, St. John Square. Fined 10s.; 2s. costs. ,, John Davies, 40, Rawstorne Street Failing to alter and amend a defective water-closet. Fined £3; 2s. costs. ,, J. Pappin, 105, Rosebery Road. Muswell Hill Constructing a water-closet at 11, High Street without first giving notice. Withdrawn on payment of £2 2s. costs. Sale of Food and Drugs Acts. Jan. 4th John Davies, 85, Judd Street, St. Pancras False warranty for milk. Fined £20 and £8 costs. „ 22nd Morgan Prytherch, 32, President Street For selling butter adulterated with 84 per cent. of foreign fat. Fined £2. „ 29th Ernest R. Brewer, 110, Southampton Street For selling coffee adulterated with 75 per cent. of chicory. Fined £1 and 12s. 6d. costs. Feb. 5th The United Kingdom Tea Co., Ltd., 1, Paul Street For selling as Demerara sugar sugarcrystals coloured with an organic dye. Ordered to pay £3 3s. costs. April 9th Emily Williason, 87, Cow Cross Street For selling butter adulterated with 87 per cent. of foreign fat. Fined £2 and 12s. 6d. costs. ,, Vincenzo Manzi, 60, Golden Lane For selling as Demerara sugar sugarcrystals coloured with an organic dye. Fined £1 10s. May 24th Louisa Keeble, 8, Corporation Row For selling milk from which 10.6 per cent. of its cream had been abstracted. Fined 1s. and 12s. 6d. costs. June 7th Joseph Hatstein, 59, Collier Street For selling butter adulterated with 87 per cent. of foreign fat. Fined £2 and 12s. 6d. costs. July 19th Enoch Lewis, 13, Yardley Street For selling margarine in an unstamped wrapper. Fined £5 and 12s. 6d. costs. ,, Andrew Marotti, 201. King's Cross Road For selling milk from which 42.3 per cent. of its cream had been abstracted. Fined £2. 148 Date. Name and Address of Defendant. Offence. Result. July 19th George Wright, 2a, Chapel Street For selling milk from which 10 per cent. of its cream had been abstracted. Ordered to pay 12s. 6d. costs. ,, Albert E. Barnes, 53, Liverpool Road For selling milk from which 11 per cent. of its cream had been abstracted. Fined £1 and 12s. 6d. costs. •• Elizabeth Leake, 40, Clerkenwell Close For selling milk adulterated with 10.2 of added water and from which 30.3 per cent. of its cream had been abstracted. Fined £1 and 12s. 6d. costs. Emma Armitage, 24, Arlington Street For selling milk from which 11.3 per cent. of its cream had been abstracted. Ordered to pay 12s. 6d. costs. ,, Geo. Evans, 100, Landcroft Rd., East Dulwich For selling milk adulterated with 11.'7 per cent. of added water. Fined £2 and 12s. 6d. costs. ,, George Evans, 100, Landcroft Road, East Dulwich For selling milk without having name and address of vendor on vehicle. Fined £1 and 2s. costs. Sept. 6th John James, 230, St. John Street For selling milk from which 8 per cent. of its cream had been abstracted. Fined £1 and 12s. 6d. costs. ,, D. Rowlands, 7, Compton Street For selling butter adulterated with 29 per cent. of foreign fat. Fined £2 and 12s. 6d. costs. „ 17th David James, 29, Wynford Road For selling milk adulterated with 49.6 grains of boron trioxide to the gallon. Fined £2 and 12s. 6d. costs. „ 24th J. Lyons. Limited, Cadby Hall, Kensington For selling milk from which 8 per cent of its cream had been abstracted. Dismissed; warranty proved. Oct. 1st North Eastern Dairy Company,52, Durham Road For selling milk adulterated with 43.4 grains of boron trioxide per gallon. Fined £10 and £6 6s. costs. „ 30th Myer Cohen, 11, Mitchell Street For selling milk adulterated with 9.1 per cent. of added water. Fined £1 and £2 2s. costs. ,, Rebecca Simpson, 13, Langton Street For selling milk adulterated