FIN 8 THE METROPOLITAN BOROUGH OF FINSBURY. REPORT on the PUBLIC HEALTH OF FINSBURY 1909. Including Annual Report on Factories and Workshops. by A. E. THOMAS, M.A., M.D., D.P.H., Medical Officer of Health. London: Printed by Vail & Co., 170, Farringdon Road, E.C. 1910. Public Health Committee, 1909-1910. Chairman. Councillor O. M. RICHARDS. Vice-Chairman. Councillor The Rev. Prebendary G. H. PERRY, M.A., J.P. HIS WORSHIP THE MAYOR. (Alderman ARTHUR MILLWARD, J.P. Alderman E. H. TRIPP. Councillor W. F. ABRAHAMS. Councillor Dr. LAUZUN BROWN. Councillor W. T. DEIGHTON. Councillor Dr. W. A. DINGLE. Councillor The Rev. T. C. ELSDON, A.K.C. Councillor A. W. HUMPHREYS. Councillor LEWIS PHILLIPS. Councillor The Rev. GEORGE SMITH. Councillor ERNEST TROTT. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Finsbury. His Worship the Mayor: Alderman Arthur Millward, J.P. Gentlemen, I have the honour to submit herewith the Annual Report on the Public Health and Sanitary condition of the Borough of Finsbury for the year 1909. The instructions of the Local Government Board, with regard to the Annual Reports of Medical Officers of Health, have been followed in its construction, and for the sake of uniformity the method of arrangement of the contents in sections, adopted in previous reports, has, in the main, been adhered to. Since my appointment I have received the greatest consideration, assistance and support from the Chairman and members of the Public Health Committee of the Council, and I take this opportunity of tendering my grateful thanks to them. I wish also to thank the staff and officials of the Health Department for the excellent work done and help given, and the staffs of the other Departments for their kindly assistance and co-operation, I am, Gentlemen, Your obedient Servant, A. E. THOMAS, Medical Officer of Health. Public Health Department, Town Hall, Rosebery Avenue, E.C. 9th March, 1910. TABLE OF CONTENTS. PAGE Population 5 Births 6 Notification of Births 7 Health Visitation 10 Birth Investigations 18 Midwives 21 Deaths and Death Rates 24 Infantile Mortality 27 Infantile Mortality (London Boroughs) 28 Infant Death Tables 39 Infant Death Distribution 43 Infectious Disease Deaths 48 Cancer 49 Alcoholism 52 Phthisis, Death Rates 53 Disease Records 56 Notifications 57 Small-Pox 58 Cholera 59 Diphtheria 60 Scarlet Fever 63 Enteric Fever 65 Measles and Hooping Cough 68 Phthisis:— Notifications and Deaths (Table) 69 Common Lodging-houses 71 Addresses 73 Residences 73 Family History 75 Source 76 Occupations 77 Street Records 80 Preventive Measures 81 PAGE Disinfection 83 Meat Seized 84 Meat Prosecutions 90 Slaughter-houses 91 Milk Supply 92 Milk Shops 93 Milk Samples 96 Milk Prosecutions 97 Ice Cream 100 Butter and Margarine 100 Sale of Food and Drugs Acts 101 Housing 103 Houses let in Lodgings 104 Common Lodging-houses 106 House-to-House Inspection 107 (Table) 108 Overcrowding 109 Underground Rooms and Stable Dwellings 111 Factories and Workshops 112 Outworkers and Homeworkers 115 Bake-houses 119 Canal Boats 119 Schools 121 Black Smoke 123 Mortuaries 124 General Powers Act, 1969 125 House Refuse 126 Drainage Plans 127 Sanitary Inspection 127 Legal Proceedings 129 5 A.-VITAL STATISTICS. POPULATION.—At the middle of 1909 the population of the Borough estimated by the Registrar-General was 95,289, the numbers for each of the sub-registration districts being :— Clerkenwell 59,829 Finsbury (St. Luke) 33,918 St. Sepulchre 1,542 95,289 This estimate does not include the Finsbury residents detained in outlying institutions, the Holborn Union Workhouse Infirmary (342), the Workhouse, Shepherdess Walk (1,359), the Holborn Union Workhouse, Mitcham (652), and the Holborn Schools, Mitcham (403), giving a total of 2,756. Adding these to the Registrar-General's estimate makes a corrected population of 98,045 for the Borough. In the present report, the rates continue, as before, to be estimated on the Registrar-General's figures; the matter will be fully discussed next year. Compared with the Registrar's estimate made to the middle of 1908 (96,007), the population shews a decrease of 718. The estimate, that obtains this decrease, is based on the assumption that the rate of progression of the population is still the same as that between the censuses of 1891 and 1901, when the population was found to have declined 9,444—from 110,907 to 101,463. The reason for the decline mentioned above, which has been going steadily on during the last 40 years, is the alteration in the circumstances of the Borough. It is becoming more and more a manufacturing and business centre and less and less residential. In the main, the inhabitants are of the working classes, who 6 reside in the district chiefly because their work is there. As means of transit further improve, and business premises multiply, and the district becomes less suited for residence, greater numbers of people will migrate, and the population will still further be depleted. With the exception of a number of model dwellings, the houses are of the older fashioned type, provided, in the majority of instances, with basements. Most of the houses are occupied by more than one family, the floors being either let separately by the owner or sub-let by the person renting the whole house. The number of houses occupied wholly by one family, even in the formerly fashionable squares, is diminishing, some being now used as offices and business premises, others being let in tenements. BIRTHS.—During the year, 2857 births were registered of Finsbury residents, equivalent to a birth-rate of 29-9 per 1,000 living. The corresponding rates for the rest of the country were as follows :— England and Wales 25.6 London 24.2 Finsbury 29.9 76 Great Towns 25.7 143 Small Towns 24.8 Rural Districts 25.6 Eighty-one of the Finsbury births took place in the City Road Workhouse; 51 were notified from other Boroughs. At the City of London Lying-in Hospital 835 births took place, of which 133 belonged to Finsbury, and the rest to other London Boroughs. The following table shews the birth rates in Finsbury and each of the sub-registration districts since the Borough was formed :— 7 TABLE A.—BIRTH RATES. ] Clerkenwell. St. Luke. St. Sepulchre. Corrected Birth Rates for the Borough. North. South. 1901 30.2 30.9 50.8 20.1 32.0 1902 30.1 30.4 45.6 23.1 31.7 1903 30.5 30.9 47.3 20.3 31.4 1904 31.5 29.7 47.1 20.5 31.3 1905 29.1 29.0 45.3 13.2 29.4 1906 30.7 30.0 45.1 24.7 30.9 1907 29.9 27.6 45.9 15.3 29.8 1908 29.3 49.1 18.6 30.3 1909 28.3 50.3 12.9 29.9 *The North and South Clerkenwell sub-registration districts were united in April, 1908. It will be seen that the birth-rate for Finsbury is greater than the rate for the whole of England and Wales, greater than the birth-rate for London, and greater than the rates in the 76 great towns, the 141 smaller towns and the essentially rural districts. The birth-rate for Finsbury is only 21 less than it was ten years ago, and is higher than it was in 1905 and 1907. The birth-rate is greatest in St. Luke, least in St. Sepulchre's. The rate in St. Luke's is exceptionally high, being 50.3 per 1,000. This figure has only once been exceeded since the Borough of Finsbury was constituted. NOTIFICATION OF BIRTHS ACT, 1907. This Act was adopted by the Borough Council on December 19th, 1907, and came into force on 9th March, 1908. 8 The Act requires the Notification to the Medical Officer of Health of all Births in the Borough, so that:— 1. Within 36 hours after the birth of a child within the Borough, notice must be given to the Medical Officer of Health. (a) By the father if he is residing at the time of the birth in the house where the birth takes place. (b) By any person who at the time of the birth or within 6 hours thereafter was in attendance on the mother. 2. Every birth must be notified whether the child be born alive or dead. 3. Any person failing to give notice of a birth as required, is liable on conviction to a penalty not exceeding twenty shillings. 4. As well as notifying the birth to the Medical Officer of Health the persons responsible must register it with the Registrar in the usual way. All Doctors and Midwives residing or practising in the Borough are, on application, provided without charge with stamped addressed letter cards, which may be used for the purpose of notifying the births. Since the adoption of the Act, the work has proceeded very smoothly. There is still occasionally a little delay on the part of the parent in sending in the form. When this happens the father is written to and his omission pointed out. The explanation usually tendered is ignorance of the existence of the Act, or a confusion with the terms of the Births and Deaths Registration Act ot 1874, which enacts that all births must be registered within 42 days. As a result of comparison with the returns of the registrars, a comparison which is carried out regularly, since by the Act these officials are to be allowed access to the notification lists, persons 9 failing to notify have been readily traced. To these a printed form has been sent, and has never failed to induce defaulters to notify. As time proceeds the Act is becoming better known—in 1908, 277 notices of omission were sent to parents; in 1909 this number was reduced to 181. The number of notifications received in 1909 was 3,526—made up of 1,921 males, and 1,705 females. There were 75 still births. Forty-two notifications were those of twins—there were no cases of triplets. It is usual to find that twins occur in about one out of every 60 or 80 births, and triplets in only one out of 6,000 to 7,000 births. The percentage notified by parents was 15-8, by medical men 3-4, by midwives 15-7, and by other persons, students and professional assistants 64.9. Two prosecutions were instituted under the Act, both against the same defendant. December 17th, at Clerkenwell Police Court, Mrs. Dorothea Tasselli, 4, Vineyard Walk, was summoned for failing to notify to the Medical Officer of Health the birth of a child, which took place at No. 6, Great Bath Street. Fined £1, and 23 shillings costs. December 17th, at Clerkenwell Police Court, Mrs. Dorothea Tasselli, 4, Vineyard Walk, was summoned for failing to notify to the Medical Officer of Health the birth of a child, which took place at No. 15, Vineyard Walk. Fined £1 and 30 shillings costs. Mrs. Tasselli is an unregistered Italian midwife who attends her compatriots in their confinements. Her work was the subject of adverse comment in the Annual Report for 1907. In that year, three of her cases in the limited period of seven months, developed puerperal fever and died from that disease. 10 One of the present cases, the subject of prosecution, was brought to light owing to the mother, who was attended by Mrs. Tasselli, sickening with puerperal fever and ultimately dying of that disease. Under the Midwives Act, 1902, it is still competent for unregistered midwives to attend women in their confinements. After the first of April, 1910, this unqualified practice will be practically put an end to by Section 1, Sub-section 2 of the Midwives Act, 1902, which stipulates that:— "From and after the first day of April, 1910, no woman shall, habitually and for gain attend women in childbirth, otherwise than under the direction of a qualified medical practitioner, unless she be certified under this Act; any woman so acting without being certified under this Act shall be liable, on summary conviction, to a fine not exceeding ten pounds; provided this section shall not apply to legally qualified medical practitioners, or to any one rendering assistance in the case of emergency." HEALTH VISITATION—INFANT BIRTHS. In May, 1909, the Finsbury Borough Council authorised the engagement of Miss Goodlass and Miss Tubbs to act as lady Health Visitors in conjunction with Mrs. Greenwood, lady Sanitary Inspector. Their work in the first instance was directed to:— 1. The systematic visitation of infant births in the poorer parts, and the instruction of the mothers in the care and upbringing of the children. 2. The supervision of the childrens' health and progress. 3. The improvement of the home conditions and especially of those which might react adversely on children or parents, whether these were due to faults of environment, to social conditions, or to dire poverty. 11 Out of these duties, other spheres of usefulness developed in the progress of the work. The Borough was divided into three, and a separate district assigned to each lady health visitor. The homes where births occur are visited, and on each occasion advice is given to the mother on the methods of feeding, washing and clothing the baby, and on the general care of its health. A small book on the management of children is left with the mother and its chief provisions explained. An invitation is extended to the parent to attend the infant consultations, held each week at 2.30 p.m. in— The Town Hall—Friday. The Mothers' Guild, 65, St. John Street—Thursday. St. Luke's Institute, Radnor Street—Thursday. Branch Library, Penton Street—Wednesday. At these centres the babies are weighed, and the weight entered on cards on each occasion. The average attendance has been just below twenty mothers. Questions are asked and answered, and short lectures are given on appropriate subjects. Tea and buns are provided—at cost price to those who can pay —gratis to those who are too poor. It is worthy of note that 50 per cent, of the expenses have been met by the contributions of the mothers. In addition to the work entailed in the immediate welfare of the children, the living-room and the houses as a whole are inspected. Measures are devised for the cleansing of verminous rooms, verminous clothing and verminous bedding. Gross sanitary defects are reported to the Sanitary Officers for notice and amendment. Mothers with sick and ailing babies have been put in the way of obtaining medical treatment, and some of the children have been sent to homes. 12 There is no doubt that this work has been attended with very great benefit to the infants and their mothers. Many of the mothers display the most absurd ignorance as to the proper methods of feeding and clothing their children—the majority, however, seem to be most anxious to learn and improve their knowledge. Many of the school children in the district have, through the courtesy and kindness of the head teachers, been allowed to knit vests for the babies. These vests are afterwards sold at cost price to the mothers, and given gratis to those who cannot afford to pay. During the eight months, 1,171 births, of which roughly onethird were first babies, were visited, and in conneation with these, 2,549 revisits made subsequently. Many of the children were found to be wasting, and to be improperly and insufficiently fed. Some were ill with measles, hooping cough, rickets, chronic ophthalmia and convulsions. Others were neglected or unsatisfactorily looked after, owing to the death of the mother, the poverty or ill-health of one or both parents, and in a few instances owing to the birth of twins. livery effort was made to remedy the evils discovered. The mothers were carefully instructed in the feeding of the young ones and shown, by actual practice, how best to dress and wash them, the dangers to avoid, and how to treat the commoner ailments. Vests, clothes, olive oil, lime water, feeding bottles, and in some cases food, were provided for the children. The expense of these details was defrayed by the voluntary gifts and subscriptions of various religious and charitable societies. The children who were wasting or acutely ill were sent into homes, nursing institutions and childrens' hospitals for treatment. In a few cases where the parents were guilty of persistent or continuing neglect or cruelty, after due warning and ample 13 opportunity and encouragement for reform, information was sent to the National Society for the Prevention of Cruelty to Children. During the cold months the work disclosed a large amount of distress and poverty in the district. One or both parents have been found out of work, bed ridden, acutely ill with phthisis, pneumonia, or other illness, blind, or suffering from exposure and want of food, conditions which but for the timely visits of the health visitors might have ended in disaster. In a few houses the mother had been deserted, was out of work, was excessively weak owing to her resuming homework as an out-worker too soon after her confinement, a course rendered necessary by her lack of means, or was unequal or succumbing to the task of rearing twins. Measures were taken wherever possible to alleviate the distress. Dispensary tickets, grocery tickets, food, clothes and boots were provided in suitable cases—the expense being defrayed by voluntary contributions and help from the churches, chapels, missions and private sources. Weak and ailing mothers, exhausted after a severe confinement, were sent to convalescent homes. Cases of phthisis were secured admission to sanatoria, or treated at other institutions. Cases of illness were accompanied to hospital and proper treatment obtained. Where deemed advisable, the parents were dressed and nursed at home. The homes were washed, cleaned, and brightened up and every effort made to encourage the parents to keep them in this condition. Kindly help and co-operation were extended to every case, not obtrusively or ostentatiously, but tactfully and free from the clogging influence of officialism, or officious interference. In addition to the work thus outlined, cases of measles discovered at home were visited, and appropriate instruction given in the methods of treatment. 14 As a rule mothers with their first children were found very amenable to instruction, willing to take pains and eager to learn, whereas mothers with two or more children were inclined to resist enlightenment and to prove a little intractable—this was specially noticeable in the few who had had many children whose grandmothers still lived. However, in all save very few cases indeed, the work of the health visitors, even where at first they met with a covert subdued passive resistance, was eventually regarded with fervent appreciation and thankfully received. The difficulties encountered were due to the crass ignorance and stupidity of a few mothers, who seem to mistake obstinancy for independence. Occasionally the work was interrupted by the parents' removal out of the district. In most cases the chief deterring associated conditions were poverty, ill-health and lack of employment; only occasionally was there reason to believe that these were immediately due to or associated with the drink question. The following cases are appended to illustrate the conditions found and thd difficulties encountered:— 1.—A twin and born prematurely. The mother died at its birth. The baby, left in the care of its maiden aunts, was being fed on a patent food and at four months of age weighed only 6 lbs. 2 oz. The father much objected to the weekly weighings of the child, but finally consented to the child being weighed at home. Advice and instruction were given and the child gained 3¼ lbs. in 8 weeks. Nineteen visits were paid. 2.—A baby breast fed, but wasting owing to insufficient food of the mother. Oil emulsion was given to the child and milk obtained for the mother. The mother proved very difficult to deal with; she expected to be confined shortly, and refused to bring the baby on consultation days after the first occasion. 3.—A baby, very much wasted, and fed on condensed milk from a fouled bottle. The mother went out to work daily and left the baby and another child aged 3 years, both suffering from ophthalmia, in charge of their grandmother, who was almost blind. The mother was induced to give up work for a time to look after her children, but with only slight resulting improvements in the home conditions. 15 4. Child of Italian parents. The family had ample means, but in spite of this, three other children, twins nearly 5 years old and a child 16 months, were unable to walk and just able to stand. Referred to the National Society for the Prevention of Cruelty to Children. 5.—A baby, three weeks old, breast fed and most emaciated. The father, mother, and 6 children, the eldest of whom was only 11 years, were all extremely thin. The man had been out of work for 9 months, and there was absolutely no food in the house at the time of the first visit. Food was given to meet immediate wants and the case referred to one of the Churches, which gave ready help. Clothing and oil emulsion were obtained for the baby and boots for the mother. The man shortly after obtained work and the family left the borough. 6.—A baby, two weeks old, with no clothes. The father, mother and five children lived in an underground room almost bereft of furniture. The father was a barber out of work, the mother an umbrella machinist—both were steady people Clothes and food were obtained for the mother and children and the case referred to a charitable mission. 7.—A baby three weeks old. The father was totally blind and either sold matches in the streets or went round the streets with a piano organ. The mother took in washing. There was no food in the house. Clothes and food were obtained for the parents and children. 8.—A baby two weeks old. The father, mother, and another child of 4 years lived in one room. The father, a carman, had consumption of the lungs and was unable to work. The mother sold flowers in the streets. A letter of admission to The Royal National Hospital for Consumption, Ventnor, was procured for the father. 9.—Baby five months old, much wasted, very dirty and neglected. The father was stated to be a lazy wastrel; the mother and home were dirty and verminous. The other children were a boy 15 years, a girl 14 years, mentally defective, and three children aged respectively 7 years, 4 years, and 21 months. Twenty-four visits were paid. Eventually after much difficulty 16 the mother was induced to try and clean up the home and improve matters, but she was much hindered by her idle and worthless husband. The mother then became ill and the whole family were ejected for non-payment of rent. 10.—First child, much emaciated, three months old and only weighing 5 lbs. It was extremely dirty, so that the dirt appeared to be ingrained into the skin. The mother was careless, incapable and afraid to wash the child. The father was in work. Daily visits were paid to the baby and to instruct the mother how to wash and feed it. The child gained 1½ lbs. in three weeks. 11.—Child, four months old, ill and wasting. The father had consumption of the lungs and was a patient in a poor law infirmary. The mother was destitute. There was no food in the house. The child had been an out-patient at the Childrens' Hospital. Boots and food were obtained for the mother, and the case referred to one of the churches. The baby was put out of doors all day and suitable food prescribed, and it soon looked quite well. Twelve visits were paid. 12.—Illegitimate child, 9 weeks old, much wasted, looked after by the grandmother. Clothing and a bottle were obtained for the child and its admission secured to The Home for Wasting Babies, where it improved remarkably in a very short time. Eleven visits were paid. The work and visits were at first construed on a liberal basis. Help was not merely confined to the baby, but was also given to the parents and to the other children. By this means it was possible to establish for the Health Visitors a reputation for kindly and sympathetic treatment, which was very desirable inasmuch as they have not the right of entry possessed by a lady sanitary inspector. The following is a case in point:— In one house visited there were found two motherless girls, 17 and 14 years respectively—both mentally defective—dirty and infested with body lice and other vermin. The father was out all day selling newspapers. The beds and walls of the rooms were dirty and very verminous. The girls were taken to a cleansing 17 station and thoroughly cleaned. The rooms and bedding were cleansed and disinfected. The elder girl developed a boil, which was dressed daily for a fortnight. The home conditions were much improved, but at this time the family moved elsewhere. To sum up, the work already accomplished by the Health Visitors completely justifies the appointments made. They have alleviated much suffering amongst infants, they have prevented much distress by bringing the cases to the notice of the appropriate agencies, and they have given much timely and helpful instruction in the care of infants, their proper clothing and common-sense methods of feeding. Many of the mothers were found to be lamentably ignorant as to the care of their children. Grandmothers having the care of infants, and mothers who had already had several were the most intractable of all. One grandmother was especially emphatic, and insisted on the depth of her expert knowledge and the width of her experience— she repeatedly urged her thorough grasp of the management of infants; the good lady had had eleven children, of whom nine had died ; she now supervised the upbringing of two grandchildren— these also died. It is very difficult to know what to do with people of this type. It is hoped that when housecraft becomes a settled subject in all elementary schools that their number will eventually vanish. Meantime it is the work of the health visitors of carry the torch of knowledge into the poorer homes, to help those who are anxious to learn, to save the lives of the infants, and to make those mothers who are dirty clean their homes, wash themselves and wash their children, for there would even now appear to be amongst some of the very poor a disinclination to wash a wasting and sickening child. An encouraging feature of the work has been the increasing number of mothers who have asked for visits to be paid by the Health Visitors, and the number of those who have come to the infant consultations on the recommendation of mothers who had previously attended. b 18 TABLE B. BIRTH INVESTIGATIONS, 1909. ]Totals. Age at Visit. Method of Feeding. Condition of Child. Mother's Work. Mother's Health. Condition of Tenement. No. of Rooms. First Born. Twins. Illegitimate. Breast only. Breast and other food. Cows' Milk. Artificial or Condensed. Died socn after birth. Well Nourished. Fairly Nourished. Badly Nourished. House work only. Away from Home. Away from Home intermittently. Some Home Work. Good. Indifferent. Bad. Clean. Fairly Clean. Dirty. One. Two. Three. Four. weeks. 