Council of the Borough of Hulham. ANNUAL REPORT OF THE Medical Officer of Health, J. Charles Jackson. For the year ending December 31st, 1903. Town Hall, Fulham, S.W. To the Mayor, Aldermen and Councillors of the Borough of Fulham. Sir and Gentlemen, I have the honour to present to you my Annual Report on the Vital Statistics and the conditions affecting the health of the Borough for the year 1903. The statistics of Births, deaths and infectious diseases relate to the 52 weeks ending January 2nd, 1904. POPULATION. The population of Fulham as enumerated at the Census taken on April 6th, 1901, was 137,289, having increased from 113,781 during the previous five years. The population in the middle of 1903, estimated on the assumption that the rate of increase which prevailed between 1896 and 1901 has been continued since, was 147,780, and on this figure the statistics in this report are based. The following table shows the increase of the population of the Borough during the last 50 years. TABLE I. Increase per cent. during previous intercensal period. Persons to the Acre. Year. Population. 7.0 1851 Census 11,866 — 1861 „ 15,539 30.9 9.1 1871 „ 23,378 50.5 13.7 1881 42,900 83.5 25.2 1891 91,640 113.6 53.9 1896 24.4 113,781 67.0 1901 137,289 20.6 80.6 1903 estimated 147,780 — 87.0 Marriages and Marriage-rate. 1182 marriages were solemnized in Fulham during the year, compared with 1162, 1139, and 1123 in the preceding three years. The marriage-rate, i.e., persons married per 1000 inhabitants, was 16.0, the rate of the County of London being 17.4 and that of England and Wales 15.9. 1900 33.9 146 3498 18.8 698 376 206 2347 17.7 133,496 4525 666 1901 138,426 4596 33.2 700 152 2298 16.6 669 367 248 2179 15.8 1902 148 2387 17.8 403 304 17.1 143,102 4790 32.9 708 766 2488 Averages for years 1893-1902. 34.8 698 165 2382 19.6 724 425 228 2186 18.0 4237 121,994 1903 4790 32.5 127 2180 14.8 732 411 278 2047 13.9 147,780 605 * Rates in Columns 4, 8, and 13 calculated per 1,000 of estimated population. Note.—The deaths included in Column 7 of this table are the whole of those registered during the year as having actually occurred within the district or division. The deaths included in Column 12 are the number in Column 7, corrected by the substraction of the number in Column 10 and the addition of the number in Column 11. By the term "Non-residents" is meant persons brought into the district on account of sickness or infirmity, and dying in public institutions there; and by the term "Residents "is meant persons who have been taken out of the district on account of sickness or infirmity, and have died in public institutions elsewhere. The "Public Institutions " taken into account for the purposes of these tables are those into which persons are habitually received on account of sickness or infirmity, such as hospitals, workhouses, and lunatic asylums. Area of District in Acres (exclusive of area covered by water), 1,703'5. Total population at all ages 137,249 Census at 1901. Number of inhabited houses 18,534 Average number of persons per house 7'4 6 BIRTHS AND BIRTH-RATE. The total number of births registered in the borough during the year was 4,790—2,409 of males and 2,381 of females. This is equivalent to a birth-rate of 32.5 per 1,000, which is the lowest as yet recorded in Fulham. The continuous decline in the birth-rate in Fulham of recent years, which is shared by nearly every part of the United Kingdom, will be seen on reference to Table II. The birth-rate of the County of London was 28.4, being lower than in any previous year, and in the three adjoining boroughs the rates were —Kensington, 20.0, Hammersmith, 25.9, and Chelsea, 20.5. In the other metropolitan boroughs the rates ranged from 13.8 in the City of London, 16.9 in Westminster, and 17.1 in Hampstead to 35.9 in Bethnal Green, 37.1 in Finsbury, and 37.6 in Stepney. The following table gives the number of births and the birth-rates in the various wards. TABLE III. Number of Births. Ward. Males. Females. Total Births. Birth-rate. The birth-rate of Margravine Ward is swollen by the births occurring in the Fulham Infirmary, but of these 130 were of the children of women who did not reside prior to their confinement within this ward, 74 belonging to other wards of the borough, and 56 to other districts. Corrected for these, the birth-rate of Margravine Ward was 37.4 and that of the Borough 32 .1. Illegitimacy. The illegitimate births numbered 223 —115 males and 108 females, forming 4.7 per cent. of the total births. Still-born Children. 173 still-born children were buried in Fulham Cemetery, being in the proportion of one still-born child to every 27.7 living. Excess of Births over Deaths. The natural increase of the population of the Borough by the excess of births over deaths was 2,743, compared with 2,178, 2,417 and 2,302 in the three preceding years. DEATHS AND DEATH-RATE. The deaths of 2,180 persons, 1,100 males and 1,080 females, were registered in Fulham during the year, but of these 411 (217 males and 194 females) were of persons not residing in the district who died in public institutions within the Borough, while the deaths of 278 persons (158 males and 120 females) belonging to Fulham occurred outside the district, chiefly in various public institutions. There were therefore 2,047 deaths of persons belonging to Fulham (1,041 males and 1,006 females), being at the rate of 13.9 per 1,000 for the year —the rate for males being 15.0 and for females 12.9. This is the lowest death-rate as yet recorded in Fulham, the lowest figure previously reached having been 15.8 in 1901. Bronchitis 8 16 154 38 11 33 72 5 24 11 22 37 31 48 Pheumonia 174 54 45 3 3 50 19 9 25 20 22 41 12 33 12 35 Pleurisy 6 2 1 ... 3 ... 1 ... 2 ... 1 ... 2 ... Other diseases of Respiratory organs 3 1 2 2 1 13 2 6 ... 3 2 ... 3 1 Alcoholism Cirrhosis of liver 28 ... ... ... ... 24 4 3 2 5 2 3 3 7 3 10 Venereal diseases 24 19 1 ... 3 1 ... 4 6 9 ... 5 10 Premature birth 97 97 ... ... ... ... ... 6 10 11 9 35 3 16 7 7 Diseases and accidents of parturition 5 ... ... ... 1 4 ... ... 2 ... 1 1 ... 1 ... 1 Heart diseases 129 4 2 7 12 76 28 6 28 14 17 21 5 25 13 28 Accidents 85 24 4 7 4 36 10 7 11 6 13 19 5 27 7 23 Suicides 7 ... ... ... 1 5 1 ... 2 1 1 ... 1 ... 2 Murder 4 2 1 1 1 2 1 ... ... All other causes 559 162 133 13 17 198 136 43 99 56 78 104 43 83 53 162 605 266 68 75 701 332 130 331 192 313 445 113 342 181 732 All causes 2047 Notes.— (a) In this Table all deaths of "Residents" occurring in public institutions, whether within or without the district, are included with the other deaths in the columns for the several age groups (columns 2—8). They are also, in columns 9 —16, included among the deaths in their respective "Localities" according to the previous addresses of the deceased as given by the Registrars Deaths of "Non-residents" occurring in public institutions in the district are in like manner excluded from columns 2—8 and 9—16 of this Table. (b) See notes on Table I. as to the meaning of "Residents" and "Non-residents," and as to the "Public Institutions" taken into account for the purposes of these Tables. The "Localities" should be the same as those in Tables II. and III. (c) All deaths occurring in public institutions situated within the district, whether of "Residents" or of "Non-residents," are, in addition to being dealt with as in note (a), entered in the last column of this Table. (d) Under the heading of "Diarrhœa" are included deaths certified as from diarrhœa alone or in combination with some other cause of ill-defined nature; and also deaths certified as from Epidemic enteritis; Zymotic enteritis; Epidemic Diarrhœa; Summer diarrhœa; Dysentery and dysenteric diarrhœa; Choleraic diarrh œa, cholera, cholera nostras (in the absence of Asiatic cholera). Under the heading of "Enteritis' are included those certified as from Gastro-enteritis, Muco-enteritis, and Gastric catarrh, unless from nformation obtained by enquiry from the certifying practitioner or otherwise the Medical Officer of Health has reason for including such deaths, especially those of infants, under the specific term "Diarrhœa." Under the headings of "Cancer," "Phthisis," and "Puerperal fever" are included all registered deaths from causes comprised within these general terms. Deaths from diarrhœa secondary to some other well-defined disease are included under the latter. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Table IV., which is prepared in accordance with the instructions of the Local Government Board, gives the causes of, and the ages at, death. In Table IV. will also be found the numbers and the causes of deaths occurring in the several wards of the Borough, and the following table gives the death-rate of each ward.:— TABLE V. Ward. Death-rate. Baron's Court Ward 10.9 Lillie Ward 14.5 Walham Ward 15.5 Margravine Ward 18.4 Munster Ward 12.5 Hurlingham Ward 13.0 Sands End Ward 13.1 Town Ward 14.1 The Borough 13.9 The death-rate of the County of London was 15.2 per 1,000, and of the three adjoining boroughs that of Kensington was 13.9, of Hammersmith 14.1, and of Chelsea 15.3. The lowest rates in the 28 metropolitan boroughs were 10.0 in Hampstead, 11.1 in Lewisham, and 12.4 in Wandsworth, while the highest rates were 18.6 in Holborn, 19.4 in Shoreditch, and 20.3 in Finsbury. The death-rate of England and Wales was 15.4, and that of 76 of the great towns 16.3. Corrected Death-rate. The Medical Officer of Health of the County of London has published a factor for correction for differences in the age and sex constitution for each of the metropolitan boroughs, based upon the age and sex constitution of the respective populations as enumerated in the census of 1901. The following table gives the crude and the corrected death-rates per 1,000 persons living in Fulham, the adjoining boroughs, and the County of London. TABLE VI. Crude Death-rate. Corrected Death-rate. 1903. 1903. Fulham 13.9 14.6 Kensington 13.9 14.9 Hammersmith 14.1 14.7 Chelsea 15.3 15.9 County of London 15.2 16.0 Seasonal Mortality. The mortality in the four quarters of the year was as follows:— TABLE VII. Deaths. Death-rate. First quarter 503 13.6 Second quarter 440 11.9 Third quarter 499 13.5 Fourth quarter 605 16.4 Mortality in former years. The following table gives the death-rates of Fulham and of London, uncorrected for age and sex distribution, during the previous 10 years. TABLE VIII. Fulham Death-rate per 1,000. London Death-rate per 1,000. 1893 19.9 21.0 1894 17.9 17.4 1895 19.9 19.5 1896 17.5 18.2 1897 17.0 17.8 1898 17.3 18.5 1899 19.4 19.6 1900 17.7 18.6 1901 15.8 17.1 1902 17.1 17.7 Mean of 10 years 1893—1902 18.0 18.6 1903 13.9 15.2 The difference between the rate for 1903 and the mean rate of the preceding 10 years in Fulham represents a saving of 606 lives. MORTALITY AT DIFFERENT AGES. Infantile Mortality. —Of the 2,047 deaths registered, 605 or 29 per cent. were of infants under one year, and the rate of infant mortality measured by the proportion of deaths under one year to births registered was 127 per 1,000. This is the lowest infantile mortality yet recorded in Fulham—the lowest previously reached having been 146 per 1,000 in 1900. The corresponding rate of the County of London was 131 per 1,000, the rates in the various boroughs ranging from 88 in Hampstead, 92 in Lewisham, and 95 in Holborn to 154 in Poplar, 158 in Bermondsey, and 171 in Shoreditch. In the 76 great towns of England and Wales the infantile mortality averaged 144 per 1000. The infantile mortality in the several wards was as under — TABLE IX. Death of Infants under one year. Death of Infants under one year of age to 1000 births. Baron's Court Ward 23 100 Lillie Ward 99 143 Walham Ward 52 147 Margravine Ward 109 143 Munster Ward 156 129 Hurlingham Ward 22 106 Sands End Ward 115 123 Town Ward 29 77 The Borough 605 127 The following Table gives the infantile mortality in London, Fulham and the adjoining boroughs for the preceding ten years: — TABLE X. Deaths under One Year per 1,000 Births. Mean of 10 years. 