with 11.1 per cent. of added water. Fined £1 and £1 3s. costs. Nov. 5th Wm. Frazer Jackson, 175, St. John Street For selling camphorated oil deficient in camphor to the extent of 10 4 per cent. Fined £1 and 12s. 6d. costs. ,, William Salmon, 37, Penton Street For selling butter adulterated with 83 per cent. of foreign fat. Fined £1 and 12s. 6d. costs. „ 6th Richard Richards, 22, Luke Street For selling milk from which 8 3 per cent. of its cream had been abstracted. Dismissed; warranty proved. Dec 31st John Sainsbury, 11 to 15, Stamford Street For selling milk adulterated with 12 2 per cent. of added water. Dismissed; warranty proved. ,, Timothy Morgan, 137, South Lambeth Road For selling butter adulterated with 2.16 per cent. of added water. Fined £4 and 12s. 6d. costs. 149 SUMMARY OF PROCEEDINGS UNDER THE PUBLIC HEALTH AND FACTORY AND WORKSHOP ACTS. The following Tables and Statement have been drawn up in accordance with suggestions received from the Home Office and the Medical Officer of Health of the Administrative County of London, in order to facilitate uniformity in stating returns for the the various Metropolitan Boroughs Proceedings during 1907. Number of Places- Premises. On register at end of 1906. Added in 1907. Removed in 1907. On register at end of 1907. Number of inspections, 1907. Number of notices, 1907- Number of prosecutions, 1907. Milk premises 256 15 12 259 481 67 — Cowsheds 5 — — 5 19 — — Slaughter-houses 3 — — 3 78 — — Other offensive trade premises — — — — — — — Ice cream premises 98 4 12 90 I99 33 — Registered houses let in lodgings 1254 — 21 1233 11463 (a)* 67 (a)* Nil (b)† 3191 (b)† 8 * (a) For overcrowding. † (b) For other conditions. Overcrowding, 1907— Number of dwelling-rooms overcrowded 121 Number remedied 121 Number of prosecutions — Underground rooms — Illegal occupation dealt with during year 6 Number of rooms closed — Insanitary houses— Number closed under the Public Health (London) Act, 1891 - Number closed under the Housing of the Working Classes Act, Part 1. - 150 Shelters provided under sec. 60 (4) of the Public Health (London) Act, 1891— Number of persons accommodated during the year 43 Revenue Acts— Number of houses for which applications were received during the year 3 Number of tenements comprised therein 174 Number of tenements for which certificates were (a) granted, 174; (b) refused, nil 174 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, etc. (h) With respect to water closets, earth closets, etc. 2 (i) With respect to sufficiency of water supply to water closets (j) W ith 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 1 Mortuaries— Total number of bodies removed 369 Total number of infectious bodies removed 13 * Blocks of Buildings counted as houses. 151 Inspection of Factories, Workshops and Workplaces. Class of Works. Number of Places: Number of Inspections, 1907. Number of Number of Prosecutions, 1907. On Register at end of 1906. Added in 1907. Removed in 1907. On Register at end of 1907. Written Intimations, 1907. Notices, 1907. Under Factory Act. Under Public Health Act. Premises. Rooms. Factories Factory Laundries 6 l 2 5 - 13 4 - - - Factory Bakehouses - - - - - - - - - - (Other Factories 561 192 35 712 — 854 106 8 — 1 Workshops * Workshop Laundries 21 2 2 21 - 53 7 1 - - Workshop Bakehouses 61 - - 61 - 113 40 - - - (Other Workshops 1822 301 221 1902 — 2132 326 52 — - Workplaces ( Places where Food is prepared for Sale † 375 14 31 358 598 182 - - - Workplaces other than the above Included in "other workshops." 