FIN 11 THE METROPOLITAN BOROUGH OF FINSBURY. ANNUAL REPORT on the PUBLIC HEALTH OF FINSBURY for the Year 1912 by A. E. THOMAS, M.A., M.D., D.P.H., Medical Officer of Health. Barrister-AT-Law. London: Printed by Vail & Co., 170, Farringdon Road, E.C. 1913. Public Health Committee, 1912-1913. Chairman. Councillor O. M. RICHARDS. Vice-Chairman. Councillor Dr. LAUZUN BROWN HIS WORSHIP THE MAYOR. (Alderman H. B. BARTON, J.P.) Alderman W. HOWES. Alderman LEWIS PHILLIPS. Councillor C. M. BROWN. Councillor The Rev. T. C. ELSDON, A.K.C. Councillor F. FOULGER. Councillor A. W. HUMPHRIES. Councillor The Rev. Prebendary G H. PERRY, M.A., J.P. Councillor Dr. W. F. ROE. Councillor J. H. STOCKTON. Councillor ERNEST TROTT. The Public Health Committee meets on the 2nd and 4th Tuesdays each month at 2.30 p.m. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Finsbury. His Worship the Mayor : Alderman H. B. Barton, J.P, Gentlemen, I have the honour to submit to you the Annual Report on the Public Health and sanitary condition of the Borough of Finsbury for the year 1912. For the sake of uniformity, the method of arrangement adopted in previous reports has, in the main, been adhered to. In presenting this review of last year's work I wish to thank the Council and the Chairman and Members of the Public Health Committee for their ever-willing help, their encouragement and support, and the Officials of the Health Department and of the other Departments for their kind 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. TABLE OF CONTENTS. page Summary 5 Population 5 Births 7 Notification of Births 10 Health Visitation 11 Creches 34 Weighing Centres 37 Puerperal Fever 43 Opthalmia Neonatorum 45 Deaths and Death Rates 46 Inquests 51 Infantile Mortality 51 Infant Deaths Street List 54 Infant Deaths (Table) 57 Cancer 72 Alcoholism 74 Consumption of the Lungs 75 Phthisis:— Notifications and Deaths (Table) 76 Finsbury cases 77 Deaths and Death Rates, 1901-1912 101 Deaths in Institutions 1901-1912 103 Death Rates—I ondon Boroughs 104 Treatment of Tuberculosis 104 Tuberculosis Dispensary 106 Street List 113 Glanders and Anthrax 117 Yellow Fever, Plague and Cholera 118 Cerebro-Spinal Meningitis 118 Polio Myelitis 118 Small-Pox 119 Measles and Hooping Cough 119 Scarlet Fever 122 Diphtheria 124 Typhoid Fever 127 Typhus Fever 129 Infec'ious Disease, Deaths and Notifications 130 page Disinfection 133 Protection of Food Supply 133 Meat and Food Inspection 134 Unsound Food Prosecutions 136 Sausage Manufacturers 136 Dealers in Cats' Meat 138 Street Markets 139 Slaughterhouses 140 Milk Supply 141 Milk Registration 141 Milk Samples and Analyses 147 Milk Samples in the Metropolitan Boroughs, 1911 144 Ice Cream Shops 149 Restaurants 149 Butter Manufacturers 150 Sale of Food and Drugs Acts 150 Housing 151 Registered Houses 153 Common Lodging Houses 153 House-to-House Inspection 154 Crowding and Overcrowding 156 Customs and Inland Revenue Acts 158 Verminous Houses 158 Stable Dwellings 159 Factories and Workshops 160 Bad Flock Act 165 Bakehouses 170 Canal Boats 170 Elementary Schools 171 Black Smoke 172 Cleansing of Persons 172 The Mortuaries 173 The Shelter 173 Offensive Trades 173 Staff of Department 174 Work of the Inspectors 175 Work of the Lady Sanitary Inspector 176 Legal Proceedings 177 5 VITAL STATISTICS. SUMMARY.—The prominent facts of the Annual Report for 1912 are given in short below :— Estimated Population at the middle of 1912 86,130. Finsbury Residents in outlying Institutions 2,127 Birth Rate 29.9 per 1,000 inhabitants. Death Rate 18.5 per 1,000 inhabitants. Infant Mortality 112 per 1,000 births. Death Rate from Phthisis 1.81 per 1,000 inhabitants. Death Rate from all forms of Tuberculosis 2.31 per 1,000 inhabitants. Death Rate from the seven Chief Zymotic Diseases 2.51 per 1,000 inhabitants. Noticeable features derived from this return are:— The declining birth rate. The number of births is still diminishing. The death rate is lower than last year. The death rates from phthisis and from all forms of tuberculosis are practically the same as they were in 1911. The large increase in the number of deaths due to Measles The slight increase in the deaths attributed to Hooping Cough and Influenza The lessened number of deaths due to Scarlet Fever, Diphtheria, Enteric Fever, Diarrhoea and Enteritis. The lessened prevalence of Scarlet Fever, Enteric Fever and Diphtheria. The great prevalence of Measles. The diminished Infantile Mortality—the lowest since the Borough was formed in 1901. POPULATION.—The population of the Borough at the middle of 1912 was estimated by the Registrar-General to be 86,130, distributed as follows :— Clerkenwell 55,966 St.Luke 28,829 St. Sepulchre 1,335 86,130 6 This estimate does not include the Finsbury residents detained in the following outlying institutions : the Holborn Union Workhouse, Shepherdess Walk (919), the Workhouse Infirmary, Archway Road (338), the Holborn Union Workhouse, Mitcham (528), and the Holborn Schools, Mitcham (344), giving a total of 2,127. Adding these to 86,130, the estimate of the Registrar-General, gives a corrected population ox 88,257 for the whole Borough. The various rates in the present report are calculated on the estimates of the Registrar-General. The reasons lor adopting this method were given in the annual report for 1910. The intra-mural population in 1912 is less by 1,436 than the population for the preceding year. This gradual depopulation of the borough has now been in progress or some considerable time, and is due to the fact that the borough is becoming more and more a business and manufacturing centre and less and less residential. Inhabited houses are being demolished and are being converted into factories, workshops and warehouses. The following details are extracted from the 1911 Census returns:— 1911. 1901. Houses inhabited 7,630 9,280 Separate occupiers 21,239 24,097 Population 87,923 101,463 Uninhabited houses 747 1,967 Being built 23 52 7 Inhabited. Separate occupiers. Population. Uninhabited. Being built. Ordinary dwelling houses 5,574 14,249 56,592 452 18 Blocks of flats 206 4,246 17,946 — — Shops 1,260 2,034 8,120 212 1 Hotels and public houses 225 239 1,688 5 — Offices, workshops & factories 232 311 1,162 58 4 Institutions 37 38 1,627 — — Separate flats, included in the blocks. 4,243 4,246 17,946 251 — In addition there are in the district the following buildings not used as dwellings:—Places of Worship 38, Government and Municipal Buildings 7, Shops 502, Offices 89, Workshops and Factories 1661, and 2 Places of Amusement. The average number of persons per inhabited building was in 1911, 11.52 ; in 1901, 10.98. The average number ot persons per family was in 1911 for all dwellings 4.14, for ordinary dwelling houses 3.97. The average number of persons per family for all dwellings in 1901 was 4-21. BIRTHS.—During 1912 there were registered 2,579 births of Finsbury residents—equal to a birth-rate of 29.9 per 1,000 inhabitants. This is the lowest birth-rate since the borough was formed. The number of births is also the lowest yet recorded The birth-rate for Finsbury still keeps higher than the birth-rate for the whole of England of Wales, and does not fall to the same appreciable extent. 8 The corrected rates for the Borough are appended :— CORRECTED BIRTHS AND BIRTH RATES. Year Population in the middle of each year. Corrected Births. Corrected Birth Rates. 1901 101,141 3,254 32.1 1902 99,846 3,191 31.9 1903 98,538 3,162 32.0 1904 97,215 3,095 31.8 1905 95,880 2,886 30.1 1906 94,529 3,012 31.8 1907 93,165 2,884 30.9 1908 91,787 2,916 31.7 1909 90,394 2,857 31.6 1910 88,987 2,833 31.8 1911 87,566 2,676 30.6 1912 86,130 2,579 29.9 9 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 95 great towns, the 146 smaller towns, and the essentially rural districts. The birth-rate is greatest in St. Luke, least in St. Sepulchre. Of the total number of Finsbury births, 292 occurred in outlying institutions ; 851 births of non-residents took place in the borough. For comparative purposes, the birth rates of the Metropolit Boroughs are annexed :— BIRTH RATES, 1912. Borough Rate. Battersea 25.4 Bermondsey 31.0 Bethnal Green 30.5 Camberwell 24.6 Chelsea 18.6 Deptford 26.5 Finsbury 29.9 Fulham 27.1 Greenwich 25.0 Hackney 23.7 Hammersmith 23.5 Hampstead 14.2 Holborn 18.8 Islington 25.1 Kensington 19.3 Borough. Rate. Lambeth 27.4 Lewisham 20.3 City of London 20.7 Paddington 21.1 Poplar 31.0 St. Marylebone 19.3 St. Pancras 24.4 Shoreditch 32.1 Southwark 29.4 Stepney 30.9 Stoke Newington 20.4 Wandsworth 21.5 Westminster 14.8 Woolwich 22.3 10 NOTIFICATION OF BIRTHS ACT, 1907.—This Act came into force on the 9th March, 1908, having been adopted by the Borough Council on December 19th, 1907. The effect of its adoption may be seen from the accompanying table. Year 1908 1909 1910 1911 1912 Births notified 2,953 3,526 3,566 3,441 3,401 Percentage attended by Doctors 3.5 3.4 3.0 4.5 3.5 Percentage attended by Midwives 11.4 15.7 13.0 18.0 18.7 Still births notified 74 75 89 92 105 Births registered 2,916 2,857 2,833 2,676 2,579 Notifications were received of 42 sets of twins and of one set of triplets. The percentage notified by parents was 10.5, by medical men 3.5, by midwives 18.7, and by others—chiefly medical students and lady midwifery students—was 67.3 per cent. The mothers in this last group were all attended gratuitously in their confinements, This means that in 1912, 2,290 Finsbury mothers, or 2 out of every 3, were cared for during child-birth, and during the subsequent lying-in period for no charge whatever, chiefly by the medical students of St. Bartholomew's Hospital, University College Hospital, the Royal Free Hospital, and by the midwives and midwifery students from the City of London Lying-in Hospital, the Maternity Nursing Association, and the Royal Maternity Charity. 11 This gratuitous treatment is so much appreciated that it is quite common for mothers in Willesden, Tottenham, Edmonton and the outlying suburbs to move their homes temporarily into Finsbury so as to be attended in child-birth, without payment, by the students. This is especially the case with expectant mothers who originally lived in Finsbury within the spheres of work of the various institutions, or whose parents still live within these districts. By the provisions of the Notifications of Births Act, local Registrars are allowed to inspect the notifications received, and to compare them with their own lists of births registered. By this means it is possible to trace those parents who have not sent information to the Public Health Office. To these a printed form is sent drawing attention to the omission and asking that the notice shall be sent. This has always been effective. In 1912, the number of notices of omusion sent to parents was 190. HEALTH VISITATION.—The visitation of infant births was begun in Finsbury in 1904, when Mrs. Greenwood was appointed Lady Sanitary Inspector. In 1905, the Borough Council appointed a second Lady Sanitary Inspector. These ladies visited a large proportion of the newly-born Finsbury babies, advised their mothers, and also investigated all the infant deaths which occurred in the borough. In 1906, the Milk Depot was established, to be eventually closed on March 3rd, 1909. In 1909, one Lady Sanitary Inspector resigned, and the Council appointed two Lady Health Visitors in her place in April of that year. The duties of the Lady Health Visitors are briefly :— 1. To systematically visit all the births in the poorer streets and some of the births in the better class districts. 12 2. To instruct the mothers, and especially young mothers with first children or twins, in the feeding and proper care of their babies. 3. To pay revisits and to carefully watch over the child's health and progress and to take the necessary steps by advice or by reference to medical or philanthropic agencies to safeguard the child's prospects and the mother's nourishment and circumstances. 4. To improve the home conditions of the mothers domestically by help, advice and suggestion, hygienically by referring defects of structure or environment to the Public Health Department. For these purposes, the Borough has been divided into two districts mapped out as containing those streets in which infant deaths have chiefly occurred in recent years. One district is assigned to each Lady Health Visitor and in the streets so defined, every household in which a birth occurs is visited on or about the eleventh day after the birth if the mother is up, or earlier on request, or if there is reason to believe that the mother is unattended by doctor, midwife, or nurse. The districts are as follows :— DISTRICT No. 1. Affleck Street Albert Street Albion Place Arlington Street Attneave Street Aylesbury Street Baker's Row Baron Street Benjamin Street Berkley Court Berkley Street Bowling Green Lane Brunswick Close Busaco Street Chapel Row Chapel Street Claremont Mews Clerkenwell Close Clerkenwell Green Coldbath Buildings Coldbath Square Collier Street Corporation Buildings Corporation Row Cow Cross Street Crawford Passage Cumming Street Cyrus Street 13 Donegal Street Donegal Street Buildings Douglas Place Dundee Buildings Eagle Court Eagle Dwellings East Place Easton Place Easton Street Farringdon Road Farringdon Road Bldgs. Fernsbury Street Field Place Fletcher's Row Francis Court Gloucester Street Godson Street Great Bath Street Great Percy Street Grimaldi Street Hallett's Place Hardwick Street Hayward's Place Hermes Hill Hermes Street Howard's Place James Gardens Jay's Buildings Jerusalem Passage Kings Cross Road Leicester Place Lloyd's Row Lock's Gardens Margaret Place Margaret Street Market Buildings Meredith Street Merlin s Place Muriel Street Myddelton Street New Buildings Noble Street Northampton Buildings Northampton Road Northampton Row Peabody Buildings, Farringdon Road Penton Place Penton Residences Penton Street Pentonville Road Pine Street Pump Court Red Lion Street Richard Street Risinghill Street Robert's Place Rodney Place Rodney Residences Rodney Street Rosoman Mews Rosoman Street Sadler Street St. Helena Street St. James Street St. James Walk St. John Street Salisbury Buildings Scotswood Street Seabrook Place Sekforde Street Seymour Place Smithfield Buildings Southampton Street Southern Street Tysoe Street 14 Victoria Dwellings Vineyard Gardens Vineyard Walk Warner Street Warren Street West Place Whiskin Street White Conduit Street White Horse Alley White Lion Street Wilmington Place Wilmington Square Winchester Cottages Winchester Street Wynford Road Yardley Street DISTRICT No. 2. Allen Street Amias Place Baldwin Street Baltic Street Bartholomew Square Bastwick Street Bath Buildings Brewer Street Buxton Houses Buxton Street Cavendish Buildings Central Street Chadworth Buildings Church Row City Road Compton Buildings Compton Passage Compton Street Costers' Dwellings Cottage Lane Dingley Road Domingo Street Dufferin Street Elizabeth Place Errol Street Europa Place Frederick Row Galway Street Gastigny Place Gee Street Goswell Road Goswell Terrace Graham Street Great Sutton Street Guest Street Guinness Buildings Hall Street Hatfield Street Helmet Row Henry Street Ironmonger Row Ironmonger Street Langton Avenue Langton Street Leage Street Lever Buildings Lever Street Leverington Street Lewin's Court Little Northampton Street Little Sutton Street Lizard Street Ludlow Street Macclesfield Place Macclesfield Street Malta Street 16 Mason's Place Memel Street Mitchell Street Mitre Court Moreland Street Murton Street Nelson Street New Street Norman Street Norman's Buildings Northampton Street Norway Street Old Street Parr's Place Paton Street Peabody Buildings, Dufferin Street Peabody Buildings, Guest Street Peabody Buildings, Roscoe Street Peartree Street Peerless Buildings Peerless Street Percival Street Powell Street President Street Radnor Street Radsworth Street Rahere Street Rawstorne Street Richmond Street Roscoe Street St. Bartholomew's Buildings St. Clement's Buildings St. John Street Sidney Grove Sydney Place Sidney Street Smith Street Valetta Street Waterloo Street Wenlake Buildings Wharf Road Whitecross Street Wynyatt Street Young's Buildings In the above streets every birth that occurs is visited from the Public Health Department. In other streets only those births are supervised where the mothers are very young, careless, negligent, ill-treated, alcoholic deserted, living in poor and domestically squalid surroundings, or are known to be the chief or sole wage earners for their families, or where the children are first children, wasting, debilitated, ailing, illegitimate or twins. Other households are visited on request, or on complaint as to ill-treatment, neglect or exposure. 16 Visitation of Births.-The number of visits paid by the Lady Health Visitors was as follows.— First Births. Total Births. Total Visits. Miss Cumming 92 513 947 Miss Macqueen 133 901 3,364 Miss O'Reilly 87 795 2,928 Totals 312 2,209 7.239 The number of the births in the Borough was 2,579, so that these figures show that in 1912 eighty-five per cent, of all the births that occurred in Finsbury came under the supervision of the Public Health Staff. In connection with this matter, it must also be remembered that in the poorer districts of the borough—in the '' slums "—all the births are visited. The number of twins born and visited was 42 sets, or one set in every 61 births. For the whole country it is usual to find that twins occur in one out of every 60 to 80 births, and triplets in only one out of 6,000 to 7,000 births. Visits of Access and Non-Access.—As a rule, the health visitors ate well received and welcomed. In Italian homes it is not uncommon for the mother to offer the health visitor a glass of " real good wine from Italy " to drink to the baby's prosperity. During 1912, in only two instances out of 7,200, was any objection raised to the visits of the ladies from the Public Health Department. One mother was specially pleased, and said that since the " lady from the Town Hall" had been, her husband had given her " her rights and had behaved quite different since." Very occasionally the mother shows a slight hesitation at the first visit especially if the tenement is in disorder or if the household cleaning and tidying up are in progress. 17 A much more serious difficulty is how to deal with those babies where no access is obtained to the tenement. These are the homes where the mother is the chief or sole support of the family and maintains an idle, dissolute, or unemployable husband. This type of home is far too common in the poorer parts of the borough and to a large extent is, in these quarters, of the very essence of the problem of the prevention of infantile mortality. In these streets, the mother, on getting up, gives the children their breakfast, washes them, sends them to school, fastens the door, goes to work at 8.30 a.m. as a charwoman, leaves the baby with a friend elsewhere or with the landlady, and returns home between 6 p.m. and 8 p.m. The husband may leave at the same time as the mother, or more frequently stays in bed until 11 a.m. or midday, then goes out and returns about midnight. The children are fed in school, or receive a halfpenny or a penny to buy fried fish or •' pieces " for their mid-day meal. • In these cases, if two visits of non-access are paid, a letter is written to the mother making an appointment for a reasonable and appropriate time. Otherwise, the neighbours are asked to obtain the baby's address. Sometimes there is no access to the home because the mother is out shopping, is in a public house bar, or because all the children are dirty, ill-developed, under-sized or ill, and the mother wishes to conceal this fact. Occasionally the mother is out drinking, this is chiefly on Monday or when there has been a recent death in the house or in the family of a neighbour. Illustrative Cases. - 1. The mother resented visitation. She did not consider it necessary for anybody to call and see her baby as she had already had 4 children and they were all living and healthy. When these four children were seen, however, they were found to be all very ricketty, ill-developed, short, slightly deformed and able to walk with difficulty. 18 2. The baby was a few months old. The mother was brought from a public house bar at 3.30 p.m. She said she had just gone there for a glass of stout to increase her supply of breast milk. She was drunk, though the baby was clean, fat and flourishing. 3. The mother had gone out to work. The baby had been sent to a friend in Hoxton. The father was in bed at mid-day. The neighbours could give no information. One stated, " We don't have no doings with her. We prefer people what has only one husband. The carryings on is disgraceful.'' 4. Mother and baby were both at home. A girl aged 11 years answered the door and said, " Mother says she's out, will you please call another day." Method of Feeding.—Nearly all the Finsbury mothers breast feed their children wholly or partially until the baby is one month old. Nearly 90 per cent, suckle their infants until the age of three months. Some prolong suckling until the child is over two years hoping by this means to avert another pregnancy. Sometimes an officious medical student, with little forethought, needlessly straps the mother's breasts, and breast feeding is thus prematurely and unnecessarily stopped. Many mothers cease breast feeding early, not because they are unwilling to continue, but because they are unable to do so. For in the poorer parts of the borough it is the mother who supports the family, it is the mother who feeds the children and clothes them; too often it is the mother who feeds and clothes her husband. In general, it may be said that owing to the father's unemployment, to the casual nature of his employment, or owing to the small wages of the family, the mother has to resume work as a charwoman, a laundry hand, a bookfolder, making cardboard boxeSj or artificial flowers in order to obtain nourishment for herself and for the others. 19 Even so, when they return to work, mothers may still be found who come home at meal times to breast feed their babies. Many of them are themselves underfed, ill, consumptive, worn out with child bearing, and quite unfit to suckle their children. For the mothers, brave and enduring, the struggle is a hard, a severe one. Ill-fed, ill-clad, ill-shod, tired out with the day's work, the mother returns home to feed and wash baby and the other children, to clean up the tenement, to do the usual household work, and to prepare supper for an unemployed or unemployable husband who arrives at midnight, it may be, noisy and "three parts drunk." The mother has broken sleep, little rest, little and poor food. Her wages are possibly enough for her and baby, but not enough for others in addition. The consequences to the baby are disastrous. It becomes ill, wastes and eventually succumbs. The woman pays, the mother suffers, the baby dies. When the mother works the baby may be left with its grandmother, with a neighbour or friend, or, quite commonly, with a young girl aged from 11 to 16 years. It may be fed on condensed milk, cow's milk, patent biscuits, " tops and bottoms," currant cake, bath buns, boiled bread, boiled potatoes, chipped potatoes patent foods, dry oatmeal, gruel, ' a bit of fried fish," tomatoes or toffee apples. Side by side with the proffering of these unsuitable foods there still linger in mean streets the traditions that " two milks will not mix," and that an ailing infant will do best '' on the milk of one cow." One father thought that next to good food there was nothing like " a day in the cattle market to cure a baby with diarrhoea and to prevent it." He put his theory into practice by taking his infant once weekly to the market in York Road. 20 Cases have been known where the mother on leaving for work in the morning has left a halfpenny to get a farthing's worth of milk at dinner time and tea time for the baby. Street hawkers, when they resume street selling, take their babies with them and mind them in a perambulator by the side of the stall. Some mothers leave their babies for payment with a friend near their places of work so that they may breast feed them during the usual meal intervals. In this connection, the establishment in the borough of two or more Creches, and of dinner centres for mothers, would prove of very great value and would meet a demand which is pressing and urgent, For, as has been already foreshadowed, the prevention of infantile mortality in Finsbury is at rock-bottom the problem of the prevention of poverty. Just as there are cases of under-feeding and of improper food so there are occasional instances of over-feeding. Some mothers feed their children whenever they cry, or assert that their children " do not seem satisfied," or that the '• breast milk is not strong enough for them." The value and importance of fresh cow's milk for baby is generally appreciated, though some mothers buy and use condensed milk because they have no convenience for storing cow's milk. The household jugs, if there are any, are frequently found to be cracked, broken, dirty, and nearly always used for fetching ale or beer. The use of a dummy teat or comforter is almost universal, and is in practice impossible to prevent. It would appear, therefore, that the better course now is to realize this fact, to accept the "dummy" as a detail which the mothers refuse to discard, and to instruct them how best to minimise its evil effects. The " comforters " are occasionally home made by putting butter, toffee, or stoned raisins in boiled butter muslin. One child was sucking the broken handle of a tooth brush tied around its neck. 21 Illustrative Cases.— 1. A baby 7 months old cried incessantly. It was being fed on the breast, and in the intervals had sips of diluted condensed milk and a breakfast cup of boiled bread, quite full, four times daily. It began to waste and to get sick; it was being overfed. The mother was dirty and careless. 2. A baby 2 weeks old was being breast fed and received daily in addition 4 bottles full of diluted condensed milk, 3 tablespoonfuls of fine oatmeal and a " dose " of Syrup of Buckthorn. The baby was being overfed and the mother was advised only to give it the breast. This she did for a time, but at a later visit when the baby was 10 weeks old, it was having cod liver oil and roast apples " as it did not seem to be satisfied." The child was now wasting and vomiting its food. 8. A baby 7 months was placed in an empty Covent Garden fruit basket by its mother's stall in a market street. It was eating chipped potatoes and sucking the batter from a piece of fried fish. The mother was a street hawker and sold fruit. The father was out of work. 4. The mother was a bookfolder and returned to work shortly after the birth of the child. The father was a carman out of work. The father cleaned the house, looked after the baby, and took it down to the mother's workshop at meal times so that it might be breast fed. The baby was fat. The house was very clean. 5. The baby was the fifth child, one month old, and the only one living. It was being fed on currant cake although the mother had abundant breast milk. The mother was unable to read or write. The other children had all died under 5 months of age. 6. The baby was five weeks old and the seventh child. It was being washed at 4 p.m., had been breast fed at 9.30 a.m. and had 22 been allowed to sleep until washing time. The mother was very dirty and slovenly. She had only lost one child, She never woke her children to feed them, " the more sleep they gets the longer and healthier they grows," 7. The father was a cloth shrinker out of work. The mother was an artificial flower maker and went out daily at 8.30 a.m., leaving the child entirely alone, unfed and unwashed until 8 p.m. or later. The baby was wasting and vomiting. 8. The mother gave her baby 8 months old breast milk and boiled bread. She would not give it cow's milk or condensed milk because she " knew that two milks would not mix." 9. The baby was 6 weeks old, first born and premature. It was being breast fed and had in addition one feed of oatmeal daily as " the child needed something stronger than breast milk." 10. The baby was 3 weeks old, dirty, thin, wasting, clad in cotton only and had a scabbed head. The mother was a drinker and stated that the baby " had no right to be thin as it took half a pound of patent biscuits every day." 11. The father was a casual labourer. The mother had to wean her baby at 6 weeks in order to go to work to support herself and her two children. She paid the next door neighbour 5s. per week to take care of her children. This neighbour had 6 children of her own and " did what she could for the baby but gave it up because it cried so much and took up too much of her time." It was being fed on diluted cow's milk. The mother kept at her work and found another " nurse.'' The infant wasted and died. 12. The father was in prison. The mother was a rag sorter working from 8 a.m. to 8 p.m. daily. She took her child with her in the morning and left her with " a person near the shop " where she went in several times a day to breast feed it. The mother, baby and three children occupied one room and slept in one bed. 13. The baby was 5 weeks old and the fourth child. Only two were now living. It was breast-fed and slept with its mother. 23 The family lived in one room in the house of the mother's parents The grandmother had had 24 children, of whom 18 had died, so that she considered that she had had " plenty of experience and could give her daughter plenty of good advice about the children's food and things of that sort." Care and Condition of Baby.—Many of the babies when first seen were wasting, improperly or irregularly fed, insufficiently, improperly or too tightly clothed, or occasionally suffered from exposure or neglect. Very few slept throughout in a separate cot, nearly all slept with their parents at night, even though they slept elsewhere during the day time. Much ingenuity is exercised in arranging for the baby's sleep in the daytime, cheap cots are fashioned out of banana crates, orange boxes, galvanised baths or washing coppers padded and lined, clothes baskets, empty compartments of chests of drawers, upturned lids of sanitary dustbins or washing coppers, or discarded old-time perambulators. Some babies were premature and delicate. Others were dirty, flea-savaged and bug-harried. It is a curious commentary upon the social conditions of the borough that some of the filthiest babies may be found in the relatively better placed families in mean streets, while some of the cleanest and bonniest babies may be seen in poverty-stricken tenements and in families who " don't know where the next penny is to come from." Some of the babies were ill, suffering from measles, bronchitis, pneumonia, diarrhoea, thrush, sore eyes, sore navels, sore buttocks, rupture, harelip. Many of the infants are left during the mother's absence in the care of quite young girls, from 10 to 16 years. So many instances of these immature, careless and ill-tutored nurses are discovered that it is well now to realise the significance of the fact and to devise means to deal with the evil which is a growing one. It is 24 very desirable that classes should be held to teach young girls of the ages specified how to take care of infants. With the poor " the little mothers " are common features of every squalid street. It is high time that their education in baby-craft should be seriously undertaken. In the New York slums, this problem is being successfully accomplished. The little mother, that pathetic figure, a girl of 10 or 12 years, deprived of her heritage of childhood, is forced into the hazardous position of foster-mother to each succeeding family baby until she herself becomes a wage-earner or a wife. The New York " Little Mothers' League " teaches these young girls how to wash and clothe baby, the importance of fresh air, the care of the milk and milk bottle, the preparation of barley water, and the hygiene of the home. Illustrative Cases. 1. The family occupied one room. The father was in prison for ill-treating his wife. The mother went out daily to work at 10 a.m. and stayed out all day. The baby, four months old, had bronchitis and was left in the care of a girl 11 years old. It was unwashed at 11.30 a.m., and clothed in a flannelette shirt, one petticoat, and a stiff binder, all filthy. The baby was fed on a patent food by the child of 11, who, at the first visit, was excessively dirty and engaged in scrubbing out the floor. The family had paid no rent for two months. There was another child, 2 years old, ricketty, thin, under-sized and dirty. 2. The family consisted of the father, mother and four children (including the baby) and slept on the stairs of " buildings" whenever and wherever they could as " they had no money to pay deposit for a room." 8. The baby was 3 weeks old and the third child. It was being breast-fed. All the children were living. The father was an odd or casual waiter and earned 14s. per week. The baby and the eldest child had Ophthalmia. The mother was giving them home treatment by pouring cold milk from a beer jug into the eyes of both. 25 4. The father was a bill poster out of work. The family consisted of the parents and three children. They occupied a oneroomed tenement and were being ejected for non-payment of rent. The eldest girl, eight years, was sent to live with her grandmother because they had not sufficient food at home. The girl, four years, was kept at home—" She'll do with a piece of bread and butter." The baby three weeks was small, thin, wasting and clad in cotton. 5. The baby was fat and flourishing, but had thrush. Some neighbours told the mother that crude chimney soot was good for cleaning the teeth. The mother thought, therefore, that it must be equally good for cleaning the tongue, and had rubbed soot roughly and copiously over the child's lips, tongue, and the inside of its mouth so that the child was bleeding from these surfaces. 6. The child was a first baby and had sore raw buttocks affected with eczema, which extended up the back of the baby. The mother changed the napkins very frequently, but washed them in a strong " magic soap." When this washing with soap was stopped the eczema disappeared. 7. The baby was very fat, clothed in cotton, and suffered from bronchitis. It was sitting on the doorstep in the care of a child seven years old. There was a cold keen wind blowing. The mother was in a public house. 8. The baby had bronchitis and was clothed in cotton. The mother did not believe in woollen vests or in '' coddling children." She was convinced that " the rougher the children are brought up the better they get on." 9. The family consisted of the parents and four children, of whom the eldest was three years and the baby three weeks. They occupied one room for living and sleeping. The children were all clothed in cotton shirts and had nothing else on. The mother stated that they " suffered cruel with their chests." The mother stayed in bed for one day only after her confinement and then got up to resume her household work. 26 10. A mother wrapped her baby's legs tightly in a long roller towel to make them grow straight. " If you start young, they will grow quite straight and handsome ; if you leave the legs loose, they will grow sideways and knock-kneed." When the towel was unwound the baby's legs were blue, cold and very much pinched and warped. 11. An Italian baby had bronchitis. It was placed " for warmth " between two feather beds. 12. The mother had twins. One died. The other wasted and got rapidly worse until the mother, on a suggestion of a neighbour, put a large doll in bed with it. From this time the mother averred that it immediately began to improve. " Dolls often cures babies, specially when doctors have no hopes and gives them up. It's a sort of 'fluence or something like that, I think," The father was out of work. He had been " smashed up at a beano." 13. The father was a casual hand at a butchers and earned. lis. weekly. The baby had bronchitis. The family occupied one room only. The mother had completely undressed the child and was washing it in a room without any fire. There was no coal, coke, or firewood in the house. The Mothers.— In the poorer parts of the borough the mother is sometimes the chief or even the only support of the family. She does her household work, and, as soon as possible after her confinement, resumes her usual occupation as a bookfolder, laundry hand, charwoman, office cleaner, ironer, machinist, or making cardboard boxes or artificial flowers. Some are homeworkers and endeavour to continue the work even when lying-in. In one house, the mother grieving at her husband's unemployment and at the gradual pawning of the household goods, obtained work as a machinist. 