1893- 1902. 1897. 1893. 1894. 1895. 1896. 1898. 1899. 1900. 1901. 1902. Fulham 177 149 187 176 161 167 189 146 152 148 165 160 147 182 179 171 183 183 Hammersmith 162 168 143 168 Kensington 169 173 175 178 166 181 180 180 163 149 172 145 Chelsea 158 131 155 169 161 176 164 149 138 145 155 142 164 161 159 143 165 London 166 166 158 148 139 157 131 Between the ages of one and five years 266 deaths were recorded, so that the deaths of children under the age of 5 years numbered 871, or 42.6 per cent of the total number. These deaths were equal to an annual rate of 47.2 per 1,000 of the population estimated to be living at that age. Deaths of Illegitimate Infants. 75 of the children who died before attaining the age of one year were illegitimate; the mortality among them being in the proportion of 337 deaths to every 1,000 births, or nearly three times as heavy as that of children born in wedlock. Insurance of Infants. Certificates under the Friendly Societies Acts were issued in respect of 468 children under the age of five years, 54 per cent. of the children dying at this age being insured. Mortality at School Age. At the ages of 5 to 15 years, which is approximately the school period of life, there were 68 deaths, or 3.3 per cent. of those at all ages, being equivalent to a rate of 2.3 per 1,000 of those living at that age. Mortality at Adolescence. Between the ages of 15 and 25 years, 75 deaths or 3.7 per cent. of the total number were recorded; the rate of mortality being 2.9 per 1,000. Mortality at Maturity. 701, or 34.7 per cent, of the deaths occurred between the ages of 25 and 65, the mortality at this age-period being at the rate of 10.5 per 1,000. Mortality at Decline. At the age of 65 and upwards 332 deaths were registered, or 16.3 per cent. of those at all ages. corresponding to a deathrate of 70.0 per 1,000. DEATHS AND DEATH-RATE FROM ZYMOTIC DISEASES. 325 deaths were due to the seven principal zymotic diseases, viz.:— TABLE XI. Small-pox — Measles 62 Scarlet Fever 8 Whooping Cough 48 Diphtheria 24 Enteric Fever 16 Diarrhœa 167 325 These deaths correspond to a death-rate per 1,000 living of 2.2 per 1,000. Distribution of Deaths from Zymotic Diseases. The following table gives the death-rate in each Ward from the several zymotic diseases. Margravine Ward Munster Ward Hurlingham Ward Sands End Ward Town Ward The Borough 0.00 0.00 0.00 0.00 0.00 0.00 1.00 0.59 0.00 0.04 0.08 0.42 0.12 0.03 0.11 0.12 0.05 0.06 0.30 0.17 0.00 0.12 0.08 0.17 0.65 0.28 0.34 0.50 0.08 0.33 0.36 0.03 0.00 0.12 0.08 0.11 3.00 1.20 0.12 0.89 0.46 1.12 5.43 2.30 0.57 1.79 0.86 2.21 During the past 10 years the deaths and death-rates from the seven principal Zymotic diseases have been as under: — TABLE XIII. Death-rate. Year. Deaths. 1893 344 3.3 1894 426 4.0 1895 345 3.1 1896 422 3.6 1897 360 3.0 1898 396 3.2 1899 423 3.3 1900 397 2.9 1901 387 2.8 1902 454 3.2 Average for 10 years 1893—1902 396 3.3 1903 325 2.2 The death-rate from the seven principal infectious diseases in the County of London was 1.8 per 1,000 as compared with a mean rate in the 10 years 1893 —1902 of 2.6 per 1,000. Among the various metropolitan boroughs the death-rates from these diseases ranged from 0.58 in Hampstead, 0.86 in the City of London, and 0.96 in Lewisham to 2.4 in Stepney, 2.9 in Shoreditch, and 3.0 in Poplar. SICKNESS AND DEATHS FROM NOTIFIABLE INFECTIOUS DISEASES. The following table gives the number of cases of infectious diseases notified in Fulham since 1890, when compulsory notification came into force, excluding duplicate notifications: — TABLE XIV. 1890 1891 1892 1893 1894 1895 1896 1897 1898 1899 1900 1901 1902 Small-pox — — 3 32 40 2 2 — — 1 9 16 94 Scarlet Fever 286 118 517 701 529 339 627 759 811 847 552 600 552 Diphtheria 70 69 96 230 329 368 341 378 465 514 630 636 417 Membranous Croup 23 13 15 20 13 18 14 10 11 14 11 8 12 Enteric Fever 72 51 41 58 37 57 53 53 71 111 92 133 74 Continued Fever — — — 6 2 3 5 5 1 1 2 1 — — Typhus Fever 2 3 — 1 — — — — — — — — — — — — — 5 — — 2 1 — 4 — 1 — Cholera Puerperal Fever 6 6 10 18 10 6 6 14 8 13 9 7 7 Erysipelas 114 67 104 153 113 94 99 134 121 178 154 132 121 Totals 573 327 786 1124 1073 887 1149 1354 1488 1683 1459 1534 1277 A 2 115 7 3 5 13 71 16 11 12 8 20 31 1 25 7 — — — — — — — — Erysipelas Scarlet Fever 404 4 139 203 37 20 1 11 39 17 62 97 19 118 41 11 33 16 59 94 16 112 28 Typhus Fever — — — — — — — — — — — — — — — — — — — — — — — Enteric Fever 80 - 6 25 13 36 — 4 10 2 37 15 — 8 4 2 9 2 32 10 — 4 Relapsing Fever — — — — — — — — — — — — — — — — — — — — — — — Continued Fever — — — — — — — — — — — — — — — — — — — — — — — *Puerperal Fever 19 — — — 5 14 — 4 2 1 2 2 3 4 1 3 1 1 1 2 2 3 1 Plague — — — — — — — — — — — — — — — — — 922 14 377 88 167 17 40 114 54 148 203 47 75 91 115 160 36 199 259 Totals 242 22 39 49 * The cases of Puerperal Fever were removed to the Fulham Infirmary. — — — — — Distribution of Cases of Notifiable Infectious Diseases. Table XV. gives the actual number of cases of infectious diseases notified, and Table XVI. the number of cases notified per 10,000 of the population in each ward. TABLE XVI. Cases of Infectious Diseases notified per 10,000 inhabitants. Scarlet Fever. Enteric Fever. Erysipelas. Small-pox. Total. Diphtheria. Puerperal Fever. 0.0 9.0 8.2 3.3 9.0 3.3 32.8 Barons Court Ward 17.5 22.9 5.4 0.9 0.0 51.2 Lillie Ward 4.5 Walham Ward 0.0 13.5 20.7 1.6 6.5 0.8 43.1 1.2 36.5 14.8 21.8 11.8 1.2 87.3 Margravine Ward 0.9 27.0 15.0 4.3 8.6 0.6 56.4 Munster Ward 0.0 21.4 27.0 0.0 1.1 3.4 Hurlingham Ward 52.9 2.3 45.4 31.2 3.1 9.7 1.6 93.3 Sands End Ward Town Ward 0.0 31.6 17.0 3.1 5.4 0.8 57.9 The Borough 0.8 27.4 19.9 5.4 7.8 1.3 62.6 SMALL-POX. Eleven cases of Small-pox were notified in Fulham during 1903, as compared with 15 and 94 in the two preceding years, and of these one patient was found after admission to the Long Reach Hospital not to be suffering from that disease, but the case so closely simulated Small-pox that the Medical Superintendent deemed it advisable to isolate him for so long a period as would have been necessary had he been so suffering. The following Table gives brief particulars of the cases in the borough, and it will be noticed that no case terminated fatally. TABLE XVII. NOTIFIED CASES OF SMALL-POX. Case. 1. A. N. 2. M. M. 3. H. S. 4. A. T. Age. 28 33 33 4 Residence. Danehurst Street Chelmsford Street Brookville Road Bagley's Lane Date of Attack. Jan. 10th Jan. 16th Jan-24th Apr. 10th Date of Removal to Hospital. Jan. 13th Jan. 19th Jan. 28th Apr. 14th Probable Source of Infection. Not known Mother, who had a mild unrecognised attack Not known Case 7, who contracted the disease when tramping in Kent, and returned to Fulham when ill Conditions as to Vaccination. Vaccinated in infancy. „ „ Unvaccinated. Sex. Result. F. Recovered. F. „ M. „ M. „ One family was accommodated in the Council's Shelter during the disinfection of their rooms. In the County of London 416 cases of Small-pox were notified during 1903, as compared with 1700 and 7797 in the two preceding years. Primary Vaccination. The following tables, furnished by Mr. Davies, the Vaccination Officer, give the Vaccination returns for 1902, and for the first six months of 1903, those for the last six months not being yet complete: TABLE XVIII. Supplemental Return for 1902, for the Borough of Fulham. No. of Births Regiatered from 1st Jan., 1902, to Dec. 31st, 1902. Successfully Vaccinated. Insusceptible of Vaccination. Had Small- Pox. Dead. Postponed by Medical Certificate. Removed. Outstanding. Certificates Granted under Clause 2 of the Vaccination Act of 1898. 4790 3700 19 51 409 20 451 49 — Return of Vaccination for the period from January to June, 1903, for the Borough of Fulham. TABLE XIX. No. of Births Registered from 1st Jan., 1903, to June, 30th, 1903. Insusceptible of Vaccination. Had Small- Pox. Postponed by Medical Certificate. Removed. Outstanding. Certificates. Granted under Clause 2 of the Vaccination Act of 1898. Successfully Vaccinated. Dead. 1838 — 193 103 206 7 33 2401 5 The following table shows the proportion of Children who have escaped vaccination during the ten years, 1893-1902: — TABLE XX. Vaccination postponed. Removed, &c. Percentage not finally accounted for. Insusceptible of Vaccination. Died Unvaccinated. Certificates Granted under Clause 2 of the Vaccination Act of 1898. Successfully Vaccinated. Year. Births. 2,840 459 29 354 — 10.9 1893 3,704 22 1894 3,792 3,068 22 333 46 323 — 10.3 1895 3,951 3,125 19 465 49 293 — 9.4 1896 3,151 24 434 34 372 - 10.7 4,015 3,341 22 432 42 266 4 8.2 1897 4,107 1898 4,311 3,170 23 453 78 497 90 16.2 1899 4,581 3,360 27 615 76 384 66 12.1 1900 4,552 3,445 13 470 65 458 63 13.2 1901 4,605 3,603 11 641 19 478 53 13.5 3,700 19 457 51 439 29 11.0 1902 4,790 SCARLET FEVER. 404 cases of Scarlet Fever were notified during the year, the disease being less prevalent than in any year since 1895. The returns for the four quarters were:— Cases. Deaths. 1st Quarter 140 3 2nd „ 106 3 3rd „ 100 1 4th „ 158 1 Fatality.—The disease was of a mild type, the 8 deaths representing a case mortality of 2 per cent., being the lowest yet recorded in Fulham. 369, or 91.4 per cent. of the patients notified, were removed to hospital. Return Cases. —20 cases occurred within 14 days of the return of a child living in the same house from one of the hospitals of the Metropolitan Asylums Board after recovering from a similar attack. Chart CHART SHEWING WEEK BY WEEK THE NUMBER OF CASES OF SCARLET FEVER Notified by Medical Practitioners as having occurred in the Borough of Fulham during the 52 weeks ending January 2nd.. 1904. FUl 9 G. Pite & Co. Ltd., Lower Clapton, N.E. Scarlet Fever 1903. Scarlet fever Mean of 10 Years 1893-1902. CHART SHEWING WEEK BY WEEK THE NUMBER OF CASES OF SCARLET FEVER Notified by Medical Practitioners as having occurred in the Borough of Fulham during the 52 weeks ending January 2nd.. 1904. Diphtheria 1903. „ Mean of 10 years 1893-1903. G. Pite & Co. Ltd., Lower Clapton, N.E. The following table shows the comparative prevalence of Scarlet Fever in the various wards of the Borough and in the County of London during the past 8 years:— TABLE XXI. Number of cases of Scarlet Fever notified per 10,000 of the population. 1896 1897 1900 1902 1903 1898 Mean of 7 years, 1896-1902. 1899 1901 Barons Court Ward 24 34 25 48 25 34 18 31 9.0 Lillie „ 56 80 51 70 34 40 25 51 17.5 45 70 61 60 28 65 17 50 13.5 Walham „ Margravine „ 72 79 83 53 37 28 53 55 36.5 46 60 87 65 43 38 29 27.0 53 Munster „ 46 63 74 40 51 21.4 Hurlingham „ 51 57 26 74 65 79 62 81 45.4 Sands End „ 66 61 70 57 39 68 67 30 30 26 45 31·6 Town „ 54 63 65 65 41 47 38 53 27·4 The Borough 58 51 38 30 41 40 27·2 The County of London 49 44 DIPHTHERIA AND MEMBRANOUS CROUP. There was a notable drop last year in the number of cases reported, there being 286 of Diphtheria and 7 of Membranous Croup which is identical with Laryngeal Diphtheria, or fewer than in any year since 1893. The cases occurring in the four quarters of the year were:— Cases. Deaths. 1st Quarter 82 7 2nd „ 86 5 3rd „ 58 4 4th „ 60 8 It will be noticed from the accompanying chart that the usual increase in the prevalence of the disease in October which has been so marked in Fulham during the past 10 years did not occur last year. Of the 293 cases, 256, or 87·4 per cent., were removed to hospital. Fatality.—The disease terminated fatally in 24 instances, the percentage of deaths to notifications being 8·2. Among the 256 cases treated in hospital there were 13 deaths, giving a case mortality of only 51 per cent., while of the cases treated at home 1J or 30 per cent. died. The reduction of recent years in the fatality of Diphtheria, due mainly to the use of Antitoxic Serum, will be seen from the following table: — TABLE XXII. Number of Cases. Year. Number of Deaths. Deaths per 100 Cases. 