101 0-1 70 — 6 — 25 59 17 25 67 10 13 11 75 22 4 66 30 5 39 36 17 9 18 8 2 215 1-2 197 12 9 4 — 153 48 14 133 25 38 19 164 38 13 148 55 12 62 94 47 12 47 11 5 210 2-3 197 1 9 3 — 142 60 8 127 18 39 26 159 42 9 141 53 16 64 96 35 15 52 8 2 119 3-4 98 10 7 4 — 76 31 12 72 14 19 14 96 18 5 69 42 8 34 56 24 5 40 5 3 53 4-5 44 4 4 1 — 40 9 4 33 7 6 7 44 9 — 39 12 2 11 27 9 6 15 3 1 50 5-6 39 3 3 5 — 34 10 6 32 5 6 7 38 10 2 34 9 7 10 24 13 3 15 - — 33 6-7 28 3 1 1 - 23 5 5 21 5 3 4 29 3 1 21 6 6 15 9 9 — 7 2 — 31 7-8 25 3 2 1 — 23 3 5 19 11 — 1 27 3 1 18 10 3 11 13 7 — 14 — — 60 8-12 over 46 8 5 1 — 35 19 6 33 12 7 8 44 11 5 38 18 4 21 26 9 4 25 3 1 66 12 44 2 13 7 — 41 13 12 47 7 6 6 45 20 1 43 18 5 18 32 12 4 25 2 1 938 — 781 46 59 27 25 626 215 97 584 114 137 103 721 176 41 617 253 68 285 413 182 58 258 42 15 % 82.5 5 6.5 3 3 67 22.5 10.5 62.5 12 14.5 11 77 19 4 66 27.5 6.5 30.5 44 19.5 6 27.5 4 1.5 19 The Table B appended shows the nature of the investigation made when the house, where a birth has recently occurred, is visited by one of the Lady Health Visitors. With regard to these births of children in Finsbury, the following inferences have been made :— Method of Feeding. Up to the age of three months, nearly 90 per cent, of the infants are entirely or partially breast fed. The importance of this in a district like Finsbury can hardly be over-estimated. It confirms the statement that nearly all the women in Finsbury when cease to breast feed their babies, do so because they cannot continue, and not because they will not. Underfeeding, homework, outwork, or over-work, the insecurity or casual nature of the husband's employment, the care of the other older children, and the thousand and one worries that persist in a poor household, all these render the mother unable to secretc milk good either in quality or quantity. The infant consequently suffers or is improperly and insufficiently fed. The percentage of children fed on cows' milk was 6-5, on artificial foods or condensed milk, three per cent. Apparent Increase of Breast Feeding.—It would appear too, that although the percentage of breast children is so high, yet it is still increasing and is a matter for congratulation. Thus in 1907, 1908 and 1909 the percentage of breast fed children were 80-6, 82, and 82-5 respectively. This improvement is probably to be associated in some measure with the instruction and advice given by the Lady Health Visitors and the supervision exercised by them over the welfare of the children. A similar result has been noticcd in the neighbouring Borough of St. Pancras. b 2 20 It will be seen that the number of children wholly breast fed far exceeds the others, including' the partially breast fed at each age interval. The ratio of the number of totally breast fed children to the number of the others is highest during the first three weeks. For the next five weeks, that is to the end of the second month, the ratio is fairly constant, but diminished to one-half of its earlier magnitude. After the age of two months there is a marked decline. Condition of Child.—This year, 67 per cent, of the children were well nourished, as against 62 per cent, in 1908, and 68.9 per cent in 1907. The largest proportion of ill-conditioned babies was found during the first week—these are the weaklings, some prematurely born, others with insufficient stamina and vitality, into whom, as it were, existence has to force its way ; these succumb because they have not the grit, the material basis, which will enable them to survive—in the words of one of the mothers—"there is no foundation to build upon, so what can you expect." After the first week and until the end of the third month the percentage of ill-conditioned babies ranges from 7 to 12 per cent. The children are at their best in the second and third weeks. After the third month their condition recedes. Mothers' Work.—Nearly 68 per rent, did house work only, 12 per cent, worked away from home, 14 per cent, worked away from home intermittently, 11 per cent. did some homework as outworkers for various firms. Mothers' Health.—In 77 per cent., as against 75 per cent. in 1908, the health of the mother was good, in 23 per cent. it was indifferent or bad. The influence of the mother's health upon the child's prospects is obvious. Mothers who enjoy good health when their infants are born are much more likely to rear healthy children, and keep them, than mothers who are weakly 2nd ailing. 21 Number of Rooms. —The percentage of families occupying one room only was 30.5, as against 35 per cent. in 1908—the number occupying four rooms or more was 6 per cent., as against 5-5 per cent. in the preceding year. Character of Birth.—Out of 938 births, the total number visited, 27.5 per cent. were first births, 4 per cent. were twins, and 1.5 were illegitimate. All twin births are visited because the nursing of twins is likely to be attended with difficulty. So with first births an attempt is made to visit all these—since, quite naturally, the mother, often young and inexperienced and weighted with the traditional lore and banal discredited dog-trot instruction of her impulsive neighbours, has endless difficulties to contend with, and if, therefore, a correct start can be made at the first birth succeeding children will be likely to benefit. MIDWIVES ACT, 1902. This Act, in London, is administered by the London County Council as the Local Supervising Authority. Under its provisions, every woman certified under the Act, before holding herself out as a practising midwife or commencing to practise as a midwife in any area, must give notice in writing of her intention so to do to the Local Supervising Authority, and must give a like notice in the month of January in every succeeding year during which she continues to practise. The following midwives, resident in Finsbury, gave notice of their intention to practise during the year 1909 :— Challen, A. M., Miss City of London Lying-in Hospital. Cimmelli, M., Mrs. 13, Great Bath Street. Cowley, E. A., Mrs. Maternity Nursing Association, 63, Myddelton Square. Cooke, H. M., Miss Lying-in Hospital. Dauney, S. A., Miss 63, Myddelton Square. 22 Duval, A. T., Miss Lying-in Hospital. Duval, E., Miss Lying-in Hospital. Frith, S. H., Miss 467, Northampton Buildings. Fox, A. M., Miss Lying-in Hospital. Goodlass, M. E., Miss 63, Myddelton Square. Hayes, E. S., Miss 63, Myddelton Square. Holmes, M. A., Mrs. 34, Richard Street. Huxtable, K., Mrs. 63, Myddelton Square. Locke, E. Mrs. 45, Hall Street, City Road. Marriott, E. S., Miss 63, Myddelton Square. Pulley, M. A., Miss Lying-in Hospital. Skinner, M. L., Miss 63, Myddelton Square. The work of attending women during their confinements is, on the whole, carried out remarkably well in Finsbury. Thus, although there were 3,427 births registered in the district, only 6 cases of puerperal fever were notified and only 2 deaths occurred from this disease. These cases were attended respectively by Medical Men (1), Students of St. Bartholomew's and the Royal Free Hospitals (3), Pupil of Midwife (1), and an unregistered and uncertificated midwife (1). The associated and predisposing causes were as follows :— Retained membranes 1 Miscarriage and retained afterbirth 1 Dead and offensive foetus 1 Very difficult delivery (twins) and adherent afterbirth 1 Douche administered by uncertificated midwife 1 Every case was made the subject of a special enquiry by the Lady Sanitary Inspector—the premises were visited, the sanitary defects ascertained and- made the subject of subsequent notice for amendment, and the premises disinfected. In Finsbury there are three institutions for the training of midwives :— 23 The City of London Lying-in Hospital, City Road. The Maternity Nursing Association, 63, Myddelton Square. The Royal Maternity Charity, 31, Finsbury Square. The City of London Lying-in Hospital, founded in 1750, admits and attends to married women, who produce their marriage certificates and to single women in exceptional circumstances after careful investigation for their first confinement. In 1909, 863 women were delivered in this hospital, of whom 244 belonged to Finsbury. The Maternity Nursing Association provides fully qualified nurses, on payment of moderate fees, to attend married women in their own homes during their confinements. The Royal Maternity Charity provides midwives and medical attendance for poor married women at home; it was founded in 1757, and has since then ministered to over half a million mothers. The students of St. Bartholomew's Hospital and the Royal Free Hospital attend mothers in St. Luke's and Clerkenwell, under the supervision of qualified resident medical officers. St. Bartholomew's owns a large amount of property in the district. During the year, classes for midwives and maternity nurses were held by the London County Council at the Hugh Myddelton School, Corporation Row. With a view to preventing the many deaths that now happen from cancer of the womb, the British Medical Association have drafted a pamphlet on the stages and symptoms of early cases of this disease. This circular, at the request of the Association, was, in 1909, distributed to nurses and midwives in the district who might be brought into contact with cases in an early stage. 24 DEATHS AND DEATH RATES. The number of Finsbury residents who died in 1909 was 1,814, equivalent to a crude death rate for the whole Borough of 19 0 per 1,000 inhabitants living. The death rate for the whole of London was 14.03 per 1,000, as compared with 14.0 and 14.6 in 1908 and 1907 respectively. CRUDE DEATH RATES. ]The Borough. North Clerkenwell. South Clerkenwell. St. Luke. St. Sepulchere. 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 I7.5 l6.4 20.3 24.9 1908 18.4 18.3 18.9 10.3 1909 19.0 18.5 19.9 20.7 In comparing one district with another it is important to take into account the number of males and females in both, the number of young people, and the number of old people. All these have different death rates. A district with a large number of infants and a large number of old people will have a higher death rate than one in which the inhabitants are chiefly young adults. In order to overcome the difficulty thus arising—the RegistrarGeneral has calculated a factor for correction for each district— which when multiplied into the crude death rate gives the ''corrected'' death rate available for comparison with the rates in other districts. The factor for correction in Finsbury is 1 0355. This multiplied into 19.0 the crude death rate gives a corrected death rate of 19.7 per 1,000. 25 The corrected death rate in preceding years since 1904 were 22.0, 19.5, 21.4, 18.9, 19.0, and 19.7 per 1,000 respectively. The comparison with the rest of the country may be seen below:— CORRECTED DEATH RATES FOR 1909. England and Wales 14.5 Finsbury 19.0 76 Great Towns 15.6 143 Small Towns 14.5 Rural Districts 13.6 In the Registrar-General's return, Finsbury is placed as having the third highest rate in London. The death rates in the City of London and in Shoreditch are both higher than the rate in Finsbury. The Finsbury deaths were apportioned as follows:— Clerkenwell 1,116 St. Luke's 664 St. Sepulchre 34 deaths. The deaths in Hospitals and other Institutions are appended:— DEATHS IN HOSPITALS AND INSTITUTIONS. 1. General Hospitals. IV. Poor Law Institutions St. Bartholomews 184 Holborn Infirmary 329 Royal Free 39 Holborn Workhouse King's College 7 City Road 220 Middlesex 8 Holborn Workhouse, University 11 Mitcham 19 Other Hospitals 21 Other Poor Law 270 Institutions 8 II. Special Hospitals. 376 Great Ormond Street V. Asylums. (Childrens') 32 Homoeopathic 3 Caterham 3 Royal Chest 7 Banstead 5 Other Hospitals 19 Colney Hatch 3 j 61 Claybury 1 III. Fever Hospitals. Other Asylums 19 Eastern 6 38 North Eastern 2 North Western 15 VI. Unclassifiable 20 23 Total 988 26 It will be seen that 571 deaths, that is 34 percent or nearly one-third of the total number, occurred in the Workhouse or Workhouse Infirmary. This gives some index of the poverty which prevails among many inhabitants of the district. Of the deaths, 417, or 22 per cent., were 65 years of age or over 65 at the time of death. The following table gives the numbers of deaths that have occurred in public institutions since 1901:— TABLE E ]Total Deaths. Deaths in Public Institutions, &c., outside District belonging to Finsbury. Percentage. 1901 2,161 876 40.5 1902 2,283 908 39.8 1903 1,993 870 43.6 1904 2,084 965 46.3 1905 1,855 886 47.8 1906 2,020 1,020 50.5 1907 1,774 911 51.3 1908 1,767 891 50.4 1909 1,814 988 54.4 It will be seen that the percentage of deaths which occur in public institutions, including poor law institutions, is gradually and with slight intermissions continuously increasing. This, again, would support the belief that the inhabitants of the district are now generally poorer than they were years ago. Crude Infantile Mortality Rates, 1901-1908. Corrected Infantile Mortality Rates, I90I-I908. Infant Mortality Rates according to the Registrar General, 1901-1909. 27 INFANTILE MORTALITY. The corrected number of births of Finsbury children for 1909 is 2,857. In the same year 366 children died, under one year of age, and belonging to the Borough. The infantile mortality for any year is obtained by multiplying the number of deaths under one year by 1,000 and dividing the result by the number of births for that year. It is a measure of the number of deaths under one year, per 1,000 births. The infantile mortality of the borough for 1909 is 128; put properly this means that out of every 1,000 children born during the year 128 died before reaching their first birthday. The corresponding figures for preceding years are annexed :— ]Year. Corrected Births. Corrected Deaths. Infantile Mortality. 1901 3,254 533 163 1902 3,191 558 174 1903 3,162 503 159 1904 3,095 522 168 1905 2,886 429 148 1906 3,012 474 157 1907 2,884 368 127 1908 2,916 400 137 1909 2,857 366 128 It will be seen that the figure for 1909 is practically the same as that for 1907, and that these two results are lower than they have ever been since the Borough was incorporated in 1901. The following table compares Finsbury with London and England and Wales generally :— Infantile Mortality or 1909. England and Wales 109 Whole of London 108 FINSBURY 128 76 Great Towns 118 143 Smaller Towns 111 Essentially Rural Districts 98 28 It will be observed that the infantile mortality of Finsbury is about 19 percent greater than the figure for the whole of London, and about 10 percent more than the infantile mortality prevailing in the 76 great towns. The birth rate and infant mortality for the Metropolitan Boroughs for 1909 are displayed below :— • ]Birth Rate. Infant Mortality. Battersea 23.9 107 Bermondsey 31.9 141 Bethnal Green 31.4 129 Camberwell 23.7 100 Chelsea 18.7 107 Deptford 26.8 103 Finsbury 35.9 128 Greenwich 22.1 102 Hammersmith 23.0 125 Hampstead 13.6 74 Holborn 18.3 101 Islington 23.3 103 Kensington 18.6 112 Lambeth 26.1 98 Lewisham 21.8 75 City of London 13.4 106 Paddington 20.0 102 Poplar 30.1 130 St. Marylebone 20.0 102 St. Pancras 22.1 109 Shoreditch 32.4 138 Southwark 27.1 119 Stepney 30.3 118 Stoke Newington 18.3 84 Wandsworth 20.6 86 City of Westminster 15.9 93 Woolwich 22.9 82 29 The figures for Camberwell have been derived from the report of the Registrar-General, the others from the Medical Officers of the various Boroughs. The Registrar's result for Finsbury is 131. In the Registrar-General's return, Finsbury stands third highest —it occupied a similar position in 1908. Ages at Death.—Out of 366 deaths, 57 children died in Ihe first week of existence, a number exceeding that of any subsequent month. Of these deaths, 45 were due to premature birth: it is difficult at present to see how to prevent this happening. It may later become possible to initiate some scheme of cooperation with the large hospitals in our midst, so that when an expectant mother applies for a midwifery ticket, her name, address and expected date of her confinement may be given to the Public Health Department and the case kept under supervision and helped until labour begins, or until the hospital takes the case over. The number of children who died in the first month was 100— more than twice the number of those who died in any succeeding month. It thus becomes obvious that the important month for health visitation is the first month of life—if the infant can be successfully brought over the first month he may then have a fair chance in the later struggle. The deaths in the first three months number 175—that is nearly half the children die before they reach the age of three months. After the third month the number of deaths becomes less and continues less with small intermissions until the end of the first year of life, when again there is a slight rise—probably associated with the weaning of the infant. 30 CAUSES OF DEATH. 1909. 1908. 1907. Measles 23 10 12 Diphtheria 1 — 2 Scarlet Fever — — 1 Hooping Cough 21 7 16 Gastritis 2 — 42 Diarrhœa 46 59 Enteritis 16 21 Premature Birth 60 62 61 Congenital Defects 7 14 13 Atrophy, Marasmus 50 42 55 Tuberculous Meningitis 7 9 3 Other Tuberculous Diseases 5 10 7 Erysipelas 1 — 2 Syphilis 9 7 3 Convulsions 3 18 14 Bronchitis 21 21 36 Pneumonia 47 50 49 Suffocation in bed 21 29 20 Other Causes 26 41 32 366 400 368 It will be seen that this year there is an increase in the number of deaths due to measles and hooping cough. The deaths from pneumonia, bronchitis, wasting affections, syphilis, premature birth and suffocation in bed are more or less stationary. As compared with last year there is a diminution in the number of deaths due to convulsions, and all forms of diarrhoea. Preventible Infants Deaths.—A large proportion of these deaths are preventible and in the years to come should be prevented. 31 Among the preventible causes are—Diarrhoea, Premature Birth, Wasting Diseases such as Atrophy, Debility, and Marasmus, Suffocation in bed with parents, Measles, Hooping Cough, Pneumonia and Bronchitis. By this it is not meant that every child who is taken ill with one of the foregoing ailments should necessarily recover, but, on the contrary, that by well directed and well reasoned measures the children should be prevented from having these affections, or if they do eventually suffer, that the attack should be deferred until a later period of life, when the children are stronger, more resistant and more capable of withstanding the onslaught of disease. Measles caused 23 deaths—chiefly in the first three months of life. This disease is very fatal to young children, especially in June and December. The longer the attack is deferred, that is, the older the child is when it has the measles, the less likely it is to succumb. Children over 5 years stand it very much better than children under 5 years—indeed, 90 percent. of the deaths amongst children occur under 5 years. It is difficult to convince the average British householder that measles is an affection that should be dealt with seriously. It is quite common still to find when a household has been attacked by measles that the other children, who have not had it and even the children of neighbouring families, are brought into the sick room so that they, too, may receive the formal baptism of the complaint and have done with it once and for all. The usual remedy, if any at all is adopted, is saffron and brandy. It is uncommon to find a doctor in attendance. The parents regard the disappearance of the rash as an index that all danger is at an end, little knowing that this heralds the most critical time of all. When the rash has gone, the child may be taken out in all weathers and exposed to trying conditions— 32 it is now that it contracts pneumonia and is in danger of dying. If the parent will only learn to isolate the first case, to keep all the other children away, to keep the child's utensils to itself, to wash them separately, above all to avoid exposing the child until a fortnight at least after the rash has gone, and to call in a medical man at an early period of the disease, the chances of recovery are very much enhanced, and the risk of its extension much reduced. Unfortunately, however, these measures are not always possible in Finsbury—isolation becomes impossible to a family who live and sleep in one room, or who have two rooms at most. And in this Borough these are the conditions which obtain in a very large number of instances. Not infrequently, too, the mother may have to go out to work and leave the child to be looked after by an adult neighbour, or even a young girl of sixteen or seventeen years. In 21 of the 23 cases now under consideration measles was followed by pneumonia, which caused the death of the infant; in the other two cases the associated causes of death were, diarrha'a and heart failure respectively. Five of the deaths occurred in the Workhouse Infirmary, three in various model "buildings." Fourteen of the deaths belonged to Clerkenwell, nine to St. Luke's. Two of the infants were illegitimate. Hooping Cough.—There were 21 deaths due to this disease a larger number than in 1908 and in 1907. Many of these deaths are due to exposure, ignorance and carelessness. In 15 cases pneumonia supervened as a complication, in the other 6 the disease was followed by sudden heart failure, meningitis, cerebral haemmorrhage and excessive diarrhoea. Eleven of the children died at home, 4 in the Poor Law Infirmary and the rest in the large general hospitals. 33 Pneumonia and Bronchitis.—The deaths numbered 68, as against 71 in 1908 and 85 in 1907, so that here apparently there is some slight improvement. Some of these deaths are possibly due to pneumonia supervening on a previous infection such as measles or hooping cough—others are doubtless due to exposure to inclement or wet weather. They arc nearly all in the main preventible, and should be prevented if parents would only exercise reasonable care. Twelve of the cases died in St. Bartholomew's Hospital, 9 in Poor Law Institutions, 3 in other hospitals, and the rest at home. Diarrhœal Diseases amongst infants caused 64 deaths in 1909 as against 80 in 1908 and 42 in the preceding year. These diseases are much commoner in hot and dry weather than they are in cold and wet weather. For this reason epidemic diarrhœa is often called summer diarrhœa. Many of these deaths may be prevented by seeing that the food of the infants is clean, by seeing that it is cleanly prepared and cleanly stored in clean utensils. These deaths occur not only in hand-fed children, but also in breast-fed children, especially if the mother is slovenly or of dirty, careless habits. It is part of the work of the lady health visitors to instruct mothers in the clean and careful feeding of their children. Breast feeding is everywhere encouraged, but if this is impossible or inadvisable a suitable bottle and a suitable teat are provided by the Public Health Department at the cost price of a penny each in the case of those mothers who cannot afford to buy feeding bottles at the chemist. C 34 Fifteen of the deaths occurred in St. Bartholomew's Hospital, 11 in the Childrens' Hospital, Great Ormond Street and other hospitals, 4 in Poor Law Institutions, and the rest at home. The parents were nearly all in poor circumstances—19 were carmen or general labourers. Epidemic diarrhoea not only attacks infants, but may also attack older children and also adults. In 1909 there were 22 Finsbury residents over one year who succumbed to the disease. This number included 7 who were over 65. For a long time it has been known that the number of deaths from diarrhoea shows a closer connection with the temperature of the soil than with the temperature of the air. The temperature of the soil naturally varies with the temperature of the air, but is always some days behind in a rise or fall— it is more steady in its record and a less sensitive indicator. Dr. Ballard has shown that:— The summer rise of diarrhceal mortality does not commence until the mean temperature recorded by the thermometer placed 4 feet below the earth's surface has attained a temperature of about 56 degrees Fahrenheit, no matter what may have been the temperature previously recorded by the air thermometer or by the thermometer placed one foot below the earth's surface. The largest number of deaths in any year from diarrhœa is usually found in the week in which the four foot earth thermometer has its greatest mean weekly value. As a rule the four foot temperature, the rainfall and the number of deaths from epidemic diarrhœa are highest in the months of July, August and September. The following tables show some of these points:- 35 ]Third Quatter Year. No. of Deaths from Epidemic Diarrhœa. Mean Temp. 4 ft. earth thermometer. Rainfall in inches. 1901 93 61.7º F. 4.63 1902 61 57.5° F. 6.02 1903 58 58.1° F. 15.56 1904 95 59.1º F. 4.88 1905 65 59.8° F. 5.45 1906 100 59.4° F. 3.78 1907 17 57.2º F. 3.77 1908 64 59.1° F. 8.16 1909 42 57.5º F. 7.15 The relationship between these deaths, the temperature and the rainfall in the third quarter of 1909 is shown below :— ]Summer Quarter. 1909. July. August. September. Dates of months (in weeks). June 27 to July 3 4-10 1117 1824 2531 Aug, 1 to Aug. 7 8-14 1521 2228 A.ug 29 to Sep. 4 5-1 1 1218 19- 25 Mean temperature, fourfoot thermometer. (Average 57.50 F.) 54.3 55.0 56.0 57.0 58.0 58.1 58.9 60.4 60.6 60.1 59.1 58.0 56.5 Rainfall (Total 7.15 in.) 0.44 0.99 0. 