27 As a consequence, a man who lived in the same house on a higher floor when he knew of this, forced his own wife to go and do likewise. In another house lived a mother with a baby 2 months old. The mother was phthisical. The father was an odd man and earned very little money. The mother stayed at home brooding over her condition. It was suggested to her that she might get her mind off herself, be less introspective if she obtained a little light work to do at home. This course she declined—alleging that " if she once started working—her old man would never let her leave it off again." Some of the mothers were ill, consumptive, overworked and overdone with childbearing. Some were drunken, slatternly and slovenly. Some were extremely clean and tidy—even in the streets like Bastwick Street or Lever Street, where one would least expect it. Some of the mothers made all their children's clothes : some were in receipt of parish relief or obtained free dinners. Many mothers resent very much being advised to enter a poor law institution, even though they may be admost destitute, insufficiently fed and clothed. Illustrative Cases. 1. The father was a casual labourer, ill with phthisis, and had been frequently in the poor law infirmary. The baby was 3 months old. The mother had had 8 children, all save baby had " wasted away." When the home was visited, the mother was clad in a skirt and blouse only. There was no food in the cupboard, there was no coal or coke in the house. The mother was given tickets for free dinners. 2. The baby was 2 months old, fat, but dirty and verminous. The father was a carman in casual employment, and earned from 28 10s. to 12s. weekly. The mother was untidy, and worked at fixing gum on envelopes for 4d. or 5d. per thousand. She earned from 3 to 5 shillings weekly. Her one-roomed tenement was dirty and verminous. 3. The father was a park attendant in casual employment, and earned 4s. per day on two days a week. The baby was 16 days old. The mother was untidy, unwashed, and clothed in a dirty nightdress and overall at 3 p.m. Her clothes were in pawn. She was receiving free dinners. 4. The father was in the workhouse. There were 11 children, of whom 7 still lived. The baby was 8 months old, clean, fat and flourishing. The mother received 5s. 6d. weekly parish relief, and 5s. from her eldest son. She took in washing to support the family, and paid 5s. 9d. weekly rent. Her tenement, in one of the lowest streets in the Borough, was extremely clean and consisted of 2 rooms. The mother explained, " She had always paid her way and did not owe a penny to anybody." 5. The mother was a widow. The father had been dead 3 months. There had been 11 children of whom only 4 now lived. The family occupied 2 rooms rented at 5s. 6d. per week. The mother sublet one room for 2s. per week, and kept the money. She had paid no rent since her husband died. She was a laundry hand, had free dinners, and was allowed 5s. 6d. parish relief in kind. She was very dirty and slovenly. The baby was clad in a dirty cotton gown and flannelette petticoat only. The rooms were verminous. 6. The father was a hair-dresser's assistant. The mother was a feather worker, occupied daily from 8.30 a.m. to 7.30 p.m. A woman called for the baby at 7.30 a.m., minded it while the mother worked and brought it back home daily at 9 p.m. 7. The father was a casual labourer, "Wheeling a truck." He used to make lead capsules, but gave it up because he suffered with the lead " Chronics." He signed a paper agreeing to accept half-pay for 5 months in lieu of compensation. The mother did 29 mangling and got up on the eighth day to resume her work. The rooms and bedding were very dirty. The baby was wasting, The family was ejected from the tenement. The same night they broke into the basement, took in the damp bedding from the back yard and slept there. The neighbours complained that the baby screamed continuously through the night. The case was referred to the National Society for the Prevention of Cruelty to Children. 8. The baby was 3 months, clean and breast fed. The mother was an industrious woman, and when first visited had a black eye. Her husband drank and "hit her about—he paid her shocking." A week later he had given her a second black eye. 9. The father was a porter earning 21s. per week. The baby was 3 weeks old and the eighth child. All of them were living. The eldest child, 14 years, was a servant. The mother earned 5s. per week making fancy leather bags and taking in washing for neighbours. The mother made all the clothes for her children. The family of 9 occupied 3 rooms in one of the worst streets in the borough, and paid 8s. 6d. weekly rent. The home was extremely clean. The children were well dressed. 10. The baby was 2 months old. The father was a labourer. The mother was consumptive and wondered how she could possibly " manage on the small money that father brought her." She resumed her work as an office cleaner for 3 hours daily. The Fathers.—In the poorer parts of the borough, the commonest occupations of the fathers were as follows:— labourers, carmen, porters, and street hawkers. Lowest in che scale were cart-minders, and messengers attached to an outside public-house " Pitch," and organ grinders. Many were out of work — many were only in casual employment. Some were blind, ill, consumptive, youthful, or under-sized. Some were epileptics, some were in the poor law infirmary or workhouse. A few were in prison. In the slums it is not uncommon to find that the fathers contribute little or nothing towards the support of their wives or families. Occasionally a father is found who has not given his wife a 30 single penny since their marriage. Even when the father does wholly or in part support the family, the mother, as often as not, does not know how much he earns or where he works. It will be noted that most of the fathers were general labourers. This term is a generic one : it is the poverty sink of the labour market, and embraces all those who, from illness, misfortune, drink, felony, or vicious habits have gradually sunk into the ranks of loafers, weeds, and "The Unemployed." It is an index, not necessarily of degradation and type of employment, but, in this connection of, great poverty, and connotes a tendency to sink still lower and attain complete loss of recuperative opportunity. It sometimes happens that a mother will state that her husband is a labourer doing casual work. In such cases the neighbours have been known to volunteer the information that the husband has been out of employment for 2 or 3 years and will not work, so that the family is supported entirely by the mother. Illustrative Examples. 1. There were 11 children of whom only 4 now lived. The father was in prison for theft. The mother was in hospital after a difficult and complicated confinement. The baby, 2 weeks old, was at home and being cared for by the two eldest daughters, aged 18 and 16 years respectively. 2. There were 7 children, including a baby, 6 weeks, all living. The mother was ill. The father was a dock labourer out on strike and receiving 10s. a week strike money. They paid 7s. 9d. weekly for rent. The family was being supported by the mother taking in washing. 3. The baby was the first child. The mother was having insufficient food and was losing her breast milk. The father had been out of work for many months. Work was found for him, and he was paid Is. 6d. on the first day he was employed. This he considered too little and struck his foreman. He was locked up for being disorderly. 31 4. The baby was 3 weeks old, the seventh child, fat and breast fed. The father was a porter. The mother was a charwoman. Both were out of work. The family was being supported by the eldest son, a carman, who earned 12s. a week. 5. The baby was 9 weeks old. The mother was in bed because there was no fire, no coal, no coke, no wood, and no food. She said " bed was the best place because there was nothing to get up for." She was given a ticket for free-dinners. The father did odd jobs and earned 7s. a week, of which 3s. 6d. went for rent. 6. The family occupied 2 rooms, and consisted of the parents, girls 15, 11, 9, 4, boys 13, 8, and the baby 11 months. The mother was out all day at work. All the children were excluded from school for scabbed heads and sore faces. The father had done no work for 4 years, and had frequently been in and out of prison during that period. He now railed at the country for not finding him work, and " thought he had better go back to prison." The whole family was supported by the earnings of the mother and eldest daughter. 7. The baby was the fifth child. Four were alive, the eldest had been burnt to death. The father was an organ-grinder and was led out in the evenings by the mother to public-houses. He played outside and was then taken by the mother into the " public bars " to get alms. The mother was taking in washing for neighbours 13 days after her confinement, and doing her household work. 8. The father was an errand boy and earned 10s. per week. The mother was a feather mounter at 7s. per week. The baby was the first child and breast fed. The parents married 9 weeks before the birth of the child and moved into Finsbury so that the mother might have the students to attend to her during her confinement without payment. 9. The father was a French polisher out of work. The mother was a bookfolder, dirty and untidy. She said she did not get enough food to breast-feed the baby. 32 10. The father was a glass-trimmer earning 19s. per week. There were 5 children, including the baby, all living. The home was a two-roomed tenement, extremely clean, and let at 8s. 6d. per week. The occupants comprised the parents, 5 children, the mother's sister, and her illegitimate child—9 persons. Home Circumstances.—In many of the homes there was evidence of poverty — sometimes verging on destitution. Occasionally there was no food, no coke, coal or wood in the house, and even the furniture was being pawned. Some of the mothers in the poorer parts were homeworkers, or took in washing. Many of the tenements were crowded, sometimes occupied by lodgers in addition to the family. Nearly all the parents drank ale, or stout; a few drank to excess. In mean streets, many of the tenements were verminous, but during the last 2 years there has been a marked improvement in this respect. The cleanliness of the tenement and its freedom from vermin depend upon the mother's house-pride and her own activity. Some of the cleanest homes may be seen in the most squalid streets. Illustrative Cases. 1. The baby was seven weeks old, breast-fed and wasting. There were 8 children, of whom 7 were now alive. The father was a fish frier doing odd jobs. The mother was thin, and "half-starved." The furniture was nearly all pawned. The home was very clean. 2. The family consisted of the parents, 4 girls, ranging trom 13 to 3 years, and the baby, 10 months. The family, the mother's mother, and a woman lodger, 8 persons in all, occupied 2 rooms, which were dirty, verminous, and overcrowded. 3. The family consisted of the parents, boys 18, 13, 7, 3, years, and girls 15, 4 years, and a baby 6 months. The father was a casual labourer. The mother was a bottle labeller in regular work, and left the baby daily in a creche. It got ill and was then left at home in charge of the girl of fifteen. 33 4. The parents, 3 children and a baby occupied 2 rooms, but lived and slept in one room, because they had no furniture to put in the other room. The children slept on an uncovered, dilapidated mattress on the floor. The baby died. Its dead body was retained in the living room until its burial. 5. The mother was 34 years old, and had suffered from phthisis for 3 years. The father was a casual porter and earned 12s. to 14s. per week. The family consisted of the parents, 3 boys and 1 girl, aged from 13 years to 3 years, and the baby 11 months. They occupied 2 rooms containing 829, and 703 cubic feet of air space—they were both dirty and verminous. The mother was advised to enter the poor law infirmary, but refused, as she did not wish to wean the baby which had a cough, and was itself presumably becoming consumptive. 6. The father had phthisis, had been ill for 8 years, and was out of work. The mother was wasting and spitting blood. She had had 8 children, of whom 4 were now living, aged 10, 5, 3 years, and one month respectively. Four children had died of tuberculosis. The baby was healthy, and weighed 9 lbs. They occupied 2 rooms—which were both clean, but stuffy. 7. A complaint was received from school that the children suffered from sore faces, sore bodies, and scabbed heads. The tenement was visited and found to consist of one small room, 800 cubic feet, occupied by the parents and 5 children, 8, 7, 6, 3 years, and the baby 9 months. The children were unwashed at mid-day. The windows were shut, the rooms smelt offensively, and were filthy and verminous. The tenement had been completely stripped and cleansed only a few weeks previously before the present occupants became tenants. 8. The father was out of work. The mother was out looking for work. Two twins, each 12 days old, were left at home in the sole charge of a boy 10 years old. One twin died. 9. The tenement consisted of 2 rooms occupied by a woman . and her 5 children, 13, 9, 5 years, 18 months, and 6 weeks 34 respectively, and also by a man and his 4 children, 12, 10, 7 and 4 years old. The man's wife had been certified to be insane, and had been removed to an asylum. The woman's husband was dead, and the two families had joined together. The baby, 6 weeks old, was fathered by the man referred to. One of the children had phthisis, and was eventually admitted to the poor law infirmary. Shortly after, the consolidated families removed and were lost sight of. 10. The baby was 4 months old. The father had been out of work a year and was alleged to be one of those who " would not work." He said he could not work because he had "heart disease." When visited he was smoking a cigarette, taking life easily and minding a small rag and bone shop. For doing this, he said that he had the " privilege " of sleeping in a small, stuffy room leading off from the shop. He paid no rent. When asked if his wife worked, he said "Certainly not." The mother was out. When seen, she was fat and flourishing. The baby was left in charge of the mother's sister. The neighbours volunteered the information that " it was a marvel how these people got their living." Creches.—There are four crèches in Finsbury affording accommodation for 140 children. With one exception they are apparently well managed and satisfactory. The crèche referred to is supervised by a woman with no nursing experience, and was recently inspected. The conditions found were as follows : — The rooms were fairly clean. The floor beds were clean and dry. There were 13 children between the ages of 2 and 11 years awaiting their mid-day meals. There were 3 infants lying in perambulators, one was unwashed, and sucking milk and water through a long unclean tube from a medicine bottle; its clothing was dirty and smelt offensively. The woman in charge did not know how the food was mixed, or in what proportions it was given, but stated that the baby was fed according to its mother's ' directions and "ate anything." 35 A second baby, 9 months, was fat and had indigestion : it was also being fed "according to it's mother's directions." The third baby, 11 months, was thin, flabby, had a cough, and was bodily dirty, and smelt very offensively. Its head was caked with scurf. It was said to be fed on milk and bread and water. The feeding bottle belonging to the crèche had been broken, and no further supply had been requisitioned. The chldren had not been washed that morning.—" they were supposed to be brought to the crèche clean." At a subsequent visit, the conditions were slightly improved, but one of the children was now ill, although a notice exhibited on the door stated that sick children were not received. The milk was stored in an open jug on the mantlepiece in the room in which the children slept. On the general question, the establishment of well-managed and well-organised crèches in the borough would confer an immense boon on those many mothers who now have to return to work soon after child-birth, and would undoubtedly save many infant lives. At the present time such mothers leave their babies in the care of young girls, young boys, their landladies, neighbours, day foster mothers, or "minders" near their workshops. Illustrative Examples— 1. The baby was 4 months old, and the first child. The mother was a bookfolder, and went out to work every morning. The family occupied one room. The baby was locked in this room every morning, and visited from time to time by the father who was out looking for work, but "dropped in about every hour or so to see how the baby was getting on." When the parents were both in work—the baby was left with the landlady. 2. The mother was a trouser presser at work. The father was a salesman out of work. They occupied one room. The baby was left in charge of the landlady during the daylime. 36 3. The baby was dirty and wasting. The mother was a laundry hand in regular employment. The baby was left in charge of the eldest child aged 8 years, and was washed by the mother " the last thing at night." 4. The mother went daily out to work. The baby was placed in a mail cart, and left in the charge of a child, aged 6 years, while the mother was away. The child upset the mail cart and bruised the baby's forehead badly. 5. The baby was the first child, and breast fed. The father was out of work. The mother was insufficiently fed, and losing her breast milk. She now proposed to " put the baby on the bottle," and look for work, as she could not go on much longer as she was placed,—" no money coming in, and the rent to pay just the same." However, she was prevented from seeking work because she had no one to mind the baby during her absence. She was given tickets for free dinners. 6. The mother was 18 years old, and an artificial flower maker. The baby was illegitimate and left in the charge of its aunt daily : it slept in the padded wicker cover of a fruit basket. 7. The baby was 10 weeks old. The mother went out to work daily as a box-maker. The father was out of work. The baby was left with the landlady, who fed it on one patent biscuit until the mother's return. 8. The father was a porter out of work. The baby was one month old. The mother had resumed her work as a ironer. She came home daily at mid-day to suckle the baby, who was left for the rest of the day in the care of its grandmother, 71 years old. 9. The mother resumed her work in the third week after her confinement. The baby was the eleventh child; only eight now lived. It was left in charge of a girl 14 years old, very dirty and careless, who fed the child on cow's milk and barley water from a very dirty bottle. 37 10. The mother was a charwoman and office cleaner, and went out to her work daily. The father was also in work. The baby was 9 months old, and left in the care of a very dirty girl, aged 16 years, who fed it on a pint of milk, currant cake, seed cake and " pieces." 11. The mother had had 11 children, eight of whom had died under one year of age. The mother had been a bookfolder before marriage, and during the whole of her married life had resumed her work when the children were 4 weeks old. At this age, they were always given into the care of a neighbour. 12. The baby was 17 day's old, and left in charge of its grandmother, who had to go out to work. The mother was out at work. Consequently the child was being left at home unattended. 13. The family consisted of the parents, girls, 16, 9, and boys, 12, 6 and 4 years. They occupied two top rooms, which were very dirty when visited by the Public Health Staff. The woman took in an illegitimate nurse-child 8 months old for 4s. per week At the time this was their only source of income. The child died of diarrhoea. The woman was not registered with the London County Council. The husband had been out of work for 11 weeks. The foregoing examples show the grevious difficulties under which the mothers of recently born babies labour when they return to work, and indicate further the pressing need there is for the establishment in various parts of the Borough of wellconducted, well-placed creches or public nurseries. Weighing Centres.—There are four weighing centres in the Borough, held in the afternoon at 2.30 p.m., at the following times and places. Wednesday: The Branch Library, Penton Street. Thursday : The Mothers' Guild, 65, St. John Street. Thursday : St. Luke's Institute, Radnor Street. Friday : The Committee Room, The Town Hall. 38 The weighing centre at 65, St. John Street, is supervised and controlled by the Peel Mission of the Society of Friends. A summary of the work done is appended :— Centre. No. of Meetings. Attendances. Average Attendance. No. of Children. Penton Street 47 909 19 138 Radnor Street 48 1,053 21 141 Town Hall 46 1,076 23 183 Totals 141 3,038 21 462 The largest average attendance, and largest number of children both belong to the Town Hall Centre. The smaller attendance at the Penton Street Centre is probably due to the fact that many of the mothers prefer to attend the weighings held at the Dinner Centre at 26, Cumming Street, and in this way achieve a standing for the daily purchase of cheap dinners for a payment which barely covers the cost of the food alone. Condition when first brought to the weighing centres. Centre. Fat, Plump. Thin. Wasting. Penton Street 114 19 5 Radnor Street 93 27 21 Town Hall 130 35 18 Totals 337 81 44 Most of the children are brought between the ages of one and three months. The above table shows that between these ages 17.5 per cent, of the babies were markedly thin, and in addition a further 9.5 per cent, were already definitely wasting. 39 Feeding.— The feeding of the infants when first attending the centres is annexed in tabular form: Centre. Wholly breast fed. Partially breast fed. Not breast fed. Penton Street 104 7 27 Radnor Street 93 15 33 Town Hall 107 11 65 Totals 304 33 125 The children breast fed are nearly twice as many as those not breast fed. Many of the children when first brought were ascertained to be fed chiefly on boiled bread, or biscuits. Work and Status of Parents.—These are included to exhibit the social status and character of the parents who resort to the weighing centres. The occupations show that the fathers are mainly of the working class, and chiefly General Labourers, Carmen, Porters, Packers and Warehousemen. These occupations were as follows:— General Labourers (83), Carmen (49), Porters (47), Packers (19), Warehousemen (15), Painters (9), Clerks (8), Printers (7), Metal Polishers (6), Window Cleaners (9), Liftmen (6), Shop Assistants (6), Asphalters (4), Cabinet Makers (4), Cabmen (4), Chauffeurs (4), Cloth Workers (4), French Polishers (4), Goods Checkers (4), Horse Keepers (4), Engineers (3), General Dealers (3), Bacon Dryers (3), Stokers (3), Leather Cutters (3), Milkmen (3), Bookbinders, Butcher's Assistants, Carpenters, Cellermen, Cooks, Coalheavers, Cocoa Roasters, Engine Drivers, Furriers, Gasfitters, Gilders, Glass Workers, Glassbevellers, Ironworkers, Innkeepers, Jewellers' Assistants, Masons, Mosaic Workers, Newsvendors, Organ Grinders, Paper Cutters, Policemen, Sawyers, Silversmiths, Soldiers, Skin Sorters, Tinplate Workers, Waiters, Walkingstick Makers, Wood Carvers, Wood Turners (2 each), Baker, Bat Maker, Bill Poster, Brass Worker, Bricklayer, Basket Maker, Box Cutter, Cab Tout, Canvasser, Caretaker, Card Gilder, Conductor, Clock Case 40 Maker, Cobbler, Commercial Traveller, Copper Smith, Electric Light Wiring Hand, Engineer, Enameller, Electroplater, Fireman, Fitter, Fish Frier, Hat Maker, Hair Dresser, Iron Trimmer, Jam Maker, Jewel Case Maker, Lamp Cleaner, Lamplighter, Machine Hand, Machine Ruler, Motor Fitter, Portmanteau Maker, Postman, Plate Cleaner, Sadler, Sailor, Shunter, Skin Dyer, Shutter Fixer, Silver Refiner, Sculptor, Solderer, Tailors' Cutter, Teacher, Telephone Fixer, Typefounder, Thermometer Maker, Watchman, Watchmaker, Washer, Window Blind Maker, Wigmaker (1 each). Ten per cent, of the parents had been out of work for some considerable time, 16 per cent, were in casual employment, "doing odd jobs." Many of those who are in regular employment have perforce to live in a hand to mouth manner. Their wages are small, and their rents are, from a wages standpoint, comparatively high. And in Finsbury the economic and labour problem is at bed rock bottom the most serious difficulty in connection with the saving of infant lives. The prevention of infantile mortality is, in Finsbury, the vention or alleviation of poverty. The key to the situation lies in the hands of the mother. If the mother has to work to support the family, or to supplement the earnings of an idle, dissolute husband, the baby is robbed of its natural sustenance, and is left daily in charge, it may be, of a careless, reckless and dirty nurse; its nutrition suffers, it wastes, it becomes ill and dies. And it should be obvious that a sanitary survey of the premises will not procure breast feeds for the infants; an increased number of visits will not constrain the husband to work or relieve the mother of the unequal task of maintaining the household. The remedies are not tempered to the disease. The founding of dinner centres would, however, allow the mother to continue to breast feed her baby for a longer period, and thus give it a firmer start; the establishment of creches, would enable the child to be cleanly fed, and well supervised when the time came for the mother to resume her employment. 41 These latter measures, however, are only palliative and alleviatory—they are not essentially preventative. They partake of the nature of relief—and this, to some minds is almost the same as anathema. It is just as well, nevertheless, to confront the actual facts and to take these suggestions into serious consideration. Their realisation might well be undertaken by voluntary or charitable organisations interested in the Borough. The work of the weighing centres is not restricted merely to weighing the children and entering the results on cards. The mother's diet and the child's feeding are inquired into very carefully, and appropriate advice is given. Babies and mothers who are ill are referred to various hospitals, or out-patient letters are given for dispensary treatment. It must be noted, however, that it is quite rare to find an ailing mother or child at the weighing centres who is not already under medical supervision. The large number of general and special hospitals, of dispensaries, and of nursing institutions in and near the Borough, make it an easy matter for any mother to obtain prompt medical treatment for herself and child. The necessity of securing the personal attendance of a doctor at each meeting of the weighing centres does, therefore, not apply with the same cogency in Finsbury as it applies in other less favoured districts. On each occasion the mothers are encouraged to ask questions, and short lectures are given on appropriate subjects. Model clothes suitable for the babies of poor parents, are shown to the mothers, and their advantages demonstrated. The mothers are shown how to cut out and make the garments. Typewritten directions for the knitting of woollen vests are given gratis. Tubeless feeding bottles, and special teats are sold at cost price to those who can pay, but are given free of charge to poor mothers. 42 In addition the Department supplies "Finsbury Cream," a special form of fat food to wasting and debilitated children. Expectant mothers come for help and advice. The homes of all the attending mothers are visited. Some look clean and tidy when they come to the weighing centre—but a visit to their homes may discover that they are domestically filthy and negligent, devoid of all house pride, living in foul and verminous tenements. Pertinent statements made as to the causes of their ailments or poverty are enquired into. To give an actual example:— A mother came to a weighing centre, and said she was "starving." Her home was visited. It was a one-roomed tenement rented at 3s. weekly, and occupied by the mother, grandmother, the mother's brother, 30 years, a girl 5 years, and the baby 5 weeks. The baby was illegitimate. Its father was the landlord of the house. There was a large and abundant meal of Irish stew on the table. The grandmother stated she had not got the old age pension. The neighbours asserted she obtained her old age pension every week and "got blind drunk on it every time." Very few of the mothers attend regularly. Some bring their babies when they are out of sorts, but stop coming if the babies begin to improve. Some again come as long as their husbands are in work, but when their husbands are unemployed, have themselves to go to work. Occasionally the mother ceases to attend because she has "no ha'pence, and does not like to come without," or because her boots and clothes are in pawn. In a few instances the mother has not brought the baby because she has been told that "it is unlucky to have the baby weighed until it is over a year old." 43 The staff—the Lady Sanitary Inspector and the Lady Health Visitors—are on the best of terms with the mothers, many of whom come at first on the recommendation of their neighbours. To sum up, the weighing centres are doing good work unobtrusively and effectively. Their influence is not confined to the mothers and children who attend. The instruction imparted at the centres survives for the benefit of later children and for the advantage of other mothers who are unable to come. PUERPERAL FEVER. This disease is compulsorily notifiable by Section 55 of the Public Health (London) Act, 1891. In 1912, there were 12 notifications and 4 deaths. The statistics for previous years are appended:— Puerperal Fever. Years. 1901-5 1906-10 1911 1912 Totals. Notifications 30 27 4 12 73 Deaths 18 17 3 4 42 This year, the number of notifications is the highest since the formation of the borough. The twelve cases in the present year were attended, eight by medical students from St. Bartholomew's Hospital, one by a lady midwifery student, one by a certified midwife, and two by private doctors. The associated causes and conditions were said to be prolonged or difficult labour causing injury to the parts (5), contracted pelvis (1), previous disease one case. In 5 instances no cause was ascertained; these were possibly cases where there had been want of care or cleanliness by the persons in attendance. The notification of puerperal fever is, at present, in a very unsettled and unsatisfactory condition. 44 A definition of the disease is much to be desired. Is the term to include cases of puerperal sapraemia, of raised temperature occurring during the puerperium presumably due to infection of the uterus and genital passages, and conditioned by such infection, or is the term to be confined to cases of undoubted puerperal septicaemia ? At one large hospital, 10 cubic centimetres of blood are taken from the basilic vein in suspected cases, and a culture made upon a suitable medium. If the culture proves positive, the case is notified as one of puerperal fever. If no growth results, the case is not notified. Under such circumstances, while waiting to learn the result of the culture it is possible for a student who has been attending the original case to infect a second case. This method has additional grave drawbacks. An example will make this clear. A culture made during the life time of a patient disclosed no growth. After death, however, the womb was found in a diseased condition, there was long standing heart disease and a streptococcus was isolated from the blood. Although the case had not been notified as one of puerperal fever, yet it was signed up as such on the death certificate. It is obvious that the test by culture as a necessary antecedent to notification is out of the question in private medical practice. There is ground for the belief that some medical men notify cases of puerperal fever only when the patient is seriously ill or likely to die, for it must be remembered that a case of puerperal fever is usually regarded as reflecting discreditably upon the cleanliness and care exercised by the doctor during a confinement. The Public Health Department is concerned with the preven2 tion of disease—its policy therefore is to include under any specific disease term, borderland cases, and any cases which may be confused with such specific disease, or offer difficulties in diagnosis. A familiar example of this policy is seen in the extension of notification to chicken pox during times of small pox epidemics. 45 From this standpoint puerperal sapraemia might be notified as puerperal fever, and often with advantage, especially where students are concerned. The term puerperal fever has long been removed from the official nomenclature of diseases of the Royal College of Physicians as vague and unnecessary. Unfortunately, it still lingers in the Public Health (London) Act, 1891. In the manual of the International List of Causes of Death, issued by the Registrar General, puerperal fever includes 30 distinct headings—puerperal pyrexia, puerperal sepsis, puerperal sapraemia, puerperal lymphangitis, puerperal parametritis and others. These examples show the unsatisfactory nature of the present circumstances, and indicate that the time is ripe for a clear definition of what is meant by puerperal fever. Meantime, those cases should certainly be notified— 1. Where the clinical symptoms suggest that the patient is possibly suffering from septicaemia, whether the blood culture is positive or negative. 2. Where there is infection of the uterus or genital passages rendering it possible that anyone in attendance may be a source of danger to other lying-in women. In Finsbury, every case is investigated by the Lady Sanitary Inspector. The premises are visited, the sanitary defects ascertained, and made the subject of subsequent notice for amendment, and the rooms are disinfected. OPHTHALMIA NEONATORUM. This is the inflammation of the eyes which is apt to occur in the newly-born, and is often associated with the presence of venereal disease in the mother. Seven cases were notified in 1912. These were all visited by the Lady Sanitary Inspector, who instructed the mothers how to carry out the treatment advised by the doctors. 46 The Borough Council supplies drop tubes gratis for this purpose; these have been found most useful. Formerly, before these tubes were provided, some of the mothers were found to be merely bathing the outside of the closed eyelids. Now, the eyelids are separated, and, by the drop tubes, the lotion is applied directly to the eyeball itself. DEATHS AND DEATH RATES. The number of Finsbury residents who died in 1912 was 1,599, equivalent to a crude death rate for the whole Borough of 18.5 per 1,000 inhabitants living. The crude death rate for the whole of London was 13.6 per 1,000, the corrected death rate 14.3 per 1,000. The Finsbury crude death rate for previous years are given in the attached table:— CRUDE DEATH RATES. Year. The Borough. Clerkenwell. St. Luke. St. Sepulchre. 1901 21.4 20.1 23.5 19.1 1902 22.8 21.8 24.7 21.3 1903 20.2 19.0 22.3 19.7 1904 21.4 20.6 22.8 24.0 1905 19.3 18.1 21.1 26.3 1906 21.4 21.1 21.5 26.1 1907 19.1 17.3 21.8 26.6 1908 19.2 18.7 20.6 11.1 1909 20.1 19.1 21.6 24.0 1910 18.4 17.7 19.6 17.3 1911 19.4 19.3 19.45 11.7 1912 18.5 18.0 19.1 28.3 The death rates in St. Luke are generally higher, and in Clerkenwell generally lower than the rates for the whole of the 47 Borough. With one or two slight exceptions the death rate in St. Luke tends to show a steady and progressive diminution, whereas the Clerkenwell death rates are rather uneven from year to year, This difference between the two districts is possibly to be associated with the fact that the population in St. Luke is, as compared with Clerkenwell, believed to be more stable, less migratory. The factor for age correction derived from the recent census is -9887. This factor enables one district to be compared with another, and smooths down the irregularities which depend upon differences in the ages and sexes of the populations of the different areas. Multiplying this number by 18.5, the crude death rate, gives a corrected death rate of 18.3 per 1,000. There is, however, still another correction to be made in the case of Finsbury due to the number of residents detained in institutions outside the Borough. When these are taken into account the crude death rate becomes 18.1 per 1,000. This, multiplied by the factor 9887 gives a fully corrected death rate of 17.8 per 1,000. The comparison of Finsbury with the rest of the country may be seen below :— Corrected Death Rates for 1912. England and Wales 13.3 London 14.3 Finsbury 18.3 95 Great Towns 14.6 146 Smaller Towns 13.0 Rural Districts 12.1 The Finsbury deaths were apportioned as follows:— Clerkenwell, 1,009; St. Luke's, 552; St. Sepulchre 38 deaths. 