1891 82 31 37·8 1892 111 30 27·0 1893 250 65 26·1 1894 342 108 31·6 1895 386 77 20·0 1896 355 78 22·0 1897 388 62 16·3 1898 476 61 12·8 1899 528 59 11·2 1900 641 65 10·2 1901 636 48 7·5 1902 429 51 11·9 1903 293 24 8·2 The following table shows the comparative prevalence of the disease in the several wards of the Borough and in the Metropolis during the past 8 years:— TABLE XXIII. Number of cases of Diphtheria notified per 10,000 of the population. Mean of 7 years, 1896-1902. 1896 1897 1898 1899 1900 1901 1902 Barons Court Ward 13 17 26 26 21 29 22 21 Lillie 30 28 36 36 43 58 23 35 Walham „ 24 38 44 40 29 36 17 33 41 41 45 40 23 34 Margravine 27 21 Munster „ 46 33 40 49 62 58 48 48 Hurlingham 12 28 44 51 18 40 19 38 Sands End „ 64 75 43 49 77 48 36 56 Town „ 15 11 34 35 36 39 16 27 The Borough 30 32 38 40 47 43 30 37 31 38 27 The County of London 26 30 26 24 28 School Influences. The following tables give the number of children in actual attendance at each school who were notified in each month as suffering from Scarlet Fever and Diphtheria:— TABLE XXIV. Number of children attending the Board and other primary Schools in Fulham who were notified in each month as suffering from Scarlet Fever. School. Jan. Feb. March. April. May. June. July. August. Sept. Oct. Nov. Dec. Ackmar Road 1 1 1 1 1 2 2 ... ... ... ... ... All Saints (Denominational) ... ... 1 2 2 4 ... ... 1 ... ... ... 10 Barclay Hall(denominational) ... 1 ... ... ... ... ... ... ... ... ... ... Clancarty Road 4 1 6 1 1 ... ... 1 ... 3 3 4 24 Elizabethan (denominational) ... 1 ... ... ... ... ... ... ... ... ... ... 1 Everington St. .. 1 2 ... 1 ... 1 1 ... ... ... 1 7 Fulham Palace Road ... ... ... 1 ... ... ... ... 1 1 ... 1 Halford Road ... ... 2 1 ... ... 3 ... 1 ... ... ... 7 Harwood Road 1 ... ... ... ... ... ... ... 1 ... ... ... 2 Holy Cross (Denominational) ... ... ... ... ... ... ... ... ... ... ... ... ... Hugon Road 2 1 7 1 2 1 1 ... 2 1 ... 1 19 Kingwood Road ... 1 ... 1 ... ... 1 ... ... ... ... ... 3 Langford Road 1 ... ... 1 3 ... ... 1 ... 1 ... ... 7 Lillie Road ... 1 2 ... 5 1 1 2 ... ... 1 13 Macmurdo Rd 1 1 ... 1 3 Munster Road 2 1 1 3 5 7 1 1 2 1 24 North End Rd. 1 3 1 1 6 Sherbrooke Rd. 1 1 1 2 ... 5 St. Dunstan's Road 6 4 5 ... 1 ... ... ... 1 ... ... ... 17 St. Thomas's Road (Denominational) ... ... 1 1 ... ... ... 1 ... ... ... 3 St. John's (Denominational) .... ... ... 1 ... ... ... ... ... ... 2 ... 3 Star Road ... ... 1 1 ... 1 ... ... 3 Townmead Rd. ... ... Varna Road 1 1 William Street ... ... ... ... ... ... ... ... 1 ... ... ... 1 18 14 27 24 13 18 7 12 8 10 7 15 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... TABLE XXV. Number of children attending the Board and other primary Schools who were notified in each month as suffering from Diphtheria. Jan. Feb. April. May. June. August. Sept. Nov. Dec. March. July. School. Oct. Ackmar Road ... 1 2 ... 1 4 1 ... 1 ... 1 ... All Saints (Denominational) ... ... ... 1 ... ... ... ... ... ... ... ... Barclay Hall(de- nominational) ... ... ... ... ... ... ... ... ... ... ... ... Clancarty Road 1 3 1 ... 1 1 2 ... 1 1 4 1 Elizabethan (denominational) ... ... ... ... ... ... ... ... ... ... ... ... Everington St. ... 1 ... ... ... ... ... ... ... ... ... ... Fulham Palace Road ... ... ... ... ... ... ... ... ... ... ... ... Halford Road ... ... ... 1 1 1 3 ... 2 1 1 Harwood Road ... ... ... ... ... 1 ... ... 1 1 ... ... Holy Cross (Denominational) ... ... ... ... ... 1 ... ... ... ... ... ... Hugon Road ... 1 2 ... 2 2 1 1 3 3 2 ... Kingwood Road 1 1 ... ... ... 1 ... ... 1 ... ... 1 Langford Road ... ... ... ... 1 ... 1 ... ... ... 1 ... Lillie Road 2 2 ... ... ... ... ... ... ... 1 ... ... Macmurdo Rd. ... 1 ... ... ... ... ... ... ... ... ... 1 Munster Road ... ... 1 ... 2 2 1 ... 3 ... 2 ... North End Rd. ... 1 ... ... ... 1 ... ... 1 ... ... 1 Sherbrooke Rd. ... ... ... ... 1 ... ... ... ... ... ... ... St. Dunstan's Road ... ... ... ... 1 ... 1 ... ... ... ... ... St. Thomas's Road (Denominational) ... ... ... ... ... ... ... ... 1 ... ... ... St. John's (Denominational) ... ... 5 2 ... ... ... ... 2 1 ... 1 Star Road ... ... ... ... 1 ... ... 1 ... ... ... ... Townmead Rd. ... ... ... ... ... ... ... ... ... 1 ... ... Varna Road ... ... ... ... ... ... 1 ... ... ... ... ... William Street ... ... ... ... ... ... 1 ... ... ... ... ... 4 12 6 2 16 16 12 2 15 8 13 5 ... ENTERIC FEVER. Eighty cases of Enteric Fever were notified, or 54 per 10,000 inhabitants, the average for the preceding 10 years being 5.9 per 10,000, ana 16 deaths were ascribed to the disease, giving a case mortality of 20 %. At the latter end of June and the beginning of July, a time of the year when there is as a rule but little Typhoid in London, there was a somewhat remarkable outbreak in Fulham, six cases being reported in the week ending June 27th, sixteen in the week ending July 4th, and four in the week ending July 11th, when it abruptly stopped, only five cases being reported in the next 6 weeks. With one exception all the cases occurred in the streets on each side of the portion of Greyhound Road running between Ancill Street and Field Road, comprising an area of about 20 acres, with an approximate population of 4000. The cases in the several streets were : Ancill Street 4 cases in 3 houses. Gastein Road 5 ,, ,, 3 ,, Crefeld Street 4 ,, ,, 2,, Chelmsford Street 3 ,, ,, 3 ,, Claxton Grove 2 ,, ,, 2 ,, Dawson Street 2 ,, ,, 2 ,, Garvan Road 2 ,, 2 „ Suffolk Street 1 case. Field Road 1 „ Hatfield Street 1 „ 25 cases in 20 houses. The ages of the patients were as under: — Under 5 years 1 Between 5 and 10 years 5 ,, 10 and 15 ,, 6 ,, 15 and 25 ,, 5 ,, 25 and 65,, 8 So far as could be ascertained all the patients fell ill between June 10th and June 17th, so that they were infected about the end of May or beginning of June, and one of them was only in Fulham prior to his illness on Whit Sunday and Whit Monday, May 31st and June Ist. Enquiries as to the probable source of infection showed that Milk could certainly be excluded, as in eleven of the affected households some brand of condensed milk was alone used and the others were supplied by seven retail vendors who appeared to obtain their milk from different sources, nor could anything be elicited tending to throw suspicion on any of the following articles of food, which have been shown to be associated at times with the origin of Typhoid Fever. Ice Creams. In four cases the parents thought it very probable that the children had eaten ice creams, but beyond this there was no evidence against them, and the age incidence of the outbreak is against the supposition that ice creams had any connection with it. Shell Fish. In only two instances was there any history of shell fish having been eaten within a fortnight or so of the commencement of the illness, and in each case these were also partaken of by several other members of the family who were unaffected. Fried Fish. An epidemic of Enteric Fever in South London in the autumn of 1900 was probably connected with the consumption of fried fish, but there was nothing in connection with these cases pointing in that direction. Uncooked Vegetables, &c. An outbreak of Typhoid in Hackney last summer was shown by the Medical Officer of Health to have been probably due to the consumption of watercress which had been grown in sewage polluted water, and five of the patients were in the habit of eating watercress and other salads, but probably an equal proportion of the rest of the population would be found at this season of the year to be watercress eaters. Water. The whole of Fulham north of the Lillie Road is supplied by the West Middlesex Water Company, and although the limited nature and restricted area of the outbreak exclude the possibility of any pollution of the reservoirs or source, that of some local contamination of the water may be considered, and in connection with this the distribution of the mains is of peculiar interest. A main runs from Fulham Palace Road along Greyhound Road, from which on the south side run service pipes terminating in dead ends in Ancill Street, Crefeld Road, Garvan Road, Bayonne Road and Tasso Road, and on the north side service pipes terminating in dead ends in Margravine Road and Field Road, Gastein Road, Claxton Grove and part of Chelmsford Street being supplied from the Margravine Road main, while Dawson Street, Suffolk Street, Hatfield Street, part of Chelmsford Street, and three other short streets derive their supply from the Field Road main, all these streets forming with the exception of Chelmsford Street, which runs between Margravine Road and Field Road, and Gastein Road where the service pipe terminates in a dead end. The water supply then of all the streets beyond Ancill Street in which the cases occurred has no connection with that of the neighbouring streets, and assuming the possibility of a local pollution of the water in the Greyhound Road main in the vicinity of Ancill Street, the polluted water would be supplied only to Tasso Road and Bayonne Road besides the affected streets. It has been shown to be possible for pollution to occur even when pipes are kept charged with water at a high pressure, but if the supply is cut off there is then a much greater chance of sewage or other injurious matter being taken into them to be distributed when the water is turned on. No information could be obtained from the Company respecting the supply having been intermitted at a time corresponding with the infection of the patients, but I was positively assured by several residents in the district affected that the water was shut off for a short time about Whitsuntide. If such were the case, it is quite conceivable that seme specifically infected sewage may have been sucked into a defective communication pipe, and it may be noted that on the evening of Thursday, May 29th, we experienced one of the heaviest of last years' storms, by which the sewers were surcharged and the basements in that locality flooded to a depth of 2 to 3 feet, so that the risk of sewage being drawn into a defective empty pipe would be increased, as the subsoil would be soaked with it. Even if the cases were due to the water, no evidence in that direction would be obtained by the examination of the water at the time when the cases were reported as some three or four weeks had elapsed since the date of infection, and the pollution, if any, must have been, from the course of the outbreak, of a very transient nature. The organic matter in the sample taken on July 2nd from the main supplying the affected area was reported by the Analyst to be " decidedly too high," but this was also the case in samples taken on the same day from other mains of the West Middlesex Company and also in two samples taken from the Chelsea Company's mains. Of the other cases in the Borough, three, in one family, were probably due to shell-fish, and six to personal infection. In the latter group were five children who were infected by their mother, the nature of whose illness was not recognised until the fourth week. Isolation of patients suffering from Infectious Diseases. Accommodation for persons suffering from Scarlet Fever, Diphtheria, Enteric Fever, Typhus Fever, and Small-pox, is provided by the Managers of the Metropolitan Asylums Board at their various hospitals, and the increasing recognition by the public of the advantages accruing from the isolation of the infectious sick, is shown by the steadily increasing proportion of patients suffering from those diseases who are removed to hospital. TABLE XXVI. Percentage of notified cases in Fulham removed to Isolation Hospitals. Scarlet Fever. Diphtheria. Enteric Fever. Small-pox. 1891 64·4 41·5 37·3 1892 75·0 64·0 66·0 100 *1893 63·6 48·0 45·0 97 1894 78·0 70·0 70·0 98 *1895 70·0 74·0 45·6 100 *1896 62·5 60·0 38·0 100 1897 75·0 65·0 41·5 - - 1898 79·0 81·1 50·0 1899 81·7 81·6 51·0 100 100 1900 84·0 86.9 72·5 1901 85·4 82·0 68·2 94 1902 85·9 85·1 72·0 99 1903 91·4 87·4 73·8 100 *In these years the accommodation in the Board's hospitals. was inadequate, and many patients remained at home who otherwise would have been removed. Puerperal Fever 19 cases of Puerperal Fever, or 4 per 1,000 births, were notified, of which 5 proved fatal, or 1·1 per 1,000 births. Erysipelas. 