677 46 20 — 3 § Home-workers' premises 651 98 389 360 — 684 2 — — — Total 3497 608 680 3419 — 5124 713 81 — 4 * In a separate Table the more important classes of workshop industry are set out. (See page 156). † 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 tood 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. 152 Number of Notices prohibiting homework in unwholesome premises (s. 108) — Number of Cases of infectious disease notified in homeworkers' premises 5 Number of Orders prohibiting homework in infected premises (s. 110) — Cases reported to H.M. Inspector— Failure to affix Abstract 82 Replies as to action taken in cases notified by H.M. Inspector 25 Other matters 26 Number of underground bakehouses in use at the end of 1907 40 Certificates granted during the year (s. 101) — 153 Factories, Workshops, Laundries, Workplaces and Homework. 1—INSPECTION. Premises. (1) Inspections- (2) Number of Written Notices (3) Prosecutions (4) Factories (Including Factory Laundries.) 867 118 1 Workshops (Including Workshop Laundries.) 2185 386 — Workplaces (Other than Outworker's premises included in Part 3 of this Report.) 677 66 3 Total 3729 570 4 2.—DEFECTS FOUND. Particulars. (1) Number of Defects. Number of Prosecutions (5) Found (2) Remedied (3) Referred to H.M. Inspector (4) Nuisances under the Public Health Acts:— Want of cleanliness 180 170 10 ... Want of ventilation 35 32 3 ... Overcrowding 5 5 ... ... Want of drainage of floors 8 7 1 ... Other nuisances 596 596 ... ... Sanitary [insufficient 22 22 ... ... accommo- unsuitable or defective 221 221 ... 2 dation (not separate for sexes 11 11 ... ... Offences under the Factory and Workshop Acts:— Illegal occupation of underground bakehouse (s. 101) ... ... ... ... Breach of special sanitary requirements for bakehouses (ss. 97 to 100) ... ... ... ... Other offences (excluding offences relating to outwork which are included in Part 3 of this Report) 94 ... 94 ... Total 1172 1064 108 4 * Including those specified in Sections 2, 3,7 and 8 of the Factory ana Workshop Act as remediable under the Public Health Acts. 154 155 3.—HOME WORK. NATURE OF WORK. 1) OUTWORKERS' LISTS, SECTION 107. OUTWORK in UNWHOLESOME PREMISES, Section 108. OUTWORK in INFECTED PREMISES, Sections 109, 110. Lists received from Employers. Addresses of Outworkers. Prosecutions. Inspections of Outworkers' premises. Instances. Notices served. Prosecutions. Instances. Orders made (S. 110). Prosecutions (Sections 109, 110). Twice in the year. Once in the year. Received from other Councils. Forwarded to other Councils. Failing to keep or permit inspection of Lists. Failing to send Lists. Lists.† Outworkers.† Lists. Outworkers.† Contractors Workmen. Contractors Workmen. (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) Wearing apparel— Nil. Nil. Nil. Nil. Nil. Nil. Nil. (1) making, &c 190 394 3948 18 20 117 670 4261 107 1 (2) cleaning and washing ... 1 ... ... ... ... 6 ... ... ... Lace, lace curtains and nets ... ... ... ... ... ... ... ... ... ... Artificial flowers 10 ... 174 2 ... 23 54 138 22 1 Nets, other than wire nets ... ... ... ... ... ... ... ... ... ... Tents ... ... ... ... ... ... ... ... ... ... Sacks ... ... ... ... ... ... ... ... ... ... furniture and upholstery 4 ... 16 1 ... 3 8 17 1 ... Fur pulling ... ... ... ... ... ... ... ... ... ... F eather sorting ... ... ... ... ... ... ... ... ... ... Umbrellas, &c. 4 ... 18 ... ... ... 37 15 11 ... Carding, &c., of buttons, &c. ... ... ... ... ... ... ... ... ... ... Paper bags and boxes 38 2 1120 1 ... 2 41 810 58 ... Basket making ... ... ... ... ... ... 