71 0.15 1.31 0.26 — 0.82 0.70 0.30 0.32 0.58 0.57 No. of Deaths from Epidemic Diarrhœa (Total 42.) ... ... ... 1 2 3 1 7 9 5 4 5 5 C 2 36 Premature Birth was responsible for the death of 60 infants. This number remains nearly stationary from year to year in Finsbury. Most of the deaths occurred in the very poorest districts. A quarter of the whole number were in the households of labourers and carmen. Most of the parents were in poor circumstances. Four of the children were illegitimate. Six of the deaths were those of twins. The common causes of premature birth, except where drugs have been taken for the purpose, are accidcnts, excessive strain, syphilis, indulgence in alcohol, working in lead, and deformities of the hips and adjacent bones. Many of these causes are preventible and remediable, and it is hoped that when their pernicious effects on pregnancy are more generally recognised,- the number of deaths due to their action may be reduced. Marasmus and Inanition.—There were 50 deaths of infants due to this cause. These are the children who waste, sometimes even despite every attention. Sixteen died in the first month of life, 20 during the next two months—so that 72 per cent, died in the first three months of existence. Some of these deaths are probably due to congenital weakness or defect, others possibly to faults in feeding—a few to syphilis in one or both parents. They are only in part preventible. Tuberculosis.—There were 12 deaths due to the presence of Tubercle—five to consumption of the lungs with a general and widespread invasion of the body by the disease, whereas the other 7 were cases of tuberculous meningitis. Convulsions caused 3 deaths. Convulsions are not a disease, they constitute a symptom and are equivalent in the infant life of what passes as "shivering fit" or a "chill" in the adult. They may occur at the onset of any infectious disease, for example, measles, during the progress of any disturbance of the stomach or bowels, at the onset of pneumonia, or may be associated with teething or pickets; but are not usually due to these last two conditions acting alone. 37 Some of the deaths ascribed to convulsions are due to suffocation in bed with the parents. Suffocation in bed with parents.—21 deaths were caused in this way. The figures for preceding years were 29 and 20 respectively. These deaths are clearly preventible. Infants should never sleep in the same bed with their parents or other persons. Every infant should have its own cradle, which need not be an ornate or elaborate structure. A banana crate or an orange box can easily be made suitable. Occasionally these deaths are due to definite overlaying, but it is quite common to find that the death occurred while the child was on the mother's arm with its lips and mouth pressed hard against the breast. Most of the cases occurred on Saturday and Sunday, least on Thursday. This fact is often citcd as lending support to the suspicion that these deaths are associated with indulgence in alcohol in the parents. Possibly this may be the correct view— but no doubt some of the deaths may also be due to simple weariness on the part of the mother after a hard day, and a strenuous week's work. Section 13 of the Childrens' Act, 1908, provides punishment on conviction where it is proved that the death of an infant under 3 years of age was caused by suffocation while the infant was in bed with some other person over 16 years of age, and that that other person was at the time of going to bed under the infiuencs of drink. The intention of this provision is excellent, and it is much to to hoped that it will lead to a reduction in the number of deaths due to suffocation in bed. The infant deaths and infant mortality rates according to district are displayed below:— 38 TABLE G.† ]The Borough. North Clerkenwell. South Clerkenwell. 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 I39.6 172 137.0 6 162.1 1902 588 174.9 183 173.3 152 172.7 217 178.4 6 157.9 1903 503 159.1 163 153.8 125 142.2 2I0 176.5 5 151.5 1904 522 168.6 191 177.2 123 147.8 206 178.7 2 60. 6 1905 429 148.6 146 148.2 98 121.7 178 165.5 7 333. 4 1906 474 157.3 183 172.5 116 135.9 166 157.0 9 2I9.5 1907 368 127.0 119 116.5 105 135.1 136 128.3 8 307.7 Clerkenwell 1908 400 137.0 Infant Deaths. 236 Infant Mortality. 131.0 163 150.1 1 34.5 1909 366 128.0 219 135.0 131 130. 0 6 300.0 *The return for 1901 includes 73 infant deaths taking place outside the Borough but belonging to Finsbury, and which cannot now be distributed in districts. Throughout the table, births taking place in the City of London Lying-in Hospital, but not belonging to Finsbury have been excluded and the births taking place in City Road Workhouse and other places belonging to Finsbury, have been included. † Contains the Corrected Rates calculated by the Medical Officer. These figures show that in recent years, Finsbury has made marked and definite progress in dealing with the saving of infant life. This is also borne out by referring to the chart, which represents the same thing graphically—whether we take the crude rates, the corrected rates, or the rates calculated by the RegistrarGeneral, definite improvement is manifested. The RegistrarGeneral's figures for Finsbury in 1909 is 131, as against 133 in the preceding year. Infant Death Investigation.—The usual enquiries have been made and the statistics are tabulated in the accompanying tables, which record the results in 265 deaths occurring in 1909. The third table is a summary of the work done during the years 1904 to 1909. 39 TABLE M. ENQUIRIES INTO INFANTS DEATHS, 1909. ]Method of Feeding. Reason for Weaning. Cause of Death. Age at Death. Weeks. Totals. Breast. Breast and other food. Cow's Milk. Artificial or Condensed. Died soon after birth. Loss of Milk. Illness of Mother or Child. Mother's Work. Mother's Death. Diarrhoea. Prematurity. Marasmus. Atrophy and Developmental Diseases Bronchitis. Pneumonia. Convulsions. Suflocation. Measles. Hooping Cough. Tuberculosis. Meningitis, including Tuberculous. Miscellaneous. First Born Twins. Illegitimate. 0-1 40 10 - 5 - 25 - 5 - - 1 22 1 10 1 - 3 1 - - - - 1 4 3 1 1-2 13 8 2 - — — — 3 — — 1 3 2 - — 1 - - - - - - I 3 1 — 2-3 9 8 - 1 — — — 1 — — — 1 2 1 — 1 1 I — 1 — — 1 3 — — 3-4 9 7 1 1 - - - - 1 — 4 1 3 — 1 - - - - - - - 1 3 — Months. 1-2 34 20 6 5 3 — 5 3 — — 5 1 4 8 2 3 1 7 — 3 — — — 6 3 1 2-3 24 13 5 5 1 — 3 2 1 — 6 1 3 5 I 2 1 2 — — — 2 1 3 3 — 3-4 22 6 6 4 6 — 5 5 — — 9 — 2 1 4 1 5 — — — — — 7 2 — 4-5 14 6 2 3 3 — 3 2 1 — 5 — 1 2 I 1 1 — — — — 3 - 4 - - 5-6 18 7 1 7 3 — 7 1 2 — 8 — 2 — 2 2 — — 2 1 — 1 — 5 1 — 6-7 12 3 2 5 2 — 5 2 — — 3 — 1 — I 4 1 1 — — — 1 — 3 — — 7-8 12 2 1 6 3 — 7 1 1 — 1 — 1 — — 6 1 — — 1 1 1 — 2 2 — 8-9 18 2 3 9 4 — 9 2 2 — 5 — 1 — 1 3 — — 2 4 1 1 — 3 — — 9-10 15 3 1 7 4 — 6 1 4 — 3 — 1 — 2 1 1 — 5 2 — — — 1 1 — 10-11 8 4 1 1 2 — 2 1 - — 2 — — — — 1 — 1 2 — 1 1 — — — — 11—12 17 5 7 3 2 — 5 - - - - - - - 1 4 2 — 3 3 1 2 1 1 — — Totals 265 104 38 65 33 25 57 29 11 1 49 32 22 34 13 34 13 18 14 15 4 12 5 46 21 2 98 98 40 TABLE N. ENQUIRIES INTO INFANTS DEATHS, 1909. ]Totals. Cause of Death. Method of Feeding. Mother's Health. Mother's Work. Condition of Tenement. Number of Rooms in Tenement. Age in Months. Breast only. Breast and o:her food. Cows' Milk. Artificial or Condensed. Died soon after birth. Good. Indifferent. Bad. Home work only. Away from Home. Away from Home intermittently. Some Home work. Clean. Fairly Clean. Dirty. One. Two. Three. Four or more. 0 1 2 3 4 5 6 7 8 9 10 11 49 Diarrhœa 10 11 17 11 - - 12 2 31 8 5 5 27 14 8 l7 18 7 7 2 5 6 9 5 8 3 1 5 3 2 - 32 Prematurity 10 1 7 — 14 16 14 2 19 5 1 7 19 10 3 10 13 7 2 30 1 1 — — — — — - - - — 22 Marasmus 9 4 7 2 - 9 9 4 12 4 3 3 12 8 2 3 14 3 2 6 4 3 2 1 1 2 1 1 1 - — 34 Atrophy & Developmental Diseases 13 3 9 3 6 18 13 3 21 6 1 6 23 8 3 10 17 4 3 19 8 5 2 - - - - - - - 13 Bronchitis 6 3 3 1 — 8 4 1 9 - 1 — 7 5 1 6 3 4 - 1 2 1 1 1 2 1 — 1 2 — 1 34 Pneumonia 16 5 7 6 — 23 9 2 17 5 9 3 15 14 5 11 13 7 3 4 2 2 4 1 2 4 6 3 1 1 4 13 Convulsions 6 1 2 1 3 10 3 9 - 4 - 7 4 2 4 5 2 2 4 1 1 1 1 1 1 - 1 - 2 18 Suffocation 12 2 3 - 1 14 4 - 10 3 3 2 8 7 3 6 7 4 1 2 7 2 5 - - 1 - - - 1 - 14 Measles 3 1 4 6 — 9 5 — 9 - 3 2 9 4 1 2 3 5 4 - - — - — 2 — — 4 3 2 3 15 Hooping Cough 7 1 5 2 — 13 1 1 10 1 2 2 5 9 1 5 7 2 1 1 2 1 — 1 — — 1 4 2 — 3 4 Tuberculosis 1 1 1 1 - 2 1 1 3 - - 1 3 1 1 2 1 - - - - - - - - 1 1 — 1 1 12 Meningitis ing Tuberculous 7 5 — — — 11 i — 4 2 3 3 6 4 2 — 10 2 — — — 2 — 3 1 1 1 1 — 1 2 5 Miscellaneous 4 — — — 1 4 1 — 4 1 — — 4 1 — 4 1 — — 3 — 1 — — — — — — — — 1 265 104 38 65 33 25 172 77 16 158 38 35 34 145 89 31 79 113 48 25 72 32 25 22 15 16 13 12 20 13 8 17 41 TABLE O. INVESTIGATION INTO INFANT DEATHS, 1904-1909. ]1904 to 1909 Cause of Death. Method of Feeding. Mother's Health. Mother's Work. Condition of Tenement. Number of Rooms in Tenement. Age in Months. Breast only. Breast and other food. Cows' Milk. Artificial or Condensed. Died soon after birth. Good. Indifferent. Bad. Home work only. Away from Home. Away from Home intermittently. Some House work. Clean. Fairly Clean. Dirty. One. Two. Three. Four or more. 0 1 2 3 4 5 6 7 8 9 10 11 387 Diarrhœa 51 43 190 103 137 63 11 256 57 34 40 206 126 55 128 161 62 36 15 35 39 62 49 38 28 41 22 17 17 24 253 Prematurity 62 10 53 6 122 b8 51 25 167 31 26 29 165 67 21 78 98 53 24 229 17 6 1 — — — — — — — — 176 Marasmus 44 31 75 24 2 56 31 13 114 23 30 9 80 65 31 65 81 20 10 28 28 34 19 14 14 8 8 10 6 3 4 101 Atrophy & Developmental Diseases 34 7 29 6 25 43 33 14 65 17 4 15 60 29 12 31 42 19 9 66 14 11 4 3 - - 1 - 1 - I 126 Bronchitis 62 23 26 15 — 43 14 6 87 12 21 6 60 54 12 31 51 34 10 17 14 17 12 6 10 9 5 7 14 8 7 198 Pneumonia 82 40 50 25 1 86 40 7 127 21 34 16 86 82 30 54 88 .37 19 13 14 19 11 4 19 22 14 17 15 18 32 105 Convulsions 40 15 26 8 7 41 14 3 71 9 14 11 66 32 7 34 50 13 8 35 9 8 7 12 7 2 4 4 6 4 7 117 Suffocation 84 15 7 2 9 57 15 1 73 8 20 16 52 51 14 41 50 18 8 29 32 21 16 8 2 5 1 1 — 1 1 63 Measles 16 14 20 11 — 32 14 1 41 4 13 5 31 23 9 14 24 19 6 — - — — 2 4 3 2 12 10 11 19 62 Hooping Cough 30 9 16 7 — 32 6 3 36 10 9 7 32 24 6 16 31 8 7 1 3 6 5 6 4 4 5 8 8 6 6 52 Tuberculosis 18 12 14 8 — 15 5 4 32 4 9 7 27 18 7 16 29 4 3 - 1 1 6 8 5 6 4 5 5 5 3 47 Meningitis including Tuberculous 31 8 5 3 35 10 2 27 6 7 7 26 18 3 12 22 13 - 2 1 3 1 9 5 5 5 6 6 1 3 138 Miscellaneous 73 15 26 12 12 49 12 3 92 15 15 16 80 45 13 46 56 25 11 53 15 4 6 6 6 8 5 6 6 11 12 1825 % 636 242 537 232 178 694 308 93 1188 217 236 184 971 634 220 566 783 325 151 488 183 169 150 127 114 100 95 98 97 85 119 35 13.2 30 12.8 9 63 29 8 65 12 13 10 53 35 12 31 43 18 8 27 10 9.5 8 7 6 6.5 5.0 5.5 5.5 4.5 6.5 % on 1095. 42 Method of Feeding.—Of the total number of cases, only 35 per cent were breast fed. Of the 18 deaths from suffocation in bed, 12 were breast-fed; this rather lends support to the view that in many of these cases, death results from the fact that the mother goes to sleep while the teat is still in the baby's mouth. Death ensues either because the breast presses over the baby's nose and mouth, or the mother rolls over upon the child. The same conclusion is upheld by the figures in the third table. The deaths from diarrhoea amongst the wholly and partially breast-fed are three-fourths of the number who died, having been artificially fed. Mothers' Health.—Of the mothers, 172 were reputed healthy— that is 64 per cent.; 77, or 29 per cent., enjoyed indifferent health, whereas 16, or 7 per cent., had bad health. That so many mothers were healthy is matter for congratulation—this means that at any rate the child probably in these cases gets a fair start in life. The largest number of unhealthy mothers was found among those whose children had been born prematurely, or whose children suffered from atrophy and developmental disease. Mothers' Work.—Fifty-nine percent. only did their own housework—14 percent, worked away from home. In Finsbury it is rather the exception for mothers to work shortly after the birth of the child, though some doubtless do so, driven to it by necessitous circumstances. Home Conditions.—Nearly 12 percent, of the homes were dirty, 54 per cent, were clean, the rest, 34 percent., a little over one-third of the houses, were only passably clean. The high percentage of dirty rooms is generally found in connection with the deaths due to diarrhoea, marasmus and pneumonia, causes which bespeak the carelessness of one or both parents. 43 DISTRIBUTION OF INFANT DEATHS. In 1909, the largest number of deaths occurred in Lever Street (9), St. Bartholomew's Buildings (9), Penton Street (8), Hatfield Street (7), Margaret Street (7), St. Helena Street (7), Bastwick Street (6), Cumming Street (6), Cyrus Street (6), Northampton Buildings (6), King's Cross Road (6), Peerless Street (6), Southampton Street (6), Galway Street (5), Guinness's Buildings (5), Northampton Street (5), Radnor Street (5), Risinghill Street (5), and Warren Street 5 deaths. It is contrary to expectation to find so many infant deaths in the "Buildings"; in the other localities the residents are some of the poorest in the district. Infant Deaths, 1904-1909.— The numbers investigated for any one year are small, and great caution is necessary in making accurate deductions from them. During the six years 1904-1909, altogether 1,825 deaths have been made the subject of enquiry, and the following deductions in the main, hold good :— 1.—One-third of the children are wholly breast fed—the rest are totally or partially fed by artificial methods. 2.—Amongst the children dying of diarrhoea, one-seventh only were totally breast fed—the large bulk, 75 per cent., were fed artificially. 3.—Of the children dead of marasmus and wasting conditions, only 25 percent, were wholly breast fed, whereas 57 per cent, were artifically fed. 4.—The majority of the children who died from suffocation in bed—71 per cent., nearly three-quarters of the whole number, were entirely breast fed. 5.—Most of the deaths occurred in the homes of persons occupying one or at most two-roomed tenements. 44 6.—Most of the mothers of the dead infants had no occupation taking them away from home—they did their own housework only. DEATHS OCCURRING IN FINSBURY IN INFANTS UNDER 12 MONTHS OF AGE IN 5 RECENT YEARS. The death records for 5 years have been investigated and the infant deaths allocated amongst the various streets as follows :— Affleck Street 17 Benjamin Square 8 Albert Street 16 Berkley Court 3 Albion Place 5 Berkley Street 14 Allen Street 2 Bowling Green Lane 8 Amwell Street 8 Brewer's Buildings 4 Anchor Yard 1 Brewer Street 13 Ann Street 4 Brunswick Close 12 Ann's Place 3 Bunhill Row 1 Arlington Street 6 Busaco Street 10 Attneave Street 5 Buxton Houses 4 Aylesbury Street 8 Buxton Street 8 Baker Street 4 Caroline Place 1 Baker's Row 7 Castle Street 1 Baird Street 1 Cavendish Buildings 3 Baldwin Street 18 Central Street 35 Baltin Court 2 Chadwell Street 1 Baltic Street 1 Chad worth Buildings 3 Banner Street 2 Chapel Place 5 Barnsbury Road 4 Chapel Row 5 Baron Street 4 Chapel Street 11 Bartholomew Square 7 Charlotte Place 3 Bastwick Street 30 Charterhouse Square 1 Bath Buildings 1 Chiswell Street 2 Bath Court 2 Church Row 3 Bath Street 7 City Road 18 Beckford Square 7 Claremont Mews 3 45 Claremont Square 2 Featherstone Street 1 Clerkenwell Close 13 Field Place 2 Clerkenwell Green 3 Finsbury Street 1 Clerkenwell Road 1 Fletcher's Row 3 Cloudesley Road 1 Fox Terrace 1 Cobden's Buildings 2 Francis Court 6 Coburg Street 4 Frederick Row 1 Coldbath Buildings 9 Fryes Buildings 2 Coldbath Square 12 Galway Street 24 Collier Street 14 Gastigny Place 8 Compton Buildings 14 Gee Street 29 Compton Passage 2George's Row 3 Compton Street 7 George's Street 3 Corporation Buildings 10 George's Yard 9 Corporation Row 6 Glasshouse Yard 1 Costers Dwellings 7 Gloucester Street 6 Cottage Lane 1 Godson Street 9 Cow Cross Street 3 Goswell Place 1 Cowper Street 1 Goswell Road 28 Crawford Passage 6 Goswell Terrace 9 Cumming Street 20 Graham Street 1 Cynthia Street 3 Granville Square 3 Cyrus Street 14 Great Bath Street 10 Domingo Street 1 Great Percy Street 12 Donegal Street 7 Great Sutton Street 1 Douglas Place 5 Guest Street 9 Dufferin Street 15 Guinness Buildings 47 Dundee Buildings 1 Hall Street 2 Eagle Court 1 Hallett's Place 3 Eagle Dwellings 7 Hardwick Street 1 Easton Street 18 Hat and Mitre Court 1 Elizabeth Place 2 Hatfield Street 15 Errol Street 2 Helmet Row 7 Europa Place 3 Henry Street, Old Street 13 Exmouth Street 2 Hermes Street 13 Farringdon Road 14 Hewitt's Buildings 2 Farringdon Road Blds. 9 High Street 1 46 Holford Square 2 Memel Street 4 Howard's Place 2 Meredith Street 3 Hull Street 1 Merlin's Place 8 Ironmonger Passage 2 Mitchell Street 20 Ironmonger Row 30 54 Mitre Court 4 Ironmonger Street 22 Moreland Street 4 James Gardens 13 Mount Pleasant 1 Jay's Buildings 2 Mulberry Place 2 Jerusalem Passage 2 Muriel Street 5 John's Place 3 Murton Street 10 King's Cross Road 15 Myddelton Square 9 King Square 2 Myddelton Street 10 Langton Avenue 4 Nelson Street 7 Langton Street 1 New Charles Street 4 Leage Street 8 Nicholl's Buildings 1 Leicester Place 2 Noble Street 16 Leverington Street 5 Norman Buildings 5 Lever Buildings 2 Northampton Buildings 49 Lever Street 31 Northampton Road 22 Lewen's Court 1 Northampton Row 1 Liverpool Road 1 Northampton Square 3 Little Northampton St. 10 Northampton Street 23 Little Saffron Hill 4 Norway Street 2 Little Sutton Street 22 Old Street 4 Lizard Street 11 Owen's Row 1 Lloyd's Row 4 Paton Street 2 Lock's Gardens 1 Peabody Buildings, Lorenzo Street 1 Farringdon Road 3 Ludlow Street 5 Peabody Buildings, Macclesfield Place 10 Roscoe Street 1 Macclesfield Street 13 Peartree Street 6 Malta Street 3 Peerless Buildings 4 Margaret Place 4 Peerless Street 18 Margaret Street 31 35 Penton Grove 2 Market Buildings 1 Penton Place 8 Mason's Place 3 Penton Residences 3 Medcalf Place 4 Penton Street 16 47 Pentonville Road 28 Percival Street 10 Percy Circus 3 Percy Square 1 Pickard Street 1 Pine Street 12 Playhouse Yard 5 Pollard Houses 5 Powell Street 3 President Street 13 Prospect Row 2 Pump Court 2 Radnor Street 29 Radsworth Street 4 Rahere Street 19 Rawstorne Building's 3 Rawstorne Street 7 Red Lion Street 12 Richard Street 5 Richmond Street 10 Risinghill Street 45 River Street 2 Rodney Place 2 Rodney Residences 2 Rodney Street 17 Roscoe Street 16 Rosebery Avenue 9 Rosoman Mews 3 30 Rosoman Street 27 Royley Street 6 St. Barts Bldgs 35 St. Clement's Buildings 8 St. Helena Street 25 St. James Street 9 St. James Walk 4 St. John's Lane 1 St. John Street 30 Salisbury Buildings 2 Sans Walk 3 Seabrooke Place 6 Sekforde Street 2 Seward Street 3 Seymour Place 3 Sidney Grove 10 Sidney Place 6 Sidney Street 10 Skinner Street 3 Smithfield Buildings 1 Smith Street 9 Southampton Street 34 Southern Street 1 Spencer Street 9 Steward's Place 4 Stratton Place 1 Suffolk Street, Clerkenwell Green 2 Tabernacle Street 1 Thomas Place 8 Thomas Street 9 Tysoe Street 3 Union Place 2 Upper Ashby Street 3 Upper Chadwell Street 3 Upper Charles Street 3 Upper Smith Street 1 Valetta Street 3 Victoria Dwellings 18 Vineyard Gardens 1 Vineyard Walk 7 Wardens Court 5 Warner Street 2 Warren Street 27 Waterloo Street 12 Wenlake Buildings 5 48 West Place 6 Weston Street 5 Wharf Road 1 Wharton Street 6 Whiskin Street 9 White Conduit Street 5 Whitecross Street 10 White Horse Alley 6 White Lion Building's 1 White Lion Street 29 William Street 2 Wilmington Place 7 Wilmington Square 9 Winchester Cottages 1 Winchester Street 4 Winton Houses 1 Withers Place 1 Woodbridge Street 1 Wynford Road 12 Wynyatt Street 6 Yardley Street 5 York Place 5 St. Luke's (unknown) 2 Clerkenwell (unknown) 2 The Lady Health Visitors are instructed to pay special attention to all births which occur in these streets where the infant deaths are highest and to visit every birth occurring in them. DEATHS FROM INFECTIOUS DISEASE. The number of deaths certified as due to the infectious diseases, named in the accompanying table, in 1909 was 232. The corresponding death rate was 2.4 per 1,000; the rate for the whole of London was 1.3, so that the death rate in Finsbury from infectious disease was nearly twice as great as that prevailing in London generally. 49 The deaths from each disease are here set out. Small-Pox. Scarlet Fever. Diphtheria and Membranous Croup. Enteric Fever. Puerperal Fever. Measles. Hooping 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 — l6 15 2 1 43 44 66 187 1908 - 12 l6 12 3 38 22 126 229 1909 — 9 13 3 2 86 51 68 232 The table discloses a diminution in the number of deaths from scarlet fever, diphtheria, typhoid fever and diarrhoea, but an increased number of deaths from measles and hooping cough. CANCER AND MALIGNANT DISEASE. In 1909, cancer was certified as the cause of death in 88 cases. The death rate was 0-92 per 1,000. More males died of the disease than females—the bulk of the deaths occurred after 50 years of age. The age, sex distribution of the cases is annexed. D 50 ]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 upwards. l. Males - 1 1 2 7 13 17 8 49 Females 1 — — — 6 15 12 5 39 Totals, 1909 1 1 1 2 13 28 29 13 88 Totals, 1908 1 — 2 5 8 27 30 14 87 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 5 13 22 22 12 79 Totals, 1903 — 1 2 10 13 29 23 14 92 Totals, 1902 — — — 1 16 17 18 20 72 Totals, 1901 1 2 2 8 14 18 14 13 72 There is a belief that in recent years cancer has increased. This is in all probability correct. Cancer is essentially, though not entirely a disease of degeneration, a disease of mature and declining years. It is obvious that if this be the case, then, as by improved sanitation, better housing, the efficient control of infectious disease, the supervision of the food supply and better circumstances the years of life are lengthened, so in like measure will cancer increase. When a man becomes 45 years he may be said to enter upon the cancer period of life—before this time cases occur but are not common—after this age they are comparatively common. 51 The apparent increase of cancer has been explained in another way—it is stated that owing to the more refined and elaborate methods now available cases of cancer are more easily recognised and correctly diagnosed. Cases of cancer are now, it is asserted, not missed as presumably they may have been in former years. Probably both these factors are concerned in the explanation of the apparent increase of the disease. The parts affected are set out below:— ]Cancer and Malignant Disease of various parts of the body. 1901 1902 1903 1904 1905 1906 1907 1908 1909 Totals Face, Tongue and Jaw — 7 12 7 7 7 9 8 5 62 Throat, Neck and Gullet — 8 7 8 8 12 13 7 9 72 Stomach 9 12 16 8 7 8 9 13 10 92 Intestines 10 17 11 14 10 20 12 29 18 141 Liver 10 6 13 11 3 13 10 11 13 90 Pancreas — — 3 3 1 — 2 3 4 16 Breast 6 9 12 4 11 8 4 3 1 58 Womb 16 12 9 14 11 9 13 10 14 108 Various 21 1 9 10 7 7 14 3 14 86 Totals 72 72 92 79 65 84 86 87 88 725 In man the sites of the disease are chiefly those parts concerned with digestion, the mouth, stomach, liver and intestines, in woman the parts concerned with reproduction, the womb and breast. RESPIRATORY DISEASES. The deaths due to this group were as follows:— Pneumonia 203, Bronchitis 222, Pleurisy 7, Other Respiratory Diseases 9. making 441 in all. D 2 52 Many of these are doubtless due to exposure, but some are due to infection as well. In 68 cases the children were under one year, in 126 cases the children were under 5 years of ape. In these children the pneumonia probably occurred after an attack of measles and hooping cough—both of which leave in their train a distinct susceptibility to pneumonia and lung affections. In addition to the deaths given above there were 228 deaths due to consumption of the lungs, so that altogether there were 669 deaths—over one-third of the total due to lung affections. ALCOHOLISM. It is quite rare to find alcoholism on a death certificate save in the case of the homeless, the destitute, or persons dying in poor law institutions. It is oftenest veiled under the term Cirrhosis of the Liver. The deaths from both these are appended:— ]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 1908 10 21 31 1909 12 34 46 Totals 150 231 381 53 It is not meant that all the deaths due to, or associated with Alcohol, are here included. Many of the cases of Bright's disease of the kidneys, of Pneumonia in young; adults, and possibly some of the cases of overlaying are due directly or indirectly to Alcohol. The ages of death are shown in the table:— ]Age. 10-20 20-30 30-40 40-50 50-60 60-70 70-80 Total. No. of Males 0 1 1 4 4 9 2 21 No. of Females 1 0 4 9 6 4 1 25 The youngest was a girl aged 18, the oldest a man aged 76 years. The table shows that between 30 and 60, more females die than males, beyond 60, more males than females. It would appear that amongst habitual drinkers the women are killed off quickest—the men last longest. More females die of Alcoholism than males. Thirteen of the cases died in the Workhouse and Workhouse Infirmary. Only two of the whole number of cases were connected with the trade. The occupations of the males were as follows:— Labourer (3), Cabdriver (2), Mechanical Engineer (2), and Barman, Clerk, Collector, Fruiterer, General Dealer, Glass Beveller, Licensed Victualler, Night Watchman, Pensioner, Silversmith, Translator of Languages and Watch Dial Painter, one each. CONSUMPTION OF THE LUNGS. In 1909, the number of Finsbury persons who died of phthisis or consumption of the lungs was 228, in addition to these 31 persons died of tuberculosis of other parts. 54 The number for previous years are given in the table subjoined:— ]Year. Finsbury Deaths from Phthisis. Finsbury Deaths from other forms of Tuberculosis. Phthisis Death Rates per 1,000 population. Finsbury. England and Wales. 