48 The death rates of the Metropolitan Boroughs are subjoined. Death Rates, 1912. Battersea 12.2 Kensington 13.3 Bermondsey 16.8 Lewisham 10.5 Bethnal Green 15.5 City of London 9.5 Camberwell 12.7 Paddington 13.27 Chelsea 14.8 Poplar 16.41 Deptford 13.2 St. Marylebone 14.8 Finsbury 18.5 St. Pancras 14.3 Fulham 13.0 Shoreditch 19.2 Greenwich 13.2 Southwark 16.8 Hackney 12.2 Stepney 15.3 Hammersmith 13.0 Stoke Newington 11.6 Hampstead 10.0 Wandsworth 11.03 Holborn 14.9 Westminster 12.5 Lambeth 13.2 Woolwich 11.5 Islington 14.34 The deaths of residents in public institutions were:— In general hospitals, 217 (238); in special hospitals, 36 (34); in fever hospitals, 54 (50); in poor law institutions, 486 (558); in asylums, 52 (44); in various hospitals, homes of rest and homes for babies, 28 (22). The figures in brackets are the corresponding numbers for the previous year. It will be noted that 486—that is, 30 per cent.—of the whole number of deaths occurred in poor law workhouses and poor law infirmaries. The following table gives the numbers of deaths of Finsbury residents that have occurred in public institutions for the last 10 years:— 49 Deaths in Public Institutions. Year. Total Deaths. Deaths in Public Institutions of Finsbury Residents. Percentage. 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 I,8l4 988 54.4 1910 1,636 889 54.3 1911 1.697 946 55.7 1912 1,599 873 54.6 The death rate of Finsbury is loaded with the deaths of 4 distinct classes which should possibly be accredited elsewhere:— 1. The deaths of those who are definitely ill when they arrive in the Borough, and who die of their diseases shortly after. These are attracted to the district by its facilities for obtaining cheap food, cheap lodging, medical treatment for nothing, and by the knowledge that when they finally come under the poor law they will be received into the infirmary of their choice. Many consumptives state definitely on enquiry that the chief reason why they have come into the Borough is that when "they break down in health they can go into the Highgate Infirmary; they have tried the lot, and prefer the one for Finsbury." They get cheap dinners at the Alexandra Trust, medical treatment for nothing at the very many hospitals and dispensaries in and near the Borough, and cheap accommodation in the slums, or they sleep at night on the stairs of the "model buildings" free of 50 charge. Some have asserted that Finsbury is the only borough where they can rent a room "without giving a reference." 2. The deaths of old people in almshouses and annuitants, who come into the Borough late in life. 3. The deaths of the homeless and of those who have never lived in the Borough, but have given a Finsbury address in order to achieve a fictitious and plausible Finsbury settlement. 4. The deaths of nurse children and of illegitimate children whose mothers live in other districts. These children are placed in Finsbury with unregistered foster mothers who adopt them for a very small sum, which is thoroughly insufficient to pay for feeding and clothing the babies properly. It must be remembered that there are in Finsbury many philanthropic and charitable associations, missions and settlements which not only relieve the needy but also bring them into the district. To every action there is a reaction equal and opposite. In the foregoing paragraphs are some of the reactions, incidental to the establishment of humane and charitable undertakings, reactions which are common knowledge and familiar enough to public health officers, but which appear to be overlooked by those genuinely kind and generous people whose object is to relieve want and to succour distress. In the interests of the poor themselves and to prevent the crowding and consequent ill-health which now occurs in boroughs, the transference of the sites of benevolent ventures to rural or to sub-rural districts would appear to be desirable. An Act is wanted on the statute book to systematize and codify voluntary philanthropic endeavour—an Act for benevolence and philanthropy planning, to promote the ruralisation of charitable effort. In addition to the foregoing factors which influence the Finsbury death rates, there are two others which deserve passing notice. 51 There is a ready market for unskilled labour in the Borough. The general or casual labourer is much in demand. The central Metropolitan Boroughs offer opportunities for becoming submerged. Men arrive, change their names, lose their identity and make fresh starts in life. Instances of both of these are from time to time brought to the knowledge of the Public Health staff—instances of persons at one time well off, but n jw out of work, almost penniless, exhausted in mind and body, released from prison or exposed to hardships, who have come into Finsbury for one or other of the reasons given. They are ill when they come. Some few stand up bravely to fate and re-establish themselves. Others succumb and their deaths are counted as Finsbury deaths. Inquests.—During the past year 201 inquests were held in the Borough, of which four were on the bodies of non-residents who died suddenly to the district. Sixty-two were on children under 5 years of age, 139 on adults and children over 5 years of age. Amongst the causes of death were the following:— Accidental falls, 26, Burns and Scalds, 12 ; run over by taxicabs and motor buses, 7; run over by cabs and horsed vans, 8; overlain in bed by parents, 11 deaths. Deaths from Destitution and Exposure.—There were 3 deaths in the district which were accelerated by want of food and destitution. One was a baby, one was a male adult, one was a widow. The baby died at home of Pneumonia in a state of semistarvation. The male died in the workhouse of phthisis. The widow died at home of heart disease. INFANT MORTALITY. The infant mortality of any district for any stated year means the number of deaths of children under one year per 1,000 births. 52 The corrected number of births of Finsbury children for 1912 is 2,579. In the same year 290 children died under one year of age and belonging to the Borough. The infant mortality is obtained by multiplying the number of deaths under one year, 290, by 1,000, and dividing the result by the number of births, 2,579, for that year. The infant mortality of the Borough for 1912 is 112; expressed in popular manner, this means that out of every 1,000 children born during the year 112 died before reaching their first birthday. The corresponding figures for previous years are annexed:— Infant Mortality, 1901=1912. Year. Corrected Births. Corrected Deaths. Infant 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 1910 2,813 342 121 1911 2,676 411 154 1912 2,579 290 112 This year, the number of infant deaths and the infant mortality are both smaller than they have ever been before. This result is in part to be accredited to the extremely mild summer of 1912. 58 The following table compares Finsbury with London and England and Wales generally:— Infant Mortality for 1912. England and Wales 95 Whole of London 90 Finsbury 112 95 Great Towns 101 146 Smaller Towns 98 Essentially Rural Districts 86 The infant mortality of Finsbury is 24 per cent, greater than the figures for the whole of London, and 11 per cent, more than the mortality prevailing in the 95 great towns The rates for the Metropolitan Boroughs are appended below:— Infant Mortality, 1912. Battersea 83 Lambeth 73 Bermondsey 114 Lewisham 69 Bethnal Green 96 City of London 26 Camberwell 83 Paddington 98 Chelsea 70 Poplar 112 Deptford 89 St. Marylebone 93 Finsbury 112 St Pancras 88 Fulham 94 Sboreditch 125 Greenwich 84 Southwark 105 Hackney 80 Stepney 110 Hammersmith 91 Stoke Newington 70 Holborn 78 Wandsworth 76 Hampstead 64 Westminster 83 Islington 86 Woolwich 73 Kensington 92 The infant deaths for the last 4 years, distributed by streets, are subjoined:— 54 Affleck Street 3 Charterhouse, The 1 Albert Street 15 Church Row 3 Albion Place 3 City Road 8 Allen Street 3 Claremont Mews 2 Amias Place 14 Claremont Square 4 Amwell Street 3 Clerkenwell Close 4 Arlington Street 6 Clerkenwell Green 1 Attneave Street 4 Clerkenwell Road 2 Aylesbury Street 3 Cobden Buildings 2 Baird Street 1 Coldbath Buildings 4 Baker's Row 13 Coldbath Square 14 Baker Street 1 Collier Street 7 Baldwin Street 21 {Compton Buildings 8 Baltic Street 2 { Compton Passage 2 Banner Street 2 {Compton Street 7 Barnsbury Road 1 Corporation Buildings 8 Baron Street 2 Corporation Row 2 Bartholomew Square 5 Costers Dwellings 4 Bastwick Street 19 Cottage Lane 1 Bath Buildings 1 Cow Cross Street 4 Bath Court 1 Crawford Passage 5 Bath Street 1 Cumming Street 17 Beckford Square 5 Cynthia Street 2 Benjamin Street 2 Cyrus Street 10 {Berkley Court 6 {Dingley Place 1 {Berkley Street 6 {Dingley Road 9 Bond Street 3 Domingo Street 1 Bowling Green Lane 3 Donegal Street 15 Brewer Street 7 Donegal Street Buildings 6 Brewer Street North 1 Douglas Place 3 Brunswick Close 6 Dufferin Street 7 Busaco Street 5 Dundee Buildings 2 Buxton Houses 3 Eagle Court 1 Buxton Street 6 Eagle Dwellings 3 Castle Street 1 East Place 1 Cavendish Buildings 3 {Easton Place 1 Central Street 8 {Easton Street 17 Chadworth Buildings 8 Elizabeth Place 1 Chapel Place 1 Errol Street 1 Chapel Row 2 Europa Place 3 Chapel Street 5 {Farringdon Road 7 Charlotte Place 1 {Farringdon Road Buildings 8 Charterhouse Square 1 Faulkner's Alley 1 Charterhouse Street 1 Fernsbury Street 3 55 Field Place 2 Leonard Street 1 Fletcher's Row 2 Lever Buildings 1 Francis Court 2 Lever Street 27 Frederick Row 1 Leverington Street 5 Fryes Buildings 1 Lewins Court 1 Galway Street 17 Little Northampton Street 4 Gastigny Place 1 Little Sutton Street 11 Gee Street 19 Lizard Street 8 Gloucester Street 6 Lloyd's Row 3 Godson Street 4 Lock's Gardens 1 Golden Lane 1 Ludlow Street 2 Goode Street 1 Macclesfield Place 2 {Goswell Road 10 Macclesfield Street 9 {Goswell Terrace 5 Malta Street 6 Graham Street 1 Margaret Place 1 Granville Square 3 Margaret Street 22 Great Bath Street 6 Market Buildings 4 Great Percy Street 7 Mason's Place 3 Great Sutton Street 1 Medcalf Place 1 Grimaldi Street 1 Memel Street 2 Guest Street 1 Meredith Street 9 Guinness' Buildings 27 Merlin's Place 3 Hall Street 2 Mitchell Street 9 Halletts Place 1 Mitre Court 2 Hardwick Street 2 Moreland Street 7 Hatfield Street 13 Muriel Street 1 Hay wards Place 2 Murton Street 5 Helmet Row 3 Myddelton Square 2 Henry Street 1 Myddelton Street 13 Hermes Hill 1 Mylne Street 1 Hermes Street 12 Nelson Place 1 Holford Square 3 Nelson Street 1 Howard's Place 7 New Buildings 2 Ironmonger Row 7 New Street 4 Ironmonger Street 7 New Charles Street 1 James Gardens 4 Nichol's Buildings 1 Jay's Buildings 5 Noble Street 10 Jerusalem Passage 1 Norman Street 2 King Square 2 Norman's Buildings 7 King's Cross Road 18 Northampton Buildings 27 Langton Avenue 1 Northampton Road 13 Langton Street 3 Northampton Row 1 Leage Street 7 Northampton Square 1 Leicester Place 4 Northampton Street 13 56 Norway Street 1 Rosoman Street 5 Old Street 3 Rydon Crescent 1 Owen's Row 1 Sadler Street 4 Parr's Place 5 St. Bart'suildings 35 Paton Street 2 St. Clement's Buildings 5 Peabody Buildings, Dufferin Street 6 St. Helena Street 16 St. James's Street 5 Peabody Buildings, Guest Street 2 St. James' Walk 3 St. John Street 12 Peabody Buildings, Roscoe Street 9 Salisbury Buildings 1 Scotswood Street 1 Peabody Buildings, Farringdon Road 5 Seabrook Place 1 Sekforde Street 6 Peartree Street 2 Seymour Place 3 1 Peerless Buildings 2 Sidney Grove 3 i Peerless Street 8 Sidney Place 2 1 Penton Place 5 Sidney Street 2 Penton Residences 2 Skinner Street 2 | Penton Street 13 Smith Street 7 Pentonville Road 14 Smithfield Buildings 3 Percival Street 8 Southampton Street 21 Percy Circus 1 Southern Street 1 Pickard Street 3 Spencer Street 2 . Pine Street 4 Tysoe Street 4 Pollard Houses 1 Upper Charles Street 4 Powell Street 10 Upper Smith Street 1 President Street 10 Upper Vernon Street 2 Pump Court 2 Valetta Street 1 Radnor Street 15 Vernon Square 2 Radsworth Street 2 Victoria Dwellings 10 Rahere Street 17 Vineyard Gardens 3 Rawstorne Buildings 1 Vineyard Walk 12 Rawstorne Street 6 Warner Street 4 Red Lion Street 6 Warren Street 19 Richard Street 2 Waterloo Street 9 Richmond Street 4 Wenlake Buildings 1 Risinghill Street 25 West Place 2 Robert's Place 1 Weston Street 1 Rodney Place 2 Wharf Road 2 { Rodney Residences 2 Wharton Street 6 { Rodney Street 14 Whiskin Street 10 Roscoe Street 9 White Conduit Street 5 Rosebery Avenue 5 Whitecross Street 5 Rosoman Mew 1 White Horse Alley 1 57 White Lion Street 19 Winton Houses 1 Wilmington Place 5 Wynford Road 9 Wilmington Square 11 Wynyatt Street 5 Winchester Cottages I Yardley Street 2 Winchester Street 6 Young's Buildings 8 The deaths of infants allocated to the various diseases are given in the following table, which contains the records for the last six years :— Infant Deaths, 1907-12. 1912. 1907-11. Totals. M easles 29 79 108 Diphtheria 4 8 12 Scarlet Fever 1 1 2 Hooping Cough 16 66 82 Gastritis — 4 4 Diarrhoea 8 257 265 Enteritis 26 84 110 Premature Birth 46 335 381 Congenital Defects 4 43 47 Marasmus 29 223 252 Tuberculous Meningitis 4 31 35 Other Tuberculous Diseases 6 29 3 Erysipelas 1 4 5 Syphilis 10 36 46 Convulsions 15 50 65 Bronchitis 16 117 133 Pneumonia 39 247 286 Overlain in bed 11 103 114 Other Causes 25 170 195 Totals 290 1,887 2,177 58 This year, there is an increased number of deaths due to the commoner infectious diseases, to syphilis, convulsions, a diminished number due to diarrhoea, enteritis, premature birth, marasmus, and overlying in bed. Whether these deaths or any of them, and if so which, are preventable by public health measures is a matter of supreme importance, and will now be briefly considered. Premature Birth.—It will be noted in the above table that more deaths are due to premature birth than to any other one cause—381 deaths in 6 years. Most of these deaths occur during the first week of life, and nearly all of them during the first month. That is to say, these deaths occur while the mother and child are still in the hands of the doctor, and before the Council's Lady Health Visitors have visited the babies. There is very little doubt that these cases of premature birth are really the result of studied and deliberate action. Some of the mothers concerned have admitted this. They frankly confess that they cannot afford to bear and rear more children,—their straightened resources, their poverty, their struggles for a livelihood will not allow it. They cannot endure the double load of child bearing and of supporting the family, necessitated by the fathers' unemployment, or by the casual nature of his work. Illustrative Cases. — 1. The father was a casual labourer. The mother was a packer and accustomed to lift heavy boxes. As a result she strained herself excessively at her work, and was prematurely confined. The mother was kept in bed for a week. The baby died. The mother expressed her satisfaction at the death of her child, and stated she would now be able to return to work. 2. A mother had had two sets of twins, and became pregnant again. She took 28 widely advertised aperient pills and a large dose of Epsom salts, and in this way wilfully produced a miscarriage. Her husband worked for a borough council under an alias. 59 3. A mother had been in the habit of taking 6 aperient pills once a week to induce a mis-carriage. She was prematurely confined. 4. An expectant mother was prematurely confined. This she attributed to being kicked in the stomach by a foreigner with whom she argued about the Insurance Act. The neighbours, however, asserted that "her husband paid her—he done it apurpose." It is difficult to see how these deaths may be prevented by public health measures in the face of the opposition and determination of the parents. The common causes of premature birth apart from its wilful procuring are working in lead works, syphilis, accidental falls or blows, muscular strain, diseases or malformations of the womb, and deformities of the hip bones and adjoining bones. In 1911 and part of 1912, a serious attempt was made to deal with these deaths. For this purpose a lady health visitor was deputed to visit St. Bartholomews Hospital every Thursday, when the maternity letters were given out, and by this means to get into touch with the expectant mothers and learn the histories of their previous confinements. Those who had been prematurely confined on previous occasions were visited at home and given appropriate advice. In one instance there was a history of lead poisoning, in a few cases histories of syphilis. In most cases there was no obvious cause : the births were prematurely induced wilfully and of set purpose. All this preventive work, however, was practically rendered of little or of no avail for the following reasons:— (a) The mothers removed and were lost sight of. (b) Even when the mothers alleged that they were anxious to have living children, they were unable to follow the instructions given, because they could not afford to give up their employment to obtain the necessary rest in bed and medical treatment. 60 It is very deplorable that this, the largest group of infant deaths should be, at present, unrelieved by public health methods. However, the reason is obvious. The cause of the evil is a social and an economic one. The remedy must be adjusted to this end. Public health measures are practically useless. Congenital Defects.—It is probable that some of these deaths are really cases of premature birth, and the foregoing considerations would then apply with equal force. Others may possibly be prevented by the mothers resting for some weeks before their confinements. To advise rest, however, for these mothers is too often to prescribe the impossible. They cannot leave their employment. They cannot afford to pay a substitute to do the household cleaning. These deaths are not " public health deaths." Marasmus.—This is a very loose term and means that the exact cause of death was ill defined, but the baby wasted for some time before its end. That is, the wasting was a marked feature of the child's illness. Some of these deaths are probably due to syphilis—a few to tuberculosis. Excluding these two sets, the other babies are often frail and puny from birth ; however well they are ted, however well they are clothed, they do not thrive, and slowly but surely degenerate into the "wasters" so common in childrens' hospitals. The fault is in the original stock whence they are sprung—the material is of very poor quality and faulty. The organs of the body are apparently incapable of performing the work of food assimilation attendant upon growth and development. These are the babies born of weak, flaccid overworked mothers, devoid of tone, and with little or no energy and reserve power. If these mothers, before confinement, were better fed, and less worked, the babies when born would start life with more grit, more stamina, more staying power, more highly developed and 61 competent glands, organs, muscles and body juices. The prevention of these deaths is almost entirely a question of relief. Pneumonia and Bronchitis.— In six years these diseases caused 419 deaths, in 1912, 55 deaths. These deaths in Finsbury are nearly always due to exposure caused by insufficient clothing, by improper cotton clothing, or by carelessness. The first two causes are often associated with poverty, the third cause with the mother's absence while working, shopping, or drinking. It is quite common in mean streets to see the baby on the doorstep, clad in little or no clothing, left in the care of a girl from 10 to 14 years, while the mother is from home. The establishment of a centre where cheap clothes can be obtained for poor mothers and their babies would be of great benefit in this connection. The institution of schools for little nurses would doubtless be also of much advantage. Sometimes when the mother goes drinking she takes the baby with her, and leaves it at the door of the public-house by itself in a cheap mail-cart, or watched by a child. Excluding the cases associated with drink, the rest would appear in the main to be instances calling for relief from a "clothing centre" or from a "dinner centre," and calling too for the awakening of an acute personal responsibility in the parents. The Borough Council officials supply woollen vests for babies at cost price to those who can pay, gratis to poor mothers. The acute cases are either sent to institutions or nursed at home. Nurses are supplied by churches, chapels, missions, and by the Association for the Nursing of the Sick Poor. It is difficult to see how these deaths can be prevented by the public health measures at present available. Action might more appropriately be taken under Section 12 of the Children Act, 1908. 62 This is administered in London by the Public Control Committee of the London County Council, and by the National Society for the Prevention of Cruelty to children. Over-lying.— In 6 years this has caused 114 deaths, or an average of 19 deaths each year. They are easily preventable if the parents would always let the baby sleep in a separate cot. Such a cot is easily made out of an orange box, and is shown, padded and dressed at the Council's weighing centres. However, even when a separate cot is obtained the baby is put to sleep in it during the daytime, but not at night. Every mother regards the accident of overlying as impossible with her baby—it may reasonably happen to other careless, indifferent, reckless mothers, but not to her. It is impossible to convince the average mother that, however strong and hearty her baby may appear, yet it may be suffocated to death by overlying when it is taken into her bed at night. Every mother scouts the suggestion. Some of these deaths are doubtless due to the parents going to bed under the influence of liquor, some to simple weariness of the mother after a hard day's work, or after the week-end clearing up. Generally the babies are found dead on the breast. The mother has been so exhausted with hard work, or so maudlin with drink that she has not felt or realised the baby's desperate struggles for air. Pinned beneath the mother's breast it becomes suffocated under her heavy body weight. If there is clear evidence that overlying occurred through the drunkenness of one or both parents, then the Children Act, 1908, Section 13 applies, and the offending parent is liable to prosecution and conviction. Short of this, however, there would appear to be no power in the Public Health Acts to deal with these deaths or with the possibility of their occurrence. The appeal in each household must be a personal one. Convulsions.—In 6 years, 65 deaths have been attributed to this cause, or an average of 11 each year. 63 The term itself is an exceedingly vague one and means that the child's violent convulsive movements were prominent features of the illness which preceded death. This, however, gives no information about the disease itself. Convulsions may occur in a child at the onset of any infectious disease such as measles, at the onset of pneumonia, during the progress of tuberculous meningitis, as the result of asphyxiation or an injury, or they may be associated with dentition or rickets and many other affections. Convulsions are not a disease; they constitute a symptom and are the equivalent in the child of what passes as a "shivering fit," or as a "chill" in the adult. Some of the deaths ascribed to convulsions are most likely due to overlying. When convulsions occur in the course of a definite recognised disease then the special sanitary measures applicable to that disease apply. Otherwise the vague group of symptoms, known as "convulsions," which passes for a disease lies outside the scope of public health intervention. Measles and Hooping Cough.—In 6 years, measles and Hooping Cough caused 190 deaths, or an average of 32 per year. Neither of these diseases is notifiable—the knowledge of their presence is derived from casual information. Provision has been made for the reception into the hospitals of the Metropolitan Asylums Board of cases occurring in poor law families, and, subject to certain restrictions, of cases occurring in non-poor law patients. This accommodation is, however, quite insufficient for the whole of London, so that many cases have perforce to be treated at home. And, unfortunately, in such homes it is nearly always impossible to secure isolation. 64 So that although at first sight it might appear that these diseases should be controlled by intelligent public health administration, yet in practice such control is thwarted by the social conditions and housing accommodation of the families concerned. In other words public health is thrown up against a back ground of economic difficulties. Syphilis-—Forty-six deaths have been accredited to Syphilis in 6 years, or an average of 7 per year. These deaths are all preventable by the mother's treatment during early pregnancy and during its continuance. Unfortunately the existence of the disease in the mother is often unknown to her, and even if known is neglected becausc she cannot afford the time to attend a hospital or dispensary. She is unable to suffer the loss of a day's work or to run the risk of losing her employment altogether. By the time the public health staff know of the disease the child has been born, and medical treatment is then less likely to be successful. The disease is not notifiable. The prevention of the disease is largely a question of public morals. The means to be adopted in preventing the deaths vary from case to case, and are decided by personal visitation and a knowledge of the home conditions. These babies are not as a rule received into public nurseries. Diarrhoea, Gastritis and Enteritis.—In six years, 379 deaths were ascribed to these diseases, an average of 63 deaths per year. The incidence of these diseases is very considerably influenced by the weather, and is low in mild, wet summers, high in dry, hot summers. They may be prevented by seeing that the food of the infants is clean, and by keeping clean every object which is likely to be put into their mouths. In a word they may be prevented by a high degree of domestic cleanliness in a sanitary environment. As such they are more or less controllable by public health administration, and respond to the work 65 of the lady health visitors. During the very hot summer of 1911, for the first five weeks of the excessively warm weather, the diarrhoea deaths in Finsbury were very few. Later, the number increased very much. It would appear that the mothers got tired of observing the domestic precautions and household cleanliness to be adopted,-and were more or less incapable of sustained effort and continuing watchfulness. During the hot summer months—leaflets on summer diarrhoea are distributed and redistributed to every tenement in the poorer parts, and a special watch is kept over the disposal of household refuse. Notices for the abatement of nuisances are served at once. Sanitary feeding bottles, appropriate teats, milk-jug cloth covers, cot covers, and bristle brushes for the cleansing of feeding bottles are given gratis or sold at cost price. Tablets of disinfectant soap for house cleaning are given on request, and are offered in suitable cases. The Lady Sanitary Inspector pays rapid visits to the areas where the stress of these diseases is greatest to offer advice, to distribute dispensary tickets, to secure the prompt amendment of nuisances, and to impress upon parents in affected households the absolute necessity of immediate treatment. Re-visits are paid to see that the mothers do actually secure medical treatment for their babies. The diseases are not notifiable. Information of the cases is derived from the weighing centres, from schools, from district visitors, from voluntary associations and by systematic house to house enquiry in the slums. In the poorer houses means are taken to obtain the speedy removal of cases to the poor law infirmary. Diphtheria and Scarlet Fever.—The deaths due to these diseases are quite small in number, and during the last six years have averaged only two in each year. The cases are subject to the public health measures of notification, isolation and removal to hospital. Tuberculous Diseases.—Tuberculosis was responsible for 70 deaths in 6 years, or an average number of 12 deaths per 66 year. All forms of tuberculosis have been made notifiable in 1913. It will take some time, however, before the effective treatment of tuberculosis is systematiscd and made available for all the community. And better far than its treatment, is its prevention. By the time that tuberculosis is recognisable in infants, it has made such progress that it is practically incurable. The outlook for tuberculous babies is always very grave. The incidence of the disease is much influenced by crowding, overcrowding, housing, work and poverty. And by far the most potent factor is poverty ; it often includes and is responsible for the others. Taking a comprehensive view, the prevention of tuberculosis is largely, though not entirely, the prevention of poverty. In babies the infection is often from one or other parent, or may be from a food substance such as cow's milk. Here is quite a common type of case:—A father was taken ill with phthisis. For months he struggled on at his employment until all his savings were spent, and he was now compelled to enter the poor law infirmary. He stayed here until he was strong enough to do a little manual work and discharged himself for home. He had now lost his employment. During his absence his wife had been confined. He got worse and was confined to bed. His wife went out as a charwoman and office cleaner. The father was now too ill to get up and stayed in bed with the baby, who mouthed and licked the counterpane fouled by the father's sputum and mucus. The parents were both sober, steady, industrious, fairly intelligent, and did their best. The baby got tuberculous meningitis and died. This type of infection and its consequences could be multiplied many times in Finsbury. Other Causes of Death include the following:— Lymphatism, collapse of lung, sarcoma (cancer), accidental falls, intestinal obstruction, overloaded stomach, spasm of glottis, cellulitis, blood poisoning, inflammation of the kidney, lockjaw, and heat exhaustion. 67 The average number has been 32 per year, distributed over all the above causes. Some of these, e.g., accidental falls, and overloaded stomachs are obviously preventable. From the foregoing observations it will be inferred that the prevention of the diseases of infants, and the reduction of infant deaths are in Finsbury not solely matters of public health administration. They are closely bound up with difficulties of wages, work and accommodation. The problem is as much an industrial, a social, and an economic one as it is a public health issue. Infant Deaths in previous years.—The number of infant deaths and the infant mortality rates for the period 1901-1912, arranged according to districts, are given in the annexed table :— Infant Deaths and Infant Mortality Rates.* The Borough. North Clerkenwell. South Clerkenwell. St. Luke. St. Sepulchre. Year 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 *533 163 158 149 124 139 172 137 6 162 1902 588 174 183 173 152 172 217 178 6 157 1903 503 159 163 153 125 142 210 176 5 151 1904 522 168 191 177 123 147 206 178 2 60 1905 429 148 146 148 98 121 178 165 7 333 1906 474 157 183 172 116 135 166 157 9 219 1907 368 127 119 116 105 135 136 128 8 307 1908 400 137 Clerkenwell 163 150 1 34 Infant Deaths. 236 Infant Mortality. 131 1909 366 128 219 135 131 130 6 300 1910 342 121 219 122 120 120 3 71 1911 411 154 251 145 156 169 4 181 1912 290 112 183 110 99 111 8 210 *The return for 1901 includes 73 infant deaths taking place outside the Borough but belonging to Finsbury, and which now cannot be distributed in districts. 68 What the Borough Council is doing. 1. The Notification of Births Act has been adopted. By this means early knowledge is obtained of all the births in the Borough. 2. The Lady Sanitary Inspector supervises the work of the three weighing centres, and investigates every infant death that occurs in the district. 3. There are two Lady Health Visitors who visit all the births in the slums, a large percentage of the births in other parts of the Borough, and expectant mothers. The progress of the mother and baby is supervised, suitable advice is given to the mother, and a booklet of infant management is left with her, and its purpose explained. An invitation is given to her to attend the weighing centres and have her baby weighed regularly. Definite instruction is given as to the best feeding, clothing and washing of the child. Mothers who are ill are referred to their own doctors, or tickets are gjven available at hospitals or dispensaries. Special attention is paid to the abatement of certain matters which may re-act adversely upon the progress of the infant—phthisis, overcrowding, domestic dirt, house refuse disposal, the condition of the gullies and the water closets. 4. Mothers who are poor are referred by the public health staff to the various and philanthropic institutions, and occasionally in urgent cases to the poor law authorities, who have on every occasion proferred ready help. Hundreds of such references are made each year to one or other of the following 'The Relieving Officers; School Care Committees; Almoners of various Hospitals; General and Special Hospitals and Dispensaries; The Leysian Mission; Claremont Hall Mission; The Charity Organisation Society; The Home of Service, King Square; The Invalid Children's Aid Association; The Churches and Chapels in the Borough; The National Society for the Prevention of Cruelty to Children; The Society for the Prevention of Cruelty to Women and Children, 60, Haymarket; The Society for the Repression of Inebriety; The Home Workers 69 Aid Association; the Prisoners' Aid Society; The Diocesan Rescue Workers Society; The Factory Girls' Holiday Fund; The Industrial Law Committee; The Church Army, Banner Street; The Queen's Nurses, 23, Bloomsbury Square; The Nurses in connection with Churches, Chapels and Missions; The Gough Street Medical Mission ; The Baptist Deaconesses' Home; The Brunswick Home for Wasting Babies; St. Barnabas Home, Lloyd Square; The various Crfeches in the Borough; The Cumming Street and King Square Dinner Centres. 5. The Public Health Department supplies the following details at cost price to mothers, gratis to poor mother:—Tubeless sanitary feeding bottles, special rubber teats, weighted milk jug covers, cot covers, bristle brushes, drop tubes, woollen vests, pneumonia jackets and "insbury Cream." Disinfectant soap is given on request. The bristle brushes are for cleaning out milk bottles. The drop tubes are for the treatment of eye affections in the newly born. The "Finsbury Cream "a special form of fat food for wasting and delicate children. It has been found of great service. The babies take it readily. The woollen vests are knitted by school children in the district by the kindness and courtesy of the head teachers, and from directions issued and devised by the Lady Sanitary Inspector, who buys the wool and attends the schools to see that the knitting is satisfactorily accomplished on the first occasion. Over two-thousand vests have been distributed in the Borough, knitted in this way by school children, girls' clubs and private persons. The pneumonia jackets are made by the Public Health Staff, by the mothers who attend the weighing centres, and by philanthropic ladies. "Layettes" for babies are given out of a private fund. The Council issues leaflets on infant feeding, summer diarrhoea, and measles, and a booklet on infant care and management Thousands of these are given gratis each year to the mothers of recently born children. The leaflets on summer diarrhoea, 70 and measles are distributed and re-distributed to every tenement in the slums and in those parts of the Borough where these diseases are known or suspected to be prevalent. 6. The Borough Council maintains three weighing centres, open from 2.30 p.m. to 4.30 p.m. as follows:—The Branch Library, Penton Street, Wednesdays; St. Luke's Institute, Radnor Street, Thursday; the Committee Room, the Town Hall, Friday. The babies are weighed at these centres and the weights entered on cards, which the mothers keep and take home with them. If the child is not thriving as evidenced by its loss of weight, the mother's diet and the child's feeding are inquired into very carefully, and appropriate advice given. Model clothes, suitable for the children of poor parents, and which defer to some of their minor prejudices, are shown on each occasion, and their advantages pointed out. The mothers are shown how to make these garments. At each meeting questions are asked and answered, and short lectures given on suitable subjects. Expectant mothers attend for advice and instruction. 7. During the hot summer months special measures are taken to deal with summer diarrhoea. These have already been given on a previous page. 8. Special attention is given to verminous houses by the district Sanitary Inspectors, who serve the usual notices and see that the tenements are cleaned. The floor and woodwork are scrubbed. The rooms are sulphur fumigated. Voluntary Societies and Institutions.