115 persons were certified to be suffering from Erysipelas, which was the assigned cause of 5 deaths. Chicken-pox. In consequence of the prevalence of Small-pox aud ths difficulty of distinguishing between Chicken-pox and modified Small-pox, this disease was added to the list of notifiable diseases for a period of one year from February 7th, 1902. From January 4th, 1903, to February, 6th, 1903, 67 cases were notified, - DEATHS FROM NOTIFIABLE INFECTIOUS DISEASES Measles. For the first six months of the year the Borough was practically free from the disease, but an epidemic commenced in July among the children attending Kingwood Road Board School, and gradually extended over the whole of the Borough to the north of Fulham Road, the southern portion remaining unaffected. The deaths from Measles in the four quarters of the year were : — No. of Deaths. Ist Quarter 2 2nd „ 1 3rd ,, 11 4th „ 48 62 These deaths correspond to a death-rate per 1,000 of 0 42. The deaths and the death-rate from Measles daring the preceding 10 years are shewn in the following table: — TABLE XXVII. Year. No. of Deaths. Death-rate per 1,000 1893 12 0·12 1894 160 1·51 1895 50 0·46 1896 101 0·88 1897 50 0·42 1898 59 0·48 1899 68 0·53 1900 80 0·60 1901 38 0·28 1902 168 1·15 Mean of 10 years — 1893-1902 79 0.64 1903 62 0·42 A 3 On April Ist the order made by the London County Council came into force which applied to Measles the sections of the Public Health (London) Act relating to dangerous infectious diseases, with the exception of those which deal with notifications. Subsequent to this, 549 cases were reported to the Medical Officer of Health by the teachers of the Board Schools, and the premises in which the cases occurred were disinfected by the Council, excepting those —50 in number —in respect of which a certificate was received from a medical practitioner that they had been disinfected to his satisfaction. The distribution of the cases which came to the knowledge of the Sanitary Authority was as under:— TABLE XXVIII. Cases. Baron's Court Ward 15 Lillie „ 181 Walham „ 34 Margravine „ 94 Munster „ 175 Hurlingham „ 3 Sands End „ 8 Town „ 39 549 Its extreme infectivity and the fact that this is probably greatest in the pre-eruptive stage of the disease renders Measles extremely difficult to control, but there is some hope that the measures now taken may have some effect in educating the public to an appreciation of the seriousness of a disease which kills far more than all the other notifiable infectious diseases put together, though generally looked upon as a trivial complaint, and as I have frequently stated many lives would be saved if some hospital accommodation could be provided for the children of the poor when suffering from Measles, since a large proportion of those who succumb to the disease would recover if they could be removed from their unfavourable surroundings and treated in a rational manner. Whooping Cough. 48 deaths were accredited to Whooping Cough, equivalent to a death-rate of 0·33 per 100, the mean death-rate of the preceding ten years being 0·51 per 1000. Diarrhœa. The deaths from Diarrhoea numbered 167, corresponding to a death-rate of 1·14 per 1,000, the mortality being in excess of that of 1902, when the death rate was 0"89 per 1,000. One hundred and twenty-seven deaths, or 76 per cent., were of infants under one year of age, and 35 were of children between 1 and 5 years. The deaths in each quarter of the year were — Ist Quarter 8 2nd „ 14 3rd 117 4th 28 The diarrhœal mortality in Fulham compared, as is always the case, very unfavourably with that of other Metropolitan Boroughs, being higher than in any other Borough excepting Shoreditch, and nearly twice as high as that of the County of London. The majority of the deaths of children from Diarrhœal disorders were investigated, and of 79 who died under the age of nine months it was ascertained that all but two were handfed. The excessive diarrhœal mortality of Fulham as compared with the adjoining boroughs will be seen from the following Table; — TABLE XXIX. Deaths from Diarrhoea per 1,000 living. Mean of 10 yrs 1893-02. 1893 1894 1895 1896 1897 1898 1899 1900 1901 1902 Fullam 1·30 0·53 1·15 1·21 1·45 1·40 1·31 1·16 1·18 1·17 0·89 Kensington 0·33 0·68 0·35 0·70 O·64 0·59 0·62 0·60 0·66 0·45 0·56 0·79 0·46 0·79 0·80 1·20 1·12 0·93 0·86 1·02 0·55 0·85 Hammersmith Chelsea 0·76 0·34 0·82 0·67 1·03 0·77 0·66 0·85 0·51 0·53 0·70 London 0·80 0·82 0·71 0·92 0.97 0·80 0·41 0·92 O·86 0·53 0·78 DEATHS FROM OTHER DISEASES. Tubercular Diseases. Phthisis was the assigned cause of "201 deaths in Fulham, against a corrected annual average of 223 deaths in the ten years 1893 —1902, while 72 deaths were ascribed to other Tubercular- cular diseases such as Tubercular Meningitis, Tabes Mesenterica, and General Tuberculosis. In the several Wards of the Borough the death-rates from Phthisis and other Tubercular diseases were as under : — Deaths per 1,000 of the population of each Ward from Phthisis and other Tubercular Diseases. TABLE XXX. Death-rate from all Tubercular Diseases. Death-rate from other Tubercular Diseases. Death-rate from Phthisis. 1·32 Barons Court Ward 0·50 1·82 1·40 Lillie Ward 0·32 1·72 1·67 Walham Ward 0·40 2·07 1·42 Margravine Ward 0·30 1·72 1·23 Munster Ward 0·56 1·79 1·24 Hurlingham Ward 0·34 1·57 1·12 Sands End Ward 0·70 1·82 1·71 Town Ward 0·62 2·33 1·34 0·49 1·83 The Borough Notification of Phthisis. The voluntary notification of cases of Tubercular Phthisis which was begun in 1902 has been continued, and 171 notifications were received—47 occurring in private and 124 in public practice. The cases notified in the various Wards were as under:— TABLE XXXI. Barons Court Ward 10 Lillie „ 21 Walham 17 Margravine 37 Munster 41 Hurlingham 9 Sands End 24 Town 12 171 In all cases in which permission could be obtained the rooms, bedding, etc., were disinfected by the Council after the removal or death of the patient. The following Table gives Phthisis death-rate of Fulham, the adjoining boroughs of London during the preceding 10 years: — TABLE XXXII. Deaths from Phthisis per 1,000 of the population. Mean of 10 yrs 1893-02. 1901 1902 1893 1894 1895 1896 1897 1898 1899 1900 1·53 1·42 1·40 1·66 1·47 1·83 1·57 1·35 1·38 1·51 Fulham 1·51 1·44 1·26 1·34 1·18 1·36 1·28 1·39 Kensington 1·57 1·53 1·49 1·42 1·48 1·61 1·42 1·43 1·51 Hammersmith 1·51 1·58 1·56 1·40 1·39 1·72 1·74 1·74 Chelsea 1·75 1·64 1·92 1·82 1·80 1·79 1·72 1·73 1·45 1·73 1·90 1.72 1·77 1·68 1·71 1·82 1·80 1·65 1·60 1·74 London Influenza. 17 deaths were registered from Influenza, the numbers for the three preceding years being 49, 15, and 35. Cancer. Malignant diseases caused 116 deaths, being 15 in excess of the average of the past ten years, allowing for the increase of the population. Diseases of the Respiratory System. From these diseases, excluding Phthisis, there were 347 deaths, or 17 % of the deaths from all causes, being 213 below the average of the last ten years, allowing for the increase of the population. Alcoholism. Twenty-eight deaths were attributed to Alcoholism or to Cirrhosis of the Liver, and in 15 cases the disease to which death was attributed was stated to have been accelerated by alcohol, though these doubtless represent but a small proportion of the actual number who shortened their lives by the abuse of alcohol. Venereal Diseases. Venereal Diseases accounted for 28 deaths, 19 of which were due to Congenital Syphilis. Diseases of the Heart. Heart Disease was the assigned cause of 129 deaths, the average for the preceding ten years being 117. Certification of the Causes of Death. Of the 2047 deaths registered, 1849 or 90·3% were certified by registered Medical Practitioners, and 197 by the Coroners after inquest, only one death being uncertified. Inquests. At the 197 inquests held on inhabitants of Fulham, the following verdicts were returned :— TABLE XXXIII. Natural causes 100 Through accidents or negligence:— Falls 21 Sun over 10 Suffocation 13 Burns and Scalds 10 Want of attention at birth 10 Drowning 2 Electric shock 2 Lead poisoning 1 Surgical narcosis 1 Puerperal septicæmia due to carelessness 1 Other injuries 11 82 7 Suicide Homicide 4 Open verdict: — found drowned 4 197 DEATHS IN PUBLIC INSTITUTIONS. Fulham Infirmary and Workhouse. Although the two Boroughs, Fulham and Hammersmith, which formerly constituted the Fulham Union, are now separated for poor law purposes, the poor of Hammersmith are still, by an arrangement between the Boards of Guardians, received into this institution. In 1903 the deaths of 562 persons occurred in the Infirmary and of 21 in the Workhouse. Of these 306 belonged to Fulham and 277 to Hammersmith and other districts. Western Fever Hospital. One hundred and forty-nine deaths occurred in the Western Fever Hospital. Of these 28 belonged to Fulham and 121 to other Metropolitan Boroughs. Deaths occurring outside the Borough among persons belonging thereto. The deaths of residents in Fulham in public institutions and elsewhere outside the borough numbered 278, and occurred in the following places : — TABLE XXXIV. St. George's Hospital 63 West London Hospital 41 St. Thomas' Hospital 8 Charing Cross Hospital 1 Guy's Hospital 2 Westminster Hospital 4 St. Mary's Hospital 5 Middlesex Hospital 4 St. Bartholomew's Hospital 1 King's College Hospital 2 University College Hospital 2 London Hospital 1 French Hospital 2 German Hospital 1 Queen's Jubilee Hospital 6 Victoria Hospital for Children 9 Hospital for Children, Great Ormond Street 4 Evelina Hospital for Children 1 St. Francis Hospital for Infants 2 Brompton Hospital for Consumption 8 Cancer Hospital 12 Chelsea Hospital for Women 3 Queen Charlotte's Hospital 1 General Lying-in Hospital 1 Fountain Fever Hospital 1 Grove Fever Hospital 1 Northern Fever Hospital 1 St. Peter's Hospital 1 St. Pelagia's Crêche 1 Freidenheim 1 Hostel of God 1 Kensington Infirmary 2 Chelsea Infirmary 1 St. Pancras Workhouse 1 Wormwood Scrubbs Prison 1 Banstead Asylum 11 Camberwell House Asylum 1 Cane Hill Asylum 8 Caterham Asylum 2 City of London Asylum 1 Claybury Asylum 2 Clerkenwell Asylum 1 Colney Hatch Asylum 5 Darenth Asylum 2 Dartford Asylum 3 Hanwell Asylum 12 Horton Asylum, Epsom 18 Leavesden Asylum 1 Manor House Asylum, Epsom 2 Peckhan House Asylum 1 Tooting Bec Asylum 1 Elsewhere 10 278 Of the 2047 deaths of residents in Fulham registered during last year, 602 or 29 - 4 % took place either in workhouses, in hospitals, or in public lunatic asylums. The percentages in the various classes of institution in Fulham and London were as under. TABLE XXXV. FULHAM. LONDON. Deaths in workhouses and workhouse infirmaries 15·2% 18·3% Deaths in Metropolitan Asylums Board hospitals 1·5% 1·6% Deaths in other hospitals 9·2 % 12·4% Deaths in public lunatic and imbecile asylums 3·5% 3·1% 29·4% 35·4% PUBLIC MORTUARY. 191 bodies were removed to the Mortuary during the year and were admitted as follows:— At the request, of the Coroner 175 Brought in by the Police 15 At the request of the Medical Officer of Health 1 191 Inquests were held on 189 and post-mortem examinations were made in 95 of the above cases. BACTERIOLOGICAL EXAMINATIONS. Increasing use continues to be made by medical practitioners of the facilities afforded by the Council for the bacteriological examination of suspected material as an aid in diagnosis, and 433 specimens were examined compared with 102, 164, 259, 342, and 408 in the 5 preceeding years, the following being the particulars. Material from cases of suspected Diphtheria. Number of Specimens. Klebs Loftier or true Diphtheria bacillus isolated 38 Pseudo Diphtheria bacillus of Hoffman isolated 20 Negative result 176 Doubtful 2 236 Examinations of blood from cases of suspected Enteric Fever. Widal or Typhoid reaction obtained 17 ,, ,, ,, not obtained 35 52 Examinations of sputa from cases of suspected Tuberculosis. Tubercle bacillus found 48 ,, ,, not found 97 145 433 DISINFECTION. . All infected articles were disinfected at the Council's Disinfecting Station, Townmead Road. The total cost of the station for the year was £1,135, including £218 for interest and £117 for repayment of principal. During the three last years the work was done by a contractor, the cost averaged £1,257, and at that time disinfection was not carried out after Measles or Tuberculosis as is now the case. FOOD SUPPLY. Milk. Under the powers transferred to the Borough Council from the County Council by the Local Government Act, 1900, 14 Dairies and Milkshops were registered during the year, and there are now 272 on the register which are regularly inspected. Cowsheds. The licenses of the undermentioned Cowsheds were renewed by the London County Council in October, no objections being raised by the Borough Council. PREMISES. LICENSEE. 