2 ... ... 1 Brush making 16 ... 94 3 ... 37 10 103 9 ... Racquet and tennis balls ... ... ... ... ... ... ... ... ... ... Stuffed toys ... ... ... ... ... ... ... ... ... ... File making ... ... ... ... ... ... ... ... ... ... hiectro-plate 8 4 30 ... ... ... 7 9 6 ... Cables and chains ... ... ... ... ... ... ... ... ... ... Anchors and grapnels ... ... ... ... ... ... ... ... ... ... Cart gear ... ... ... ... ... ... ... ... ... ... Locks, latches and keys ... ... ... ... ... ... ... ... ... ... Pea picking ... ... ... ... ... ... ... ... ... ... Total 270 401 5400 25 20 182 835 5353 ... ... 214 ... ... ... 3 ... ... 1 The figures in columns 2, 3 and 4 are the total number of Lists (received from employers who sent them both in February and August as required by the Act) and of the entries of names of Outworkers in those Lists. They will, therefore, usually be double of the number of such employers and (approximately) double of the number of individual Outworkers whose names are given, since in the February and August Lists of the same employer the same Outworker's name will often be repeated. 156 * 4.—REGISTERED WORKSHOPS AND WORKPLACES. Workshops and Workplaces on the Register (s. 131) at the end ot the year. (1) Number. (2) Clocks and Watches 120 Jewellery 91 Cabinet-making, Polishing, &c. 68 Tailors and Clothiers 68 Engravers, Chasers, and Embossers 63 Underclothing, Blouses, Shirts, &c. 48 Leather Goods 46 Building Trades 44 Gilding and Plating 44 Gold and Silversmiths. 43 Millinery 42 Fancy Goods, Toys, &c. 4i Furriers and Skindressers 40 Other 1209 Total number on Register 1923 * For full Table of Trades, &c., see pages 107 & 108 of Report. 5.—OTHER MATTERS. Class. (1) Number. (2) Matters notified to H.M. Inspector of Factories :— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 82 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5) Notified by H.M. Inspector 25 Reports (of action taken) sent to H.M. Inspector 25 Other 26 Underground Bakehouses (s. 101):— Certificates granted during the year — In use at the end of the year 40 LOCAL GOVERNMENT TABLES. 159 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 Deaths in Public Institutions. Deaths of nonresidents registered in District. Deaths of Residents registered beyond District. Deaths at all Ages Nett. Ages. Total. 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 36.4 503 137.3 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 34.6 429 126.2 1,014 10.3 38 45 886 1,855 18.9 1906 97,466 3,464 35.5 474 136.8 1,032 10.6 37 32 1,020 2,020 20.7 1907 96,732 3,361 34.7 368 109.4 912 9.4 54 49 911 1,774 18.3 * Rates calculated per 1,000 of estimated population. † The numbers in this column include births at City of London Lying-in Hospital, not belonging to Finsbury (see p. 9). Note.—The deaths included in Column 7 of this table are the whole of those registered during the year as having actually occurred within the district. The deaths 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 dving there- and by the terin "Residents" is meant persons who have been taken out of the district on account of illness and have died elsewhere. Area of Districts in acres 589 Total population at ail ages 101,463 (exclusively of area Number of inhabited houses, 9,820 At Census of 1901. covered by water). Average number of persons per house, 10.9. 160 TABLE II. Borough of Finsbury. Names of Locai.ities. 1 -The Borough. 2—North Clerkenwell. 3—South Clerkenwell. 4—Finsbury (St. Luke). 