—There are many of these bodies in or near the Borough whose work closely touches the prevention of infant mortality. A list was given in last year's report. It comprises, General and Special Hospitals; the Lying-in Hospital, City Road; the Maternity Nursing Association, 63, Myddleton Square; the Royal Maternity Charity, 31, Finsbury Square; the Finsbury Dispensary, Brewer Street; the Leysian Medical Mission, City Road; the Bunhill Medical Mission, 71 Roscoe Street ; the St. Barnabas Home, Lloyd Street, Lloyd Square; the Home for Wasting Babies, Brunswick Place, Hoxton; the Gough Street Medical Mission ; the Northampton Estate Sick and Provident Society; the Royal General Dispensary, 26, Bartholomew Close; the Fore Street Dispensary; the Claremont Mission Crèche; the St. Agnes Crèche, 48 Amwell Street; the Hope Mission Crèche, Banner Street; the Guinness Buildings Crèche, Lever Street; the Field Lane Crèche; the Mothers' Guild and weighing centre attached to the Peel Mission, 32, St. John's Lane; the School for Mothers and dinner centre, 26, Cumming Street; the Dinner Centre, Employment Bureau, and Home of Service, 36, King Square; the School for Mothers, St. Anne's; the Association for the Nursing of the Sick Poor, 23, Bloomsbury Square. Many of the Churches also support nurses. There are classes for sewing and cutting out childrens' garments in connection with the schools for mothers, and the London County Council evening classes held in the elementary schools. This list is quite incomplete, and illustrates the exceptionally lavish manner in which Finsbury is endowed with voluntary agencies for relief. Some of the above Societies have milk funds, boot funds, and clothing funds. Some receive discarded and second-hand clothing for distribution amongst the necessitous poor. An additiona' list has already been given of the agencies to which the public health staff refer cases for help. What More may be Dene.—The following proposals are submitted for careful consideration. Some of them have already been noticed in previous pages. 1. The establishment of dinner centres for mothers and expectant mothers. 2. The provision of Crèches or Public Nurseries. 3. The founding of Schools for little nurses. 4. Additional Schools for mothers, Maternity Clubs, Cuttingout Classes, attached to churches, chapels, or missions. The cards, booklets, and leaflets already used by the Public Health 72 Department might be given gratis to such schools. This would standardize the methods adopted and the instruction imparted, and would systematise the work. 5. Clothing Centres for the sale and tree distribution of disinfected clothing for mothers and babies. 6. The engagement of a lady,—a "Pudding Lady" to teach nutritious and economical cooking to poor mothers. 7. The registration of societies and of private persons who will undertake to deal with poor mothers and babies requiring relief. 8. The devising of a scheme by which the names and addresses shall be sent to the Public Health Department of immigrant mothers and their babies, that is, of mothers who have come into the Borough. They are not visited by the Lady Health Visitors because the births, occurring in another Borough, are not notified to the new Borough on the mother's removal. Such a scheme would require the co-operation of nurses, district visitors, the visitors of philanthropic societies, and of neighbouring public health departments. Some of these proposals offer ample scope for the help and activity of voluntary organisations. CANCER. In 1912, death was accredited to Cancer in 86 persons, of whom 44 were males, and 42 females. The death rate was 0-998 per 1,000. The deaths in previous years from 1901 upwards were 72, 72, 92, 79, 65, 84, 86, 87, 88, 79 and 81 respectively. The following tables show the deaths distributed according to sex and age:— 73 Cancer Deaths, 1901 1912. Ages. Under 10 years. 10- 20- 30- 40- 50- 60- 70+ Totals. Males 7 9 10 24 61 127 151 91 480 Females 2 4 5 35 96 133 118 98 491 Totals 9 13 15 59 '57 260 269 189 971 Most of the deaths occur between 50 and 70 years; between 40 and 50 the females exceed the males, between 50 and 60 the sexes are very nearly equal; after 60 the males are more numerous. The parts affected are set out below:— Cancer Deaths, 1901 1912. Sites of the Disease. 1912. 1911. 1901-10. Totals. Face, Tongue and Jaw 6 6 75 87 Throat, Neck and Gullet 11 9 77 97 Stomach 14 5 107 126 Intestines 11 16 154 181 Liver 14 8 92 114 Pancreas 2 3 18 23 Breast 12 11 67 90 Womb 13 13 116 142 Various 3 10 98 hi Totals 86 81 8o4 971 The sites of the disease differ in the two sexes, fn man they are chiefly those parts concerned with feeding and the digestion of food, the mouth, tongue, stomach, liver and intestines; in 74 woman they are chiefly those parts concerned with child-bearing and reproduction, the womb and the breast. ALCOHOLISM. Alcoholism and Cirrhosis of the Liver caused 42 deaths in 1912. Cirrhosis of the Liver is the euphemism under which, in deference to the susceptibilities of relatives and friends, alcoholism is masked on death certificates. It is quite uncommon to find alcoholism entered as a cause of death, except in the case of those who are friendless, homeless, unknown, destitute, or who die in the workhouse or workhouse infirmary. The deaths in previous years are appended: — Deaths from Alcoholism, 1901-1912. Years. Alcoholism and Delirium Tremens. Cirrhosis ot the Liver. Total. 1901-10 164 257 421 1911 11 18 29 1912 16 26 42 Totals 1901-12 191 301 492 In addition to the numbers given above there will be other deaths due to alcoholism, but in which it has been omitted as the primary cause from the certificate, and the secondary cause or terminal disease alone inserted. Thus many of the deaths of young adults from pneumonia, many of the cases of Bright's disease of the kidneys, some of the deaths due to "influenza" or bronchitis, many street and night accidents, and possibly some of the cases of overlying are attributable directly or indirectly to alcohol. It will be noticed that in the above table the deaths from cirrhosis of the liver much outnumber the deaths from alcoholism. 75 This alone is eloquent of the desire to exclude the presence of alcoholism from the certificates of the causes of death. Insurance companies and friendly societies watch the death certificates for its inclusion. The patient's friends therefore, endeavour to conceal the part it played in the illness which preceded death, otherwise the insurance payment and the friendly society benefits might be withheld. The ages at death are shown in the table:— Age. 20- 30- 40- 50- 60- 70- 80- Totals. Males 0 3 8 5 6 4 0 26 Females 0 3 3 3 3 4 0 16 Thirteen of the cases died in the workhouse and workhouse infirmary. CONSUMPTION OF THE LUNGS. Notification.— Finsbury was one of the very first boroughs to adopt the voluntary notification of phthisis and of "open" tuberculosis, that is, tuberculosis associated with discharges. This was in 1900, or 12 years ago. From the very first, the cases were visited by the public health staff, suitable enquiries were made into the origin of the disease, the home circumstances and the sanitary condition of the premises. Appropriate advice was given to the patient and to the contacts. A leaflet of instruction was left with the patient, and periodic disinfection of the premises was offered. In recent years events have moved rapidly. The notification of patients in poor law institutions was made compulsory under the Public Health (Tuberculosis) Regulations of the Local Government Board, which came into force on the 1st January, 1909. 76 By the Public Health (Tuberculosis in Hospitals) Regulations, 1911, phthisis from the 1st May, 1911, was made compulsorily notifiable in all hospitals, dispensary and institutional patients. By the Public Health (Tuberculosis) Regulations, 1911, a general order was issued by the Local Government Board making all cases of pulmonary tuberculosis compulsorily notifiable from the 1st January, 1912. Finally, by the Public Health (Tuberculosis) Regulations, 1912, all forms of tuberculosis are compulsorily notifiable from and after the 1st February, 1913. The notifications and deaths of Finsbury cases of phthisis since 1901, are appended :— Phthisis Notifications and Deaths, 1901-1912. Total No. of Notifications. No. of Cases notified per 10,000 of inhabitants. Total No. of Deaths Death Rate per 1,000. 1901 70 6.9 216 2.13 1902 121 12.1 240 2.40 1903 219 22.2 223 2.26 1904 210 21.6 251 2.57 1905 178 18.5 215 2.24 1906 217 22.9 232 2.45 1907 217 23.2 243 2.60 1908 220 23.9 221 2.40 1909 359 39.7 228 2.52 1910 319 35.8 166 1.86 1911 419 47.8 159 1.81 1912 438 49.6 160 1.85 The actual number of notifications received in 1912 was 1,169, but of these many refer to the same patient. There were 438 primary notifications, of which 133 were from poor law sources, 77 149 from hospitals and dispensaries, 26 from schools, and 130 from private doctors. In reference to the 133 poor law cases, there were received 701 notifications, re-notifications, and notices of discharge. This means that each poor law case was notified on an average, nearly six times, and is due to the fact that these pauper cases are restless in institutions, and frequently come out, especially at holiday time, and later seek re-admission. Two hundred and seventy-four cases gave a Clerkenwell address, 164 lived in St. Luke. Institutions.—The institutions and the number of notifications from each are appended:— Holborn Union Workhouse and Infirmary, 133; the Finsbury Dispensary, Brewer Street, 47; St. Bartholomew's Hospital, 30; the Royal Chest Hospital, City Road, 41; Mount Vernon Hospital, Hampstead, 5; Brompton Chest Hospital, 3; Royal Free Hospital, 5; Royal General Dispensary, Aldersgate, 1; University College Hospital, 3; Metropolitan Convalescent Hospital, Walton-onThames, 3; Middlesex Hospital, 2; and one each from the following:— King's College Hospital; the German Hospital, Dalston; the French Hospital, Shaftesbury Avenue; the Hospital for Sick Children, Gt. Ormond Street; the London Homoeopathic Hospital; Queen Mary's Hospital, Carshalton; the Royal Sanatorium, Bournemouth; the City of London Infirmary; the Havelock Hall Dispensary; the Kennington Tuberculosis Dispensary; St. Katharine's Hospital, Ramsgate; and the North London Tuberculosis Dispensary, Oakley Square. Fifteen Finsbury patients received institutional treatment in a sanatorium—other than in a poor law infirmary. How many of the whole number are Finsbury cases. —A patient is said to belong to Finsbury by residence when he has resided in the Borough for at least five years, or, if not yet five years of age, since his birth. The period five years has been arbitrarily assumed as one of a reasonable duration entitling to a public health settlement, and also because it is generally asserted that the average duration of a case of phthisis from early demonstrable clinical signs to death is about 5 years. A 78 case is accredited to Finsbury by infection when the presumed duration of the disease, as elicited by enquiry, is less than the length of the patient's residence in the Borough. Adopting these definitions, the cases may be grouped as follows:— 1. Finsbury Cases by residence and infection 242 2. Finsbury Cases by infection 40 3. Finsbury Cases by residence 15 4. Cases from Common Lodging Houses 13 5. Cases homeless, or giving false addresses or about whom no information could be obtained 23 6. Cases probably not phthisis 1 7. Not Finsbury Cases 104 438 The cases which may be definitely associated with the Borough are the first two groups, and amount to 282, that is, to 64 per cent, of the whole number. The Finsbury cases by residence had definite signs of the disease before living in the Borough. Very little information could be obtained about the cases from common lodging houses. These patients are generally restless, wandering, and homeless. They move from lodging house to lodging house, infecting all, a danger to themselves and to the other occupants. They use common eating utensils, and common towels. They spit broadcast on the walls and on the floors. They take no preventive measures. Twenty-three of the cases were homeless, or gave false Finsbury addresses, sometimes the address of a brother, sister, daughter, brother-in-law, friend or casual acquaintance. They sought by this means to achieve a Finsbury settlement, so as to obtain admission to the local workhouse infirmary. 79 The cases "probably not phthisis" were those notified by school doctors, and thereafter re-examined by experts in the large general hospitals, who failed to find evidence of the disease. The cases which were "not Finsbury" were those which had the disease when they first came into the Borough, and who had also lived here for less than 5 years. Such cases live in common lodging houses, Rowton Houses, or in philanthropic institutions, and wilfully give a fictitious address in order to escape the supervision which naturally follows notification. Very many of the poor law cases do this, and it is only after repeated enquiry and much difficulty that the permanent address is obtained, or, if this is not available, where the patient has been sleeping. Sometimes when the correct address is given, the present occupant of the house denies that the patient ever stayed there. In 1912, there were 104 cases notified, or over 23 per cent. of the whole number—which were considered to be dumped cases attributable to other districts. The never-ending immigration of these cases into the Borough is possibly the most serious difficulty of all in dealing with the phthisis problem in Finsbury. There is a continuous accession of patients who have developed the disease elsewhere, and worse still from the standpoint of a public health reputation, once they come into the Borough they shou no disposition to move elsewhere. In course of time, when these patients die, their deaths are counted as Finsbury deaths, and tend to attach to the Borough a public health odium which it does not deserve. Illustrative Cases.— 1. A patient was notified from an address in Helmet Row. He had gone to the occupant of the house and asked him if he might be allowed to use the address so that he might get into the Finsbury Infirmary. The occupant agreed to this course. The patient had never lived at the address he had given. 2. A letter was received from the Medical Officer of Health for Wandsworth that a phthisis patient from that borough had 80 removed and had given a Finsbury address. During the next few days this patient was notified from this Finsbury address from three different hospitals. Enquiry showed that the patient had never lived at the Finsbury address, but was known to the occupier. They had been at school together, but had not met since that time for 20 years. The patient was eventually traced to another Wandsworth address. He had used the Finsbury address without the occupier's knowledge or consent. 3. A patient had lived in Stepney for a year, in Edmonton for five weeks, and then moved into Finsbury. She had had phthisis for years. She entered the Holborn (Finsbury) Infirmary and was notified as a Finsbury case. 4. A patient was homeless. He gave a fictitious Finsbury address "to satisfy the Guardians." He was admitted to the Infirmary. 5. A woman and her daughter, both suffering from phthisis, were notified from a Finsbury address. They had never lived at the address given, but had a permanent residence in Shoreditch. The occupant stated that the patient came to her and asked to be permitted to use the Finsbury address so that the patient might obtain admittance to the Holborn Infirmary. She did not want to go into the Shoreditch Infirmary. Both cases had been previously notified in Shoreditch, and were well known in that borough. 6. A patient was notified from a Clerkenwell address. He had attended a Finsbury Dispensary. Enquiry at the address he had given failed to discover him, and a note to this effect was sent to the doctor concerned. At the patient's second visit he was asked to give his correct address. He asserted that he still lived at the false address first given. Further enquiry was made and it was found that he had a sister-in-law living there. Meantime, becoming alarmed, his wife wrote to her sister in Finsbury a letter from which the following extracts have been made. These show the attitude adopted by poor patients towards preventive measures. The names have been altered to prevent identification:— 81 "Just a line to tell you that when Jack went to—————— Dispensary, he was told he must give the address over there so he gave your address he finds out to-day they have been to you and they told him that he dont lieve there he will have it he did so if they come again Jack said will you say you dont lieve there will you say you dont know anythink about it it is the santiary people they tell Jack it is compsuntion what he is in as well as the other to save further trouble know nothing about dont give our addres. Jack wont go there anyme——————— it a surt dear Rose that he will have to go away after Christmas if not before——————" This patient was eventually traced to Wandsworth. Sex and Age.—The notified cases, classified according to sex and age are given below:— Years o-1 1-2 2-5 5-15 15-25 25-45 1 45-65 65 + Males 1 1 4 42 19 111 57 9 Females 1 - 3 48 32 75 28 7 Totals 2 1 7 90 51 186 85 16 Bed-ridden Cases.— Ninety-six of the patients were bed-ridden at the time of notification. They included 56 males and 40 females. Fifty-eight had been confined to bed for periods ranging from one week to one month, 5 between three and six months, 2 between six and twelve months. Patients who are not notified until they become bed-ridden are patients generally with long-standing disease, who may presumably have taken few or no precautions to prevent infecting others. These cases, where the circumstances are suitable, are urged to enter the Holborn Infirmary. Distribution by streets and blocks of dwellings. The largest numbers were notified from the following places:— Guinness Buildings, Lever Street, 12; Donegal Street, 12; 82 Goswell Road, 9; St. Bartholomew's Buildings, 8; Central Street, 8; Lever Street, 7; Rahere Street, 7; Rodney Street, 7; St. John Street, 7; Brunswick Close, 6; Compton Buildings, 6; Ironmonger Street, 6; Old Street, 6; Pentonville Street, 6; Radnor Street, 6; Victoria Dwellings, 6; and Bastwick Street, Coldbath Square, Hermes Street, Mitchell Street, Nelson Street, Rising Hill Street, 5 cases each. The notifications from the Peabody Buildings were as follows:—Dufferin Street, 5; Errol Street, 4; Farringdon Road, 7; Guest Street, 3; and Roscoe Street, 5 cases. Length of residence.—The duration of residence in the Borough and of residence at the notified address were ascertained in over 383 cases, with the following results:— Duration 0-1 week 1 week1 month 1-3 months 3-6 months 6-12 months 1-5 years 5 years and over Finsbury Residence 2 6 9 11 20 89 246 Present Address 3 30 24 38 53 155 89 Nearly 38 per cent, of the patients had lived less than one year at the addresses given when they were notified. These poor people, as their savings get exhausted, and their sick benefits get less, get in arrears with their rent, and are for ever moving from one house to another, often clandestinely, or are being ejected. They thus continue infecting fresh tenements in their quests for cheaper accommodation, and in their struggles to stave off the ultimate resort to the poor law. Place of Birth.—This was ascertained in 333 cases as follows: —Finsbury, 116; other parts of London, 170; England, 30; Wales, 1; Scotland, 1; Ireland, 5; Canada, 2; Malta, 1; Germany, 4; and Italy, 3 cases. Eighty-six per cent, were Londoners by birth, 35 per cent, were born in Finsbury. Family History.—In many cases this information cannot be obtained owing to the patient's disappearance or his removal to 83 the infirmary. Out of 328 cases, there was a clear history in 157 households of other previous cases—that is a definite family history of infection was obtained in 48 per oent. of the cases where the information was obtainable. In each of three families there had already been five deaths from phthisis, in each of four others, 4 deaths, and in four families 3 deaths, in sixteen families 2 deaths, and in seventy-five families one death. In addition to the above records, there were seven cases of phthisis still living in one family, six cases living in one family, four cases living in each of two families, three cases living in each of sixteen families, and two cases living in each of thirty-five families. This list bears witness to the destruction wrought by this disease and to the way in which it passes from one member to another in the same household. Presumed Source.—In most families where this fact was fairly well established, the father was marked out as the chief or only primary infecting agent. Next to the father in order of occurrence came the mother. In both instances the children were infected. Other presumed sources in order of frequency were the husband, the brother, the sister, the wife, the son, the uncle, aunt, cousin, sister-in-law, and grandmother. In many instances, especially in model buildings, the presumed source was a case in a tenement on the same landing as the case under investigation, in other examples the origin was a known case in the same block of buildings pr in the same street, with whom the patient concerned used to play, or whom he used to visit and accompany. One patient was a lodger in a family where there were 5 cases living and 4 dead. He contracted the disease. What First took the Patients to the Doctors.—The early signs which first induced the patients to seek medical advice are annexed:— Prolonged cough or prolonged cold on the chest, 205; cough associated with pain in the back, side, or front of the chest, 19; cough associated with difficulty of breathing, 5; cough and 84 hæmorrhage, 6; cough and wasting, 3; pains in the chest, 29; difficulty in breathing, alone or associated with other conditions, 22; hæmorrhage from the chest and blood spitting, 18; bronchitis, 16; wasting, 6; severe or "influenza cold," 3; pains in the back, 2; enlarged neck glands ("lumps in the neck,") 3 cases. In 18 instances, the presence of the phthisis was discovered as the result of systematic medical examination while the patient was under treatment for one or other of the following complaints:— Pneumonia, 9; tonsillitis, 3; hooping cough, 2; and diarrhœa, indigestion, influenza, and heart disease one each. The commonest signs and symptoms taken singly and arranged in order of frequency were cough, pain in the chest, hæmorrhage or blood spitting, difficulty in breathing, "bronchitis" and wasting. Often these signs were present in groups. The commonest sign present by itself was persistent cough,—a cold which the patient "could'nt shake off." The difficulty or hardness of breathing is known popularly as a "bad chest," "tight chest," or "asthma." Long continued cough is considered as a sign of "weak lungs" or of a "weak chest." In 392 cases, enquiry was made after the patient had been notified as to whether he knew the nature of the disease from which he was suffering,—out of all these, 150, or only 38 per cent. were aware they had consumption. The results of this ignorance are disastrous. It will be obvious that, if the patient, after he has been medically examined, after he has been notified, does not realise that he has consumption, it will be useless to expect him to take those necessary preventive measures for the protection of the other members of his family. Duration of the Disease.—The presumed duration of the disease when the case was first notified is given in the attached table, which records the results in 374 patients. 0-1 month 0-3 months 3-6 months 6-12 months 1-5 years 5-10 years 10-20 years 20 years and over 9 35 33 41 149 65 41 1 85 Few cases are recognised in the early and curable stages- 68 per cent. had been ill for periods over one year before notification. This shows an improvement over 1911, when the corresponding figure was 83 per cent. It illustrates the expediency of a systematised search in the homes for slight, missed, and suspicious cases amongst the contacts in the households of notified and recognised cases. Previous addresses in the Borough.—Out of 134 cases, 169 had lived in two or more Finsbury addresses while definitely known to be consumptive. Fifteen had lived in four different houses in the Borough during their illness. Out of these 169 cases, 78 lived in houses from which cases of phthisis, numbering 91, had already been notified, and in which 41 deaths from phthisis had occurred prior to their occupancies. It is quite possible that some of these patients may have been infected with phthisis from the houses, from the home surroundings of the tenements into which they had moved. Owing to the demand for accommodation, many of these tenements remain empty but a short time, and are not disinfected after the removal of the last occupier. There is no power to enforce systematic disinfection, though it is offered and its necessity emphasized in all cases. The Borough Council provides a "disinfectant" soap gratis for washing the walls and for the effective scouring and scrubbing out of the rooms. Residence in other boroughs.——During their illnesses and before they were notified, 74 patients had lived in other metropolitan boroughs, chiefly Islington and Holborn. Six had lived in various country districts while suffering from phthisis. OCCUPATIONS. The occupations of the patients were as follows:— Males.—'Bus conductor, 1; bailiff, 1; boots, 1; baker, 1; barman, 6; butcher, 2; brass finisher, 1; boot repairer, 2; bullet maker, 1; bottle tester, 1; billiard marker, 1; carman, 10; cabdriver, 2; clarionet player, 1; coal dealer, 1; clerk, 1; cutler, 1; 86 caretaker, 1; cinematograph operator, 1; compositor, 6; chemist. 1; chaff cutter, 1; errand boy, 1; engraver, 1; engineer, 2; fish fryer, 1; greengrocer, 1; glass etcher, 1; glass grinder, 1; glass blower, 1; hat maker, 1; hawker, 8; hair frame maker, 1; knocker-up, 1; kitchen manager, 1; labourer, 23; lamplighter, 1; lodging house deputy, 1; licensed victualler, 2; locksmith, 1; liftman, 1; litho stone grinder, 1; litho polisher, 1; motor driver, 1; messenger, 2; market porter, 3; mangle worker, 1; painter, 4; packer, 3; paper seller, 1; postman, 1; picture-frame maker 1; paper pattern cutter, 1; press tool maker, 1; painter, 5; piano maker, 1; photographer, 2; packing case maker, 2; publishers' reader, 1; porter, 10; rubber stamp maker, 1; rent collector, 1; shunter, 1; soldier, 1; silversmith, 1; stoker, 1; store-keeper, 1; shop assistant, 3; stationer's cutter, 1; scullery hand, 1; spectacle maker, 1; taxi driver, 3; travelling showman, 1; tramp, 1; upholsterer, 1; van-guard, 2; window cleaner, 1; waste water inspector, 1; waiter, 1; warehouseman, 1; wood turner, 1. Females.—Artificial flower maker, 5; bookfolder, 1; boxmaker, 3; bottle washer, 2; bracemaker, 2; bonnet shape maker, 1; bottle labeller, 1; bottle packer, 1; chairwoman, 12; clerk, 3; cloth sorter, 1; dressmaker, 10; embroiderer, 1; fancy frame maker, 1; flower seller, 3; gold layer, 1; gold braid maker, 1; glove maker, 1; housework, 59; lacquer hand, 1; novelty worker, 1; nursemaid, 1; organ grinder, 1; relief stamper, 1; shop assistant, 4; shoe trimmer, 1; Turkish bath attendant, 1; warehouse assistant, 1; and waitress, 2. In 86 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 its distribution. This is a most undesirable association, but one which, with the powers at present available, it would be difficult entirely to prevent. Many patients showed signs of very marked poverty—they were chiefly labourers and carmen, out of work through illness or in casual employment and leading a precarious hand to mouth existence. 87 Thirty-four were employed in dusty occupations: these are known to favour the onset of consumption. Thirty-one were engaged in work of a sedentary and confined nature. Twelve patients were homeworkers. The straitened circumstances which force the father or mother, harassed with consumption, to undertake work at home augur very badly for recovery from the disease or even for the staying of its downward progress, and foreshadow the ultimate infection of other members of the family. Unemployment and Insurance. — Enquiry was made as to the unemployment of the patients during the 52 weeks preceding notification. Thirty-two per cent. of the whole number had been in regular employment without losing a single day; 25 per cent. had been absent from work for periods ranging from a few days to one month; 16 per cent. had lost from one to three months work; 9 per cent. had been out of work from three to six months. The rest had been unemployed for six months or more. Information was obtained as to thrift and insurance. Forty-four per cent. were insured at the time of the first visit, 6 per cent. had been formerly insured but had allowed the policies to lapse owing to poverty. Nine per cent. were members of friendly societies, 8 per cent. belonged to share-out clubs, 7 per cent. were members of trade unions, 25 per cent. were definitely not insured, and 1 per cent. were formerly members of a trade union, but had been unable to keep up their subscriptions. Treatment.—Out of 438 patients, 133 had been treated at the Holborn Poor Law Infirmary or Workhouse. Fifteen patients received sanatorium treatment during the year, and thereby obtained a training which is of great preventive and educational value. Each patient, when visited, was asked whether he would like to have sanatorium treatment or not—210 stated that they would 88 be very glad to have the opportunity of entering a sanatorium 143 did not wish to accept. Home Circumstances and Social Conditions.—One hundred and six families were in great poverty, 24 others were destitute, that is to say 130 households, or 30 per cent. of the whole number, bore evidencs which convinced the casual visitor of the existence of very straitened circumstances. This raised an important issue. Public Health measures can, and will, prevent the spread of phthisis to others provided the home circumstances are favourable and the patients are willing. Progressive sanitation will help to prevent fresh cases in the comparatively well-to-do, but, in its larger sense, the prevention of phthisis in the poor is a social problem—the relief and prevention of poverty. One hundred and sixty-one patients were total abstainers, 204 were said to be moderate drinkers, 30 drank to excess. One hundred and five families, comprising 358 children and adults, lived and slept, each family, in one room. For these the prevention of infection would be a matter of great difficulty, if not almost impossible. Overcrowding was discovered in 45 households. In 393 homes, excluding common lodging houses, there were altogether 1,466 other members of the family besides the patient —these would be naturally in close contact with the disease and very liable to be infected. In addition to these close contacts, there were 2,389 remote contacts living in these houses, so that there would be altogether 3,855 persons more or less exposed to infection from the phthisis patients living in their houses. In making this estimation in the case of tenements in buildings, regard is only had to the patients in the affected households. This number does not include the occupants of the tenements on the same landing as the patient. 89 Labour and Economic Conditions.—The mothers of three families volunteered information as to their daily routine, their home circumstances and their expenditure. These statements are inserted here so that it may be realised how extremely difficult it is in actual practice to deal with these cases of phthisis in their own homes. They are not cases specially chosen save for the fact that the mothers were poor and communicative. 1 Poverty, Difficulties of Isolation, Possible Infection of the Family.—The family consisted of the father, mother, and three children, 9 years, 4 years, 2 years, and occupied a one-roomed tenement in a mean street, rented at 4s. weekly. There was five weeks' rent owing. The father was a labourer in casual employment, and had had no work at all for two weeks at the time of the visit. For many months the family had lived on articles pawned, and the odd pence earned by the father in the streets, minding carts and horses, portering, or doing "anything that came his way." The mother was thirty years old and had phthisis. The room was dirty, squalid, smelt offensively, and contained one bed. The floor was black with grime. The mother pawned her husband's shirts and pants for 2s. 6d., and spent the money as follows:—Tea dust (2 oz.) 2d.; sugar (1 lb.), 2d.; condensed milk, 2d.; margarine (4 oz.), 2d.; coal, 4½d.; gas, Id.; potatoes, 2d.; sausages, 4d.; bread, 5½d.; tobacco and cigarette papers, l½d.; borrowed money repaid, 2d,; pawn ticket, 1d.; paid a woman for pawning clothes, ½d. The mother had ½d. over from the previous day. She did not go to the pawn shop herself—it is generally considered that a woman who is well known to the pawnbroker can get better terms than a casual visitor. The father brought home l½d. On the next day further articles were pawned for 2s., expended as follows:—Coal, 4½d.; sugar, 1d.; bread, 5½d.; potatoes, 2d.; tea dust, 2d.; condensed milk, 2d.; soap, l½d.; soda, ½d.; wood, ½d.; sausages, 3d.; gas, 1d.; butter, 2d. 90 These people lived on the poverty line and often below it. Whenever they earned a little extra money, it was spent in drink. The family went hopping in the autumn. The mother said she got up at 7 a.m., prepared the breakfast, sent the children to school, "wiped up" the floor, but scrubbed it only when she had suds over from washing the clothes. She "did not know what she did with herself in the afternoon." The children belonged to a boot club held in school. Their clothes were second-hand ones bought in a street market. At a special visit paid on a Saturday, the whole family were found to be just getting up at 10.15 a.m. 2. Poverty, Family Infection, Difficulties of Isolation.— The family consisted of the mother, four children, 10 years, 7 years, 5 years, 3 years, and an adult female lodger. They occupied one room let at 4s. 6d. weekly rent. The mother had obtained a separation order from her husband, who was to pay her 15s. weekly. As a rule, however, he allowed the payments to accumulate in arrear, and went to prison to wipe out his debt. The mother was an office cleaner for 10s. weekly ; she got up at 5.30 a.m., left home at 6.40 a.m., and returned at 9.30 a.m. She left again in the evening at 5.40 p.m., and came back at 9.20 p.m. The room was clean and orderly. The windows were kept open. The adult lodger took in sewing, looked after the four children while the mother was at work, and gave the mother "what she could" for her food and accommodation, usually from 1s. to 1s. 6d. or more weekly. The father, mother and child of 7 years had phthisis. The mother and child had presumably been infected by the father, who was notified in 1909. The child, 10 years, had free dinners at school. Her daily expenditure was as follows:— Saturday: Stale bread, 3d.; beef, 3½ lb., 8d.; suet, 1d.; tea, ¼ lb., 4d.; sugar, 1 lb., 2d.; milk, 7d.; coal, 4½d.; paraffin, 2d.; potatoes, l½d.; cabbage, 1d.; jam, 3¾d.; margarine, 3d.; flour, 3d.; onions and carrots, ½d.; borrowed money repaid, 5s 91 Monday: She borrowed 6s. and spent it as follows:—Rent 4s. 6d.; insurance, 11d.; stale bread, 3d.; potatoes, 1d. Tuesday: Coal, 2¼d.; paraffin, 2d.; bread, 3d.; meat "pieces," 3d.; suet, 1d.; carrots and onions, ½d. Wednesday: Bread, 3d.; meat "pieces," 3d.; suet, 1d.; carrots and onions, ½d. Thursday: Bread, 3d.; meat "pieces," 3d.; suet, 1d.; potatoes, 1d.; margarine, l½d.; soda, ½d.; matches, ½d.; salt, ½d. Friday: Mackerel, 2½d.; potatoes, 1½d.; soap, soda and blue, l¾d.; paraffin, 2d.; coal, 2¼d. The total for food for 2 adults and 4 children for one week came to 7s. 6½d. The family obtained firewood by going to Smithfield Market and begging for wooden boxes 3. Poverty, Difficulties of Isolation, Possible Family Infection.