23, Burlington Road Thomas Ball. 25, Vanston Place Richard Turvey. 2, Haldane Koad William Pettit. Slaughter Houses. The licenses of the undermentioned slaughter-houses were renewed by the County Council in October, no objections being raised by the Borough Council. PREMISES. LICENSEE. 611, Fulham Road J. Cragg. 52, Melmoth Place R.Lowther. 640, Kings Road T. Vaughan 603, Kings Road S. Stone. 105, Hammersmith Road H. Boughton. Ice Creams. One hundred and seventeen places where ice creams are made, sold or stored were registered and frequently inspected*. Proceedings under the London County Council General Powers Act, 1902, were taken against two ice cream vendors for manufacturing ice creams in a sleeping room, the mixture intended to be frozen in the morning having been found at midnight in an ill-ventilated room occupied by five persons. Proceedings were also taken by the Council, under the Public Health (London) Act, against the occupier of a confectionery shop for obstructing one of their Sanitary Inspectors by refusing to allow him to inspect her premises upon which it was believed that ice creams were manufactured, there being a notice in the window that they were sold there. The summons was dismissed with two guineas costs against the Council, the Magistrate holding that the refusal or failure of an occupier to admit an inspector could only be made the subject of a penalty if it were proved that such refusal was made with a view to preventing the discovery of some contravention of the Public Health (London) Act. In view of this and other somewhat similar cases the London County Council is endeavouring to secure further legislation so as to give the sanitary authority power to examine premises where food is prepared or stored and to require the removal of conditions which are likely to give rise to contamination. Unsound Food. The stalls and shops where food is sold or stored have been regularly inspected. Proceedings were taken in three instances in respect of unsound fruit, and in two in respect of unsound fish exposed for sale. Convictions were obtained in four cases and penalties amounting to £14 and £3 costs imposed, while in one case the summons was dismissed on the ground that the fruit which had been seized was not intended for sale. Forty-four lots of fish and twenty-eight of fruit examined at the request of the owners were condemned and destroyed. Proceedings under the Sale of Food and Drugs Act. The following samples were taken for analysis in 1903. Number of Samples. Number Adulterated. Percentage of Adulteration. Article. Milk 169 20 11·9 Butter 189 20 10·6 Margarine 2 - - Cheese 2 - - Lard 2 - - Dripping 3 - - Coffee 31 4 12·9 Chicory 2 - - Cocoa 10 - - Chocolate Powder 1 - - Black Pepper 6 - - Cayenne Pepper 2 - - Vinegar 1 - - Mixed Spice 4 - - Cinamon 3 - - Mace 4 - - 10 Olive Oil - - Linseed Meal 5 - Preserved Peas 11 8 72·7 2 11·8 Whiskey 17 Gin 8 - 3 - - Rum Brandy 2 - - 487 54 11·1 - - In the three preceding years the samples taken for analysis were as under: — Number of Samples. Number Adulterated. Percentage of Adulteration. 21 5·8 1900 363 1901 366 24 6·6 1902 354 18 5·1 In April last the Council resolved that the number of samples taken annually should be increased to 550, and having regard to the amount of adulteration and the number of milk and provision shops in Fulham it is advisable that there should be a further increase. TABLE XXXVI. Proceedings were instituted by the Council in the following cases, under the sale of Food and Drugs Acts: — DEFENDANT. OFFENCE. RESULT. PENALTY. COSTS. £ £ s. d. s. d. W. A. Seaman, 303. Munster Road Selling margarine as butter Convicted 10 0 0 0 14 6 7 0 Do. do. Convicted 0 0 14 6 Mary Davies, 105, Munster Road ... ... Whiteman & Cox, Ltd. Giving a false warranty in respect of milk, certified to have been adulterated with 14 per cent, of added water Dismissed G. Demario, 845, Fulham Rd. Selling milk adulterated with 14 per cent. of added water Convicted 2 0 0 0 2 0 J. Burridge, 55, Kilmaine Road Selling milk from a vehicle not having his name and address inscribed on it. Convicted 0 2 6 0 2 0 DEFENDANT. OFFENCE. RESULT. PENALTY. COSTS. £ 2 d. £ s. d. Robert Price, 123, Stephendale Road Selling margarine as butter Convicted s. 0 0 0 14 6 Arthur Butt, 170, Stephendale Road Do. do. Convicted 2 0 0 0 12 6 King & Mortimer, 807, Fulham Road Selling preserved peas adulterated with 3·09 grains of sulphate of copper per lb. Convicted ... 1 3 0 Selling preserved peas adulterated with 2·21 grains of sulphate of copper per lb. Convicted W.H. Cullen, 701, Fulham Road 1 3 0 J. F. Pane, 2, Castletown Rd. Selling preserved peas adulterated with 2·32 grains of sulphate of copper per lb. Convicted 1 3 0 Alfred Cockerell, 202, North End Road Selling preserved peas adulterated with 2.32 grains of sulphate of copper per lb. Convicted ... 1 3 0 Selling preserved peas adulterated with 2·21 grains of sulphate of copper per lb. John Elmsley, 62, North End Rd. Convicted 1 3 0 ... 1 Baines Bros., 119, North End Road Selling preserved peas adulterated with 2·65 grains of sulphate of copper per lb. Convicted 3 0 Convicted 1 Alfred Bartlett, 843, Fulham Road Selling preserved peas adulterated with 2.32 grains of sulphate of copper per lb. 3 0 Convicted 0 0 12 6 W. Cory, 156, Munster Rd. Selling milk adulterated with 14 per cent. of added water 1 0 Dismissed ... Thomas Jones, 24, Filmer Road Selling milk adulterated with 5 per cent. of added water ... ... Dismissed J. Spackman, Wootten Bassett, Wilts Giving a false warranty in respect of milk from which 20% of its ori- ginal fat was certified to be abstracted. ... ... ... ... ... RESULT. PENALTY. OFFENCE. DEFENDANT. COSTS. s. Convicted £ d. £ s. 0 12 3 0 0 6 William Stone, 81, Estcourt Road Selling milk from which 20 per cent. of the original fat had been abstracted. Convicted 0 0 0 12 6 Thomas Jones, 127, Munster Rd. Selling milk from which 20 per cent. of the original fat had been abstracted 1 Convicted 30 0 0 0 12 6 W. A. Seaman, 303, Munster Rd. Selling margarine for butter Convicted 20 0 0 0 12 6 Henry Brown, 2, Dieppe Street Selling margarine as butter Convicted 0 10 0 0 17 6 F. Blanchard, 16, Pellant Road Selling milk adulterated with 14 per cent. of added water Convicted 1 0 W. Scarlett, 48, Bagley's Lane Selling milk from which 70 per cent. of the original fat had been abstracted 0 0 12 6 Robert Price, 123, Stephendale Road Selling margarine as butter Convicted 10 0 0 0 12 6 Convicted 5 0 0 0 12 6 Charles Starr, 12, Stephendale Road Do. do. Convicted 2 0 0 0 12 Edwin Toy, 130, Lower Richmond Road, Putney Selling milk from which 10 per cent. of the original fat had been abstracted Convicted 10 0 0 0 12 Selling milk from which 65 per cent. of the original fat had been abstracted Wm. Lambourn, 134, Estcourt Rd. 3 0 0 Convicted 0 14 i E. Lacy, 164, Wandsworth Bridge Road Selling margarine as butter 0 4 Convicted Selling coffee adultera- ted with 60 per cent. of chicory 0 0 2 A. Nicholas, 75, Moore Park Rd. OFFENCE. DEFENDANT. RESULT. PENALTY. COSTS. £ d. £ s. d. s. C. Mills, 612, Kings Road Selling coffee adulterated with 45 per cent. of chicory Convicted 3 0 0 0 12 6 C. H. Bassett, 268, New Kings Road Selling coffee adulterated with 30 per cent. of chicory Convicted 4 0 0 0 12 6 C. H. Bassett, 2, New Kings Road Selling butter adulterated with 10 per cent. of margarine Convicted 4 0 0 0 14 6 J. Chinnock, 81, Estcourt Road Selling milk from a vehicle without name and address thereon Convicted 0 5 0 0 2 0 Withdrawn ... H. Clack, 253, Dawea Road Selling margarine as butter ... Do. do. Convicted 0 0 0 12 6 4 W. Pope, 91, Munster Road Convicted 5 0 0 0 12 6 Do. do. Alfred Cockerell, 202, North End Road Convicted 2 0 0 Do. do. 0 12 6 J. Chinnock, 81, Estcourt Road Convicted 0 0 Do. do. 10 0 12 6 J. Appleyard, 35, Elmdale Street Selling milk from which 22 per cent. of its original fat had been abstracted Convicted 0 0 10 0 12 E. Fricker, 112, Waterford Road 24 6 6 135 18 0 A 4 FACTORY AND WORKSHOP ACT. in May last year, the Council appointed Miss J. Brown, B.A., as Sanitary Inspector, who has been mainly employed since her appointment in the supervision of laundries and other workshops where women are employed, and in the inspection of the premises of out-workers. Miss Brown has succeeded in doing most excellent work and has thoroughly justified her appointment. The following is a summary of the work done in connection with the inspection of factories, workshops, and workplaces, in tabular form, as suggested by His Majesty's Chief Inspector of Factories. TABLE A. INSPECTION OF FACTORIES, WORKSHOPS, AND WORKPLACES. Number Of Places. Number of Inspections, 1903. Number of Notices, 1903 Number of Prosecutions, 1903. On Register at end of 1902. Added in 1903. Removed in 1903. On Register at end of 1903. CLASS OF WORKS. Premises. Rooms. ... 30 1 29 ... 58 19 ... Factory Laundries Factories Factory Bakehouses 2 ... ... 2 ... 6 ... ... Other Factories 12 11 ... 23 ... 44 7 ... Workshop Laundries ... 50 2 48 156 97 31 ... Workshops Workshop Bakehouses 72 1 5 68 150 250 61 ... Other Workshops 86 130 200 227 201 32 ... 16 Outworker's Premises ... 150 18 132 ... 102 25 ... Places where Workplaces Food is Prepared for Sale* ... 66 2 64 71 66 17 ... Workplaces other than the above ... 37 ... 37 ... 37 17 ... Total 172 475 44 603 604 861 209 ... Under this head are included the Kitchens of Hotels, Restaurants, Eating Homes of all sorts, Tripe, Fried Fish and Eel Shops, and other places where food is prepared. A Register is required by s. 131 in the case of Workshops only. TABLE B. MATTERS DEALT WITH. PARTICULARS. Number Of Defects. Found. Notified by Home Office. Remedied. Notified to Home Office. Notices Issued. Prosecutions. Matters under the Public Health (London) Act, 1891. t — Want of Cleanliness 3 138 ... 140 Want of Ventilation ... ... ... ... Want of Air Space : Overcrowding 3 ... 3 ... I Insufficient 4 ... 4 ... Sanitary Accommodation Unsuitable (S. 38). 15 ... 15 ... 209 Not Separate for Sexes 3 ... 3 ... Want of Drainage of Floors 2 ... ... ... I 89 ... 84 ... Other Nuisances Contraventions of Factory and Workshop Act, 1901. Occupying Underground Bakehouse without Certificate ... ... ... ... I Breach of Special Sanitary Requirements for Bakehouses (ss. 97 to 100) ... ... ... ... ... Failure as regards Lists of Outworkers (s. 107) ... ... ... ... 19 Giving out work to Unwholesome (s. 108) be done in ... ... ... ... ... ises which are infected (s. 100) ... ... ... ... ... Allowing Wearing Apparel to be made in Premises infected by Scarlet Fever or Small Pox (s. 109) ... ... ... ... ... Other Contraventions ... ... ... ... ... 256 3 247 ... 228 Total TABLE C. Cases reported to H.M. Inspector. Abstract not affixed 72 As to action taken in cases notified by H.M. Inspector 4 Other cases 3 Number of underground bakehouses in use at the end of 1903 50 Certificates granted (S. 101), 49 Number of workshop rooms measured 149 LIST OF OUTWORKERS S. 107). Class of Homework. Number of Addresses of Outworkers. 1903. Number of Lists Received. Up to Feb. 1st. Forwarded to other Authorities. Received from other Authorities. Up to Aug. 1st. No. of Outworkers. No. of Lists. No. of Outworkers. *Wearing Apparel:— No. of Lists. 