1901 216 30 2.12 1.260 1902 240 23 2.38 1.230 1903 223 39 2.21 1.200 1904 251 67 2 .53 1.230 1905 215 52 2. l8 1.140 1906 232 48 2.38 1.150 1907 243 42 2.51 1.140 1908 221 39 230 1.115 1909 228 31 2.39 It will be observed that the phthisis death rate is very high in Finsbury—it is more than double the rate that prevails in England and Wales generally. The phthisis death rate in England and Wales has never been above 2 per 1,000 since the year 1880, so that at first sight it would appear that consumption of the lungs in Finsbury now stands in about the same position that it did in England and Wales generally in 1871, when the rate was 2.34 per 1,000, that is nearly 40 years ago. However, there are several reasons for this, which must be gone into in next year's report. Of the whole number of deaths in Finsbury in 1909, consumption of the lungs caused more than any other single disease. Altogether 14 per cent. of the total deaths in Finsbury were due to tuberculosis in this year. The broad fact then issues that the question of the prevention of consumption of the lungs is one of most urgent and most important before the Borough Council. 55 But it is very doubtful whether it can be dealt with by one Borough acting independently of its neighbours—the probability is that before this fell disease can be efficiently tackled, it will be necessary for all metropolitan boroughs to co-operate in the work and to co-ordinate their efforts. At the present day, many of the deaths from consumption which occur in Finsbury are those of people who have lived in the Borough a very short time. Some of these indeed, it is asserted, have advisedly moved into the Borough so that they may thereby secure admission to the Poor Law Infirmary at Highgate. Others have lodged for one or two nights in a Finsbury common lodginghouse and and have thereby achieved a "settlement" in the district, entitling them also to admission to the poor law infirmary at the appropriate time. The Poor Law Infirmary at Highgate has for many years past had an excellent reputation amongst the poor of North London for its humane and considerate treatment of consumption. It is obvious that these deaths, though nominally belonging to Finsbury and correctly accredited to the Borough, cannot legitimately be said to be associated with any presumed insanitation, overcrowding or bad housing in Finsbury. They are focussed in the district from altogether different causes. This raises another question—which is gradually crystallising and taking form in the definite opinion that the establishment of large philanthropic and charitable institutions is not altogether an unmixed blessing from a public health and statistical standpoint for the Borough concerned. These institutions, it is true, relieve the distress in their spheres of interest and are of exceeding great value, but they have another and unexpected result—they attract into the district the needy, the derelicts, the consumptives, the weak and ailing, the vagabonds and thieves. These people invade the cheap restaurants, live in the common lodging houses or cheap institutions, and, unfortunately, by so doing have an intensified and increasing opportunity of spreading consumption and infectious disease to their neighbours. 56 The accession of these cases, the facility with which each one disseminates consumption or whatever other contagious or infectious disease taint he possesses, both these causes tend to raise the general death rate, or to keep it at its level, and have a similar result in the case of consumption or of any other special affection to which this paragraph applies. INQUESTS. Inquests were held on the bodies of 175 persons belonging to the Borough. 1 he verdicts were as follows:— ]Natural Causes— Suicide— Pneumonia 13 Hanging 2 Bronchitis 1 Poisoning 5 Heart and Circulatory Diseases 36 Run over 4 Injuries from fall 1 Cerebral Haemorrhage 15 — Alcoholism 3 12 Cirrhosis of Liver 2 Congestion of Lungs 3 Accidents— Tuberculosis 4 Diarrhoea 6 Burns and scalds 12 Intestinal obstruction 1 Suffocation in bed 21 Influenza 1 ,, by feeding 3 Miscellaneous 5 Injuries from fall 25 Run over 2 90 Drowning 2 Injuries to lungs, limbs, skull 6 While under Chloroform 1 Poisoning 1 73 DISEASE RECORDS. The diseases now notifiable under Section 55 of the Public Health (London) Act, 1891, are Smallpox, Cholera, Diphtheria or Membranous Croup, Erysipelas, Scarlet Fever, Typhus, Typhoid, Relapsing, Continued and Puerperal Fevers. Cerebro Spinal Fever, Glanders, Anthrax, and Hydrophobia in man are likewise notifiable in London, under an order of the London County Council under Sections 55 and 56 of the Public Health (London) Act. 57 Sections 60-65, 68-70, 72-74 of the same Act apply to Measles. Cases of Anthrax, or poisoning' by mercury, arsenic, lead and phosphorus, must be notified to the Chief Inspector of Factories, Whitehall. Phthisis is voluntarily notifiable in Finsbury in the case of private patients, and compulsorily notifiable in the case of poor law patients. Compulsory notification of poor law patients with Phthisis is provided for under the Public Health (Tuberculosis) Regulations, 1908, of the Local Government Board, which came into force on the 1st January, 1909. NOTIFICATIONS. The number of notifications of infectious disease received in 1909 was 534, as compared with 654 in 1908, 735 in 1907, and 764 in 1906, so that it appears that the number has gradually been diminishing in recent years. These notifications were apportioned thus:—Smallpox none, Scarlet Fever 231, Diphtheria 152, Cerebro Spinal Fever 3, Typhoid Fever 15, Erysipelas 127, and Puerperal Fever 6 cases. The figures for previous years are appended :— ]Year. Number of Notifications Received. Notifications per 1,000 of the population. Percentage of Cases removed to Hospital. 1901 1,101 10.8 85.5 1902 1,026 10.1 82.4 1903 566 5.5 78.8 1904 609 61 72.5 I905 745 75 81.8 1906 764 78 76.9 1907 735 7.6 83.4 1908 654 6.5 83.6 1909 534 5.6 74.7 In the above table "Notifications " of Chicken-Pox are excluded (203 in 1907). 58 The amount paid in fees this year for notifications was £46 18s. 0d., which is the lowest yet recorded since 1901. The highest amount was in 1902 when the amount was £175 16s. 0d. —this was at the time of the Small-pox epidemic. DIAGNOSIS.—In 21 cases out of a total number of 420, the patients after admission to a fever hospital were returned home as not suffering at the time of admission from any notifiable infectious disease. Most of these mistakes—over 80 per cent, of them were made not by private doctors, but at the large general hospitals. The errors were chiefly in connection with Diphtheria—out of 167 cases removed 15 were returned as not having the disease. Diphtheria is a disease in which it is of the utmost importance to secure treatment at the earliest possible moment, so that these removals, even when the case is a little doubtful are justifiable. The diagnosis of the cases of Typhoid Fever was sustained in hospital in every instance. Five cases of Scarlet Fever were returned home as incorrect. The small number of mistakes made is an excellent criterion of the good work done in the district when one considers the difficult circumstances, the badly lit, stuffy, small rooms in which the patients are found, often unwashed since the onset of the disease and in which they are at first seen by the medical men in attendance. SMALL-POX. No case of Small-pox was notified in Finsbury in 1909. There were a few cases in other metropolitan boroughs, derived originally from persons entering London from Turkish, Levantine and Algerian ports. One imported case is interesting as showing how the disease may be spread. The patient, a stoker, left a ship at Algiers on September 1st, 1909, with 4 other men and all went into hospital there. Two of 59 the men died. The patient was detained a few days and then discharged. All were supposed to be suffering from "Java" fever. He took train to London and arrived on September 28th. He went to his sister's house in the East End and found that she and her husband were hop-picking in Kent. He followed her there the next day and stayed with her family—feeling very ill. They all slept in a barn. The patient, his sister and her husband came to London by train on September 30th and proceeded immediately to their home in the East End. This sister, her husband and other persons in the "buildings" were infected by the patient, who eventually died on October 9th, 1909, of severe and confluent Small-pox. CHOLERA. In September, 1909, cases of Cholera occurred at St. Petersburg and Rotterdam. Persons travelling from these ports into England were required to give their correct names and destinations to the Port Medical Officer of the port of entry in England, who then forwarded these to the Medical Officer of Health of the district concerned so that these contacts might be kept under supervision. In this way the names and Finsbury addresses of 38 persons who had been in contact with cases of Cholera were received by the Council's Medical Officer from the Port Medical Officers of London and Harwich. The persons travelling were then visited at intervals while they remained in Finsbury:— This supervision was often thwarted, however, and the work rendered fruitless for the following reasons:— One person gave an accommodation address and could not be traced. 60 One gave the address of an hotel that was closed. Six were not known at the address given, nor did they arrive there. Two left the address given on the same afternoon that they arrived and were completely lost sight of. Three arrived at the address and in a day or so went elsewhere—telling the hotel-keeper they were going to the Continent. In two instances the hotel-keeper refused information and resisted all enquiry. So that, in all, out of the 37 persons, only 22 were subject to useful supervision. If this enquiry shows anything at all, it demonstrates the uselessness of this method, at all events in England. It may perhaps be an effective method in Continental towns where a man has to register himself with the police within 24 or 48 hours of his arrival. In England, however, unless some further powers are available, the work in Finsbury shows that the method is worse than useless —because it is assumed to be effective when it is in reality nothing of the kind. GLANDERS. No case of glanders in man was notified during the year. Notice was, however, received of two outbreaks of glanders amongst horses in mews in the Borough. DIPHTHERIA. The number of true cases notified was 152, of which 13 died, equal to a case mortality of 8.5 per cent., or, put in another way, this means that 8.5 per cent. of all the cases died of the disease. The percentage of deaths is lower than it has ever been since the borough was incorporated. The number of cases has recently shown a tendency to increase. 61 Most of these cases occurred between the ages of one and fifteen years—nearly all the deaths were in children between one and five years. At this age they are less prone to complain of discomfort and the less able intelligently to explain how, when and where they feel unwell, so that the disease may make much headway before it first receives medical attention. The cases in previous years are given here:— DIPHTHERIA SINCE 1901. ]Year. No. of Cases. No. of Deaths. Case Mortality No. of Deaths per 100 cases notified. No. of Cases per 10,000 of Population. No. of Deaths per 10,000 of Population. 1901 289 36 12. 5 28.4 3.5 1902 216 37 171 21.1 36 1903 119 12 10.1 11 8 1.2 1904 123 14 11.4 12.4 1.4 1905 126 11 87 128 1.1 1906 151 25 165 15.5 2.5 1907 127 15 11 8 12.7 1.5 1908 130 16 12.3 13.5 1 .6 1909 152 13 8.5 15.9 1.6 Whenever a case occurs in a house, a careful sanitary survey is made of the premises and the source of infection elucidated or inquired into. The following defects were thus found in the houses where the 152 cases occurred:— Dirty rooms (13), verminous rooms (2), yard dirty (1), staircases and passages dirty and dilapidated (2), defective drains (7), w.c. pan broken (2), w.c. choked (2), w.c. insufficient flush (3), soil pipe broken (1), defective sink waste (1), dirty water cisterns (2), yard gulley choked (1), dustbins broken and absent (2'), yard pavement broken (1), stinking accumulation of refuse in back yard, one instance. 62 It will be noticed that defective drains were only found in 7 houses, and shows what slight ground there is for the popular association of diphtheria with defective drainage. Source—The source was in 15 cases due to previous cases in the same house, or in its immediate vicinity, in 12 other cases due to members of the same family suffering with the disease. School infection was responsible in 3 instances. Two persons contracted the disease by going to convivial meetings at the beginning of the year. Three occurred in the Remand Home and 2 in a day nursery. In two instances there was reason to believe that diphtheria was caught from another patient while visiting a general hospital and in one instance a cat was the presumed source. A few were presumably due to premature discharge from the Fever Hospitals. In one household a young child recently discharged had sore throat a day or two after his arrival home— soon after 3 other children in the same family had diphtheria— the original returned case was now seen by the Medical Officer of Health and found to have diphtheria and sent back to the Fever Hospital for the second time. Cases discharged for home—All these are examined most carefully shortly after their arrival home from the fever hospitals and a record kept of their condition, and, if necessary, preventive measures are taken. The conditions found amongst these convalescent patients are shown below:— Nasal Discharge 6 Sore Throat 1 Sore nostrils 2 Weakness of limbs, probably slight paralysis following diphtheria 9 Nasal Voice (Paralysis of Palate) 2 Neck Glands enlarged 1 Ear Discharge 1 General Weakness 2 There were 5 return cases. Throat swabs are examined gratuitously by the Public Health Department; 98 were submitted in 1909, and in 25 specimens the diphtheria bacillus was found present. 63 SCARLET FEVER. In all, 231 cases were notified, which is a smaller number than of any previous year since the Borough was formed. The cases were nearly all in children between one and fifteen years. There were 9 deaths, 3.89 per cent. of the total number of the cases, or one, in every 26 children affected, died. The particulars with regard to previous years are annexed:— SCARLET FEVER SINCE 1901. ]Year. Actual No. of Cases No. of Deaths. Case Mortality No. of Deaths per 100 cases notified. No of Cases per 10,000 of population. No. of Deaths per 10,000 of population. 1901 495 19 3.8 48.1 1.8 1902 381 15 3.9 37.9 1.5 1903 283 12 4.2 28.1 1.2 1904 323 17 5.2 32.6 1.7 1905 456 21 4.6 46.4 2.1 1906 422 13 6.1 43.5 2.6 1907 471 16 3.4 48.6 1.7 1908 387 12 3.1 40.3 1.2 1909 231 9 3.89 24.2 .9 The number of deaths this year is less than it has been for 9 years. The larger number of cases occurred in the first and third quarters of the year, least in the fourth quarter. Probable Source—In 27 instances the infection was derived from previous cases in the same family, in another 29 there was reason to believe that the disease had been contracted by visiting cases in houses in the vicinity. In 12 persons the disease was probably contracted from schoolfellows while in schools or on the way home; the seven other patients had been infected while sitting or standing by scarlet fever patients awaiting examination in the out-patient departments of large hospitals. 64 Six were examples of so-called "return" cases. These are cases which are associated with the return home of scarlet fever patients who have been detained in a fever hospital. They may also occur in households where the patients have been treated at home when these later re-enter the family circle. The original case is called the infecting case, the secondary cases are "return cases." It is very difficult, sometimes impossible, to say when a scarlet fever patient becomes free from infection. Some patients are infectious long after they are convalescent—it may be even months after they have apparently recovered in every way. These cases—the infecting cases—are often found to have a discharge from the nose—it may be only slight in degree and only evident on pressure—this discharge is now in most instances considered to be the infecting agent during convalescence from scarlet fever. In Finsbury every case discharged from the Fever Hospital is visited soon after return home and carefully examined. The possibility of further infection is explained to the mother, suitable measures suggested and a leaflet of instruction left with her. There were 6 return cases in 1909. The cases examined at home after their discharge from the fever hospitals had the following complications:— Discharge from nose 9 Sore nostrils and lips 3 Discharging ears 6 Enlarged neck glands 3 Boils 1 Peeling on feet 5 General weakness 2 All the houses where cases occurred were visited and inspected. Nuisances that called for remedy were made the subject of notice and the bedding and clothing were disinfected. 65 ENTERIC FEVER. The number of cases notified during the year was 15, with 3 deaths. The numbers in previous years are given in the accompanying table:— ]Year. No. of Cases Notified. No. of Deaths. Case Mortality. No. of Deaths (per 100 cases notified.) No. of Cases per 10,000 of Population. No. of Deaths per 10,000 of Population. 1901 65 11 16.9 6.4 1.1 1902 77 9 11.7 7.6 0.9 1903 47 11 23.4 4.7 1.1 1904 40 8 20.0 4.0 0.8 i905 42 9 21.4 4.3 0.9 1906 44 14 31.8 4.4 1.4 1907 22 2 21.0 2.2 0.2 1908 41 12 29.2 4.3 1.2 1909 15 3 200 1.5 0.3 This year there has been a substantial diminution in the number of cases notified and in the number of deaths due to typhoid fever The number of cases is less than it has been in the 8 preceding years, the number of deaths is less than it has been since 1901, save in the year 1907. The deaths occurred in a child aged 3, and in two females, aged 25 and 23 years. Source.—The presumed source was in one instance an attack of Typhoid Fever in one parent many years previously—for it is now well recognised that a patient who has had Typhoid Fever may remain infectious for many years after the attack. Four cases occurred in this family. In two other cases the infection was from recent cases in the same family. In 3 patients suspicion was directed to mussels, E 66 whelks and other shell fish. One female had contracted the disease in Italy, and was ill on her arrival in the Borough. For the other cases, no presumed sources were discovered. At the present day there is every reason to believe that these cases for which no source is found are often due to undiscovered "carrier" cases—people who have had typhoid 10, 20 or 30 years previously, who are now apparently in excellent health, but yet who may pass countless millions of typhoid germs daily in their stools or urine, as a result of the attack years ago. ERYSIPELAS. Notifications to the number of 127 were received, distributed as follows:— Under 1 year 1-10 10- 20— 30- 40- 50- 6o- Total all ages Males 1 7 6 5 5 7 4 8 43 Females 2 4 7 14 12 23 13 9 84 Totals 3 11 13 19 17 30 17 17 127 Disinfection is done after Erysipelas only on request and not as a routine measure. There were three deaths due to the disease, one in a child under 1 year, the other two in adults. MEASLES. This disease is not compulsorily notifiable. Notice of 436 cases was received in 1909 from Schools inside and outside the Borough, from School Visitors, from Medical Men, from other Borough Councils, from Registrars of Births and Deaths, from Relieving Officers, Sanitary Inspectors, Superintendents of Dwellings and from Parents and Guardians. 67 The age incidence and the age at death from 1903 to 1909 is shown in the tables given:— AGE INCIDENT OF CASES OF MEASLES, 1903-1909. ]Under 1 year of age in months. 1- 2- 3- 4- 5-10 10-15 Total 1903-1909 0-3 3-6 6-9 9-12 2 31 93 125 540 537 663 40 1,.254 49 4.135 The actual numbers notified year by year were 577, 802, 561, 1,036, 478, 245 and 436 from 1903 up to the present year. AGE AT DEATH IN CASES OF MEASLES, 19031909. ]Under 1 year of age in months. 1- 2- 3- 4- 5-10 10-15 Total 1903-1909 o-3 3-6 6-9 9-12 1 12 31 57 204 60 48 13 13 3 434 The deaths year by year were 69, 60, 31, 115, 43, 38, and 86 from 1903 until 1909. The largest number of cases and deaths were in 1906, when the disease was very prevalent. The houses where cases occur are disinfected-—this measure, however, does not appear to have limited the spread of the disease or to have lessened its virulence. The remedy lies with the parents themselves, who must be educated to recognise the loss of life that is yearly accredited to measles. Disinfection will not achieve this end—disinfection will not cure ignorance or carelessness. HOOPING COUGH. This is not a notifiable disease. School teachers sent in notices of 257 cases. E 2 68 MEASLES AND HOOPING COUGH. Measles caused 86 deaths, hooping cough 51 deaths in 1909. These two diseases are most fatal to children under 5 years, as may be seen from the accompanying table:— DEATHS IN CHILDREN UNDER 5 YEARS. ]Year. Measles. Hooping Cough. Small Pox. Scarlet Fever. Diphtheria. Enteric Fever. 1901 45 37 11 24 1902 79 70 11 11 28 — 1903 67 47 — 6 6 — 1904 57 26 2 11 13 — I905 30 31 — 14 9 - 1906 111 53 — 8 22 - 1907 43 43 — 11 J5 - 1908 36 20 — 9 12 — 1909 86 51 — 9 13 1 Totals 554 378 13 90 142 1 From this table it appears that amongst children under 5 years of age, measles kills more than twice, and hooping cough more than one and a half times the number of children whose deaths are caused by small-pox, scarlet fever, diphtheria and typhoid fever all added together. And yet the average British matron is inclined to treat measles with an indifference which is almost stupefying, or as a disease whose advent in the house should be welcomed and even encouraged and whose arrival should be notified to the neighbours so that they too may negotiate its successful acquisition for their own children. The Measles deaths occurred chiefly in Cyrus Street, Easton Street, Mason's Place, Risinghill Street, Bartholomew Square, 69 Brewer Street, Crawford Passage, Cumming Street, Farringdon Road Buildings, Great Bath Street, Helmet Row, Margaret Street Myddleton Street and Victoria Dwellings. The deaths from Hooping Cough were chicfly in Hatfield Street, Cavendish Buildings, Farringdon Road Buildings, l'enton Place and Rodney Street. CONSUMPTION OF THE LUNGS. This disease is compulsorily notifiable in poor law patients, beginning with the present year. Voluntary notification of all cases has existed in Finsbury since 1900. The notifications and deaths since 1901 are given below:— Total No. of Notifications. No. of Cases notified per 10,000 of population. Total No. of Deaths. Death Rate per 1,000. 1901 70 6.9 216 2.12 1902 121 12.0 240 2.38 1903 219 21.8 223 2.21 1904 210 21.2 251 2.53 1905 178 l8.l 215 2.18 1906 217 22.2 232 2.38 1907 217 22.4 243 2.51 1908 220 22.9 221 2.30 1909 359 37.4 228 2 39 The total number of notifications in 1909 was 359, and is larger than that of any preceeding year, by reason of the introduction of compulsory notification for poor-law patients. 70 This number includes 251 males and 108 females. Of the whole number 316, or 92.7 per cent., were sent by poor-law medical officers with respect to poor-law patients, and many notifications were received in respect of the same person. Thus, when he first entered the workhouse he was notified by the workhouse medical officer. Passing from the workhouse to the infirmary he was notified by the infirmary medical officer. Then, when he had picked up a little strength and a bank holiday or other festival was approaching he sought his discharge and was again notified by the workhouse master as about to be discharged to a certain address in Finsbury. Here he came under the supervision of the health authorities until he fell ill again, when the system of notification outlined above was once more re-enacted. Thus, to take 10 specified poor-law patients, they cost the Borough in notification fees alone in 1909 the following sums— 12/-, 8/6, 7/3, 6/6, 6/-, 5/3, 5/-, 3/9, 3/9, and 3/6 or £3/1/6 in all. The total number of poor-law notices received referring to 316 different patients was 791 notifications and 234 discharge notices—a total of 1025. One poor-law patient was in and out of the Infirmary no less than ten times in the year and was discharged to three different addresses during this period, presumably infecting each one of these places; on five occasions he went to reside at a common lodging-house. Other poor-law patients were discharged as follows:—10, 7, 7, 7, 5, 5, 3, and 3 times respectively, and proceeded straightway in a large number of instances to one of the Finsbury common lodging-houses. Altogether 188 notifications of consumption were received from Finsbury common lodging-houses, and 56 patients were discharged to common lodging-houses. It thus becomes obvious that the common lodging-house of the present day tends to become little more than a receiving-house 71 for consumption. Indeed, there is the best reason to believe that in Finsbury the common lodging-houses are being extensively used by tramps who stay there one night only for the purpose of obtaining a Finsbury "settlement" and admission to the infirmary at Highgate. This, of course, tends to raise the prevalence of phthisis in Finsbury and also to keep up the death rate from the disease. On the general question, that this is not a theoretical consideration, but is common to most lodging-houses and is even recognised by tramps themselves, the following extract is taken from a book published this year and written by a man who has spent many years in common lodging-houses:— "It is a pathetic sight to see men dying in a lodging-house, fighting against death day after day. "The few healthy men that are present are quite indifferent to life and do not care if their health is impaired through breathing in the same room as a dozen consumptives. These healthy men are so thoughtless of themselves that they offer their dying comrades saucers of tea, after which they drink with their own lips perhaps on the same places as their unfortunate fellows used. I well remember one man who was in a terrible condition for the last three months before he was carried to the hospital. He was a man of about middle age, and his face was very white, and, all day long he was coughing and spitting in the kitchen with only enough strength in his body to take him to bed. . . . I began at last to look upon these consumptives as murderers, who, by their stubbornness in not going to the hospital were killing me and others with their breath." Eleven cases of consumption admitted to the Infirmary or Workhouse from common lodging-houses died not long after their admission. Tramps, as a rule, struggle and fight until they can hardly move before they will enter a hospital or infirmary for the first time. Many of them are under the imoression that medical science, when it has to do with the friendless, homeless, and *"Beggars " by W. H. Davies. 