—The family consisted of the mother (a widow) and two girls, 12 years and 7 years. They occupied a small oneroomed tenement, of 80 square feet superficial area, rented at 3s. weekly. The mother has phthisis and is an office cleaner at 14s. per week, less 2d. insurance money. She gets up daily at 6 a.m. and gives her children breakfast. She goes to work at 6.40 a.m., and comes home at 10 a.m., cleans up her room and goes out shopping. She rests in the afternoon, and leaves for work at 5.40 p.m., to return at 10.20 p.m. The room was very small, and contained one bed. The furniture was scanty. The washing basin was put on a chair, and when not in use was kept under the bed. Her weekly expenditure was as follows:—Rent, 3s.; clothing club, 1s. 6d.; funeral insurance, 3d.; coal, 1s l½d.; coke, 3¾d.; wood, 2d.; paraffin, 8¾d.; tea, 6d.; sugar, 2¾d.; condensed milk, 2d.; butter, 6d.; jam, 4d.; bread, 1s. 7¼d.; meat, 2s. 4d.; vegetables, 6d.; fish and chips, 4d.; soap, soda and matches, 2½d. 92 The children have free dinners at school. The weekly expenditure conies to 13s. 9½d., or just less than her weekly earnings; it varied from time to time, but she" rarely had a shilling over when she came to settle up at the end of the week." The three foregoing cases suggest the following considerations:— 1. In each family isolation was impossible,—in each household there was only one room and one bed. There is, therefore, every fear that, in the near future, some of the other occupants will be infected. Under present conditions, the best course, in the interests of the others, would be to remove the infected members, or the noninfected members to the poor law infirmary or workhouse. Generally, however, these poor people, so long as they have the ability and prospect of earning any money, be it ever so little, will not enter the poor house. 2. The weekly budgets were:— Family. Rent. Food and Household Necessaries. 2 adults 3 children 4/- 15/- to 16/- 2 adults 4 children 4/6 7/6½ 1 adult 2 children 3/- 13/9½ The disparity between the food expenditures of the second family and of the others suggests the desirability of instruction in the elementary schools, in continuation schools, and in the homes of the patients, of the nutritive values of food substances, of simple nutritious cooking methods, economical and devoid of waste, and of thrifty household management. 93 3. In each home, there was only one bed. In each household the family could not afford to rent a second room. In one tenement there was no space to accommodate another bed. In the others the. provision of second beds by voluntary agencies would be of great value. The loan of shelters or of hammocks to be used for open air treatment on the "leads" or in back gardens would be most helpful in all three cases, and, combined with the tuberculin treatment at a Dispensary, would apparently constitute the best practical means of dealing with them. The advantage of the tuberculin treatment is that the patient, while undergoing it, is enabled to continue at his work, and thus not to become a charge upon the poor rates. The Tenements.—Out of the whole number, excluding common lodging houses, 105 were one-roomed tenements, that is to say, in these tenements the patient and family lived and slept in one room only, 156 were two-roomed tenements—the rest had three to eight rooms. Forty-five tenements were overcrowded. It is difficult to conceive a condition which favours the spread of infection more than overcrowding. In phthisical families the abatement of overcrowding is insisted upon forthwith. Ninety-nine tenements had only one cupboard each for food, clothes and coke. Eight had no cupboard accommodation at all. These are very unsatisfactory conditions for a phthisical household. When the household utensils of the patient are kept in the same cupboard as the other household utensils, when his clothes are hung on the common peg, when he uses the common towel and washing basin, the common knives, forks, spoons, cups saucers and glasses, when the utensils of the household are all washed together indiscriminately, the spread of infection from the patient to his family is greatly favoured. 94 When, in addition to these, the tenement is overcrowded, the conditions for promoting the spread of the disease are as pernicious as they possibly can be. Eighty-eight tenements were on the list of houses-let-inlodgings; sixty-one tenements were in the so-called model buildings, which, with their common landings and their many points of contact between the families who occupy them, are only too well adapted for the spread of phthisis. Homework was carried on in ten tenements. Of the houses occupied by the patients, 4 were milkshops, 2 were restaurants, 5 were public houses, and 4 others were used for the sale or preparation of food products. It is very unfortunate and most undesirable that these consumptive patients should have to do with the handling or manufacture of articles for human consumption. There is not, however, at present, any practical method of preventing or otherwise satisfactorily dealing with their employment in such occupations. A sanitary survey was made of every tenement and the nuisances found made the subject of subsequent notice. The following defects were ascertained:—Insufficient headroom, 90; insufficient lighting, 43; dirty rooms, 17; broken or dilapidated walls or roofs, 11; insufficient ventilation, 10; verminous rooms, 3; basement room illegally occupied, 1; defective and dirty wash-houses, 4; defective water closets, 4; and a sink waste untrapped in one tenement. The Patient's Bedroom—The number of beds in the patient's bedroom, the number of persons occupying the patient's bodroom and the number of families affected are given in the attached table. 95 Persons and Beds in the Patient's Bedroom. One Bed. Two Beds. Three Beds Persons. Families. Pertons. Families. Persons. Families. 1 86 1 7 — — 2 133 2 23 — — 3 38 3 37 3 1 4 7 4 34 - — 5 1 5 14 5 1 6 1 6 5 6 1 In two instances there were 4 beds in the patient's bedroom, occupied by 2 and 6 persons respectively. This list excludes common lodging houses. Only 86 patients out of 438 were able to have a bed and bedroom all to themselves. In the other households where only one bed was available, 419 persons slept in the same bed with the consumptives, and were consequently closely exposed to infection. This number refers to those families which only possessed one bed. In addition to these there were 440 persons who occupied the same bedroom as a phthisical patient, and in some instances the same bed. Four bedrooms had no fireplace, so that ventilation in them was absent or impossible. The ventilation was insufficient in 55 other bedrooms, making a total of 59 bedrooms, or 13 per cent. of the whole number. The defective ventilation and absence of ventilation greatlv facilitate the spread of the disease. It is difficult sometimes to suggest means by which it may be overcome—occasionally owners have been induced to place gratings in the walls. Unfortunately, even when they have been provided, the occupants have been known to stuff the apertures with rags and thus render these gratings useless. The absence of fireplaces bespeaks very bad housing—in some instances these rooms without fireplaces were 96 originally attached to the tenements as lumber rooms, or as odd rooms for storage purposes. They were not built for occupation as living rooms or as sleeping rooms. In some parts of the Borough it is found that tenements which originally contained three rooms have been in recent years converted into three one-roomed tenements. With this degradation of the tenement, and its attendant abolition of home isolation and family seclusion, the old-time lumber room comes to be used as a living room and sleeping room. It is extremely important that every room used for human habitation should have a fireplace or means of communication with the outer air in addition to the window frame. Thirty-three bedrooms had dirty walls and ceilings, 13 were damp. In 18 instances the walls and bedding were verminous. In 14 bedrooms the bedding was fouled with the patient's sputum, in 8 the bedroom utensils were contaminated, in another 8 the patients had been spitting broadcast and had bespattered the floors and walls. In 10 homes the bedding was excessively filthy, grimy, and in parts almost caked with dirt and mucus. The conditions thus found bespeak wanton carelessness, and show a callous indifference on the part of the patients concerned to the health and welfare of their families. The Kitchens.—In 255 instances, or 58 per cent. of the whole number of cases the kitchen was being used as a living room and a sleeping room. This is one index of poverty, and shows the difficulties of accommodation and the facilities for infection which accrue in these poor households. Sometimes the patient himself occupies the kitchen by day and night. The conditions found in the kitchens were as follows:—Forty had dirty walls and ceilings, 16 were verminous, 17 were damp, and in 15 houses the kitchen and feeding utensils were extremely dirty. 97 The presence of dirt or vermin may be taken to connote carelessness, and carelessness in the family of a consumptive means increased risk of exposure for the rest of the family. The Houses.—Fifteen houses in which cases occurred were being used for the purpose of sale or manufacture of food as follows:—Restaurants, 2; food preparation, 4; milkshops, 4; and 5 public houses. Notifications of phthisis had been previously received from 152 houses, or from 35 per cent. of the whole number of houses affected. From one such house 5 previous notifications had been received; from each of 18 houses, 3 prior cases had already been notified. Deaths from phthisis had occurred in 69 houses, or in 16 per cent of the houses concerned. It is possible that in both these groups the subsequent cases may have been due to family infection or to house infection. The demand for cheap tenement accommodation is often so urgent in the Borough that very soon after a tenement is empty, it is sought by a prospective tenant and occupied before the rooms have been disinfected or scoured out. Disinfection is offered in all cases, and a special soap provided free of cost by the public health department. There is, however, no power to enforce compulsory cleansing or disinfection. Whenever a case is visited the whole house is made the subject of a critical sanitary inspection. As a result in 1912, the following defects were ascertained and notices were served for them:— Dirty walls, ceilings, staircases and passages, 45; damp and verminous rooms, 4; overcrowded rooms, 3; basement kitchens illegally occupied, 2; dilapidated rooms, 4; dirty yards, washhouses and areas, 28; dilapidated yards and wash-houses, 7; leaking roofs, 10; unventilated basements, 1; dirty, leaking or defective water closets, 39; dilapidated water closets, 3; insufficient water closet accommodation, 2; improper and offensive accumulations of refuse, 4; choked or untrapped sink wastes, 5; fowls improperly kept, 1; dilapidated or insufficient dust-bins, 8; foul or leaking water cisterns, 3; broken guttering, 3; no water supply to the upper storeys in 6 houses. 98 A perusal of the above list will show that many patients were living under very unsatisfactory sanitary conditions, and illustrates the need that exists for the recurring, the unceasing inspection of house property in poorer districts. Not infrequently the detects discovered are due to the occupants themselves. On the other hand, in the slums, there is much property, old and weathered, becoming worn out and subject to continued patching. The repairs when completed are not of a substantial character, and dilapidations are quickly apt to recur. The work when effected is known popularly as a "hospital job." There is often no well considered preventive effort. The Streets.—The number of notifications of phthisis during the years 1904-1911 from whole streets, and the number of streets affected in 1912, the number of deaths in these streets from 1904 to 1911, and the number of streets in which deaths occurred in 1912, are indicated in the table given below:— Street Notifications and Deaths, 1904-12. Streets affected in 1912. Notifications, 1904-11 0 1-5 5-10 10-20 20-30 30-40 40+ Streets affected in 1912 20 68 79 129 78 24 27 Deaths, 19041911 0 1-5 5-10 10-20 20-3 30-40 40+ Streets affected in 1912 21 98 125 140 35 6 — From this table it will be seen that fresh streets are being invaded, and that the disease is tending to spread into streets and parts of the Borough hitherto unaffected. In 1912, notifications were received from 20 streets in which there had been no previous notifications, and deaths occurred in 21 streets in which there had been no previous deaths from phthisis. 99 Disposal of Sputum.—Twenty-five per cent. of the patients used a special spit cup; 12 per cent. were said to spit into pieces of paper or rag, which were subsequently burnt. One per cent. stated that they spat into the fire or fireplace whenever this was convenient, but were said to be very careless by the other members of the family. The others, may be confidently assumed to have taken few or no precautions in disposing of their sputum. The result is very disheartening, especially, when it is known that the Public Health Department supply special sputum flasks gratis. The Borough Council examines for medical men the sputa of all patients suspected to have phthisis, free of charge. In 1912, 159 specimens were examined. Of these, 60 were found to have the tubercle bacillus present. Search for missed and unrecognised cases. -As the result of a special enquiry, in 23 affected families 26 suspicious cases of chronic cough and wasting were discovered and put in the way of obtaining treatment. By investigation into the other families inhabiting the same houses as the consumptives, 11 other suspicious cases of phthisis were referred to hospitals and dispensaries. This is one of the most important purposes of visitation, to enquire after missed and unrecognised cases in the homes of the patients and in the households of the other families inhabiting the houses affected. These overlooked cases, unless captured early, are possessed of infinite possibilities of spreading phthisis. Disinfection and Preventive Measures.—The rooms, bedding, feeding utensils, towels, handkerchiefs and linen were disinfected in 186 instances, or in 42 per cent. of the households. In many of the affected homes the responsible head of the family refused any disinfection whatever, in some cases only the bedding was disinfected, in a few homes only the rooms were attended to. In every case it was urged that the room, the bedding, sheets, pillow-slips, curtains, valances, towels, handkerchiefs, feeding 100 utensils, knives, forks, spoons, cups, plates, saucers, clothes for wearing week-day, and Sunday clothes, should be disinfected. The feeding utensils used by the patient are boiled for ten minutes in boiling water containing a little washing soda. The wafer must be boiling before the utensils are placed in it. After disinfection, it is advised that the room should be well scrubbed out with soap and water. The Council supplies a special "disinfectant" soap gratis for this purpose. Some patients took no special precautions whatever to prevent the infection spreading to the rest of the family, and were apparently indifferent as to whether they caught the disease or not. A few patients thought that by using a spittoon they were doing all that could reasonably be expected of them—they were disinclined to put themselves to any further trouble. In every case it is urged that the patient should have a separate living room for his own exclusive use and a separate bedroom, or, failing these, a separate bed. The importance of separate feeding utensils, of separate towels, and handkerchiefs, of wet dusting and wet sweeping, of fresh air, open windows and sunshine, of the nutritive values of milk and eggs is strongly urged in every instance. In practice it must, however, be confessed that in Finsbury the achievement of these ideal conditions is only too often impossible. In such straits the patient is instructed how to make the best of things as they are. In only 26 homes was wet dusting adopted at the first visit, and in only 38 homes was wet sweeping the invariable method. Two hundred and forty patients were alive to the importance of milk as a food and drank it daily; 169 were ardent egg eaters. Death Notification Interval.—Of all the 438 cases notified during 1912, 77 died before the end of the year. Eleven died within a week of the time when they were notified; 42 died within a month. 101 These late notifications are of very little public health value. A good deal of the mischief has already been done before the cases came under the purview of the Public Health Department. Deaths.—In 1912 the number of Finsbury persons who died of phthisis or consumption of the lungs was 160, as against 159 in the previous year; in addition to these 26 died from tuberculous meningitis, and 18 from other forms of tuberculosis. The deaths for previous years are given in the subjoined table: Phthisis Deaths and Death Rates, 1901—1912. Year. Finsbury Deaths from Phthisis. Finsbury Deaths from other forms of Tuberculosis. Phthisis Death Rates per 1,000 inhabitants. Finsbury. England and Wales. 1901 216 30 2.13 1.260 1902 240 23 2.40 1.230 1903 223 39 2.26 1.200 1904 251 67 2.58 1.230 1905 215 52 2.24 1.140 1906 232 48 2.46 1.150 1907 243 42 2.60 1.140 1908 221 39 2.40 1.115 1909 228 31 252 1.081 1910 166 31 1.86 1.015 1911 159 45 1.81 1.084 1912 160 44 1.81 — It will be observed that the deaths this year are only one more than in 1911. The death rate is practically the same as it was last year. With the exception referred to, the deaths and death rates from phthisis in Finsbury in 1912 are both less than they have been since the Borough was formed. 102 Enquiry was made into the length of residence of each case in the Borough, and as to the duration of the disease. Adopting the classification indicated in an earlier part of this report, it was found that out of 160 deaths, 108 patients were Finsbury cases by residence and infection, that is, they had lived in the Borough for five years, and had presumably been infected with the disease since their arrival in Finsbury. Fourteen patients had lived in the Borough less than five years, but had been infected since they had come to reside in the district, that is to say, they were Finsbury cases by infection, and not by residence. Twenty-five persons were considered on this basis to be not Finsbury cases, that is, they had definite signs of phthisis when they came into the Borough, and had not lived here five years. Three were Finsbury cases by residence—that is, they had lived here for 5 years, although there was reason to believe that they had phthisis before coming to Finsbury. In 10 instances very little information could be obtained, the addresses were false ones, or the patient came from common lodging houses, or had been removed to asylums or poor law infirmaries many years ago, and their relatives had died or had removed, so that the available knowledge was scanty. If we include only the Finsbury cases by infection, and by residence and infection, these amount to 122; adding in the deaths in Finsbury common lodging houses and the doubtful Finsbury cases, gives a total of 132 deaths, which may reasonably be associated with the Borough, and a corresponding death rate from phthisis of 1.49 per thousand inhabitants. Of the whole number of deaths in Finsbury in 1912, 10 per cent. were due to phthisis, as against 9.3 and 10 per cent. in 1911 and 1910 respectively. Four-fifths of the deaths due to phthisis took place between 25 and 65 years, the period of maximum working efficiency in men—the "working life" period when their earnings are most needed and their usefulness greatest. Seventy-one died in the poor law institutions. 103 The deaths from phthisis in institutions for previous years are appended:— Phthisis Deaths in Institutions, 1901—1912. Year. Total Number of Phthisis Deaths. Phthisis Deaths in Holborn Union Infirmary. In other Institutions. Total in Institutions. Percentage of Deaths in Institutions. 1901-6 1.377 572 195 767 55 1907 243 108 51 159 65 1908 221 81 50 131 59 1909 218 87 59 146 67 1910 166 63 25 88 53 1911 159 74 14 88 55 1912 160 71 32 103 64 It is of 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 method adopted by the Registrar General, of allocating deaths in institutions to the districts in which the patients reside immediately after admission, makes the Finsbury death rate from phthisis higher than it otherwise would be. The reasons and inducements which move these phthisical patients to come into the Borough have been set out at length in previous reports. The death rates in the metropolitan boroughs are subjoined:— 104 Phthisis Death Rates, London Boroughs, 1912. Borough. Phthisis Death Rate per 1,000. Borough. Phthisis Death Rate per 1,000. Battersea 1.13 Lambeth 1.20 Bermondsey 2.18 Lewisham 0.68 Bethnal Green 1.62 City of London 1.06 Camberwell 1.30 Paddington 0.82 Chelsea 1.35 Poplar 1.54 Deptford 1.35 St. Marylebone 1.35 Finsbury 1.81 St. Paricras 1.48 Fulham 1.36 Shoreditch 1.9 Greenwich 1.41 Southwark 1.89 Hackney 1.36 Stepney 1.56 Hammersmith 1.40 Stoke Newington 0.69 Hampstead 0.73 Wandsworth 0.96 Holborn 1.98 Westminster 1.16 Islington 1.31 Woolwich 1.01 Kensington 1.04 Phthisis Death Rate, 1911 England and Wales 1.084 The Finsbury death rate is seen to be the fifth in order, and is exceeded by the rates in Bermondsey, Holborn, Shoreditch and Southwark. Only 20 per cent, of-the Finsbury phthisis patients who died in 1912 were born in the Borough : 45 per cent. were born in other metropolitan districts and had migrated into Finsbury. Twenty-seven per cent. of the deceased patients lived and slept in one room with the other members of their families. During the illnesses which preceded their deaths 18 per cent. had lived in other metropolitan boroughs, and had come into Firsbury so as to be near the hospitals. The Treatment of Tuberculosis.—In 1912, the Public 105 Health Committee devoted much time to considering the treatment of tuberculosis on a municipal basis and in connection therewith to considering the desirability of founding a tuberculosis dispensary. A well considered scheme for the treatment of tuberculosis will contain the following details:— 1. The provision of a Tuberculosis Dispensary at which all the activities for dealing with the disease may be focussed. Here patients will be treated and a search made for missed and unrecognised cases in the family, in the house, and amongst the relatives of the patient. Treatment will comprise:— (a) The provision of leaflets of instruction, spittoons, shelters for the use of patients and disinfecting soap for the cleansing of tenements. (b) Medical treatment and the use of tuberculin. (c) The disinfection of tenements on removal, periodically on request, and after death. 2. The retention of educational beds in a sanatorium. 3. Some provision for the isolation of advanced and bed-ridden cases, or the devising of some other means of preventing these cases infecting the rest of the household. 4. An After Care Society. (a) To look after the patient's family while he is out of work or in a sanatorium. (b) To care for the patient when he returns from a sanatorium and to find him work. This will include the furthering of good relations with employers who will be willing to engage tuberculous patients, and the keeping of a list of such employers. For some districts a working Colony has been founded, to which certain patients are sent after passing through the sanatorium. 106 5. The supervision of tuberculous cases from a public health standpoint, including the correction of sanitary defects reacting adversely on the patient's condition and progress. This matter is dealt with fully in the annual report for 1911. Where the public health measures desirable are, in practice, found to be impossible of achievement, the patient may be shown how, under the circumstances actually prevailing, he can best order his life for his own benefit and for the protection of those around him. 6. The establishment of a special open air school for tuberculous children. Such schools may be seen in active work at Kensal House, Harrow Road, and in Regent's Park, where they have been instituted by Voluntary Societies, with the co-operation of the Education Department of the London County Council. The Tuberculosis Dispensary. The active staff of a tuberculosis dispensary consists of one or more medical officers, nurses and voluntary workers. The Medical Officer visits the homes of patients to:— 1. Ensure that his instructions, given to the patient at the dispensary, are all being carried out. 2. Advise the patient, in his own tenement, with its own attendant difficulties of space and accommodation, how best to carry out home treatment and to instruct the rest of the family and the relatives how best to avoid infection. 3. To examine all the other members of the patient's family, known as "contacts," so that the early cases may be recognised and cured while they are still curable, without interfering with their occupation. In this way, chronic infecting cases are discovered which have hitherto been unrecognised or treated as cases of "influenza," or "chronic bronchitis." This routine examination of contacts has been called "The March Past." 107 4. Inquire as to the existence of suspicious cases of tuberculosis amongst non-resident relatives and friends, and to put them in the way of obtaining treatment and adopting preventive measures. 5. Discover and, if possible, remove the source of infection if still existing, or at least to endeavour to lessen the risk of infection for other members of the family. 6. Examine and treat all patients confined to bed, and those unable or unwilling to attend at the dispensary. The Medical Officer of the dispensary reports all insanitary matters requiring amendment and discovered during his visits, to the Public Health Department, notifies the patient's new address on removal, and arranges for the disinfection of the vacated tenement. The Nurse visits the patient's home after his first attendance at the dispensary for the following purposes:— 1. To rectify, as far as possible, any faulty or insanitary conditions prevailing in the homes. If necessary, these are reported to the Public Health Department for its co-operation. 2. To gain the confidence and good-will of the patients, and to show them and their relatives how the doctor's wishes as to fresh air, open windows, sleeping accommodation, disposal of sputum, diet, clothing, table utensils, disinfection and home isolation may be most simply carried out. For example, patients who live in dark basements are advised to move into the light upper stories. 3. To collect for examination from time to time specimens of the patient's early morning sputum, and to teach the patient how to use the clinical thermometer. 4. To collect information as to the social, economic and hygienic surroundings of the patients, for future reference by the Dispensary Medical Officer and for statistical purposes. No actual nursing is done by the dispensary nurse—this is left to nursing associations, to church nurses and to nurses supplied 108 by voluntary societies. As the nurse has to report on the sanitary condition of the tenements, it is desirable that she should hold a certificate of competency in sanitary matters. Voluntary Workers are capable of rendering great service in connection with the annexed details, more especially if the dispensary is insufficiently supplied with nurses: 1. On After Care Committees. 2. On Case Committees to discuss cases of poverty and of difficult home circumstances brought to the notice of the Dispensary Medical Officer. 3. The re-arranging of the work of members of the patient's family and finding suitable employment for adult patients. 4. Boot Clubs and Clothing Clubs. 5. Teaching simple cookery and the nutritive values of various food substances and adjusting the practical use of the instruction given to the patient's home and circumstances. 6. The visiting of dying patients. 7. The care and nourishment of older children. 8. The selection of children for apprenticing after leaving school. 9. Looking up patients who have not attended at the dispensary for some considerable time. Charitable and Philanthropic Agencies. Co-operation with these societies is most desirable. In many boroughs effective help has been rendered by the churches, chapels, missions, charity organisation society, hospitals, invalid kitchens, invalid children's aid association, poor law guardians, children's care committees, and nursing associations in connection with the following matters:— 1. The supply of extra beds so that the tuberculous patient may sleep by himself. 2. The provision of extra blankets and warm clothing. 109 3. Dinners for school children and nourishing food, milk and eggs for the patient. 4. Monetary allowances to the family until the children are old enough to work. 5. Subsidy by way of a loan to a family to enable them to pay arrears of rent and remove to a healthier neighbourhood and to a healthier house. 6. Nursing facilities for the patient and his family. 7. The treatment of enlarged tonsils, and the correction of diseases and deformities of the nose, throat and mouth interfering with the patient's progress. The provision of false teeth and the filling of decayed teeth. The surgical treatment of pleural effusions, of empyemata, and of tuberculous glands. Open Air Shelters.—These are wooden structures holding a narrow bed or fitted with a seat large enough to accommodate a mattress. The shelters are easily moved, easily taken to pieces, and allow of means of free ventilation which can be adjusted to varying wind directions. They cost from £7 to £15 each. In Paddington they have been made from old Church pews. They are adapted for open-air treatment; the patient lives and sleeps in them. They may be placed on flat roofs, on the leads, in backyards or in the garden. They are used for the following purposes:— 1. The after-treatment of patients discharged from a sanatorium. 2. The treatment of early cases who do not wish to give up their work in order to enter a sanatorium. 110 3. The treatment of advanced cases—to remove from the home circle a possible focus of infection. Several of the Metropolitan Borough Councils already supply shelters at the public expense for the use of phthisis patients within their boundaries. Power to do this is given by Article XIII. of the Public Health (Tuberculosis) Regulations, 1912. To sum up then, the Dispensary is meant to be a clearing house for tuberculous patients, and deals not only with the patient, but with the patient's whole family and home. The Dispensary may also, by giving popular lectures and by holding tuberculosis exhibitions, prove of very great value as an educational centre. At first the dispensary should be open each week for one or more afternoons for males, for one or more separate afternoons for women and children, and during one evening at least for those who, owing to their occupation, are unable to attend during the afternoon. The closest co-operation is sought between the Dispensary and local medical men. In general, it may be stated that no patient is seen by the Dispensary staff if he has a family doctor, or if he has attended a doctor within the previous three months, unless he has that doctor's consent in writing. Fitting and Equipment: Capital and Annual Outlay. The reasonable accommodation of a dispensary will include— Two rooms for the medical officer—one for the examination of patients, the other to be used as the Committee room and as the medical officer's sitting room. One room for the nurse. A laboratory. A weighing room to be used also as a waiting room. A dispensary to be used also as a store room. 111 Two caretakers' rooms. Making altogether an eight-roomed house. The estimates for fitting and equipping, based on the actual expenditure incurred in three other metropolitan dispensaries, are— £ Fitting up and altering the premises 150 Furniture and fixtures 120 Instruments and appliances 30 Making a total of £300 The staff will consist of— One Tuberculosis Officer £300 to £500 per annum. One Nurse £120 ,, One Caretaker £60 ,, The salaries paid to the Tuberculosis Officers in other Boroughs vary considerably. In Deptford, for example, he is paid a salary of £300 per annum, rising to £350 by annual increments of £25 on satisfactory service. The other annual charges are estimated as follows:— £ Rent, rates and taxes 80 Coal, lighting 40 Printing, stationery 25 Repairs and renewals 25 Uniform, insurance, postage, petty cash 30 Telephone 5 Drugs and tuberculin 100 Giving a Total of £305 In this estimate no provision is made for a clerk or for a dispenser. It is assumed that the dispensing and the correspondence will be done by arrangement between the medical officer and the nurse. The expenses may now be summarised:— Capital outlay, £300, Salaries and wages, £480 minimum, £680 maximum, Other annual charges, £310, 112 or, a Capital outlay of £300 and annual expenses ranging between £790 per annum as a minimum and £990 as a reasonable maximum. The net produce of a penny rate in the Borough is estimated to be £3,950. The provision of sanatorium beds is an essential constituent of every complete scheme, whether the dispensary be established at a hospital or under municipal control and management. In London these sanatorium beds will be provided for insured persons by the London County Insurance Committee. Power to extend this provision to the dependants of insured persons is given by Sec. 17 of the National Insurance Act, 1911. For other persons, and possibly for the dependants of insured persons, excluding poor law patients, it is probable that such provision will eventually be made by the London County Council. The present number of sanatorium beds available for treatment throughout the whole country is quite insufficient. During the last twelve years, 2,554 Finsbury residents have died from phthisis and 491 from other forms of tuberculosis, giving a total of 3,045 persons. Nor is this the complete record of the ravages due to this fell disease. There is every reason to believe that very many of the deaths entered on death certificates as due to bronchitis and pneumonia are really due to tuberculosis. Instances of such inaccuracies were given in the Annual Report for 1911. The addition of such make it probable that, during the years 1901-1912, at least 3,500 Finsbury residents have died from all forms of tuberculosis. And the tragedy of it all is that tuberculosis is in a very large measure a preventable disease and should be prevented. It is estimated that there are between 1,600 and 2,000 cases of phthisis actually living in the borough at the present time. 113 These figures show the magnitude of the problem of dealing with tuberculosis in Finsbury, and indicate the urgent necessity of sound, prompt, and energetic measures in suppressing the scourge. At the end of the year, the means eventually to be adopted were still under discussion. Street List of Phthisis Deaths and Notifications, 1904 1912. These records have been investigated and the deaths and notifications allocated amongst the various streets as follows:— For statistical purposes large blocks of tenement buildings have been detached from the streets in which they lie, and are enumerated separately. Street. Notifications. Deaths. Street. Notifications. Deaths. Affleck Street 15 12 Beckford Square 2 5 Albemarle Street — 2 Benjamin Street 5 3 Albert Street 6 8 Berkley Court 3 4 Albion Place — 1 Berkley Street 15 5 Aldersgate Street — 1 Berry Street 3 — Allen Street 5 3 Bowling Green Lane 5 1 Amwell Street 7 6 Brewer's Buildings 4 1 Ann Street 2 — Brewer Street 15 11 Ann's Place 2 1 Brewer Street North 1 1 Arlington Street 10 5 Brunswick Close 19 7 Attneave Street 6 5 Bunhill Row 2 1 Aylesbury Place 2 2 Busaco Street 20 17 Aylesbury Street 14 9 Buxton Houses 3 3 Baker Street 5 3 Buxton Street 5 3 Baker's Row 7 6 Castle Street 1 2 Baldwin Street 83 19 Cavendish Buildings 14 8 Baltic Street 5 2 Cayton Street 2 1 Banner Street 18 3 Central Street 32 17 Barnsbury Road 11 3 Chadwell Street — 4 Baron Street 14 9 Chapel Place — 1 Bartholomew Square 12 7 Chapel Row 4 7 Bastwick Street 50 37 Chapel Street 5 10 Bath Buildings 6 2 Charles Street 1 — Bath Street 3 5 Charlotte Place 5 2 114 Street. Notifications. Deaths. Street. Notifications. Death Charter Buildings 3 3 Elizabeth Place 1 - Chadwortk Buildings 4 4 Errol Street 2 1 Charterhouse Square 2 2 Europa Place 7 4 Charterhouse Street 1 3 Exmouth Street 5 1 The Charterhouse — 1 Farringdon Road 5 4 Chiswell Street 2 2 Farringdon Rd. Bldngs. 