7 12 37 31 16 Tailoring 28 4 2 1 Bootmaking 3 2 44 Shirts 2 1 2 4 1 1 ... ... ... 48 Dressmaking 1 Artificial Flowers ... ... ... ... ... 1 Lace Cabinetmaking (Upholstery) ... ... ... ... ... 1 Fur pulling Other (Incandescent Mantles) ... ... ... ... ... 1 Total 12 13 36 35 41 111 *The more important branches of homework wearing apparel should be distinguished, each in a separate line ; e.g. dressmaking, tailoring. Number of Notices prohibiting homework in unwholesome premises (S. 108) Number of Orders prohibiting homework in infected premises (S. 110) ... ... ... ... ... Bakehouses. At the end of 1902, fifty-five underground bakehouses were in use in Fulham. Five of these have since been closed, while in forty-nine various improvements have been carried out, in order to comply with the requirements of the Council and certificates of suitability, in accordance with Sec. 101 (4) of the Factory and Workshop Act, 1901, have been granted to the occupiers. In one instance the Council refused the application of the occupier of an underground bakehouse for a certificate, on the ground that the electric light had not been installed in the bakehouse, as required by the Council, and since he continued to occupy the bakehouse, proceedings have this year been taken against him, and a penalty inflicted. Since then the electric light has been installed, and the Council have been recommended to grant a certificate. In addition to the fifty underground bakehouses there are twenty other bakehouses which are regularly inspected. DRAINAGE OF NEW BUILDINGS. During the year the following drainage plans of proposed new buildings were submitted to and approved by the Public Health Committee:— Houses and Shops 439 Workshops, etc. 10 Blocks of Flats 6 Board Schools 3 Stables 2 Assembly Hall 1 I 461 REMOVAL OF DISUSED DRAINS. The London School Board appealed to the Divisional Court against the decision of the magistrate, Mr. Rose, sitting at the West London Police Court, imposing a penalty on the Board for not having taken up the old disused drains at Everington Street Board School —as required by the Council —when reconstructing the drainage of the School. A notice having been served requiring the reconstruction of the drainage of the School, which had been found to be defective, the London Sanitary Protection Association submitted, on behalf of the School Board, a plan showing the proposed reconstruction, and were informed that the plan submitted would be approved, provided the whole of the old drains proposed to be abandoned were removed. On this understanding the work was then proceeded with, and the necessary connections to the sewer were made by the Council's workmen. In carrying out, however, the new drainage scheme, certain of the old soil drains were not removed, but were cleared out as far as possible and filled up at the ends with concrete. A further notice was then served by the Council upon the School Board, requiring them to remove all the old disused drains and sewage charged earth," and on their failing to do this, proceedings were taken against the Board, who were fined £2 with 10s. costs. At the hearing of the appeal it was contended on behalf of the School Board that Section 83 of the Metropolis Local Management Act, 1855, under which the notice was served, only relates to "drains or other connected works made or provided," and not to old disused drains which were not physically connected with the new drains, and that as regulations and directions as to old drains are not contemplated by the section, a fine could only be imposed if regulations and directions as to new drains were not complied with. The Court, however, held that under Section 76 of the Metropolis Local Management Act, 1855, which provides that "before making any drain notice must be given to the Council, and that every such drain shall be made in such direction, manner and form, and of such materials and workmanship, &c., as the Council shall order," it was competent for the Council, before sanctioning the new system of drainage, to require the removal of the old disused drains. The appeal was therefore dismissed with costs. FLOODING OF BASEMENTS WITH SEWAGE. The madequacy of the main drainage system of London was painfully in evidence last year, as the basements of hundreds of houses in all parts of the borough were time after time flooded with sewage, causing the unfortunate occupiers the most intolerable discomfort and seriously endangering their health. The local authority in common with those of other metropolitan districts have for the last ten years been continually pressing the London County Council to carry out the recommendations of their Engineer in connection with the enlargement of the main drainage system, but till recently little or nothing has been done in that direction. It is hoped, however, that the new pumping station, which has been recently completed at Lot's Road, Chelsea, may have some effect in relieving the Fulham sewers, as it must be remembered that in addition to the grave nuisances to the occupiers arising from the flooding of basements, the frequent pollution of the soil by sewage must be prejudicial to the public health. VENTILATION OF SEWERS. Ventilating shafts continue to be erected by the Council in all suitable places where the necessary permission can be obtained. Ventilating shafts have also—at the request of the Borough Council —been placed by the London County Council over the their main sewer, in Fulham Palace Road near Distillery Lane, and at the corner of Fulham Palace Road and Lillie Road; there having been constant complaints of the offensive emanations from the surface ventilators in these roads. SANITARY CONVENIENCES AT LICENSED HOUSES. An inspection was made of the sanitary conveniences at all the licensed houses within the borough, and in five cases the Town Clerk opposed, on behalf of the Council, the renewal of the licences, on the ground of there being no public sanitary convenience on the premises. In each case the licence was renewed only on the distinct understanding that, unless such accommodation were provided before next year, the magistrates would exercise fully the powers they possess of refusing the application. SMOKE ABATEMENT. Fifteen intimations and eight statutory notices under the Public Health (London) Act were served in respect of chimneys (not being chimneys of private dwelling houses) sending forth black smoke in such quantities as to be a nuisance. Proceedings were taken against the Fulham Pottery and the Burlington Troy Laundry, and prohibition orders were made in each case, with a penalty of £5 and 2s. costs against the Fulham Pottery and one of £10 and £2 2s. costs against the Burlington Laundry. HOUSING. The Public Health Committee have had under consideration the plan prepared by the Borough Surveyor for a block of dwellings proposed to be built on the land belonging to the Council in Townmead Road, on a portion of which the Electric Light Station, Dust Destructor and Disinfecting Station have been erected, but no decision has as yet been arrived at. Overcrowding. Notices in respect of 150 rooms which were found to be overcrowded were served and complied with. Houses Let in Lodgings. New by-laws in respect of houses let in lodgings were made by the Council and sanctioned by the Local Government Board in October last. In these by-laws the " owner," i.e., the person who receives or is entitled to receive the rack-rent of the house, is made responsible for the annual cleaning of the premises, the condition of the drains, etc., in place of as in the old by-laws the "landlord," who was the person by whom the rooms were actually let, since in administering the by-laws it was found that the latter was frequently in such a financial position as to be unable to comply with their requirements. The question as to the exemption of certain houses from the operation of the by-laws led to considerable discussion with the Local Government Board. As originally submitted to the Board, the by-laws only applied to such of the houses let in lodgings as were registered by the Council as lodging houses, but the Board objected to this on the ground that, as they were informed by the London County Council, it lent itself to lax administration. Shortly after this the London County Council forwarded to the Borough Council the opinion which they had obtained from Mr. Cripps, K.C., to the effect that having regard to the terms of Section 94 of the Public Health (London) Act, 1901, which enacts that every sanitary authority shall make and enforce by-laws as to lodging houses there was no power to make exemptions. The Council then submitted to the Local Government Board a series of by-laws containing no exemption clause, but were informed that the Board were not prepared to assent to them unless an exemption clause were inserted. A clause therefore exempting lodging houses from the operation of the by-laws where the rent paid by each lodger for unfurnished rooms was 12s. a week or upwards and for furnished rooms 15s. a week and upwards was inserted and approved by the Board. With the confirmation of the by-laws arrangements were at once made for actively administering them, and one of the Sanitary Inspectors was instructed to devote himself entirely to that work. Early, however, in the present year it was held by the Divisional Court in the case of Stiles v. Gelinski that a by-law made by the Metropolitan Borough of Stepney under Section 94 of the Public Health (London) Act in respect of the annual cleansing of a lodging house was unreasonable, and therefore invalid, because it did not provide for notice to be given to the landlord, who was the person made responsible under the by-law. As the corresponding by-law made by the Borough Council is in similar terms, both being based on the Model By-law of the Local Government Board, the Council have drafted the necessary amendment for submission to the Board, but meanwhile the work in connection with the by-laws of necessity remains in abeyance. Certificates under the Customs and Inland Revenue Acts. 0 By the Revenue Act of 1903, the provisions of the Customs and Inland Revenue Acts of 1890 and 1891, reducing the rate of inhabited house duty on houses built or adapted by additions, for the purpose of providing separate dwellings, on the production of a certificate from the Medical Officer of Health "that the house is so constructed as to afford suitable accommodation for each of the families or persons inhabiting it, and that due provision is made for their sanitary requirements," were extended to flats of an annual value not exceeding ₤60. Applications were made for certificates in respect of 605 dwellings, of which 455 were granted, 66 were given after certain specified works had been completed, and 84 were refused. WATER SUPPLY. Samples of the water supplied by the West Middlesex and Chelsea Water Companies were taken from time to time. Samples taken from the mains of the two Companies in July were pronounced by the Analyst to show a much higher proportion of organic matter than an efficiently filtered Thames derived water should contain. With respect to a sample of water taken from the Chelsea Company's main on November 13th, the Analyst reported that "it contains far more organic matter in solution than should be present in any water intended for drinking purposes, the free and albuminoid Ammonia being both about three times above what may be considered a reasonable figure for efficiently filtered London water and the other figures indicative of organic matter are similarly in excess. In view of the fact that the water is derived from a sewage-polluted source it must be regarded as dangerous and unfit for drinking purposes." The attention of the Company was at once called to this report and notices were issued, as was also done in July, recommending consumers to boil the water. Samples taken subsequently from the mains on November 21st, 24th, and 27th were pronounced by the Analyst to showthat