1909. 72 incurable, finds some means of dispatching them, and no amount of argument will convince them of the contrary. When once, however, they have become in-patients, this misconception is erased and they become "in-ners and out-ers," chiefly at times of festival or holiday, and by careless and negligent habits when discharged infect their surroundings broadcast. During the year 120 deaths occurred at the Highgate Infirmary from phthisis. Nearly all of these were admitted from addresses in Finsbury, but only 87 were considered to have a Finsbury settlement. Towards the end of 1909 there were nearly 200 phthisis patients still under treatment, and of these a little more than half really belonged to Finsbury. It is a great advantage to have cases of phthisis removed to an institution, especially in the later stages when the expectoration may be very profuse. This measure removes a possible source of infection to others. Unfortunately, however, it is difficult to secure the removal of these poor-law cases until they are helpless or sometimes almost moribund. Under these circumstances the removal, although still advisable, is not nearly as salutary as if it were done earlier. The deaths in institutions are appended:— ]Year. 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 1908 221 81 50 131 59.3 1909 218 87 59 146 67.0 73 Notification of Address.—Of the notifications, 216 were received from Tenement Houses, 188 from Common Lodging Houses, 48 from Model Buildings, 11 from Private Houses, and 2 from Hotels. Many of the cases removed elsewhere almost at once after notification, presumably to evade supervision and inspection-these disappeared completely and were not traced further. The Model Buildings with their common landings, the tenement houses with their many points of contact between the families who occupy them, are too well adapted for the further spread of the disease-in these the isolation of patients is almost impossible over the long period of time-years it may be-during which phthisis lasts. And as a rule the patient, though anxious at first to carry out the requisite instructions and to prevent infecting his neighbours, tends to tire of the restrictions he is subjected to, and becomes careless. The supply of Model Buildings and tenement houses on easy terms is an excellent provision from a philanthropic and humane standpoint; but it has this reacting incident-these buildings afford the greatest facilities for the dissemination of consumption. Districts whose inhabitants are poor, where the density of population on area is greatest, where the proportion of model dwellings and tenement houses is high, where common lodging house accommodation is large or tramps many, where cheap restaurants abound, where charitable efforts are prominent, where alcoholism is rife, where the air is moist, where there is crowding or overcrowding in rooms, where lighting is poor, sunlight absent and ventilation insufficient, where labour is arduous and pay poorthese are the districts where consumption will be found common and where the disease is easiest disseminated. Residences during Illness.-The addresses of the patients during their illness and before notification were investigated. In 85 cases the patients had lived at two addresses while suffering from consumption, 37 patients had had three addresses, 7 had had 74 four, 6 had had five addresses, and one patient had lived in eight houses during the time of his illness. It is deplorable that these poor people move from one house to another-infecting one after the other. These removals are however, often due to poverty-the rent falls behind, and the sick tenant is either evicted or escapes clandestinely. Very many of the cases were never traced-they had moved to unknown addresses elsewhere and were now, probably, infecting a new house and new neighbours, free from supervision and subject to no restraint. Many of these people are said to be regular frequenters of common lodging houses. Others slept at an address in the Borough for one or two nights with relatives, or as lodgers, and had disappeared before the inspector had time to call upon them. One patient slept, when he had the means, in a Finsbury common lodging house, at other times on the Thames Embankment. One, a boy of 11 years, had no home and had been sleeping in the streets of Finsbury for some weeks. No. of Rooms occupied.—In 217 cases, the number of available rooms were as follows:—91 patients and their families lived and slept in one room, 88 in 2 rooms, 23 in 3 rooms, 10 in 4 rooms, 4 in 5 rooms, and one luxuriated in the possession of 7 rooms. It is obvious that when a family includes a consumptive and lives and sleeps in one or at most two rooms, that practicable measures for securing the protection of the rest of the family are impossible. And unfortunately these are the circumstances under which 82 per cent, of the Finsbury cases of consumption are found, on the above figures. And these are th circumstances which make the spread of the disease easy and its progress difficult to prevent. 75 Two illustrative cases are given. 1. A mother and six children, ranging from six months to thirteen years, live and sleep in one room. Two of the children are consumptive. The father is away, employed on relief works. 2. A man, wife, and one adult child, and six little children occupy two rooms. Two children have already died from consumption. The mother and one child of twelve years are now consumptive. The man earns 24/- per week. They have lived at three other addresses in Finsbury, while one or other of the family was consumptive. The rooms occupied were clean, not overcrowded, and not verminous. These two show some of the difficulties which are met in actual practice-difficulties not due to consumption alone, but to the poverty which accompanies it. From a public health point of view it may be broadly stated that the prevention of consumption is largely the prevention of poverty. The rich consumptive can well look after himself. Cases in Family or House.—In 27 cases there had been one previous case in the family or house, in 15 families 2 previous cases, in 7 households 3 previous cases, in 5 families 4 previous cases, in one household there had been 6 previous cases, and in one other there were said to have been even more than this. These figures illustrate the potential ravages of the diseasecases are on record where all the members of a family except one have been wiped out of existence by consumption. The probability is that if, in these households preventive measures had been adopted and been effectively and continuously practised, some at all events of these lives might have been saved. Family History.—In 174 cases, where this information was obtained, 84 had a history of consumption in the family, in the 76 other 90 cases there was no such history. It is probable that the importance of a family history in consumption has been overrated. It has endowed the patient with a distress bordering on fatalism-it has tended to convince him that it is useless to fight against the scourge, and that preventive measures are useless, do not prolong life, or retard the progres of the disease. It is exceedingly rare to find a child born with consumption or tuberculosis actually present in its tissue at birth. Many have doubted the existence of such cases and await further proof. What seems to be fairly well established is the inheritance in the various parts of the body of a medium, or what may be called, for lack of a better term, a soil favourable to the growth of the tubercle germ. If now by favourable sanitary surroundings, good food, and warm clothing the body may be armed and strengthened it is quite possible that it may be able to destroy the germ even if it were implanted, or at least inhibit its growth and propagation. Many cases of family infection are doubtless cases of infection not at birth but at later epochs when the child crawls, inhaling the dried expectoration voided by its parents, or eats from the same plate, using the same uncleaned utensils as its consumptive parents, or drinks from the same uncleaned cup, as many of the children of the poor are apt to do. Source and Predisposing Causes—The presumptive source, where it could be ascertained, was generally a case with which the patient had been in close contact over a long period of time. Thus, a husband had contracted it from his wife. One man had taken it from a consumptive boy-oth had slept in the same bed for five years. A girl had nursed her mother with phthisis for a few months before her death and later became herself consumptive. A father ill with consumption, living and sleeping with his family in one room, used to nurse and fondle his child of three years who subsequently developed the disease. 77 Most of the cases whose probable sources were located were were cases of family infection. In one instance the grandfather father and mother of the patient had all died of phthisis, and now the patient-42 years of age, out of work-and his brother were both consumptive. In another the mother, sister, and husband of a consumptive charwoman, 54 years of age, had died of the disease, and her daughter now had consumption also. The mother, father, and five brothers and sisters of another consumptive had all died of phthisis. In the case of a consumptive tailor, 41 years of age, two of his brothers had died of consumption, his wife had contracted the disease, and his niece, who lived with them, had tuberculous disease of the hip.. Cases of this kind could be multiplied many times in Finsbury, and show very vividly the ravages which consumption may produce in the Borough. In nineteen cases the probable predisposing cause was given as excessive indulgence in alcohol. In four patients there was reason to believe that the disease had followed neglect and destitution. No case was definitely associated with a milk supply: the poor often have no fixed milkshop and are inclined either to use condensed milk or buy from casual vendors. OCCUPATIONS. 1. Food.—In 81 cases the occupation of the patient brought him or her into close relationship with the preparation of food, either for the household or for public consumption, or with the distribution of food. Thus, 41 were mothers of families and prepared food for their husbands and children, 9 were potmen or barmen, 8 were hawkers 78 selling foodstuffs in the street, 3 were washers-up in coffee-shops, one was a coffee-shop proprietor, 6 were domestic servants, 2 were general dealers and kept small shops, 2 were bakers, 1 was a fish salesman, while the rest were a waiter, butcher, grocer, fruitpacker, dining-room proprietor, kitchen porter, children's nurse, and a housekeeper respectively. It is deplorable to realise that a consumptive may handle food in a public place, and more distressing still to know that he may take a large part in its preparation. All the foregoing may possibly be persons capable of freely spreading the disease. When a mother is consumptive and still attends to her household duties all the rest of the family stand in peril. Domestic servants, bakers, butchers, and all the persons pursuing the callings given above, if attacked by phthisis should on no account be allowed to handle the food of others, or to be employed in its production or manipulation. 2. Attended by poverty and exposure.—Twenty-six patients were general labourers, 16 were carmen, 1 was an occasional cart minder attached to a public-house "pitch," 1 was an organ-grinder, 2 were street flower-sellers. The general labourers were all in casual employment and led a precarious hand to mouth existence. Most of the carmen were out of work through illness. The rest were all poor. It is reasonable to assume that in these cases the poverty, the lack of employment, and the exposure had in some instances acted as predisposing causes leading to the successful implantation and growth of the tubercle germ. People who are robust and in rude health are able to fend off disease with little effort, the poor, badly fed and clothed and exposed to the inclemencies of the weather, easily succumb. 79 3. Sedentary and Confined.—Four were shop assistants, 2 were clerks, 4 were tailors,(male and female), and 1 was a milliner. People who work in close, stuffy, ill-ventilated workrooms contract phthisis easier than those whose work lies in the open and in well-aired establishments. The open-air cure is also openair prevention, and special attention is given to the ventilation of all workshops or shops where consumptives are employed, and every effort is made to secure amelioration and an adequate supply and continuous renewal of fresh air. 4. Dusty.—It has long been known that certain dusty occupations favour the onset of consumption. One Finsbury case was a street sweeper, 3 were turners, 1 a cloth-worker, 1 a brassfinisher, 1 a pot maker. Among the remainder there were 7 charwomen, 2 caretakers, 1 guide, 4 artificial flower-makers, 3 bookfolders, 3 cardboard box makers, 8 porters, 4 packers, and 26 others, all possessed in more or less degree of facilities for furthering the spread of this fell disease. Duration of Disease before notification.—Fifty-nine had been ill less than 6 months, 23 under 1 year, 89 under 5 years, 32 under 10 years, and 9 cases had been ill between 10 and 20 years before being notified to the Health Authority. It may be said that most cases had existed for between 3 and 4 years before coming under medical supervision. This means that for that length of time, although he might expectorate broadcast and freely, yet for this period, for three years, he probably took little or no pains to prevent himself communicating the disease to his neighbours. Fourteen patients even after notification were quite unaware that they were consumptive and were adopting no precautions whatever. 80 Distribution by Streets in 1909.—In the present year, deaths from phthisis occurred in the following streets in Finsbury. 8 deaths in Baldwin Street. 7 deaths in St. John Street. 6 deaths in Old Stret. 5 deaths in Radnor Street and Bartholomew's Buildings. 4 deaths in Busaco Street, Goswell Terrace, Hatfield Street, Margaret Street, Northampton Buildings, Northampton Road, and Rodney Street. 3 deaths occured in Bastwick Street, Clerkenwell Green, Compton Buildings, Cyrus Street, Galway Street, Guinness Buildings, Mitchell Street, Pentonville Road, Red Lion Street, Rosebery Avenue, St. Helena Street, Victoria Dwellings, White Lion Street. 2 deaths in Albert Street, Bartholomew Square, Brunswick Close, Chadworth Buildings, Chapel Row, City Road, Coldbath Square, Costers' Dwellings, Donegal Street, Dufferin Street, Easton Street, Farringdon Road, Fletcher's Row, Gastigny Place, George Yard, Great Bath Street, Great Percy Street, Ironmonger Street, James Gardens, Lever Street, Nelson Street, Peerless Street, Rahere Street, Risinghill Street, Royley Street Seward Street, Warren Street and Whitecross Street. 1 death from Consumption in each of the following:— Affleck Street, Amwell Street, Arlington Street, Banner Street, Buxton Buildings, Buxton Street, Cavendish Dwellings, Central Street, Chadwell Street, The Charterhouse, Church Row, Coldbath Buildings, Collier Street, Compton Street, Corporation Buildings, Corporation Row, Cumming Street, Eagle Dwellings, Errol Street, Europa Place, Farringdon Road Buildings, Finsbury Square, Francis Court, Frederick Row, Glasshouse Yard, Goswell Road, Granville "Square, Great Sutton Street, Hermes 81 Street, Ironmonger Row, Lewen's Court, Little Northampton Street, Lizard Street, Lloyd's Row, Macclesfield Place, Malta Street, Murton Street, Myddelton Square, Myddelton Street, Neston Street, Noble Street, Northampton Street, Peabody Buildings(Guest Street), Peerless Street Buildings, Pine Street, Richmond Street, Roscoe Street, Sans Walk, Spencer Street, St. John's Lane, Thomas Place, Victoria Dwellings, Upper Charles Street, Wardens Place, Warner Street, Waterloo Street, West Place, Whiskin Street, White Lion Buildings, Wilmington Place, Wilmington Square, Winchester Street and Wynyatt Street. In addition many of these streets had deaths from other forms of tuberculosis-so that the above list is not the full record of the total number of deaths in Finsbury due to Tuberculosis. And the list shows what a formidable canker the disease is in the Borough; very few streets, if any, are free from it. How best to deal with it is at present a matter of great difficulty, and the position is further complicated by the continual stream of fresh cases, not Finsbury cases, who enter the Borough, attracted, it is asserted, by the many charitable and philanthropic agencies in the district and the facilities for obtaining cheap lodging and cheap food. One issue at all events seems tolerably clear: it will probably be undesirable for Finsbury to undertake the solution of the work independently of the other metropolitan Boroughs. London should unite as a whole and begin to fight the scourge in earnest. PREVENTIVE MEASURES. 1.—Every death and every notified case is visited, and appropriate advice given both to those affected and to those exposed to infection. Missed cases and unrecognised cases are sought for both in the family of the case under notice and in the other families in the same house. F 82 If any are found they are put in the way of obtaining treatment either by being referred to one of the three large general hospitals close by, or a dispensary ticket is given gratuitously. A critical sanitary survey is made of the premises, and of the whole house, and defects are made the subject of subsequent notice and remedy. A card of enquiry is filled up concerning the case and filed for future reference as to the progress of the patient. A leaflet of instructions is left, and its terms explained. Cases of destitution are referred to the Relieving Officer. Cases out of work are referred to the Distress Committee. In advanced cases every effort is made to get these, if poor, to enter the Poor Law Infirmary. Cases occurring in schoolchildren are referred to one or other of the philanthropic agencies in the district. Suspicious cases amongst contacts are referred to St. Bartholomew's Hospital, The Royal Free Hospital, The Hospital for Diseases of the Chest, City Road, or to the Brewer Street Dispensary. 2. Measures in connection with the Food Supply.— Samples of milk are from time to time examined specially for tubercle. The meat supply is most closely watched-there is a special meat inspector. It is believed that practically no tuberculous meat now finds its way into the Finsbury retail shops. 3. Revisits.—These are undertaken by Miss Burt, the Phthisis worker of the Finsbury Social Workers Association. 4. Sanatorium Treatment.—Finsbury has no special provision for the sanatorium or open air treatment of cases of 83 Phthisis, though in the Highgate Infirmary a modified form of open air treatment is being carried out. 5. General Sanitary Measures.—Include the abolition of overcrowding, improving the housing conditions and the opening up of confined areas. 6. Disinfection.—After a death the bedding and clothing are disinfected, and the premises fumigated, washed down, and re-papered. When a case is notified, periodic disinfection is offered and periodic cleansing advised. 7. Bacteriological Examination of the sputum in suspected cases is done at the expense of the Borough. DISINFECTION. There are two disinfecting stations in the district-one at 49, Northampton Road, and the other at Warwick Place, Whitecross Street. At each station there is a mortuary and a Coroner's Court. There is a shelter for suspicious infectious cases during the incubation period, at 49, Northampton Road. It is also used for the reception of families while their rooms are being disinfected after infectious disease. The Borough has two steam disinfectors-a Washington Lyons High Pressure Steam Apparatus, and a Thresh Current Steam Machine. For the disinfection of rooms, formic aldehyde gas, liberated by an Alformant lamp burning 30 tabloids per 1,000 cubic feet, is used, or sulphur fumigation, or a spray of chloride of lime dissolved in water and having a strength of 12 per cent., whichever is considered appropriate. During the year 945 separate rooms were disinfected. F 2 84 In addition, bedding and mattresses were steam disinfected for the following institutions:— The Baltic Street School, The City of London Lying-in Hospital, The Claremont Hall Creche, The House of Retreat and Creche, The King's Cross Police Station, St. Barnabas House, St. Luke's Hospital and St. Mark's Hospital. Altogether 5,697 articles were disinfected in connection with cases of infectious disease and phthisis-these were chiefly mattresses, pillows, bolsters, sheets, blankets, quilts, cushions, curtains, carpets, tablecloths and clothes. Besides these, 11,384 articles of wearing apparel were disinfected for a City firm at a price agreed upon, prior to exportation to South Africa. PROTECTION OF FOOD SUPPLY. Each district inspector is responsible in his own district for the inspection of foods, of restaurants, of restaurant kitchens, of fried fish shops, of ice cream shops, and generally of all places used for the preparation of food for human consumption. The street markets are kept under close supervision, and are continuously and specially inspected throughout the year on every Saturday evening and Sunday morning. This latter duty is done by every inspector in turn. Each district inspector holds the certificate for meat inspection granted by the Royal Sanitary Institute. Inspector Billing is the specially appointed meat inspector for the Borough, and pays special attention to the meat deliveries in the wholesale market in Charterhouse Street, St. John's Street, and Cow Cross Street, all adjacent to Smithfield Market. Inspector Billing also systematically inspects butchers' shops, food stuffs and shops for the preparation of food throughout the whole Borough. The following table is a summary of the diseased and unsound meat and offal confiscated during the year ending 31st December, 1909:- 85 Diseased. Sides of Beef 17 Beef Tongues 47 Quarters of Beef 21 ,, Kidneys 12 Carcases of Stirks 18 Stirks' Livers 30 ,, Veal 3 Staeeps' Livers 26,591 ,, Mutton 2 ,, Plucks 366 ,, Pork 3 „ Lungs 1,702 Beef Livers 1,819 Pigs' Plucks 203 „ Lungs 667 ,, Milts 11 „ Hearts 5 ,, Mesenteries 2 ,, Heads 241 Rabbits 88 Total Weight Tons. Cwts. Qrs. Lbs. 42 19 1 23 Decomposed. Sides of Beef 2 Cases of Sheep's Kidneys 36 Quarters of Beef 49 ,, Livers 3 Pieces of Beef 138 ,, Hearts 2 Tins of Beef 45 „ Plucks 15 Carcases of Mutton 71 Hampers of Sheeps' Kidneys 5 Pieces of Mutton 115 Lambs' Plucks 190 Carcases of Lamb 328 Calves' Plucks 67 ,, Veal 10 ,, Tongues 72 ,, Stirks 3 Hampers oi Calves' Heads 6 Pieces of Veal 6 ,, Livers 1 „ Pork 9 Pigs' Plucks 186 Hams 29 ,, Omentums 15 Pieces of Bacon 12 ,, Mesenteries 15 Rabbits 345 Baskets of Chitterlings 9 Cases of Rabbits 124 Barrels of Pigs' Kidneys 6 Cat 1 Crates of Fowls 3 Parcels of Sweetbreads 10 Fowls 28 Cases of Sweetbreads 4 Turkeys 33 Beef Livers 703 Partridges 390 „ Kidneys 18 Grouse 106 „ Hearts 190 Hares 120 ,, Lungs 2,219 Eggs 400 ,, Tails 254 Boxes of Herrings 1 „ Milts 1,470 ,, Hake 1 „ Heads 25 ,, Plaice 1 „ Tongues 429 ,, Cod 1 ,, Tripes 15 ,, Haddock 1 Hampers of Beef Kidneys 17 ,, Skate 6 Cases of Beef Kidneys 12 Bag of Whelks 1 ,, Livers 7 Baskets of Peaches 25 „ Tails 3 „ Cherries 2 ,, Skirts 1 Basket of Apples 1 ,, Cheeks 56 Baskets of Pears 2 Hampers of Tripe 3 „ Oranges 3 Sheeps' Heads 2,719 „ Strawberries 27 „ Plucks 3,853 „ Grapes 1 ,, Livers 2,842 Bottles of Mineral Waters 80 ,, Hearts 110 Bag of Flour 1 ,, Lungs 160 ,, Kidneys 2,400 Tons. Cwts. Qrs. Lbs. Total Weight(Decomposeed) 64 6 0 8 Total Weight(Diseased) 42 19 1 23 Grand Total Weight 107 5 2 3 86 This meat is removed under agreement by Messrs. C. & H. Webb, Bone and Tallow Melters, 155, Bow Road, London, E. Messrs. Webb have their factory in Bow Common Lane, and pay the Borough Council one penny per stone of eight pounds for all the meat removed. In the summary of the meat seized given above, there is a cat, which deserves a little fuller notice. This cat came as one of a consignment of rabbits and packed in a case with them in the ordinary way from Ostend. The circumstances were these-the cat, a fat, sleek, well-matured animal, weighing about 4 lbs., had been decapitated, its tail removed, and its carcase had been dexterously attached to the emaciated head of a rabbit, sewn on by ordinary grey thread. The rabbit's head was much emaciated and probably belonged to a diseased animal, so that its carcase was useless. The cat was offered as an efficient substitute. At this time rabbits were very dear-and cost about eightpence a pound wholesale. On a previous occasion three carcases of cat-rabbit had been confiscated in like manner. The moral is obvious-persons buying foreign rabbits should make sure that the animal bought is first of all a rabbit, and, secondly, that the head is attached to the trunk by flesh, continuous with both, and not by thread or any other artificial means. A complaint was received in the Public Health Department from a man who had bought a bottle of lemon squash and later discovered that the bottle contained a large portion of the backbone of a fish and some other black granular débris. 