5—St. Sepulchre. YEAR. Population estimated to middle of each Year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each Year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each Year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each Year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each Year. Births registered. Deaths at all Ages. Deaths under 1 year. a b c d a b c d a b c d a b c d a b c d 1901 101,463 3,792 2,161 461 35,028 1,059 699 158 28,676 888 583 124 36,116 1,808 848 173 1,643 37 31 6 1902 100,487 3,624 2,283 558 34,691 1,056 783 183 28,400 881 593 152 37,769 1,649 873 217 1,627 38 34 6 1903 100,487 3,664 1,993 503 34,691 1,060 667 163 28,400 879 519 125 35,769 1,692 776 210 1,627 33 31 5 1904 98,958 3,603 2,084 522 31,163 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 1906 97,466 3,464 2,020 474 33,648 1,032 764 183 27,547 828 513 116 34,693 1,565 704 166 1,578 39 39 9 1907 96,732 3,361 1,774 368 33,395 1,000 585 119 27,340 756 450 105 34,431 1,581 700 136 1,566 24 39 8 Notes—(a) The separate localities adopted for this table are areas of which the populations are obtainable from the census returns, i.e., registration sub-districts. Block I is used for the whole district ; and blocks 2, 3, &c., for the several localities. (b) Deaths of residents occurring beyond the district are included in sub-columns c of this table, and those of non-residents registered in the district excluded. (See note on Table I, as to meaning of terms "resident" and "non-resident.") (c) Deaths of residents occurring in public institutions are allotted to the respective localities, according to addresses of the deceased. 161 TABLE III. Cases of Infectious Disease Notified during the Year 1907. Borough of Finsbury. Notifiable Disease. Cases Notified in Whole District. Total Cases Notified in each Locality. No. of Cases removed to Hospital from each Locality At all Ages. At Ages—Years. 1 2 3 4 1 2 3 4 North Clerkenwell South Clerkenwell Finsbury (St. Luke) St. Sepulchre North Clerkenwell South Clerkenwell Finsbury (St. Luke) St. Sepulchre Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 65. 65 and upwards. Small-pox - - - - - - - - - - - - - - - Cholera — — — — — — — — — — — — — — — Diphtheria (including Membranous Croup) 127 5 70 43 7 2 - 48 38 39 2 47 37 39 2 Erysipelas 108 5 4 14 9 68 8 31 39 37 1 — — — — Scarlet Fever 471 8 153 281 25 4 — 143 147 169 12 141 144 165 12 Typhus Fever - - - - - - - - - - - — — — — Enteric Fever 22 - 1 4 17 - - 11 3 8 - 11 2 8 — Relapsing Fever - — - - - — — — - — — — — - — Continued Fever - - - - - - - - - - - - - - - Puerperal Fever 3 — — — 1 2 - 2 - - 1 - - - 1 Plague - - - - - - - — — — — — — — — Cerebro-Spinal Meningitis 4 2 1 — — 1 — 1 1 2 - 1 1 2 - Totals 735 20 229 342 59 77 8 236 228 255 l6 200 184 214 15 162 TABLE IV. Causes and Ages at Death During the Year 1907. Cause of Death. Deaths in District at Subjoined Ages. Deaths in Localities. Deaths in Public Institutions in the District, whether Residents or Non-Residents. All Ages. Under 1. 1 and under 5. 5 and under 15. 15 and under 25. 25 and undei 65. 65 and upwards. Worth Clerkenwell. South Clerkenwell. Finsbury (St. Luke). St. Sepulchre. Small-pox - - - - - - - - - - - - Measles 43 12 31 — — — - 14 13 16 — — Scarlet Fever 16 1 10 4 1 — — 3 4 8 1 — Whooping Cough 44 16 27 1 - - — 15 8 20 1 — Diphtheria and Membranous Croup 15 2 13 - - - - 5 7 3 — — Croup 1 1 — - — — — — 1 — — — Fevers Typhus. - - - - - - - - - - - - Enteric 2 — — - 1 1 — — — 2 — — Continued - - - - - - - - - - - - Epidemic Influenza 13 2 — 1 6 4 2 6 4 1 — Diarrhoea 33 20 9 - — 2 2 10 2 21 — — Enteritis 33 22 5 1 1 3 1 10 9 12 2 1 Puerperal Fever 1 — - - 1 - — 1 - — — — Erysipelas 7 2 — - — 4 1 1 2 4 - — Other Septic Diseases 5 3 1 - — 1 — — 2 3 — 4 Phthisis 243 6 13 6 28 182 8 84 51 105 3 1 Other Tuberculous Diseases 42 4 17 12 1 5 3 13 11 18 - — Cancer, Malignant Disease 86 1 - — 3 52 30 31 19 36 — 7 Bronchitis 205 36 16 - — 75 78 55 63 83 4 — Pneumonia 184 49 48 3 2 54 28 44 51 87 2 3 Pleurisy 5 - 2 - — 3 — — 3 1 1 — Other Diseases of Respiratory Organs 15 - 4 - - 9 2 5 5 5 - - Alcoholism 20 — — — — 20 - 5 6 8 1 — Cirrhosis of Liver 26 - 1 — — 22 3 11 5 10 — — Premature Birth 61 61 - — - — - 25 16 19 1 6 Diseases and Accidents of Parturition 6 - - - 2 4 - 1 2 3 - - Heart Disease 123 3 1 5 8 66 40 49 35 37 2 3 Other Diseases of Circulatory System 82 1 - 1 - 30 50 39 18 23 2 5 Accidents 60 6 13 7 2 24 8 18 15 24 3 1 Suicides 17 — - 1 13 3 9 4 4 - 2 Nervous and Cerebral Diseases 33 2 - 2 1 22 6 6 11 15 1 6 Senility 83 — — — — 5 78 26 20 33 4 4 Overlain in Bed 20 20 — — — - — 5 3 11 1 — Convulsions 18 14 4 — — - — 9 6 3 — 1 Developmental Disease 28 21 7 — — — — 7 6 14 1 3 Diseases of Stomach 10 — 3 - 3 4 — 6 2 2 — — Inflammation and Softening of brain 5 - - - - 3 2 1 2 2 - - Meningitis 15 7 4 3 — 1 — 5 4 6 — — Nephritis and Bright's Disease 64 - 3 2 4 32 23 26 14 22 2 3 Intestinal Obstruction 20 3 - 2 — 7 8 7 7 4 2 — Tumours and other Diseases of Female Organs - - - - - - - - - - - - Murder 1 — - — 1 — — — — 1 — — Venereal Diseases 4 3 — 1 — — — 1 2 I — — Marasmus 49 44 5 — — — — 24 6 18 1 3 All Other Causes 36 6 2 - 4 19 5 12 9 12 3 1 All Causes 1774 368 239 50 65 669 383 585 450 700 39 54 163 Showing the State of Pauperism in the Holborn Union (Including Finsbury) puring the Year 1907. Quarters. Average number Relieved during each week. Indoor Paupers, Adults and Children. Out-door Paupers. Totals. Totals corresponding periods. 1900. Vagrants Relieved. Children Boarded Out. Finsbury Death Rates. Adults. Children under 16. 1 2 3 4 5 6 7 8 9 1st Quarter 4,224 1,449 771 6,444 6,448 60 51 22.4 2nd „ 3,860 1,286 719 5,865 6,029 65 56 18.4 3rd „ 3,718 1,254 712 5,684 5,736 59 62 13.9 4th „ 3,940 1,237 810 5,987 6,123 68 62 18.6 Totals 15,742 5,226 3,012 23,980 24,336 252 231 Weekly averages during the year 3,935 1,306 753 5,995 6,084 63 58 18.3 164 Borough of Finsbury. Infantile Mortality during the Year, 1907. Deaths from stated Causes in Weeks and Months under One Year of Age. CAUSE OF DEATH. Under 1 Week 1-2 Weeks 2-3 Weeks 3-4 Weeks Total under 1 Month 1-2 Months 2-3 Months 3-4 Months 4-5 Months 5-6 Months 6-7 Months 7-8 Months 8-9 Months 9-10 Months 10-11 Months 11-12 Months Total Deaths under 1 Year Common Infectious Diseases— Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... 1 ... ... 2 2 2 5 12 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 Diphtheria : Croup ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 2 Whooping Cough ... ... ... ... ... 1 2 1 ... 1 2 2 3 1 2 1 l6 Diarrhoeal Diseases— Diarrhoea, all forms ... 2 2 4 4 4 9 9 2 2 5 1 ... ... 2 42 Enteritis, Muco-enteritis, Gastro-enteritis Gastritis, Gastrointestinal Catarrh Wasting Diseases— Premature Birth 34 5 10 7 56 4 ... ... ... 1 ... ... ... ... ... ... 6l Congenital Defects 8 1 ... 1 10 1 ... ... 1 ... ... ... ... ... ... 1 13 Injury at Birth 5 ... ... ... 5 ... ... ... ... ... ... ... ... ... ... ... 5 165 Want of Breast-milk (Starvation) 10 1 4 5 20 7 10 6 3 2 4 1 1 1 ... ... 55 Atrophy, Debility, Marasmus Tuberculous Diseases— Tuberculous Meningitis ... ... ... ... ... ... ... 1 ... ... 2 ... ... ... ... ... 3 Tuberculous Peritonitis : Tabes Mesenterial ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... 2 Other Tuberculous Diseases ... ... ... ... ... ... ... 1 1 ... ... 1 2 ... ... ... 5 Erysipelas ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... 2 Syphilis ... ... ... 1 1 ... 1 1 ... ... ... ... ... ... ... ... 3 Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 Meningitis (not Tuberculous) ... ... 1 ... 1 ... ... ... 2 ... 1 2 1 ... ... ... 7 Convulsions 1 1 ... ... 2 4 1 2 ... 1 ... ... 2 1 1 ... 14 Bronchitis ... 2 1 ... 3 6 4 4 2 4 2 1 ... 3 3 4 36 Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia ... 2 1 1 4 4 5 6 1 2 7 6 2 3 4 5 49 Suffocation, overlaying 1 3 2 1 7 7 3 1 2 ... ... ... ... ... ... ... 20 Other Causes 5 2 2 2 11 ... ... ... ... ... 3 2 ... 1 2 ... 19 All Causes (Certified) 64 17 23 20 124 39 31 33 21 15 23 21 x4 12 14 21 368 Population, estimated to middle of 1907, 96,732. Rirths in the year: Legitumate, 3326. Illegitimate, 35. Deaths from all Causes at all Ages, 1,774. Deaths in the year of Legitimate infants, 341 Illegitimate infants, 27. 166 VACCINATION RETURNS. Total Return tor 1906. Return made on or before 8th February, 1908, by Mr. P. E. Capps, 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, 1906, 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., 1906. Number of these Births duly entered by 31st January, 1908, in Columns I, II, IV and V of the "Vaccination Register" (Birth List Sheets), viz. : Number of these Births which on 31st January, 1908, remained unentered in the "Vaccination Register" on account (as shown by Report Book) of :— Number of these Births remaining on 31st January, 1908, 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 the calendar year 1907. Col. I. Successfully Vaccinated. Col. II. Col. IV. Number in respect ot whom Certificates of Conscientious Objection have been received. Col. V. Dead, Un vaccinated. Postponement byMedical Certificate. Removal to Districts, the Vaccination Officer of which has been d ily 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, St. Luke 1569 917 3 0 9 168 29 315 119 9 1028 2. Clerkenwell, North 1041 681 0 0 11 102 19 125 98 5 689 3. Clerkenwell, South 830 607 3 0 8 82 11 72 46 1 575 Total 3440 2205 6 0 28 352 59 512 263 15 2292 Dated 6th February, 1908. Signed, PERCY E. CAPPS, Vaccination Officer. 167 VACCINATION RETURNS. Return for the Period January—June, 1907. Return to be made on or before 8th February, 1908, by Mr. P. E. Capps, 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, 1907, 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 ist January to 31st Dec., 1907. Number of these Births duly entered by 31st January, 1908, in Columns 1,11, IV and V of the 44 Vaccination Register " (Birth List Sheets), viz.; Number of these Births which on 31st January, 1908, remained unentered in the "Vaccination Register" on account (as shown by Report Book) of;— N umber of these Births remaining on 31st January, 1908, 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). 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 1907. Col. I. Successfully Vaccinated. Col. II Col. IV. Number in respect of whomCertificates 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 9 10 11 12 1. Finsbury 785 427 0 0 9 89 24 147 67 22 14 2. Clerkenwell, North 556 336 0 0 2 41 30 71 53 23 8 3. Clerkenwell, South 368 255 2 0 5 29 13 32 19 13 7 Total 1709 1018 2 0 16 159 67 250 139 58 29 Dated 6th February, 1908. Signed, PERCY E. CAPPS, Vaccination Officer.