14 17 Church Row 4 5 Featherstone Street 2 - City Road 13 10 Field Place 2 - Claremont Mews 1 1 Finsbury Square — 1 Claremont Square 6 6 Fletcher's Row 4 4 Clerkenwell Close 1 8 Francis Court 6 5 Clerkenwell Green 51 18 Frederick Row 1 3 Clerkenwell Road 12 6 Frye's Buildings 1 — Cloudesley Road 1 2 Galway Street 22 18 Cobden Buildings — 1 Gastigny Place 7 6 Coburg Street 3 3 Gee Street 44 28 Coldbath Buildings 16 11 George Street 4 4 Coldbath Square 10 11 George Yard 5 8 Coleman's Buildings 11 11 George's Row 1 1 Collier Street 8 4 Gibson Houses 2 1 Compton Buildings 21 17 Glasshouse Chambers 2 1 Compton Passage 1 1 Glasshouse Yard 2 3 Compton Street 12 9 Gloucester Street 6 9 Corporation Buildings 20 9 Godson Street 6 7 Corporation Row 10 9 Golden Lane 1 — Costers' Dwellings 5 5 Goswell Place 1 — Cottage Lane 4 1 Goswell Road 26 19 Cowcross Street 2 3 Goswell Terrace 3 8 Cowper Street 1 1 Granville Square 8 7 Crawford Passage 6 4 Granville Street 1 — Cumberland Terrace 1 2 Great Bath Street 9 9 Cumming Street 28 18 Great Percy Street 11 14 Cynthia Street 7 5 Great Sutton Street 5 4 Cyrus Street 26 12 Guinness' Buildings 16 2 Dingley Street 16 8 Hall Street 7 7 Domingo Street — 2 Hallett's Place 9 7 Donegal Street 16 10 Hardwick Street 3 2 Douglas Place 3 — Hat and Mitre Court 1 2 Dundee Buildings 4 — Hatfield Street 19 10 Eagle Court 4 1 Hayward's Place 6 1 Eagle Dwellings 4 2 Helmet Row 13 9 East Place 3 — Henry Street 1 — Easton Place 7 4 Hermes Street 15 8 Easton Street 14 10 Hewitt's Buildings 2 — Edmunds Place 1 - High Street 3 1 115 Street. Notifications. Deaths. Street. Notifications. Deaths. Holford Square 5 2 Muriel Street 1 2 Honduras Street 3 1 Murton Street 7 10 Howard's Place 7 3 Myddelton Square 6 2 Ironmonger Passage 1 1 Myddelton Street 18 6 Ironmonger Row 15 11 New Buildings 1 — Ironmonger Street 16 12 Newcastle Row — 1 James Street — 1 New Charles Street 5 3 Jay's Buildings 2 1 New Street 6 3 John's Place 1 1 Noble Street 31 11 Jerusalem Passage 3 — Norman Buildings 9 11 King's Cross Road 15 6 Norman Street 1 l Lamb's Buildings 4 1 Northampton Building 39 33 Langton Avenue 1 1 Northampton Road 26 13 Langton Street 2 2 Northampton Row 5 3 Leage Street 9 4 Northampton Square 7 7 Lever Buildings 1 — Northampton Street 31 17 Lever Street 29 15 Norway Street 3 2 Lewin's Court 2 3 Old Street 87 27 Little Northampton St. 13 9 Owens Row 2 4 Little Saffron Hill 3 4 Parr's Place — 1 Little Sutton Street 19 13 Paton Street 1 2 Lizard Street 7 10 Paul Street — 1 Lloyd Square 2 3 Lloyd Street 1 2 Peauody Buildings 90 59 Lloyd's Row 10 5 Dufferin Street 20 16 Lock's Gardens 3 1 Errol Street 9 9 Lorenzo Street 2 — Farringdon Road 15 10 Lower Charles Street 1 — Guest Street 12 5 Ludlow Street 5 4 Roscoe Street 34 19 Macclesfield Place 2 1 Peartree Street 5 1 Macclesfield Street 13 6 Peerless Buildings 7 8 Macclesfield Terrace 2 — Peerless Street 18 14 Malta Street 6 3 Penny Bank Buildings 1 1 Mantell Street 3 1 Penton Place 14 6 Margaret Place 2 — Penton Residences 2 2 Margaret Street 47 29 Penton Street 12 9 Market Buildings 5 6 Pentonville Road 48 27 Mason's Place 3 — Percival Street 9 10 Medcalf Place 1 — Percy Circus 2 1 Memel Street 6 5 Percy Square 1 1 Meredith Street 9 5 Peter's Lane 1 — Merlin's Place 6 2 Pickard Street 2 1 Mitchell Street 24 19 Pine Street 8 7 Mitre Court 1 — Playhouse Yard 1 2 Moreland Street 9 7 Pollard Houses 1 3 116 Street. Notifications. Deaths. Street. Notifications. Deaths. Powell Street 6 3 Smithfield Buildings 3 3 President Street 8 8 Smith Street 11 6 Prospect Row 2 2 Southampton Street 19 18 Pump Court 6 2 Southern Street 1 — Radnor Street 28 15 South Place 1 1 Radsworth Street 2 2 Spa Cottages 3 1 Rahere Street 21 19 Spencer Street 9 10 Rawstorne Street 7 4 Stewart's Place — 2 Ray Street — 1 Thomas Place 6 7 Red Lion Market 1 1 Tilney Court 4 — Red Lion Street 21 17 Turnmill Street 1 — Richard Street 5 3 Tysoe Street 4 4 Richmond Street 8 5 Union Place 4 4 Risinghill Street 49 30 Union Square 1 — River Street 5 — Upper Ashby Street 5 1 Rodney Place 3 — Upper Smith Street — 1 Rodney Residences 3 2 Upper Charles Street 1 — Rodney Street 21 19 Upper Vernon Street 1 — Roscoe Street 2 2 Upper Yardley Street 2 2 Rosebery Ayenue 7 10 Valetta Street 2 — Rosoman Street 26 10 Vernon Square 1 2 Royley Street 1 1 Victoria Dwellings 34 18 Rydon Crescent 1 — Vineyard Gardens 6 3 Sadler's Buildings — 1 Vineyard Walk 5 7 Sadler Street 14 3 Warden's Court 7 3 St. Bartholomew's Warner Street 4 3 Buildings 45 34 Warren Mews 1 1 St. Clement's Buildings 6 3 Warren Street 30 7 St. Helena Street 44 30 Warwick Place — 1 St. James' Street 5 4 Waterloo Street 16 7 St. James' Walk 6 2 Wellington Place 4 1 St. John's Lane 14 6 Wenlake Buildings 7 3 St. John's Square 5 1 West Place 11 2 St. John Street 32 27 Weston Street 5 3 Salisbury Buildings 1 — Wharf Road 1 2 Sans Walk 2 1 Wharton Street 6 5 Seabrook Place 5 2 Whiskin Street 9 10 Sekforde Street 6 4 White Conduit Street 8 2 Seward Street 5 3 White Cross Street 14 10 Seymour Place 2 — White Horse Alley 9 9 Shrewsbury Court 2 — White Lion Buildings 3 2 Sidney Grove 4 — White Lion Street 45 25 Sidney Place 4 2 William Street 5 3 Sidney Street 10 8 Wilmington Place 11 6 Skinner Street 11 2 Wilmington Square 11 8 117 Street. Notifications. Deaths. Street. Notifications. Deaths. Wilmington Street 1 3 Woodbridge Street 12 12 Wilson Street 1 1 Wynford Road 10 14 Winchester Cottages 1 — Wynyatt Street 17 15 Winchester Street 9 6 Yardley Street 2 2 Winton Houses 3 1 Withers Place 2 3 Unplaced 53 Totals : Notifications 2,749 Deaths 1,885 GLANDERS AND ANTHRAX. Both these diseases in men are notifiable in London to the Medical Officer of Health of the local authority under orders of the London County Council, made in pursuance of Sections 55 and 56 of the Public Health (London) Act. Outbreaks amongst animals are notified to the Medical Officer of Health concerned, by the London County Council Veterinary Inspector of the Public Control Department. The premises are disinfected, and precautionary measures carried out under the supervision of the County Council staff. In 1912, notice was received of an outbreak of glanders in a mews in the Borough and of one case of anthrax in a horse. One case of anthrax occurred in a workman employed in a Finsbury factory. It was associated with the taking up of the old wooden floor of the storage room and the laying of a new floor. The woodwork was well soaked with a resinous disinfectant before being disturbed. However, the application proved insufficient. It is possible that these resinous disinfectants are not in practice effective for dealing with anthrax spores. The resin is precipitated around the spores and tends to protect them from the destructive action of the disinfecting solution. 118 Possibly if the floor were scoured with boiling water containing ordinary washing soda, the result would be better. Similar precautions might be adopted for dealing with hair, though in this case, the effect of the soda might be to soften the hair and to lessen its commercial value. YELLOW FEVER, PLAGUE AND CHOLERA. The names and Finsbury addresses of oversea contacts with cases of these diseases are sent to the public health department by the medical officers of health of the various ports of entry in the United Kingdom. These contacts in Finsbury are then visited periodically and kept under supervision by the public health staff for varying periods, ft has been pointed out in previous reports that this supervision is often thwarted by the incorrect addresses sent. Other cases of failure have been: the use of an accommodation address; the rapid and covered movements of the contacts and the refusal of information by the hotel keepers concerned. One yellow fever contact arrived in the Borough in 1912 and gave an incorrect address. No notices were received of plague or cholera contacts. CEREBRO-SPINAL FEVER. POLIO-MYELITIS AND POLIO-ENCEPHALITIS. These diseases have been made notifiable by an order of the London County Council, dated March 9th, 1912, to come into operation from and including March 13th, 1912. For notification purposes, posterior basal meningitis is included in the term "cerebrospinal fever." This term, however, is not to include cases of meningitis due to tuberculosis, syphilis, middle ear disease or injury. One notification was received of cerebro spinal fever, three of polio myelitis. 119 They were all investigated—two of the tenements were dirty and verminous, the others were clean. No source of infection was found. Three of the patients had recently had measles SMALL-POX. No case of small-pox was notified in Finsbury in 1912. The Medical Officer of Health was asked to see one case suspected to be small-pox. It proved to be a case of chicken-pox. Notices were received from Port Medical Officers of 10 oversea small-pox contacts proceeding to Finsbury. One gave an incorrect address, but was eventually traced. They were all visited daily until the incubation period was well passed. MEASLES AND HOOPING COUGH. Measles.—This disease is not notifiable. In 1912 notice of 625 cases was received from the London County Council Education Department, from head teachers of schools, from school visitors, from doctors, from other borough councils, from relieving officers, from registrars of births and deaths, from sanitary inspectors, superintendents of dwellings, and from parents and guardians. The sections of the Public Health (London) Act, 1891, which refer to the cleansing and disinfection of premises and materials, and to contact with, or exposure of, infected persons and things, have been extended to measles. These are Sections 60-65, 68-7C, and 72-74. By the Metropolitan Asylums (Measles) Order, 1911, dated May 30th, 1911, the hospitals of the Metropolitan Asylums Board were made available for the reception of non-pauper cases of measles. 120 The age incidence and the ages at death from 1903 to 1912 are shown in the subjoined table:— Age Incidence of Cases of Measles, 1903-1912. Under 1 year of age in months. 1- 2- 3- 4- 5-10 10-15 Total 1903-1912. 0-3 3-6 6-9 9-12 3 43 117 170 679 644 808 1,183 2,314 71 6,032 The disease was very prevalent towards the end of 1912. The actual numbers notified year by year were:—577, 802, 561, 1,036, 478, 245, 436, 898, 384, and 625 from 1903 to 1912 respectively. Ages at Death in Cases of Measles, 1903-1912. Under 1 year of age in months. 1- 2- 3- 4- 5-10 10-15 Total 1903-1912 0-3 3-6 6-9 9-12 3 14 56 90 331 114 73 21 19 8 729 The deaths year by year were 69, 60, 31, 115, 43, 38, 86, 73, 85, and 129 from 1903 until 1912. The largest number of cases and deaths were in 1906, when the disease was very prevalent. The cases are visited by the Lady Sanitary Inspector, who gives the parents suitable advice as to nursing and feeding the patients. A leaflet of instruction is left at the house, and dispensary tickets given for those children needing treatment. The dirty tenements are disinfected at the end of the case. The rooms were disinfected in 146 tenements. From 1909 to 1912 deaths from measles occurred chiefly in the 121 following streets :—Albert Street (5), Amias Place (5), Baker's Row (8), Baldwin Street (11), Bastwick Street (9)., Coldbath Square (6), Cumming Street (7), Donegal Street (11), Gee Street (5), Guinness Buildings (8), Lever Street (6), Margaret Street (7), Mason's Place (6), Nelson Street (5), Northampton Buildings (5), Peerless Street (5),. Risinghill Street (6), St. Bartholomew's Buildings (5), St. Helena Street (8), Victoria Dwellings (5), Warren Street (8), and White Lion Street 5 deaths. Hooping Cough.—This is not a notifiable disease. Information of cases is generally received from schools and from the other bodies and persons who send notices of measles. The deaths numbered 31 ; all except one were under five years of age. Disinfection is done on request: it is not done as a routine after recovery. The hospitals of the Metropolitan Asylums Board are now available for the reception of non-pauper cases as well as of pauper cases of hooping cough. From 1909-1912, the deaths have chiefly occurred in Ann Street (3), Collier Street (3), Donegal Street (5), Guinness Buildings (3), Hatfield Street (3), Hermes Street (6), Lever Street (3), Northampton Buildings (3), Peerless Street (4), Penton Place (3), Penton Street (3), Risinghill Street (3), Rodney Street (3), Southampton Street (3), St. Bartholomew's Buildings (3), and White Conduit Street 3 deaths. Comparative Table.—In 1912 Measles caused 129 deaths hooping cough 31 deaths. These two diseases are very fatal to children under 5 years. The following table compares the deaths in children under five years from measles and hooping cough with the deaths from other infectious diseases. 122 Deaths in Children under 5 years—1901-191 2. Year. Measles. Hooping Cough. Small Pox. Scarlet Fever. Diphtheria. Enteric Fever. 1901-5 278 211 13 53 80 — 1906-10 347 202 — 39 80 1 1911 82 26 — 4 14 — 1912 124 30 — 4 12 — Totals 831 469 13 100 186 1 From this table it appears that the deaths in 12 years due to scarlet fever, diphtheria, enteric fever, and small-pox, all taken together numbered 300, to hooping cough 469, to measles 831. In children under five years, therefore, it is seen that measles kills more than twice the number of children whose deaths are caused by small-pox, scarlet fever, diphtheria, and typhoid all included. Hooping cough causes a little more than one-and-a-half times the number of deaths accredited to the other four named infectious diseases. SCARLET FEVER. The number of notifications, 159, and the number of deaths, 5, are, with the exception of 1910, less than they have been in any previous year since the Borough was formed. With the exception of 9 cases, all the rest, 150 in number, were in children between one and fifteen years. The deaths were 315 per cent, of the total number of cases, or one in every 32 children affected died. Four cases were treated at home; suitable measures were taken to ensure the isolation of the patient. 123 The rest, 155, were treated in hospital. The particulars with regard to previous years are appended. Scarlet Fever, 1901-1912. 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 48.9 1.8 1902 381 15 3.9 38.1 1.5 1903 283 12 4.2 28.7 1.2 1904 323 17 5.2 33.2 1.7 1905 456 21 4.6 47.5 2.1 1906 422 13 6.1 44.6 1.3 1907 471 16 3.4 50.5 1.7 1908 387 12 3.1 42.1 1.3 1909 231 9 3.89 25.5 .9 1910 126 4 3.17 14.1 .4 1911 171 6 3.5 19.5 .6 1912 159 5 3.15 I8-4 .58 Probable Sources—In 23 cases the infection was derived from previous cases in the same families, in another 2 the disease had been contracted from mild unrecognized cases in the affected households. Three were examples of school infection, four were caught from playfellows in the street. Four had been infected when visiting or being visited by friends or relatives. Two cases were not discovered until 17 and 19 days after the rashes had appeared. The patients were then peeling. They were mild missed cases that had apparently only suffered from slight headaches and sore throat, which their parents attributed to the "heat." Nine developed scarlet fever while detained in 124 hospital for other causes. These are called cross infections and occur when a patient is being treated in hospital for one disease, say measles or hooping cough, and contracts another disease, e.g., scarlet fever or diphtheria, from some other hospital patient. Unfortunately, they occur in nearly all fever hospitals and point to serious flaws in their administration. All the houses where cases occurred were visited and inspected. Nuisances that called for remedy were made the subject of notice and amendment. The rooms, the bedding and the clothing were disinfected. There were two return cases. Cases discharged for Home.—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. Special attention is paid to children who develop a discharge from the nose after their return home, to children with adenoids, and to children with sores on their lips and their faces. Eighteen such cases were kept under the supervision of the Medical Officer for periods varying from one to three months before they were certified as being free from infection and fit to resume school attendance. The cases examined alter their return home from fever hospitals had the following complications : enlarged neck glands 26, general weakness of limbs 19, discharge from' nose 15, sores on lips, face, mouth, or nostrils 2, conjunctivitis 5, discharge from cars 2, peeling on hands or feet 2, sore throat 4, and shortness of breath 19 cases. DIPHTHERIA. The number of cases notified was 163. Of these, 15 were subsequently sent home as not suffering from diphtheria, leaving 148 true cases. 125 There were 14 deaths, so that 9.4 per cent. of all the patients died. The number of cases is 11 less than last year, the number of deaths 3 less. The particulars of cases in previous years are appended :— Diphtheria, 1901-1912. 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 28.5 3.5 1902 216 37 17.1 21.6 3.7 1903 119 12 10.1 12.0 1.2 1904 123 14 11.4 12.6 1.4 1905 126 11 8.7 13.1 1.1 1906 151 25 16.5 15.9 2.6 1907 127 15 11.8 13.6 1.6 1908 130 16 12.3 14.1 1.7 1909 152 13 8.5 16 .8 1.4 1910 126 19 15 .1 14.1 2.1 1911 159 17 10.7 18.1 1.9 1912 148 14 9.4 17.1 1.6 All the cases are investigated, and the source, if possible, is ascertained. The premises are inspected and notices served for sanitary defects. Sources of Infection.—In 15 instances the disease was contracted from members of the same family known to be already suffering from diphtheria, in 3 others from missed or unrecognised cases which had occurred in the household. Nine patients were infected by hospital patients after they had been admitted to hospital suffering from various diseases other 126 than diphtheria. In this connection three diphtheria patients caught scarlet fever in hospital. These cross infections have already been referred to in the section devoted to scarlet fever. Three patients were infected with diphtheria from playfellows. Two caught the infection on visits to people in the country. Six developed the disease after recent attacks of measles. The association between the two diseases, measles and diphtheria, is often a close one. There were 3 return cases. Cases discharged cured from Hospitals.—A few days after their arrival home from fever hospitals, all patients are examined very carefully and a record kept of their condition. A leaflet is given to the parents, its terms explained, and precautionary measures are advised. If a child has a discharge from the nose, or if for any other reason the infection is believed to persist, the mother is advised to take the child to her own doctor, or if poor to bring it to the public health department. The conditions found amongst these convalescent patients after their return home are shown below :— Neck Glands enlarged 19 Nasal Discharge 20 Nasal Voice (Paralysis of Palate) 7 Sore Nostrils 1 Ear Discharge 1 Conjunctivitis 21 Anaemia 12 Sore Throat 5 Difficulty of swallowing 1 Vomiting 2 Weakness of limbs, probably slight paralysis following diphtheria 12 Shortness of breath 13 Rashes, possibly due to the use of anti-toxin serum 1 It is quite possible that some of the cases in the above list were discharged from hospital rather a little too soon. Eleven of the cases referred to were examined by the Medical Officer of Health, and swabs taken from their throats. In seven of these the diphtheria bacillus was still present. The cases were kept under supervision and excluded from school until they were considered to be free from infection. 127 Throat swabs are examined bacteriologically free of charge for medical men by the Public Health Department, 89 were submitted in 1912, and in 22 specimens the diphtheria bacillus was found present. A supply of diphtheria antitoxin serum is kept at the public health office and is available gratis for doctors on request. TYPHOID FEVER. In 1912 only 8 cases were notified, and only one patient died of typhoid fever. These figures are the lowest yet recorded since the borough was formed. The numbers in previous years are given in the accompanying table:— Enteric Fever, 1901-1912. 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 1.08 1902 77 9 11.7 7.7 0.9 1903 47 11 23.4 4.7 1.1 1904 40 8 20.0 4.1 0.8 1905 42 9 21.4 4.3 0.9 1906 44 14 31.8 4.6 1.4 1907 22 2 21.0 2.3 0.2 1908 41 12 29.2 4.4 1.3 1909 15 3 20.0 1.6 0.3 1910 28 4 14.3 3.1 0.4 1911 74 9 12.2 8.4 1.02 1912 5 1 20.0 0.58 0.11 128 Of the 8 cases, 2 after admission to hospital were found not to have typhoid fever, one other had typhus fever. With these omissions only 5 cases of typhoid fever occurred in Finsbury last year. Sources of Infection. - The first case was an unrecognised one in a patient who died while being removed to hospital. He had been medically treated for " influenza and debility," and had kept at his work until a few days before his death. He had stayed in the country a fortnight before his illness became acute, but no actual source was discovered. One of the other cases was infected in a country village, where it had been sent by the promoters of a holiday fund. The other three patients had contracted the disease by eating shell fish taken at the seaside from fouled estuaries. In one such case, notices were displayed on the sea shore warning visitors against eating the shellfish as they were laid in sewage polluted water. All cases of typhoid fever on their discharge from hospital are visited and examined. A leaflet of instruction is left with them and special attention is directed to its more important clauses, which are orally explained at some length. The faeces and urine are examined bacteriologically only in those patients discharged for home where there is some evidence or suspicion which points to their acting as typhoid carriers. Measures.—The measures adopted were chiefly those set out in last year's report with the following additional details :— 1. A list of the patients' friends who accompanied them on the seaside excursions was obtained from school teachers. Leaflets of instruction were distributed to these contacts in school. Their families were visited and kept under supervision. Letters of information were sent to the various Medical Officers of Health when the patients lived in other boroughs. 129 The contacts that were ailing were referred to their own doctors and the results of the medical examination afterwards ascertained. 2. Information was sent to the Medical Officer of Health of the borough in which one of the patients worked. 3. Search was made in the affected tenements and houses for missed and unrecognised cases possibly being wrongly regarded as cases of pneumoniae diarrhcea, liver complaint or "influenza." 4. Enquiry was made at the addresses of the patients for probable "carriers" who might have had typhoid fever in previous years. 5. Infectious bedding was removed into another borough before it had been disinfected. Information was sent to the Medical Officer of Health concerned. 6. School children in the affected schools, absent for illdefined causes, were visited and referred for medical examination and treatment. Diagnosis.—Specimens of blood from suspected cases of typhoid fever are examined free of charge for medical men by the Public Health Department. The examinations are conducted at the Bacteriological Laboratory of the Middlesex Hospital. In 1912, four specimens of blood were reoeived—one gave a positive Widal reaction, the rest were negative. TYPHUS FEVER. A case of this rare disease, formerly known as ship fever, hulk fever, and gaol fever, occurred in Finsbury in 1912. The patient was a married woman, 39 years old, who had lived in Pentonville for the two years which preceded her death with the exception of 3 weeks in August, 1911. She was a laundress ironer in a Holloway laundry. Her illness began with vomiting and diarrhcea thirteen days before her death. The case was first notified as one of typhoid, but suspected to be typhus soon after her admission to hospital. This suspicion was confirmed by a post mortem examination which disclosed no evidence of typhoid. No source of infection was discovered for the original 130 case. The Finsbury contacts were kept under supervision. Information of other contacts was sent to the Medical Officers of Health. No further cases occurred. INFECTIOUS DISEASES. General Considerations.—The notifiable diseases named in Section 55 of the Public Health (London) Act, 1891, are small pox, cholera, diphtheria, membranous croup, erysipelas, scarlet fever, typhus, enteric, relapsing, continued and puerperal fevers. Cerebro-spinal fever, posterior basal meningitis, polio-myelitis, polio-encephalitis, ophthalmia neonatorum, glanders, anthrax, and hydrophobia in man are likewise notifiable in London by an order of the London County Council, made under Sections 55 and 56 of the Public Health (London) Act. Sections 60-65, 68-70, 72-74 of the same Act, referring to the cleansing and disinfection of premises and materials, and to contact with, or exposure of infected persons and things have been made applicable to measles. Measles and hooping cough are not notifiable. All cases of pulmonary tuberculosis have been made notifiable by the Public Health (Tuberculosis) Regulations, 1911, of the Local Government Board. Outbreaks of glanders and anthrax are notifiable to the Health Authority by the Inspectors appointed under the Diseases of Animals Act, 1894, in pursuance of the provisions of the Anthrax Order, 1899, and of the Glanders and Farcy Order, 1907, of the Board of Agriculture. Cases of anthrax, or poisoning by mercury, arsenic, lead and phosphorus, must be notified to the Chief Inspector of Factories, Whitehall. Notifications.—The notifications of infectious disease received in 1912 were as follows:—Small pox none (none), scarlet fever 159 (170) diphtheria 133 (159), cerebro spinal fever 1 (2), typhoid 131 fever 8 (74), erysipelas 143 (223), puerperal fever 12 (4), ophthalmia neonatorum 7, polio myelitis 7, and typhus fever one case. The figures in brackets refer to the year 1911. The numbers for previous years are appended:— Notifications of Infectious Disease, 1901-1912. 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 10.2 82.4 1903 566 5.7 78.8 1904 609 6.2 72.5 1905 745 7. 7 81.8 1906 764 8.08 76.9 1907 735 7.8 83.4 1908 654 7.1 83.6 1909 534 5.9 74.7 1910 455 5.1 63.5 1911 640 7.3 61 .4 1912 467 5.4 72.1 The above table excludes notifications of Chicken-Pox—there were 203 in 1907 and 181 in 1911. The amount paid in fees this year for notifications of infectious disease was £41 12s. 6d., and is the lowest yet recorded. The highest was £175 16s. 0d., in 1902, at the time of the small pox epidemic. The sums paid for notifications of phthisis were, Poor Law, £22 15s. 9d.; private doctors and members of hospital staffs, £34 19s. 6d. The fees paid under the Diphtheria Antitoxin (London) Order, 1910, amounted to £5 7s. 6d. Diagnosis.—In 21 cases out of a total number of 321, the patients after admission to a fever hospital were returned home as not suffering, at the time of admission, from any notifiable infectious disease. 132 Thirty-three per cent. of these mistakes were made at the large general hospitals. The errors were chiefly in connection with diphtheria—out of 148 cases removed, 15 were returned home as not having the disease. The diagnosis of typhoid fever was sustained in hospital except in 2 cases. Four cases of scarlet fever were returned home as incorrect. Deaths—The number of deaths certified in 1912 as due to the infectious diseases named in the accompanying table, was 226. The corresponding death rate was 2.6 per 1,000 inhabitants. Deaths from Infectious Disease, 1901-1912. 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 — 16 15 2 1 43 44 66 187 1908 — 12 16 12 3 38 22 126 229 1909 — 9 13 3 2 86 51 68 232 1910 — 4 19 4 6 73 36 50 192 1911 — 6 17 9 3 85 27 152 299 1912 — 5 14 1 4 129 31 42 226 The diminution this year is associated with the lessened number of deaths accredited to diarrhœa and enteric fever. 133 DISINFECTION. In Finsbury there are two disinfecting stations—one at 49, Northampton Road, Clerkenwell, and the other at Warwick Place, Whitecross Street, St. Luke. At each station there is a mortuary and a coroner's court. The Warwick Place station was closed towards the end of the year. At 49, Northampton Road, provision is made for the housing and accommodation of families during the disinfection of their premises after infectious disease, and for the reception of smallpox contacts during the incubation period. It was used in 1912 by one family from Finsbury (4 persons) and three families from Holborn (14 persons). The Holborn Metropolitan Borough is allowed to use this shelter by an agreement made between the two boroughs, dated October 4th, 1911, and terminable at the pleasure of either Council. The Borough has two steam disinfectors—a Washington-Lyons high-pressure steam apparatus and a Thresh current steam machine. During the year, 1,197 separate rooms were disinfected, of which 146 were for measles, 118 after notifications of phthisis, 68 after deaths from phthisis, 38 on account of vermin, and 8 on request. In addition, bedding and mattresses were steam disinfected for the following institutions:—The City of London Lying-in Hospital, the Claremont Hall Crfeche, St. Barnabas' Home, St. Mark's Hospital, and White Lion Street School. Altogether 5,509 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, 3,165 articles of wearing apparel were disinfected for city firms at a price agreed upon, prior to exportation to South Africa. PROTECTION OF FOOD SUPPLY. General Considerations.—Each of the five district inspectors is responsible in his own district for the inspection on foods, of bakehouses, restaurants, or restaurant kitchens, of fried 134 fish shops, of ice cream shops, and generally of all places used for the preparation of food for human consumption. The three street markets are kept under close supervision and are continuously and specially inspected throughout the year on every Saturday evening and Sunday morning. The latter duty is done by every inspector in turn. Each inspector takes samples under the Sale of Food and Drugs Act in his district. These purchases are nearly always made by deputy. Meat and Food Inspection.—The Borough Council have appointed Mr. Billing as a special meat inspector to inspect systematically butchers' shops, food stuffs, shops for food preparation and cold stores throughout the whole district. In addition he pays special attention to the meat deliveries in the wholesale market in Charterhouse Street,, St. John Street, and Cowcross Street, all adjacent to Smithfield Market. Each district inspector holds a certificate of competency in meat inspection. The attached table is a summary of the diseased and unsound meat and offal confiscated during the year ending 31st December, 1912. All the unsound 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 market stone of eight pounds for all the meat removed. There was one case of some interest. Information was received from the police that a cow had died in a Finsbury shed. The premises were visited and the carcase was found to be that of an aged cow, well nourished, well bled, roughly dressed and dirty. The lungs and many of the lymphatic glands were tuberculous. The cow had been unwell for two days, and was thought to be choked. A probang was used and the cow seemed to improve. Later it got restless and was killed "to save its life." The carcase and offal were removed to the destructor and burnt. 135 Diseased and Unsound Meat Confiscated in 1912. Diseased. Sides of Beef 24 Beef Spleens 3 Quarters of Beef 94 Sheep's Livers 29,286 Carcases of Mutton 1 Lungs 2,478 „ Veal 1 ,, Plucks 7 ,, Stirks 8 ,, Heads 4 „ Pork 7 Pig's Plucks 65 Beef Livers 3,376 ,, Mesenteries 5 ,, Lungs 2,801 ,, Omentums 15 ,, Heads 58 ,, Spleens 7 „ Tongues 68 Stirk's Liver 6 ,, Hearts 2 ,, Plucks 4 „ Tripes 2 Tons. Cwts. Qrs. Lbs. Total Weight 74 1 0 19 Decomposed. Quarters of Beef 24 Sheep's Heads 539 Pieces of Beef 85 ,, Plucks 372 Carcases of Mutton 13 „ Livers 1,342 Pieces of Mutton 113 ,, Kidneys 206 Carcases of Lamb 4 Bags of Sheep's Offal 4 Pieces of Lamb 14 Calves' Plucks 46 Carcases of Deer 9 ,, Heads 5 ,, Veal 25 Pigs' Plucks 46 Pieces of Veal 11 ,, Livers 52 „ Pork 16 „ Mesenteries 150 ,, Bacon 15 Cases of Sheep's Sweet-breads 36 Beef Lungs 8,202 ,, Kidneys 44 ,, Livers 927 „ Livers 4 „ Hearts 29 Barrels of Pigs' Plucks 28 „ Heads 52 „ ,, Kidneys 4 Tongues 255 ,, „ Chitterlings 32 „ Tails 111 Turkeys 205 „ Tripes 10 Pheasants 12 ,, Kidneys 50 Partridges 8 ,, Heels 40 Ptarmigan 12 ,, Spleens 5,123 Hares 3 Cases of Beef Kidneys 86 Ducks 164 ,, Tails 18 Cases of Rabbits 161 ,, Skirts 2 „ Eggs 17 ,, Livers 9 Barrels of Grapes 24 ,, Cheeks 6 Boxes of Skate 2 „ Tongues 44 Railway Truck load of Cabbage 1 Tierces of Beef Casings 2½ Tubs of Strawberries 83 Hampers of Mixed Offal 8 ,, Raspberries 83 Tons. Cwts. Qrs. Lbs. Total Weight (Decomposed) 82 13 2 18 Total Weight (Diseased) 74 1 0 19 Grand Total Weight 156 14 3 9 136 The largest amount of meat confiscated was 213 tons in 1911. Australian Beef.—During the year, 10,729 hindquarters of frozen Queensland beef were delivered to the various Finsbury cold air stores. The "worm nests" had been extirpated by cutting out from the carcases the parts adjacent to the stifle joints prior to exportation. Prosecutions.—There were no prosecutions in respect of unsound meat in 1912. The butchers' shops, the provision shops and the street stalls were regularly and critically inspected. There was a general shortage of meat for human consumption. Since 1901, there have been 103 meat prosecutions, with 99 convictions. The largest number was 24 in 1901, with 24 convictions. During this period the meat confiscated has amounted to 1,304 tons. In recent times the average number of prosecutions has been three yearly. 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 meat food products for export to the Argentine Confederation, to the United States of America, and to the Phillipine Islands. Six certificates were granted in 1912 to Messrs. Bovril, Ltd., 152 to 166, Old Street, Finsbury, E.C. Sausage Manufacturers.—There are 20 sausace makers in the borough. Their names and addresses are attached. Mr. A. Robinson, 30, Chapel Street. Mr. T. Allright, 50, Chapel Street. Messrs. C. & E. Goebbles, 93, Chapel Street. Mr. G. Cowley, 59, Chapel Street. Messrs. Barnett & Co., 29, Exmouth Street. Mr. E. Kusch, 55, Exmouth Street. Mr. J. Larkcom, 13, Exmouth Street. 137 Mr. Domicio, 30, Great Bath Street. Mr. G. Sauer, 229, Goswell Road. Mr. H. S. Collingwood, 96, King's Cross Rowd. Mr. G. F. Mobbs, 14, Penton Street. Mr. YV. Harris. 3, St. John Street. Messrs. Lemming & Sons, 138, St. John Street. Messrs. H. Hearne, 152, Whitecross Street. Mr. VV. Rutter, 179, Whitecross Street. Mr. R. Firmin, 141, Whitecross Street. Mr. H. N. Spencer, 96, Central Street. Mr. J. Ching, 93, Central Street. Mr. A. Rdfe, 28, Bath Street. Mr. A. Morris, 31, Aylesbury Street. Seven of the above make sausages in the shop itself, seven in the basement, and six in the rear of the shop. In the manufacture, the meat is denuded of bones and cartilage. The glands are not removed. The " head meat " is generally used, but not the heart, lungs, liver, kidneys, spleen, or tongue. The meat is cut up line and put into a chopping machine. Bread, and seasoning (salt, pepper, thyme, mace) are added to the contents of the machine while the chopping is in progress. Some makers use in addition to, or as a substitute for bread, ground rice, boiled rice or " farina " (meal). The finely divided mass is placed in a sausage filling machine, over whose nozzle the casing is carefully threaded. Hog's casings (derived from the small intestines) are mostly used at the present day. The sheeps' casings do not, in actual use, attain the same convenient lengths, but are likely to break off short. The difference between the two varieties is probably due to the fresher character and more abundant market supply of pigs' intestines. The sheeps' casings are kept too long in a solution and are apt to decompose and to become friable at inconvenient length intervals. In filling the casing, the end is pinched by the fingers at the 138 outset to prevent leakage: later the filling progresses automatically. The lengths are weighed into pounds as the filling proceeds, cut off and pleated or twisted, each pound length into six sausages. In Finsbury these shops are subject to very frequent and acute inspection. The sausages are chiefly of pork and beef. When pork is dear and veal cheap, some veal may be worked in with the pork. There is no fixed test or measure for a sausage: there is no standard sausage. In Finsbury good wholesome meat and good bread are used even in the poorest parts of the borough. In some parts of London it is stated to be customary to introduce into sausages stale and discarded bread and bread pieces bought from restaurants or derived from religious orders, and collected by their officers from large town houses and hotels. Apart from the undesirable previous handling of such bread, the use of stale bread is likely to make the sausage prematurely sour and decomposed. Its use is not countenanced or favoured in Finsbury. One maker in the borough uses eggs in sausage making and has been known to incorporate venison and sweetbreads into the sausage meat. Retail Dealers in Cats Meat.—There are sixteen in the borough, 7 sell from street stalls, 9 from shops. Their names and addresses are as follows:— Mr. H. Pruden, 31, Costers Dwellings. Mr. J. Cathercole, 60, Whitecross Street. Mr. A. Clayton, 10, Fann Street. Mr. W. Simmons, 55, Whiskin Street. Mr. F. Ward, 9, Hallett's Place. Mr. W. Collett, 3, Charlotte Place, Baron Street. Mr. A. Hooper, 27, Warren Street. Mrs. Telford, 31, Penton Street. Mr. J. W. Gardner, 35, Donegal Street. Mr. H. J. Beckett, 72, Lever Street. Mrs Wood, 77, Bastwick Street. Mr. E. A. Eastop, 35, Central Street. 139 Mr. T. Williams, 31, Lloyds Row, Mr. T. Downs, 5, New Charles Street. Mr. F. Joy, 4, Sydney Street. Mr. W. Bailey, 31, Baldwin Street. All the above deal exclusively in horse flesh for cats' meat, they do not sell meat for human consumption. A few years ago in another metropolitan borough the question was asked, what becomes of horse tongues? In Finsbury at all events, they are daily exposed for sale by cats' meat vendors. With every purchase of horse flesh from a wholesale dealer it is customary for the retailer in Finsbury to receive, as part of his purchase, pieces of horses' heart, tongue, liver and kidneys. Street Markets.—These are three in number, and are situated in the following streets and in the side streets which lead out of them:—Chapel Street, Pentonville; Exmouth Street, Clerkenwell; and Whitecross Street, St. Luke's. The barrows, shops and food stalls in these streets are regularly inspected on week-days by the Inspectors in whose districts they lie, and on Saturday nights and Sunday mornings by each Inspector in turn throughout the whole year. A census of stalls was taken in December, 1912, with the following results:— Chapel Street, Chapel Place, White Conduit Street and Baron Street.—Fruit, 22; lemons, 1 ; sweets and confectionery, 8; vegetables, 26; celery, 8; tomatoes, 6; artificial flowers, 1; eggs, 5; butchers, 13; rabbits and pork, 6; offal, 2; cats' meat, 3; furs and blouses, 7; second-hand clothing, 10; hats, caps, feathers, 4; ribbons and hat pins, 6; millinery, 1; women's underclothing, 5; hosiery, embroidery, 8; umbrellas, 1 ; table linen and towels, 2; curtains and lace, 3 ; blankets and flannelette, 1; carpets and rugs, 4 ; cushions, 1 ; linoleum, 2 ; cutlery, 2 ; ironmongery, 3 ; chandlery, 4; china and glass, 8; second-hand furniture, 12 ; pictures and picture-frames, 2 ; brooms and brushes, 2 ; toys, 12 ; Christmas cards and decorations, 6; perfumery and soap, 2; cheap 140 jewellery, 1 ; bays, purses, hair brushes, and combs, 5 ; secondhand books, 3 ; boots, 6 ; oddments of cloth, 2 ; fish, wet and dry, 7; shell fish, 4; ice cream, hot drinks and roast chestnuts, 5 stalls. Whitecross Street Banner Street and Roscoe Street, —Vegetables and greengrocery, 18 ; fruit, 19 ; plants and flowers, 11; celery, 3; butchers, 13; bacon, 4; rabbits, 3; offal, 2 ; cats' meat, 4 ; eels, 1 ; fish, wet and dry, 5 ; eggs, 1 ; sweets, 7 ; hot drinks and baked chestnuts, 5 ; cakes and biscuits, 1 ; toys, 12 ; books, magazines, comic papers and Christmas cards, 25 ; haberdashery—pins, tapes, buttons, cotton, gloves, lace, brooches, 12; millinery, feathers, braid, ribbons and artificial flowers, 6 ; secondhand clothes, 9 ; hosiery, 9 ; chandlery,, 2 ; umbrellas, 1 ; secondhand furniture, 1 ; china, glass ware and household ironmongery, 10; keys and locks, 1 ; fountain pens, 1 ; boots and boot repairing materials, 7 ; hair oil and toilet requisites, 2 stalls. Exmouth Street and Rosoman Street.—Vegetables and greengrocery, 23 ; fruit, 16 ; cut flowers, 4; general grocery, 1 ; butchers, 12 ; bacon, 1; rabbits, 1 ; fish, wet and dry, 4; eels, 1 ; shell fish, 1 ; cats' meat, 2 ; ice cream, 3 ; sweets, 1; toys, 1 ; soaps, powders and toilet requisites, 1 ; clothes, 8; boots and boot repairing materials, 5 ; haberdashery, 10 ; millinery, 4 ; china, glassware, household ironmongery and mats, 10; keys, locks and miscellaneous ironwork, 4; carpets, 1; books, magazines and comic papers, 2 ; hair restorers, one stall. Slaughter houses.—In Finsbury there are three 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 Goswell Road slaughter house is licensed for the slaughter of small animals only. The average number of animals slaughtered in the Finsbury slaughter houses is 24 per week—2 heads of cattle and 22 sheep. The quality of meat is distinctly good. 141 There are no knackers' yards in the Borough. The slaughter houses were inspected in 1912 on 90 occasions. No defects were ascertained, and consequently no notices were served. MILK SUPPLY. There are in Finsbury only three sets of premises licensed for cowkeeping. The addresses are annexed. Name of Occupier. Situation of Premises. Actual No. of Cows. Licensed for. Mrs. Elizabeth Davies Mrs. Nancy Evans 19a, Baldwin Street 15 17 Mr. Harry Eade 40, Rawstorne Street 15 15 Mr. J. H. Jenkins 230. St. John Street 28 30 The premises were inspected by the district inspectors on 40 occasions. They are also periodically inspected by the London County Council staff and their veterinary inspector. No notices were served in 1912. Dairies and Milkshops.—The number of persons registered during the year as purveyors of milk was 37, of which 14 were new registrations. During the same period 55 names were removed from the register for various reasons, chiefly on transfer of business. The total number left on the register was 242. Of these, 197 are milkshops, as distinguished from dairies, and sell milk in driblets, for a farthing or a halfpenny at a time, in this way disposing of three or four quarts per day. These milkshops, which are also small general or grocery shops, were inspected on 224 occasions, and 40 notices served for various sanitary defects. In registering and regulating these small shops, it is the practice to enforce the appropriate provisions of the Dairies, Cowsheds 142 and Milkshops Orders, the various Public Health Acts, and the General Powers Acts of the London County Council. It is a condition precedent to registration that no offensive material (such as, for example, paraffin oil) shall be sold from the same counter or from the same room as that from which the milk is sold, or sold from any place in or near that in which the milk is stored. The sale of paraffin oil or other offensive material from the premises is not objected to provided the oil is stored and sold outside the shop. The floor of the chandlers' shop must be free from accumulations of titter, or of stored shop material, which would render it difficult or impossible to ensure the efficient cleansing and proper sweeping of the shop day by day. The shop milk must be kept in an approved vessel with an imperforate metal cover. It must be confessed, however, that in actual practice it is very difficult to secure satisfactory conditions of milk sale in these small general shops. They are often dusty. In one such shop, each loaf of bread was being wrapped in paper " to keep the dust out." The shopkeeper observed: " If it wasn't for the dust, I should be a lazy woman." In these dusty shops, the milk vessel is kept in a special closed glass case. Many shops are overcrowded with stock; in mean streets they are the local " Whiteley's," they sell everything they can find room for. Two general shops were inspected for registration for the sale of milk in 1912. The floor space, and stock in each shop are set out below:— Shop A.—The space in front of the counter was 8 ft. 8 ins. by 2 ft. 10 ins. The articles sold were milk, bread, seed cake, currant cake, dripping, margarine, sweets, several kinds of packet teas, several kinds of cocoa, many brands of sauce, corned beef, 143 mineral waters, hot drinks, liquorice powder, flour, salt, egg powder, baking powder, chloride of lime, soda, blue, condensed milk, desiccated soups, rice, pearl barley, lump sugar, moist sugar, rubber heels, small-toothed combs, baby's comforters, castor oil, pea flour, tablets of melrose, baby baskets, bon-bons, dry soap, bootlaces, boot blacking, jam, marmalade, pins, needles, cotton, thread, Chinese lanterns, candles, herrings, firewood, pickled onions, bath brick and furniture polish. Shop B.—The space in front of the counter was 4 ft. 4 ins. by 10 ft.. The counter consisted of two parts apposed at right angles to each other. The spaces behind were 1 ft. 6 ins. by 12 ft., and 3 ft. 6 ins. by 7 ft. 6 ins. The stock included milk, bacon, cheese, butter, margarine, corned beef, German sausage, cooked ham, lard, dripping, jam, marmalade, onions, bread, firewood, eggs, scented soap, household soap, soda, biscuits, enamelline, matches, sauces, toys, beef tea, sweets, loaf sugar, moist sugar, custard powder, packets of tea, loose tea, cigarettes, small-toothed combs, dressing combs, tablets of melrose, rubber heels, skipping ropes, boot laces, vinegar, bath brick, mineral waters, starch, blacklead, paraffin, flour, pinol lozenges, pins, safety pins, needles, thread, cotton, tapes, buttons, split peas, pearl barley, rolled oats, bird seed, bird sand, candles, dry soap, lux, carbosil, pickled onions, mixed pickles, pepper whole and ground, salt, mustard loose and in tins, pickling spices, bi-carbonate of soda, baking powders, washing blue, furniture polish, metal polish, pea flour, gas mantles and chimneys, ketchup, bath brick, whiteing, sardines, tinned salmon, condensed milk, cocoa, headache powders, loose coffee, coffee in bottles and in tins, cordials, orange wine, raisins, currants, sultanas, lemon peel, nutmeg, allspice, stationery, seidlitz powders, lamp wick, gravy salt, golden syrup, cornflour, blanc-mange powder, jellies, bloater paste, lung syrup, camphorated oil, castor oil, hat pins, hair pins, vaseline, and haricot beans. A special closed-in glass counter case was obtained for milk storage and the shop was registered. 144 The following table compares the milk vigilance of Finsbury with that of the other London boroughs:— MILK SAMPLES, 1911. Borough. No. of Samples. No. Adulterated. Percentage. Battersea 645 76 11.7 Bermondsey 838 99 11.8 Bethnal Green 505 59 11.6 Camberwell 484 22 4.5 Chelsea 161 10 6.2 Deptford 291 50 17.1 Finsbury 374 43 11.4 Fulham 386 25 6.4 Greenwich 167 7 4.1 Hackney 508 69 13.5 Hammersmith 252 28 11.1 Hampstead 314 15 4.7 Holborn 230 29 12.6 Islington 602 59 9.8 Kensington 311 37 11.8 Lambeth 743 85 11.4 Lewisham 300 20 6.6 London (City of) 533 19 3.5 Paddington 372 39 10.4 Poplar 191 11 5.7 St. Marylebone 603 48 7.9 St. Pancras 426 53 12.4 Shoreditch 390 134 34.3 Southwark 940 114 12.1 Stepney 1,052 161 15.3 Stoke Newington 85 13 15.2 Wandsworth 603 67 11.1 Westminster(City of) 968 107 11.0 Woolwich 297 21 7.0 Whole of London 13,571 1,520 11.2 It will be noticed that with regard to the percentage of adulteration estimated on the whole number of milk samples in each borough, Finsbury is thirteenth on the list. The boroughs which precede it and their corresponding adulteration percentages are 145 Shoreditch (34.3), Deptford (17.1), Stepney (15.3), Stoke Newington (15.2), Hackney (13.5), Holborn (12.6), St. Pancras (12.4), Southwark (121), Bermondsey (11.8), Kensington (11.8), Battersea (11.7), and Bethnal Green (11.6). The percentage in Finsbury was 11-4. Court of Appeal ; Green v. Spiers & Pond; Definition of Milk Purveyor.—In this case, Messrs. Spiers & Pond were, on January 19th, 1912, summoned for that in the preceding November they had sold milk without being registered as milk purveyors in accordance with Section 6 of the D.C.M.O. of 1886, which provides that " It shall not be lawful for any person to carry on in the district of any local authority the trade of cowkeeper, dairyman or purveyor of milk unless he is registered as such in accordance with this article." These Orders are made under Section 34 of the Contagious Diseases (Animals) Act, 1878, amended by the Act of 1886. The Magistrate who heard the case, defined a purveyor of milk to be one who provided and supplied milk to persons wishing for it with a view of making an actual profit on the sale. He held that the quantity sold or so provided was immaterial and might be on a large scale or on a small scale. From this decision the defendants appealed. The appeal was heard on November 1st, 1912, before Lord Alverstone, C.J., and Justices Channell and Avery, forming a Court of Appeal. The magistrate's conviction was quashed and the appeal allowed with costs against the Borough of Finsbury. In the course of the judgment, the following observations were made as to the meaning of the word purveyor. The term purveyor in this connection meant one who sold retail to refreshment establishments and wholesale to other milk dealers, in short, one whose trade of milk selling was a substantial part of the business carried on, or one who kept a dairy or milk shop or milk store. The term did not apply to one who kept a small general shop, and merely sold milk to oblige his customers and to retain their custom. 146 It would appear, then, that the wholesale dealers who supplied the milk by contract to Messrs. Spiers & Pond, were the actual purveyors in this instance, and who ought possibly to be registered with the Local Authority. It must be noted, however, that the Contagious Diseases (Animals) Act, 1878, and the Order do not say that every purveyor must be registered, but only such persons as carry on the trade of purveyors of milk. This point was considered in the case of Emmerton v. Hall, 102 L.T. 889; 74 J.P. 301. In that case the defendant, Hall, who had a milk shop in St. Pancras and was there registered as a purveyor of milk, sold from a churn carried on a hand-cart one pennyworth of milk within the limits of the Borough of St. Marylebone. It was contended that he ought to have been registered as a purveyor of milk in Marylebone. The magistrate refused to convict, and was of opinion that the actual trade or business of a purveyor was carried on in St. Pancras where the defendant had a shop and kept his cans and cart. The mere selling of milk in a neighbouring borough did not make him a purveyor within that Borough. The case eventually reached the Court of Appeal, who held that the Magistrate's decision was correct. As a consequence of the case Green v. Spiers & Pond, it is decided that the owner of a small general shop who sells milk in small quantities need not be registered with the local authority, so that it follows that the knowledge of his existence and of his trade will now become the result of casual detection rather than the consequence of systematic application for registration by the shop owner. Moreover, the disciplinary Section 5 of the London County Council (Genera! Powers) Act, 1908, has its application to small traders now nullified. This section gives the local authority power to remove from the register or to refuse to register persons who carry on the trade of cowkeepers, dairymen or purveyors of milk upon unsuitable premises. 147 In the case of a small retailer, as the necessity for registration does not now arise, the power to remove his name from the register or to refuse registration becomes null and void. The small shop-keepers, however, are still subject to the provisions of Regulations 28-32 made by the Metropolitan Board of Works in pursuance of the D.C.M.O. 1885, and dated 3rd July of the same year. These regulations deal with the following matters 1. Notice of the outbreak of disease. 2. Precautions to be adopted in dealing with the milk offered for sale and the milk utensils on infected premises. 3. The prevention of the contamination of milk by offensive effluvia. 4. The cleanliness of milk receptacles and utensils. 5. The precautions to be taken for preserving the purity of milk and protecting it against contamination. The word purveyor originally meant a provider and is its exact equivalent. Purveyor was introduced into the English language from the Norman French. Provider came from the Latin. There are many such doubles in English which have come by these different routes, e.g., royal and regal, frail and fragile, delay and dilate, caitiff and captive. In each case, the words of each double at first meant the same, but the one word was used by the Norman French invader, the other by the ecclesiastical authorities and by the common people. The derivation of the word purveyor also explains why, in some dictionaries, it is stated that the word means the provision by anticipation of food for the King. In Norman times, when all the nobles held their lands from the King, it is quite plausible to suppose that they entered places and requested provisions in the name of their lord and master, the Sovereign. Milk Samples and Analyses—The total number of milk samples taken in 1912 was 370 of which 28, or 7.5 per cent., were found to be adulterated on the standard adopted by the Board of Agriculture—that is not less than 8.5 per cent. of non-fatty solids and not less than 3 0 per cent. of fat. The percentage is the lowest yet recorded for the borough. 148 The following table gives the statistics for the last 10 years:— ANALYSES OF MILK SAMPLES, 1903-1912. 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% 6% 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. 1903 348 58 16.7 19 20 6 l l 13·5 3 5 3 — — 3·2 1904 346 48* 13.9 14 4 2 l l 6·0 2 8 6 2 2 5·5 1905 349 38* 10.9 16 1 1 — l 5·4 7 8 1 1 1 5·1 1906 377 51* 13.5 10 11 1 2 — 6·3 9 8 1 — 1 5·0 1907 329 38* 11.5 7 4 4 — — 4·5 5 9 4 — 2 6·0 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 1910 362 38 10·8 5 3 4 1 — 3·7 2 16 5 1 1 71 1911 373 43 11·5 4 12 - 1 — 4·6 8 7 7 2 2 6·9 1912 370 28* 7·5 2 3 1 - - 1·6 8 5 7 — 1 5·6 *These figures include samples of milk which were adulterated with preservatives. 149 Ice Cream Shops.—These are all periodically inspected. At the end of 1912, there were on the register the names and addresses of the proprietors of 106 shops in the Borough. They were inspected on 126 occasions, and as a result 18 notices were served for sanitary and other defects. There were no prosecutions. The methods Of manufacture adopted by itinerant ice cream vendors are far from satisfactory. The ice cream may be made in the common wash-house used as a lumber room and containing fouled straw mattresses, discarded bedding and dirty, soiled blankets. The boiled milk may be cooled in a dark, frowsy basement or in an open iron bucket on the wash-house floor. Sometimes a gauze cupboard has been provided for cooling, but even then the top of the cupboard is littered with lumber and broken so that cats can and do enter. The churns are washed in spent soap suds, which are kept over from one day to the next. The freezing is done on the gutter kerb. The cover of the freezer is placed on the dirty pavement and replaced without being cleaned. The man employed in freezing may be smoking a cigarette and spitting on the pavement quite near to the cover. He is too lazy or too unconcerned to spit into the roadway away from the cover When the freezing is approaching completion he takes out a sample on a wooden spoon, draws his teeth and tongue along the edge and replaces the spoon without cleaning it. Worse still, he has been known to use the side of his barrow for purposes of micturition. The difficulties of supervision are further increased by the fact that the itinerant may sleep in one borough, manufacture his ice in another borough and sell it in still another borough. Restaurants.—There are 237 restaurants in the borough. They are regularly inspected. In 1912 the number of notices served was 42, the number of inspections 278. These premises are not included in the sum total of workplaces given on another page. 150 Butter Manufacturers and Wholesale Margarine Dealers—At the end of 1912 there were on the register 9 butter manufacturers and no margarine manufacturers. Four additional names of wholesale margarine dealers were registered during the year; the number on the register at the end of the year was 24. One hundred and eighteen samples of butter were taken for analysis, and four found to be adulterated ; 23 samples of margarine were obtained, all genuine. Sale of Food and Drugs Acts —In Finsbury 500 food samples are taken for analysis each year, and, in addition, 100 samples of milk are taken in the evening, or on Sundays at irregular and unusual hours. A rota is arranged at the beginning of the year, but each inspector may also take samples at his own discretion. All the shops in the Borough are sampled from time to time—no exception is made. In 1912, 601 samples were taken, of which 34, or 5.6 per cent. of the total, were adulterated. The tables given below show the number and nature of the samples collected and the number adulterated in each case :— Substance. Samples taken. Adulterated Substance. Samples Adulterated. Milk 370 28 Ground Ginger 1 0 Butter 118 4 White Pepper 60 Margarine 23 0 Vinegar 4 0 Coffee 22 2 Cheese 1 0 Cocoa 24 0 Bread 1 0 Cocoa Essence 1 0 Custard Powder 1 0 Pepper 9 0 Separated Milk 2 0 Mustard15 0 Lard 3 0 Total 601 34 151 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 7·8 1910 600 541 59 9·83 8·5 1911 600 549 51 8·50 9·3 1912 601 567 34 5·65 — HOUSING. In 1912 one house was represented by the Medical Officer of Health as being unfit for human habitation. The Council made a closing order on January 23rd, 1912. The walls, ceilings, floors were damp, verminous and dilapidated. At the request of the agent a specification of the repairs and alterations necessary to make the house habitable was sent to him. These repairs were subsequently executed and the closing order withdrawn. During the year an enquiry was held for the Board of Trade into the rents paid in the Borough for typical working-class dwellings. The results ascertained are placed on record here for reference in future years. The streets chosen were Affleck Street, Rawstorne Street, Rahere Street, President Street, Gloucester Street, Upper Ashby Street and Lower Charles Street. 152 Street. Rooms in tenements. No. of tenements. Rents of tenements. Commonest rent of tenements. Affleck Street 1 20 2/6 — 5/- 8 @ 4/- 2 101 6/- — 7/6 54 „ 6/6 3 24 6/6 — 10/- 14 .. 8/6 4 2 9/9 & 10/- 5 2 13/6 & 14/- Rawstorne Street- 1 19 2/— 5/- 7 @ 2/6 2 39 5/6— 7/- 20 ,, 6/6 3 2 7/6 & 8/- 4 1 9/- Habere Street 1 43 2/- — 5/6 11 @ 5/- 2 69 5/6 — 8/6 24 ,, 6/6 23 ,, 7/- 3 6 6/6 — 9/- 3 ,, 8/6 4 1 9/- 5 1 15/- President Street 1 40 2/6 — 6/6 12 @ 5/- 2 31 5/6- 9/- 11 ,, 7/- 3 8 6/- - 10/- 5 1 11/- Gloucester Street 1 61 3/-- 5/6 22 @ 5/- 2 23 5/- 10/- 7 ,, 7/6 3 3 8/- - 9/6 4 1 8/6 Upper Ashby St. and Lower Charles St. 1 17 2/6 — 5/6 2 20 5/- 8/- 3 7 6/- - 8/6 4 3 8/- - 9/6 In the above streets there is in most cases, but not in all, a resident landlord who personally occupies two or more rooms, and whose rent is for this reason unliquidated, and not included in the above return. In Affleck Street there is a scullery at the top of each house used by the top tenants, and another scullery common to the house mid-way on the staircase. In each house the tenants have the use of a common washhouse. 153 Registered Houses let in Lodgings.—During 1912 no fresh houses were placed on the register, and none were removed, so that the number on the books, 1,209, was the same as in 1910. For the purpose of cleansing, 945 intimation notices and 237 statutory notices were served. For overcrowding there were 58 notices. The number of visits paid was 10,240. There were no prosecutions. In 72 tenement houses a separate water supply was laid on to the upper storeys. Before an owner is called upon to make such an installation in Finsbury the following matters are taken into consideration:— 1.—The available water supply must inflict hardship upon the tenants of the upper storeys by reason of the number of steps to be traversed to reach the supply, or by reason of the difficult and tortuous character of the stairs. 2.—There must be a desire on the part of the occupants to have the supply. 3.—The tenants must be responsible people who are not likely to abuse the installation. On the general question, it is usually stated that ill tenement houses the tenants on the upper floors pay less rent because they have to go downstairs for their water. Common Lodging Houses.—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 93 55 White Lion Street, 57 Mr. Shuttleworth 98 70 Clerkenwell Green, 35 Mr. J. H. Claytor 73 34 Old Street, 97 Mr. W. H. Hatch 80 62 Banner Street, 6 Mr. C. Fitzwm. Campbell 140 105 Totals 484 326 154 They are administered by the London County Council, and are licensed annually at a special meeting held in June of each year. Notice of objection to the licence of any common lodging house must be sent in duplicate to the Clerk of the London County Council, at least a week before the date of the special meeting. The occupants of one of the above houses were very much harassed in July, 1912, by a plague of mosquitos. The inmates, drawn from the very lowest grades of society, were becoming almost panic stricken : they were afraid to go to sleep. Very few escaped being bitten; some were bitten very severely. They were alarmed to find that when the mosquitos were caught and squashed that blood stains were left on the wall or table. It was commonly asserted that the mosquitos had been liberated from some foreign chests and boxes of a neighbouring firm having an extensive trade with Argentine houses. Many were caught and submitted to the Entomologist of the London School of Tropical Medicine, who recognised them as specimens of the common English mosquito—Culex pipiens. Their breeding ground was searched for, but not discovered. All the known neighbouring water cisterns and places holding stagnant water were carefully examined for larvae, but without success. The closest largest water areas are the Regents Canal and the lake at Finsbury Park. The existence of these places would not, however, explain the curious localisation of the mosquitos to this one common lodging house. The rooms and passages were fumigated. Fly killers made of wire gauze were given to the night porter and inmates and were effective in destroying the pests. Systematic House to House Inspection.—The details of the work done under the Housing (Inspection of District) Regulations, 1910, are indicated briefly in the subjoined table :— 155 SYSTEMATIC HOUSE TO HOUSE INSPECTION, 1912. Street, Place, or Buildings. No. of houses inspected. No. of houses in which defects were found. Percentage of houses with defects to houses inspected. Families occupying. Number of rooms. Total. Occupied. Empiy. Overcrowded. Affleck Street 38 21 55·2 151 418 354 64 1 Albert Street 33 13 39·3 105 243 230 13 — Albion Place 16 11 68·7 47 108 103 5 — Allen Street 13 4 30·7 29 68 66 2 — Amias Place 21 12 57"1 57 124 116 8 35 Anns Place 9 9 100·0 9 18 18 — — Arlington Street 26 13 50'0 64 184 181 3 — Baird Street Buildings 20 0 — 20 42 42 — — Baltic Street 8 3 37·5 34 48 43 5 — Baron Street 24 14 58·3 62 187 149 38 — Bastwick Street 36 33 91·6 113 232 202 30 2 Bath Buildings 8 2 25·0 19 44 42 2 — Bath Court 4 1 25· 0 4 12 12 — — Berkley Court 13 10 76'9 45 78 76 2 1 Brewer Street 27 21 77'7 103 207 203 4 1 Brunswick Close 41 36 87· 8 74 185 183 2 — Busaco Street 31 21 67·7 81 221 203 18 2 Buxton Buildings 25 13 52·0 25 56 56 — — Buxton Street 3 1 33·3 11 24 24 — — Chadwell Street 21 6 28·5 53 172 157 15 — Charter Buildiugs 12 2 16·6 12 34 34 — — Clarence Place 3 2 66·6 3 9 9 — — Clements Buildings 37 6 l6·2 37 73 73 — — Cynthia Street 14 11 78·5 27 78 76 2 — Dingley Place 4 0 — 6 20 18 2 — Fletchers Row 13 9 69·2 31 62 62 — 2 Fredericks Row 4 4 100·0 8 16 16 — — Gee Street 70 54 77·1 188 389 368 21 5 Glasshouse Chambers 21 5 23·8 21 58 58 — — Goswell Terrace 23 19 82·6 70 173 169 4 — Granville Square 10 9 90·0 39 103 100 3 — Hall Street 33 15 45·4 73 238 226 12 — Hatfield Street 21 8 38·0 78 116 111 5 19 Hermes Street 31 22 70·9 101 235 205 30 5 Hermitage Buildings 8 1 12·5 8 24 24 — — Leage Street 22 6 27·2 74 151 149 2 — Lever Buildings 10 4 40·0 10 16 16 — — Lewins Court 8 3 37'5 16 38 38 — — Little Northampton Street 31 15 48·4 45 122 113 9 — L ittle Sutton Street 14 9 64·3 48 82 74 8 2 Ludlow Street 12 4 33·3 14 29 29 — — Macclesfield Street 10 7 70·0 15 48 48 — — Market Buildings 15 3 20·0 15 16 16 — - Mitchell Street 4 2 50·0 12 30 30 — — Murton Street 8 4 50·0 22 55 52 3 3 New Charles Street 35 25 71·4 83 199 192 7 — Northampton Buildings 55 4 7·3 55 139 139 - - Northampton Street 36 13 36·1 85 230 207 23 — Penton Residences 23 8 34'7 23 68 68 — — Rawstorne Buildings 22 1 4'5 22 66 66 — — Richmond Street 11 4 36·3 23 41 41 — — Roscoe Street Buildings 54 3 5'5 54 143 143 — — St. Bartholomews Buildings 137 35 25· 5 164 334 328 6 — Salisbury Buildings 6 3 50·0 6 12 12 — — Sekforde Street 5 1 20·0 14 30 29 1 — Smithfield Buildings 12 4 33·3 12 24 24 — — Warren Street 15 4 26·6 40 100 73 27 — White Lion Street 70 38 54·2 184 472 437 35 3 Totals 1,336 611 45·6 2,844 6,744 6,333 411 81 156 The number of houses inspected similarly in preceding years were 1,746, 1,501. 1,447, 1,548, 2,250, 1,841, 806, 534, 789, 1,355, and 888, from 1901 to 1911 respectively. The houses in the poorer districts are subject to more frequent systematic inspection than houses in the better parts. Some streets are inspected almost every year. In these cases this inspection is very necessary. In 8 recent years the streets and buildings subject to most frequent inspection have been as follows:—Little Sutton Street (8), Galway Street (7), Peerless Street (6), Whitecross Street (5), Eagle Dwellings (5), Central Street (4), Hat and Mitre Court (4), Moreland Street (4), Risinghill Street (4), Rodney Street (4), Hattield Street (4), Baldwin Street, Easton Street, Lever Street, Gee Street, Ludlow Street, Memel Street, Merlin's Place, Northampton Road, Southampton Street, Whitehorse Alley and Young's Buildings, 8 each. It must be noted that this summary refers strictly to systematic house-to-house inspection, where the examination is begun at one end of the street and every house is then taken in order. Crowding and Overcrowding.—During the year 141 cases of overcrowding were dealt with and abated : 58 of these were in registered houses. Eighty-one were discovered as the result of house-to-house inspection. The largest number of overcrowded tenements were in Amias Place (35), Hatfield Street (19), Gee Street (5), Hermes Street (5). Overcrowding, 1912. Street. Families occupying. Rooms occupied. Rooms empty. Overcrowded tenements. Rooms per family. Amias Place 57 116 8 35 2·03 Hatfield Street 78 111 5 19 1·42 Gee Street 188 368 21 5 1·95 Hermes Street 101 205 30 5 2·02 In the above streets every house is occupied by 3 to 5 families. 157 In the area covered by systematic house-to-house inspection 2,844 families occupied 0,838 room*, or 2.22 rooms per family. Of the total number of rooms inspected 6.1 per cent, were empty; this shows that the crowding is not due to lack of available accommodation. It is difficult sometimes to appreciate the stress on room accommodation that is experienced in the poorer quarters of the Borough. By way of illustration, the rooms, occupants, cubic space, and disposition for sleeping purposes are given below in two houses in the same street. Both houses contain a basement, a ground floor and 3 upper floors—10 rooms. In the first house there are 9 families or one family in each room except on the third floor. In the second house each family luxuriates in the occupation of one whole floor. Floor. Room Cubic Sapce. Occupied at night by Basement Front 1,082 c. ft. Father, mother, boy 8, girl 2 years. Basement Back 965 c. ft. Mother, girls 14, 9, hoy 3 years. Ground Front 960 c. ft. Widow. Ground Back 1,827 c. ft. Father, mother, girl 10, boys 12, 8 years. First Front 1,116 c. ft. Maiden lady. First Back 1,829 c.ft. Father, mother, boy 7, girls 6, 3 years. Second Front 936 c. ft. Father, mother, girl 6 years. Second Back 1,578 c. ft. Father, mother, girls 9, 8, 3 years and baby 15 months. Third Front 566 c. ft. Father, mother, boy 18 months, baby 3 weeks. Third Back 938 c. ft Boys 13, 5, 3, and girl 8 years. 158 Three of the above tenements were overcrowded. The family occupying the ground floor back room had another daughter 10 years who slept with friends elsewhere. Floor. Room. Cubic Space Occupied at night by Basement Front 1,274 c. ft. Father, mother, boy 13, girl 10 years. Basement Back 701 c. ft. Girls 20, 9, boy 17 years. Ground Front 1,178 c. ft. Father, mother, twins 8 months. Ground Back 948 c. ft. Girls 5, 2 years. First Front 1,602 c. ft. Father, mother, boy 6 years. First Back 918 c. ft. Girl 19, boy 8 years Second Front 1,187 c. ft. Father, mother, girl 4 years. Second Back 680 c. ft. Boy 13, girl 12 years. Third Front 1,050 c. ft, Grandmother, mother. Third Back 595 c. ft. Girl 11, boys 5. 2 years. One of the above tenements was overcrowded. In the first floor back room, when the occupants got up in the morning, the bed was taken by a son of 21 years, who worked at night and slept home in the day time. The above two houses accommodated 66 people, equal to the population of an English hamlet. Customs and Inland Revenue Acts, 1890 and 1903.— No application for certificates were received in 1912. Verminous Houses.—When school children are found to be verminous in school by the London County Council medical 159 officers in the course of their official inspections, the names and addresses of such children are sent to the Public Health Department. Their homes are then visited by the sanitary inspectors, and notices for cleansing are served on the occupiers where the premises are dirty and verminous. The parents are offered steam disinfection for the verminous bedding and clothing, and sulphur fumigation for the rooms. The number of children notified in 1912 was 597. The number of homes found clean on the first visit was 391, or 65 per cent. This confirms the view that, while the presence of head lice or body lice discovered in school children may suggest the presence of bugs in the home, the association is not a close one. Of the rest, 160 tenements were dirty or verminous. Forty-six of the addresses were inaccurate, and in 26 instances the correct addresses could not be obtained. In 38 cases the tenements were disinfected by the Borough Council. Of the 160 dirty or verminous homes, the walls and ceilings of 76 were dirty; the walls and ceilings of 76 were verminous. The bedding in 9 homes was very much fouled, the bedding in 76 was very verminous. In 42 instances the bugs had invaded the wall picture frames. The number of registered houses affected was 60 as against 100 unregistered houses. It is not unreasonable to infer that this smaller incidence on registered houses is to be attributed to the regular annual cleansing and closer supervision which obtains in them. Underground Rooms.—In twenty-four instances underground rooms were found to be separately occupied in contravention of the provisions of the Public Health (London) Act, 1891, Section 96. Notices were served and the illegal occupations were discontinued Stable Dwellings.—The stable dwellings remaining in the Borough are given in the following list. They are all frequently inspected, 160 Premises. No. of Occupancies. No. of Persons. Total. Adults. Children. 82, Bath Street 1 1 1 2 93A, Charterhouse Street 1 2 3 5 Claremont Mews 9 19 13 32 14 Clerkenwell Close 1 1 1 2 Davis Yard 1 1 1 2 Garnault Mews 1 I 1 2 Holford Yard 3 7 0 7 Holford Mews 3 7 8 15 Jay's Buildings 13 34 32 66 119, Lever Street 1 4 2 6 1, New Court, Peter's Lane 1 2 4 6 FACTORIES AND WORKSHOPS. The number of workshops and workplaces on the Register at the end of 1912 was 1,950, compared with 1,960 at the end of 1911. During the year 383 entries were removed from the register owing to the closing or removal of the workshops and workplaces or their conversion into factories, and 323 re-opened or newly-established workshops and workplaces were placed on the register. The factories on the register at the end of 1912 numbered 1,016, compared with 936 at the end of 1911. During the year 95 factories were removed from the register, and 175 were added. The factories on the register include 7 tenement factories, in which there are 36 occupiers, carrying on different trades or processes, and supplied with mechanical power by the owners of such factories. Each of these occupiers and his tenement is individually and separately subject to the provisions of the Factory Acts for certain purposes, but the whole premises are treated as one building. 161 The number of registered workshops and workplaces has diminished each year from 2,059 in 1908 to 1950 in 1912. The number of factories has steadily increased from 828 in 1908 to 1,016 in 1912. Factories may be defined for practical purposes as premises using mechanical power ; they are under the supervision of the Home Office. The increased number of factories and the conversion of workshops into factories are due to the more general use of electricity for trade purposes. Small electric motors can be hung to ceiling joists, bracketted to walls, or placed in corners or under benches, economising space in a manner impossible in the case of steam, compressed air or water power. The introduction of the smallest electric motor (e.g., of one-eighth horse power) converts the premises into a factory. The following paragraphs indicate the workshops, workplaces and factories on the registers, and show the large variety of manufacturing processes which are carried on in Finsbury. Workshops and Workplaces.