87 As a result the Chief Inspector visited the shop where the lemon squash was bought and inspected the rest of the mineral waters and other temperance drinks and seized in all 38 bottles of lemon squash, ginger beer, ginger ale, cream soda, soda water, kaola and lemonade. These were certified by the Medical Officer of Health, as unfit for human consumption, and later the evidence was submitted to a Metropolitan magistrate, who gave an order for their destruction. The makers were communicated with, and their representatives attended a subsequent meeting of the Public Health Committee. They expressed the opinion that in the case of the fish bone, the bottle might possibly have been tampered with, and in some of the other samples that they were probably aged. They explained the method of inspection and washing employed in the business and the routine associated with the re-issue of returned bottles. On the whole, it appeared rather doubtful whether the cleansing and inspection could be satisfactorily performed under the conditions said to be observed in the factory-the establishment, however, lying in another borough was not visited by the Medical Officer for Finsbury. Five samples were sent to Dr. Foulerton, the Borough Bacteriologist, who reported, in essence as follows:— REPORT ON MINERAL WATERS. Sample I. Lemon Squash.—The contents of this bottle were turbid, and in addition to the effervescing drink included a large piece of the back-bone of a fish, and a quantity of coarse brown debris. The débris consisted of yeast cells, various 88 bacteria, and brown amorphous material, the last derived presumably from the remains of the fish. Also one or two fibres of striated muscle, probably from the fish, were identified. Cotton fibre also was present. The bacterial contents of this sample were very high; an enumeration was not practicable under the conditions, but the number of micro-organisms present, including yeasts, amounted to many hundred thousands at least per cubic centimetre. Sample 2. Lemon Squash.—This bottle contained a fine brown sediment consisting of yeast cells, mycelium, and various bacteria, together with a small quantity of inorganic matter. One cubic centimetre of the fluid contents contained about 9,600 yeasts and bacteria. Sample 3. Ginger Ale.—This contained a large amount of brown coarse flocculent matter, consisting chiefly of yeast cells, bacilli, and cocci and a fair amount of inorganic débris. The number of bacteria and yeasts present was about 5,200 per cubic centimetre. Sample 4. Kaola.—The contents included a considerable sediment consisting of yeast cells of elongated type, numerous clear hair-like fibres, cotton fibre, animal hair, and masses of vegetable cuticle and bacteria. The bacteria and yeasts numbered about 12,000 per cubic centimetre. Sample 5. Soda Water.—The contents were clear and included a small quantity of very fine sediment. The drink contained a large number of bacteria. On incubation for 48 hours it yielded 242 large colonies of bacteria and an uncountable number of minute colonies of another organism per cubic centimetre. 89 Comment.—Of the five samples examined Nos. 1 and 5 call for special remark. Sample 1, Lemon Squash, was grossly contaminated, and because of the decomposition of the fish, the contents would have been dangerous to drink. The possible danger would be increased by the fact that, owing to the dark colour of the bottle, the presence of the fish relic, which was too large to pass the neck when the contents were poured out, might not have been noticed. Sample 5, Soda Water, is from the bacteriological point of view a very inferior one. The very high bacterial contents indicate three possible faults in the making of the beverage: (a) The use of impure water, or (b) The use of dirty bottles, or (c) Insufficient safeguarding of the purity of the water during the process of manufacture. Samples 3 and 4 contained a larger quantity of suspended solids than should be contained in effervescing drinks of this kind. A. G. R. Foulerton. Three prosecutions for unsound and diseased meat were instituted during the year-the particulars are appended:— 90 MEAT PROSECUTIONS —1909. ]Date of Trial. Name and Address. Article. Where seized and Name of Inspector. Penalty and Costs Inflicted. 1909. August 3rd. Thomas Gent, 88. East India Dock Road, E. Twenty-nine pieces of beef and mutton weighing 829 lbs. The whole of this meat was foreign. It was very soft, slimy, in parts green in colour, and mouldy, and the whole of it smelt very offensively. 69, Chapel Street, Finsbury. Inspector Billing. £.50 and £5 5s. od. costs. August 24th. Ernest E. Robinson, 96, Central Street, Finsbury. A piece of beef weighing 32 lbs., and a quantity of sausages and sausage meat weighing 40 lbs. The piece of beef was slimy, mouldy, maggoty, and in parts green in colour and smelling offensively. The sausages and sausage meat were very sour. 96, Central Street, Finsbury. Inspector Billing £50 and £5 5s. od costs. November 16th. Arthur Cart, 40, Turner Road, Leicester. Four sides of stirk veal weighing 526 lbs. This veal was diseased with generalized tuberculosis. The pleura and peritoneum had been partly stripped from each side and fat had been rubbed over the stripped parts, thus concealing to a large extent the evidence of stripping. There were many tubercles on the marginal portions of pleura and peritoneum. The whole of the glands were enlarged and some were tuberculous. There was a large abscess, about the size of a cocoanut on one fore quarter. Nos. 101 & 103, Charterhouse Street. Inspector Billing. This case was adjourned from time to time to suit the convenience of the defendant, and on one occasion for want of time. It was eventually finished on February 17th, 1910, when the defendant was convicted, and fined £100 and £25 costs. The prosecution had considerable trouble in bringing the case home to the defendant. The meat was sent to London in the name of T. Jennings, but no such person could be traced. The defendant sought to prove that T. Jennings was really a man named Chas. Morris, who it was alleged could not be found. 91 The following table gives the statistics for previous years:— MEAT PROSECUTIONS AND MEAT CONFISCATED, 1901-1909. ]Years. No. of Cases of Meat Prosecution. No. of Convictions. Cases Dismissed. Weight of Meat Confiscated (in tons). 1901 24 24 — 3° 1902 16 16 — 75 1903 19 18 1 101 1904 15 15 — 76 1905 9 9 — 84 1906 5 3 — 121 1907 2 2 — 100 1908 3 3 — 100 1909 3 3 — 107 Certification of Meat Food Products.—The Medical Officer of Health, with the consent of the Council, was designated the certifying officer by the Local Government Board, for certification of these products for export to the Argentine Confederation. A certain number of Certificates were granted in 1909 to Messrs. Bovril, Ltd., whose establishment is at 152 to 166, Old Street, Finsbury. SLAUGHTER HOUSES. These are all licensed in London by the County Council for one year only, and licenses are renewed each year at a special sessions of the London County Council. 92 In Finsbury there are 3 slaughter houses; the owners names and addresses are as follows:— Mr. A. E. Spink, 20, Amwell Street. Mr. Thos. Webb, 191, Goswell Road. Mr. J. A. Mobbs, 14, Penton Street. The premises at 191, Goswell Road, are licensed for the slaughter of small animals only. There are no knackers' yards in the borough. The slaughter houses are inspected periodically both at the time of slaughter and at other times. MILK SUPPLY. There are in Finsbury only three sets of premises licensed for cowkeeping. The owners' names and the addresses of the premises are given below:— ]No. Name of Occupier. Situation of Premises. Actual No. of Cows. Licensed for. 1 Mrs. Rachel Hughes 39a, Baldwin Street 16 17 2 Messrs. John James & Son 40, Rawstorne Street 3 15 3 Mr. Johnames 230, St. John Street 28 30 All cowsheds in London are licensed annually for one year only by the London County Council at a special session. Two proprietors have given up keeping cows since last year. Most of the milk in Finsbury is produced elsewhere, chiefly in the Midlands, and in the West of England. Large quantities come from cowsheds as far off as Derbyshire. 93 The premises are regularly inspected by the Medical Officer of Health, the Chief Inspector, and the District Inspector at milking times and at other times. Any defects elicited are pointed out to the owners and remedy requested. As a rule, the work called for is done at once. MILKSHOPS AND DAIRIES. The number of persons registered during the year as purveyors of milk was 56; during the same period 34 names were removed for various reasons. The total number left on the register was 265. The majority of these sell milk in small general or grocery shops-a farthing's worth, or a halfpenny worth at a time, selling perhaps 3 or 4 quarts per day. The registration of these persons is made under the Dairies, Cowsheds and Milkshops Order, 1885, Clause 6. Under this clause it is incumbent upon the Council to register the applicant, quite irrespective of the character of the premises, or of any other business carried on along with the sale of milk. By the London County Council (General Powers) Act, 1908, Section 5, however, the Metropolitan Borough Councils were empowered to remove from the register kept by them of persons from time to time carrying on in their district the trade of cowkeepers, dairymen, or purveyors of milk; or to refuse to enter upon the register the name of any person carrying on or proposing to carry on the trade of dairyman or purveyor of milk upon premises which are, in the opinion of the Sanitary Authority for any reason unsuitable for the sale of milk therein. 94 Since the coming- into force of this section no name has been placed on the Register until the shop has been found to be suitable, not only in construction, but also with reference to the character of the business, its associations and prevailing conditions. Many of the applications are refused in the first instance, either because the premises arc unsuitable, or the conditions of trading render the milk liable to contamination. In these small shops the number and variety of articles stocked is often very large, and may include articles like paraffin and boot blacking; the premises are generally overcrowded with stock and difficult to keep clean. The proprietors admit that they sell very little milk-but as it is usual for buyers to wish to purchase it with their tea, coffee sugar, or bread, the discontinuance of milk-selling would lead to a serious loss of custom. This is a very fair and reasonable contention, but the liability of milk to become contaminated and to act as a carrier of disease renders it imperative in the interest of the consumer that all possible precautions shall be taken. These shops are therefore frequently visited and the owners instructed and advised as to the measures they should take. One precaution is especially insisted upon-that the milk shall be kept in closed vessels or the milkpans kept continually covered. Last year sections 5 and 8 of the London County Council (General Powers) Act, 1908, relating to the registration of milkshops and to the sanitary regulations for premises for the sale and storage of food for human consumption, were reprinted and distributed to the shops in the Borough, and where necessary these provisions explained. Examination of Milk.—Each District Inspector is appointed for his district as an inspector under the Sale of Food and Drugs Acts. Samples of milk are taken in each district periodically and at other uncertain times whenever anything arises 95 that may call for action in this respect. In addition, special samples, 100 in number, are taken in the evening or on Sundays at irregular and unusual hours. The total number of milk samples taken was 365, of which 33, or 9 per cent., were found to be adulterated. The percentage of adulterated samples in previous years is given in the attached table. With the exception of 1908, the percentage of adulterated samples for the present year is the lowest since 1899, the first year for which this record is available. After the Public Analyst has reported on a sample of food taken for analysis, if the analysis shows the sample to be genuine, this fact is communicated to the vendor. If, on the other hand, the sample is found to be adulterated, further action depends on the amount of the adulteration and the circumstances of the sale and the exposure for sale. These considerations are gone into carefully by the Medical Officer and the Inspector, and ocasionally, but only rarely, when the circumstances or the slight amount of the adulteration warrant the procedure, the vendor may be asked to furnish an explanation, if he would wish to adopt this course. If the adulteration is very small in amount, the vendor is usually warned and cautioned. If the adulteration is gross, a prosecution is instituted. If the case is a difficult one, the details are referred to Mr. Ricketts, Solicitor to the Council, and his advice is followed. All milk dealers in the Borough, large as well as small, are sampled. The accompanying table gives the statistics for the last 11 years. 96 MILK SAMPLE, 1899-1909. ] 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. 1899 205 55 26.8 9 16 9 4 6 21.5 — 2 2 6 l 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 51 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 1908 365 32 8.7 11 2 1 1 1 3.6 7 5 2 1 1 4.3 1909 365 33 9.0 6 2 2 — — 2.7 7 8 1 2 3 5.7 *These figures include samples of milk which were adulterated with preservatives. 97 During the year 18 prosecutions were instituted in connection with the adulteration of milk. The details are displayed on a subsequent page. The subjoined table gives the statistics since 1901. MILK PROSECUTIONS, 1901- 1909. ]Year. No. of Convictions. Fines amounting to. Costs amounting to. 1901 32 £44 17 6 £17 12 6 1902 23 £33 5 9 £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 1908 12 £22 10 0 £8 5 0 1909 9 £21 15 1 £5 12 6 Totals for the 9 years 156 £305 18 7 £139 10 0 Total for Fines and Costs = £445 8s. 7d. G 98 The following table, taken from the Annual Report of the Local Government Board for 1908-1909, compares the milk vigilance of Finsbury with the other Metropolitan Boroughs. MILK ANALYSIS IN THE METROPOLITAN BOROUGHS. 1909. ]Metropolitan Boroughs. No. of Milks Examined. No. found to be Adulterated. Percertage of Adulteration. St. Pancras 414 87 21.0 Hackney 583 104 19.5 Shoreditch 353 61 17.2 Stepney 779 129 16.9 Stoke Newington 87 12 13.8 Holborn 224 28 12.5 Fulham 875 42 11.2 Bermondsey 659 73 11.0 Battersea 693 75 10.8 Poplar 159 19 10.6 Westminster (City) 889 91 10.2 Hammersmith 199 20 10.0 Lambeth 838 78 9.3 Lewisham 272 25 9.1 Finsbury 365 32 8.7 Bethnal Green 414 36 8.6 Islington 604 52 8.6 Southwark 1,145 94 8.2 Kensington 284 23 8.1 Chelsea 199 15 7.5 Wandsworth 516 37 7.1 Deptford 165 11 6.6 London (City) 485 81 6.3 St. Marylebone 260 16 6.1 Camberwell 378 20 5.2 Greenwich 218 8 3.7 Hampstead 331 11 3.3 Paddington 848 6 1.7 Woolwich 360 6 1.6 Whole of London 12,526 1,240 9.9 99 Warranty Defence in Prosecutions.—In any prosecution under the Sale of Food and Drugs Act, 1875, the defendant is to be discharged if he proves to the satisfaction of the Court— (a) That he bought the article in question as the same in nature, substance, and quality as that demanded of him, and with a written warranty to that effect. (b) That at the time of sale he had no reason to believe it to be otherwise. (c) That he sold it in the same state as when he purchased it. By the Sale of Food and Drugs Act, 1899, Section 20:— A warranty or invoice shall not be available as a defence under the Sale of Food and Drugs Act unless the defendant has within seven days after the service of the summons sent to the purchaser a copy of such warranty or invoice, with a written notice stating that he intends to rely on the warranty or invoice, and specifying the name and address of the person from whom he received it, and has also sent a like notice of his intention to such person. The warranty defence in London is chiefly used in connection with milk cases. In Finsbury the warranty was put in as a defence in 1909 in three cases only. In none of these were preceedings taken against the warrantor. Enquiry was made from all the other metropolitan boroughs as to the extent to which the warranty defence was being used in milk prosecutions. Replies were received from 21—of these a summary is here given. In these boroughs 9514 samples of milk were taken, of which 928 were found adulterated. The warranty defence was pleaded in 104 cases and the warrantor was afterwards prosecuted in three boroughs onJy— five cases in all. In eleven boroughs 328 samples of milk were taken at railway stations in the various districts, and in five boroughs action was taken against the consignors implicated— altogether eight prosecutions. G 2 100 ICE CREAM. There are in Finsbury 82 shops in which ice cream is sold. These are all registered, and their premises periodically inspected. The materials commonly used are milk, eggs, granulated sugar, cornflour, vanilla or lemon flavouring, and some colouring agent. Fruit pulp is used in only a very few establishments. By the London County Council (General Powers) Act, 1902, itinerant ice cream vendors must have the name and address of the ice cream manufacturer prominently displayed on their barrows. It was not found necessary to take legal proceedings for this omission. BUTTER AND MARGARINE. Since 1908 wholesale dealers in and manufacturers of butter and milk-blended butter must be registered with the local authority. Margarine dealers and manufacturers have also to be registered in accordance with the Margarine Act, 1887, Section 9, and the Sale of Food and Drugs Act, 1889, Section 7, subsection 4. In 1909 one butter manufacturer was registered, and the name of one was removed, leaving seven names still on the register. The name of one wholesale dealer in margarine was placed on the register, which now contains 20. The samples of butter taken during the year were 77, of which 10 were found adulterated; 46 samples of margarine were obtained, all genuine. RESTAURANTS AND FOOD STALLS. The accompanying table gives the details of the inspection of the restaurants since 1902. 101 ]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 1908 269 120 44 1909 260 122 46 The barrows, shops, and food stalls in Chapel Street, Exmouth Street, and Whitecross Street are regularly inspected. Each inspector takes it in turn to supervise the food products exposed in these places on Saturday nights and Sunday mornings throughout the whole year. SALE OF FOOD AND DRUGS ACTS. In Finsbury it is usual to take 500 ordinary samples of food for analysis each year, and in addition 100 extra samples of milk at irregular and unusual times, and whenever or wherever there is reason to apprehend that adulteration may be prevalent. Each inspector takes samples in his own district either personally or by deputy. No tradesman's shop is omitted—all are visited for the purpose of obtaining samples. A rota is arranged at the beginning of each year, but each inspector is allowed to take samples also at his own discretion. The number of samples taken in 1909 was 600—of these 47, or 7.8 per cent. were adulterated. There were 37 prosecutions, and £122 4 7 was recovered in fines. In 1908 the percentage of adulterated samples was 8.94, and the number of prosecutions 28. 102 The tables given below show the number, the nature of samples collected, and the number adulterated in each case. ]Substance. Samples taken. Adulterated. Substance. Samples taken. Adulterated. Milk 365 33 Flour 5 0 Milk (Separated) 2 0 Tapioca 1 0 Milk (Condensed) 3 0 Jam 1 0 Butter 77 10 Lard 7 0 Margarine 46 0 Olive Oil 1 0 Cheese 11 0 Ground Ginger 1 0 Mustard 15 0 Camphorated Oil 2 0 Pepper 21 0 Sago 1 0 Malt Vinegar 4 1 Ground Rice 2 0 Cocoa 11 0 Sweets (Mixd.) 1 0 Coffee 20 3 Coffee Mixture 3 0 Total 600 47 The statistics for previous years are subjoined:— ]Year. Total Examined. Genuine. Adulterated. Percentage of adulterated samples. Percentage of adulterated samples for the whole of London. 1901 501 413 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 10•0 1908 601 547 54 8•94 9•9 1909 600 553 47 7•83 103 It will be observed that there has been, with the exception of two years, a gradual decline in the Borough of the percentage of adulterated samples. Moreover, since 1907 the percentage of adulterated samples in Finsbury has been less than that prevailing in London generally. In October a resident bought some tinned salmon in the Borough, ate part of it, and was shortly afterwards taken ill. She visited St. Bartholomew's Hospital for treatment and here suspicion was directed to the salmon. Accordingly another tin of salmon of the same brand was the same day bought at the same shop and analysed by the Public Analyst, who reported as follows:— "I received the sample of tinned salmon on October 4th, 1909. On opening the can, the contents were found to be perfectly fresh, no gas was given off, and the inner surface of the can was bright and not discoloured. Preservatives were not found, nor were any traces of tin, lead, copper, or zinc detected either in the liquid or solid contents. '' The salmon appeared to be normal.'' (Signed) "J. Kear Colwell. " The original tin and the slight amount available of the salmon originally impugned were inspected and examined by the Medical Officer. The fish appeared to be sweet and wholesome and the tin was not discoloured. HOUSING. No action was taken under the Housing of the Working Classes Act in 1909. There are, however, in the Borough a few houses in respect of which action may become necessary in a year or two. At the present time the inspection of house property has been reorganised in the office and placed upon a systematic anu continuous basis. The number of inhabited houses in the Borough in March, 1909 was 9,519, and of these 303 were let in two or more separately rated hereditaments, the number of such separate occupations being 5,087. In this calculation a block of dwellings is 104 Regarded as one house. The number of separate occupations in any house let out in tenements, and for which only rating exists, is not included. A careful watch is kept over the condition of the house property in the district, and whenever necessary notices served for insanitary conditions. In some of the worse streets inspections are very frequent, and necessarily so. In some districts a house or set of rooms may be well cleaned, and occupied by new tenants, say, for a few weeks, to be ejected later for non-payment of rent. When a house after such a short tenancy is next inspected, it may be dirty,even filthy, with fittings dilapidated and windows smashed. These undesirable occupiers often show no trace of housecraft and may even maliciously damage the house. These short tenancies and frequent removals increase the work of the department considerably. HOUSES LET IN LODGINGS—These are sometimes called for short registered houses, and are houses entered in the register of Houses let in lodgings. They are subject to special supervision by the Inspectors, and very frequently visited by them. In all these houses the following cleansing operations are carried out each year in April, May, or June:— 1. The internal surfaces of the yards, water-closets, and houses are limewhited. 2. The internal surfaces of the rooms, passages, and staircases are always stripped, whitened, distempered, or repapered where necessary. 3. The ceilings are whitened. The old wall-paper is always stripped off before the new is put on, so that there is only one layer of paper on all the walls. Bye-laws for these houses were ''allowed'' by the Local Government Board on July 29th, 1904, and received the Board's sanction on that date. Cubic Space.—These bye-laws stipulate that, where a room is used solely as a sleeping room, each adult and each child over 105 10 years of age must have at least 300 cubic feet of air space. If the room is, however, used both for living and sleeping purposes, then each adult and each child over 10 years must have at least 400 cubic feet of air space. Children under 10 years are allowed half these amounts in each case. Although the bye-laws only call for cleansing operations once at least in every year in the month of April, yet, if these houses are found to be dirty or insanitary or in any condition which may interfere with the reasonable and healthful comfort of the occupants, abatement or remedy may be requested or secured at any time, in any month, under the provisions of the Public Health (London) Act, 1891. The bye-laws do not contain clauses dealing with the separation of the sexes. During 1909 the number of notices served for cleansing was 1,145 intimation notices and 277 statutory notices when the cleansing was not done by the time of the second visit. Notices for overcrowding were served in 46 cases. The number on the register at the end of 1909 was 1,223. The statistics for former years are given below:— ]Year. No. placed on Register. No. removed. On Register at end of year. 1900 — — 327 1901 — — 327 1902 612 — 939 1903 170 — 1,109 1904 52 30 1,131 1905 45 7 1,169 1906 111 26 1,154 1907 — 21 1,233 1908 — 9 1,224 1909 — 1 1,223 106 Most of the houses in Finsbury are let in tenements, but these are only placed on the register if, from the environment, the reputation of the district, the nature of the property, the character of the occupiers, the defects disclosed at frequent inspections, or for any other reason they are considered to be such as to call for special regulation and supervision. COMMON LODGING HOUSES—In London, these are administered by the London County Council. Visits of inspection have been regularly made during the year. The common lodging-houses in the Borough are given in the following table:— ]Address. Registered Owner Registered Number of Occupants. Average Attendance. Pentonville Road, 19-23 Mrs. Shuttleworth 97 78 White Lion Street, 57 Mr. Shuttleworth 98 60 Clerkenwell Green, 35 Mr. J. H. Claytor 73 68 St. John's Lane, 34 Mrs. Holland 48 30 Old Street, 97 Mr. W. H. Hatch 80 60 Banner Street, 6 Mr. C. Fitzwm. Campbell 140 130 Totals 536 426 A census of homeless persons throughout London was taken at night by the London County Council in January, 1909. In the district covered by Long Acre, Great Queen Street, Kingsway, Finsbury, Broad Street and Bishopsgate 102 homeless persons comprising 90 men, 11 women, and 1 child, were found sleeping on staircases and under arches. In the Finsbury common lodginghouses there were 414 males, and in addition 129 unoccupied beds. Of males, 21 had been turned away from the Finsbury 107 common lodging-houses because they were drunk, were too dirty, were disorderly, were too young, had no money, or because the house was full. On the same night there were 132 males in the Church Army Home in Banner Street. In this home they get food and lodging in return for work done at wood-chopping. SYSTEMATIC HOUSE TO HOUSE INSPECTIONS—There is a tendency in many Health Offices to focus acutely the work upon drains—the location of drain defects and their amendment— and to overlook the ever quick and pressing condition of the home, the cleanliness of the rooms, the supply of sufficient cupboard accommodation, sufficiency of headroom, and of cubic space, of light and of ventilation, and the many other details that stand imminent during the day's work and the mother's toil. Systematic house to house inspection is one of the chief, if not the most important measure of sanitary administration and bears more closely upon the comfort of home life than probably any other procedure. During 1909, 698 houses were inspected as a result of systematic visitation. The numbers for preceding years were—1901, 1,746; 1902, 1,501; 1903, 1,447; 1904, 1,548; 1905, 2,250; 1906, 1,341; 1907, 806; 1908, 534. The work is done in Finsbury upon standardised methods, and the results in each separate house are drawn up in succinct tabular form and laid on the table at each meeting of the Public Health Committee. 108 SYSTEMATIC HOUSE TO HOUSE INSPECTION. 1909. ]Street or Buildings. No. of houses 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 and over. Albert Street 19 13 68•4 35 22 3 9 Ann's Place 9 8 88•8 4 7 — — Bartholomew's Square 13 9 69•2 17 15 9 4 Bath Buildings 5 5 1OO•O 10 8 1 — Berkeley Court 3 1 33•3 7 4 1 — Brunswick Close 11 3 27•2 3 8 3 5 Chadwell Street 4 2 50•0 7 2 1 3 Chapel Place 13 7 53•8 4 9 3 4 Coleman's Buildings 5 3 60•0 - 5 — — Corporation Row 13 8 61•5 3 1 11 — Dingley Road 15 13 86•6 3 2 7 9 Donegal Street 2 1 50•0 — 9 — — Eagle Dwellings 23 12 52•1 — 10 12 — Elizabeth Place 6 4 66•6 4 5 1 — Farringdon Road Buildings 49 8 16•5 25 14 10 — Fox Terrace 3 1 33•3 — 3 — — Gee Street 11 7 63•6 12 15 2 1 Georges Row 4 4 100•0 3 3 1 1 Gibson Houses 6 1 16•6 - - 6 — Gordon Houses 5 3 60 •0 — — 4 1 Helmet Row 12 6 50•0 13 15 5 4 Hermes Street 2 2 1OO•O - 6 — — Hewitt's Buildings 12 7 58•3 11 1 — — Ironmonger Row 12 8 66•6 17 12 4 5 Lease Street 11 7 63•6 22 11 7 2 Little Sutton Street Buildings 30 20 66•6 5 25 Masons Place 19 18 94•7 — 19 — — Mount Zion 2 1 50•0 — 2 — 1 Mulberry Place 2 2 100•0 2 1 1 — New Charles Street 32 17 53•1 17 26 11 22 Nelson Street 24 19 79• 1 33 18 7 12 Norman Street 5 4 80•0 2 7 2 1 Old Street 29 10 34•5 26 5 4 18 Paton Street 9 7 77•7 5 6 7 2 Peartree Street 5 5 1OO•O 2 14 - — Peabody Buildings 133 59 44•4 24 50 57 1 Pentonville Road 6 2 33•3 2 3 4 — Powell Street 14 6 42•8 17 13 9 5 President Place 2 2 1OO•O 1 - 1 1 Risinghill Street 5 5 1OO•O 10 16 — — Rodney Street 4 3 75•0 11 13 1 — Seward Street 6 4 66•6 1 1 3 2 Smithfield Buildings 14 10 71•4 — 14 - — Victoria Buildings 111 26 23•4 4 65 42 — Warren Street 33 17 51•5 35 30 19 9 Waterloo Street 16 13 81•2 15 15 7 2 West Place 2 2 1OO•O 2 3 - — Whitecross Street 2 2 1OO•O 1 1 1 1 White Lion Street 3 1 33•3 7 3 2 — Wither's Place 10 10 1OO•O 14 2 4 — Wynyatt Street 12 4 33•3 12 6 2 6 698 412 58•1 448 545 275 132 109 OVERCROWDING.—In 1909, the total number of cases of overcrowding discovered was 88, of which 46 were in registered houses. The problem of overcrowding is a most difficult one and is intimately bound up with the questions of poverty, unemployment, drink and thriftlessness. The cases are difficult of discovery and the conditions very often difficult to amend or abate save by recourse to the Poor Law. The people are in a dilemma. On the one hand they are being urged by State Officials, learned divines, and eminent men to increase and multiply—for the birth rate has fallen and is falling. On the other hand, the poor know and know only too well that the possession of three or four children in the family may render it difficult, nay almost impossible, for them to secure sufficient and comfortable accommodation. A few landlords in the district insist on having a written statement as to the number of children in the family in a prospective tenant before letting their rooms. And cases have been brought to the Health Office where the tenants have wilfully understated these numbers. So that the responsibility—the legal responsibility—may be with either the landlord or the tenant. But even when the overcrowding has been discovered the difficulty is not solved. It is impossible, from considerations of humanity alone to eject these tenants into the open streets at a minute's notice. The practice in Finsbury has been to allow the most ample time to get rooms elsewhere. The air space demanded is, where a room is used solely as a sleeping room, 300 cubic feet for each adult and child over 10 years, if used for living and sleeping 400 cubic feet. Children under 10 years are allowed half these amounts in each case. Sometimes the overcrowding may be slight in degree. Slight Illegal Overcrowding.—It sometimes happens, when the cubic space of a room has been calculated and the number of occupants known, that the actual space falls short of the full legal requirement by a small amount. 110 To take an actual example from Finsbury:— A second floor front room contains 1,138 cubic feet and is occupied by a man, wife, a girl of 6 years and a boy 5 years. The room is used for sleeping- and living. The two children being under 10 years count as one adult. The cubic space legally requisite is 3 times 400 cubic feet, that is 1,200 cubic feet. The actual cubic space is 1,138 cubic feet, and is too little by 62 cubic feet. This is a case of slight legal overcrowding, and not such as to call for immediate and drastic intervention. Take another example from Clerkenwell, December, 1909 :— A man, wife, and 8 children: girl 18, girl 15, boy 14, boy 12, boy 8, boy 7, boy 5, girl years, occupied two rooms. The front room was used as a living room for the whole family and as a sleeping room for the man, wife, boy 14, boy 6, girl 1½. It has 1,498 cubic feet and is therefore 102 cubic feet short of the required amount. The back room is occupied as a sleeping room by a girl 18, boy 12, boy 7, boy 5, and has 836 cubic feet and is 64 cubic feet short. The girl of 15 sleeps at another address. The parents had removed to their present address in September, 1909. The rooms they had previously occupied were said to be ample and convenient. A daughter died at home of Consumption in September, 1909, and this, coupled with the fact that they were now bereft of her earnings had induced them to remove elsewhere. This case is quoted as another example of slight illegal overcrowding and shows how it sometimes arises. The investigation of the cases in Finsbury proves, if it proves anything, that the mere provision of up-to-date dwellings at moderate or even low rentals will not abolish overcrowding, indeed, this provision may even increase it. The causes are complex and lie deeply. 1ll UNDERGROUND ROOMS AND STABLE DWELLINGS— An underground room is defined in the Public Health (London) Act, 1891, Sec. 96, Sub-sec. 9, as "Any room of a house, the surface of the floor of which "room is more than three feet below the surface of the foot"way of the adjoining- street, or of the ground adjoining or "nearest to the room." At the present time, it is illegal for any underground room to be let or occupied separately as a dwelling unless it satisfies the very stringent conditions and requisites contained in the 11 clauses (a—k) of Sec. 96 of the Public Health (London) Act, 1891. It must be noted that the Act only applies when an underground room is separately occupied as a dwelling. If a room is occupied underground in conjunction with a room or rooms on a higher floor, there is no separate occupation of the underground room. In 18 instances, underground rooms were found by the Inspectors to be separately occupied in contravention of the law. Notices were served and the conditions remedied. The stable dwellings remaining in the Borough are given in the following list. These are all frequently inspected. ]Premises. No. of Occupancies. No. of Persons. Total. Adults. Children. Claremont Mews 12 23 18 41 Holford Yard 2 4 6 10 Holford Mews 3 6 9 15 Jay's Buildings 16 25 49 74 Garnault Mews 1 2 0 2 Bakers Row 1 6 4 10 14, Clerkenwell Close 1 3 0 3 93A, Charterhouse Street 2 4 2 6 1, New Court. Peter's Lane 1 2 3 5 82, Bath Street 1 2 0 3 119, Lever Street 1 6 1 7 Davis Yard 1 3 0 3 112 CUSTOMS AND INLAND REVENUE ACTS—No applications for certificates exempting from Inhabited House Duty were received during the year. FACTORIES AND WORKSHOPS. The number of workshops and workplaces on the Register at the end of the year was 2,039, made up as follows:— Clocks and Watches 112 Jewellery 112 Cabinet Making and Polishing 76 Tailors and Clothiers 66 Engraving, Embossing and Chasing 64 Leather Goods 51 Gold and Silver Smiths 49 Building Trades and Material 45 Underclothing, Shirts, Skirts, & Blouses 45 Provisions, Grocery, Bacon and Food Preparation 44 Fancy Goods and Toys 42 Millinery 41 Furriers and Skin Dressers 40 Hats and Caps 39 Others 1,213 Total 2,039 The other workshops, not mentioned in detail, are with changes more or less as they were last year. The numbers for previous years were 1900, 1,266; 1901, 1,356; 1902, 1,374; 1903, 1,651; 1904, 1,745; 1905, 1,859; 1906, 1,843; 1907, 1,923; 1908, 2,059. A register of Factories is kept in the Public Health Department. This register, though not a statutory requirement, has proved extremely useful. 113 A systematic survey of the workplaces was commenced in 1902 and completed in 1908. A summary of the inspections made is subjoined. ]Inspections. Written Notices. Prosecutions Factories (Including Factory Laundries.) 973 127 2 Workshops (Including Workshop Laundries.) 1,729 323 — Workplaces (Other than Outworkers' premises detailed in the subsequent special table.) 609 42 1 Total 3,311 492 3 The defects found on inspection were as follows:— ]Defects. Prosecutions. Found Remedied Referred to H.M. Inspector. Nuisances under the Public Health Acts.— Want of cleanliness 166 163 3 .. Want of ventilation 14 11 3 .. Overcrowding 4 3 1 .. Want of drainage of floors 1 1 .. .. Other nuisances 454 454 .. .. Saniary accommodation insufficient 33 33 .. 3 Sanitary accomodation unsuitable or defective 251 251 .. Offences under the Factory and Workshop Act— Illegal occupation of underground bakehouse .. .. .. .. Breach of special sanitary requirements for bakehouses .. .. .. • • Other offences (excluding those referring to outworkers given in the subsequent table) 27 .. 27 .. Total 967 933 34 3 H 114 Cleanliness.—Out of 967 defects, 166 or about one-sixth of the whole referred to the dirty condition of the rooms. As a rule, the large and modern workshops are kept in a clean condition—the dirty ones are often small ones hidden away in back yards or behind occupied houses. Air Space.—The usual standard taken is 250 cubic feet per worker. In the large and modern workshop the space provided generally exceeds the minimum. In three cases it was found necessary to serve notices for the abatement of overcrowding, while one case was referred to H.M. Inspector of Factories. Ventilation.—This is made the subject of careful enquiry. In many places the fault arises from neglect to use existing appliances or from their improper use. Eleven notices were served, and three other cases referred to the Home Office. Sanitary Conveniences. —The standard taken is one water closet for each 25 persons, with separate accommodation foi females. In addition, as far as is. practicable, the conveniences for females must have bolts or fastenings on the inside of the door, have substantial partitions between each seat, have approaches well screened and be conspicuously labelled "For Females," or "For Women only." In addition to these special details, they have, of course, to be efficient, clean and well kept. Notices were served for 284 defects—all of which except 3 were remedied without recourse to proceedings in a Police Court. The circumstances of these three prosecutions were as follows :— On January 22nd, 1909.—At Clerkenwell Police Court. Mr. Richard Moore, trading as Messrs. M. & R. Moore, at No. 64, Pentonville Road, for erecting a Water Closet without giving previous notice in writing of his intention to do so. Fined 10/- and 2/- costs. 115 January 22nd, 1909.—Mr. Richard Moore, for constructing; the above-named Water Closet in a manner contrary to the requirements of the London County Council bye-laws. Fined £1/0/0 and £1/3/0 costs. March 5th, 1909.—At Clerkenwell Police Court. Mr. E. Crowne, 47, King's Cross Road, for fixing a new pan to the Water Closet at No. 1, Granville Place, without first giving written notice of his intention to do so. Fined £1/0/0 and £1/3/0 costs. OUTWORKERS AND HOMEWORKERS. By the Factory and Workshops Act, 1901, the duty is now cast upon every employer in certain specified trades. 1. To keep a register of outworkers, to be open to inspection by any duly authorised Inspector. 2. To send a list of outworkers, their names, addresses, and the nature of their employment to the Borough Council, on or before the first of February and on or before the first of August in each year. Each Borough on the receipt of such lists, transmits to other Boroughs the names and addresses of outworkers, or homeworkers living outside its own district. The number of lists received and forwarded is shown in the attached table. The number of outworkers' premises inspected was 58; it is intended in 1910 to pay greater attention to this work and to report fully upon it. H 2 116 117 NATURE OF WORK, OUTWORKERS LISTS, SECTION 107 OUTWORK IN UNWHOLESOME PREMISES, SECTION 108. OUTWORK IN INFECTED PREMISES, SECTIONS 109, 110. Lists received from Employers. Addresses of Outworkers. Notices served on Occupiers as to keeping or sending Lists. Prosecutions. Inspections of Outworkers' premises. Instance. Notices served. Prosecutions. Instances. Orders made (S. 110) Prosecutions (Sections 109,110). Sending twice in the year. Sending once in the ear. Received from other Councils Forwarded to other Councils. Failing to keep or permit inspection of Lists. Failing to send Lists. Lists† Outworkerst Lists† Outworkerst Contractors Workmen. Contractors Workmen. (I) (2) (3) (41 (5) (6) (7) 18) (9i (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) Wearing Apparel — (i) making, &c. 192 586 3566 26 25 196 664 4043 30 3 (2) cleaning and washing .. .. .. .. .. .. 9 .. •• •• Lace, lace curtains and nets •• •• Artificial flowers 4 .. 92 5 .. 31 54 89 •• •• Nets, other than wire nets .. .. .. 1 .. 5 .. 4 6 •• Tents .. .. .. .. .. .. .. .. •• •• Sacks .. .. .. .. .. .. .. .. •• •• Furniture and upholstery .. .. .. .. .. .. 6 .. •• •• Fur pulling .. .. .. .. .. .. .. .. •• •• Feather sorting .. .. .. .. .. .. .. .. •• •• Umbrellas, &c 4 .. 18 .. .. .. 59 16 •• •• Carding, &c., of buttons &c .. .. .. .. .. .. .. .. Nil. Nil. Nil. •• Nil. Nil. Nil •• Nil. Nil. Paper bags and boxes 40 .. 749 3 .. 45 67 515 •• •• Basket making .. .. .. .. .. .. .. .. 15 •• Brush making 16 .. 129 1 .. 1 16 99 •• •• Racquet and tennis balls .. .. .. .. .. .. .. .. 4 •• Stuffed toys .. .. .. .. .. .. .. .. •• •• File making .. .. .. .. .. .. .. .. •• •• Electro-plate 8 13 16 .. .. .. 24 13 •• •• Cables and chains .. .. .. .. .. .. .. .. •• •• Anchors and grapnels .. .. .. .. .. .. .. .... •• •• Cart gear .. .. .. .. .. .. .. •• •• Locks, latches and keys .. .. .. .. .. .. .. .. •• •• Pea picking .. .. .. .. .. .. .. .. •• •• Total 264 599 4570 36 25 278 899 4799 •• •• •• 58 •• •• •• 3 •• •• 118 The following table shows in the prescribed form the matters referred to His Majesty's Inspector of Factories and information desired respecting underground bakehouses:— 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) 18 Action taken in matters referred by H. M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshops Act (s. 5) Notified by H. M. Inspector 47 Reports (of action taken) sent to H. M. Inspector 47 Other 16 Underground Bakehouses (s. 101):— Certificates granted during the year — In use at the end of the year 36 During the year, a list of workshops and workplaces in the Borough was got out, embracing those in which : 1. Women do heavy labour. 2. The sanitary conditions were, owing to dirty environment, or to the dirty character of the work, not of a high order. 3. The social condition of the workers was not all that might be desired. 4. Sweating might possibly be rife, or in which the conditions of work were onerous and the pay small. 5. There were interesting Clerkenwell survivals, as, for example, clay pipe making. 119 6. Foreigners were wholly or chiefly employed. 7. Firewood chopping- was carried on. The list included two sets of premises used for waste paper sorting, 2 establishments for the scalding of calves' heads, 1 maker of pianoforte keys, 1 mat bag maker, 1 clay pipe maker and 1 glass eye maker. There were three shops for firewood chopping—this is an industry which tends to get year by year into fewer hands. The large philanthropic institutions, especially in London, have adopted wood-chopping as one of the unskilled labour tests which they may reasonably impose upon their clients. The consequence has been that, with the entry of these large competitors into the market, the available supply of wood for wood chopping has in great measure been cornered by them. Special attention is given to the workshops on this list and they are frequently inspected. BAKEHOUSES. In 1909, 2 underground bakehouses were closed—leaving 36 at present in the Borough. Three new bakehouses were opened above ground—so that now there are 24. The total number of bakehouses above and below ground is therefore 60. All the bakehouses were inspected and notices for cleansing and repairing issued in 18 cases; these were all complied with. GENERAL ADMINISTRATION. Canal Boats Acts, 1887, 1884.—The Regent's Canal and Dock Company own the City Road Basin and adjacent waterway, whose superficial area within the Borough is 5¾ acres. This 120 forms a connecting link between the Thames and the Canals of the Midlands. The Finsbury portion of the Canal is largely a blind end, on whose banks are premises used as wharves, warehouses and factories, and in a few cases as residential houses. The wharf at No. 26, Wharf Road, belongs to the Borough of Finsbury, and is used for loading boats with street sweepings and house refuse. The number of boats inspected during the year was 105, of which 13 were boats carrying offensive cargoes. There were 15 infringments of the Acts and Regulations—for which 11 complaint notes were issued to the owners requesting abatement within a specified time. If these infringements were not rectified by the date mentioned in the complaint note, a further written communication to the owners always brought about the desired result. The details of the infringements are given below:— Absence of certificate from registration authority 3 Absence of marking on the boat 1 Overcrowding 1 Females over 12 years improperly occupying a cabin 1 Cabin interior dirty 1 Boat not painted according to the Canal Boats Acts 3 Insufficient ventilation 1 Dilapidations 4 It was not found necessary to take legal proceedings in any instance. All the infringements were abated except one case in which there were dilapidations. This was still outstanding at the end of the year. The following defects were ascertained in addition to those already given:— Deck Heads leaking (2), Cabins not weather proof (2), Defective hatches, 2 cases. These were all remedied. 121 The following table gives the statistics for the past seven years:— ]Year. Boats inspected. Persons found on Boats. Totals. Registered Men. Women. Children. 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 1908 101 267 18 36 321 353 1909 105 261 28 47 379 336 Amongst all the boats inspected, 78 were occupied by men only, and 27, or about 25 per cent., were occupied by men, women and children. The Canal Boats are inspected by the Inspector through whose district the Canal passes. There is no special remuneration for the work, which is included in the duties of the District Sanitary Inspector. ELEMENTARY SCHOOLS. There are in Finsbury 19 Public Elementary Schools—14 Provided and 5 Non-provided. They afford accommodation for nearly 18,000 children. The average daily attendance in 1909 was 14,700. The school premises are visited from time to time by the Medical Officer and the Sanitary Inspectors. The greater part of the work, however, in connection with these schools lies with the Medical Department of the London County Council Education Committee. 122 INFECTIOUS DISEASE IN SCHOOLS.—During the year 286 children were excluded from school owing to the presence of notifiable infectious disease in their homes. In addition, 1,559 children were kept at home in connection with outbreaks of measles, hooping cough, chicken-pox and other infectious or contagious disorders in their households. Information of these matters was received from the school teachers:— The figures for the year have been as follows:— ]SCHOOLS. Average Attendance in 1909. NOTIFIED BY MEDICAL MEN. INFORMATION FROM SCHOOLS. Total. Scarlet Fever. Diphtheria. Enteric Fever. Measles. Hooping Cough. Chicken Pox. Other Diseases Albion Place 603 5 10 - 92 24 19 36 186 Amwell Street 577 6 4 - 9 11 41 20 91 Ann Street 896 13 7 1 56 18 31 44 170 Baltic Street 583 2 - - 9 16 13 28 68 Bath Street 1,349 17 28 1 58 36 14 47 201 Bowling Green Lane 700 - - - - - - - - Central Street 727 17 4 - 28 14 7 56 126 Chequer Street 763 7 4 - 8 4 - 12 35 Compton Street 1,107 26 5 - 58 23 20 75 207 Hugh Myddelton 1,500 26 19 2 110 46 44 51 298 Moreland Street 1,053 5 10 - 74 40 41 79 249 Risinghill Street 1,245 13 23 - 16 11 9 39 111 Winchester Street 1,249 11 7 - 3 6 6 26 59 White Lion Street 869 - - - - - - - - St. John Street 159 - - - 10 3 - - 13 St. Luke 699 5 6 - 4 5 - 5 25 St. Mark 199 - - - - - - - - St. Joseph's 364 - 2 - 3 - - - 5 St. Peter & Paul 221 - - - - - 1 - 1 Totals 14,783 153 129 4 538 257 246 518 1,945 123 BLACK SMOKE. During 1909, the Inspectors made 32 special smoke observations. The London County Council sent notice of 23 infringements, and one was derived from a private source. In 15 cases the emission of black smoke lasted three minutes or more, and in respect of these action was taken as recorded in the accompanying table. In the other cases, the emission were not considered sufficiently serious to justify further action. No. Premises. Date. Duration in minutes of Black Smoke. Action taken. 1 F. Kehrein, 2, Tysoe Street Jan. 13 3 Cautioned. 2 City of London Lying-in Hospital Feb. 10 4 Notices served. 3 S. Haskins, Memel Street Feb. 23 5 Cautioned. 4 Thos. De la Rue & Co., Errol Street June 10 14 Notices served 5 H. Hopton, 34, Powell Street April 19 7 Cautioned. 6 G. R Peerless & Sons, 61, Old Street July 1 5½ Notices served. 7 E. Dohm, 57, Rosoman Street Aug. 16 13 Notices served. 8 Thos. De la Rue & Co., Errol Street Oct. 23 4 Notices served. 9 Northampton Institute, St. John Street Nov. 3 5 Notices served. 10 Do. do Nov. 3 17 11 R. S. Murray & Co., 67, Turnmill Street Nov. 9 5 Notices served. 12 Do. do. Nov. 10 3½ 13 Hermes Hill Laundry, Risinghill Street Nov. 19 10 Notices served. 14 Northampton Institute, St. John Street Nov. 23 7 Case pending. 15 Thos. De la Rue & Co., Errol Street Dec. 6 7 Cautioned. 124 CLEANSING OF PERSONS ACT, 1907. Applications were received from 7 persons for cleansing orders, and 2 were later cleansed and their clothing freed from vermin at the Casual Wards in Little Grays Inn Lane. It will be remembered that in 1909 an arrangement was entered into with the Holborn Board of Guardians to provide for the cleansing of applicants under the above Act at a cost of six shillings per person. THE MORTUARIES. These are two, and are situated at Warwick Place, off Whitecross Street, and at 47, Northampton Road. There is a Coroner's Court at each place and also a disinfecting station. The returns for the year are as follows:— ] Northampton Road Mortuary. Warwick Place Mortuary. Total. Inquest cases 77 45 122 Infectious Diseases 1 6 7 Bodies deposited by Borough Orders 2 1 3 Bodies brought for convenience of relatives 79 97 176 159 149 308 At the Warwick Place Mortuary 41 post-mortem examinations were made; at Northampton Road 64 examinations. THE SHELTER. In connection with the disinfecting station at 47, Northampton Road, there is a shelter to house families during the time their rooms are being disinfected after infectious disease, and used also for the isolation of suspicious cases of infectious disease or small-pox contacts during the incubation period and before the disease has clearly declared itself. During the year 6 families— 125 22 persons in all—were lodged in the shelter in accordance with the provision under Section 60 of the Public Health (London) Act, 1891. LONDON COUNTY COUNCIL (GENERAL POWERS) ACT, 1909. Part III. and Part IV. of this Act are of significance from a Public Health standpoint. Part III. refers to the accommodation for the storage of food in tenement houses and deals with a long standing grievance. So often does it happen that, under existing conditions, the coal or coke, paraffin, blacklead, and other household details are kept in the same cupboard as the food, or this may even necessitate keeping the food elsewhere in undesirable situations exposed to contamination. Its chief provision is here given—it does not apply to tenement houses already occupied or erected. Section 16.—If at any time it appears to any sanitary authority that in any tenement house within their district sufficient and suitable accommodation for the storage of food is not provided for the use of each family occupying such house on the storey or one of the storeys in which are situate the rooms or lodgings in the separate occupation of such family the sanitary authority may, if the provision of such accommodation is practicable, cause notice to be served on the owner of such house requiring him within such reasonable time as may be specified in the notice to provide sufficient and suitable accommodation for the purpose aforesaid, and any owner failing to comply with such requirement within the period prescribed in the notice shall be liable on summary conviction to a penalty not exceeding forty shillings and to a daily penalty not exceeding twenty shillings. Provided that this section shall not apply to any tenement house used or occupied as such before the passing of this Act. 126 Part IV. amends the London Building Acts, 1894 to 1908, and deals with buildings of iron and steel skeleton construction, the strength of materials, the construction and thickness of walls, floors, pillars, the working stresses and strains permissible, and gives power to make regulations as to the use of reinforced concrete. REMOVAL OF DUST AND HOUSE REFUSE.—This is done by the Wharf and Cleansing Department under the superintendence of Mr. Arthur May. The refuse is removed weekly from all houses, oftener if necessary. In the main thoroughfares it may be done daily. Every house is provided with sufficient accommodation for the disposal of ashes and refuse generally in the form of a round metallic bin and cover. Whenever no such provision is made a notice is served upon the owner to rectify the omission. This the owner usually does immediately. Complaints—verbal or written—with regard to non-removal are occasionally received at the Public Health Department, and are referred to the Cleansing Department for attention. Special bins are provided by the Borough Council for the collection of offensive refuse from fish shops, fried fish shops, restaurants and wholesale butchers. A deposit of 8/- is required for each bin—this sum is returned when the use of the bin is discontinued. A sum varying from 1/- to 2/-, according to the quantity removed, is charged for each occasion when the bins are used. A specially constructed van is used for collecting this refuse—the amount removed in 1909 was 8,320 bins. The household refuse collected and destroyed in 1909 was 14,216 loads, the trade refuse 2,308 loads—the total weight 21,570 tons. The cost of collection was £5,645, the cost of disposal by burning and barging £3,176. The Council have a Horsfall destructor at 26, Wharf Road. The house refuse is in part dealt with at Bull Stairs Wharf, Southwark, and conveyed by barge down the Thames. 127 DRAINAGE PLANS.—In Finsbury, drainage plans are passed by the Public Health Committee—in 1909, 167 sets of plans were considered and dealt with. Of these, 36 referred to combined systems of drainage concerning 89 premises. In the case of old buildings, the work under plans passed by the Council is supervised by the Sanitary Inspectors. In new buildings, the supervision of the sanitary inspectors is limited to the construction of water closets and soil pipes. All plans of new buildings and of the reconstruction of old buildings are referred both to Mr. P. G. Killick, Borough Surveyor, and to the Medical Officer of Health. The drainage of new buildings is supervised by the Borough Surveyor, who advises and co-operates with the Health Department in all matters affecting drainage generally. SANITARY INSPECTORS. The following table summarises the work done during 1909 by the Sanitary Inspectors. The staff throughout the year consisted of:—A Chief Sanitary Inspector, six District Sanitary Inspectors, a spccial Meat Inspector, a special Factory and Workshop Inspector, one Lady Sanitary Inspector, two Lady Health Visitors (appointed in 1909) and three clerks. All these devote the whole of their time to the work of the Department. The Borough is divided into six districts, and an inspector placed in charge of each. Each district inspector carries out all the ordinary duties of a sanitary inspector, including the taking of samples under the Sale of Food and Drugs Act. Canal Boat inspection is carried out by the inspector (Draper) in whose district the Canal lies. The Chief Sanitary Inspector exercises a general supervision over the work of the staff. 128 WORK OF SANITARY INSPECTORS. ] Inspector Davis. Inspector Longden. Inspector Norman. Inspector Matson. Inspector Draper. Inspector Jackson. Total. Houses damp, dirty or dilapidated remedied 185 120 106 118 140 126 795 Doors, windows, floors, ceilings, sash cords, etc., repaired 30 25 25 34 40 22 176 Overcrowding cases abated in other than Registered Houses 7 4 12 7 3 9 42 Illegal occupations of underground rooms - 1 3 8 2 4 18 Water closet defects remedied 197 206 300 203 254 203 1363 Water closets erected 94 39 2 11 45 10 201 Urinal defects remedied 4 2 6 1 3 5 21 Urinals erected 4 2 - - 10 1 17 Soil pipe and ventilating shaft defects remedied 6 2 6 4 11 10 39 Soil pipe and ventilating shafts erected 24 3 14 4 10 2 57 Yard defects remedied 86 46 101 128 127 50 538 Waste pipe defects remedied 12 6 19 22 34 37 130 Waste pipes erected 50 10 4 3 43 2 112 Water cistern defects remedied 46 21 12 33 9 10 131 Rubbish, manure, &c., accumulations removed 21 12 18 29 20 24 124 Dung or Dust receptacles repaired or renewed 42 40 89 37 29 39 276 Drains relaid or amended 20 20 50 36 52 60 238 Drains cleared 12 12 44 29 17 35 149 Rain water pipes repaired or renewed 31 30 46 11 20 22 160 Water supply to houses re-instated 4 4 6 5 3 3 25 Roofs and Gutters repaired 29 39 61 59 53 44 285 Area defects remedied 2 10 17 37 14 14 94 Washhouse defects remedied 21 21 65 61 43 41 252 Bakehouses cleansed or repaired 3 5 2 5 2 1 18 Animal Nuisanses abated 7 3 4 2 2 7 25 Basement defects remedied 7 13 7 31 35 6 99 Stables cleansed or repaired 9 - 5 - 2 2 18 Water Supply laid on to upper storeys of house - 6 42 11 9 2 70 Miscellaneous Nuisances abated 65 8 5 18 7 13 116 Restaurants cleansed or repaired 65 17 10 8 17 5 122 Smoke observations 8 30 16 31 39 10 134 Overcrowding cases abated in Registered Houses 5 7 8 4 4 18 46 Registered Houses cleansed throughout 77 187 220 194 149 301 1128 Registered Houses—Intimation (Cleansing) Notices served 77 200 224 194 149 301 1145 Registered Houses—Statutory (Cleansing) Notices served 17 20 68 68 21 83 277 First visits on complaint, &c. 811 1155 1223 1171 1308 1231 6899 Revisits 4035 4075 4591 4591 4273 3953 25518 Intimation Notices served 442 316 572 364 378 447 2519 Statutory Notice served 54 59 116 134 60 57 480 Infectious disease investigations 112 223 204 211 114 210 1074 House inspections 63 250 314 293 195 193 1208 House to house inspections 151 186 104 134 138 87 800 Canal Boats inspected - - - - 105 - 105 129 LEGAL PROCEEDINGS. The following table gives the details of the legal proceedings instituted during the last year:— ]Date. Name and Address of Defendant. Offence. Result. 1909. Jan. 22nd Moore, M & R., 64, Pentonville Road, N. Erecting a water-closet without first giving notice under bye-laws at 64, Pentonville Road, N. Fined 10s. and 2s. costs „ 22nd Moore, M. & R., 64, Pentonville Road, N. Constructing a water-closet at 64, Pentonville Road, contrary to the bye-laws Fined £1 and £1 3s. costs Mar. 5th Sanders, A., 36, Pembury Road, Hackney, N.E. Failing to provide proper water supply at 112. Wynford Road, N. Fined £5 and £1 3s. costs „ 12th Bicknell, Thos., 9, Princes Road, Kilburn, N.W. Failing to provide proper water supply at 104, Wynford, Road, N. Fined £5 and £1 3s. costs „ 5th Crowne, E., 47, King's Cross Road, N. Fixing a water-closet pan without first giving notice under bye-laws at 1, Granville Place, W.C. Fined £3 and £1 3s. costs „ 6th Davies, John, 40. Rawstorne Street, E.C. Failing to alter and amend defective water apparatus to water-closet at 40, Rawstorne Street, E.C. Fined £5 and £2 costs May 6th Waldron, Jno., 90, Hatton Garden, E.C. Failing to alter and amend defective water apparatus at 67, Myddelton Street Fined £2 and 2s. costs „ 28th Hutton, A. & J., 158, Lordship Road Stoke Newington, N. Failing to alter and amend defective drain at 19, Warren Street Fined £1 and £2 2s. costs Aug. 6th Gough Cooper, Ltd., 10, Exmouth Street, W.C. Failing to provide water to watercloset at 10, Exmouth Street, W.C. Fined £2 and 2s. costs Sept. 21st Hornett, Foster & Co., Marsh Gate Lane, Stratford, E Failing to remove obnoxious refuse within time allowed by L.C.C. byelaws Withdrawn Dec. 17th Mompalao, Achille, M.D., 3, Calthorpe Street, W.C. Failing to notify a case of puerperal fever at 6, Great Bath Street, E.C. Fined £1 10s. and 2s. costs „ 17th Tasselli, Dorothea, 4, Vineyard Walk, E.C. Failing to notify a birth at 6, Great Bath Street, E.C. Fined £1 and £1 3s. costs „ 17th Tasselli, Dorothea, 4, Vineyard Walk, E.C. Failing to notify a birth at 15, Vineyard Walk, E.C. Fined £1 and £1 10s. costs 130 Sale of Food and Drugs Act. [###Date. Name and Address of Defendant. Offence. Result. 1909. Jan, 19th Hawkins, Harriett, 140, Central Street, E.C. For selling Gregory powder adulterated with 15 per cent. of sodium carbonate and 41 per cent. of basic magnesium carbonate Fined £4 „ 19th Brown, C. M., 80, Bath Street, E.C. For selling liniment of lime adulterated with 50 per cent. of oil other than Olive oil Dismissed with £2 2s. costs against Council „ 28th Morgan, Timothy, 11, Chapel Street For selling butter adulterated with 84 per cent. of foreign fat Fined £20 and £2 4s. costs Mar. 5th Evans, Jane, 94, Chapel Street, N. For exposing margarine for sale without being properly labelled Fined £5 and £1 3s. costs „ 5th Evans, Jane, 94, Chapel Street, N. For selling margarine containing more than 10 per cent. of butter fat Fined £10 and £1 3s. costs „ 16th Lewis, Enoch, 13, Yardley, Street, E.C. For selling butter adulterated with 81 per cent. of foreign fat Fined £5 and 12s. 6d. costs. „ 19th Howell, Thos. E., 24, Collier Street, N. For selling butter adulterated with 38 per cent. of foreign fat Fined £20 and £3 3s. costs. „ 19th Howell, Thos. E., 24, Collier Street, N. For exposing margarine for sale without being labelled Ordered to pay 2s. costs. „ 19th Howell, Thos. E., 24, Collier Street, N. For selling margarine containing 20 per cent. of butter fat Ordered to pay 2s. costs. Apr. 22nd Rowlands, David, 7, Compton Street, E.C. For selling margarine in an unstamped wrapper Fined £3 and 12s. 6d costs. „ 22nd Jenkins, William, 6, Aylesbury Street, E.C. For exposing margarine for sale without being properly labelled Fined £2 and 12s. 6d. costs „ 22nd Williams, Margaret, 74, Farringdon Road, E.C. For selling margarine in an unstamped wrapper Fined £2 and 12s. 6d. costs „ 28th Peate, John Morgan, 1, Leverington Street, E.C. For selling margarine in an unstamped wrapper Fined 7s. and £1 3s. costs „ 28th Grinsdall, Ernest, 284, Goswell Road, E.C. For exposing margarine for sale without being properly labelled Fined £1 5s. and £1 3s. costs „ 28th Grinsdall, Ernest, 284, Goswell Road, E.C. For selling margarine in an unstamped wrapper Withdrawn 131 ]Date. Name and Address of Defendant. Offence. Result. Apr. 28th O'Connell, Margaret, 40, Mitchell Street, E.C. For selling milk adulterated with 10.7 of added water Fined £1 and £1 3s. costs May 28th Jarvis, William, 170, Stapleton Hall Road, N. For selling milk from which 8.3 of its cream had been abstracted Fined £10 and 12s. 6d. costs „ 28th North Eastern Dairy Co., 54, Durham Road, Finsbury Park, N. For selling milk from which 8.3 of its cream had been abstracted Withdrawn „ 28th Osborn, William, 60, St. Peter Street, N. For selling milk from which 8.3 of its cream had been abstracted Fined £3 and 2s. costs June 8th Evans, Elizabeth, 189, Whitecross Street, E.C. For selling margarine in an unstamped wrapper Ordered to pay 12s. 6d. costs „ 8th Jones. Thomas, 32, President Street, E.C. For selling margarine in an unstamped wrapper Ordered to pay 12s. 6d. costs July 2nd James, John, 230, St. John Street, E.C. For selling milk from which 7 per cent. of its cream had been abstracted Dismissed. Defendant proved that he sold the milk exactly as the cows gave it „ 2nd Wilson, Ada, 18, Wynford Road, N. For selling milk from which 26.6 per cent. of its cream had been abstracted Fined £2 and 12s. 6d. costs. „ 13th Richards, Ann, 19, Fann Street, E.C. For selling milk from which 10 per cent. of its cream had been abstracted Fined £4 „ 13th Jones, Richard, 18, Upper Ashby Street, E.C. For selling milk from which 16.6 per per cent. of its cream had been abstracted Dismissed. Defendant proved a warranty „ 20th Appleby, Henry, 19, Dingley Road, E.C. For selling milk adulterated with 29.7 grains of boric acid per gallon Fined 1d. „ 20th North-Eastern Dairy Co., 54, Durham Road, Finsbury Park, N. For selling milk from which 15 per cent. of its cream had been abstracted Ordered to pay 12s. 6d. costs. Aug. 6th Williams, Z. & E., 2, Great Bath Street, E.C. For selling milk from which 15 per cent. of its cream had been abstracted Ordered to pay 12s. 6d. costs „ 6th James, David, 29, Wynford Road, N. For selling milk from which 5.3 per cent. of its cream had been abstracted Dismissed. Warranty proved 132 ]Date. Name and Address of Defendant. Offence. Result. Aug. 6th Hall, Robert, 3, Churchway, Somers Town. For selling milk from which 6.6 per cent. of its cream had been abstracted Fined £1 and 12s. 6d. costs Dec. 3rd Jenkins, William, 6, Aylesbury Street, E.C. For selling butter adulterated with 81 per cent. of foreign fat Fined £5 and 12s. 6d. costs „ 3rd Phillips, Jno., 13. Yardley Street, E.C. For selling butter adulterated with 87 per cent. of foreign fat Fined £2 and 12s. 6d. costs. „ 17th Sills, J., 13, Sheen Grove, Barnsbury, N. For selling milk adulterated with 12 8 per cent. of added water Fined 10s. and 12s. 6d. costs „ 17th Wright, Mary, 2a, Chapel Street. N. For selling milk adulterated with 6.1 per cent. of added water Fined 5s. and 12s. 6d. costs „ 17th Wyatt, Frank, 49, Corporation Row, For selling milk from which 27.6 per cent. of its cream had been abstracted Adjourned to Jan. 14th, 1910 „ 17th James, John, 230, St. John Street, E.C. For selling milk adulterated with 3.6 per cent. of added water and from which 33 per cent. of its cream had been abstracted Adjourned to Jan. 14th, 1910. Sample sent to Somerset House LOCAL GOVERNMENT BOARD AND OTHER TABLES. 134 TABLE I. Vital Statistics of Whole District during 1909 and previous Years. Metropolitan Borough of Finsbury. ]Year. Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Total Deaths in Public Institutions in the District Deaths of Nonresidents registered in Public Institutions in the District. Deaths of Residents Registered in Public Institutions beyond the District. Nett Deaths at all Ages belonging to the District. Number. Rate.* Under 1 Year of Age. At all Ages. Number. Rate.* Number. Rate per 1,000 Births registered. 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 1908 96,007 3,474 36.2 400 115.1 931 9.7 64 55 891 1,767 18.4 Averages for years 1899-1908. 98,726 3 547 35.9 464 130.6 1,120 11.3 46 43 916 1,993 20.1 1909 95,289 3,427 35.9 372 108.5 882 9.2 56 56 988 1,814 19.0 * Rates in Columns 4 and 8 should be calculated per 1,000 of the estimated gross population. In districts in which large public institutions seriously affect the statistics, the rates in Column 13 may be calculated on a nett population, obtained by deducting from the estimated gross population the average number of inmates not belonging to the district in such institutions. Note.—The deaths to be included in Column 7 of this Table are the whole of those registered during the year as having actually occurred within the district or division. The deaths to be included in Column 12 are the number in Column 7, corrected by the subtraction of the number in Column 10 and the addition of the number in Column 11. By the term "Non-residents" is meant persons brought into the district on account of sickness or infirmity, and dying in public institutions there; and by the term "Residents" is meant persons who have been taken out of the district on account of sickness or infirmity, and have died in public institutions elsewhere. The "Public institutions" to be taken into account for the purposes of these Tables are those into which persons are habitually received on account of sickness or infirmity, such as hospitals, workhouses and lunatic asylums. Area of District in acres Total population at all ages 101,463 (exclusively of area 589 Number of inhabited houses, 9,820 At Census of 1901. covered by water). Average number of persons per house, 10.9. 135 TABLE II. Vital Statistics of separate Localities in 1909 and previous Years. ]Names of Localities. 1.—The Borough. 2.—Clerkenwell. 3.—St. Luke. 4.—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 estimaied 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 Deaths under 1 year. a b c d a b c d a b c d a b c d 1901 101,463 3,792 2,161 461 63,704 1,947 1,282 282 36,116 1,808 848 173 1,643 37 31 6 1902 100,487 3,624 2,283 558 63,091 1,937 1,376 335 37,769 1,649 873 217 1,627 38 34 6 1903 100,487 3,664 1,993 503 63,091 1,939 1,186 288 35,769 1,692 776 210 1,627 33 31 5 1904 98,958 3,603 2,084 522 62,131 1,910 1,272 314 35,225 1,660 775 206 1,602 33 37 2 1905 98,207 3,398 1,855 429 61,660 1,790 1,110 244 34,957 1,587 705 178 1,590 21 40 7 1906 97,466 3,464 2,020 474 62,195 1,860 1,277 299 34,693 1,565 704 166 1,578 39 39 9 1907 96,732 3,361 1,774 368 60,735 1,756 1,035 224 34,431 1,581 700 136 1,566 24 39 8 1908 96,007 3,474 1,767 400 60,280 1,766 1,104 236 34,173 1,679 647 163 1,554 29 16 , Averages of Years 1899 to 1908. 98,726 3,547 1,992 464 62,486 1,863 1,205 278 35,392 1,653 753 181 1,598 32 33 5 1909 95,289 3,427 1,814 366 59,829 1,699 1,116 229 33,918 1,708 664 131 1,542 20 34 6 Notes—(a) The separate localities adopted for this Table should be areas of which the populations are obtainable from the census returns, such as wards, parishes or groups of parishes or registration sub-districts. Block 1 may, if desired, be used for the whole district; and blocks 2, 3, &c., for the several localities. In small districts without recognised divisions of known population this Table need not be filled up. (b) Deaths of residents occurring in public institutions beyond the district are to be included in sub-columns c of this Table, and those non-residents registered in public institutions in the district excluded. (See note on Table 1 as to meaning of terms "resident" and "non-resident." (c) Deaths of residents occurring in public institutions, whether within or without the district, are to be allotted to the respective localities according to the addresses of the deceased. (d) Care should be taken that the gross totals of the several columns in this Table respectively equal the corresponding totals for the whole districts in Table 1. and IV.; thus, the totals of sub-columns a, b and c should agree with the figures for the year in the columns 2,3, and 12, respectively, of Table I ; the gross total of the sub-columns c should agree with the total of column 2 in Table IV., and the gross total of sub-columns d with the total of column 3 in Table IV. 136 TABLE III. Cases of Infectious Disease notified during the Year 1909. ]Notifiable Diseases. 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 1 2 3 8 Clerkenwell. St. Luke. St. Sepulchre. Clerkenwell. St. Luke. St. Sepulchre. Total cases removed to Hospital. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 65. 65 and upwards. Small Pox - - - - - - - - - - - - - - Cholera - - - - - - - - - - - - - - Diphtheria (including Membranous croup) 152 13 62 61 10 6 - 76 74 2 75 74 2 151 Erysipelas 127 3 11 5 11 62 35 78 49 — — — — — Scarlet Fever 231 2 80 120 16 13 — 159 72 — 155 71 — 226 Typhus Fever - - - - - - - - - - - - - - Enteric Fever 15 - 4 4 5 2 - 11 4 - 9 4 - 13 Relapsing Fever - - - - - - - - - - - - - - Continued Fever - - - - - - - - - - - - - - Puerperal Fever 6 — — — — 6 — 5 1 — 4 1 — 5 Plague - - - - - - - - - - - - - - Cerebro Spinal Meningitis . 3 1 1 1 — — — 3 — — 3 — — 3 Totals 534 19 158 191 42 89 35 332 200 2 246 150 2 398 137 TABLE IV. Causes of, and Ages at, Death during Year 1909. ]Causes of Death. Deaths at the subjoined ages of "Residents" whether occurring in or beyond the District. Deaths at all ages of "Residents" belonging to Localities, whether occurring in or beyond the District. Total Deaths, whether of "Residents" or "Non-Residents" in Public Institutions in the District. All ages. Under 1 year. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under , 65 65 and upwards. Clerkenwell. St. Luke. St. Sepulchre. Small-pox - - - - - - - - - - - Measles 86 23 59 4 - - - 52 30 4 - Scarlet fever 9 - 6 3 - - - 6 3 - - Whooping-cough 51 21 29 1 - - - 31 18 2 - Diphtheria (including Membranous croup) 13 1 11 1 - - - 7 6 - - Croup - - - - - - - - - - - Fever Typhus - - - - - - - - - - - Enteric 3 - 1 - - 2 - 3 - - - Other continued - - - - - - - - - - - Epidemic influenza 20 1 - - - 13 6 13 7 - 1 Cholera - - - - - - - - - - - Plague - - - - - - - - - - - Diarrhoea 68 46 13 1 - 1 7 43 25 - 1 Enteritis 27 16 4 1 - 5 1 16 10 1 - Gastritis 8 2 - - 1 3 2 3 5 - - Puerperal fever 2 - - - - 2 - 1 1 - - Erysipelas 3 1 - - - 1 1 1 2 - - Phthisis (Pulmonary Tuberculosis) 228 5 19 9 18 159 18 127 98 3 5 Other tuberculous diseases 31 7 12 9 2 1 - 18 13 - - Cancer, malignant disease 88 - — 1 1 59 27 63 24 1 7 Bronchitis 222 21 14 3 - 66 118 131 87 4 1 Pneumonia 203 47 44 10 3 58 41 114 85 4 5 Pleurisy 7 - - 1 - 4 2 5 2 - - Other diseases of Respiratory organs 9 - 2 - - 3 4 6 3 - 2 Alcoholism Cirrhosis of liver 46 — — — — 35 11 26 18 2 — Venereal diseases 21 9 - - - 11 1 13 8 - - Premature birth 60 60 - - - - - 43 16 1 5 Diseases and accidents of parturition 12 - - - 1 11 - 9 3 - 2 Heart diseases 176 8 2 7 10 91 58 115 59 2 4 Accidents 85 26 17 6 4 20 12 51 33 1 1 Suicides 10 - - - 1 8 1 6 4 - - Marasmus and Inanition 51 50 1 - - - - 38 12 1 5 Convulsions 5 3 2 - - - - 1 4 - - Brights Disease 122 - — 1 2 60 59 83 36 3 1 Old Age 27 - — — - - 27 19 8 — 2 All other causes 121 19 8 8 11 54 21 72 44 5 14 All causes 1814 366 244 66 54 667 417 1116 664 34 56 138 139 TABLE V. Infantile Mortality during the Year, 1909. 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. i. Common Infectious Diseases— Small-pox .. .. .. .. .. .. .. .. . .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. 1 1 .. 3 .. 1 1 4 4 8 23 Scarlet Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria (including Membranous Croup) .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 1 Whooping Cough 1 .. 1 .. 2 1 2 .. .. 1 1 2 5 3 1 3 21 ii. Diarrhoeal Diseases— Diarrhœa, all forms .. .. .. .. .. 3 7 8 3 8 6 2 4 3 2 .. 46 Enteritis, teritis, teritis 2 1 .. .. 3 2 .. 1 3 1 .. 1 4 .. 1 .. 16 Gastritis, testinal Catarrh .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. 1 2 iii. Wasting Diseases— Premature Birth 45 4 2 4 55 2 2 1 .. .. .. .. .. .. .. .. 60 Congenital Diseases 3 .. 1 1 5 1 1 .. .. .. .. .. .. .. .. .. 7 Injury at Birth .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Want of Breast-milk (Starvation) .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Atrophy, Debility Marasmus .. 6 4 6 16 10 10 5 4 1 2 1 .. .. .. 1 50 iv. Tuberculous Diseases— Tuberculous Meningitis .. .. .. .. .. .. .. .. 1 2 1 1 1 .. .. 1 7 Tuberculous Peritonitis, Tabes Mesenterica .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other Tuberculous Diseases .. .. .. .. .. .. .. .. .. .. 1 1 1 1 .. 1 5 v. Other Causes— .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. 1 Erysipelas .. 2 .. 1 3 4 2 .. .. .. .. .. .. .. .. .. 9 Syphilis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Rickets .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Meningitis (not culous 1 .. .. .. 1 .. 1 .. .. .. .. 1 .. .. .. .. 3 Convulsions .. 1 .. .. 1 3 1 1 1 2 .. 1 3 5 .. 3 21 Bronchitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Laryngitis 1 .. 2 .. 3 3 3 6 1 1 5 9 3 3 2 8 47 Pneumonia 2 .. 1 .. 3 10 2 5 .. .. .. .. .. .. 1 .. 21 Suffocation, overlying Other Causes 2 1 5 .. 8 3 1 2 2 1 2 1 1 3 1 1 26 All Causes (Certified) 57 15 16 12 100 42 33 31 16 20 18 21 23 22 12 28 366 Population, estimated to middle of 1909, 95,289. Legitimate, 2822. Births in the year: Illegitimate, 35 Deaths from all Causes at all Ages, 1,814. (Legitimate infants, 348. Deaths in the year of Illegitimate infants, 18.