a decided improvement had taken place in the condition of the water, though the organic impurity was still rather high, and the samples taken in December were pronounced to be of satisfactory quality. The reports of the Analyst together with the correspondence with the Company on the subject were forwarded to the Water Board. HOUSE REFUSE. The weekly service for the collection of house refuse has been regularly maintained, but I would again strongly press upon the Council the necessity for a more frequent removal, at any rate during the summer months. Having regard to the exceptionally high mortality in Fulham from Diarrhœa, which is essentially a filth disease, the Sanitary Authority should spare no effort nor expense in securing the prompt removal of all decomposing refuse from the dwelling-houses and streets. COMBINED DRAINAGE. Twenty-seven systems of combined drainage, for portions of which the Council were liable, owing to their being "sewers" within the meaning of the Metropolis Local Management Act, were reconstructed during the year at a cost to the Council of £304, the work being carried out by a contractor at a schedule of prices. The sum of £73 14s. 8d. was also paid to owners in respect of work executed by them in compliance with notices of the Council at nine houses in connection with house drains which were "sewers" within the meaning of the Metropolitan Local Management Act. In the case of Silles v. The Fulham Borough Council, in which the Court of Appeal held that a pipe became a "sewer" within the meaning of the Metropolis Local Management Act, 1855, from the point where it receives the rainwater of two or more houses, the Council have resolved not to proceed with an Appeal to the House of Lords against the decision of the Court of Appeal. SANITARY STAFF. The appointment of a Lady Inspector brings up the number of Sanitary Inspectors employed by the Council to seven —there being now 21,110 inhabitants and 2,810 houses to each inspector, as compared with 15,000 inhabitants and 1,900 houses to each inspector in the County of London and Fulham has, I believe, proportionally fewer inspectors than any Borough in the Metropolis. GENERAL SANITARY WORK. The following is a summary of the Sanitary Work of the year:— Complaints received 1186 Intimation notices served 2357 Statutory notices served 736 Nuisances abated. Drains reconstructed 272 Drains repaired 377 W.C's repaired, etc. 682 Stack Pipes repaired or disconnected 235 Soil Pipes renewed 174 Yards and Forecourts paved 509 Dustbins provided 507 Cisterns repaired 74 Supply of water from rising main provided 360 Sinks repaired 390 Roofs repaired 245 Floors repaired 75 Ventilation under floors provided 32 Dampness in rooms remedied 144 Accumulation of refuse, etc., removed 95 Manure receptacles provided 23 Stables paved and drained 8 Nuisances from animals abated 62 Water supply provided 34 Cases of overcrowding abated 138 Rooms cleansed or repaired 1420 Rooms disinfected and cleansed after infectious illness 1340 Proceedings under the Public Health (London) Act, and the Metropolis Local Management Acts, were instituted by the Council in the following cases: — OFFENCE. PENAL TY. DEFENDANT. RESULT. COSTS. Dismissed £ s. d. £ s. d. Messrs. Flew & Co., North End Road Constructing rainwater pipes not in accordance with the by-laws of the London County Council 2 J. Wilson, Gorringe Park, Tooting Constructing a water closet not in accordance with the by-laws of the London County Council Convicted 0 0 0 2 0 B. Martin, 14, Dowell Mews Convicted 0 Exposing unsound herrings for sale 5 2 0 0 0 House without a proper water supply Closing Order made ... 0 Occupier, 37, Epirus Road 5 J. Howes, 3, Peterboro Mews Exposing unsound bananas for sale 3 2 Convicted 0 0 10 J . Howes, 3, Peterboro Mews Convicted 5 Exposing unsound apples for sale 0 0 ... Fulham Pottery, Ltd. Prohibition Order Chimney emitting black smoke 0 0 5 0 2 Chimney emitting black smoke Prohibition Order 0 Burlington Troy Laundry 10 0 0 4 0 Obstructing a Sanitary Inspector employed in the execution of the Public Health Act Dismissed £2 2s. costs against the Council M. A. May, 833, Fulham Road ... ... S. Necundine Convicted 0 Manufacturing ice cream in a room used for living and sleeping 0 15 0 5 Do. do. Convicted 0 G. Corozze 0 15 0 5 0 DEFENDANT. RESULT. PENALTY. COSTS. OFFENCE. Failing to remove manure Convicted ₤ s. d. £ s. C. Ade, 50, New Kings Rd. d. 2 0 0 0 2 0 A. Hawkin, 106, New Kings Road Do. do. Convicted 2 0 0 0 2 0 Do. do. Convicted 2 0 T. Ford, 74, New Kings Rd. 0 0 2 0 F. & J. Silles, 131, Wandsworth Bridge Road Failing to comply with London County Council drainage by-laws 1 0 0 Convicted 0 2 0 A. Smith, 64, Lancaster Rd., East Ham Convicted 0 0 0 Removing offensive refuse during prohibited hours 3 2 0 Premises in such a state as to be a nuisance Closing Order ... 0 Owner, 106, Greyhound Road 5 0 Do. do. Closing Order i * ... 0 Owner, 108, Greyhound Road 5 0 A. Hesketh, 113, Tachbrook Rd. Exposing for sale unsound fish Convicted 3 0 0 0 8 0 Owner, 20, Ewald Road Premises in such a state us to be a nuisance Abatement Order 0 10 0 0 5 0 Do. do. Abatement Order ... 1 0 0 Owner, 44, 46, 48 & 50, Hannell Road Exposing unsound bananas for sale Dismissed ... ... H. Humphries, 39, Church Street Premises in such a state as to be a nuisance Abatement Order ... I 0 5 0 Owner, 31, Waldemar Avenue Using ice cream barrow without name and address thereon 0 5 0 Convicted 0 2 0 A. Santille, 50, Garvan Road RESULT. PENALTY. DEFENDANT. OFFENCE. COSTS. ₤ s. d. £ s. d. ... ... Dismissed J. Nicholls, New Kings Road Reconstructing drain without previously submitting plan Convicted 1 1 W. Brcason. 54a, Goldhawk Rd. Refusing or failing to admit the Sanitary Inspector to 3, Hannell Road 0 0 1 0 Convicted 0 A. Rust. 77, Bayonne Road Failing to remove manure 0 5 0 2 0 Convicted 0 0 5 0 2 0 J. Rust, 52, Bayonne Road Do. do. 43 0 5 18 10 0 In thirteen other cases in which proceedings had been instituted, the summonses were withdrawn, on the payment of the costs, the works necessary to abate the nuisances having been executed. The following summary has been prepared at the request of the Medical Officer of Health of the London County Council: — PROCEEDINGS DURING 1903. PREMISES. NUMBER OF PLACES. Number of Inspections, 1903. Number of notices, 1903. Number of Prosecutions. 1903. On register at end of 1902. Added in 1903. Removed in 1903. On Register at end of 1903. Milk premises 267 14 9 272 - 15 - Cowsheds 3 - - 3 12 - - Slaughter-houses 5 - - 5 20 - - Other offensive trade premises - - - - - - - Ice cream premises - 117 - 117 150 22 2 329 - - 329 (a)* (a)* Registered houses let in lodgings 420 (b)* (b)* (a) For overcrowding. * (b) For other conditions. Overcrowding, 1903 — Number of dwelling rooms overcrowded 150 Number remedied 150 Number of notices issued 136 Number of prosecutions 2 Underground rooms — Number closed during year 4 Insanitary houses — Number closed under the Public Health (London, Act, 1891 4 Shelters provided under see. 60 (4) of the Public Health (London) Act, 1891— Number of persons accommodated during the year 7 Customs and Inland Revenue Acts — Number of houses for which applications were received during year 65 Number of dwellings comprised therein 605 Number of certificates granted 56 Number of prosecutions under By-laws under Public Health Act, 1891— (a) For prevention of nuisance arising from snow, ice, salt, filth, &c. 1 (b) For prevention of nuisance arising from offensive matter running out of any manufactory, etc. - (c) For the prevention of keeping of animals in such a manner as to be injurious to health 1 (d) As to paving of yards, &c., of dwelling houses 5 (e) In connection with the removal of offensive matter, etc. 2 (f) As to cesspools and privies, removal and disposal of refuse, etc. - (g) For securing the cleanliness of tanks, cisterns, etc. — (h) With respect to water closets, earth closets, etc. 1 (i) With respect to sufficiency of water supply to water closets - (j) With respect to drainage, etc. (Metropolis Management Act, Section 202) 5 (k) With respect to the deposit of plans as to drainage, etc. (Metropolis Management Act, Section 202) 1 Mortuaries — Total number of bodies removed 191 Total number of infectious bodies removed 1 In conclusion, I have to thank all the Members of the Staff of the Public Health Department for the faithful and willing assistance they have at all times rendered me. I am, Sir and Gentlemen, Your obedient Servant, J. CHARLES JACKSON, Medical Officer of Health. April, 1904. A 5 APPENDIX. TABLE A. Giving the Meteorological Conditions of the 52 Weeks ending 2nd January, 1904, together with the number of Deaths from certain Diseases and at certain Ages. Week ending. Mean Temperature. Highest Temperature. Lowest Temperature. MeanTemperature of the earth 3 ft. below surface. Mean height of Barometer. Rainfall in inches. Sunshine in hours. Prevailing Wind. Total Deaths. Deaths under 1 year. Deaths over 60. Deaths from Respiratory Diseases. Deaths from Phthisis. Deaths from Zymotic Diseases, excluding Diarrhœa. Deaths from Diarrhœa. January 10 42.1 53.9 35.0 44.7 29.4 0.95 10.6 S.W. 40 12 12 8 2 2 - „ 17 30.1 37.0 43.5 0.21 23.2 N.E. & S.E. 15 7 6 3 6 - 23.6 30.1 38 „ 31 46.7 52.6 39.6 42.8 30.0 0.37 13.7 S.W. 46 10 14 16 3 5 1 February 7 42.5 31.3 43.1 0.22 15.7 S.W. 44 12 12 8 2 6 - 52.1 29.9 „ 14 47.7 56.0 36.4 44.4 30.2 0.00 11.3 W.S.W. 39 10 8 8 3 3 1 „ 21 44.4 58.3 31.3 44.2 30.2 0.01 29.7 S.E. & S.W. 39 12 13 6 2 6 3 „ 28 45.0 54.4 35.2 44.7 29.6 1.13 16.6 S.W. 30 9 8 9 6 1 - March 7 42.7 54.9 34.0 44.2 29.5 0.86 12.0 S.W. 38 10 8 8 3 1 - „ 14 42.9 57.8 30.6 43.6 29.8 0.17 31.3 S.S.W. 33 12 5 5 2 5 1 „ 21 46.6 57.2 32.8 44.0 29.8 0.17 32.8 S.W. 41 13 8 9 4 1 2 51.0 68.0 38.6 45.9 29.5 0.60 39.8 33 10 8 6 6 4 „ 28 S.S.W. - - 2 4 13 15 11 52 E. & S.W. 4.8 0.36 30.0 40.9 33.3 48.9 40.4 „ 24 9 50.4 65.3 38.2 48.3 29.4 0.79 16.4 S.E. & S.W. 34 9 12 11 1 2 - „ 16 48.8 60.9 31.3 49.1 29.8 0.31 20.0 N. & S.W. 33 9 3 7 4 4 - „ 23 54.6 77.9 35.4 49.9 29.9 0.34 57.0 Variable 33 4 10 8 4 2 - „ 30 58.4 77.5 38.1 52.7 N.E. 29.9 0.33 66.1 27 6 8 5 1 1 2 June 6 57.0 82.6 42.0 55.5 N.N. E. 30.0 0.13 63.7 24 7 5 2 4 - - „ 13 52.8 65.1 37.1 55.9 Variable 29.8 2.34 21.2 36 6 8 5 3 3 3 „ 20 49.9 67.0 41.3 54.3 29.5 3.73 16.5 N. 30 7 6 5 8 - - „ 27 59.6 83.3 38.7 54.6 30.0 0.00 65.0 Variable 35 7 7 5 3 - 1 „ 8 „ 15 „ 22 „ 29 Septem. 5 „ 12 „ 19 „ 26 61.2 59.5 58.3 58.1 62.9 53.7 54.7 59.3 77.5 73.5 73.4 71.0 82.0 67.9 64.1 70.5 44.2 45.3 47.6 44.3 48.9 40.3 38.4 50.5 60.7 60.9 60.5 59.8 60.7 60.5 58.0 57.9 29.8 29.6 29.6 29.8 29.8 29.7 30.0 29.9 0.35 2.11 1.11 1.23 0.86 0.55 0.01 0.22 53.1 42.1 45.2 33.9 49.6 39.4 45.5 28.3 S.W. S.W. S.W. S.S.W. S.W. & S.E. S.W. N.W. & N.E. E. 45 41 40 41 34 42 50 31 20 20 19 19 17 21 23 11 Mean Temperature of the earth 3-ft. below surface. Mean height of Barometer. Rainfall in inches Sunshine in hours. Deaths over 60. Deaths from Respiratory Diseases. Deaths from Zymotic Diseases, excluding Diarrhœa. Mean Temperature. Highest Temperature. Lowest Temperature Total Deaths. Deaths under 1 year. Deaths from Phthisis. Prevailing Wind. Week ending. S.E. & S.W. October 3 59.3 70.7 50.2 58.7 29.7 0.61 30.5 33 12 5 3 2 - „ 10 51.9 64.8 39.2 58.3 29.5 1.05 20.3 S.W. 37 6 8 - 5 4 „ 17 52.0 62.6 42.3 56.4 29.4 1.39 22.5 49 S.W. 12 2 4 4 4 „ 24 49.3 56.6 36.5 54.8 29.6 0.60 7.1 S.E. & S.W. 42 14 11 4 3 4 „ 31 50.8 58.7 38.2 53.6 29.4 1.39 21.0 S.E. & S.W. 41 14 6 8 3 5 TABLE B. Showing the localities in which the cases of Notifiable Infectious Diseases and Deaths from Measles, Diarrhœa and Phthisis occurred during the year. (The figures in brackets denote the number of houses in which the cases occurred. The asterisks denote the fatal cases of Notifiable Diseases.) Puerperal Fever. Diphtheria and Membranous Croup. Enteric Fever. Scarlet Fever. Deaths from Measles. Deaths from Diarrhœa. Deaths from Phthisis. Small-pox. Erysipelas. Acfold road 1 Ackmar road ... Adeney road 1 1 1 2(2) 2(2) Aintree street 1 3(3) Alderville road 2(1) Allestree road 1 1 3(2) Althea street 1 Ancill street 1 5(4) 1 1 1 Anselm road 3(2) 5(5) 1 2(2) Archel road 2(2) 1 1 1 2(2) Argon mews 2(2) Armadale road 1 1 Ashcombe street 3(3) 4(3) 1 Ashington road 1 Ashton terrace Aspenlea road 2(2) 1 1 2(2) 1 Atalanta street *1 1 Auriol road 1 Averil street 3 ( 2 ) 2(2) Avonmore road 5(3) 1 Avalon road 2(2) 1 Bagley's lane 1 5(1) 1 1 1 ... Barclay road 4(3) 1 Barons Court road 1 1 ... Barton street 1 Basuto road 1 Bayonne road 2(2) 1 2(2) 3(3) 5(5) 1 Beaufort mews ... Beaumont crescent ... Bedford place ... Beryl road 1 1 1 *1 2(2) ... Beltran road 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bettridge road ... ... ... ... 