—Clocks and watches, 132; jewellery, 116; cabinet making and polishing, 77; tailoring and clothing, 68; engraving, embossing and chasing, 60; stabling, 58; leather and leather goods and trunks, 56 ; provisions, bacon, grocery, food preparation, 44; building trades, 43 ; furriers and skin dressers, 42; cycles and motors, 39; hats and caps, 39; underclothing, shirts, skirts, blouses, aprons, 36; boots and shoes, 35; forwarding goods, 34; drugs, chemicals, perfumery and sundries, 33 ; gold and silver workers and refiners, 32 ; fancy goods and toys, 30; millinery, 30; picture frames, mouldings and mounts, 30; iron and metal workers, 29; glassware and glass work, 26; mantles and costumes, 25 ; engineers and machinists, 23; farriers and smiths, 23 ; box-making, 22 ; paper and cardboard, 22; feather work, 21 ; ironmongery and hardware, 21 ; stationery and sundries, 20; stick making and mounting, 20; ink, paint, oil, gum, colours and dyes, 19; laundries, 19; packing cases, 19; ties and neckwear, 19; barometers and thermometers, 18; gilding and plating, 18; woollen, linen and cotton goods, 18; artificial flowers and plants, 17 ; rag and paper waste, 17 ; shop 162 fitting and show cases, 17; basket, cane and wicker work, 16; firewood, 16; rubber and waterproof goods, 16; book and card edge gilding, 15 ; jewel and instrument cases, 15 ; optical goods, 15; brushes, 13; upholstery, 13; wine, spirits and cordials, 13; athletic and sporting goods, 12 ; books and book materials, 12 ; surgical instruments and goods, 12 ; timber, 12 ; sign making and ticket writing, 11; brass work, 10; children's clothing, 10; embroidery, lace, fancy needlework, 10; pianos, organs and musical instruments, 10; wirework, 10; Christmas cards and postcards, art publishing, 9; coach builders and wheelwrights 9 ; confectionery, 9 ; copperwork, 9 ; dressmaking, 9 ; harness and saddlery, 9; phonograph and automatic machines, 9; tin-plate work, 9; wood, ivory and bone turning, 8 ; marble and stone work, 7 ; trucks and barrows, 7 ; electrical goods. 6 ; lamps, lanterns and stoves, 6; photographic goods, 6; scientific instruments, 6; tailors' and drapers' dummies, 6; umbrellas, 6; agricultural and horticultural goods, 5 ; bedding and bedsteads, 5 ; gold blocking, 5 ; hair goods, 5 ; lithography and stereotyping, 5 ; locksmiths, 5 ; scales and balances, 5 ; stamp and die cutting and sinking, 5 ; wood carving, 5 ; china and earthenware, 4 ; cork goods, 4 ; pipe making and mounting, 4 ; buttons, 3 ; enamelling and japanning, 3; glaziers' diamonds, 3; gloves, 3; linen collars and cuffs, 3; machine ruling, 3 ; pattern making, 3; rope, string and twine, 3; and others 31, making of total of 1,950. The summarised "other" workshops include those of the following trades :—Knife machine goods, pattern cards, saws, surveying instruments, poultry incubators, combs, sponges, tobacco, window cleaners' depot, glove hands, rule maker, undertakers, carpet planning, plaster casts, clean towel supply, taxidermy, saw-piercing, type-casting, and printers joinery. Factories.—Printing and stationery, 146 ; engineering and machinery, 93; shirts, skirts, blouses, ties, underclothing, children's clothing, aprons, costumes, 82; gilding, plating and polishing, 53 ; jewellery, gold and silver workers, 51 ; bookbinding, 37; box and paper bag making, 34; provision, grocery, bacon, sausages, food preparation, 29 ; foundries, 27 ; stick making 163 and mounting', 27 ; scientific and surgical instruments, 23 ; glasswork, 19 ; iron and metalwork, 18; leather goods, bags and trunks, 18; engraving and die sinking, 16; brass and copper work, 15 ; ink, paint, gum, soap, polish and varnish, 15 ; ivory, wood and bone turners, 15; cycles and motors, 14; joinery and saw-mills, 13; pipe making and mounting, 13; brushes, 12; cabinet making, 12; clock, jewel, and instrument cases, 12; clocks and watches, 12; drugs and drysaltery, 12; picture frames and mouldings, 11; shop-fitting, 11; cigars, cigarettes and tobacco, 10; art publishing and Christmas cairds, 9; mantle making, 9; van and wheelwrights, 9; optical goods, 8; packing cases, 8 ; beer and spirits, 7 ; cutlery, 7 ; rubber goods, 7 ; book, and card edge gilding and blocking, 6 ; confectionery and cocoa, 6 paper and cardboard, 6; wirework, 6; boots and shoes, 5 ; cold-air storage, 5 ; laundries, 5; silk goods and weaving, 5; sports goods, 5 ; surgical goods, 5 ; buttons and studs, 4 ; clothworking, 4; glaziers' diamonds, 4; horsehair, feathers and bedding, 4; mineral waters, 4; patterns and models, 4; pianos and musical instruments, 4; artificial flowers, 3; forage, 3; pattern cards, 3 ; phonographs and records, 3 ; saws, 3 ; and 34 other trades, giving a total of 1,045. The trades summarised under the term "other" in the foregoing table include the following: Pens and pencils, photographic work, waste paper and rags, cornice poles, cork goods, vulcanised fibre, electrotyping, hats, saw piercing, whips, electricity station, addressing machines, machine ruling, fur and skin dying, tar-felting, bamboo work, mortar-mill, murac, marble work, mono-service vessels, bakehouse, wharf, flooring, clay pipes, and carpet planning. During the year, 533 first visits and 637 re-visits were made by the Council's Inspector to factories, and 1,139 first visits and 1,421 re-visits to workshops and workplaces. A summary of the defects found is appended :— 164 Summary of Defaults and Defects in Factories, Workshops and Workplaces for which Notices were served during 1912. Workshops. Factories. Work. places. Totals. Dirty workshops and workplaces 195 7 2 204 Damp and dilapidated premises 47 12 1 60 Dirty passages and staircases 15 5 1 21 Overcrowded workshops 5 ... ... 5 Insufficient ventilation 17 1 ... 18 Fumes from stoves, acids and gas 8 1 ... 9 Drainage of floors 3 1 ... 4 Water supply lacking or inadequate 5 2 ... 7 Sanitary conveniences, cleansing 70 55 10 135 Sanitary conveniences, defects 111 88 11 210 No sanitary convenience 3 2 ... 5 Insufficient sanitary convenience accommodation 4 6 ... 10 Improper use of sanitary conveniences by both sexes 34 12 ... 46 Defective soil pipes 1 ... 1 2 Yards cleansed, paved, or paving repaired 18 7 2 27 Defective sinks, gullies and wastepipes 16 8 8 32 Water cisterns dirty and defective 27 9 4 40 Accumulations of refuse 14 10 1 25 Dustbins, defective or absent 68 28 3 99 Drainage defective 12 4 3 19 Rain-water pipes choked or broken 7 4 1 12 Stables in need of limewasliing ... ... 4 4 Stable paving defective ... 1 1 2 Nuisance from rats 2 ... ... 2 Animals improperly kept 1 ... 1 2 Verminous condition of workshop 1 ... ... 1 Food utensils dirty ... 1 ... 1 Totals 684 264 54 1,002 In connection with these defects, 524 intimation notices and 108 statutory notices were served. Infectious Disease.—Notice was received of the occurrence of 3 cases of infectious disease (scarlet fever, diphtheria, and typhoid fever) in the homes of out-workers and of workers employed in Finsbury and resident in other districts. These were inquired into and suitable precautions adopted. 165 Dangerous Structures. -In three instances serious structural defects were found by the workshop inspector during his official visits to work premises. These were referred to the London County Council to be dealt with as dangerous structures under the London Building Acts. The Home Office.—Eighty-eight notices of occupation of workshops were received from the Home Office, and 17 notices of complaint referring to the following matters : Sanitary conveniences, 8; dirty walls, 7; insufficient ventilation, 3 notices. The notices sent to the Home Office were as follows :—Abstract of F.W. Act not affixed, 72; dirty walls, 23; insufficient ventilation, 9 ; dangerous machinery, 3 ; dangerous trade processes, 4 ; lack of means for heating, 4; insufficient fire exits, 2; illegal employment, 2 ; and overcrowding one case. Prosecutions.—There was one prosecution—for failing to alter and amend two water-closets. Two summonses had been adjourned from 1911, one for failing to provide sufficient w.c. accommodation and the other for failing to provide a proper dustbin. There were convictions in all the cases. Manufacture of Table Sauce or Relish.—A newly-established workshop for the making of table sauce was discovered in Pentonville in the course of the systematic inspection of the district. Two brothers carried on the business and employed 3 women, a girl and a boy. In addition to making sauce, this firm made and bottled hair oil, lime cream, perfumery and boot polish. The table sauce was mixed in a large galvanized iron bath and baled into bottles by means of a jug. Pressed dates, old and of poor quality, were extensively used in its manufacture. The surroundings were not clean, and the process adopted was far from satisfactory. The occupiers were cautioned and gave up its manufacture. The Rag Flock Act, 1911.—This Act came into operation on July 1st, 1912. By the Rag Flock Regulations, 1912, of the Local Government Board, a standard of cleanliness is prescribed that the amount of soluble chlorine (chlorides) removed from at least 40 grammes of flock shall not exceed 30 parts of chlorine in 100,000 parts of flock. 166 Six samples of flock were taken in October, 1912, from 4 manufacturers in the borough. On the above standard 4 samples were very grossly polluted, one to the extent of 604 parts of chlorine per 100,000 parts of flock. The dealers implicated were specially cautioned. Further, a circular letter and copies of the Rag Flock Act and Regulations were sent to the following firms, manufacturers of bedding, upholsterers and others, in the borough who might possibly use rag flock for trade purposes Bedding Manufacturers. Withers & Withers, 16-18, Mallow Street, Old Street, London, E.C. W. & C. White Howies, 111-113, Lever Street, London E.C. Upholstery. C. Garrett & Co., 185, Central Street, London, E.C. W. Furst & Co., 22, Worship Street, London, E.C. E. H. Griffiths, 91, Pentonville Road, London, N. G. J. Jessup, 204-206, Old Street, London, E.C. F. Smith, 13, Earl's Buildings, Featherstone Street, London, E.C. Falet, Walker & Co., 20, Worship Street, London, E.C. Other Possible Users of Rag Flock. Morrison & Austin, 31-37, Worship Street, London, E.C. Sewell & Sewell, 8-16, Worship Street, London, E.C. E. A. George & Co., 14, Roscoe Street, London, E.C. R. Lawrence & Son, Oliver's Yard, City Road, London, E.C. A. Preston, 210, St. John Street, London, E.C. J. T. Wright & Sons, 198, Old Street, London, E.C. T. Lawes & Co., 65, City Road, London, E.C. W. & C. Nightingale, 70-74, Old Street, London, E.C. J. Finch & Co., 3, Oliver's Yard, City Road, London, E.C. James De Lay, 73, Lever Street, London, E.C. Frederick Ing, 100, Old Street, London, E.C. Alex. Lefever, 226, Old Street, London, E.C. William Hickin, 10, Penton Place, London, W.C. 167 The following matters are presented in the form required by the Home Office:— Inspection of Factories, Workshops and Workplaces. Premises. Inspections. Written Notices. Prosecutions Factories (Including Factory Laundries.) 1,170 171 — Workshops (Including Workshop Laundries.) 2,325 431 1 Workplaces (Other than Outworkers' premises included in Part 3 of this Report) 235 30 — Total 3,730 632 1 Defects found in Factories, Workshops and Workplaces. Particulars Number of Defects. Number of Prosecutions. Found Remedied Referred to H.M. Inspector. Nuisances under the Public Health Acts.— Want of cleanliness 248 225 23 .. Want of ventilation 27 18 9 .. Overcrowding 6 5 1 .. Want of drainage of floors 4 4 .. .. Other nuisances 479 479 .. .. Sanitary accommodation Insufficient. 15 15 .. .. Unsuitable or defective 210 210 .. 1 Not separate for sexes. 46 46 . .. Offences under the Factory and Workshop Act— Illegal occupation of underground bakehouse (S. 101) .. .. .. .. Breach of special sanitary requirements for bakehouses (SS. 97 to 100) .. .. .. .. Other offences (excluding offences relating to outwork which are included in Part 3 of this Report) 87 .. 87 .. Total 1,122 1,002 120 1 168 169 HOME WORK. NATURE OF WORK. OUTWORKERS' LISTS, SECTION 107 Prosecutions. OUTWORK IN UNWHOLESOME PREMISES, SECTION 108. OUTWORK IN INFECTED PREMISES, SECTIONS 109, 110. Lists received from Employers. Notices served on Occupiers as to keeping or sending Lists. Instances Notices served. Prosecutions. Instances. Orders made. Prosecutions Sending twice in the year. Sending once in the year. Failing to keep or permit inspection of Lists. Failing to send Lists. Lists Outworkers Lists Outwoikers Contractors Workmen. Contractor Workmen. Wearing Apparel— . (i) making 218 433 3742 25 48 289 Circular letters and forms are sent to all employers when the lists are due. All the forms are promptly returned. Nil. Nil Nil. Nil. Nil. 2 Nil. Nil. (2) cleaning and washing .. .. .. .. .. .. 3 Household linen .. .. .. .. .. .. .. Lace, lace curtains and nets .. .. .. .. .. .. .. Curtains & furniture hangings .. .. .. .. .. .. .. Furniture and upholstery .. .. .. .. .. .. .. Electro-plate 4 .. 13 .. .. .. .. File making .. .. .. .. .. .. .. Brass and brass articles .. .. .. .. .. .. .. Fur pulling .. .. .. .. .. .. .. Cables and chains .. .. .. .. .. .. .. Anchors and grapnels .. .. .. .. .. .. .. Cart gear .. .. .. .. .. .. .. Locks, latches and keys .. .. .. .. .. .. .. Umbrellas 6 .. 47 1 .. 3 .. Artificial flowers 14 .. 144 2 .. 28 .. Nets, other than wire nets 2 13 .. Tents .. .. .. .. .. .. .. Sacks .. .. .. .. .. .. .. Racquet and tennis balls .. .. .. .. .. .. .. Paper, etc., boxes, paper bags 28 4 516 8 .. 72 1 Brush making 14 .. 120 2 .. 11 .. Pea picking .. .. .. .. .. .. .. Feather sorting .. .. .. .. .. .. .. Carding of buttons .. .. .. .. .. .. .. Stuffed toys .. .. .. 1 .. 3 .. Basket making .. .. .. .. .. .. .. Chocolates and sweetmeats .. .. .. .. .. .. .. Total 286 437 4595 39 48 406 .. .. .. .. .. .. 6 .. .. 170 OTHER MATTERS. Matters notified to H. M. Inspector of Factories: — Failure to affix Abstract of the Factory and Workshop Act (s. 133) 72 Action taken in matters referred by H. M. Inspector as remediable under the Public Heath Acts but not under the Factory and Workshops Act (s. 5) Notified by H. M. Inspector 17 Reports (of action taken) sent to H. M. Inspector 17 Other 48 Underground Bakehouses (s. 101):— Certificates granted during the year None In use at the end of the year 34 Bakehouses.—At the end of 1912 the total number of bakehouses in the Borough was 60, of which 24 are above ground and 36 below ground. All the bakehouses are periodically inspected; in 1912 the number of visits paid was 106. Notices for cleansing and dilapidations were issued in 13 instances. These were all complied with. At one visit of inspection, the baker was found at his work with arms and hands very dirty. The top of his flour bin was greasy and filthy. He was cautioned. Canal Boats Acts, 1877 to 1884.—During the year the total number of boats inspected was 100. The Acts and Regulations were contravened in four instances, and for this complaint notes were sent to the owners requiring abatement within a specified time. The details of the contraventions are as follows :— Boats being worked without registration certificates 2 Cabin deck heads and sides leaking 2 These defects were all remedied within the times specified. No legal proceedings were taken. 171 The following table gives statistics relating to the inspection of boats for the past 5 years:— Year. Boats inspected. Persons found on Boats. Totals. Registered. Men. Women. Children. 1908 101 267 18 36 321 353 1909 105 261 28 47 336 370 1910 112 299 29 36 364 413 1911 106 270 39 50 359 377 1912 100 249 28 41 318 363 Of the 100 boats inspected, 73 were occupied by men only, 8 by men and women, and 19 by men, women and children. The children accompanying their parents on the boats appeared to be strong and healthy. No case of infectious disease was notified or discovered in the Canal Boats, therefore isolation of the patient and detention of the boat have not been necessary. The inspection of canal boats is part of the duty of the Sanitary Inspector whose district includes that portion of the borough in which the canal is situated. This year the duties were carried out by Inspector Norman. There is no separate remuneration for this work. Elementary Schools.—There are in Finsbury nineteen Public Elementary Schools—14 provided and 5 non-provided, affording accommodation for nearly 18,000 children. The average daily attendance is approximately 14,430. In 1912, 249 children were excluded from school owing to the presence of notifiable infectious disease in their homes. In addition, 1978 children were kept at home in connection with outbreaks of measles, hooping cough, chicken pox, and other infectious or contagious disorders in their households. The names and addresses of the children concerned were sent to the Public Health Department by the school teachcrs. 172 The figures for the year have been as follows:— SCHOOLS. Average Attendance. NOTIFIED BY MEDICAL MEN. INFORMATION FROM SCHOOLS. Total. Scarlet Fever. Diphtheria. Enteric Fever. Measles. Hooping Cough. Chicken Pox. Other Diseases Albion Place 580 5 7 1 25 21 23 48 130 Amwell Street 570 5 3 — 16 38 11 22 89 Ann Street 880 14 2 — 79 37 16 25 173 Baltic Street 580 5 1 — 24 60 11 19 120 Bath Street 1,280 4 25 — 49 47 39 59 223 Bowling Green Lane 690 5 3 — 5 11 7 24 55 Central Street 730 11 17 — 35 35 24 27 149 Chequer Street 740 1 4 — 32 34 2 8 81 Compton Street 1,080 4 6 — 5 10 12 11 48 Hugh Myddelton 1,440 32 9 — 151 13 56 98 359 Moreland Street 1,020 6 6 — 51 18 28 36 145 Risinghill Street 1,240 11 11 — 110 10 11 18 171 Winchester Street 1,225 11 12 — 40 7 28 63 161 White Lion Street 850 10 3 — 55 13 3 65 149 St. John Street 145 — 5 — 24 4 — 5 38 St. Luke's 690 2 1 — 30 9 23 26 91 St. Mark's 130 — 1 — 11 5 — — 17 St. Joseph's 370 1 1 — 4 — — 6 12 St. Peter & Paul 190 — 4 - 3 2 3 4 16 Total 14,430 127 121 1 743 374 297 564 2,227 Black Smoke.—During the year 66 black smoke observations were made by the district and workshop inspectors. Notices of 6 infringements were received from the London County Council. In 14 cases, the black smoke was emitted for 3 minutes or longer and, in respect of these, cautionary letters and notices calling upon the occupiers to prevent the recurrence of the black smoke were issued. Summary proceedings for the abatement are taken under Section 24 of the Public Health (London) Act, 1891. Where the black smoke lasted less than three minutes no action was taken. There were no prosecutions. Cleansing of Persons Act, 1907. In 1909 an arrangement was entered into with the Holborn Board of Guardians to provide for the cleansing of Finsbury cases under this Act, at a cost of six shillings per person. This cleansing was effected at the Casual 173 Wards in Little Gray's Inn Lane, Holborn. When the casual wards were taken over by the Metropolitan Asylums Board, this arrangement was discontinued. During the year applications were received from 2 persons, for whom orders were duly issued. Both availed themselves of the facilities offered. The Mortuaries.—There are two mortuaries in the borough, one at Warwick Place, St. Luke's, and one at 47, Northampton Road, Clerkenwell. At each place there is a disinfecting station and a Coroner's Court. The Warwick Place mortuary was closed in December, 1912. The mortuary returns for the year are appended:— Northampton Road Mortuary. Warwick Place Mortuary. Total. Inquest cases 86 35 121 Infectious Diseases 2 0 2 Bodies deposited by Borough Orders 7 0 7 Bodies brought for convenience of relatives 58 66 124 153 101 254 At the Warwick Place Mortuary 24 post mortem examinations were made; at Northampton Road 75 examinations. The Shelter.—The Council's shelter is situated at 47, Northampton Road, Clerkenwell, in connection with the Disinfecting Station. In 1912, 4 families, 18 persons in all, availed themselves of its accommodation. Offensive Trades.—In Finsbury there is only one registered offensive trade—Mr. Joseph L. Henson, Tripe Dresser, 137. Whitecross Street. This was inspected on 5 occasions in 1912, It was not found necessary to serve any notice for sanitary defects. 174 One complaint was received with reference to the fat melting done on the premises of a butcher in the Borough. The premises were visited and the melting was discontinued on request. This practice of fat melting by retail butchers is very much on the increase in Finsbury and may soon raise the desirability of seeking further powers to deal with the very offensive smells caused by the process. Staff of the Public Health Department.—The staff consists of: — A Chief Sanitary Inspector, five District Sanitary Inspectors, a special Meat Inspector, a special Factory and Workshop Inspector, one Lady Sanitary Inspector, two Lady Health Visitors, one Chief Clerk, and two Clerks. In addition there are two Disinfectors, one Van Driver, who may assist with disinfection, and two Keepers of the Mortuaries and Coroner's Courts. One of the Mortuary Keepers assists in disinfecting rooms; the other works the steam disinfector, and his wife attends to those who are temporarily housed in the Council's shelter. The following table summarises the work done during 1912 by the Sanitary Inspectors:— 175 WORK OF SANITARY INSPECTORS, 1912. Inspector Davis. Inspector Longden. Inspector Norman. Inspector Jackson. Inspector Roes. Totals. Houses damp, dirty or dilapidated remedied 253 160 123 100 175 811 Doors, windows, floors, walls, ceilings, sash cords repaired 78 96 63 26 45 288 Overcrowding cases abated in other than Registered Houses 34 10 22 8 9 83 Illegal occupation of underground rooms 12 3 - 4 5 24 Water closet defects remedied 238 138 149 184 220 929 Water closets erected 54 24 84 53 35 250 Urinal defects remedied - 1 4 - 1 6 Urinals erected 10 3 4 2 — 19 Soil pipe and ventilating shaft defects remedied 2 - 0 4 3 9 Soil pipe and ventilating shafts erected 32 3 32 4 15 86 Yard defects remedied 109 103 58 76 102 448 Waste pipe defects remedied 33 17 12 17 50 129 Waste pipes erected 30 3 30 5 17 85 Water cistern defects remedied 21 14 7 6 10 58 Accumulations, rubbish, manure removed 51 17 10 24 32 134 Dung or Dust receptacles repaired or renewed 72 47 90 26 41 276 Drains relaid or amended 46 19 32 39 31 167 Drains cleared 103 27 53 99 80 362 Rain water pipes cleared, repaired, or renewed 12 12 28 16 14 82 Water supply to houses re-instated 2 3 3 1 9 Roofs and Gutters repaired 57 75 67 29 63 291 Area defects remedied 13 13 4 1 22 53 Washhouse defects remedied 133 93 41 36 116 4'9 Animal Nuisances abated 7 2 3 - 8 20 Floor space unventdated 2 4 0 1 3 10 Stables cleansed or repaired 3 — 2 — 1 6 Smoke observations 2 4 30 2 26 64 Water Supply laid on to upper storeys of house 7 28 25 8 4 72 Miscellaneous Nuisances abated 50 26 7 32 21 136 Bakehouses cleansed or repaired 3 4 1 3 2 13 Restaurants cleansed or repaired 10 8 18 8 4 48 Milkshops cleansed or repaired 7 12 8 10 2 39 Public Houses cleansed or repaired Ice Cream Manufactories cleansed or repaired 2 2 4 3 — 11 3 4 6 3 4 20 Butchers' shops cleansed or repaired 2 — 2 — — 4 Fish Purveyors' Shops cleansed or repaired 4 - 2 2 - 8 Registered Houses — Overcrowding cases abated 16 9 8 4 21 58 Registered Houses—cleansed 208 168 150 154 238 918 Registered Houses — Intimation (Cleansing) Notices served 214 168 143 158 262 945 Registered Houses — Statutory (Cleansing) Notices served 67 38 28 70 34 237 First visits (complaints, casual visits) 1087 1365 1430 922 1496 6300 Re-visits 3475 3376 2966 2528 2651 14996 Intimation Notices served 559 404 513 401 523 2400 Statutory Notices served 124 46 68 41 61 340 Infectious disease Investigations 195 218 145 182 280 1020 House inspections 303 307 207 347 368 1532 House to house inspections 289 280 311 198 272 1350 Canal Boats inspected - - 100 - - 100 176 Work of Mrs. Greenwood, Lady Sanitary Inspector, 1912. First Visits. Phthisis 167 Infant Deaths 269 Homeworkers 371 Factories & Workshops 23 Measles 80 Births 109 Complaints 39 Sundries, (including Puerperal Fever, and Ophthalmia Neonatorum) 320 Re-visits. Phthisis 426 Infant Deaths 239 Homeworkers 137 Factories & Workshops 12 Complaints 76 Births 200 2,458 Number of Notices served 124 Dirty rooms and tenements 35 W.C's dirty or defective 53 Insufficient W.C. accomodation 2 Yard paving defective or walls dirty 21 Waste pipe of sink defective 4 Dust bins absent or defective 15 Roofs and guttering defective 15 Wash-house walls dirty or paving defective 16 No water supply to upper floors 3 Rooms illegally occupied 6 Rooms overcrowded 17 Dirty floors & bedding 10 Other nuisances 13 Nuisances referred to District Ispectors 26 Supervision of weighing centres from September 25th, 1912 38 177 LEGAL PROCEEDINGS UNDER THE PUBLIC HEALTH (LONDON) ACT 1891. Date. 1912. Name and address of Defendant. Offence. Result. Jan. 10th Pisa Barnett, 58, Moorgate Street, E.C. Failing to alter and amend a dustbin at 18, Sydney Street Fined £2 and £2 2s. costs. Jan. 22nd S. J. Soanes, 6, Harpur Street, W.C. Failing to provide additional water closet accommodation at 154, Farringdon Road Fined £5 and £2 2s. costs Jan. 24th Feb. 7th Isodore Cohen, 9, Playhouse Yard Failing to alter and amend a defective water closet at 9, Playhouse Yard Fined 10s. and £2 2s. costs. Feb. 23rd E. Gerard Stanley, M.D., St. Bartholomew's Hospital Failing to notify a case of Puerperal Fever Withdrawn. 178 SALE OF FOOD AND DRUGS ACTS. Date. Name and Address of Defendant. Offence. Result. 1912. Jan. 18th Robert Keene, 1, Fann Street For selling milk with 3·5 per cent. of added water and with 5·3 per cent. of ts cream abstracted Fined £2 and £1 3s. costs Feb. 29th Mary and Hannah Lewis, 29, Bath Street For selling milk from which 6·6 per cent. of its tat had been abstracted Fined £1 and £1 3s. costs Mar. 11th Benjamin Eynon, 231, Goswell Road For selling milk from which 6 per cent. of its fat had been abstracted Fined 2s. and 10s. 6d. costs. „ 21st Anton Domeyer, 13, Fann Street For selling butter adulterated with 25 percent. of foreign fat Fined £1 and £1 3s. costs Apr. 23rd Thomas Anderson, 4, Norman Street For selling milk from which 11·3 per cent. of its fat had been abstracted Fined £1 and £1 13s 6d.costs „ 23rd „ 30 th E. Owen. 43, Red Lion Street For selling milk from which 10 per cent. of its fat had been abstracted Dismissed. Warranty proved May 9th John Morgan Peate, 1, Leverington Street For selling milk from which 11 per cent. of its fat had been abstracted Fined £5 and £1 13s. 6d. costs „ 28th June 11th John Thomas Evans, 47, Myddelton Street For selling milk from which 5·6 per cent. of its fat had been abstracted Withdrawn Warranty proved May 31st James Humphries, 48, Northampton Road For selling milk from which 12·6 per cent. of its fat had been abstracted Fined 1s. and 12s. 6d costs. June 13th Benjamin Jones, 19, St. Helena Street For selling milk from which 5 per cent. of its fat had been abstracted Ordered to pay 12s. 6d. costs „ 27th George Frederick Wright, 189, Whitecross Street For selling milk containing 7·5 per cent of added water Fined £1 and 12s. 6d. costs July 4th Arnold Clack, 163, Whitecross Street For selling milk from which 10 per cent. of its fat had been abstracted Fined £1 and 12s. 6d. costs ,, 25 th David Jones, 6, Castle Street For selling milk from which 11·6 per cent. of its fat had been abstracted Dismissed. Warranty proved Aug. 9th Sept. 17th Dunham's Dairies, Ltd., 245, Lavender Hill, S.W. For selling milk from which 6·6 per cent. of its fat had been abstracted Fined £1 and 12s. 6d. costs Oct. 11th Allan Perring, 54, Kawstorne Street For selling milk from which 27·6 per cent. of its fat had been abstracted Ordered to pay 12s. 6d. costs 179 Date. Name and Address of Defendant. Offence Result. 1912 Nov. 1st H. Gullett, 21a, St. John's Lane For selling milk containing 8.4 per cent. of added water Fined 8s. 6d. and 12s. 6d. costs Dec. 27th Eliza Hole, 16, King's Cross Road For selling milk containing 12.4 per cent. of added water Fined 5s. and 12s. 6d. costs DAIRIES, COWSHEDS AND MILKSHOPS ORDERS. Date. Name and Address of Defendant. Offence, Result. 1912. Jan, 11th Lipton, Ltd., City Road Carrying on the trade of purveyor of milk at 9, High Street without being registered as such Withdrawn „ 19th Spiers & Pond, 35-38, New Bridge Street, E.G. Carrying on the trade of purveyor of milk at Farringdon Street Station without being registered as such Fined £5 and £2 2s. costs. Defendants appealed. The appeal was upheld and costs given against the Borough Council. LOCAL GOVERNMENT BOARD AND OTHER TABLES. 182 TABLE I. Vital Statistics of Whole District during 1912 and previous Years. Metropolitan Borough of Finsbury. Year. Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Transferable Deaths. Nett Deaths belonging to the District. Uncorrected Number. Nett. Number Rate. of Nonresidents registered in the District. of Residents not registered in the District. Under 1 Year of Age. At all Ages. Number. Rate. Number. Rate per 1,000 Nett Births. Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 1907 93,165 3,361 2,884 30•9 912 9•8 49 911 368 127 1.774 19•1 1908 91,787 3,474 2,916 31•8 931 10•1 55 891 400 137 1,767 19•2 1909 90,394 3,427 2,857 31•6 882 9•7 56 988 366 128 1,814 20•1 1910 88,987 3,566 2,833 31•8 819 9•2 69 886 342 121 1,636 18•4 1911 87,566 3,441 2,676 30•6 839 9•6 67 935 411 154 1.697 19•4 1912 86,130 3,138 2,579 29•9 790 9•1 69 878 290 112 1,599 18•5 Area of District in acres exclusive of area 586•6 covered by rate Total population at all ages 87,976 Number of occupancies, 21,278 At Census of 1911 Average number of persons per occupancy, 4•13 183 TABLE II. Case of Infectious Disease notified during the Year 1912. Notifiable Disease. Number of cases notified. Total cases notified in each locality. (e.g., Parish or Ward of the District.) Total cases removed to Hospital. Clerkenwell.1 St. Luke.2 St. Sepulchre.3 At all Ages. At Agest—Years. Under 1 1 and under 5 years 5 and under 15 years 15 and under 25 years 25 and under 45 years 45 and under 65 years 65 and upwards. Small Pox — — — — — — — — — — — — Cholera (C) Plague (P) — — — — — — — — — — — — Diphtheria (including Membranous croup) 133 8 59 58 5 3 — — 75 50 2 132 Erysipelas 143 4 4 6 17 35 56 21 117 25 1 27 Scarlet Fever 159 3 59 88 7 2 — — 111 47 1 155 Typhus Fever 1 — — — — — 1 — 1 — — 1 Enteric Fever 8 — — 5 2 — 1 — 7 1 — 8 Relapsing Fever (R) Continued Fever (C) — — — — — — — — — — — — Puerperal Fever 12 — — — 3 9 — — 10 2 — 7 Cerebro Spinal Meningitis 1 1 — — — — — — — 1 — 1 Poliomyelitis 3 — 3 — — — — — 2 1 — 3 Pulmonary Tuberculosis 438 2 8 90 51 186 85 16 274 164 — 67 Ophthalmia Neonatorum 7 7 — — — — — — 6 1 — 3 Totals 905 25 133 247 85 235 143 37 603 298 4 404 184 TABLE III. Causes of, and Ages at, Death during Year 1912. Causes of Death. Nett Deaths at the subjoined ages of "Residents" whether occurring in or without the District. Total Deaths, whether of "Residents" or "Non-Residents" in Institutions in the District. All ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 and upwards 1 2 3 4 5 6 7 8 9 10 11 All causes Certified — — — — — — — — — — Uncertified — 1 — — — — — — — 1 Enteric Fever 1 — — — — — 1 — — — Small-pox — — — — — — — — — — Measles 129 29 56 39 5 — — — — — Scarlet fever 5 1 1 2 1 — — — — — Whooping-cough 31 16 8 6 1 — — — — — Diphtheria and Croup 14 4 4 4 2 — — — — — Influenza 12 — — 1 — — 4 4 3 — Erysipelas 2 1 — — — — — 1 — — Phthisis (Pulmonary Tuberculosis) 160 1 1 3 4 11 75 53 12 — Tuberculous Meningitis 26 4 7 8 6 1 — — — — Other tuberculous diseases 18 6 1 3 3 3 2 — — — Cancer, malignant disease 86 — — — 1 — 21 38 26 7 Rheumatic Fever 7 — — — 1 1 2 3 — — Meningitis 11 2 2 1 1 — 2 2 1 — Organic Heart Disease 116 — — 1 5 6 23 38 43 — Bronchitis 178 16 5 3 1 2 9 45 97 3 Pneumonia (all forms) 152 39 34 15 3 3 12 32 14 3 Other diseases of Respiratory organs 7 2 — — 1 — 1 1 2 — Diarrhœa and Enteritis 42 34 3 2 — — 1 2 — — Appendicitis and Typhlitis 4 — — — 2 2 — — — — Cirrhosis of liver 26 — — — — — 3 18 5 — Alcoholism 16 — — — — — 6 9 1 — Nephritis and Bright's Disease 118 1 — — 1 5 13 59 39 2 Puerperal Fever 4 — — — — — 4 — — 1 Other accidents and diseases of Pregnancy and Parturition 4 — — — — 1 3 — — 1 Congenital Debility and Malformation, including Premature Birth 81 79 1 — 1 — — — — 14 Violent Deaths, excluding Suicide 77 12 1 5 13 4 11 12 19 1 Suicide 10 — — — — — 5 4 1 — Other Defined Diseases 162 23 2 2 3 3 22 41 66 12 Diseases ill-defined or unknown 100 20 2 — — 3 3 5 67 7 1599 290 128 95 55 45 223 367 396 51 185 TABLE IV. Infant Mortality, 1912. cause of death. Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. Total under 1 month. 1-3 months. 3-6 months 6-9 months. 9-12 months. Total Deaths under 1 year. All causes Certified 41 .. .. .. 69 .. .. .. .. 289 Uncertified 1 .. .. .. 1 .. .. .. .. 1 Small-pox .. .. .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. 2 1 8 18 29 Scarlet Fever .. .. .. .. .. .. .. .. 1 1 Diphtheria and Croup .. .. .. .. .. 1 2 .. 1 4 Whooping Cough .. .. .. .. .. 3 2 1 10 16 Diarrhœa .. .. .. 1 1 1 1 5 .. 8 Enteritis .. .. .. .. .. 4 15 4 3 26 Tuberculous Meningitis .. .. .. .. .. .. .. 1 3 4 Abdominal Tuberculosis .. .. .. .. .. 1 .. .. 1 2 Other Tuberculous Diseases .. .. .. .. .. l 2 .. 1 4 Congenital Malformations .. .. 2 .. 3 l .. .. .. 4 Premature Birth 29 3 3 2 37 8 .. .. 1 46 Atrophy, Debility, and Marasmus 2 3 .. 3 8 13 7 .. 1 29 Atelectasis 4 .. .. .. 4 .. .. .. .. 4 Injury at birth .. .. .. .. .. .. .. .. .. .. Erysipelas .. .. .. .. .. .. 1 .. .. 1 Syphilis 1 1 1 1 4 4 2 .. .. 10 Rickets .. .. .. .. .. .. .. .. .. .. Meningitis (not Tuberculous) .. .. .. .. .. .. .. .. 2 2 Convulsions 3 1 .. 1 5 4 3 .. 3 15 Gastritis .. .. .. .. .. .. .. .. .. .. Laryngitis .. .. .. .. .. .. 2 .. .. 2 Bronchitis .. .. 3 1 4 4 1 4 3 16 Pneumonia (all forms) .. .. .. .. .. 4 9 12 14 39 Suffocation, overlying 1 .. .. .. 1 8 1 .. 1 11 Other Causes 1 .. 1 1 3 4 4 4 2 17 42 8 10 10 70 63 53 39 65 290 Nett Births in the year legitimate 2528 illegitimate 51 Nett Deaths in the year of legitimate infants 278 illegitimate infants 12 INFANTILE MORTALITY, 1886 - 1912 189 TABLE VII. INFANT MORTALITY DURING THE YEAR 1912. Nett Deaths from stated causes at various Ages under One Year of Age. Deaths under One Year belonging to Localities. Deaths under One Year in previous years. CAUSE OF DEATH. Under 1 Week. 1—2 Weeks. 2—3 Weeks. 3—4 Weeks. Total under 1 Month. 1—3 Months. 3—6 Months. 6—9 Months. 9—12 Months. Total Deaths under One Year. Barons Court Ward. Lillie Ward. Walham Ward. Margravine Ward. 1 Munster Ward. Hurlingham Ward. Sands End Ward. Town Ward. Total Deaths under 1 year, 1911. Total Deaths under 1 year, 1910. Total Deaths under 1 year, 1909. Total Deaths under 1 year, 1908. Total Deaths under 1 year, 1907. Total Deaths under 1 year, 1906. All causes Certified 92 18 21 6 137 88 77 44 49 395 24 60 31 67 106 13 76 18 517 462 466 544 564 667 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 2 Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... 1 5 6 12 1 2 2 2 3 1 1 ... 16 16 14 19 10 10 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 Whooping Cough ... ... 1 1 2 6 4 4 7 23 2 4 1 3 8 ... 3 2 11 27 21 14 41 11 Diphtheria and Croup ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... 1 ... ... ... 3 1 3 3 4 ... Erysipelas ... ... ... ... ... 1 ... ... ... 1 ... 1 ... ... ... ... ... ... 1 ... ... 1 ... 1 Tuberculous Meningitis ... ... ... ... ... ... ... 1 2 3 ... ... ... ... 2 ... 1 ... 9 6 4 8 4 10 Abdominal Tuberculosis (a) ... ... ... ... ... ... 3 1 ... 4 1 ... ... 1 1 ... 1 ... 3 2 2 6 3 3 Other Tuberculous Diseases ... ... ... ... ... ... 1 ... 1 2 ... 1 ... ... ... ... 1 ... 7 7 10 11 17 12 Meningitis (not Tuberculous) ... ... ... ... ... ... 2 2 1 5 ... ... ... 3 2 ... ... ... 3 7 3 8 7 10 Convulsions 4 1 ... 1 6 2 3 1 2 14 3 2 1 2 2 3 1 ... 8 9 10 10 7 20 Laryngitis ... 1 ... ... 1 ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... 1 ... ... ... Bronchitis 1 1 4 1 7 15 7 5 1 35 2 5 2 5 8 1 9 3 18 30 24 21 50 19 Pneumonia (all forms) 1 ... ... ... 1 18 21 11 15 66 5 8 7 12 16 2 15 1 45 62 53 74 67 52 Diarrhœa ... ... 2 ... 2 6 7 3 6 24 1 2 1 10 6 ... 2 2 142 46 82 97 69 192 Enteritis ... ... ... ... ... 2 4 1 2 9 ... 3 ... ... 4 ... 1 1 38 21 16 21 26 34 Gastritis ... ... ... ... ... 1 1 ... 1 3 ... ... ... ... 2 ... 1 ... 3 5 1 2 3 2 Syphilis ... ... 1 ... 1 2 3 ... ... 6 ... 1 ... 2 3 ... ... ... 16 13 23 16 8 9 Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 5 2 3 2 Suffocation, overlying 2 1 ... 1 4 5 ... 1 ... 10 2 1 2 2 1 ... 2 ... 10 14 11 14 15 18 Injury at Birth 8 ... ... ... 8 ... ... ... ... 8 ... 1 1 1 2 ... 2 1 8 11 8 8 8 11 Atelectasis 6 ... ... ... 6 1 ... ... ... 7 ... 2 ... 1 3 ... 1 ... 10 12 13 20 18 19 Congenital Malformations 8 ... 1 ... 9 3 3 ... 1 16 ... 3 2 2 3 1 4 1 10 16 17 20 14 20 Premature Birth 54 9 8 ... 71 9 1 ... ... 81 ... 14 6 13 26 4 14 4 85 86 78 101 100 94 Atrophy, Debility and Marasmus 8 5 3 1 17 12 12 6 ... 47 4 7 4 8 11 1 9 3 55 48 49 47 59 50 Other causes ... ... 1 1 2 5 4 2 4 17 3 2 2 ... 2 ... 8 ... 16 21 18 22 31 49 92 18 21 6 137 88 77 44 49 395 24 60 31 67 106 13 76 18 517 462 466 545 565 649 Nett Births in the year—Legitimate, 4,008; Illegitimate, 205. Nett Deaths in the year of—Legitimate infants, 365 ; Illegitimate infants, 30. (a) Under Abdominal Tuberculosis are included deaths from Tuberculous Peritonitis and Enteritis and from Tabes Mesenterica. Want of Breast Milk is included under Atrophy and Debility.