1 Biscay road 3(3) 1 Bishop King's road ... ... Bishop's mews Bishop's Pk.mansions Bishop's road 2(2) 2(2) 1 1 Bishop's terrace Blake road 2(2) Bloompark road 1 Bothwell street Bovingdon road 4(3) Bowerdean street 1 2(2) Bradbourne street 3(2) 1 Bramber road 1 *3(2) 2(2) 1 2(2) Brandenburgh road 1 1 1 Brecon road 1 Breer street 4(3) Britannia road 2(1) 2(2) Broadway Brookville road 1 3(2) 1 1 1 Broomhouse road 1 1 Bronsart road 1 1 Broughton road 6(5) *5(5) 2(2) 1 Buer street Bulow road 1 2(2) 1 1 1 Burlington road 1 Burnfoot avenue 4(4) 1 Burnthwaite road 5(3) **5(3) 1 2(2) Byam street 1 1 1 Branksea street Cambria street 1 Campbell street 1 Campana road 1 *1 Carlton mews Caroline place 1 2(2) ... 1 Cassidy road 2(1) 1 1 Castletown road ... Cedar road 1 ... Chaldon road 1 1 Challoner road ... Chancellor's road 2(2) 2(2) 3(1) 2(1) Charleville road 1 Chelmsford street 1 *3(2) 1 ***9(5) 3(3) 1 Chesilton road 1 2(2) 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chesson road 1 *1 1 2(2) Church path 1 2(2) 1 Clancarty road 1 Claxton grove 9(5) 2(2) 3(3) 1 2(2) 1 Claybrook road 9(6) 1 1 1 Clonmel road 1 2(2) 1 Colehill lane 1 4(1) 3(3) 1 Comeragh mews Comeragh road 1 1 Coniger road 1 Coomer road 1 1 Cornwall street 1 1 Cortayne road Crabtree lane 1 Cranbury road 2(2) 1 1 2(2) Crefeld road *2(2) 4(3) 1 4(3) 5(5) Cresford road ... *1 1 1 Crookham road 1 2(2) 1 Cristowe road *1 Crondace road 1 Cumberland crescent. Chiddingstone road 5(3) 1 Cloncurry street 1 *1 1 Dalebury road 1 1 1 1 Dancer road 1 Danehurst street 1 2(1) 1 Darlan road ... 1 Dawes road 1 2(2) 2(2) 1 Dawson street 2 (2) 2(2) Delaford street 1 1 Delorme street 2(2) 1 1 Delvino road 1 De Morgan road 5(3) 2(2) 1 1 1 Devonshire street Dieppe street 1 4(2) *1 1 1 1 1 Dimsdale road 1 1 *1 Disbrowe road 3(3) Distillery lane *1 1 Dolby road Doria road 2(2) Dorncliffe road Dowell mews 1 Dymock street 1 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Durrell road 1 Doneraile street 3(2) 2(2) Eddiscombe road 1 Edenvale street 5(3) 3(3) Edgarley terrace 1 2(2) Edith row Edith villas 1 1 1 Edith road *1 2(2) Eelbrook terrace 1 Effie road 1 1 Elbe street Eli mews Eli street Elmdale street 5(4) 1 1 1 Elmstone road Elthiron road 2(2) Epirus road 1 6(5) 1 1 Epple road Estcourt road 2(1) 5(5) 1 2(2) 2(2) Eustace road Everington street 1 1 1 1 Ewald road Epirus mews Fabian road 1 1 Factory lane 1 1 Fairholme road Fane street 1 Farm lane 1 1 1 Favart road Felden street 1 1 Fernhurst road 1 1 Field road 1 1 1 1 2(1) 1 *1 Filmer road 2 2(1) Firth gardens Foskett road Francis street 2(2) 1 Friston street Fulham Palace road 1 1 1 1 2 2(2) Fulham Park gardens Fulham Park road 2(1) Fulham road 6(5) 4(4) 1 2(1) Furness road 1 *1 Fitzgeorge avenue 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... *2(2) Garvan road 1 8(5) 1 Gastein road 1 *7(3) 2(2) 1 2 1 1 George square *2 (1) *1 Gilstead road Gironde road 1 Gledstanes road Gowan avenue 3(3) 1 1 1 Glenrosa street 5(2) Goodson road 1 Greyhound road 2(1) *1 2(1) 2(2) 1 Grimston road 1 1 Grove avenue 2(2) *1 1 2(2) 2(2) Grove terrace Guion road 2(2) Gunterstone road 1 Gwendyr road 1 3(2) Haldane road Halford road 1 *2 2(2) 3(3) Hamble street 6(3) 7(5) 1 1 Hammersmith road 2(1) 1 1 1 Hannell road Harbledown road 1 Hartismere road 1 Hartopp avenue 1 1 2(2) 2(2) Harwood road 2(1) 1 1 1 Harwood terrace *4 (4) Hatfield street 1 2(2) *9(6) Hazlebury road 3(3) 1 2(2) 2(2) Hestercombe avenue. 1 High street 2(1) 1 *1 Hilmer street 2(2) 1 1 1 Hildyard road 1 1 Holyport road 4(4) Homestead road 1 1 Horder road 1 Hugon road 6(3) 2(1) 1 1 1 1 Humbolt road 1 1 1 Hurlingham road 3(1) Hawksmoor street 1 Imperial cottages 2(2) Imperial road Irene road Ismailia road 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Deaths from Measles. Scarlet Fever. Diphtheria and Membranous Croup. Puerperal Fever. Enteric Fever. Deaths from Diarrhœa. Small- pox. Erysipelas. Jerdan place Jervis road *2(1) John street Kelvedon road 1 1 Kempson road Kenneth road 1 2(1) 2(2) Kilmaine road 2(2) Kimbell gardens 1 1 1 2(2) 1 King's road 5(4) 2(2) 2(2) 1 Kingwood road Kinnoul road 1 Knivett road 1 Kilkie street 1 1 Kensington Hall gdns. 1 Lalor street 1 1 Lambrook terrace 1 Landridge road 1 2(2) Langford road 2(2) 1 1 Langthorn street Lanfrey place Laundry road Lawn terrace *1 1 Letterstone road 1 6(5) 1 2(2) 2(2) 2(2) Lillie road *2(2) 1 Lilyville road 1 1 Lindrop street 1 Lintaine grove 1 4(4) 1 1 Linver road Lisgar terrace 2 2(2) 1 Lodge avenue 1 Lochaline street *1 2 Lurgan avenue 1 1 3(1) Lysia street 7(5) 1 1 Mablethorpe road Macmurdo road 1 Margravine road 1 Margravins gardens Marinefield road 1 2(2) Marville road Matherson road Maxwell road 1 May street 2(2) 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Melmoth place ... *8(5) ... ... ... ... 2(1) ... ... ... ... ... ... 1 Mendora road 1 1 Merrington road Milton street 2(2) 1 1 Mimosa street 6(4) ... ... ... ... ... Mirabel road Molesford road Mooltan street *1 1 Moore Park road 1 1 Mornington road 1 1 Moylan road Mulgrave road 1 1 1 1 3(3) 2(2) Mund street *1 1 1 Munden place 1 1 1 1 Munden street 3(3) 2(2) 3(3) 1 2(2) Munster road 1 Musard road *1 Musgrave crescent Napier avenue ... *6(4) 1 Narborough street 5(5) 3(3) 2(2) New King's road 2(2) ... ... ... 4(4) Niton street *1 1 Normand road 1 Northampton place 1 1 2(2) ... ... 1 1 1 2(2) North End road 2(1) Novello street 1 1 Norfolk terrace 1 3(3) 1 Oakbury road 2(2) 4(4) 1 Orbain road 1 ... ... Orchard place 1 1 Orchard street 1 Oxberry avenue 7(4) 1 ... ... *2(2) Palace terrace Palliser road 1 Parkville road 3(1) 2(2) Parsons green 4(2) ... ... 5(5) 1 Parsons green lane Parthenia road 1 1 1 2(2) 1 Pellant road Perrymead street 1 ... Perham road Peterborough road 1 6(4) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Small-pox. Diphtheria and Membranous Croup. Enteric Fever. Puerperal Fever. Erysipelas. Deaths from Diarrhœa. Deaths from Phthisis. Deaths from Measles. Scarlet Fever. Peterborough villas Petley road Playfair street Portland place Portland street Pownall road Prince of Wales mews Protheroe road Purcell crescent Pursers Cross road Quarrendon road Queens Club gardens Querrin street Queensmill road Radipole road Racton road Rainville street Ranelagh avenue Rectory road Reporton road Richmond road Rickett street Rigault road Ringmer avenue Rock avenue Rosaline road Rosaville road Rosebury road Rostrevor road Rowallan road Ruby terrace Roxby place Rycroft street Rylston road Rosebank flats St. Alban's terrace St. Dunstan's road St. Maur road St. Olaf's road ... ... ... ... ... ... ... ... 1 2(2) 1 ... ... 1 ... ... ... ... 1 2(2) ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... 1 ... ... 1 ... 2(2) ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... 2(2) ... 1 ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... 1 1 ... ... ... 1 ... 1 1 ... ... ... ... 3(3) ... ... 1 ... ... 1 ... 1 ... ... ... ... ... 1 ... ... 1 1 ... ... ... 1 ... ... ... 1 ... ... ... 1 ... ... 1 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... *1 ... ... ... ... ... ... ... ... ... ... ... ... ... **5(4) ... 2(2) ... ... 1 ... ... ... ... ... 1 1 ... ... ... ... 1 ... ... ... ... ... 1 1 ... 1 1 ... 1 ... 3(3) ... 2(1) ... ... ... 1 ... ... ... 7(3) ... 1 ... ... ... 1 3(3) 6(3) 3(2) ... ... ... 1 ... ... 1 *3(1) ... 1 1 ... 1 1 ... 1 3(2) 2(2) 9(6) ... ... ... ... 4(3) 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... St. Oswald's road 1 1 2(2) St. Peter's terrace St. Thomas' road 4(2) 3(1) 1 2(2) 1 1 1 Sandilands road Seagrave mews Seagrave road 1 *1 1 1 Seddlescombe road 1 1 8(5) 5(4) Settrington street 1 4(3) 2(2) Sherbrooke road *3(2) Shorrolds road *2(2) 1 Shottendane road ... Sotheron road 1 Stamford road 2(2) 1 1 1 Stamford place Stamford street 1 Stanley road 1 1 Stanwick road 3(3) 1 2(2) Star road Stokenchurch street Stonor road Strode road 1 Studdridge street 2(2) 1 Suffolk street 10(5) *5(5) 1 3(3) Stephendale road 1 2 Sylvio street Talgarth road 1 1 1 Tamworth street 1 Tasso road Tilton street 1 Tournay road 1 1 1 1 1 1 Townmead road 1 Turneville road Tyrawley road 1 Trevanion road Tynemouth street 2(1) *1 1 2(2) Vanston place 1 Varna road Vereker road 1 1 1 Vernon street 1 1 1 2(2) Victoria road Vera road ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Waldemar avenue 1 1 1 1 1 ... 2(1) Walham avenue 2(2) 1 1 6(5) ... Walham grove 1 2(2) Wandon road 1 1 Wandsworth Bdge.rd. 7(6) 5(3) 3(3) 1 3(3) 2(2) Wardo avenue 2(2) 2(2) 1 Waterford road 1 1 2(2) Werley avenue 3(2) 1 1 2 Westbury terrace 1 Wheatsheaf terrace 1 2(1) Whittingstall road 1 Wigan street William street Wyfold road Winchendon road 1 2(2) 1 1 Woodlawn road 1 Woolneigh street 1 Yeldham road 6(3) 2(2) 1 Fulham Union Infirm *1 ... 3 Fulham Workhouse 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... TABLE C. COMPARISON OF PREVALENCE OF SICKNESS & DEATHS FROM NOTIFIABLE INFECTIOUS DISEASES. (Rates calculated per 1,000 persons on the population estimated to the middle of each year.) Scarlet Fever. Diphtheria and Membranous Croup. Enteric and Continued Fever. Small-pox. Typhus Fever. Cholera. Erysipelas. Deaths. Cases. Deaths. Deaths. Deaths. Cases. Deaths. Cases. Cases. Cases. Deaths. Cases. Cases. Deaths. 1891 1.33 0.09 0.93 0.21 0.62 0.03 0.84 0.05 1892 0.02 5.45 0.23 1.13 0.32 0.47 1.12 00.8 1893 0.30 0.03 6.98 0.32 2.48 0.63 0.59 0.13 0.01 0.05 1.54 0.17 1894 0.38 0.03 5.07 0.32 3.26 0.99 0.39 0.05 1.09 0.06 - - - - - - - - - - - - - - - - - - TABLE D. Showing the number of Cases of Infectious Diseases notified to the several Metropolitan Medical Officers of Health during the Year 1903. CITIES AND BOROUGHS. Estimated population in the middle of 1903. Scarlet Fever. Diphtheria and Membranous Croup. Typhus Fever. Other continued Fevers. Erysipelas. Cholera. Enteric Fever. Puerperal Fever. Small-Pox. Total. West Districts. 147,780 11 406 293 80 - 19 115 924 146,032 5 417 150 1 44 3 4 119 743 Paddington Kensington 178,409 5 335 180 66 2 4 177 769 115,803 7 316 59 1 664 Hammersmith 166 6 109 98 Chelsea 74,169 7 209 13 - 6 55 388 179,052 City of Westminster 45 352 186 71 2 5 111 772 North Districts. St. Marylebone 131,234 4 414 228 67 4 7 177 901 85,197 1 174 29 41 332 Hampstead 86 1 St. Pancras 235,716 31 658 522 88 5 224 1528 339,137 Islington 12 867 458 131 2 19 228 1717 52,069 2 87 40 35 1 2 30 197 Stoke Newington 224,082 Hackney 4 667 545 271 5 21 281 1794 Central Districts. Holborn 57,845 2 144 52 54 2 4 90 348 Finsbury 99,717 2 293 129 52 8 106 590 City of London 24,539 73 27 14 1 10 125 East Districts. 259 154 99 1 7 147 Shoreditch 117,513 667 Bethnal Green 130,028 3 392 242 2 59 1 6 214 919 26 878 1 199 Stepney 302,153 543 10 376 2033 Poplar 169,550 28 450 425 93 8 144 1148 South Districts. 40 512 354 122 13 239 Southwark 207,369 1280 401 Bermondsey 129,801 7 174 16 76 9 182 865 73 745 346 136 7 18 231 1556 Lambeth 307,711 314 173,422 37 474 89 8 149 1071 Battersea 249,678 532 101 Wandsworth 29 821 3 13 235 1734 265,562 19 666 365 103 2 6 233 Camberwell 1394 502 134 Deptford 112,537 2 456 2 31 1 6 1134 99,824 4 164 208 44 7 73 Greenwich 500 278 49 82 Lewiaham 136,405 1 463 8 881 121,478 184 42 2 58 Woolwich 6 390 3 685 2 Port of London 3 2 22 1 30 COUNTY OF LONDON. 4,613,812 416 12,531 7,737 22 2,339 40 233 4,371 27,689 Fulham - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -